CLINICAL OBSERVATION OF MODERATE TO SEVERE BLEPHAROPTOSIS CORRECTION WITH ARC-SHAPED FRONTALIS APONEUROSIS FLAP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIZhengyong , WUJunliang , CENYing , ZHANGZhenyu , CHENZhixing ,  CHENJunjie

Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

CHENJunjie, Email: cjjemail@163.com

Keywords：

Blepharoptosis; Arc-shaped frontalis aponeurosis flap; Suspension surgery

DOI：

10.7507/1002-1892.20160092

Video：

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Objective To evaluate the effectiveness of an arc-shaped frontalis aponeurosis flap for the treatment of moderate to severe blepharoptosis. Method Between January 2011 and December 2014, 80 cases (140 eyes) of moderate to severe blepharoptosis were treated, including 31 males and 49 females with a median age of 16 years (range, 6-45 years). One eye was involved in 20 cases and both eyes in 60 cases. Upper eyelid ptosis degree ranged from 3 to 6 mm (average, 5 mm) when looking at the front horizontally. Fifty-one patients had underwent plastic surgery, and the first operation was performed in others. The arc-shaped frontalis aponeurosis flap was created by incision of upper and middle edge of the eyebrow, then it was retracted to the upper eyelid aponeurosis and was fixed in a slight over-correction position. Results The operation was completed smoothly. The intraoperative blood loss was 5-10 mL (mean, 7 mL). Mild swelling of incision was observed after operation, and disappeared at 3-5 days after operation. Primary healing of incision was obtained, with no complications of infection and flap necrosis. The follow-up duration was 1-3 years (mean, 1.5 years). Seventy-nine cases could close upper eyelid completely and the function of upper eyelid was satisfactory within 3 months. One patient could not close upper eyelid completely after 6 months, and mild keratitis occurred, which was cured by anchyloblepharon. Conclusions The arc-shaped frontalis aponeurosis flap can be regarded as a minimally invasive procedure for the treatment of congenital moderate to severe blepharoptosis, it was safe, reliable, and easy-to-grasp.

Citation： LIZhengyong, WUJunliang, CENYing, ZHANGZhenyu, CHENZhixing, CHENJunjie. CLINICAL OBSERVATION OF MODERATE TO SEVERE BLEPHAROPTOSIS CORRECTION WITH ARC-SHAPED FRONTALIS APONEUROSIS FLAP. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(4): 457-460. doi: 10.7507/1002-1892.20160092 Copy

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2.	赵天兰, 余道江, 谢晓明, 等. 以额肌为动力治疗上睑下垂方法的改进. 中华医学美学美容杂志, 2011, 17(1) :9-11.
3.	宋玖, 刘毅, 陈元婕, 等. 宽大额肌瓣悬吊治疗重度先天性上睑下垂. 中国美容医学, 2011, 20(9) :1334-1336.
4.	de Figueiredo AR. Blephayoptosis. Semin Ophthalmol, 2010, 25(3) :39-51.
5.	Kokubo K, Katori N, Hayashi K, et al. Frontalis suspension with an expanded polytetrafluoroethylene sheet for congenital ptosis repair. J Plast Reconstr Aesthet Surg, 2016.[Epub ahead of print].
6.	Zhang D, Guo B, Cai W. Effect of frontal muscle aponeurosis flap suspension surgery for severe congenital ptosis in children. Minerva Pediatr, 2015.[Epub ahead of print].
7.	Krohn-Hansen D, Haaskjold E, Nicolaissen B. Suspension surgery with autogenous fascia lata via a less invasive modification of the Crawford method on 85 patients with congenital severe eyelid ptosis. J Plast Surg Hand Surg, 2015, 49(4) :214-219.
8.	Göncü T, Çakmak S, Akal A, et al. Improvement in levator function after anterior levator resection for the treatment of congenital ptosis. Ophthal Plast Reconstr Surg, 2015, 31(3) :197-201.
9.	Woo KI, Kim YD, Kim YH. Surgical treatment of severe congenital ptosis in patients younger than two years of age using preserved fascia lata. Am J Ophthalmol, 2014, 157(6) :1221-1226.e1.
10.	Rizvi SA, Gupta Y, Yousuf S. Evaluation of safety and efficacy of silicone rod in tarsofrontalis sling surgery for severe congenital ptosis. Ophthal Plast Reconstr Surg, 2014, 30(1) :11-14.
11.	Skaat A, Fabian D, Spierer A, et al. Congenital ptosis repair-surgical, cosmetic, and functional outcome:a report of 162 cases. Can J Ophthalmol, 2013, 48(2) :93-98.
12.	Handor H, Hafidi Z, Bencherif M, et al. Congenital ptosis:experience of a tertiary Moroccan center and latest development. Pan Afr Med J, 2014, 19:150.
13.	Nucci P. Congenital ptosis. Pediatr Med Chir, 2011, 33(3) :146.
14.	高明宏, 蓝平, 于静, 等. 重度先天性上睑下垂的早期手术治疗. 中国实用眼科杂志, 2005, 23(2) :185-187.
15.	袁秀云, 王占云. 上睑下垂的治疗. 中国实用眼科杂志, 2005, 23(11) :1160-1163.
16.	Medel R, Vasquez L, Wolley Dod C. Early frontalis flap surgery as first option to correct congenital ptosis with poor levator function. Orbit, 2014, 33(3) :164-168.
17.	Zhou M, Jin R, Li Q, et al. Frontalis muscle flap advancement for correction of severe ptosis under general anesthesia:modified surgical design with 162 cases in China. Aesthetic Plast Surg, 2014, 38(3) :503-509.
18.	Gupta A, Ganesh S, Adil S. A case of A-pattern esotropia with dissociated vertical deviation with bilateral congenital ptosis. Indian J Ophthalmol, 2008, 56(6) :521-523.
19.	Zinkernagel MS, Ebneter A, Ammann-Rauch D. Effect of upper eyelid surgery on corneal topography. Arch Ophthalmol, 2007, 125(12) :1610-1612.

1. SooHoo JR, Davies BW, Allard FD, et al. Congenital ptosis. Surv Ophthalmol, 2014, 59(5) :483-492.
2. 赵天兰, 余道江, 谢晓明, 等. 以额肌为动力治疗上睑下垂方法的改进. 中华医学美学美容杂志, 2011, 17(1) :9-11.
3. 宋玖, 刘毅, 陈元婕, 等. 宽大额肌瓣悬吊治疗重度先天性上睑下垂. 中国美容医学, 2011, 20(9) :1334-1336.
4. de Figueiredo AR. Blephayoptosis. Semin Ophthalmol, 2010, 25(3) :39-51.
5. Kokubo K, Katori N, Hayashi K, et al. Frontalis suspension with an expanded polytetrafluoroethylene sheet for congenital ptosis repair. J Plast Reconstr Aesthet Surg, 2016.[Epub ahead of print].
6. Zhang D, Guo B, Cai W. Effect of frontal muscle aponeurosis flap suspension surgery for severe congenital ptosis in children. Minerva Pediatr, 2015.[Epub ahead of print].
7. Krohn-Hansen D, Haaskjold E, Nicolaissen B. Suspension surgery with autogenous fascia lata via a less invasive modification of the Crawford method on 85 patients with congenital severe eyelid ptosis. J Plast Surg Hand Surg, 2015, 49(4) :214-219.
8. Göncü T, Çakmak S, Akal A, et al. Improvement in levator function after anterior levator resection for the treatment of congenital ptosis. Ophthal Plast Reconstr Surg, 2015, 31(3) :197-201.
9. Woo KI, Kim YD, Kim YH. Surgical treatment of severe congenital ptosis in patients younger than two years of age using preserved fascia lata. Am J Ophthalmol, 2014, 157(6) :1221-1226.e1.
10. Rizvi SA, Gupta Y, Yousuf S. Evaluation of safety and efficacy of silicone rod in tarsofrontalis sling surgery for severe congenital ptosis. Ophthal Plast Reconstr Surg, 2014, 30(1) :11-14.
11. Skaat A, Fabian D, Spierer A, et al. Congenital ptosis repair-surgical, cosmetic, and functional outcome:a report of 162 cases. Can J Ophthalmol, 2013, 48(2) :93-98.
12. Handor H, Hafidi Z, Bencherif M, et al. Congenital ptosis:experience of a tertiary Moroccan center and latest development. Pan Afr Med J, 2014, 19:150.
13. Nucci P. Congenital ptosis. Pediatr Med Chir, 2011, 33(3) :146.
14. 高明宏, 蓝平, 于静, 等. 重度先天性上睑下垂的早期手术治疗. 中国实用眼科杂志, 2005, 23(2) :185-187.
15. 袁秀云, 王占云. 上睑下垂的治疗. 中国实用眼科杂志, 2005, 23(11) :1160-1163.
16. Medel R, Vasquez L, Wolley Dod C. Early frontalis flap surgery as first option to correct congenital ptosis with poor levator function. Orbit, 2014, 33(3) :164-168.
17. Zhou M, Jin R, Li Q, et al. Frontalis muscle flap advancement for correction of severe ptosis under general anesthesia:modified surgical design with 162 cases in China. Aesthetic Plast Surg, 2014, 38(3) :503-509.
18. Gupta A, Ganesh S, Adil S. A case of A-pattern esotropia with dissociated vertical deviation with bilateral congenital ptosis. Indian J Ophthalmol, 2008, 56(6) :521-523.
19. Zinkernagel MS, Ebneter A, Ammann-Rauch D. Effect of upper eyelid surgery on corneal topography. Arch Ophthalmol, 2007, 125(12) :1610-1612.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL OBSERVATION OF MODERATE TO SEVERE BLEPHAROPTOSIS CORRECTION WITH ARC-SHAPED FRONTALIS APONEUROSIS FLAP

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