Innervation Zone of Orbicularis Oculi Muscle and Implications for Botulinum A Toxin Therapy
作者:
Gary Borodic,
David Cozzolino,
Robert Ferrante,
Allen Wiegner,
Robert Young,
期刊:
Ophthalmic Plastic and Reconstructive Surgery
(OVID Available online 1991)
卷期:
Volume 7,
issue 1
页码: 54-60
ISSN:0740-9303
年代: 1991
出版商: OVID
关键词: Botulinum toxin;Blepharospasm;Facial nerve;Orbicularis oculi;Innervation zone
数据来源: OVID
摘要:
Motor points (areas of maximal sensitivity to electrical stimulation) were found in constant locations over orbicularis oculi when measured in both eyes of six normal subjects. All subjects had a motor point at the lateral terminus of the upper lid crease and the medial extent of the lower lid crease. A study of the innervation zone [distribution of neuromuscular junctions (NMJ) was conducted on strips of pretarsal and preseptal portions of the upper eyelid orbicularis that had been removed routinely during involutional ptosis surgery. There was no significant difference in NMJ concentration between the medial and lateral sections, as determined by cholinesterase staining. Therefore, we concluded that the innervation zone is diffuse for the orbicularis muscle within this portion of the upper eyelid. Single-point injections of botulinum toxin were then compared to the conventional multiple injection sites on separate eyes in 10 patients with benign essential blepharospasm. Eight of the 10 patients reported greater relief on the side given injections into multiple points; the other two patients experienced no difference between the two methods. Both histologic data and clinical observation of response to botulinum toxin injection suggest the innervation zone for the upper orbicularis is diffuse. Thus, we conclude that multiple injections are superior to the injection of a single motor point.
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