Hönig Johannes Franz, Frank Michael Hasse, Knutti Daniel, de La Fuente Antonio
University Hospital and Medical School of Goettingen, Germany.
J Craniofac Surg. 2008 Jul;19(4):1140-7. doi: 10.1097/SCS.0b013e3181764b19.
To improve brow ptosis and forehead rhytids, minimal invasive surgery has successfully been applied more recently. Clinical studies have revealed that inadequate fixation for anchoring a transposed released soft tissue will result in a loss of suspension of the lateral eyebrow. Therefore, we evaluated the results of eyebrow position in a series of endoscopic-assisted eyebrow lift cases by comparing broad base of fixation with an Endotine device versus conventional single-point tissue fixation with suture loop fixation of the soft forehead tissue. Between 2003 and 2005, 47 patients (12 males and 35 females, age 38.5 +/- 6.2 years)) underwent eyebrow lift and a forehead plasty. In one group, which consists of 25 patients (6 males and 19 females, age 36.5 +/- 5.1 years), soft tissue fixation of the elevated forehead was performed conventionally with one suture loop on each side that passed through the galea-periosteum and anchored to the cranial bone (bone tunnels). In the other group of 22 patients (4 males and 18 females, age 39.3 +/- 6.4 years), the elevated forehead was anchored to Endotine 3.5 version. Despite the fact that 6 months after surgery, drooping of the lateral brow position was observed, with a mean of 2.3 +/- 0.8 mm, in the overall cases 12 months after surgery, differences in the position of medial third of the eyebrow were noted between these groups. In the Endotine group, the medial third of the eyebrow portion stayed more stable at its transposed position and was in mean 1.5 +/- 0.6 mm higher compared with the suture soft-fixed group. The results confirmed that Endotine enhances soft tissue suspension by allowing better distribution of tension over multiple points over time and thereby supports re-adherence strength of the transpose medial flap forehead to the frontal bone. For minimizing a relapse of the elevated lateral eyebrow portion after adequate dissection and tissue release, suspension of the lateral soft forehead tissue is paramount. It should be located between the temporoparietalis fascia and the deep temporal fascia, with extensive tension after resection of temporal fascia window additionally supported by reabsorbable threads or gore tex sutures.
为改善眉下垂和前额皱纹，近年来微创外科手术已成功应用。临床研究表明，用于固定移位松解软组织的固定不充分会导致外侧眉悬吊丧失。因此，我们通过比较使用Endotine装置的宽基底固定与前额软组织缝线环固定的传统单点组织固定，评估了一系列内镜辅助提眉病例中的眉位结果。2003年至2005年期间，47例患者（12例男性和35例女性，年龄38.5±6.2岁）接受了提眉和前额整形手术。一组由25例患者（6例男性和19例女性，年龄36.5±5.1岁）组成，常规采用双侧各一个缝线环进行前额软组织固定，缝线环穿过帽状腱膜-骨膜并固定于颅骨（骨隧道）。另一组22例患者（4例男性和18例女性，年龄39.3±6.4岁），将抬高的前额固定于Endotine 3.5版本。尽管术后6个月时观察到外侧眉位下垂，平均为2.3±0.8mm，但在术后12个月时，两组间眉内侧三分之一位置存在差异。在Endotine组中，眉内侧三分之一部分在移位位置保持更稳定，与缝线软固定组相比平均高出1.5±0.6mm。结果证实，Endotine通过使张力随时间在多个点上更好地分布来增强软组织悬吊，从而支持移位的前额内侧皮瓣与额骨的重新粘连强度。为使充分解剖和组织松解后抬高的外侧眉部分复发最小化，前额外侧软组织的悬吊至关重要。它应位于颞顶筋膜和颞深筋膜之间，颞筋膜窗切除后产生的广泛张力可通过可吸收线或戈尔特斯缝线进一步支撑。
