Frontalis suspension surgery to treat patients with blepharospasm and eyelid opening apraxia: long-term results.
Blepharospasm may be accompanied by eyelid opening apraxia (EOA) reducing the efficacy of botulinum toxin (BT) therapy. The frontalis suspension operation (FSO) is then the only effective treatment option available. We want to report the first long-term results with FSO. We studied 15 patients with blepharospasm and EAO unresponsive to BT therapy (9 females, 6 males, age 61.9 ± 11.5 years). FSO was performed by applying 2 polytetrafluoroethylene threads (PTFE, Gore-Tex®) per eye connecting the frontalis muscle to the upper eye lid. Tension of the two carrés was set to produce a palpebral fissure width of 2-3 mm. Therapy outcome was monitored by a quality-of-life questionnaire (QoL-Q) and a self-assessment calendar reviewing postoperative days 0-9 (T1), 10-89 (T2), 90-179 (T3), 180-365 (T4), and >365 days (T5). Altogether, 40 FSO were performed. Postoperatively, all patients reported improved eyelid opening, 4 (27%) complete remission of symptoms. At T1, this improvement was 74.6 ± 26.4% on the self-assessment scale, after 1 year 68.2 ± 27.5%. Throughout the observation period (T1-T5), the improvement was 71.9 ± 25.6%. All 19 items on the QoL-Q (except for presence of involuntary eye lid closure) showed postoperative improvement. Adverse effects included circumscript upper eyelid haematomas, suture extrusion, suture granuloma, lacrimation, and infections. In all patients, BT therapy had to be continued to treat orbicularis oculi contractions. Our first long-term results demonstrate that FSO is a benign procedure producing robust and stable therapeutic effects on EOA in blepharospasm.
Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. dressler.dirk@mh-hannover.de.
Dirk
D
Dressler
Department of Ear-, Nose and Throat, Universitätsmedizin Göttingen (UMG), Göttingen, Germany.
Chrisanthi
C
Karapantzou
Department of Audiology and Phoniatrics, Charité-Universitätsmedizin, Berlin, Germany.
Saskia
S
Rohrbach
Department of Medical Statistics, Universitätsmedizin Göttingen (UMG), Göttingen, Germany.
Simon
S
Schneider
Department of Ear-, Nose and Throat, Universitätsmedizin Göttingen (UMG), Göttingen, Germany.
Rainer
R
Laskawi
D000328:Adult; D000368:Aged; D001072:Apraxias / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D001764:Blepharospasm / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D001905:Botulinum Toxins / Q000627:therapeutic use; D005143:Eyelids / Q000601:surgery; D005152:Facial Muscles / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D001905:Botulinum Toxins
Blepharospasm; Botulinum toxin therapy; Eyelid opening apraxia; Failure; Frontalis suspension operation; Long-term results