Whitaker L A
Plast Reconstr Surg. 1984 Nov;74(5):611-9. doi: 10.1097/00006534-198411000-00004.
A method is described for altering the shape and position of the palpebral fissure at the lateral canthus. Three steps are essential to alter shape and position. They are (1) identification of a lateral canthal soft-tissue mass consisting of periosteum, lateral canthal ligament, and orbicularis muscle, (2) extensive subperiosteal soft-tissue mobilization of the lateral canthal soft-tissue mass (LCSTM) from a point just superior to the zygomaticofrontal suture and inferiorly along the infraorbital rim to a point corresponding with a vertical line drawn from the pupil downward, and (3) cutting of all soft tissue, including orbicularis muscle from dermis to bone and from bone to conjunctiva, from the lateral canthal soft-tissue mass medially to a point equal to a vertical line drawn from the pupil downward. After tension-free shifting laterally and superiorly has been accomplished, the lateral canthal soft-tissue mass is fixed into bone with minimal overcorrection. If there is still soft-tissue skin resistance, then overcorrection is desirable. The most difficult judgments in the procedure are the amount of superior and lateral tension to be placed on the palpebral fissure. As an aid in these judgments, the lateral-most extent of the palpebral fissure should be approximately 3 mm above the medial canthus horizontally and 3 to 4 mm medial to the medial-most portion of the lateral orbital rim. If overcorrection occurs, it can be released relatively simply.
描述了一种改变外眦睑裂形状和位置的方法。改变形状和位置有三个关键步骤。它们是：（1）识别由骨膜、外眦韧带和眼轮匝肌组成的外眦软组织块；（2）从颧额缝上方一点开始，沿着眶下缘向下， 将外眦软组织块（LCSTM）广泛地从骨膜下软组织游离至与从瞳孔向下画的垂直线相对应的一点；（3）从外眦软组织块内侧向内侧至与从瞳孔向下画的垂直线相等的一点，切断所有软组织，包括从真皮到骨以及从骨到结膜的眼轮匝肌。在完成无张力地向外上方移位后，将外眦软组织块以最小的过度矫正固定到骨上。如果仍然存在软组织皮肤阻力，则需要过度矫正。该手术中最困难的判断是施加在外眦睑裂上的向上和向外的张力大小。作为这些判断的辅助，睑裂的最外侧范围在水平方向上应比内眦上方约3mm，且在外眶缘最内侧部分内侧3至4mm处。如果发生过度矫正，可以相对简单地进行松解。
