经结膜入路眶隔脂肪瓣内外固定在矫正泪沟以及面中部凹陷的临床应用

Clinical application of orbital septal fat flap internal and external fixation via conjunctival approach in the correction of lacrimal groove and mid facial depression

目的 探讨扩展下睑成形术解决泪沟畸形及面中部老化的远期临床效果。方法 选取2023年1月至2024年1月商丘华美医疗美容医院收治的52例泪沟畸形患者,采用经结膜入路眶隔脂肪瓣内外固定的方式治疗,通过睑板下1 mm的位置切开结膜,在眼轮匝肌下进入眶隔前间隙,在弓状缘水平,依次分离松解眼轮匝肌支持韧带、泪沟韧带以及眼轮匝肌部分起源,在提上唇肌表面进入上颌前间隙,然后打开眶隔脂肪,将内中侧脂肪修剪成长约2 cm长条脂肪瓣,脂肪瓣中段固定于弓状缘,远端通过上颌间隙外固定在皮肤侧。结果 52例患者术后均顺利恢复,外侧固定的线结7 d拆线,术后无患者发生感染,结膜切口愈合良好,随访6个月,全部患者对治疗效果满意。结论 经结膜入路眶隔脂肪瓣内外联合固定的手术方法可以实现下睑年轻化的临床效果。

Objective To explore the long-term clinical effect of extended lower eyelid plasty in the treatment of lacrimal groove deformity and mid cheek aging.Methods A total of patients with lacrimal groove deformity admitted to Shangqiu Huamei Medical Beauty Hospital from January 2023 to January 2024 were selected.They were treated by internal and external fixation of orbital septal fat flap via conjunctival approach.The conjunctiva was cut 1 mm below the tarsal plate,and entered the pre orbital septal space under the orbicularis oculi muscle.At the level of the arcuate margin,the proper ligament of the orbicularis oculi muscle,the lacrimal ligament,and part of the origin of the orbicularis oculi muscle were separated and released in turn,and entered the pre maxillary space on the surface of the levator labii muscle.Then,the orbital septal fat was opened,and the inner and middle fat was trimmed to a 2 cm long strip of fat flap.The middle part of the fat flap was fixed at the arcuate margin,and the distal part passed through the fixed on the skin side.Results All the patients recovered smoothly after operation,and the lateral fixed suture knot was removed in 7 days.No patient had infection after operation,and the conjunctival incision healed well.Among them,5 patients had unilateral conjunctival congestion without strabismus and ectropion of the lower eyelid.All patients were followed up for 6 months,and were satisfied with the treatment effect.Conclusions The combined internal and external fixation of orbital septal fat flap via conjunctival approach can achieve the clinical effect of younger lower eyelid.