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Objective:To observe the effect of a new modified double-eyelid operation.Methods:From February 2018 to January 2021, modified tarsal plate-orbicularis oculi muscle-orbital septum (TMS) suture was performed in 193 double-eyelid operation in the plastic surgery department of Peking Union Medical College Hospital, including 14 males and 179 females. The patients aged from 18 to 45 years with an average of (22.3±4.2) years. The patients were followed up for 6-24 months to observe the morphology of the double eyelid fold and complications.Results:The 193 patients were included. The double eyelid lines of 173 patients were smooth, natural, durable and the scar was shallow; both doctors and patients were satisfied. There were no obvious complications after the operation. The double eyelid line became shallow or disappeared in 11 patients, and the double eyelid asymmetry occurred in 7 patients after the operation. However, the folds were symmetrical and natural after secondary operation, and both doctors and patients were satisfied.Conclusions:TMS suture not only establishes a firm adhesion, but also effectively transmits the force of the levator aponeurosis with significant advantages. After the operation, the double eyelid line is smooth, natural and stable. Both doctors and patients are highly satisfied. It is an improved double eyelid procedure worthy of clinical promotion.
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Objective@#To establish a treatment protocol for severe blepharoptosis. This protocol helps to achieve better accuracy and more stable result.@*Methods@#Evaluate levator muscle function pre-operatively. When levator function ≤ 1 mm, frontalis suspension technique was performed. When levator function more than 1 mm, technique of levator resection, combining excision of tarsus and levator, and tarsus-levator-CFS suspension was performed accordingly until it reaches adequate correction result during the surgery.@*Results@#A total of 275 severe ptosis patients was included from January 2015 to June 2016. 52 cases (388 eyes) received levator resection. 162 cases received combining excision of tarsus and levator. 24 cases received tarsus-levator- CFS suspension. 37 cases received frontalis suspension. 326 eyes achieved adequate correction results. 62 cases were still undercorrected. The asymmetry result showed that 76 cases presented good symmetry. 142 cases presented moderate asymmetry and 57 showed severe asymmetry.@*Conclusions@#The new treatment protocol shows a satisfactory result with better accuracy and more stable correction for severe ptosis correction.
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Objective Patients with mild or moderate blepharoptosis performed with double eyelid operation only will lead to high complication rates,such as eyelid crease disappearance,unphysiological appearance.In such cases,utilizing levator aponeurosis can create more physiological double eyelid and correct blepharoptosis in the meantime.Methods Levator aponeurosis is utilized as "connecting tissue" to transmit dynamic "motor power" of levator muscle to upper eyelid.Levator advancement was performed at the same time to correct blepharoptosis.Results A total of 74 patients (125 eyes) were operated on in this study.117 eyes (93.6％) showed adequate blepharoptosis correction results,8 eyes (6.4％) showed inadequate correction results.Sixty six cases (89.2％) showed good symmetry results,5 cases (6.8％) showed fair results,3 cases (4％) showed bad symmetry results.One hundred and fourteen eyes (91.2％) showed stable crease,11 eyes (8.8％) showed fair results,no disappearance result was observed in this study.No scar hypertrophy or blepharoptosis on the upper eyelid was encountered.Conclusions This new technique uses pretarsal levator aponeurosis to connect levator muscle and upper eyelid skin,it transmits the dynamic power of the levator muscle to the lid skin directly,which created palperbral crease more anatomically and physiologically.In the meantime,levator advancement can be performed to correct blepharoptosis.Furthermore,"skin adhesion" is formed between levator aponeurosis and dermis in a plane planar manner,allowing for more stable palperbralpalpebral crease and more preserved,and preserving orbicularis oculi in situ,leaving no gap in skin and thus reducing eyelid scar formation.
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PURPOSE: Folliculosebaceous cystic hamartoma is a rare cutaneous hamartoma consisting of dilated folliculosebaceous units invested in mesenchymal elements. There is no report of folliculosebaceous cystic hamartoma case occurred in the eyelid. We report here on this case along with a review of the relevant literature. CASE SUMMARY: 72-year-old female visited for the complaint of a mass in right upper eyelid. The mass was 1.9 × 1.2 cm sized and palpated in the subcutaneous level of right upper eyelid. The mass was not tender and had hardness like rubber. It was covered by skin without adhesion but fixed on the upper tarsal plate. Turning the eyelid inside out, it was found that the upper tarsal plate was penetrated by the mass. There was no specific finding except both cataract by other ophthalmic examination. The paranasal sinus computed tomography finding was well demarcated 0.9 cm sized mass with calcification. The excisional biopsy was performed for diagnosis and treatment. In pathologic finding, various sized normal sebaceous lobules were connected with the dilated follicles through the sebaceous canal and formed infundibular structure. There were sclerosing collagen, adipose cells and vessels between follicles and sebaceous lobules. So it was compatible with folliculosebaceous cystic hamartoma. 18 months later, there was no recurrence and wound was clear. CONCLUSIONS: Folliculosebaceous cystic hamartoma of the eye lid is rare disease, and differential diagnosis is necessary in patient with mass of eyelid.
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Aged , Female , Humans , Biopsy , Cataract , Collagen , Diagnosis , Diagnosis, Differential , Eyelids , Hamartoma , Hardness , Rare Diseases , Recurrence , Rubber , Skin , Wounds and InjuriesABSTRACT
ObjectiveTo evaluate the clinical effects of one stage treatment for the temporal divided naevus of the eyelid.MethodsThe divided naevus infiltrated to the skin,eyelid margin and tarsal plate was completely resected,and co-pedicle double hatchet skin flaps were trimmed.According to the areas of the defects and tension of the sliding flaps,shortening of the eyelids' margins were undertaken.The upper eyelid margin was reconstructed by the downward shift of the tarsal plate.According to the resected height of the tarsal plate,the extended length of the levator aponeurosisMüller's muscle compound was measured.Skin trimming was unnecessary and the incisions were usually closed under no tensions.ResultsEight eyelids of eight cases were treated by this method and followed up for 22 months to 3 years,the eyelids' margins were all in normal positions,without skin chromatic aberration and obvious scar formation.The size of the palpebral fissure and eyelids' movement were normal and no recurrence happened in all patients.Conclusions In addition to the design of the skin flaps,the shortening and reconstruction of the eyelid margin and the balance of the levator palpebrae muscle should also be considered for a bigger temporal divided uaevus in the eyelid.
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PURPOSE: To report a simple surgical technique for rebuilding the palpebral tarsal plate using a Medpor(R) sheet. The formation of a palpebral tarsal plate is very important in the reconstruction of the eyelid. Transplantation of cartilaginous tissue is often necessary to create the palpebral tarsal plate. However obtaining enough cartilaginous tissue is difficult. CASE SUMMARY: Eyelid reconstruction and surgical resection of each lesion was attempted on two patients clinically diagnosed with basal cell carcinoma and sebaceous gland carcinoma between August, 2006 and November, 2007. Reconstruction was performed using a modified Cutler-Beard method or the sebaceous gland carcinoma that occurred in the upper eyelid, and a modified Tenzel semicircular rotational flap procedure was used or the basal cell carcinoma that occurred in the lower eyelid. For the reconstruction of tarsus, 0.45 mm Medpor(R) sheet was used. Complications, such as shortage of eyelid movement, dragging of eyelid or unstable eyelid margin, did not occur after the operations in either subject. In the case of the upper eyelid reconstruction, the eyelid became stiff at the early stage, but the condition improved after 6 months. CONCLUSIONS: The reconstruction of the palpebral tarsal plate using a Medpor(R) sheet is considered an effective and safe technique for the reconstruction of an eyelid.
Subject(s)
Animals , Humans , Ankle , Carcinoma, Basal Cell , Eyelids , Sebaceous Glands , TransplantsABSTRACT
PURPOSE: To assess the efficacy of porous polyethylene (Medpor(R)) sheet as a substitute material for tarsus in lid reconstruction of rabbits. METHODS: A nonrandomized animal study was conducted in 12 rabbits. The Medpor(R) sheet which has a 0.85 mm thickness with barrier surface was implanted in 6 rabbits, and the Medpor(R) sheet without barrier surface was implanted in the others. The full-thickeness eyelid defect which was one third size of eyelid were made in the center of eyelids, and then the Medpor(R) sheet substituted for tarsal plate was sutured with conjuctiva, muscle and skin. At 1, 2 and 4 weeks after implantation, the status of eyelid defect coverage and corneal injury were evaluated. RESULTS: At 1 and 2 weeks after implantation, the shape of eyelid was well maintained, but at 4 weeks, implanted Medpor(R) was exposed and dislocated. However, there was no injury of cornea. CONCLUSIONS: In this study, Medpor(R) sheet which has a 0.85mm thickness was not useful as a substitute for tarsal plate because of incomplete fibrovascularization. The further study for the development of variable size, thickness and shape of Medpor(R) sheet is aquired.