Bach C A, Raphael M, Krastinova D
Unité de chirurgie cranio-orbito-palpébrale, hôpital Foch, 40 rue Worth, Suresnes, France.
Ann Chir Plast Esthet. 2009 Feb;54(1):37-44. doi: 10.1016/j.anplas.2008.05.007. Epub 2008 Oct 19.
Patients with complete facial nerve palsy are at risk of severe eye complications due to corneal exposure. The aim of this study was to highlight the effects of using a gold weight in paralyzed eyelid, and to prove the safety of the levator palpebrae lengthening.
This retrospective study compared the records of 24 patients who received a gold weight of the upper eyelid between 1976 and 2003 with those of 22 patients who benefit from levator palpebrae lengthening between 1997 and 2005. Two endpoints were seen in postoperative: the occurrence of complications related to lagophthalmia secondary to facial palsy, and the occurrence of complications related to surgical technique.
The occurrence of a complication related to the facial palsy is significantly associated with the surgical technique. Patients with gold weight had significantly more complications related to their pathology than others (67% versus 18%, respectively, p=0.001). The occurrence of a surgical complication was significantly associated with the surgical technique. Patients with gold weight have significantly more complications due to surgery than others (83% versus 5%, respectively, p<0.0001).
Our clinical study and statistical comparison of the two surgical techniques for paralysed eyelid clearly show that the oldest is unsatisfactory and that it should be abandoned. Levator palpebrae lengthening improves eye symptoms with a very low morbidity.
完全性面神经麻痹患者因角膜暴露有发生严重眼部并发症的风险。本研究的目的是强调在上睑使用金片的效果，并证明提上睑肌延长术的安全性。
这项回顾性研究比较了1976年至2003年间接受上睑金片植入的24例患者与1997年至2005年间受益于提上睑肌延长术的22例患者的记录。术后观察两个终点：面神经麻痹继发兔眼相关并发症的发生情况，以及与手术技术相关并发症的发生情况。
与面神经麻痹相关并发症的发生与手术技术显著相关。植入金片的患者与其他患者相比，与其病情相关的并发症明显更多（分别为67%和18%，p = 0.001）。手术并发症的发生与手术技术显著相关。植入金片的患者因手术出现的并发症明显多于其他患者（分别为83%和5%，p < 0.0001）。
我们对两种上睑麻痹手术技术的临床研究和统计比较清楚地表明，较古老的技术并不令人满意，应该摒弃。提上睑肌延长术能改善眼部症状，且发病率极低。
