Frontal muscle flap suspension surgery for the treatment of severe congenital ptosis incision design
【Abstract】 Objective: To explore the treatment of moderate and severe congenital ptosis and effective surgical incision method and design of orthopedic effects. Methods: 32 patients (39 eyes) of blepharoptosis incision according to the amount of pre-designed muscle flap suspension of efficacy were analyzed retrospectively. Results: All 39 ptosis correction, 37 eyes double eyelid symmetry, two due to symmetry. The cure rate 100%, satisfaction rate of 95%. Conclusion: The frontal muscle flap suspension surgery for the treatment of moderate and severe congenital ptosis incision design can achieve a better focus on the improvement of function and orthopedic
Key words ptosis
Moderate and severe congenital ptosis not only affect the appearance of appearance, but also affect the visual function. The surgical method of its correction more, each with advantages and disadvantages, we have 2003-01/2005-03
with the amount of muscle flap suspension surgery for moderate to severe ptosis, a total of 32 cases (39) achieved good long-
term effect , are reported as follows.
An object and method
1.1 The object of this group of 32 cases (39), the 20 males and 12 females. Ages 2 to 19 years old. Monocular 25
cases, 7 cases of both eyes. Blepharophimosis were ? 4mm,
levator muscle strength 0 ~ 3mm, the amount of muscle activity rate of 8 ~ 13mm. Bells exist in the phenomenon.
1.2.1 Design of monocular ptosis incision persons, to enable patients to sit in front of patients, eyes flat as the front of the first measurement of health right now palpebral margin to double eyelid sulcus, middle and outer height, and
then as a high mark in the affected eye out 3 points, draw a line, an additional measure eye on the palpebral margin to double eyelid sulcus, middle and outer height, as height of the affected eye and then mark with a line of 3:00. Head-eye
double eyelid when the line parallel to the middle of the upper edge of the bridge of the nose do a tag. Double eyelid drooping eyes, who according to conventional design method of double eyelid line draw.
1.2.2 pediatric surgical methods using general anesthesia
may be collaborators with 10g / L lidocaine and 7.5g / L bupivacaine epinephrine (1:1000) line of local infiltration anesthesia. The upper eyelid incision in the default skin incision, if the two-lane who do not coincide, then the
removal of two lines in the skin, then cut off the top of the skin, using scissors along the surface of the orbicularis oculi muscle and subcutaneous tissue from the incision between the stripping sneak up to reach the orbital margin to continue upward after the amount of muscle and subcutaneous tissue in between the strip up to the eyebrow 15mm, width 25mm, with curved mosquito clamp blood vessels in the last upper lid of the Central Office, stretching along the skin to the orbital rim when the clamp open curved , in the orbital margin
equivalent to the amount of muscle attachment clamp the amount of muscle, pull up the skin with retractors, exposing the orbital orbicularis oculi muscle and the amount of muscle occupies occupies a pair of scissors at the tip into the
muscle up to the periosteum, and then Scissors mouth opening parallel to the orbital margin to separate the muscle fibers, separated from the width of about 15mm, deep muscle whole floor, and then along the supraorbital margin blunt periosteal
surface upward separation, the separation of a considerable scope and subcutaneous . The amount of muscle in the free edge of the medial incision, diagonal cut in the top 10 ~
15mm, lateral oblique cut out on the 10 ~ 15 mm, to form - a
pedicle at the top, under the narrow width of the tongue on the amount of muscle tissue flap, and its pull is easily pulled up to tarsus, or go further separation, in particular the separation of periosteal surface can form a migration of the frontal muscle flap can be . Further down the
separation of exposed tarsal orbicularis oculi muscle, cut into pre-tarsal orbicularis oculi muscle 1, with the muscle flap with 3-0 silk mattress suture tarsus 3-pin. Observation
of the position and curvature of palpebral margin to the
highest point of double eyelid line mark point flush with the bridge of the nose, curvature and contralateral symmetry. Observed with satisfaction, the skin incision double eyelid operation by suture, coated eye ointment within the conjunctival sac, doing lower lid traction sutures in order to protect the cornea and supporting upper eyelid, 4d remove the stitches. Postoperative pressure bandage daily, continuous 5d, when dressing and povidone iodine wash with corneal incision and observe the situation inside the points conjunctival sac antibiotic eye drops and eye ointment. To give the body to stop bleeding, anti-inflammatory, hormone therapy 5d Across treatment of promoting blood circulation Huayu. Reposted elsewhere in the paper for free download http://
After 2d, 34 Yan cured, improved in 5 eyes. After 7d, cured 37 were followed up for 3 ~ 18mo, ipsilateral palpebral fissure dysraphism 2mo disappeared after the operation, the basic symmetrical eyes, blepharophimosis, ptosis campaign
freely, frontal wrinkles symmetry, eyebrow area skin feels normal, two cases of brow and upper eyelid than the opposite side between the bloated, no other complications, efficiency 100%.
For moderate or severe ptosis patients, levator muscle
function completely disappeared, or muscle strength <5mm cases, simply shorten the levator muscle, to my hospital on past experience, difficult to achieve improvement of function and swarmed up his eyes look symmetrical, and easy to rollback
failed. The amount of functional muscle flap with muscle stretching, muscle fibers strong, brought great strength,
because the amount of muscle flap retained only for the bottom cut off the blood supply and physical function, and thus in line with physiological state, relying on the flexibility of the amount of muscle against the orbicularis muscle and upper eyelid gravity, to achieve the purpose of the levator [3-5].
The traditional frontal muscle flap suspension, in order to facilitate the operation, in doing an additional incision below the eyebrow, postoperative left traces of knife-edge is
not conducive to beauty.
This group of patients in the surgery, cosmetic plastic surgery will be fully integrated only did double eyelid incision site carefully before surgery carried out in the two-
lane design. For the majority of those with moderate ptosis, two-lane can coincide, while for those with severe ptosis, two-lane do not coincide, and thus to quantify the number of skin removed so that surgery is not necessary to repeatedly compared with the healthy side and can be reached after surgery good symmetry effects. Many surgical patients has opened the orbital septum, so that the amount of muscle flap in orbital septum flap to cross the bridge, and then suturing
the tarsal plate. Patients in the cases in this group, will produce a good amount of muscle flap sutured directly to pull down on the tarsal plate, simplifying the surgical procedure and the scope of damage. Postoperative pressure bandage for a
long time and bleeding, anti-inflammatory, hormone therapy,
reduce swelling, hematoma as early as possible to eliminate and reduce scar formation. Summary two cases occurred in children affected side compared with contralateral bloated because children do not cope with postoperative pressure bandage. Failed to eliminate hematoma, until 10d after the swell was significantly reduced, while the other children 5d edema, hematoma disappeared. While the reference to the amount of muscle is vertical upward eyelid , the group frontal
muscle flap suspension surgery for the treatment of moderate to severe ptosis, than in the past by making use of the amount of muscle strength suspension surgery simply because of the emphasis on preoperative incision design, eye-pleasing in
appearance symmetrical, less complications, is currently the best surgical treatment of blepharoptosis.
1 Yin Xiaolong Lu Chun Bao, Peng Xiaowei, Mao Huan-wen, Yu
Qian, Jin-Song Wu, Yang Yang. Under general anesthesia improved the amount of muscle flap suspension surgery for severe congenital blepharoptosis clinical observation. International Ophthalmology, 2004; 4 (5 ) :953-954
2 Shaozhen, Chen Qi, Wu Zhong-yao. Eye surgery study.
Beijing: People's Health Publishing House, 1997
3 Wang Wenhua, Li Long, LI Shuming. The amount of tendon membrane suspension in the treatment of severe blepharoptosis in 8 cases. International Ophthalmology, 2005; 5 (3) :588-589
4 Wu pairs have, Linmao Chang, Mao Yi-Hsing, Wang Li, Tao Lu,
Li Chunlin. Levator aponeurotic flap - the amount of muscle
anastomosis in the treatment of severe ptosis, International Ophthalmology, 2004; 4 (4) :743-745
5 Lei Hsien-wen, Chen Hu, Wang Liang. Conventional frontalis muscle suspension surgery with levator tendon membrane - the
amount of muscle anastomosis in the treatment of severe blepharoptosis clinical analysis. International Ophthalmology, 2005; 5 (5): 1080
6 Song Chen. Eye-forming surgery. Beijing: People's Medical Publishing House, 1996 reposted elsewhere in the paper for free download http://