Treatment Of Anderson Muscular Resection On Essential Blepharospasm

Object: To estimate the therapeutic effect and safety of Anderson muscular resection for the essential blepharospasm. Method: 36 patients(11 men and 25 women) of the essential blepharospasm treated by Anderson muscular resection were collected from January 1995 to june 2004 in the ninth hospital of shang hai second medical university. The patients had a mean age 58.7 years (range 51-72 years, course of disease 6 months-8 years). All the patients were involved in both eyes. Blepharelosi, acute conjunctivitis, ceratitis, iridocyclitis and so on were precluded by the examination, at the same time, no abnormalities are detected by the neurological examination. All the 36 cases were treated by Anderson surgical method. This surgery involved myectomy ( musculus orbicularis, corrugator glabellae, proceru ), superciliaris elevation and blepharoplasty. Among 9 patients accompanied with lapsus palpebrae superioris, 3 patients were treated with pleating of levator palpebrae superioris, 6 patients with apertor oculi shortening. 11 cases accompanied with decurtation of blephara diameter transversa were treated with external palpebral ligament repair. Follow-up period was from 6-month to 12-month after surgery. Result: 3 cases recovered from â…¢grade to 0 grade after surgery. 22 cases from â…¢grade to â… g rade. 2cases from â…£grade to â… g rade. 6 cases recovered from â…£grade to â…¡grade(2 cases of â… g rade aggravated to â…¡grade respectively in 3-month and 4-month , but better compared to preoperative). 3 cases from â…£grade to â…¡grade and aggravated to â…¢grade, then reduced to â… g rade by reoperation. 3 cases of â…£grade aggravated to â…¢grade in 1 week, and after reoperation reduced to â… g rade. For the rest of 31 cases, subjective symptom dispeared, blink reflex and visual function was recovered and looks was improved. Conclusion: Anderson myectomy is a very safe and effective treatment for blepharospasm patients who failed to botulinum therapy or reluctancy for repeatedly injection of botulinum. 1 Indication of Anderson muscular resection for essential blephrospasm The myectomy generally is suitable for the patients whosecondition belong to from â…¢to â…£grade. Botulinum toxin injection is effective for most light patients and surgery processor is not essential. Myectomy is an option for a few patients who never or nonideally respond to botulinum toxin, or after a period of successful treatment become refractory to the toxin. Especialy for a series of pathological alteration such as eyebrow descensus, ptosis and so on after long-term, severe eyelid spasm, Myectomy has to be applied[11]. 2 The key points of Anderson muscular resection The kernel of Anderson muscular resection mainly includes some key points as follow: â‘ Add incision through eyebrow to remove all the muscles responsible for the eyelid closuer (pretarsal, preseptal, orbital portions of upper eyelid orbicularis oculi muscles, procerus and corrugator muscles). â‘¡Branch fibra of facial nerve are cutted surrounded the orbital portions. â‘¢Repair the pathological alteration caused by blephrospasm. To retain 2-3mm orbicularis muscle nearby the lid-margin is very important to prevent the complication evoked by blephrospasm. In the experiment, 2-3mm orbicularis musclenearby the lid-margin of 36 patients were reserved, so the complication after hypophasis had been avoided. 3 Evaluation of Anderson muscular resection The most common and effective surgical procedure for blephrospasm of full myectomy is Anderson muscular resection[7]. The surgical procedure is relatively simple, safe and has a low recurrence rate, few side-effect. Xu gao-feng and Liu mo-er have reported this surgical procedure and considered it satisfactory method. Of 36 patients in our study, 3 cases completely restored, 30 cases obviously improved, 3 cases in part, and the effective power reached to 91.7%. Of all the patients, eyebrow descensus, ptosis, blepharochalasis, palpebral fissure TD completely restored. Botulinum toxin injections were only effective for the spasm, but for the symptom induced by the spasm such as ptosis, seemed to be unefficient. The symptom induced by the spasm markedly impacted the quality of life of patients. Besides, the muscles responsible for the eyelid closuer such ascorrugator glabellae, procerus that were fully resected was impossible, then most patients still remained frown and spasm more or lesss after surgery. So of 36 patients in our study, 33 cases still had the symptom of frown and spasm to some extent after surgery. Facial Nerve Section around the arcula is a key point of Anderson muscular resection. This procedure will contribute to the improvement of symptom resulted by incomplete resection of muscle responsible for the the eyelid closuer. In our study, 3 cases in grade â…£who aggravated to grade â…¢after surgery in one week received facial nerve section again and reduced to grade â… . In the follow-up of one year, patient's condition of the case was stable. Anderson myectomy is a ideal and effective treatment for blepharospasm patients who failed to botulinum therapy or reluctancy for repeatedly injection of botulinum. 4 Complications of Anderson muscular resection Possible postoperative complications include swelling around...