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A New Upper-Lid Implant for Facial Palsy

Alexander Berghaus, MD; Kerstin Neumann, MD; Thomas Schrom, MD

Arch Facial Plast Surg. 2003;5:166-170.

Background  When using upper-lid gold implants in facial palsy, a certain percentage of undesired effects and complications are known to occur (eg, astigmatism, pseudoptosis, migration, bulging, and extrusion). Our flexible platinum chain implant adapts better to the changing radius of the tarsus with movement of the globe and reduces the complication rate. Platinum implants are smaller, owing to their higher density.

Objective  To compare the results with 33 gold and 30 platinum chain implantations.

Methods  Clinical follow-up study at a university otorhinolaryngology department. The mean follow-up was 11 months in the gold-implant group and 9 months in the platinum-implant group. The treatment consisted of pretarsal fixation of the metal weights to the upper lid.

Main Outcome Measures  Criteria for evaluation of results include reduction of lagophthalmos and keratopathy and gain of visual acuity. Complications that have been assessed include astigmatism, bulging, migration, pseudoptosis, and extrusion of implants. We evaluated histological samples of the implant bed and performed ultrasound measurements of the tarsal radius.

Results  The restoration of lid closure was a visual and aesthetic improvement for all patients. We found a tendency toward a higher rate of complications with gold implants compared with platinum chains, especially for astigmatism and bulging. Ultrasonographic measurements showed ongoing flexibility of the platinum chains after implantation, and histological findings confirmed their good biocompatibility.

Conclusions  Flexible platinum chain implants lead to better results with fewer complications compared with standard rigid gold implants.

From the Department of Otorhinolaryngology–Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany (Drs Berghaus and Neumann); and the Department of Otorhinolaryngology–Head and Neck Surgery, Charité at Humboldt–University, Berlin, Germany (Dr Schrom).