Cruz Antonio A V, Akaishi And Patricia M S
Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
Ophthalmic Plast Reconstr Surg. 2018 Nov/Dec;34(6):510-515. doi: 10.1097/IOP.0000000000001145.
To review the level of standardization of frontalis-orbicularis muscle advancement to correct severe blepharoptosis and the degree of scientific evidence supporting the procedure as a useful modality of blepharoptosis repair.
The authors searched the Medline, Lilacs, and Scopus databases for all articles in English, Spanish, and French that used as keywords the terms "frontalis muscle flap," "orbicularis muscle flap," and "ptosis." Data retrieved included authorship specialty, geographic region where the surgeries were performed, characteristics of the samples reported, type and dimensions of the flaps used, time of follow-up, rate of undercorrection, and complications.
Thirty-eight articles were retrieved and analyzed. Most studies originated from Asian countries, especially China, Taiwan, and Korea. Many variations of the procedure were encountered, including location of incisions and frontalis flap design. There were 23 case series with more than 10 patients. None compared the procedure to conventional frontalis suspension surgery. The samples were not homogeneous, including patients with different type of ptosis, variable degrees of levator function, and using distinct methods of evaluating eyelid position. Undercorrection rates ranged from 1.8% to 38% with a median value of 12.2%. The rate of complications (eyelid crease abnormalities, entropion, hematoma, and supraorbital nerve injury) was low.
The direct frontalis-orbicularis muscle advancement has been judged positively in all reports analyzed. However, the level of standardization of the surgery is low, and the reported series are not homogeneous. Further studies are needed to better evaluate this operation.
回顾额肌-眼轮匝肌前移术矫正重度上睑下垂的标准化水平，以及支持该手术作为上睑下垂修复有效方式的科学证据程度。
作者检索了Medline、Lilacs和Scopus数据库，查找所有英文、西班牙文和法文文章，这些文章将“额肌瓣”“眼轮匝肌瓣”和“上睑下垂”作为关键词。检索到的数据包括作者专业、手术实施的地理区域、所报告样本的特征、所用皮瓣的类型和尺寸、随访时间、矫正不足率及并发症。
检索并分析了38篇文章。大多数研究来自亚洲国家，尤其是中国、台湾和韩国。该手术存在多种变体，包括切口位置和额肌瓣设计。有23个病例系列，患者超过10例。没有研究将该手术与传统额肌悬吊手术进行比较。样本不具有同质性，包括不同类型上睑下垂、提上睑肌功能程度不同以及采用不同眼睑位置评估方法的患者。矫正不足率在1.8%至38%之间，中位数为12.2%。并发症发生率（眼睑皱襞异常、睑内翻、血肿和眶上神经损伤）较低。
在所有分析的报告中，直接额肌-眼轮匝肌前移术均得到了积极评价。然而，该手术的标准化水平较低，且所报告的系列不具有同质性。需要进一步研究以更好地评估该手术。
