DiFrancesco Lisa M, Anjema Christopher M, Codner Mark A, McCord Clinton D, English Jeffrey
Paces Plastic Surgery, Atlanta, GA 30327, USA.
Plast Reconstr Surg. 2005 Aug;116(2):632-9. doi: 10.1097/01.prs.0000173446.21513.47.
The purpose of this study was to evaluate the innervation and function of the orbicularis oculi area clinically, with video imaging, and electrically, with electromyography, before and after lower-eyelid blepharoplasty using a conventional subciliary incision.
Nine patients (18 eyes) were studied before and 4 to 12 weeks after lower-eyelid blepharoplasty. Video imaging documented clinical changes in involuntary (blink) and voluntary (squeeze and squint) eyelid function as well as resting lid position and tone. Electromyography was performed using concentric needle electrodes (25 mm in length, 0.03 mm in diameter) placed in the lateral and medial subciliary orbicularis oculi. A total of 36 sites in nine patients (four sites per patient) were studied. Acute denervation was identified by the presence of fasciculation; fibrillation potentials; insertional activity; sharp waves; and grade based on standard electromyography techniques. All patients underwent lower-eyelid blepharoplasty with a subciliary incision, skin-muscle flap and canthal anchoring with canthopexy or cantholysis, and canthoplasty.
Video imaging of the lower eyelid before and after blepharoplasty showed evidence of eyelid malposition or abnormal voluntary or involuntary orbicularis oculi muscle function. There was no evidence of acute denervation in 34 of 36 sites (94 percent). Two patients had abnormal fasciculation in the left lateral position on two of 36 sites (6 percent). Thirty-three weeks postoperatively, one patient was retested and a normal electromyography result was obtained.
This study demonstrated that lower-lid malposition or abnormal function after lower-lid blepharoplasty cannot be explained by denervation of the zygomatic branch of the facial nerve. Any acute or residual denervation seen in the subciliary orbicularis is not clinically significant. The importance of lower-lid support and canthal anchoring cannot be emphasized enough in preventing lower-lid malposition. Blepharoplasty is a challenging procedure that requires careful preoperative planning, intraoperative reassessment, and meticulous surgical technique to optimize facial rejuvenation and patient safety.
本研究旨在通过视频成像和肌电图，在使用传统睫毛下切口进行下睑成形术前后，对眼轮匝肌区域的神经支配和功能进行临床评估。
对9例患者（18只眼）在进行下睑成形术前以及术后4至12周进行研究。视频成像记录了非自主（眨眼）和自主（挤压和眯眼）眼睑功能以及静息眼睑位置和张力的临床变化。使用同心针电极（长度25mm，直径0.03mm）置于睫毛下眼轮匝肌的外侧和内侧进行肌电图检查。对9例患者共36个部位（每位患者4个部位）进行了研究。根据标准肌电图技术，通过观察是否存在肌束震颤、纤颤电位、插入活动、锐波以及分级来确定急性去神经支配。所有患者均采用睫毛下切口、皮肤肌肉瓣以及通过眦固定术或眦松解术和眦成形术进行眦部固定来进行下睑成形术。
下睑成形术前后的下睑视频成像显示有眼睑位置异常或眼轮匝肌自主或非自主功能异常的证据。36个部位中的34个（94%）没有急性去神经支配的证据。2例患者在36个部位中的2个左侧部位出现异常肌束震颤（6%）。术后33周，对1例患者进行重新检测，获得了正常的肌电图结果。
本研究表明，下睑成形术后下睑位置异常或功能异常不能用面神经颧支去神经支配来解释。在睫毛下眼轮匝肌中观察到的任何急性或残留去神经支配在临床上均无显著意义。在预防下睑位置异常方面，下睑支撑和眦部固定的重要性再怎么强调也不为过。睑成形术是一项具有挑战性的手术，需要仔细的术前规划、术中重新评估以及精细的手术技巧，以优化面部年轻化效果和患者安全性。
