Friedhofer Henri, Coltro Pedro Soler, Vassiliadis Aneta Hionia, Nigro Marcelus Vinícius, Saito Fábio Lopes, Moura Tatiana, Faria José Carlos, Ferreira Marcus Castro
Division of Plastic Surgery, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Ann Plast Surg. 2013 Aug;71(2):135-9. doi: 10.1097/SAP.0b013e318248b87c.
This study aims to analyze the use of autogenic auricular cartilage grafts as weight for the upper eyelid in conjunction with lateral canthopexy for patients with mild paralytic lagophthalmos. This procedure was also accompanied by elevation of the lower eyelid using the cartilage graft for moderate cases.
We conducted a retrospective study including case series of 30 patients with paralytic lagophthalmos from 1997 to 2010. For mild cases, cartilage from the auricular scapha was placed in pretarsal space of the upper eyelid and cartilage from the concha was inserted in preaponeurotic space and then sutured to the levator aponeurosis in conjunction with lateral canthopexy. For moderate cases, lower eyelid was also elevated by suturing cartilage graft to tarsum and resting it by the inferior orbital rim.
All patients had some degree of keratopathy before the intervention. After treatment, they presented with evident clinical improvement, reduction of eye symptoms, and resolution of keratopathy. During the mean postoperative follow-up of 37.3 months, none of the patients presented with cartilage graft exposition, reabsorption, visibility, infection, or warping. Complete eye closure was achieved in 24 (80%) patients, whereas the remaining 6 (20%) patients had residual asymptomatic lagophthalmos.
The intervention using autogenic auricular cartilage grafts explained in this study was only effective for the treatment of mild and moderate cases of paralytic lagophthalmos. This outpatient surgery is associated with low morbidity and achievement of functional and aesthetic improvement.
本研究旨在分析自体耳廓软骨移植作为上睑重物联合外眦固定术治疗轻度麻痹性兔眼症患者的效果。对于中度病例，该手术还包括使用软骨移植抬高下睑。
我们进行了一项回顾性研究，纳入了1997年至2010年30例麻痹性兔眼症患者的病例系列。对于轻度病例，将来自耳廓舟状窝的软骨置于上睑睑板前间隙，将来自耳甲的软骨插入腱膜前间隙，然后与外眦固定术一起缝合至提上睑肌腱膜。对于中度病例，还通过将软骨移植缝合至睑板并使其靠在下眶缘上来抬高下睑。
所有患者在干预前均有一定程度的角膜病变。治疗后，他们的临床症状明显改善，眼部症状减轻，角膜病变消退。在平均37.3个月的术后随访期间，没有患者出现软骨移植暴露、吸收、可见、感染或扭曲。24例（80%）患者实现了完全闭眼，而其余6例（20%）患者有残留的无症状兔眼症。
本研究中所阐述的使用自体耳廓软骨移植的干预措施仅对轻度和中度麻痹性兔眼症病例有效。这种门诊手术的发病率低，且能实现功能和美观的改善。
