Morax S, Baudoin F, Hurbli T
Service d'Ophtalmologie et de Chirurgie Oculo-Plastique, Fondation Ophthalmologique A. de Rothschild, Paris.
Ann Chir Plast Esthet. 1995 Dec;40(6):691-705.
Post-traumatic ptosis may be classified as follows: ptosis occurring during lid avulsion, ptosis associated with fractures of the orbital roof and with foreign bodies, post-contusional ptosis, cicatricial ptosis, neurogenic ptosis and post-surgical ptosis. The patient must be thoroughly examined, including examination of the eye-ball, extra-ocular muscles, eyelid and evaluation of upper eyelid levator function and orbital and facial examination. The various surgical methods proposed include levator muscle surgery, aponeurotic surgery, Müller's muscle surgery and frontalis suspension surgery. Surgical indications and choice of surgical method essentially depend on the anatomo-clinical forms. The general rule is to operate under local anesthesia to obtain better control of the muscular function. Some cases are simple to treat such as post-contusional ptosis with good levator function which allows functional surgery with excellent static and dynamic results. Other relatively simple cases with non functional levators may only be treated on a static basis. Last but not least are more difficult cases in which levator function is difficult to evaluate pre-operatively because of severe fibrosis. The aim in such cases is to explore the eyelid by an anterior approach under local anesthesia and to propose either muscular surgery or a frontalis suspension according to the anatomical and functional status of the levator muscle.
眼睑撕脱时出现的上睑下垂、与眶顶骨折及异物相关的上睑下垂、挫伤后上睑下垂、瘢痕性上睑下垂、神经源性上睑下垂和手术后上睑下垂。必须对患者进行全面检查，包括眼球、眼外肌、眼睑检查以及上睑提肌功能评估和眼眶及面部检查。提出的各种手术方法包括提肌手术、腱膜手术、米勒肌手术和额肌悬吊手术。手术适应证和手术方法的选择主要取决于解剖临床类型。一般原则是在局部麻醉下进行手术，以便更好地控制肌肉功能。有些病例治疗简单，如提肌功能良好的挫伤后上睑下垂，可行功能性手术，静态和动态效果均佳。其他提肌无功能的相对简单病例可能仅能进行静态治疗。最后也是最难的病例是，由于严重纤维化，术前难以评估提肌功能。在此类病例中，目的是在局部麻醉下通过前路探查眼睑，并根据提肌的解剖和功能状态进行肌肉手术或额肌悬吊手术。
