Head & Neck Plastic and Cosmetic Surgery Center, Beijing Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
J Craniofac Surg. 2023;34(2):580-583. doi: 10.1097/SCS.0000000000008838. Epub 2022 Jul 29.
Lagophthalmos and lid lag is the most common complication after ptosis correction. Great efforts had been made to control it, but little was known about the factors influencing it. So we ran this research to explore the possible mechanisms underlying it. This would be beneficial to solving this problem.
In this cohort study, patients treated with the forked frontalis muscle aponeurosis suspension and levator aponeurosis-Muller's muscle complex resection were identified. Lagophthalmos height and lid lag was measured at the postoperative week 1 visits. The Spearman correlation test was run to test whether lagophthalmos was related to patients' age, levator function, and severity of ptosis. Then we measured the contents of collagen and elastin fibers of frontalis muscle fascia and levator aponeurosis from the patients and levator aponeurosis from cadaver heads histologically and compared the contents in these 3 groups.
No correlation was found between patients' age, levator function, the severity of ptosis, and with lagophthalmos height. However, the contents of collagen and elastic fibers were both higher in the frontalis fascia than in the normal aponeurosis tissues. The difference in collagen fibers content between frontalis muscle fascia and patients' aponeurosis was statistically insignificant.
The severe lagophthalmos and lid lag may be caused by the poor mechanical features of the frontalis muscle. A better source of motive force to elevate the eyelids and a novel sling material with proper elasticity and stiffness would be the solution to improve the lagophthalmos and lid lag after ptosis correction.
上睑下垂矫正术后最常见的并发症是睑裂闭合不全和上睑迟滞。尽管人们已经做了很多努力来控制它，但对于影响它的因素知之甚少。因此，我们进行了这项研究，以探讨其潜在的机制。这将有助于解决这个问题。
在这项队列研究中，我们确定了接受分叉额肌筋膜悬吊和提上睑肌-米勒肌复合体切除术的患者。在术后第 1 周就诊时测量睑裂闭合高度和上睑迟滞。采用 Spearman 相关检验来检验睑裂闭合高度是否与患者年龄、提上睑肌功能和上睑下垂的严重程度相关。然后，我们从患者和尸头的提上睑肌筋膜中测量了胶原和弹性纤维的含量，并将这 3 组的含量进行了比较。
患者年龄、提上睑肌功能、上睑下垂的严重程度与睑裂闭合高度均无相关性。然而，额肌筋膜中的胶原和弹性纤维含量均高于正常的腱膜组织。额肌筋膜中的胶原纤维含量与患者的腱膜组织之间无统计学差异。
严重的睑裂闭合不全和上睑迟滞可能是由于额肌的机械性能较差所致。寻找一种更好的动力源来提上睑，并使用具有适当弹性和硬度的新型悬吊材料，可能是改善上睑下垂矫正术后睑裂闭合不全和上睑迟滞的方法。
