Bhiromekraibhak Keerapat
Plastic and Reconstructive Division, Department of Surgery, Faculty of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand.
J Med Assoc Thai. 2010 Feb;93 Suppl 2:S15-20.
The treatment of blepharoptosis depends on the degree of ptosis and the function of the levator muscle. In cases of severe blepharoptosis, however, the levator muscle is essentially nonfunctional, thus frontal sling procedure, a static correction method, is usually performed. Recently the orbicularis oculi flap has become popular but lagopthalmos is still a bothersome problem. A new technique has been introduced in order to reduce the lagopthalmos.
Our technique is modified from a technique using double breast frontalis-orbicularis oculi muscle flap. The technique enhances mobility and amount of the pretarsal orbicularis oculi muscle and is devoid of vertical cutting of the flap and orbital septum involvement.
The technique was performed in 8 patients (12 lids) between 2007 and 2008. All patients were congenital and had severe ptosis. All of them were able to close their eyelids completely by 2 weeks. There was no complication in the series.
This novel technique yields an excellent result in cases of severe blepharoptosis. The technique is superior to the technique using frontalis muscle flap because there is only one incision, no forehead depression and no neurovascular injury. In addition, this technique also reduced period of lagopthalmos compared with the original technique.
上睑下垂的治疗取决于上睑下垂的程度和提上睑肌的功能。然而,在严重上睑下垂的病例中,提上睑肌基本无功能,因此通常采用额肌悬吊术这种静态矫正方法。近来,眼轮匝肌瓣已开始流行,但睑裂闭合不全仍是一个棘手的问题。为了减少睑裂闭合不全,一种新技术被引入。
我们的技术是对使用双侧额肌 - 眼轮匝肌瓣技术的改良。该技术增强了睑板前眼轮匝肌的活动度和数量,且无需垂直切开皮瓣和累及眶隔。
2007年至2008年间,对8例患者(12只眼睑)实施了该技术。所有患者均为先天性且患有严重上睑下垂。所有患者在2周内均能完全闭合眼睑。该系列病例无并发症发生。
这种新技术在严重上睑下垂病例中取得了优异的效果。该技术优于使用额肌瓣的技术,因为它只有一个切口,无额部凹陷且无神经血管损伤。此外,与原技术相比,该技术还缩短了睑裂闭合不全的时间。