Surgical Treatment of Essential Blepharospasm: Using Highly Selective Facial Neurectomy

利用高選擇性顏面神經切除術治療原發性眼瞼痙攣

陳明庭(Ming-Ting Chen) ； 楊永健(Eng-Kean Yeong) ； 顔江龍(Chiang-Long Yen)

《中華民國重建整形外科醫學會雜誌》 3卷3期 (1994/09) Pp. 105-111

https://doi.org/10.7096/JPRSA.199409.0105

摘要

雖然原發性眼瞼痙攣並非很罕見的疾病，但卻常因誤診或治療的方法不當而使得治療的效果不佳。首先我們必須強調要認識此疾病，做正確的診斷方可做到道當的治療。關於其病理原因雖有很多學說假設但仍無定論。我們利用高選擇性顏面神經切除術治療四例原發性眼瞼痙攣的病人，首先將顏面神經遠端超過腮腺的部份很仔細的分離出來再分離出末端支，然後利用神經刺淚器找出所有支配到眼輪肌的顏面神經分枝，通常有六至七條，加以切除一段約八毫米長度的神經，並將切除後顏面神經的近端利用電燒加以燒灼。四個病例追縱一至二年結果相當滿意，除了一例在感冒期間有暫時性眼瞼痙攣復發的現象。其他的治療方法如心理治療、藥物治療使用鎮靜劑則沒有什麽大的效果，至於局部注射臘腸桿菌毒素(Botulinum toxin)則有暫時性的效果。談到外科治療大致分為兩種：一為切斷神經，另一種為眼輸肌剝斷法；而神經切斷法以往常由顏面神經主幹下手如此可帶來顏面麻痺之合併症。我們利用高選擇性顏面神經切除術四例中，我們發現的兩例合併症只是眼皮鬆弛而已。因此只要正確的診斷原發性眼瞼痙攣，用高選擇性顏面神經切除術，其治療效果是可期待的。因為追蹤時間仍不夠長，所以再發的可能性並不能排除，希望繼續追蹤。

並列摘要

We treated 4 patients with bilateral essential blepharospasm using highyly selective facial neurectomy and obtained satisfactory results. The branches of the facial nerve distal to the parotid gland were identified and their destinations were confirmed with an electric stimulator. All visible branches supplying the orbicularis oculi muscle were resected. Segments of 8 mm in length were resected, and the proximal ends of the branches were treated by electric cauterization. The follow-up results over a 1 to 2 year period were satisfactory. Only 1 case (case 2) had a transient recurrence during an episode of common cold which subsided spontaneously. This highly selective facial neurectomy has the advantage of preserving normal innervation of the frontal muscle and buccal muscles supplying the cheek and mouth angle.

並列關鍵字

essential blepharospasm ； highly selective facial neurectomy