眶隔筋膜瓣及提上睑肌与额肌瓣吻合悬吊矫正重度上睑下垂

目的：研究利用眶隔筋膜瓣、提上睑肌腱膜联合额肌瓣悬吊矫正重度上睑下垂的临床效果。方法：术中切开眶隔,形成蒂在睑板上缘的眶隔筋膜瓣,在眉部分离形成额肌瓣,将这两瓣与提上睑肌腱膜重叠缝合固定,建立与额肌的连接,悬吊上睑并矫正下垂畸形。结果：采用此方法对27例35侧重度上睑下垂的眼睑进行了治疗,随访3～6个月,其中31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,睑缘位置正常,外形自然,睑缘弧度及重睑外形满意。矫正不足4侧,后行二次手术而修复。结论：利用眶隔筋膜瓣、提上睑肌腱膜联合额肌瓣重叠吻合悬吊矫正重度上睑下垂,上睑悬吊牢固,不易复发,保持了眼睑的原有结构,睑缘和重睑线弧度及外观满意,畸形矫正效果良好,优于传统的上睑提肌腱膜瓣悬吊和单纯额肌悬吊的方法。     

上睑提肌腱膜瓣联合宽大额肌瓣融合术治疗重度上睑下垂

目的：探讨上睑提肌腱膜瓣联合宽大额肌瓣融合术治疗重度上睑下垂的效果。方法：对27例（36眼）重度先天性上睑下垂患者进行上睑提肌腱膜联合宽大额肌瓣融合手术治疗,术后随访3个月～2年。结果：矫治良好25例,基本矫正2例,无过矫及欠矫者。结论：上睑提肌腱膜瓣联合宽大额肌瓣融合矫治手术,符合生理解剖的特点,可充分利用无功能提上睑肌腱膜,具备功能矫正效果,手术后外形满意,功能良好。     

提上睑肌腱膜眶隔膜复合瓣额肌吻合术治疗重度上睑下垂

对于重度上睑下垂需要手术矫治者，临床一般首选借助额肌力量的矫正术式，其方法颇多，各有优点和不足。我们采用提上睑肌腱膜眶隔膜复合瓣和额肌吻合术方法，矫正30例重度上睑下垂患者收到了满意效果。现总结讨论如下。     

上睑提肌腱膜瓣与额肌瓣悬吊缝合矫正重度上睑下垂

目的：为克服单纯额肌瓣悬吊治疗重度上睑下垂存在的缺点，更好地保持眼睑的原有结构，使矫治后的眼睑符合其生理和生物力学特点。方法：在患侧分别形成额肌瓣和上睑提肌腱膜瓣，将两瓣相互重叠缝合固定，起到悬吊上睑、矫正下垂畸形的作用。结果：利用该方法对46例52侧重度上睑下垂的眼睑进行了治疗，随访患者24例，28侧眼睑，其中23侧眼睑取得了较满意的治疗效果，患睑睁大时额肌收缩两侧眼裂大小基本对称，可达到正常睑缘的位置。睑缘弧度及重睑线外形满意。5侧眼睑矫正不完全，仍有一定程度的下垂。结论：术者认为利用无功能的上睑提肌形成腱膜瓣与传统的额肌瓣重叠悬吊缝合，保持了眼睑的原有结构，具有上睑悬吊牢固、不易复发、睑缘和重睑线弧度及外观满意的优点，对畸形矫正效果良好，优于传统的单纯额肌悬吊术。     

提上睑肌腱膜瓣──额肌吻合术治疗重度上睑下垂（附30例报告）

本文报告了作者采用提上睑肌腱膜瓣──额肌吻合术治疗重度上睑下垂３０例（３６只眼），手术后上睑下垂矫正和美容效果均非常满意。介绍了该手术主要方法和步骤。讨论了手术的机理、优点和注意事项等。     

提上睑肌腱膜瓣联合额肌瓣悬吊治疗先天性上睑下垂畸形

目的：研究改良的提上睑肌腱膜瓣联合额肌悬吊治疗重度先天性上睑下垂的，临床治疗效果。方法：自2005年8月～2008年3月，笔者采用该方法矫治重度先天性上睑下垂患者20例，年龄6～27岁，单侧8例，双侧12例。手术形成蒂在睑板上缘的的提上睑肌腱膜瓣，并与额肌建立连接，模拟提上睑肌上提眼睑的功能。结果：本组患者20名，术后随访6个月，15例矫正效果良好，4例好转，1例无效，部分患者出现不同程度的眼睑闭合不全，术后2-3月恢复。无明显并发症发生，效果良好。结论：与单纯的额肌悬吊不同，该术式形成的上提眼睑系统更符合生理结构，并且具备动态矫正效果，手术后外形满意、功能良好。     

矫正重度上睑下垂的临床体会

上睑下垂是整形外科中常见的疾病之一.而重度上睑下垂不但影响视觉功能,还会因眼部缺陷而影响面部容貌.自2000年1月至2010年7月,我们分别采用额肌瓣悬吊术[1]、提上睑肌腱膜瓣-额肌吻合术、改良方形缝线悬吊术的方法矫重度上睑下垂患者108例,效果满意.现报道如下.     

协同开睑术矫治上睑下垂的临床研究

克服以往手术单肌负荷过大,提肌力＜５ｍｍ者提肌手术出现矫正不足和额肌手术后有明显兔眼及上睑迟滞等现象,并使术后开睑功能更接近生理。改变以往治疗中单一利用额肌或提上睑肌矫治的方法,采用提上睑肌折叠瓣—额肌协同开睑矫正重度上睑下垂。本组３８例５３只眼重度上睑下垂,经提上睑肌折叠瓣额肌吻合术矫治,疗效满意。协同开睑术矫治重度上睑下垂比单一提上睑肌或额肌手术更为合理。     

提上睑肌-额筋膜瓣吻合治疗重度上睑下垂

目的：为重度上睑下垂的治疗提供一个效果理想、外观满意的方法。方法：自2000年1月至2002年12月采用提上睑肌-额筋膜瓣吻合术治疗重度上睑下垂16例(20眼)，并对术后效果进行了随访观察。结果：本组病例术后效果良好，创伤小，医患双方均感满意。术后对其中的12例进行了半年至一年的随访，远期效果满意。结论：提上睑肌-额筋膜瓣吻合术适用于重度上睑下垂．上睑提肌肌力≤4mm的患者。     

提上睑肌腱膜Muller‘s肌瓣与额肌连接术治疗重度上睑下垂

报道采用提上睑肌腱膜Ｍｕｌｌｅｒ＇ｓ肌瓣与额肌连接术治疗重度上睑下垂２０例（２５只眼），经６个月￣３年随访，满意率为６０％，基本满意２０％，有５只眼矫正不足，无过度矫正者。详细介绍了手术方法。讨论了手术原理、优缺点等。     

上睑下垂的分型及手术方法选择的临床分析

目的：探讨上睑下垂的分型及手术方法和疗效。方法：上睑下垂分轻、中、重3型。手术选择包括：①轻度下垂：可选择上睑提肌折叠缝合;②中度下垂：可选择上睑提肌部分切除缩短术;③重度下垂：可选择额肌筋膜瓣下移悬吊术。结果：本组60例,经6个月～5年的随访,外形满意,仅有1例眼眶弧度形态欠自然,经二次修整术后外形满意,无其他并发症。结论：上睑下垂,按分型程度选择适宜的手术方法和完善手术技巧是提高手术成功率的关键。     

Ptosis: Causes,Presentation, and Management

Drooping of the upper eyelid (upper eyelid ptosis) may be minimal (1–2 mm), moderate (3–4 mm), or severe (>4 mm), covering the pupil entirely. Ptosis can affect one or both eyes. Ptosis can be present at birth (congenital) or develop later in life (acquired). Ptosis may be due to a myogenic, neurogenic, aponeurotic, mechanical or traumatic cause. Usually, ptosis occurs isolated, but may be associated with various other conditions, like immunological, degenerative, or hereditary disorders, tumors, or infections. Besides drooping, patients with ptosis complain about tired appearance, blurred vision, and increased tearing. Patients with significant ptosis may need to tilt their head back into a chin-up position, lift their eyelid with a finger, or raise their eyebrows. Continuous activation of the forehead and scalp muscles may additionally cause tension headache and eyestrain. If congenital ptosis is not corrected, amblyopia, leading to permanently poor vision, may develop. Patients with ptosis should be investigated clinically by an ophthalmologist and neurologist, for blood tests, X-rays, and CT/MRI scans of the brain, orbita, and thorax. Treatment of ptosis depends on age, etiology, whether one or both eyelids are involved, the severity of ptosis, the levator function, and presence of additional ophthalmologic or neurologic abnormalities. Generally, treatment of ptosis comprises a watch-and-wait policy, prosthesis, medication, or surgery. For minimal ptosis, Müller's muscle conjunctival resection or the Fasanella Servat procedure are proposed. For moderate ptosis with a levator function of 5–10 mm, shortening of the levator palpebrae or levator muscle advancement are proposed. For severe ptosis with a levator function <5 mm, a brow/frontalis suspension is indicated. Risks of ptosis surgery infrequently include infection, bleeding, over- or undercorrection, and reduced vision. Immediately after surgery, there may be temporary difficulties in completely closing the eye. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return. In some cases, more than one operation is required.     

重睑成形术求术者中先天性轻度上睑下垂的情况调查

目的：探究要求行重睑成形术的求术者中患有先天性轻度上睑下垂的比率。方法：对近5年42068名来我科要求行重睑成形术者和来咨询相关手术人士,结合病史询问及上睑提肌肌力检查,诊断是否患有先天性轻度上睑下垂。同时调查求术者对自己患有该病的认知情况以及医师对该病确诊的时间。结果：先天性轻度上睑下垂的检出率平均2.75%,单侧检出率占69.87%,双侧占30.13%。受术者术前未知自己患有该病者占87.97%;术前确诊率94.89%,术中确诊率4.85%,术后确诊率0.26%。结论：先天性轻度上睑下垂的患病率较高,医师在行重睑术前应重视患者有无该病的检查,以免误诊误治。     

Technique for combined blepharoplasty and ptosis correction

Ptosis is one of the most common involutional changes of the eyelid. It frequently occurs concomitantly with dermatochalasis. The surgeon must be aware of the likelihood of this association when evaluating a patient for blepharoplasty because failure to develop an appropriate surgical plan will lead to an imperfect outcome. Ptosis correction can be undertaken at the same time as upper lid blepharoplasty. The many types of ptosis have a complex underlying anatomy and pathology, however, and the variety of surgical alternatives for ptosis repair are associated with a certain degree of unpredictability. The focus of this discussion is the management of acquired ptosis of aponeurogenic origin, which is most commonly associated with dermatochalasis. A surgeon who is conversant with the underlying anatomy of the ptotic lid and the general guidelines for ptosis repair will be prepared to manage combined dermatochalasis and ptosis.     

The evaluation and management of the patient with ptosis

This article deals with fundamentals in evaluation and correction of ptosis, with some references to special situations. Ptosis defies a cookbook approach if one wishes predictable results. In a certain percentage of patients, the result will remain unpredictable and the surgeon must be prepared to perform revisional surgery.     

Ptosischirurgie

Ptosis can be congenital but is more commonly an acquired condition occurring in particular as involutional forms. In addition to the aesthetic aspects ptosis mostly also leads to functional problems. Congenital ptosis in particular carries a high risk of amblyopia in childhood, therefore competent and close-knit pediatric ophthalmological treatment is important. Correction of ptosis is surgical and direct or indirect procedures are available depending on the conditions. Transcutaneous levator surgery has proven to be the universally applicable method for ptosis of all degrees of severity and can be combined with other corrective measures, such as temporal canthopexy or blepharoplasty, particularly for eyelids of elderly patients. In cases of severely impaired levator function and poor Bell phenomenon the indirect frontalis suspension method can be used. Congenital ptosis in childhood should be surgically treated at an early stage because of a substantial risk of amblyopia even if the central visual axis is still clear. The results of ptosis surgery are generally good and serious complications are rare.     

Mons Pubis Ptosis: Classification and Strategy for Treatment

Background  

Obesity and massive weight loss cause bulging and ptosis of the mons pubis. The pubic area can cause an embarrassment to patients. In some cases, the deformity can be seen even under clothing. Ptosis of the mons usually is addressed during abdominoplasty. The author presents a new clinical classification of mons deformity based on the amount of adipose tissue deposit and the degree of ptosis. A strategy of treatment to achieve a proper rejuvenation of mons deformities is provided.     

Combined superior crescentic total glandular augmentation mastopexy: report of 37 cases

Methods of periareolar, donut, or crescentic patterns for augmentation mastopexy in mild to moderate ptosis cases are minimally invasive (short scar) options. In this article, we report a modified version of the classical crescentic technique of augmentation mastopexy, namely, “superior crescentic total glandular augmentation mastopexy”. Thirty-seven patients with (a) breasts having mild to moderate ptosis (Regnault grades I–II), (b) breasts requiring less than 3 cm of nipple–areola elevation, and (c) mild skin elasticity were included in the study. During surgery, the mean size of 290 cc of silicon gel-filled implants were placed. The mean follow-up was 39 months ranging from 6 and 58 months. None of the patients had disastrous complications such as skin or nipple–areola necrosis. Poor scar healing and areolar asymmetry were the main problems encountered during follow-up. Ptosis recurrence (n = 1), and capsular contracture (n = 1) were the main reasons for revision surgery (5.4%). Five patients were re-operated on due to complications and implant change requirements (13.5% , total revisions). Mean suprasternal notch–nipple distance was recorded as 20.8 cm (19.3–22.4 cm) postoperatively. After an average time of 39 months, this distance was found to be 21.2 cm (20.1–23.2 cm) (the case with the recurrent ptosis was excluded). Superior crescentic total glandular augmentation mastopexy has yielded satisfactory results in patients with mild to moderate breast ptosis; therefore, it seems to be a valuable option in terms of minimally invasive augmentation mastopexy techniques.     

额肌瓣悬吊术治疗重度上睑下垂的术式改进

目的：评价改进额肌筋膜瓣悬吊术治疗先天性重度上睑下垂术式的可行性及其效果。方法：20例先天性重度上睑下垂患者,采用美容的重睑切口入路,将额肌瓣向下拉至睑板上1／3部位,缝合固定于眼睑板前上方。结果：本组20例患者,术后随访3-36个月,上睑下垂均得到矫正,睁眼、闭眼功能恢复良好,眼睑、眉外形和位置均无异常,重睑弧度和形态自然,效果满意。结论：采用改进的重睑切口行额肌瓣悬吊治疗先天性重度上睑下垂,具有操作简单,疗效确切,术式隐蔽,无瘢痕等优点。     

Roentgenographic evaluation of nephroptosis

Vertical and medial nephroptosis was assessed on 60 consecutive excretory urographic examinations. Ptosis, both vertical and medial, was seen more commonly in females, and vertical ptosis was more frequent than medial ptosis. In our series there was no significant evidence of predominance on the right side. Dietl crisis, nausea, vomiting, hypotension, oliguria, or orthostatic hypertension were not encountered. Nephroptosis was mostly asymptomatic. In those patients with symptoms, lumbar pain was common and could be either aggravated or relieved by change in position. A new sign, paradoxic displacement, is described. This could be of value to the surgeon and radiotherapist in evaluating enlargement of a huge abdominal mass - a difficulat task to assess clinically.