Ocular Outcomes after Gold Weight and Facial Nerve Resection

Abstract

Objective 1) To assess the effectiveness of acute gold weight placement following facial nerve resection. 2) To determine the role of concomitant lower eyelid procedures. Methods 22 patients who received an upper eyelid gold weight at the time of parotidectomy and facial nerve resection were retrospectively reviewed (mean follow-up: 23 months). Outcomes included the assessment of eye closure, gold weight complications (i.e., extrusion, need to upsize weight), ectropion, and need for tarsal strip procedure. Results The range of gold weight size used was 1–1.4 (g), where 1.2 g was the predominant size used (18/22). 12 patients (12/22, 54.5%) presented with ocular symptoms following gold weight placement. Within these 12 patients, 9 presented with lower lid ectropion, 5 with lagopthalmos, and 6 with corneal exposure. 9 of the 12 patients subsequently received a tarsal strip procedure. The mean time to lower eyelid procedure was 14.2 months (range: 0–61) following gold weight placement. 6 patients, in addition to a gold weight, also underwent a static sling to the midface at the time of facial nerve resection. None of these 6 patients received subsequent lower eyelid procedure. Two patients required gold weight upsizing. Two patients required weight removal because of exposure. Conclusions Insertion of 1.2 gm upper eyelid weight with concomitant placement of midface sling is recommended at the time of acute facial nerve resection. Due to the need to tighten the lower eyelid in a majority of patients, we now also recommend performing a tarsal strip procedure at the time of facial nerve resection.