Spadaro Jane Z, Patel Nikita, Kahana Alon
Ophthalmology, Kahana Oculoplastic and Orbital Surgery, Livonia, Michigan, USA.
Department of Ophthalmology, Beaumont Eye Institute, William Beaumont Hospital, Royal Oak, Michigan, USA.
Orbit. 2025 Jun;44(3):306-313. doi: 10.1080/01676830.2024.2381240. Epub 2024 Jul 29.
Assessment of the frontalis muscle flap eyelid reanimation surgical technique for adults with severe ptosis and apraxia of eyelid opening.
A retrospective case series of 30 eyes with severe ptosis or apraxia of eyelid opening. Outcomes were assessed for margin to reflex distance 1 (MRD1), lagophthalmos, complications, and need for subsequent surgical intervention. A paired t-test was used to compare preoperative and postoperative scores of a quality-of-life questionnaire.
Thirty eyes of 19 patients underwent surgery, 16 (53%) with combined frontalis + levator-Muller muscle flap and 14 (46%) with frontalis muscle flap alone. There were 14 female and 5 male patients, with an average age of 55 years (range, 18-76). Mean preoperative MRD1 was -0.6 mm (range, -5 to 2) with mean levator excursion of 7.1 mm. Seventeen eyes had a myogenic etiology, five had a paralytic etiology, six had blepharospasm with apraxia of lid opening, and two had a neurodegenerative etiology. Nineteen eyes (63%) had previously undergone ptosis repair. Mean postoperative MRD1 was 2.5 mm (range, 0.5 to 5) at mean follow-up of 63.3 days. There were no serious surgical complications; minor complications included ocular surface keratopathy and one patient who required surgical revision. Results of the QOL questionnaire indicated significant improvement in vision-related symptoms postoperatively ( = 0.02).
Use of the frontalis muscle flap eyelid reanimation technique, with or without a levator-Muller retractor muscle flap, was very effective in this case series and provided good upper eyelid position with acceptable corneal protection and high patient satisfaction.
评估额肌瓣眼睑重建手术技术在患有严重上睑下垂和眼睑开合失用症的成人中的应用。
对30例患有严重上睑下垂或眼睑开合失用症的患者进行回顾性病例系列研究。评估指标包括缘-反射距离1（MRD1）、兔眼、并发症以及后续手术干预的必要性。采用配对t检验比较术前和术后生活质量问卷得分。
19例患者的30只眼接受了手术，其中16只眼（53%）采用额肌联合提上睑肌-米勒肌瓣，14只眼（46%）仅采用额肌瓣。患者中女性14例，男性5例，平均年龄55岁（范围18 - 76岁）。术前平均MRD1为 -0.6毫米（范围 -5至2），平均提上睑肌活动度为7.1毫米。17只眼病因是肌源性，5只眼是麻痹性病因，6只眼是伴有眼睑开合失用症的眼睑痉挛，2只眼是神经退行性病因。19只眼（63%）之前接受过上睑下垂修复术。平均随访63.3天时，术后平均MRD1为2.5毫米（范围0.5至5）。无严重手术并发症；轻微并发症包括眼表角膜病变和1例需要手术翻修的患者。生活质量问卷结果显示术后视力相关症状有显著改善（P = 0.02）。
在本病例系列中，无论是否联合提上睑肌-米勒肌瓣使用额肌瓣眼睑重建技术都非常有效，能提供良好上睑位置，角膜保护可接受，患者满意度高。
