From the Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine; and Area88 Plastic Surgery Clinic.
Plast Reconstr Surg. 2019 Apr;143(4):829e-839e. doi: 10.1097/PRS.0000000000005477.
Restoration of paralytic lower eyelid retraction is challenging in the surgical management of facial paralysis. In this study, quantitative measurements were compared between the suspension sling and lower eyelid-supporting midcheek lift techniques.
From 2014 to 2016, 36 operations were performed on 28 patients with a mean age of 45.6 years (range, 7 to 80 years), a mean denervation time of 13.5 years (range, 0.2 to 44 years), and a mean follow-up period of 636 days (range, 261 to 1143 days). The surgical techniques included autologous tendon sling (n = 9), Mitek suspension (n = 12), and midcheek lift (n = 15). The distance from the pupil center to the lower eyelid margin was measured, and the ratio of the distance on the paralyzed side to that on the normal side was analyzed.
The change in the ratio between the paralyzed side and the normal side was 0.098 (from 1.264 to 1.166; p = 0.353) in the autologous tendon sling group, 0.104 (from 1.231 to 1.127; p = 0.243) in the Mitek suspension group (p = 0.05), and 0.179 (from 1.234 to 1.055; p = 0.038) in the midcheek lift group. Two patients in the Mitek suspension group developed foreign body infection.
The midcheek lift group showed the greatest change in the ratio between the distance from the pupil center to the eyelid margin on the paralyzed side and that on the normal side. Eyelid-supporting midcheek lift is superior to suspension sling for restoration of paralytic eyelid retraction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在面瘫的外科治疗中，瘫痪性下眼睑回缩的修复具有挑战性。在这项研究中，我们比较了悬吊吊带和下眼睑支撑中脸提升技术之间的定量测量值。
2014 年至 2016 年，对 28 例平均年龄为 45.6 岁（范围 7 至 80 岁）、平均失神经时间为 13.5 年（范围 0.2 至 44 年）和平均随访时间为 636 天（范围 261 至 1143 天）的患者进行了 36 次手术。手术技术包括自体肌腱吊带（n = 9）、Mitek 悬吊（n = 12）和中脸提升（n = 15）。测量瞳孔中心至下眼睑边缘的距离，并分析患侧与健侧距离的比值。
自体肌腱吊带组患侧与健侧比值的变化为 0.098（从 1.264 变为 1.166；p = 0.353），Mitek 悬吊组为 0.104（从 1.231 变为 1.127；p = 0.243）（p = 0.05），中脸提升组为 0.179（从 1.234 变为 1.055；p = 0.038）。Mitek 悬吊组有 2 例患者发生异物感染。
中脸提升组患侧与健侧眼睑缘至瞳孔中心距离比值的变化最大。中脸提升在修复瘫痪性眼睑回缩方面优于悬吊吊带。
临床问题/证据水平：治疗，III 级。
