Hassan Adam S, Frueh Bartley R, Elner Victor M
Department of Ophthalmology, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, USA.
Arch Ophthalmol. 2005 Sep;123(9):1221-5. doi: 10.1001/archopht.123.9.1221.
Facial nerve palsy often results in symptoms of ocular irritation due to inadequate eyelid closure. Weakened protractor function results in relative upper eyelid retraction and contributes to lagophthalmos.
To evaluate the role of müllerectomy in the comprehensive surgical treatment of ocular exposure due to facial nerve palsy.
Thirty-four patients with chronic facial nerve palsy underwent unilateral transconjunctival removal of Müller muscle and were followed up for an average of 20 months postoperatively. Other procedures were performed to treat lower eyelid retraction, as required. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, lagophthalmos, and keratopathy were compared.
Of the 59 preoperative symptoms, 15 (25%) resolved and 39 (66%) improved. Upper eyelid position was lowered by an average of 1.35 mm (P<.001). Lagophthalmos (P = .002) and corneal exposure (P<.001) were significantly improved. Three patients required levator aponeurosis repair, 2 for preexisting dehiscence and 1 for inadvertent aponeurosis transection.
Müllerectomy is a rapid, safe, and reproducible surgical method for lowering the upper eyelid and reducing ocular exposure symptoms and signs due to chronic facial nerve palsy.
面神经麻痹常因眼睑闭合不全导致眼部刺激症状。上睑提肌功能减弱导致相对的上睑退缩，并导致兔眼症。
评估米勒肌切除术在面神经麻痹所致眼部暴露综合手术治疗中的作用。
34例慢性面神经麻痹患者接受了经结膜单侧米勒肌切除术，术后平均随访20个月。根据需要进行其他手术治疗下睑退缩。比较术前和术后的眼部暴露症状、上睑位置、兔眼症和角膜病变。
术前59项症状中，15项（25%）症状消失，39项（66%）症状改善。上睑位置平均降低1.35mm（P<0.001）。兔眼症（P = 0.002）和角膜暴露（P<0.001）明显改善。3例患者需要进行提上睑肌腱膜修复，2例因既往存在腱膜裂开，1例因意外腱膜横断。
米勒肌切除术是一种快速、安全且可重复的手术方法，可降低上睑高度，减轻慢性面神经麻痹所致的眼部暴露症状和体征。
