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Restoration of movement to the upper eyelid in facial palsy by an individual gold implant prosthesis
Restoration of movement to the upper eyelid in facial palsy by an individual gold implant prosthesis M. Sela, D.M.D.,* and S. Taicher, D.M.D.* Hetbrcw University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
F
acial nerve palsy causes lagophtalmia of the upper lid (Fig. 1). In addition to being an esthetic deformity, it may lead to recurrent keratitis, keukoma, conjunctivitis, and even blindness. In facial palsy, overaction of the levator palpebrae muscle is present. Closure of the eye and downward movement of the lid can be achieved by adding weight to the upper lid. This article describes a technique for providing upper lid implants of gold for patients who have experienced facial palsy. MATERIAL
AND METHODS
Fig. 1. Right seventh nerve paralysis. Bell’s palsy patient demonstrating inability to close right eye.
A small tray is prepared, which is attached to the central third of the upper lid to measure the weight necessary to pull the paralyzed upper eyelid closed during blinking and restore full “normal blinking reflex” (Fig. 2). Closure is achieved by weight plus gravity (Fig. 3). Measuring and testing are carried out with the patient seated and looking straight forward. Special attention is given to the individuality of the shape, size, and curvature of the prosthesis. The diameter of the lid is measured with a key that corresponds to the shape of the sphere in ranges from 4 to 10 mm (Figs. 4 and 5). The shape of the prosthesis is formed on the sphere with a casting (Fig. 6). At this stage the weight of the proposed casting is calculated depending on the specific gravity (SG) of the wax and gold used. The following formula is used to determine the final weight of the casting. weight of wax pattern X SG of gold = weight of gold SG of wax Casting is done in the usual manner. The prosthesis is highly polished and tried on before the operation (Fig. 7). The eyelid weight prosthesis is constructed of 24karat gold. This metal is resistant to all common acids, *Lecturer. Maxillofacial
A8
Prosthetic Unit
Fig. 2. Tray attached to upper lid to measure weight necessary to close right eye.
IULY
1984
VOLUME
52
NUMBER
1
IMPLANT
PROSTHESIS
FOR EYE CLOSURE
Fig. 5. Templates of different arc sizes. Fig. 3. Optimal weight for closing.
Fig. 6. Wax-up of gold implant by curvature determination.
Fig. 4. Measuring upper lid arc. is easy to form into the required shape, and causes minimal tissue reaction. Specifications of the prosthesis for this patient are 0.9 x 0.2 mm to 1.3 X 0.4 cm in size and 1 to 1.75 gm in weight. The prosthesis conforms in all its curvatures to the individual cornea1 surface, which is simulated by different sizes for laboratory purposes.
_ Fig. 7. Test of gold leaf effectiveness.
DISCUSSION Sheehan’ first described the lid load operation by means of a tantalum wire and mesh implant. Smellie* and Perdikis3 reported the use of gold for the same purpose. The restoration is desirable both to protect the cornea and to decrease the discomfort of the ever-open eye. A secondary consideration that is important is the improvement of the patient’s appearance. The advan-
THE JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 8. Right eye closure 5 weeks after insertion of gold implant prosthesis.
89
SELA AND
tage of this technique is that the prosthesis is prepared individually for each patient with an ideal weight and shape. The prosthesis must be an optimal weight to be elevated easily. The eyelid is opened by the action of the levator palpebrae superioris muscle, which has a sympathetic innervation and is preserved in facial palsy. The closure of the lid is performed by the correct weight of the prosthesis combined with gravity. The 24-karat gold is of high density, inert in the tissue, and of good color to be unobtrusive below the thin skin of the upper lid. The lid load operation achieves a good cosmetic result (Fig. 8). The patient can close the eye almost completely in the immediate postoperative period.
TAICHER
REFERENCES I. 2. 3.
Sheehan, J. I;.: Progress in correction of facial paralysis with tantalum wire and mesh. Surgery 27:122, 1950. Smellic, G. 11.: Restoration of the blinking reflex in facial palsy by a simple lid load operation. Br J Plast Surg 19:2?9, 1966. Perdikis: P.: Lid load operation in facial palsy. S Afr ,J Surg 11:197,
1971
ARTICLES TO APPEAR IN FUTURE ISSUES Development and use of water-hardening
glass-ionomer luting cements
John W. McLean. O.B.E., D.Sc., M.D.& L.D.S., Alan D. Wilson, D.Sc., D.Tech.. CChem, F.R.S.C.. and Havard J. Prosser,B.Sc., Ph.D.
A clinical evaluation of two base metal alloys and a gold alloy for use in fixed prosthodontics: A five-year study ~JosephP. M&a. D.D.S.. M.S.D., Wayne A. Jenkins, D.D.S., M.S.Ed., James A. Ellison, D.D.S., and James C. Hamilton. 11.11,s
Sanitization
of dentures by several denture hygiene methods
T. C. Moore, D.D.S., M.S.D., D. E. Smith, D.DS.. M.S.D., and G. E. Kenny, M.S., Ph.D
Preclinical teaching technique for making master impressions ilrthur
Muncheryan. D.D.S.. and Thomas Wood. D.D.S.
Duplicating ~Joseph Nassif,
maxillary complete dentures D.D.S.,
M.Sr., and Russell Jumbelic.
D.M.D.,
M.S
Fracture of ceramic and metalloceramic cylinders 1~.A. Oram, M.Sc., B.D.S., E. H. Davies, M.I.S.T., and D. W. Cruickshanks-Boyd, Ph.D., B.Sc., M.1.M
Consistency of performance of a new craniostat for oblique lateral transcranial radiographs of the temporomandibular joint G. Preti, M.D., D.D.S., A. Arduino, M.D.. D.D.S., and P. Pera, M.D., D.D.S.
Influence of oral fluid on composite resin and glass-ionomer cement .Jean-Francois Roulet, D.D.S., Dr.Med.Dent.,
and Christian WBlti, D.D.S., Dr.Med.Dent.
Improved occlusal equilibration of complete dentures by augmenting occlusal anatomy of acrylic resin denture teeth Anthonv R. Ruffino, D.D.S.
JULY 1984
VOLUME
52
NUMBER
1
F
acial nerve palsy causes lagophtalmia of the upper lid (Fig. 1). In addition to being an esthetic deformity, it may lead to recurrent keratitis, keukoma, conjunctivitis, and even blindness. In facial palsy, overaction of the levator palpebrae muscle is present. Closure of the eye and downward movement of the lid can be achieved by adding weight to the upper lid. This article describes a technique for providing upper lid implants of gold for patients who have experienced facial palsy. MATERIAL
AND METHODS
Fig. 1. Right seventh nerve paralysis. Bell’s palsy patient demonstrating inability to close right eye.
A small tray is prepared, which is attached to the central third of the upper lid to measure the weight necessary to pull the paralyzed upper eyelid closed during blinking and restore full “normal blinking reflex” (Fig. 2). Closure is achieved by weight plus gravity (Fig. 3). Measuring and testing are carried out with the patient seated and looking straight forward. Special attention is given to the individuality of the shape, size, and curvature of the prosthesis. The diameter of the lid is measured with a key that corresponds to the shape of the sphere in ranges from 4 to 10 mm (Figs. 4 and 5). The shape of the prosthesis is formed on the sphere with a casting (Fig. 6). At this stage the weight of the proposed casting is calculated depending on the specific gravity (SG) of the wax and gold used. The following formula is used to determine the final weight of the casting. weight of wax pattern X SG of gold = weight of gold SG of wax Casting is done in the usual manner. The prosthesis is highly polished and tried on before the operation (Fig. 7). The eyelid weight prosthesis is constructed of 24karat gold. This metal is resistant to all common acids, *Lecturer. Maxillofacial
A8
Prosthetic Unit
Fig. 2. Tray attached to upper lid to measure weight necessary to close right eye.
IULY
1984
VOLUME
52
NUMBER
1
IMPLANT
PROSTHESIS
FOR EYE CLOSURE
Fig. 5. Templates of different arc sizes. Fig. 3. Optimal weight for closing.
Fig. 6. Wax-up of gold implant by curvature determination.
Fig. 4. Measuring upper lid arc. is easy to form into the required shape, and causes minimal tissue reaction. Specifications of the prosthesis for this patient are 0.9 x 0.2 mm to 1.3 X 0.4 cm in size and 1 to 1.75 gm in weight. The prosthesis conforms in all its curvatures to the individual cornea1 surface, which is simulated by different sizes for laboratory purposes.
_ Fig. 7. Test of gold leaf effectiveness.
DISCUSSION Sheehan’ first described the lid load operation by means of a tantalum wire and mesh implant. Smellie* and Perdikis3 reported the use of gold for the same purpose. The restoration is desirable both to protect the cornea and to decrease the discomfort of the ever-open eye. A secondary consideration that is important is the improvement of the patient’s appearance. The advan-
THE JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 8. Right eye closure 5 weeks after insertion of gold implant prosthesis.
89
SELA AND
tage of this technique is that the prosthesis is prepared individually for each patient with an ideal weight and shape. The prosthesis must be an optimal weight to be elevated easily. The eyelid is opened by the action of the levator palpebrae superioris muscle, which has a sympathetic innervation and is preserved in facial palsy. The closure of the lid is performed by the correct weight of the prosthesis combined with gravity. The 24-karat gold is of high density, inert in the tissue, and of good color to be unobtrusive below the thin skin of the upper lid. The lid load operation achieves a good cosmetic result (Fig. 8). The patient can close the eye almost completely in the immediate postoperative period.
TAICHER
REFERENCES I. 2. 3.
Sheehan, J. I;.: Progress in correction of facial paralysis with tantalum wire and mesh. Surgery 27:122, 1950. Smellic, G. 11.: Restoration of the blinking reflex in facial palsy by a simple lid load operation. Br J Plast Surg 19:2?9, 1966. Perdikis: P.: Lid load operation in facial palsy. S Afr ,J Surg 11:197,
1971
ARTICLES TO APPEAR IN FUTURE ISSUES Development and use of water-hardening
glass-ionomer luting cements
John W. McLean. O.B.E., D.Sc., M.D.& L.D.S., Alan D. Wilson, D.Sc., D.Tech.. CChem, F.R.S.C.. and Havard J. Prosser,B.Sc., Ph.D.
A clinical evaluation of two base metal alloys and a gold alloy for use in fixed prosthodontics: A five-year study ~JosephP. M&a. D.D.S.. M.S.D., Wayne A. Jenkins, D.D.S., M.S.Ed., James A. Ellison, D.D.S., and James C. Hamilton. 11.11,s
Sanitization
of dentures by several denture hygiene methods
T. C. Moore, D.D.S., M.S.D., D. E. Smith, D.DS.. M.S.D., and G. E. Kenny, M.S., Ph.D
Preclinical teaching technique for making master impressions ilrthur
Muncheryan. D.D.S.. and Thomas Wood. D.D.S.
Duplicating ~Joseph Nassif,
maxillary complete dentures D.D.S.,
M.Sr., and Russell Jumbelic.
D.M.D.,
M.S
Fracture of ceramic and metalloceramic cylinders 1~.A. Oram, M.Sc., B.D.S., E. H. Davies, M.I.S.T., and D. W. Cruickshanks-Boyd, Ph.D., B.Sc., M.1.M
Consistency of performance of a new craniostat for oblique lateral transcranial radiographs of the temporomandibular joint G. Preti, M.D., D.D.S., A. Arduino, M.D.. D.D.S., and P. Pera, M.D., D.D.S.
Influence of oral fluid on composite resin and glass-ionomer cement .Jean-Francois Roulet, D.D.S., Dr.Med.Dent.,
and Christian WBlti, D.D.S., Dr.Med.Dent.
Improved occlusal equilibration of complete dentures by augmenting occlusal anatomy of acrylic resin denture teeth Anthonv R. Ruffino, D.D.S.
JULY 1984
VOLUME
52
NUMBER
1