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Lee, Park, and Lew: Botulinum Toxin A Treatment for Patients with Periorbital Spasm after Facial Nerve Paresis
Original Article

J Korean Ophthalmol Soc 2011;52(8):910-915.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.8.910

Botulinum Toxin A Treatment for Patients with Periorbital Spasm after Facial Nerve Paresis

Jae Yeun Lee, MD, Jong Seo Park, MD, Helen Lew, MD

Department of Ophthalmology, Bundang CHA Medical Center, CHA University, Seongnam, Korea

Address reprint requests to Helen Lew, MD Department of Ophthalmology, Bundang CHA Medical Center #351 Yatap-dong, Bundang-gu, Seongnam 463-712, Korea Tel: 82-31-780-5330, Fax: 82-31-780-5333, E-mail: eye@cha.ac.kr

Received 2 November 2010       Revised 8 February 2011       Accepted 16 May 2011

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate clinical features of periorbital spasm and facial asymmetry in the patients who recovered poorly from Bell's palsy and facial trauma and to investigate the effect of Botulinum toxin A as a treatment for periorbital spasm and facial asymmetry.

Methods

Between November 2001 and January 2010, Botulinum toxin injection was performed in 17 patients who had blepharospasm and facial asymmetry following poor recovery from facial palsy. The past history, trauma history, clinical manifestation of blepharospasm, Botulinum toxin A injection dose, injection site, frequency of injection, and duration of effect was evaluated. Data was analyzed using the Mann-Whitney U test, SPSS 12.0

Results

The mean number of injections was 2.7 ± 2.4 times and the mean dose per injection unit was 12.2 ± 1.2 units. The Botulinum toxin effect lasted 6.9 ± 5.5 months in Bell's palsy patients, and 8.0 ± 4.2 months in trauma patients. There was no significant difference between the 2 groups. Most patients reported improvement of periorbital spasm and facial asymmetry. After treatment, 1 patient complained of epiphora and 1 patient complained of ptosis; conservative treatment was performed for these patients.

Conclusions

Blepharospasm can be treated and a cosmetic improvement in facial symmetry can be achieved by Botulinum toxin A injection in the patients who recover poorly from facial palsy.

Keywords: Aberrant facial nerve regeneration, Blepharospasm, Botulinum toxin, Facial palsy, Hypertonicity, Synkinesis

References

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Figure 1.
A 51-year-old male with left facial palsy had improved of facial asymmetry after botulinum toxin injection. Physician's grading scale (PGS) 1. (A) Before botulinum toxin treatment. (B) After botulinum toxin treatment.
jkos-52-910f1.tif
Figure 2.
A 73-year-old male with left facial palsy had improved of facial asymmetry and hypertonicity after botulinum toxin injection. Physician's grading scale (PGS) 2. (A) Before botulinum toxin treatment. (B) After botulinum toxin treatment.
jkos-52-910f2.tif
Table 1.
Clinical characteristics of the patients treated with botulinum toxin for incomplete recovery from facial nerve paralysis
No. Sex Age (yr) Cause Duration of disease (yr) Past treatment Characteristic of periorbital spasm Location of periorbital spasm
1 F 47 Bell's palsy 10 None Synkinesis ULLL:OD
2 F 75 Bell's palsy 0.5 Physiotherapy Hypertonicity ULLL:OD
3 F 50 Bell's palsy 20 Blepharoplasty Synkinesis LL:OD
4 F 69 Bell's palsy 19 Blepharoplasty Hypertonicity ULLL:OU
5 F 66 Bell's palsy 0.7 Herb medicine Synkinesis ULLL:OD
6 F 50 Bell's palsy 0.7 Herb medicine Hypertonicity ULLL:OS
7 M 67 Bell's palsy 3 None Hypertonicity ULLL:OS
8 M 74 Bell's palsy 0.2 None Hypertonicity ULLL:OD
9 M 51 Bell's palsy 13 Botulinum toxin injection Hypertonicity UL:OS
10 M 29 Blunt trauma 0.1 None Synkinesis LL:OD
11 F 62 Fall down 0.1 None Hypertonicity UL:OD
12 M 55 Blunt trauma 0.1 None Hypertonicity UL:OU
13 F 62 Traffic accident 10 None Hypertonicity UL:OU
14 M 44 Fall down 2 None Synkinesis LL:OS
15 F 60 Fall down 2 None Synkinesis UL:OU
16 F 60 Blunt trauma 0.1 None Synkinesis UL:OD
17 M 18 Blunt trauma 0.1 None Synkinesis LL:OD

UL = upper lid; LL = lower lid.

Table 2.
Clinical manifestation of periorbital spasm in the patients of incomplete recovery from facial nerve paralysis
Synkinesis Hypertonicity
Bell's palsy (n = 9) 6 (67%) 3 (33%)
Trauma (n = 8) 3 (37%) 5 (63%)
Total (n = 17) 9 (100%) 8 (100%)

Fisher's exact test, p = 0.347.

Table 3.
The patterns of Botulinum toxin injection in the periorbital spasm in the patients of incomplete recovery from facial nerve paralysis
Sites Total number Frequencies (number of injection /per person) Average dose (mean ± SD, UNIT)
Upper lid:OD 40 3.1 13.0 ± 8.0
Lower lid:OD 40 3.1 12.5 ± 7.8
Upper lid:OS 22 2.8 10.9 ± 1.5
Lower lid:OS 26 2.9 13.9 ± 8.2
Right nasolabial fold 10 2 11.3 ± 4.5
Left nasolabial fold 2 1 6
Perioral 6 2 6
Table 4.
Clinical use of Botulinum toxin injection in the periorbital spasm patients according to the cause of facial nerve paralysis
Causes No. of injection (mean ± SD) Dose of injection (mean ± SD, UNIT) Duration of effect (mean ± SD, mon)
Bell's palsy (n = 9) 3.2 ± 2.7 33.0 ± 20.0 6.9 ± 5.5
Trauma (n = 8) 2.2 ± 2.1 44.8 ± 22.3 8.9 ± 5.5
Total (n = 17) 2.7 ± 2.4 35.5 ± 20.5 7.6 ± 4.8

Mann-Whitney U test, p > 0.05.

Table 5.
Outcomes of Botulinum toxin injection based on Physician's grading scale in the periorbital spasm patients for incomplete recovery from facial nerve paralysis
Physician's grading scale (score) Facial palsy Trauma
No response (0) 0 (0%) 0 (0%)
Improvement of spasm (1) 7 (78%) 7 (87.5%)
No spasm (2) 2 (22%) 1 (12.5%)
Total 9 8

Mann-Whitney U test, p = 0.611.

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