From the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University.
Plast Reconstr Surg. 2023 Nov 1;152(5):885e-894e. doi: 10.1097/PRS.0000000000010368. Epub 2023 Mar 7.
The conventional frontalis muscle advancement technique still has some disadvantages, such as residual lagophthalmos, eyebrow ptosis, eyelid contour abnormality, and undercorrection. This article describes the authors' extended frontalis muscle advancement technique, which takes extensive subcutaneous separation through the eyelid crease incision for the treatment of severe congenital blepharoptosis.
A retrospective review was performed that included patients with severe congenital ptosis who underwent extended frontalis muscle advancement technique from April of 2019 to April of 2021. Preoperative evaluation included age, sex, and margin reflex distance 1, levator function, and lagophthalmos. Postoperative evaluation including correction result, closure function of eyelid, and cosmetic result was performed at the last follow-up.
From April of 2019 to April of 2021, a total of 102 patients (137 eyes) who underwent extended frontalis muscle advancement technique were included in the study. The mean postoperative margin reflex distance 1 in unilateral and bilateral ptosis patients was 3.84 ± 0.60 mm and 3.86 ± 0.56, respectively, and 126 eyes (92.0%) showed successful correction. Postoperatively, the mean residual lagophthalmos was 0.88 ± 1.40 mm, and 127 eyes (92.7%) showed excellent or good eyelid closure function. The average score of cosmetic results was 8.29 ± 1.34, and 94 patients (92.2%) had an excellent or good cosmetic result.
Extensive subcutaneous separation relieves the mutual restriction between the forehead skin and frontalis muscle. The extended frontalis muscle advancement technique is effective in correcting severe congenital ptosis, and minimizes undercorrection, residual lagophthalmos, eyelid contour abnormality, and eyebrow ptosis.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
传统的额肌前徙术仍存在一些缺点，如残余上睑下垂、眉下垂、睑缘轮廓异常和矫正不足。本文描述了作者采用的广泛额肌前徙术，该术式通过经睑缘切口进行广泛的皮下分离，用于治疗重度先天性上睑下垂。
回顾性分析 2019 年 4 月至 2021 年 4 月期间接受广泛额肌前徙术治疗的重度先天性上睑下垂患者。术前评估包括年龄、性别、MRD1、提上睑肌功能和瞬目不全。末次随访时进行术后评估，包括矫正结果、眼睑闭合功能和美容效果。
2019 年 4 月至 2021 年 4 月，共 102 例（137 只眼）患者接受广泛额肌前徙术。单侧和双侧上睑下垂患者术后平均 MRD1 分别为 3.84±0.60mm 和 3.86±0.56mm，126 只眼（92.0%）获得成功矫正。术后平均残余瞬目不全为 0.88±1.40mm，127 只眼（92.7%）眼睑闭合功能良好。美容效果平均评分为 8.29±1.34，94 例（92.2%）患者获得良好或极好的美容效果。
广泛的皮下分离可解除额部皮肤与额肌之间的相互制约。广泛额肌前徙术可有效矫正重度先天性上睑下垂，且可减少矫正不足、残余上睑下垂、睑缘轮廓异常和眉下垂。
临床问题/证据水平：治疗，IV。
