Treatment of essential blepharospasm. I. Comparison of facial nerve avulsion and eyebrow-eyelid muscle stripping procedure
C. D. McCord Jr, W. H. Coles, J. W. Shore, R. Spector and J. R. Putnam
Benign essential blepharospasm is an incurable disease for which many
treatment modalities have been suggested. The two surgical procedures that
have been used most commonly are avulsion of the facial nerve and stripping
of the protractor muscles of the eyelid and brow. We compare two matched
series of 22 patients; one group underwent facial nerve avulsion
("Reynold's" procedure), and the other underwent "muscle stripping"
("Anderson's" procedure). We noted the number of procedures required for
the patient to obtain a functional visual result and the side effects
produced. Additional surgical procedures required by patients undergoing
facial nerve avulsion were additional facial nerve avulsion, repair of
ectropion, and correction of dermatochalasis and brow droop. Additional
procedures required in patients who had muscle stripping were excision of
lower lid orbicular fibers or residual brow fibers. The Reynold group
required 16 additional procedures (38 separate procedures) to obtain
functional results, as opposed to the four additional procedures (26
separate procedures) required in the Anderson group. Two patients in the
Reynold group who needed surgery have not yet undergone it at this writing.
If they did, that would boost the total number of procedures to 40.
Secondary procedures are needed 4.5 times more often with the Reynold
procedure than with the Anderson procedure. The patient's subjective
response to and acceptance of the procedure are much greater for the
Anderson procedure.
