Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Microsurgery Program, Eastern Virginia Medical School.
Plast Reconstr Surg. 2010 Feb;125(2):629-644. doi: 10.1097/PRS.0b013e3181c91f69.
Surgical planning aims to restore coordinated eyelid function. Although achieving voluntary eye closure is one of the primary goals, it cannot guarantee return of involuntary blink. Restoration of the afferent pathway of the reflex is a prerequisite, but successful coordination of the reflex components and restoration of their time-related function are also required.
A retrospective review of 49 patients who underwent dynamic procedures for blink restoration was performed. The patients were divided into two groups. Group A (n = 42) included patients who underwent nerve transfers: cross-facial nerve grafting and subsequent microcoaptations, mini-hypoglossal nerve transfers, and direct orbicularis oculi neurotization. Group B (n = 14) included patients who underwent eye sphincter substitution techniques: pedicled frontalis, free platysma, mini-temporalis, and a slip of free pectoralis minor transfers. Seven of the patients included in the groups underwent both nerve and muscle transfer procedures. Objective blink ratios were measured according to an established protocol by the senior author (J.K.T.).
Thirty patients were girls and 19 were boys. The age of the patients ranged from 1 to 17 years, with a mean +/- SD age of 7.5 +/- 3.2 years. Denervation time ranged from 76 months to 15.25 years. Blink improvement was noted in all of the patients. Blink scores and ratios were consistently better in group A than in group B.
Dynamic procedures provide the functional potential on which subsequent static procedures can be performed to aid blink return, taking into account the future needs of the still growing patient.
手术规划旨在恢复协调的眼睑功能。虽然实现自愿性闭眼是主要目标之一，但它不能保证恢复非自愿性眨眼。反射传入通路的恢复是前提，但还需要协调反射成分并恢复其时间相关功能。
对 49 例行眨眼恢复动态手术的患者进行回顾性研究。将患者分为两组。A 组（n = 42）包括接受神经转移的患者：面神经交叉移植和随后的微吻合、微型舌下神经转移以及直接眼轮匝肌神经化。B 组（n = 14）包括接受眼括约肌替代技术的患者：带蒂额肌、游离颈阔肌、微型颞肌和游离胸小肌转移。两组中有 7 名患者同时接受了神经和肌肉转移手术。根据资深作者（J.K.T.）制定的协议测量客观眨眼比。
30 名患者为女孩，19 名患者为男孩。患者年龄从 1 岁到 17 岁，平均年龄 +/- SD 为 7.5 +/- 3.2 岁。神经切断时间从 76 个月到 15.25 年不等。所有患者的眨眼均有改善。A 组的眨眼评分和比值均明显优于 B 组。
动态手术提供了功能潜力，随后可以进行静态手术以帮助眨眼恢复，同时考虑到仍在成长的患者的未来需求。
