Nassif P S, Kokoska M S, Homan S, Cooper M H, Thomas J R
Department of Otolaryngology-Head and Neck Surgery, St Louis University School of Medicine, MO, USA.
Arch Otolaryngol Head Neck Surg. 1998 Nov;124(11):1209-15. doi: 10.1001/archotol.124.11.1209.
To compare eyebrow and forehead elevation and tension among the following 3 surgical techniques: subperiosteal dissection to the supraorbital rim, subperiosteal dissection with release (elevation, incision, and spread) of periosteum at the supraorbital rim, and subgaleal dissection to the supraorbital rim, and to determine the optimal method of elevation in an aesthetically accepted range for the endoscopic forehead lift.
A randomized, self-controlled study using an open approach to the forehead in cadaver heads. Each half of head was compared with the other in the following 2 study groups: subperiosteal dissection without release vs subperiosteal dissection with release of periosteum (group 1) and subperiosteal dissection with release of periosteum vs subgaleal dissection.
Anatomy laboratory at a university medical center.
Eight cadaver heads fixed with ethylene glycol in each group.
Predissection distances in millimeters from fixed anatomic landmarks were measured. The forehead flaps were elevated using a coronal incision and divided with a midline incision for side-to-side comparison. Cadaver heads and side of surgical intervention were selected randomly. The flap tensions associated with incremental flap advancement of 0.5 and 1.0 cm were measured. Traction of 2.2 kg was then applied to each flap, and distances between the fixed landmarks were measured.
Mean predissection and postdissection distance of brow and forehead elevation for each dissection type and mean distance and median tension of brow and forehead elevation within each group.
The mean postdissection brow measurements at rest were significantly greater than the mean predissection measurements at most landmarks in all dissections for both groups (P<.05). The mean postdissection brow and forehead measurements with 2.2 kg of traction were significantly greater than the mean predissection measurements at all landmarks in all dissections for both groups (P<.05). The mean increase in distance from predissection to postdissection (at rest and with 2.2 kg of traction) did not significantly differ between the different dissection types (P>.05). For group 1, the median flap tension for subperiosteal dissection without release was greater than that for subperiosteal dissection with release (P>.05). For group 2, subperiosteal dissection with release had greater median flap tension than subgaleal dissection (P>.05).
All 3 methods of dissection significantly elevated the brow at rest for most landmarks. All 3 methods of dissection significantly elevated the brow and forehead when traction was applied to the flap. Brow and forehead elevation at rest and with 2.2 kg of traction did not significantly differ between the dissections. Subgaleal dissection was associated with less flap tension compared with the subperiosteal dissection with or without release. The data support the use of all 3 methods of forehead dissection for brow elevation and subgaleal forehead dissection as the optimal approach for the forehead lift, whether performed endoscopically or open.
比较以下三种手术技术中眉部和额部的抬高程度及张力：骨膜下剥离至眶上缘、骨膜下剥离并在眶上缘松解（抬高、切开和展开）骨膜、帽状腱膜下剥离至眶上缘，并确定在内镜下额部提升术中在美学可接受范围内的最佳抬高方法。
在尸体头部采用开放性额部手术的随机、自身对照研究。在以下两个研究组中，将头部的每一半与另一半进行比较：无松解的骨膜下剥离与骨膜松解的骨膜下剥离（第1组）以及骨膜松解的骨膜下剥离与帽状腱膜下剥离。
大学医学中心的解剖实验室。
每组8个用乙二醇固定的尸体头部。
测量距固定解剖标志的术前距离（以毫米为单位）。使用冠状切口提起额部皮瓣，并通过中线切口进行分割以进行左右对比。随机选择尸体头部和手术干预侧。测量皮瓣推进0.5厘米和1.0厘米时的皮瓣张力。然后对每个皮瓣施加2.2千克的牵引力，并测量固定标志之间的距离。
每种剥离类型的眉部和额部抬高的平均术前和术后距离，以及每组内眉部和额部抬高的平均距离和中位张力。
在两组的所有剥离术中，大多数标志点处，静息状态下的平均术后眉部测量值均显著大于平均术前测量值（P<0.05）。在两组的所有剥离术中，施加2.2千克牵引力时的平均术后眉部和额部测量值均显著大于所有标志点处的平均术前测量值（P<0.05）。不同剥离类型之间，术前到术后（静息状态和施加2.2千克牵引力时）的平均距离增加无显著差异（P>0.05）。对于第1组，无松解的骨膜下剥离的中位皮瓣张力大于松解的骨膜下剥离（P>0.05）。对于第2组，松解的骨膜下剥离的中位皮瓣张力大于帽状腱膜下剥离（P>0.05）。
所有三种剥离方法在大多数标志点处均能使静息状态下的眉部显著抬高。当对皮瓣施加牵引力时，所有三种剥离方法均能使眉部和额部显著抬高。静息状态下以及施加2.2千克牵引力时，不同剥离方法之间的眉部和额部抬高无显著差异。与有或无松解的骨膜下剥离相比，帽状腱膜下剥离的皮瓣张力较小。这些数据支持使用所有三种额部剥离方法进行眉部抬高，以及帽状腱膜下额部剥离作为额部提升的最佳方法，无论采用内镜还是开放手术。
