Korteweg Steven F S, Stenekes Martin W, van Zyl Fiona E, Werker Paul M N
Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Plast Reconstr Surg Glob Open. 2014 Jun 6;2(5):e151. doi: 10.1097/GOX.0000000000000084. eCollection 2014 May.
Paralytic ectropion patients suffer from impairment of function and appearance of the lower eyelid and are at high risk of developing an exposure keratitis. A canthoplasty procedure can reduce the horizontal eyelid laxity and elevate the lower eyelid. We used a periosteal flap from the outer orbit to create a new canthal ligament. This study investigates the long-term outcomes of this technique.
Cross-sectional outcome study in which 30 cases of paralytic ectropion are treated with a lateral periosteal flap canthoplasty after adequate eyelid shortening. At the desired canthal height, a periosteal flap from the outer temporal orbital rim is mobilized around the rim and sutured in a double-breasted fashion to a tarsal strip. Effect of the operation is measured by comparing preoperative and postoperative photographs for signs of ectropion. For this purpose, a new photograph-based scoring method [the Ectropion Severity Score (ESS)] was developed and evaluated.
The ESS proved to be reliable and sensitive to the presence of ectropion. Significant improvement of the ectropion sequelae was measured after a mean follow-up period of 2 years. In 3 cases (13%), a revision procedure was necessary because of relapse of lower eyelid sagging after a mean time of 1.9 years. In these cases, the periosteal flap could be reused.
The ESS is a useful instrument to score the severity of paralytic ectropion. The periosteal flap canthoplasty is an effective procedure, with durable results in paralytic ectropion patients. The same periosteal flap can be used in a revision procedure.
麻痹性睑外翻患者存在下睑功能和外观受损的问题，且发生暴露性角膜炎的风险很高。眦成形术可减少睑裂水平方向的松弛并提升下睑。我们采用眶外侧骨膜瓣来重建新的眦韧带。本研究旨在探讨该技术的长期疗效。
进行一项横断面疗效研究，对30例麻痹性睑外翻患者在充分缩短眼睑后采用外侧骨膜瓣眦成形术进行治疗。在理想的眦部高度，将颞侧眶缘的骨膜瓣游离并围绕眶缘，以双排缝合法缝合至睑板条。通过比较术前和术后照片中睑外翻的体征来评估手术效果。为此，开发并评估了一种基于照片的新评分方法[睑外翻严重程度评分（ESS）]。
ESS被证明对睑外翻的存在具有可靠性和敏感性。平均随访2年后，睑外翻后遗症有显著改善。3例（13%）患者在平均1.9年后因下睑下垂复发而需要进行修复手术。在这些病例中，骨膜瓣可再次使用。
ESS是评估麻痹性睑外翻严重程度的有用工具。骨膜瓣眦成形术是一种有效的手术方法，对麻痹性睑外翻患者有持久的疗效。同一骨膜瓣可用于修复手术。
