眶隔筋膜瓣与额肌瓣重叠吻合悬吊矫正重度上睑下垂

Correction of severe congenital blepharoptosis by suspension of frontal muscle flap overlapped with orbital septum aponeurosis flap

目的:为更好地保持眼睑的原有结构,符合其生理和生物力学特点,探索一种治疗重度上睑下垂的新方法。方法:术中于眼轮匝肌下分离并显露眶隔筋膜至近眶上缘处,在眶隔表面设计一蒂位于睑板上缘的梯形瓣,按设计线全层切开眶隔,形成眶隔筋膜瓣。在患侧眉上形成一额肌瓣,将两瓣相互重叠缝合固定,上提睑缘至角膜上缘处,起到悬吊上睑、矫正下垂畸形的作用。结果:作者利用该方法对22例26侧重度上睑下垂的眼睑进行了治疗,随访病人17例,19侧眼睑,其中16侧眼睑取得了满意的效果,额肌收缩时患睑睁大两侧眼裂大小对称,可达到正常睑缘的位置。睑缘弧度及重睑外形满意。3侧眼睑矫正不完全,经二次手术修复得以矫正。讨论:作者认为利用眶隔筋膜形成的组织瓣与额肌瓣重叠吻合悬吊缝合,保持了眼睑的原有结构,具有手术损伤轻,上睑悬吊牢固,不易复发,睑缘和重睑线弧度及外观满意,畸形矫正效果良好,优于传统的单纯额肌悬吊术和上睑提肌腱膜瓣悬吊的方法。

Objective To investigate a new method for correction of severe congenital blepharoptosis, Methods Frontal muscle flap and obital septum aponeurosis Flap were formed in the frontal part and upper eyelid, respectively. Two flaps were overlapped and sutured in order to suspend the upper eyelid and to correct severe congenital blepharoptosis, Results 22 cases （26 eyes） with severe congenital blepharoptosis were treated by suspension of frontal muscle flap overlapped with orbital septum aponeurosis flap, 17 cases （19 eyes） were follow-up and analyzed retrospectively after operation, 16 eyes of blepharoptosis were completely corrected and had symmetric double eyelids but 3 eyes of blepharoptosis need to be reconstructed again. No ectropion and other complications were happened. Conclusion It is helpful to get better improvement in the function and reshaping effect we treat serious congenital blepharoptosis by suspension of frontal muscle flap overlapped with orbital septum aponeurosis flap, which have a better cosmetic result than traditional frontal musle flap suspension or levator palpebrae superioris musculoaponeurotic flap-frontalis anastomosis.