Department of Burn and Plastic Surgery, the Fourth Medical Center of PLA General Hospital.
Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Craniofac Surg. 2023 May 1;34(3):e321-e325. doi: 10.1097/SCS.0000000000009255. Epub 2023 Mar 15.
In senile patients with sunken superior sulcus, involutional ptosis, and higher eyelid crease, a single operation to correct depression or ptosis cannot achieve good results. We demonstrated the anatomy of periorbital septum fibers, which may contribute to the levator muscle's volume depletion and dynamic power transmission disorder, and described a procedure for correcting upper-eyelid depression and blepharoptosis in senile patients. The fibrous webs in these patients connected the posterior aspect of the orbicularis and the orbital septum and extended to the orbital fat and levator aponeurosis. These fibers were dissected to release the periorbital septal fibers, and the orbital septal fat flap was transferred to the depressed region. Advancement or plication of the levator aponeurosis was performed in patients with uncorrected blepharoptosis after the procedures described above. The technique was applied to 13 Chinese patients (25 eyes) between May 2021 and April 2022. Postoperative magnetic resonance imaging revealed that the preaponeurotic fat was displaced forward and down to the upper margin of the tarsus, and the curvature of the upper-eyelid depression was significantly improved. Moreover, the superior sulcus deformity improved, the ptosis was corrected, and the uppermost crease decreased in all patients. No recurrence of ptosis or abnormal adhesion was observed. We believe this is the first study using magnetic resonance imaging to evaluate eyelid anatomy and the effects of surgery in this patient group. Releasing periorbital septum fibers is crucial for correcting a portion of the sunken eyelid and ptosis in Asians.
在患有上颌窦凹陷、退行性上睑下垂和高位上睑皱襞的老年患者中，单一手术矫正凹陷或上睑下垂无法获得良好效果。我们展示了眶隔纤维的解剖结构，这可能导致提上睑肌体积耗竭和动力传递障碍，并描述了一种矫正老年患者上睑凹陷和上睑下垂的手术方法。这些患者的纤维网连接眼轮匝肌后缘和眶隔，并延伸至眶脂肪和提上睑肌腱膜。分离这些纤维以释放眶隔纤维，并将眶隔脂肪瓣转移到凹陷区域。在上睑下垂未矫正的患者中，上述手术完成后可进行提上睑肌腱膜的推进或折叠。该技术于 2021 年 5 月至 2022 年 4 月应用于 13 名中国患者（25 只眼）。术后磁共振成像显示，腱膜前脂肪向前向下移位至睑板上缘，上睑凹陷的曲率明显改善。此外，所有患者的上颌窦畸形改善，上睑下垂得到矫正，上睑皱襞最高点降低。未观察到上睑下垂复发或异常粘连。我们认为这是第一项使用磁共振成像评估亚洲人眼脸解剖结构和手术效果的研究。释放眶隔纤维对于矫正亚洲人部分凹陷性上睑下垂至关重要。
