What is the role of myectomy in the treatment of benign essential blepharospasm (BEB)?

Updated: May 20, 2019
  • Author: Robert H Graham, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Limited myectomy involves surgical extirpation of protractors of the eyelids, including the pretarsal, preseptal, and orbital portions of the upper and lower eyelid orbicularis oculi muscle. Extended myectomy includes removal of the procerus and corrugator muscles. Myectomy is a staged procedure with upper eyelid surgery typically performed first, followed by lower eyelid surgery if symptoms persist. Simultaneous upper and lower eyelid myectomy is avoided because it typically leads to chronic lymphedema.

  • Adequate access to the orbicularis oculi, corrugator, and lateral procerus muscle can be gained through an upper eyelid crease incision. Muscle is removed in 3 en block sections.

  • Dissection begins in a plane between the skin and the pretarsal muscle.

  • A 1- to 2-mm band of pretarsal muscle is preserved at the eyelid margin, and the rest of the pretarsal muscle is removed.

  • Dissection proceeds superior in a plane between the skin and the muscle to above the eyebrow. The orbital septum is left intact, and the preaponeurotic fat pad is not sculpted. The remaining preseptal and orbital orbicularis is removed. A thin band of muscle is left beneath the eyebrow to prevent alopecia.

  • Finally, the lateral orbicularis is removed over the lateral raphe and extending into the lateral portion of the inferior orbicular. The lateral dissection is aided by retroilluminating the skin muscle flap. When lower lid myectomy is required, adequate access can be obtained via a lower eyelid crease incision.

Many patients with BEB have aesthetic concerns about eyebrow ptosis or forehead rhytids, which can be addressed safely at the time of myectomy by sculpting or repositioning of the retro-orbicularis oculi fat pad or by endoscopic forehead lift surgery.

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