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综合征患者的临床特点及其手术治疗

目的分析中重度Marcus-Gunn综合征患者的临床特点,探讨和评价其手术治疗效果。方法对中山大学中山眼科中心1997年7月至2003年7月收治的33例中重度Marcus-Gunn综合征患者的病历资料进行临床特点分析。患者均行单侧提上睑肌节段切除联合同侧额肌肌瓣悬吊术治疗上睑下垂,评价其术后治疗效果。结果所有患者术前的上睑下垂及颌动瞬目量均大于2mm,无家族史,无明显性别差异（男：女=16：17）,左眼（22例）多于右眼（11例）。术后随访1—6年。随访期末进行的上睑下垂矫治效果评价中26／33例患者满意,3／33例较满意,1／33例不满意,另有3例失访。结论中重度Marcus-Gunn综合征患者伴有的上睑下垂需行手术矫正。单侧提上睑肌节段切除联合同侧额肌肌瓣悬吊术可以满意地矫正中重度Marcus-Gunn综合征患者的上睑下垂。     

Marcus Gunn张口瞬目综合征手术方式探讨

目的探讨Marcus Gunn张口瞬目综合征不同手术方式和治疗效果。方法Marcus Gunn张口瞬目综合征6例(6眼)采用上睑提肌水化分离及节段切除联合额肌瓣悬吊术。结果6例随访6月～2年,双眼睑裂高度对称,弧度自然,颌动瞬目联合性动作消失。结论采用上睑提肌水化分离及节段切除联合额肌瓣悬吊,是治疗Marcus Gunn张口瞬目综合征的较好术式。     

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.     

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.     

额肌瓣悬吊术治疗完全性上睑下垂临床观察

目的 观察额肌瓣悬吊术治疗完全性上睑下垂的治疗效果。方法 对18例（21只眼）完全性上睑下垂患者施行额肌瓣悬吊术。平均随访18个月，观察其睑裂高度、上睑弧度、闭眼状态和角膜情况。结果 15例（17只眼）效果理想，3例（4只眼）效果显著，总有效率100％。结论 额肌瓣悬吊术治疗完全性上睑下垂效果良好，并有其独特优势。     

学龄前儿童额肌瓣悬吊术后角膜损伤的相关问题研究

目的:探讨学龄前儿童先天性上睑下垂额肌瓣悬吊术后角膜损伤发生的原因及预防措施。方法:先天性上睑下垂患儿94例108眼采用额肌瓣悬吊术矫正上睑下垂,观察治疗前、后的Bell氏现象、上睑睫毛方向,瞬目次数,睑裂闭合不全情况,常规裂隙灯检查角膜荧光素染色、泪膜破裂时间的变化,对结果进行统计学分析。结果:术后1wk角膜损伤的发生率为10.2%,术后2wk所有患儿的角膜损伤都基本痊愈。术后早期角膜荧光素染色、瞬目次数及BUT与术前相比有显著统计学差异,术后2wk与术前相比无明显改变。结论:额肌瓣悬吊术矫正学龄前儿童先天性上睑下垂是一种比较安全、有效的手术方式,术后角膜损伤的发生主要与睑裂闭合不全、倒睫、瞬目减少、Bell氏现象消失以及泪膜不稳定有关。     

改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂

目的:探讨改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂的有效性。方法:20例(25眼)学龄前儿童先天性重度上睑下垂,采用改良式额肌瓣悬吊术,利用额肌力量提起上睑。结果:术后1～4a上睑缘位于角膜上缘下1mm20眼,2mm5眼,无复发。结论:改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂效果肯定。     

上睑下垂额肌瓣悬吊术中上睑缘位置控制法探讨

目的 探讨上睑下垂额肌瓣悬吊术中上睑缘位置与手术效果的关系。方法 28例35眼先天性上睑下垂，全部在局麻下采用额肌瓣悬吊术治疗，术中将上睑缘位置矫正到角膜上缘处，术后常规处理，并严密观察上睑缘位置的下降程度。结果 术后随访1～3年，上睑缘位于角膜七缘以下1mm者4眼(11．43％)，2mm者28眼(80．00％)，3mm者3眼(8.57％)。术后上睑缘位置下降2mm，符合正常人上睑缘遮盖上方角膜2mm左右的解剖结构和生理要求。全部病人均获得满意和比较满意的矫正效果。结论 上睑下垂额肌瓣悬吊术术中上睑缘应恰位于角膜上缘处，方可获得良好的手术矫正效果。     

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。     

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.     

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。     

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.     

Oculopalpebral and facial synkinesis associated with ptosis: epidemiological, clinical, and therapeutic features

Synkinetic movements of the upper eyelids may be noted in association with movements of either extraocular muscles or other muscles of the face. Patients with oculopalpebral or facial-palpebral synkinesis may also have ptosis of the involved eyelid. The clinical and therapeutic features of this association are specific. We mainly distinguish two forms of synkinetic movements, characterized either by the elevation of the ptotic eyelid such as in Marcus Gunn phenomenon and in the Fuchs sign or by the falling of the upper lid such as in Marin Amat syndrome. Many surgical techniques have been used to correct the blepharoptosis and the synkinetic movement. Levator resection is often advocated for correction of blepharoptosis with a mild degree of synkinesis. However, when the ptosis is major, eyelid lag is a possible outcome. For moderate or major synkinesis, bilateral frontalis suspension with disinsertion of the levator has been suggested. This procedure generally provides satisfactory cosmetic results.     

儿童额肌瓣悬吊术中术后常见并发症及处理

目的 探讨儿童额肌瓣悬吊术中术后并发症的发生原因及相应处理措施.方法 2002年1月至2010年8月行额肌瓣悬吊术的120例(141只眼)病人临床资料进行回顾性分析.结果 发生术中并发症19只眼(13.48％),其中出血影响操作17只眼(12.06％),眶脂肪突出2只眼(1.42％);术后并发症21只眼,发生率为14.89％,其中矫正不足7只眼(4.96％),倒睫5只眼(3.55％),缝线滑脱致复发1只眼(0.71％),矫正过度1只眼(0.71％),上睑肿胀1只眼(0.71％),睑缘位置不自然3只眼(2.13%),角膜上皮脱落2只眼(1.42％),角膜溃疡1只眼(0.71％),给予相应的处理措施,治愈所有并发症.结论 术前全面准备、术中精细操作、术后及时处理是减少儿童额肌瓣悬吊手术并发症的关键.