A modified transconjunctival technique for botulinum toxin chemodenervation of levator palpebrae superioris for corneal protection

Object High-grade postoperative facial nerve paresis after surgery for vestibular schwannoma with insufficient eye closure involves a risk for severe ocular complications. When conservative measurements are not sufficient, conventional invasive treatments include tarsorrhaphy and eyelid loading. In this study, injection of botulinum toxin into the levator palpebrae muscle was investigated as an alternative for temporary iatrogenic eye closure. Methods Injection of botulinum toxin was indicated by an interdisciplinary decision (neurosurgery and ophthalmology) in patients with a postoperative facial nerve paresis corresponding to a House-Brackmann Grade of IV or greater and documented abnormalities concerning corneal status such as keratopathia or conjunctival redness. Twenty-five IUs of botulinum toxin were injected transcutaneously and transconjunctivally. Results Six of 11 patients with high-grade paresis showed abnormal corneal findings in the early postoperative period. In 4 of these patients, botulinum toxin was injected; 1 patient declined the treatment, and in 1 patient it was not performed because of contralateral blindness. Temporary eye closure was achieved for 2 to 6 months in all cases. In all cases, facial nerve function had recovered sufficiently in terms of eye closure when the effect of botulinum toxin subsided. Conclusion The application of botulinum toxin for temporary iatrogenic eye closure is an excellent low-risk and temporary alternative to other invasive measures for the treatment of postoperative high-grade facial nerve paresis when the facial nerve is anatomically intact.

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Pathological changes in levator palpebrae superioris muscle treated with botulinum toxin in a case of carotico-cavernous fistula.

British Journal of Ophthalmology ◽

10.1136/bjo.75.3.181 ◽

1991 ◽

Vol 75 (3) ◽

pp. 181-184 ◽

Cited By ~ 1

Author(s):

G G Adams ◽

P N Dilly

Keyword(s):

Botulinum Toxin ◽

Pathological Changes ◽

Cavernous Fistula ◽

Levator Palpebrae ◽

Levator Palpebrae Superioris Muscle

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Botulinum Toxin Injection Therapy for Abductor Spasmodic Dysphonia

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd14.1.10 ◽

2004 ◽

Vol 14 (1) ◽

pp. 10-12

Author(s):

Christy L. Ludlow

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin Injection ◽

Injection Therapy ◽

Spasmodic Dysphonia

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Severe Drooling and Treatment With Botulinum Toxin

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd21.1.15 ◽

2012 ◽

Vol 21 (1) ◽

pp. 15-21

Author(s):

Merete Bakke ◽

Allan Bardow ◽

Eigild Møller

Keyword(s):

Botulinum Toxin ◽

Side Effects ◽

Health Risk ◽

Flow Rate ◽

Clinical Evidence ◽

Acetylcholine Release ◽

Psychosocial Problems ◽

Rate Reduction ◽

Local Inhibition ◽

Surgical Treatments

Severe drooling is associated with discomfort and psychosocial problems and may constitute a health risk. A variety of different surgical and non-surgical treatments have been used to diminish drooling, some of them with little or uncertain effect and others more effective but irreversible or with side effects. Based on clinical evidence, injection with botulinum toxin (BTX) into the parotid and submandibular glands is a useful treatment option, because it is local, reversible, and with few side effects, although it has to be repeated. The mechanism of BTX is a local inhibition of acetylcholine release, which diminishes receptor-coupled secretion and results in a flow rate reduction of 25–50% for 2–7 months.

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