Repositioning of a Gold Weight
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This is Richard Allen at the University of Iowa. This video demonstrates repositioning of a gold weight in a patient with a long standing 7th nerve palsy secondary to neurofibromatosis type 2. The skin and orbicularis muscle overlying the previously placed gold weight is very thin. The eyelid crease is incised with the 15 blade. Westcott scissors are used to dissect through the underlying orbicularis muscle. The thermal cautery is then used to dissect though the orbital septum to expose the underlying preaponeurotic fat and levator aponeurosis. Westcott scissors are then used to incise the pretarsal orbicularis muscle to expose the gold weight. Dissection is carried out around the gold weight and the previously placed 6-0 prolene sutures are cut and the gold weight is removed. The thermal cautery is then used to disinsert the levator aponeurosis from the anterior surface of the tarsus. Dissection is performed between the levator aponeurosis and the underlying Muellers muscle. The gold weight is then repositioned superior to the superior border of the tarsus. A 6-0 prolene suture is the used to engage the superior border of the tarsus followed by the inferior holes of the gold weight. The prolene is then placed through the levator aponeurosis approximately 5 mm superior to its cut edge. The suture then engages the superior hole of the gold weight. The suture is then placed back through the levator aponeurosis and tied to complete a mattress suture. This allows the levator aponeurosis to cover the gold weight. Thus the gold weight has been repositioned superior to the superior border of the tarsus and covered by an additional layer using the levator aponeurosis. The incision is then closed using deep sutures which engage the pretarsal orbicularis followed by the levator aponeurosis followed by the preseptal orbicularis. Additional sutures are placed along the width of the eyelid crease incision in the exact same manner with 7-0 vicryl sutures. The skin can then be closed with a running 6-0 prolene suture. At the conclusion of the case, the gold weight has been repositioned superiorly as well as covered by additional tissue layers. The patient will return in approximately one week for suture removal.