Abstract：
BACKGROUND: The lateral orbital crow\'s feet area is one for which rejuvenation is most frequently requested by patients. Moreover, lateral canthal wrinkles are a common source of dissatisfaction after rhytidoplasty. Botulinum toxin injection has emerged as a most popular, easy, and effective solution; nevertheless, repeated injections are required periodically for long-term effect. Other nonsurgical options have also been described to have some demonstrable advantages. Orbicularis oculi surgical manipulations have been described as well.
METHODS: A systematic PubMed literature search was conducted to identify clinical cohort studies including more than 10 patients describing surgical approaches for improvement of crows\' feet wrinkles in combination with face and/or temporal lifts. The search was complemented by Embase, Medline, and Cochrane searches in addition to screening of reference lists of selected studies and simple term searches about surgical treatment of crow\'s feet.
RESULTS: Fourteen studies satisfied the inclusion criteria and were included in this review describing various muscle excision techniques including vertical strip excision, lateral partial resection, wedge resection, muscle resection in \"C\" pattern, and enlarged myectomy of about one-third of the whole orbital extension in addition to muscle manipulation modalities, including muscle splaying, muscle division, muscle division and splaying, muscle undermining with partial denervation, and muscle suspension. Interposition of fascia between orbicularis muscle and overlying skin was also reported.
CONCLUSIONS: View the few studies retrieved and the wide spectrum of reported techniques, it is not possible to determine from this review the most effective modality. Nevertheless, it seems that subcutaneous undermining of the lateral canthal area combined with splaying and traction of the orbicularis oculi muscle and fixation to the temporalis fascia with or without muscle division would yield the best long-term results. This review indicates also that surgical correction of crow\'s feet during rhytidectomy or temporal lift could be a positive complement to improve aesthetic outcome. Unfortunately, if not underreported, it is definitely neglected. We believe that this review may be an eye-opener for surgeons.
METHODS: A systematic PubMed literature search was conducted to identify clinical cohort studies including more than 10 patients describing surgical approaches for improvement of crows\' feet wrinkles in combination with face and/or temporal lifts. The search was complemented by Embase, Medline, and Cochrane searches in addition to screening of reference lists of selected studies and simple term searches about surgical treatment of crow\'s feet.
RESULTS: Fourteen studies satisfied the inclusion criteria and were included in this review describing various muscle excision techniques including vertical strip excision, lateral partial resection, wedge resection, muscle resection in \"C\" pattern, and enlarged myectomy of about one-third of the whole orbital extension in addition to muscle manipulation modalities, including muscle splaying, muscle division, muscle division and splaying, muscle undermining with partial denervation, and muscle suspension. Interposition of fascia between orbicularis muscle and overlying skin was also reported.
CONCLUSIONS: View the few studies retrieved and the wide spectrum of reported techniques, it is not possible to determine from this review the most effective modality. Nevertheless, it seems that subcutaneous undermining of the lateral canthal area combined with splaying and traction of the orbicularis oculi muscle and fixation to the temporalis fascia with or without muscle division would yield the best long-term results. This review indicates also that surgical correction of crow\'s feet during rhytidectomy or temporal lift could be a positive complement to improve aesthetic outcome. Unfortunately, if not underreported, it is definitely neglected. We believe that this review may be an eye-opener for surgeons.
摘要：
背景：眼眶外侧乌鸦脚区域是患者最经常要求恢复活力的区域。此外，经鼻外侧皱纹是除皱术后不满意的常见来源。肉毒杆菌毒素注射已经成为最受欢迎的，easy,和有效的解决方案；然而，需要定期重复注射以获得长期效果。其他非手术选择也被描述为具有一些明显的优点。眼轮匝肌的手术操作也已被描述。
方法：进行了系统的PubMed文献检索，以确定临床队列研究，其中包括10多名患者，这些患者描述了改善乌鸦脚皱纹并结合面部和/或颞部隆起的手术方法。搜索得到了Embase的补充，Medline,除了筛选选定研究的参考列表和关于乌鸦脚手术治疗的简单术语搜索之外，还有Cochrane搜索。
结果：14项研究符合纳入标准，纳入本综述，描述了各种肌肉切除技术，包括垂直条切除，外侧部分切除,楔形切除术,“C”模式的肌肉切除，除了肌肉操纵方式外，还有大约三分之一的眼眶延伸的扩大肌切除术，包括肌肉张开，肌肉分裂,肌肉分裂和张开，部分去神经支配的肌肉破坏，和肌肉悬浮。还报道了眼轮匝肌和上覆皮肤之间的筋膜插入。
结论：查看检索到的少数研究和报告的广泛技术，从这篇综述中无法确定最有效的治疗方式.然而，似乎外侧can区的皮下破坏，再加上眼轮匝肌的张开和牵引以及在有或没有肌肉分裂的情况下固定在颞肌筋膜上，将产生最佳的长期效果。这篇评论还表明，在除皱术或颞部抬起时对乌鸦脚进行手术矫正可能是改善美学效果的积极补充。不幸的是,如果没有被低估，它绝对被忽视了。我们相信这篇综述可能会让外科医生大开眼界。
方法：进行了系统的PubMed文献检索，以确定临床队列研究，其中包括10多名患者，这些患者描述了改善乌鸦脚皱纹并结合面部和/或颞部隆起的手术方法。搜索得到了Embase的补充，Medline,除了筛选选定研究的参考列表和关于乌鸦脚手术治疗的简单术语搜索之外，还有Cochrane搜索。
结果：14项研究符合纳入标准，纳入本综述，描述了各种肌肉切除技术，包括垂直条切除，外侧部分切除,楔形切除术,“C”模式的肌肉切除，除了肌肉操纵方式外，还有大约三分之一的眼眶延伸的扩大肌切除术，包括肌肉张开，肌肉分裂,肌肉分裂和张开，部分去神经支配的肌肉破坏，和肌肉悬浮。还报道了眼轮匝肌和上覆皮肤之间的筋膜插入。
结论：查看检索到的少数研究和报告的广泛技术，从这篇综述中无法确定最有效的治疗方式.然而，似乎外侧can区的皮下破坏，再加上眼轮匝肌的张开和牵引以及在有或没有肌肉分裂的情况下固定在颞肌筋膜上，将产生最佳的长期效果。这篇评论还表明，在除皱术或颞部抬起时对乌鸦脚进行手术矫正可能是改善美学效果的积极补充。不幸的是,如果没有被低估，它绝对被忽视了。我们相信这篇综述可能会让外科医生大开眼界。
