Department of Ophthalmology, Korea University, Seoul.
Blue Eye Center, Incheon.
J Craniofac Surg. 2021;32(5):e437-e439. doi: 10.1097/SCS.0000000000007243.
Bell palsy is the most common lesion affecting the facial nerve. Aberrant facial nerve regeneration following facial nerve palsy may cause facial nerve synkinesis and ptosis. The authors present a 65-year-old male who suffered from left peripheral facial nerve palsy in 2017. During the recovery period, he had moderate ptosis in primary gaze, and he also noted left upper eyelid closure when he tried to blow something or puff his cheeks. Neurologic examination was normal except for the synkinetic movements as described above. Surgery was planned with an attempt to resect a part of the orbicularis oculi muscle (OOM) to decrease the synkinetic eyelid closure. In addition, the levator muscle was advanced for treatment of the ptosis. Before surgery, an electromyography study by a neurologist showed normal activity of the OOM but failed to demonstrate the relationship between this muscle and other muscles due to technique failure. However, after surgery electromyography studies of the facial and orbicularis oris muscle suggested that cheek puffing produced contraction in the OOM. During follow-up time, the patient was satisfied with the surgical results. To the best of our knowledge, this is the first report to describe ptosis with aberrant facial synkinesis during cheek puffing was treated with surgery.
贝尔面瘫是最常见的面神经病变。面神经麻痹后异常的面神经再生可能导致面神经联带运动和上睑下垂。作者报告了 1 例 65 岁男性，2017 年患左侧周围性面神经麻痹。在恢复期，他在第一眼位有中度上睑下垂，当他试图吹东西或鼓起脸颊时，他还注意到左眼上睑闭合。除了上述联带运动外，神经系统检查正常。计划手术切除部分眼轮匝肌（OOM）以减少联带性眼睑闭合。此外，为治疗上睑下垂，还进行了提上睑肌移位术。手术前，神经科医生进行的肌电图研究显示 OOM 活动正常，但由于技术失败，未能显示该肌肉与其他肌肉之间的关系。然而，手术后对面部和口轮匝肌的肌电图研究表明，脸颊鼓起时 OOM 会收缩。随访期间，患者对手术结果满意。据我们所知，这是首例描述因颊部鼓起而导致的异常面神经联带运动性上睑下垂的病例，并采用手术治疗。
