提上睑肌离断额肌瓣悬吊术治疗中重度Marcus-Gunn综合征的临床研究

目的研究提上睑肌离断额肌瓣悬吊术治疗中重度Marcus-Gunn综合征的临床疗效。方法6例中重度Marcus-Gunn综合征患者采用提上睑肌离断额肌瓣悬吊手术治疗。结果随访6个月～5年,6例患者术后颌动瞬目症状消除,双侧睑裂对称,上睑缘无遮盖瞳孔,睑缘弧度自然美观,2例伴有轻度的上下睑闭合困难及上睑迟滞现象。结论提上睑肌离断额肌瓣悬吊术是治疗中重度Marcus-gunn综合征较理想的手术方法。     

中重度Marcus-Gunn综合征患者的手术治疗

目的分析中重度Marcus-Gunn综合征患者的临床特点,评价其手术治疗效果。方法收集武汉大学人民医院2006年1月至2010年1月收住院治疗的12例中重度Marcus-Gunn综合征患者的病历资料,对其临床特点进行分析。患者均行患眼提上睑肌离断联合同侧额肌瓣悬吊术治疗颌动瞬目现象,术后随访6个月,依据静态时双眼睑弧度及对称情况、颌动瞬目现象根治情况评价其术后治疗效果。结果所有患者术前下颌运动时上睑至少开大到角膜上缘,男性多于女性(男8例,女4例),均为单眼发病,右眼7例,左眼5例。术前8眼伴随屈光不正,5眼伴有斜视。术后2眼出现角膜点样损害,药物治疗7d后恢复。随访期末进行颌动瞬目矫治效果评价中10眼效果良好,2眼效果满意。结论中重度Marcus-Gunn综合征患者伴有的颌动瞬目现象可通过手术治疗,患侧提上睑肌离断联合同侧额肌肌瓣悬吊术可以满意地矫正Marcus-Gunn综合征患者伴有的中重度颌动瞬目现象。     

额肌瓣悬吊术和上睑提肌额肌吻合术治疗Marcus-Gunn综合征术式探讨

目的 比较额肌瓣悬吊术和上睑提肌腱膜-额肌瓣吻合术治疗Marcus-Gunn综合征的疗效.方法 回顾性分析采用额肌瓣悬吊术、上睑提肌腱膜-额肌瓣吻合术治疗Marcus-Gunn综合征20例20只眼.比较两组手术的疗效.结果 额肌瓣悬吊术组和上睑提肌腱膜-额肌瓣吻合术组均能有效治疗Marcus-Gunn综合征.但前者术后有2例睑缘弧度不自然(25%),3例半年后仍眼睑闭合不全.后者术后睑缘弧度均较自然,半年后无眼睑闭合不全.结论 额肌瓣悬吊术和上睑提肌腱膜-额肌瓣吻合术均能有效治疗Marcus-Gunn综合征,但后者更符合眼睑生理解剖,术后睑缘弧度更自然.     

改进的额肌瓣悬吊术矫正儿童先天性上睑下垂

目的评价改进的额肌筋膜瓣悬吊术治疗儿童先天性上睑下垂。方法对35例中重度先天性上睑下垂采用改进的额肌瓣悬吊术。术后观察3～6月。结果眼睑高度正常，上睑弧度自然，无并发症发生。结论改良型额肌瓣悬吊术适用于儿童先天性上睑下垂，其效果优于上睑提肌缩短术及传统额肌瓣悬吊术，能达到矫正畸形及改善外观的效果。     

额肌瓣悬吊术和上睑提肌额肌吻合术治疗Marcus-Gunn综合征术式探讨

目的 比较额肌瓣悬吊术和上睑提肌腱膜-额肌瓣吻合术治疗Marcus-Gunn综合征的疗效.方法 回顾性分析采用额肌瓣悬吊术、上睑提肌腱膜-额肌瓣吻合术治疗Marcus-Gunn综合征20例20只眼.比较两组手术的疗效.结果 额肌瓣悬吊术组和上睑提肌腱膜-额肌瓣吻合术组均能有效治疗Marcus-Gunn综合征.但前者术后有2例睑缘弧度不自然(25%),3例半年后仍眼睑闭合不全.后者术后睑缘弧度均较自然,半年后无眼睑闭合不全.结论 额肌瓣悬吊术和上睑提肌腱膜-额肌瓣吻合术均能有效治疗Marcus-Gunn综合征,但后者更符合眼睑生理解剖,术后睑缘弧度更自然.     

改良额肌瓣悬吊矫正上睑下垂的临床应用

目的 观察改良额肌瓣悬吊矫正上睑下垂的治疗效果。方法 共150例(160眼)，男90例，女60例。施行改良额肌瓣悬吊矫正上睑下垂。结果 160眼术后有效率100％，治愈率95％。随访观察2月到3年。结论 改良额肌瓣悬吊是将额肌瓣直接与睑板缝合，术后提睑作用可靠而持久，美容效果满意。     

改良式额肌瓣悬吊术治疗先天性上睑下垂的体会

目的:探讨额肌瓣悬吊术治疗先天性上睑下垂的临床效果和方式方法。方法:采用额肌瓣悬吊术治疗先天性上睑下垂患者34例46眼,对术后效果进行随访观察并对疗效进行回顾性分析。结果:本组病例34例46眼随访3～12mo,上睑下垂全部矫正,均获得良好效果。术后3mo满意率96%,基本满意率100%。结论:额肌瓣悬吊术是治疗提上睑肌肌力<4mm的先天性上睑下垂的有效方法,不仅能恢复上睑功能,同时能够达到美观的效果。     

三种术式治疗重度先天性上睑下垂的疗效对比

目的:探讨提上睑肌缩短术、额肌瓣悬吊术、阔筋膜悬吊术治疗重度先天性上睑下垂的效果。方法:手术治疗重度先天性上睑下垂患者42例47眼,其中提上睑肌缩短术25例28眼、额肌瓣悬吊术10例12眼、阔筋膜悬吊术7例7眼,比较手术效果,上睑弧度、双重睑成形情况及手术并发症情况。结果:采用提上睑肌缩短术者,术后外观自然美观,兔眼恢复时间短,效果满意;采用额肌瓣悬吊术者术后外形欠自然、兔眼恢复时间长;采用阔筋膜悬吊术者,上睑迟滞和眼睑闭合不全较明显,易发生矫正不足。结论:三种手术方式均能有效治疗先天性上睑下垂。提上睑肌缩短术更符合生理状态,手术效果最好且并发症少。     

额肌瓣悬吊术矫正重度先天性上睑下垂

目的:探讨额肌瓣悬吊术矫正重度先天性上睑下垂的临床效果。方法:对28例35眼重度先天性上睑下垂患者,施行额肌瓣悬吊术,观察分析术中、术后并发症,随访观察术后效果。结果:本组病例均矫正理想,无严重术中术后并发症发生。结论:额肌瓣悬吊术矫正重度先天性上睑下垂的手术可靠,效果满意,是治疗重度上睑下垂较可靠的手术方法。     

额肌瓣悬吊术治疗重度上睑下垂

目的 探讨额肌瓣悬吊术矫正重度上睑下垂的可行性。方法 对30例41眼重度上睑下垂患者将睑板于适当位置缝线后自眼轮匝肌后向上悬吊于额肌上，借助额肌力量提吊眼睑。结果 效果良好者22眼占53．7％，满意14眼占34．1％。结论 额肌瓣悬吊术治疗重度上睑下垂效果好。     

提上睑肌离断联合EPTFE额肌悬吊术治疗儿童中重度下颌瞬目综合征的疗效

目的探讨提上睑肌离断联合EPTFE额肌悬吊术治疗中重度儿童下颌瞬目综合征手术疗效。方法回顾性系列病例研究。分析2013-2014年行提上睑肌腱膜节段去除联合EPTFE额肌瓣腱膜悬吊术治疗单眼中、重度下颌瞬目综合征患儿49例的临床资料。其中下颌瞬目中度27例（55%）,重度22例（45%）;上睑下垂中度19例（39%）,重度30例（61%）。年龄18个月～13岁。术后随访10～12个月。计量资料之间的比较采用方差分析,计数资料之间的比较采用卡方检验。结果49例中46例（94%）下颌瞬目治愈,术后未出现下颌联动现象。2例好转,1例无效。上睑下垂矫正后功能与美容疗效满意,其中31例（63%）提高≥6 mm,17例（35%）提高3～5 mm,1例（2%）在术后3个月上睑高度回落,遮盖瞳孔1/2。1例（2%）下颌瞬目联动幅度为3 mm,但功能及美容疗效满意。4例（8%）术后发生暴露性角膜炎,3例（6%）发生结膜撕裂,2例（4%）上睑下垂复发,2例（4%）上睑内翻倒睫,1例（2%）排异,1例（2%）下颌瞬目联动运动矫正失败。结论患眼提上睑肌腱膜节段去除联合EPTFE额肌瓣腱膜悬吊术治疗单眼中、重度下颌-瞬目综合征手术疗效好,术后反应轻,为合并弱视患儿早期治疗提供必要条件。     

Management of moderate-to-severe Marcus-Gunn jaw-winking ptosis.

OBJECTIVE: To report the results of levator excision and frontalis suspension for moderate-to-severe Marcus-Gunn jaw-winking ptosis. DESIGN: A retrospective noncomparative case series. PARTICIPANTS: Twenty-four patients with moderate-to-severe Marcus-Gunn jaw-winking ptosis (21 unilateral and 3 bilateral) were treated surgically between 1978 and 1997 by one surgeon. INTERVENTION: Levator excision either in the involved eyelid or in both eyelids, followed by bilateral frontalis suspension, was performed. MAIN OUTCOME MEASURES: Postoperative improvement of jaw-winking was determined. The surgical results of ptosis surgery were assessed as good, fair, or poor based on habitual upper eyelid heights and symmetry. RESULTS: Postoperative follow-up periods ranged from 6 months to 153 months, with an average of 36.9 months. After levator excision in a total of 27 eyelids exhibiting jaw-winking, 10 eyelids (37.0%) showed complete resolution of jaw-winking, and 13 eyelids (48.2%) showed mild winking (1 mm or less) on the lateral jaw movement only (functionally and cosmetically not a problem). In four eyelids (14.8%), these results were not recorded. In the group of five patients undergoing bilateral frontalis suspension and levator excision only on the involved side, final results were good in two patients (40%) and poor in three (60%). Of the 19 patients who underwent bilateral levator excision, final results were good in 13 (68.4%) and fair in 6 (31.6%). CONCLUSIONS: For moderate-to-severe jaw-winking ptosis, bilateral frontalis suspension after bilateral levator excision generally provided satisfactory correction of both jaw-winking and ptosis.     

Use of the levator muscle as a frontalis sling

PURPOSE: To investigate the use of the distal portion of levator aponeurosis as a flap for frontalis suspension in patients with severe congenital ptosis and poor levator function. METHODS: Eleven procedures were performed on 8 patients with severe congenital ptosis and poor levator muscle function. Three of the 8 patients had Marcus-Gunn jaw-winking phenomenon. Preoperative evaluation included measurements of the degree of ptosis, levator function, superior rectus action, Bell phenomenon, lagophthalmos, and (if present) synkinetic eyelid movement. Surgery involved fashioning a flap from the distal portion of the levator aponeurosis and anchoring it to the frontalis muscle. Postoperatively, patients were followed for at least 6 months to assess the level of the eyelid in the primary position at rest and when the brow is raised, the degree of eyelid margin excursion on brow elevation, persistence of synkinetic eye movement, presence of complications, lagophthalmos, corneal exposure, and symmetry. RESULTS: Synkinetic muscle movements were completely abolished. All cases had good primary eyelid position, no corneal complications, and effective frontalis action on eyelid elevation. CONCLUSIONS: The distal levator muscle flap is an effective frontalis suspension material to correct ptosis with poor levator function and to abolish synkinetic eyelid movement without compromising corneal protection.     

Direct Frontalis Flap with and without Levator Pulley for Correction of Severe Ptosis with Poor Levator Function in the Same Patient

Purpose: To compare two techniques of frontalis muscle flap suspension in different eyelids of the same patient for correction of severe ptosis with minimal levator function.

Material and methods: A prospective study of four patients with severe bilateral ptosis and poor levator function, who underwent direct frontalis muscle flap on the right eyelid and frontalis muscle flap with levator pulley on the left eyelid was conducted. Eyelid studies measurements were taken at baseline, 2 months, one year and 5 years after surgery. The presence of complications, flap function and palpebral contour were evaluated.

Results: Despite the surgical technique performed, good results in terms of functionality, contour and aesthetics were observed. In the eyes that underwent frontalis muscle flap (FMF)-direct, there were 2 cases with moderate anteriorization of eyelid margin in extreme upgaze and all patients showed eyelash ptosis that persisted one year after surgery, but improved after 5 years. In the eyes that underwent FMF-pulley, no upgaze anteriorization of eyelid margin was observed and three patients had eyelash ptosis of lesser extent than the fellow eye, improving after 1 year follow-up. FMF-pulley showed more long-term stability in eyelid height, compared with FMF-direct.

Conclusions: Frontalis muscle flap with a pulley in the levator aponeurosis prevents some complications caused by the excessive vertical component of the direct frontalis muscle flap, especially in deep-set eye patients, with better stability of the eyelid height and contour over time.     

超常量提上睑肌缩短及额肌瓣悬吊治疗重度先天性上睑下垂效果比较

目的：比较提上睑肌缩短术与额肌瓣悬吊术治疗重度先天性上睑下垂的疗效与并发症。

方法：对40例58眼重度先天性上睑下垂患者进行手术治疗,其中,20例28眼行额肌腱膜瓣悬吊术,20例30眼行改良的提上睑肌缩短术,术后随访6mo,观察两种手术方式治疗重度先天性上睑下垂的治疗效果及术后并发症的发生情况。

结果：术后随访6mo,提上睑肌缩短术组及额肌瓣悬吊术组治疗重度先天性上睑下垂的正矫率分别为：83%、82%,差异无统计学意义(P>0.05),但术后并发症的发生,如倒睫、闭合不全、暴露性角膜炎、结膜脱垂等,提上睑肌缩短术组少于额肌瓣悬吊术组,且有更好的外观。提上睑肌缩短术后6mo复诊时,眼睑闭合不全15眼,暴露性角膜炎共1眼,结膜脱垂2眼; 额肌瓣悬吊术后6mo随诊,眼睑闭合不全23眼,暴露性角膜炎2眼,上睑倒睫3眼。

结论：提上睑肌缩短术及额肌瓣悬吊术均能有效矫正重度先天性上睑下垂,但前者并发症少,术后外观好。     

环扎带悬吊术治疗儿童重度先天性上睑下垂的临床分析

目的观察硅胶环扎带悬吊术在先天性重度上睑下垂术中的远期治疗效果。方法应用环扎带额肌悬吊术治疗先天性重度上睑下垂患儿23眼。随访6月~3年,平均1.9年。观察术后上睑下垂的矫正效果及并发症情况,并与在我院行额肌筋膜瓣悬吊术的病例对比分析。结果环扎带悬吊术23眼,满意17眼（73.9%）;额肌筋膜瓣悬吊术18眼,满意15眼（83.3%）,二者之间满意率差异无统计学意义（χ2=0.1308,P〉0.05）。结论环扎带悬吊术治疗先天性上睑下垂的手术简易,取材方便,术后并发症少,远期效果肯定,值得推广。     

Frontalis muscle flap advancement for jaw-winking ptosis

PURPOSE: To describe the technique and results of frontalis muscle flap advancement for correction of ptosis associated with jaw-winking. METHODS: Four cases of unilateral jaw-winking ptosis were corrected with frontalis muscle flap advancement after excision of levator muscle on the affected side. RESULTS: Three of the 4 patients achieved good results with the correction within 1 mm of the opposite eyelid. The residual asymmetry on downgaze after follow-up of 4 to 18 months ranged from 1 to 5 mm. The main complication was mild forehead hypoesthesia in 2 patients, which resolved over a period of 1 month. CONCLUSIONS: Frontalis muscle flap advancement is an effective procedure when performed unilaterally for jaw-winking ptosis. It is simple, safe, and involves a single surgical field. Eyelid lag on downgaze improves considerably over time, and the remaining asymmetry between the two eyelids is cosmetically acceptable to most patients.