Watanabe Akihide, Katori Nobutada, Selva Dinesh, Hayashi Kengo, Kinoshita Shigeru
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Oculoplastic and Orbital Surgery, Seirei Hamamatsu Hospital, Shizuoka, Japan.
J Plast Reconstr Aesthet Surg. 2015 Jul;68(7):902-6. doi: 10.1016/j.bjps.2015.03.019. Epub 2015 Mar 23.
To evaluate the outcomes of a modified auricular cartilage sling for paralytic ectropion.
We treated 17 eyelids of 17 patients (average 67 years old) with an auricular cartilage sling between 2004 and 2012. All patients had paralytic ectropion with lower eyelid ptosis. Cartilage was harvested via an incision just inside the anterior rim of the helix. Skin incisions were made at the subciliary, medial and lateral canthal regions. The auricular cartilage graft was sutured to the medial canthal tendon medially, lateral orbital rim laterally, inferior tarsus superiorly, and lower eyelid retractors inferiorly. Average follow-up period was 40 months (range 16-60 months).
The median L-MRD (mm) was improved from 8.4 preoperatively (interquartile range 7.5-8.9) to 5.2 postoperatively (4.8-5.3). The median lagophthalmos (mm) was improved from 5.8 preoperatively (4.7-7.0) to 2.2 postoperatively (1.6-2.6). 16 patients had corneal exposure preoperatively and this resolved completely in 12 patients. All patients experienced good anatomical and functional results with relief of their preoperative pain/discomfort symptoms without complications. No patients required reoperation and none experienced infection, exposure of the cartilage graft, or recurrence of lower eyelid malpositions. Postoperatively, all lower eyelids moved downward with down-gaze. The auricular scar left no significant cosmetic deformity.
The modified auricular cartilage sling with 4 point fixation for paralytic ectropion appears to maintain normal eyelid mobility with down-gaze and avoids the problem of lower eyelid fixation.
评估改良耳廓软骨悬吊术治疗麻痹性睑外翻的效果。
2004年至2012年期间，我们对17例患者（平均年龄67岁）的17只眼睑采用耳廓软骨悬吊术进行治疗。所有患者均患有麻痹性睑外翻并伴有下睑下垂。通过在耳轮前缘内侧的切口获取软骨。在睑缘下、内眦和外眦区域做皮肤切口。将耳廓软骨移植物内侧缝合至内眦腱，外侧缝合至眶外侧缘，上方缝合至上睑板，下方缝合至下睑缩肌。平均随访期为40个月（范围16 - 60个月）。
L - MRD（毫米）中位数从术前的8.4（四分位间距7.5 - 8.9）改善至术后的5.2（4.8 - 5.3）。睑裂闭合不全（毫米）中位数从术前的5.8（4.7 - 7.0）改善至术后的2.2（1.6 - 2.6）。16例患者术前有角膜暴露，其中12例完全缓解。所有患者均获得良好的解剖和功能结果，术前的疼痛/不适症状得到缓解，且无并发症。无患者需要再次手术，也没有患者发生感染、软骨移植物暴露或下睑错位复发。术后，所有下睑在向下注视时向下移动。耳廓瘢痕未造成明显的美容畸形。
改良的四点固定耳廓软骨悬吊术治疗麻痹性睑外翻似乎能在向下注视时保持正常的眼睑活动度，并避免下睑固定的问题。
