目的:评估使用自体耳廓软骨(位于螺旋和反螺旋之间的前表面沟槽内)进行下睑牵开手术的疗效,并在患者队列中呈现手术结果。
方法:回顾性分析了21例接受下睑后缩手术的患者的病历。回缩,存在时间延长(6个月至20年),表现为1毫米或更大的下巩膜显示,归因于之前的下眼睑眼睑成形术,面神经麻痹,或者作为正常的解剖变异。手术干预措施包括外侧than切开术,弯管溶解,睑下结膜-下眼睑牵开器的切口,下眼睑牵开器松解术,软骨移植物缝合到无结膜覆盖的缺损区域,并收紧所有患者的外侧角。
结果:21例患者共29个眼睑行手术,术中无并发症。平均随访11个月(范围:6-30个月),96.5%的眼睑改善了下眼睑回缩。与术前相比,术后边缘到反射距离测量值(MRD2)显着降低(p=0.001;p<0.01)。MRD2-a(中瞳孔到下眼睑)和MRD2-b(外侧角膜缘到下眼睑)的平均改善分别为1.77±0.80和2.04±0.81(p=0.001;p<0.01)。四个眼皮(4/29)因眼角松动而需要翻修,矫正需要骨膜瓣。所有四名患者先前都曾在其他地方接受过两次或更多次修复。移植物在两个盖子上可见,但不需要进一步修改。一名患者在供体部位出现轻度螺旋畸形,这不需要额外的干预。
结论:在下眼睑回缩与中/后板层缩短相关的情况下,利用自体耳骨软骨垫片移植提供了显着的好处。这些优点包括直接收获与最小的供体部位并发症,稳定而不经历收缩,与后软骨相比,质地更柔软,便于正确安装在地球仪上的凹形形状,和它的自体性质。
OBJECTIVE: To assess the efficacy of lower eyelid retraction surgery utilizing autologous auricular scapha cartilage (located within the anterior surface groove between the helix and anti-helix) and to present the surgical outcomes in a patient cohort.
METHODS: Medical records of 21 patients who underwent lower eyelid retraction surgery with scapha cartilage were retrospectively reviewed. Retractions, present for an extended duration (6 months to 20 years), exhibited 1 mm or more inferior scleral show, attributed to prior lower eyelid blepharoplasty, facial palsy, or as a normal anatomical variation. Surgical interventions included lateral canthotomy, cantholysis, incision of the subtarsal conjunctiva-lower eyelid retractors, lower eyelid retractor lysis, cartilage graft suturing to the defect area without conjunctival cover, and tightening of the lateral canthal corner in all patients.
RESULTS: A total of 29 eyelids in 21 patients underwent surgery without intraoperative complications. Over a mean follow-up period of 11 months (range: 6-30 months), lower lid retraction improved in 96.5% of eyelids. Postoperative margin-to-reflex distance measurements (MRD2) significantly decreased compared to preoperative values (p = 0.001; p < 0.01). Average improvements in MRD2-a (midpupil to lower lid) and MRD2-b (lateral limbus to lower lid) were 1.77 ± 0.80 and 2.04 ± 0.81, respectively (p = 0.001; p < 0.01). Four eyelids (4/29) required revision due to canthal corner loosening, with correction necessitating periosteal flaps. All four patients had previously undergone two or more repairs elsewhere. The graft was visible in two lids but did not require further revision. One patient experienced mild helix deformity at the donor site, which did not warrant additional intervention.
CONCLUSIONS: In cases of lower lid retraction associated with middle/posterior lamellar shortening, utilizing an autologous auricular scapha cartilage spacer graft offers notable benefits. These advantages comprise straightforward harvesting with minimal donor site complications, stability without experiencing shrinkage, a softer texture in comparison to posterior cartilage, a concave shape that facilitates proper fitting on the globe, and its autologous nature.