Extended frontalis orbicularis oculi muscle flap shortening for treating refractory apraxia of eyelid opening associated with blepharospasm

Q: What problem does the procedure aim to treat?

It targets refractory apraxia of eyelid opening (AEO) associated with blepharospasm, a condition often unresponsive to botulinum toxin and that can result in functional blindness.

Q: What surgical components are included in the extended FOOM flap shortening?

The technique combines frontalis suspension, partial myectomy, and myotomy in situ of eyelid protractors.

Q: How did postoperative results relate to botulinum toxin use and eyelid function?

Postoperatively, BTx dosage and injection frequency decreased, while voluntary eyelid opening was restored and palpebral fissure height increased, with high patient satisfaction reported.

Sep 29, 2026

Uploaded by Noah

Refractory apraxia of eyelid opening (AEO) often does not respond to botulinum toxin (BTx) and can lead to functional blindness. An innovative surgical strategy was evaluated for AEO associated with blepharospasm using extended frontalis orbicularis oculi muscle (FOOM) flap shortening, incorporating frontalis suspension, partial myectomy, and in-situ myotomy of eyelid protractors. Outcomes and patient satisfaction were assessed after surgery, showing improved eyelid opening and reduced dependence on BTx.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Definition and causes of apraxia of eyelid opening (AEO)

Methods

Study design and patient treatment period

J Chin MedAssoc Original article Extended frontalis orbicularis oculi muscle flap shortening for treating refractory apraxia of eyelid opening associated with blepharospasm Yu-Chi Wanga, Ya-Wei Laia,b,c, Chia-Chen Leea, Shu-Hung Huanga,e, Yur-Ren Kuoa, Chung-Sheng Laia,e,* aDivision of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC; bGraduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; cDivision of Plastic Surgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan, ROC; dDivision of Plastic Surgery, Department of Surgery, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan, ROC; eDepartment of Surgery, School of Medicine, College of Medicine, Kao.hsiung Medical University, Kaohsiung, Taiwan, ROC Abstract Background: Refractory apraxia of eyelid opening (AEO) is mostly unresponsive to botulinum toxin (BTx) and inevitably leads to functional blindness. To treat this challenging condition, an innovative surgical technique was proposed. Methods: The extended frontalis orbicularis oculi muscle (FOOM) flap shortening consisting of frontalis suspension, partial myectomy, and myotomy in situ of eyelid protractors was applied to treat refractory AEO associated with blepharospasm. The postoperative outcomes and patient satisfaction were evaluated. Results: Seven patients (mean ages 64.1 ± 3.9 years) of 14 eyelids in total had an average flap shortening distance of 24.4 ± 1.3 mm. During a mean follow-up of 31.6 ± 11.4 months, the average BTx dosage reduced from 58.6 ± 12. 1 units to 30.0 ± 8.2 units, with a mean injection interval decreasing from 2.3 ± 0.5 months to 4.1 ± 0.9 months (p < 0.05) . Palpebral fissure height increased from 1.4 ± 0.5 mm to 7.9 ± 0.7 mm, and the disability scale decreased from 78.8% ± 7.2% to 12.6% ± 7.0%(p < 0 .05) . The postoperative BTx dosage and frequency were significantly reduced. All patients restored voluntary eyelid opening and reported high postoperative satisfaction (average Likert scale 4.6 ± 0.5) . Conclusion: Extended FOOM flap shortening is an effective treatment to solve refractory AEO associated with blepharospasm. Keywords: Apraxia of eyelid opening; Blepharospasm; Botulinum toxin; Frontalis orbicularis oculi muscle flap; Frontalis suspension 1. INTRODUCTION Apraxia of eyelid opening (AEO) is defined as the inability to open the eyelids voluntarily with sustained brow elevation in the absence of obvious blepharospasm.1,2 Although the etiology and pathophysiology of AEO are poorly understood, idiopathic focal dystonia is the most common cause.1 Other causes, infection, toxic exposure, autoimmune, neurodegenerative, neuromuscular diseases, and ocular/central nervous system lesions have all been reported.1–6 AEO is most commonly associated with blepharospasm and is occasionally seen in patients with Parkinson’s disease or other movement disorders,7,8 which is caused by prolonged involuntary pretarsal orbicularis oculi muscle (OOM) contractions, involuntary levator palpebrae inhibition, or a combination of the two.9 Tawfik and Dutton10 proposed that a spasmodic *Address correspondence. Dr Chung-Sheng Lai, Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, 100, Tzyou 1st Road, Kaohsiung 807, Taiwan, [ROC. E-mail address: chshla@kmu.edu.tw](ROC. E-mail address: chshla@kmu.edu.tw) (C.-S. Lai). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Author contributions: Dr. Yu-Chi Wang and Dr. Ya-Wei Lai contributed equally to this work. Video content is available on the journal website at [https://journals.lww.com/jcma](https://journals.lww.com/jcma). Journal of Chinese Medical Association. (2023) 86: 935-939. Received October 23, 2022; accepted July 14, 2023. doi: 10. 1097/JCMA.00

FAQs

What problem does the procedure aim to treat?

It targets refractory apraxia of eyelid opening (AEO) associated with blepharospasm, a condition often unresponsive to botulinum toxin and that can result in functional blindness.

What surgical components are included in the extended FOOM flap shortening?

The technique combines frontalis suspension, partial myectomy, and myotomy in situ of eyelid protractors.

How did postoperative results relate to botulinum toxin use and eyelid function?

Postoperatively, BTx dosage and injection frequency decreased, while voluntary eyelid opening was restored and palpebral fissure height increased, with high patient satisfaction reported.

Sep 29, 2026

Uploaded by Noah