Manchester Royal Eye Hospital, Manchester, UK.
Eye (Lond). 2012 Nov;26(11):1431-6. doi: 10.1038/eye.2012.189. Epub 2012 Sep 14.
In long-standing facial palsy, muscles on the normal side overcontract causing difficulty in articulation, eating, drinking, cosmetic embarrassment, and psychological effects as patients lack confidence in public.
We injected botulinum toxin A (BTXA) into the normal contralateral smile muscles to weaken them and restore symmetry to both active and passive movements by neutralising these overacting muscles.
A total of 14 patients received BTXA (79% women, median age 47 years, average length of palsy 8 years). They were all difficult cases graded between 2 and 6 (average grade 3 House-Brackmann). All 14 patients reported improved facial symmetry with BTXA (dose altered in some to achieve maximum benefit). Average dose was 30 units, but varied from 10 to 80 units. Average time to peak effect was 6 days; average duration of effect was 11 weeks. Three patients had increased drooling (resolved within a few days).
The improvement in symmetry was observed by both patient and examining doctor. Patients commented on increased confidence, being more likely to allow photographs taken of themselves, and families reported improved legibility of speech. Younger patients have more muscle tone than older patients; the effect is more noticeable and the benefit greater for them. BTXA improves symmetry in patients with facial palsy, is simple and acceptable, and provides approximately 4 months of benefit. The site of injection depends on the dynamics of the muscles in each individual patient.
在长期面瘫中，健侧肌肉过度收缩导致发音、进食、饮水困难，患者在公众面前缺乏自信，造成美容尴尬和心理影响。
我们将肉毒毒素 A（BTXA）注射到正常的对侧微笑肌中，通过中和这些过度活跃的肌肉来减弱它们的力量，并使主动和被动运动恢复对称。
共有 14 名患者接受了 BTXA 治疗（79%为女性，中位年龄 47 岁，面瘫平均病程 8 年）。他们都是 2 至 6 级之间的困难病例（平均 House-Brackmann 分级 3 级）。所有 14 名患者均报告 BTXA 治疗后面部对称性得到改善（一些患者调整了剂量以达到最大获益）。平均剂量为 30 单位，但从 10 到 80 单位不等。平均起效时间为 6 天；平均持续时间为 11 周。3 名患者出现流涎增加（数天内缓解）。
患者和检查医生均观察到对称性改善。患者表示自信心增强，更愿意让自己的照片被拍摄，家属报告称患者的言语清晰度提高。年轻患者的肌肉张力比老年患者高；对他们来说，效果更明显，获益更大。BTXA 可改善面瘫患者的对称性，方法简单，患者接受度高，可提供约 4 个月的疗效。注射部位取决于每位患者肌肉的动力学。
