Surgical approach to limiting skin contracture following protractor myectomy for essential blepharospasm

Abstract

Purpose-To report our experience with protractor myectomy in patients with benign essential blepharospasm who did not respond to serial botulinum toxin injection, and to describe intra-and postoperative techniques that limited skin contracture while also providing excellent functional and cosmetic results.Methods-The medical records of patients with isolated, benign, essential blepharospasm who underwent protractor myectomy from 2005 to 2008 by a single surgeon were reviewed retrospectively. The technique entailed operating on a single eyelid during each procedure, using a complete en bloc resection of all orbicularis tissue, leaving all eyelid skin intact at the time of surgery, and placing the lid under stretch with Frost suture and applying a pressure dressing for 5-7 days.Results-Data from 28 eyelids in 7 patients were included. Average follow-up was 21.5 months (range, 4-76 months). Of the 28 eyelids, 20 (71.4%) showed postoperative resolution of spasm, with no further need for botulinum toxin injections. In the 8 eyelids requiring further injections, the average time to injection after surgery was 194 days (range, 78-323 days), and the average number of injections was 12 (range, 2-23 injections). All but one eyelid had excellent cosmetic results, without signs of contracture; one eyelid developed postoperative skin contracture following premature removal of the Frost suture and pressure dressing because of concerns over increased intraocular pressure.Conclusions-In our patient cohort, this modified technique resulted in excellent cosmetic and functional results and limited postoperative skin contracture.

Disabling muscle of Riolan: A novel concept of orbicularis oculi myectomy for refractory benign essential blepharospasm

“…Previous studies by Anderson et al 8 and Chapman et al 23 showed that 38.0% to less than 50.0% of the patients required BTX-A injection after full eyelid protractor myectomy with or without lower eyelid myectomy. Clark et al 27 presented that 71.4% of the eyelids were free from BTX-A injection after the upper and lower OOM myectomy. Kent et al 28 and Mauriello et al 9 demonstrated that extended OOM myectomy with or without blepharoplasty and/or levator advancement enhanced the effectiveness of BTX-A injection.…”

Impact of Upper Eyelid Surgery on Symptom Severity and Frequency in Benign Essential Blepharospasm

“…11 However, this surgery has decreased in popularity due to the availability and efficacy of BTIs. 12 Orbicularis stripping can result in poor cosmetic outcomes with adherent visibly scarred skin contractures, 13 orbital septal scarring, 14 chronic lymphoedema, and lagophthalmos. 11 Worse yet, these patients may experience severe pain during further injections of botulinum toxin into the scarred tissues.…”

Extended frontalis orbicularis oculi muscle flap shortening for treating refractory apraxia of eyelid opening associated with blepharospasm

“…The overall prevalence of AEO was approximately 7% to 10.8% in the general population of blepharospasm, 14,15 but the incidence was as high as 88% in the patients suffering from blepharospasm refractory to BTx. [15][16][17][18] In the previous literature, radical myectomy [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] or myotomy in situ combined with partial myectomy of eyelid protractors 16 were performed separately from frontalis suspension in patients who sustained concomitant refractory blepharospasm and AEO. 14,[31][32][33][34] We herein proposed a novel technique "the extended frontalis orbicularis oculi muscle (FOOM) flap shortening" for treating refractory AEO associated with blepharospasm.…”

“…The overall prevalence of AEO was approximately 7% to 10.8% in the general population of blepharospasm, 14,15 but the incidence was as high as 88% in the patients suffering from blepharospasm refractory to BTx. 15–18 In the previous literature, radical myectomy 16–30 or myotomy in situ combined with partial myectomy of eyelid protractors 16 were performed separately from frontalis suspension in patients who sustained concomitant refractory blepharospasm and AEO. 14,31–34…”