Postgraduate Program in Physiopathology and Surgical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro-RJ, Brazil.
Postgraduate Program in Oculoplastic Surgery, State University of Rio de Janeiro, State University of Rio de Janeiro (UERJ), Rio de Janeiro-RJ, Brazil.
Aesthet Surg J. 2023 Jan 9;43(1):13-23. doi: 10.1093/asj/sjac181.
Paralytic lagophthalmos can have devastating consequences for vision if left untreated. Several surgical techniques have been described, including the utilization of alloplastic and autologous materials.
The authors sought to evaluate the effectiveness of the surgical treatment of paralytic lagophthalmos with combined techniques employing autologous material and involving the upper and lower eyelids.
Patients with paralytic lagophthalmos underwent stretching of the levator aponeurosis with interposition of conchal cartilage in the upper eyelid associated with sectioning of the orbitomalar ligament and lateral canthoplasty in the lower eyelid. The effectiveness of the technique was evaluated employing subjective (symptomatology) and objective parameters (ophthalmologic evaluation and measurements of lagophthalmos and marginal reflex distances 1 and 2).
Eight patients with paralytic lagophthalmos were subjected to the proposed technique. In the postoperative period, 85.7% reported complete improvement of symptoms and 62.5% presented a normal eye examination. The mean lagophthalmos measurement was reduced by 5.93 mm, the mean marginal reflex distance 2 was reduced by 2.61 mm, and the mean marginal reflex distance 1 was reduced by 0.69 mm.
The technique presented herein, employing autologous material associated with sectioning of the orbitomalar ligament and lateral canthoplasty, was effective in the treatment of paralytic lagophthalmos and did not present significant complications, such as extrusion.
如果不加以治疗，麻痹性睑裂闭合不全可能会对视力造成严重后果。已经描述了几种手术技术，包括使用异体和自体材料。
作者旨在评估采用联合技术治疗麻痹性睑裂闭合不全的效果，该技术使用自体材料，涉及上、下眼睑。
患有麻痹性睑裂闭合不全的患者接受了上睑提肌腱膜延长术，同时使用耳软骨进行了鼻中隔软骨的置入，还进行了眶颧韧带切断术和下睑外侧切开术。通过主观（症状）和客观参数（眼科评估和睑裂闭合不全及边缘反射距离 1 和 2 的测量）来评估该技术的效果。
8 例麻痹性睑裂闭合不全患者接受了该技术治疗。术后，85.7%的患者报告症状完全改善，62.5%的患者眼部检查正常。睑裂闭合不全的平均测量值减少了 5.93mm，平均边缘反射距离 2 减少了 2.61mm，平均边缘反射距离 1 减少了 0.69mm。
本文介绍的采用自体材料联合眶颧韧带切断术和下睑外侧切开术的技术，治疗麻痹性睑裂闭合不全的效果较好，且未出现明显并发症，如脱出。
