Treatment of Pseudoptosis Secondary to Aberrant Regeneration of the Facial Nerve with Botulinum Toxin Type A

摘要

?Purpose:?Aberrant facial nerve regeneration can result in various presentations including pseudoptosis during facial movements (Fig 1). This can pose both visual and social challenges for the patient. Only 1 prior report documents treatment of this malady with botulinum toxin type A (Botox ?, BTX-A). We detail the etiology, duration since onset of palsy and aberrant regeneration, location, dosage, frequency, success, and side effects of BTX-A injections in 15 such patients.?Methods:?The charts of 15 patients with pseudoptosis secondary to aberrant facial nerve regeneration were reviewed.?Results:?6 men and 9 women had a median age of 65 years (range 34-84). Etiology of facial nerve palsy included Bells palsy (10 patients, 67%), iatrogenic following surgery (2, 13%), trauma (2, 13%), and Ramsey-Hunt syndrome (1, 7%). The mean duration since onset of VII palsy was 8.7 years (range 1.1-30), while the mean duration since onset of pseudoptosis was 7 years (range 0.5-29). The mean number of upper lid sites injected was 2.3 (range 2-4), with a mean of 3.6 units per site (range 2.5-7.5), and mean of 8.4 total units (range 5-20). All patients received repeat injections at 3-6 month intervals, and all patients displayed improvement in pseudoptosis with a mean follow up of 13 months (range 3-61).?Conclusions:?Pseudoptosis secondary to aberrant facial nerve regeneration is a functional problem for patients which can be successfully treated with injection of BTX-A into the paradoxically contracting orbicularis oculi muscle of the upper lid. This represents a safe and effective treatment for such patients. We believe this to be the largest such series to date, and only second of its kind in the literature. ?View OriginalDownload SlideView OriginalDownload Slide?View OriginalDownload SlideView OriginalDownload Slide ? Keywords: eyelid ? regeneration ? neuro-ophthalmology: diagnosis?.