PERIPHERAL - SURGICAL PROCEDURES FOR DYSTONIA


Posted by Curtis Dylan , Jul 26,2001,04:43   Archive
"PERIPHERAL" SURGICAL PROCEDURES FOR DYSTONIA

Blepharospasm

Before botulinum toxin therapy revolutionized the management of this disabling form of focal dystonia, a number of surgical therapies had been attempted, often without much sustained benefit. Peripheral facial neurectomy was the most common of these, utilizing various techniques including alcohol injections, surgical sectioning, selective peripheral nerve avulsion, and percutaneous nerve thermolysis. These techniques resulted in a high recurrence rate and a wide variety of complications including paralytic ectropion, lagophthalmos, epiphora, exaggeration of upper lid dermatochalasis, lip paresis, dropping of the mouth, and loss of facial expression (4,27,45). A very high proportion of these patients also required secondary surgical procedures either because of inadequate effect or to correct one or more of the complications of the original procedure. In response to these unsatisfactory results, Gillum and Anderson (30) introduced a myectomy or extirpation procedure that entailed removing the upper orbicularis oculi, procerus and corrugator muscles, as well as the facial nerves in the postorbital facia combined with a browplasty with resectioning of the lower portion of the frontalis muscle and reinforcement of the levator aponeurosis. If necessary a lower myectomy resecting the tarsal, septal, and orbital portions of the orbicularis oculi in combination with a tarsal tuck procedure is performed as a secondary approach in patients obtaining incomplete benefit from the upper myectomy. The need for this second procedure has varied from 22% to 35% (28,40,45). Side effects of the myectomy include numbness of the forehead, chronic lymphedema of the periorbital region, and, less often, exposure keratitis, ptosis, or lid retraction and ectropion and lower lid retraction with the lower myectomy. In their review Patel and Anderson (48) report "improved visual disability in approximately 90% of cases of blepharospasm" with more than 400 myectomies over a 12-year period. When compared with facial nerve avulsion, myectomy has resulted in superior benefit, better patient acceptance, and a much lower need for secondary surgical procedures [required 4.5 times more frequently following facial nerve avulsion in a study by McCord et al. (45)].

Related link: http://www.dystonia-support.org/la-surgical%20treatment%20of%20dystonia.htm




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Re: PERIPHERAL - SURGICAL PROCEDURES FOR DYSTONIA

Re : PERIPHERAL - SURGICAL PROCEDURES FOR DYSTONIA --- Curtis Dylan
Posted by Shirley-Arkansas-USA , Jul 26,2001,09:24 Top of Thread Archive
Hi Curtis,
You have presented a good historical surgical overview with this site and the information that they give.
For more updated information, you could contact the BEBRF for papers published more recently. Things have changed since this information was put out.
Dr. Richard Anderson has done well over 1000 myectomies at this point and techniques and procedures have changed. Some of the information brought up at this site was presented in 1983 and early 90's.
I wouldn't want people to think that this is the latest information.

Past BEBRF newsletters have excellent write-ups on current surgical techniques and procedures and surgeons doing them.
Thanks for the info. I for one am glad to see that things are improving and moving along.

Shirley In AR.




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dates from 1940's to late 1999 ???

Re : Re: PERIPHERAL - SURGICAL PROCEDURES FOR DYSTONIA --- Shirley-Arkansas-USA
Posted by Curtis Dylan , Jul 26,2001,12:40 Top of Thread Archive
1999? I dont think that's old at all. I believe the article has merit even today and should be a benchmark for anyone considering Neuromyectomy. There are some very recent references in that article.
If my past years (14) of suffering, dealing, reading, researching & studying about Dystonia are doing harm by me posting that article then
I'm sorry. Most doctors still use oral meds that were given 15 to 20
years ago. I realize that everyone can be a critic but I don't think
that this article presents any harm nor does it impose any injustice to
"recent" treatments for Blephs. I have a stack that's about 2 feet
high of newsletters and publishments from BEBRF. Please dont
rain on my parade because you may not like what I post on here.
Take it or leave it. Awareness is what we're all about and whatever
I post should be taken as such, that's all. No harm was meant on
my part Shirley in Arkansas. I'll try to post more recent articles
for you.

Curtis


--modified by Curtis Dylan at Thu, Jul 26, 2001, 12:43:06




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1940's to late MID 90's , made a mistake

Re : dates from 1940's to late 1999 ??? --- Curtis Dylan
Posted by curtis dylan (Curtis Dylan,curtis dylan), Jul 26,2001,12:51 Top of Thread Archive



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Re: dates from 1940's to late 1999 ???

Re : dates from 1940's to late 1999 ??? --- Curtis Dylan
Posted by Shirley-Arkansas-USA , Jul 26,2001,14:54 Top of Thread Archive
I apologize for offending you, Curtis. That was not my intention. I did not feel that you intended any harm nor did you cause any harm by your post and I was not trying to rain on your parade. I am sorry. I don't believe that I said that the article did not have merit.
I still stand by what I did say. In going back to the link and reading the article that you posted, it did not appear to me to be current information. In checking the reference numbers in the article to the published articles, they were as follows: (4)1991, (27)1976, (28)1992, (30)1981, (40)1985, (45)1984, (48) 1993.

I merely wanted people to know that there was more recent information. I don't feel like apologizing for that.

Once again, I am sorry for offending you and you have certainly been researching and dealing with this longer than I have. I do feel that anyone considering a myectomy needs the most current information available, though.

This is only my opinion. You may take it or leave it. I'm not here to hurt people.

Shirley in AR. who is still learning




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surgery for blepharospasm/apraxia

Re : PERIPHERAL - SURGICAL PROCEDURES FOR DYSTONIA --- Curtis Dylan
Posted by Virginia , Jul 26,2001,12:47 Top of Thread Archive
Here is a link to an abstract from the 1999 BEBRF conference in which Dr. Anderson and an associate describe their approach to surgery.

Related link: http://www.blepharospasm.org/99anders.html

--modified by Virginia at Thu, Jul 26, 2001, 12:50:00




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Re: surgery for blepharospasm/apraxia

Re : surgery for blepharospasm/apraxia --- Virginia
Posted by MaryNY (Mary,MaryNY), Jul 30,2001,17:45 Top of Thread Archive
Virginia - Thank you for posting that link to Dr. Anderson's surgery report. I think I read it before, but can't be sure (CRS, you know) so I printed it out. It is certainly very informative, and helps me to remember what my limited myectomy in 1999 was all about! Mary



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Re: PERIPHERAL - SURGICAL PROCEDURES FOR DYSTONIA

Re : PERIPHERAL - SURGICAL PROCEDURES FOR DYSTONIA --- Curtis Dylan
Posted by Sally - in - Idaho , Jul 27,2001,02:05 Top of Thread Archive
My mother (now age 84) had facial neurectomy (4 times, in fact) in the late 1960s-'70s and considers herself "cured." She had many other treatments, including MANY DRUGS and shock treatments, before this surgery. It did leave her with one side of her face drooping and one eye that won't close and which tears constantly, but she says that's far better than having them close ... at least she can see and get on with life. She gets quite upset because I don't "go have an operation and get cured!" I guess she was one of the lucky ones for whom the results of that surgery were satisfactory.

Sally in North Idaho




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