Myotomy for idiopathic blepharospasm

Idiopathic hernia is the involuntary contraction of the eyebrows and the eyebrows between the eyelids and the eyebrows, causing the patient not to blink and form functional blindness. Since the pathogenesis of idiopathic sputum is still unknown, there is still no specific drug treatment. The purpose of surgical treatment is to reduce or eliminate muscle contracture from the outside of the periorbital area, relieve functional blindness caused by closed hernia, and restore vision. But the effect is not absolutely reliable. There are two kinds of surgical treatment methods: 1 selectively remove the branch of the facial nerve, the branch of the iliac crest, and reduce the contraction of the eyelid and the eyebrow muscle. Due to serious adverse reactions, such as paralytic valgus, eyebrows, eyebrows, tears, etc., and a 50% recurrence rate, has not been used clinically. 2 times total resection of the orbital rim muscle and eyebrow muscle, this method has mild adverse reactions, low recurrence rate, and clinical use. Treatment of diseases: preoperative preparation Shave the hair, wash the scalp with soapy water, and wash the entire face and ears. Intravenous infusion of prophylactic antibiotics and corticosteroids (1 d before surgery) helps to reduce postoperative swelling and wound infection. Surgical procedure 1. The first step is to remove the eyebrow muscle, frowning muscles, and the rim of the ankle. (1) Draw a scalp incision and a midline mark. The double external ear canal is wrapped with a wet cotton ball to prevent short-term hearing loss caused by blood inflow. The surgical field is sutured after the predetermined incision. (2) Both sides of the incision to the underside of the ear, 3 cm behind the midline to the hairline. (3) Incision of the skin and cap-shaped diaphragm, the surgeon and assistant pressed the hemostasis by hand, and the Dandy hemostatic clip on both sides of the wound was made into a crown flap with sharp and blunt dissection. (4) Expose the periosteum of the upper and lateral condyle of the double iliac crest, and the medial to the upper part of the nasal bone. Do not open the septum. (5) Using a Bovie coagulator to divide and cut the eyebrows, frowning muscles and ankle rim muscle. (6) scalp and cap-like aponeurosis layered suture. Several vertical incisions were made on the scalp to help estimate the number of scalp resections. The scalp under the drainage tube prevents hematoma and seroma formation. 2. In the second step, the iliac muscle is removed. (1) 8~10mm on the eyelashes to make a sacral incision, sharply separate (upward, downward) the rim muscle underneath, the muscle fiber is directly under the skin. (2) The upper segment is connected with the space between the eyebrow and the eyebrow muscle, and the 3mm rim muscle (near the eyelash) is completely retained in front of the sac to provide postoperative eye closure. The iliac muscles of the anterior and posterior tibia were removed before the ember. (3) After the hemostasis is completed, the skin is interrupted (with a seesaw) and the ligation is not too tight. 3. The third step is the removal of the rim rim muscle. (1) 4-0 silk traction to the lower edge to help split. (2) Make a sacral incision incision, slightly over the gingival margin and the zygomatic arch, and tear the flap downward. (3) All the ankles and the anterior iliac muscles were removed, and only the 3mm rim muscle in front of the tarsal plate was reserved to provide closure. Do not open the interval. 7-0 silk sutures. Do not remove the skin to prevent postoperative contraction and valgus.