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Isaac Reich, Benjamin O. Burt, Ronald Mancini, Edward J. Wladis, Vikram D. Durairaj, Roman Shinder; Treatment of Pseudoptosis Secondary to Aberrant Regeneration of the Facial Nerve with Botulinum Toxin Type A. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1021.
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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.
The charts of 15 patients with pseudoptosis secondary to aberrant facial nerve regeneration were reviewed.
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).
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.
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