Upper Eyelid Gold Weight Implantation for Facial Nerve Palsy—Short-Term and Long-Term Results

Implantation of gold weights into the upper eyelid is a proven method of treating lagophthalmos and exposure keratopathy in patients with unresolved facial nerve palsy. The aim of this study was to evaluate the factors affecting visual acuity and corneal complications in patients after upper eyelid gold weight lid loading. Material and methods: This prospective consecutive clinical study was conducted in years 2012–2018. In total, 59 people (40 women, 19 men aged 55.5 ± 17.4 years) meeting the inclusion criteria were treated with gold weights. The ordered multinomial logit model was used to analyze the factors affecting best-corrected visual acuity (BCVA) and degree of exposure keratopathy after surgery. The influence of the following variables was analyzed: patient age, etiology and duration of the facial nerve palsy, history of the previous eyelid surgery, degree of lagophthalmos in mm, presence of Bell’s phenomenon, and corneal sensation, Schirmer test results. Results: Implantation of gold weights into the upper eyelid effectively reduced lagophthalmos and exposure keratopathy in the study group (p < 0.001). BCVA was maintained or better in 95% of patients after surgery. Patient age, presence of the Bell’s phenomenon, and corneal sensation significantly affected the final BCVA (p < 0.1). The presence of Bell’s phenomenon and corneal sensation had a positive effect on the degree of keratopathy after surgery (p < 0.1). In turn, patient age and history of tarsorrhaphy were significant negative prognostic factors of exposure keratopathy and BCVA after surgery (p < 0.05). Etiology and duration of facial nerve palsy, degree of corneal exposure in mm, and results of the Schirmer test did not have a significant impact on the outcome after surgery (p > 0.1). Conclusions: The results of our study may help to answer the question of how to direct ophthalmologists and other specialists who refer to ophthalmologists for management advice in patients with facial nerve palsy. Elderly patients with a history of tarsorrhaphy who present with poor Bell’s phenomenon and/or a lack of corneal sensation should be the first candidates for immediate correction of lagophthalmos.

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Long-Term Outcome in Children with Congenital Unilateral Facial Nerve Palsy

Neuropediatrics ◽

10.1055/s-2001-16610 ◽

2001 ◽

Vol 32 (3) ◽

pp. 130-135 ◽

Cited By ~ 21

Author(s):

S. P. Toelle ◽

E. Boltshauser

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Term Outcome ◽

Long Term Outcome

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Long-Term Outcomes of Children with Facial Nerve Palsy Due To Lyme Disease

Pediatric Research ◽

10.1203/00006450-199904020-01050 ◽

1999 ◽

Vol 45 (4, Part 2 of 2) ◽

pp. 177A-177A

Author(s):

M Vazquez ◽

S Sparrow ◽

D Goudreau ◽

A Catalano ◽

J Klunk ◽

...

Keyword(s):

Lyme Disease ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Long Term Outcomes

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Long-Term Facial Nerve Outcomes after Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1607320 ◽

2017 ◽

Vol 79 (03) ◽

pp. 309-313 ◽

Cited By ~ 1

Author(s):

Michael Mooney ◽

Benjamin Hendricks ◽

Christina Sarris ◽

Robert Spetzler ◽

Randall Porter ◽

...

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Tumor Diameter ◽

Nerve Function ◽

Facial Nerve Function ◽

Microsurgical Resection ◽

Grade Iii

Objectives This study aimed at evaluating facial nerve outcomes in vestibular schwannoma patients presenting with preoperative facial nerve palsy. Design A retrospective review. Setting Single-institution cohort. Participants Overall, 368 consecutive patients underwent vestibular schwannoma resection. Patients with prior microsurgery or radiosurgery were excluded. Main Outcome Measures Incidence, House–Brackmann grade. Results Of 368 patients, 9 had confirmed preoperative facial nerve dysfunction not caused by prior treatment, for an estimated incidence of 2.4%. Seven of these nine patients had Koos grade 4 tumors. Mean tumor diameter was 3.0 cm (range: 2.1–4.4 cm), and seven of nine tumors were subtotally resected. All nine patients were followed up clinically for ≥ 6 months. Of the six patients with a preoperative House–Brackmann grade of II, two improved to grade I, three were stable, and one patient worsened to grade III. Of the three patients with grade III or worse, all remained stable at last follow-up. Conclusions Preoperative facial nerve palsy is rare in patients with vestibular schwannoma; it tends to occur in patients with relatively large lesions. Detailed long-term outcomes of facial nerve function after microsurgical resection for these patients have not been reported previously. We followed nine patients and found that eight (89%) of the nine patients had either stable or improved facial nerve outcomes after treatment. Management strategies varied for these patients, including rates of subtotal versus gross-total resection and the use of stereotactic radiosurgery in patients with residual tumor. These results can be used to help counsel patients preoperatively on expected outcomes of facial nerve function after treatment.

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