Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
J Chin Med Assoc. 2023 Oct 1;86(10):935-939. doi: 10.1097/JCMA.0000000000000979. Epub 2023 Aug 22.
Refractory apraxia of eyelid opening (AEO) is mostly unresponsive to botulinum toxin (BTx) and inevitably leads to functional blindness. To treat this challenging condition, an innovative surgical technique was proposed.
The extended frontalis orbicularis oculi muscle (FOOM) flap shortening consisting of frontalis suspension, partial myectomy, and myotomy in situ of eyelid protractors was applied to treat refractory AEO associated with blepharospasm. The postoperative outcomes and patient satisfaction were evaluated.
Seven patients (mean ages 64.1 ± 3.9 years) of 14 eyelids in total had an average flap shortening distance of 24.4 ± 1.3 mm. During a mean follow-up of 31.6 ± 11.4 months, the average BTx dosage reduced from 58.6 ± 12. 1 units to 30.0 ± 8.2 units, with a mean injection interval decreasing from 2.3 ± 0.5 months to 4.1 ± 0.9 months (p < 0.05). Palpebral fissure height increased from 1.4 ± 0.5 mm to 7.9 ± 0.7 mm, and the disability scale decreased from 78.8% ± 7.2% to 12.6% ± 7.0% (p < 0.05). The postoperative BTx dosage and frequency were significantly reduced. All patients restored voluntary eyelid opening and reported high postoperative satisfaction (average Likert scale 4.6 ± 0.5).
Extended FOOM flap shortening is an effective treatment to solve refractory AEO associated with blepharospasm.
难治性眼睑张开性运动障碍（AEO）大多对肉毒杆菌毒素（BTx）无反应，不可避免地导致功能性失明。为了治疗这种具有挑战性的疾病，提出了一种创新的手术技术。
采用额肌眶部眼轮匝肌（FOOM）扩展缩短术，包括额肌悬吊、部分肌切除术和眼外肌原位肌切开术，治疗伴有眼睑痉挛的难治性 AEO。评估术后结果和患者满意度。
7 名患者（平均年龄 64.1±3.9 岁）共 14 只眼睑中，平均缩短距离为 24.4±1.3mm。平均随访 31.6±11.4 个月后，BTx 剂量从 58.6±12.1 单位减少到 30.0±8.2 单位，注射间隔从 2.3±0.5 个月减少到 4.1±0.9 个月（p<0.05）。睑裂高度从 1.4±0.5mm 增加到 7.9±0.7mm，残疾量表从 78.8%±7.2%减少到 12.6%±7.0%（p<0.05）。术后 BTx 剂量和频率明显减少。所有患者均恢复了自愿性眼睑张开，并报告了高术后满意度（平均李克特量表 4.6±0.5）。
扩展 FOOM 瓣缩短术是治疗伴有眼睑痉挛的难治性 AEO 的有效方法。
