Frontalis muscle fascial flap passing through the pulley of orbital septum for correction of severe blepharoptosis / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical result of the frontalis muscle fascial flap passing through the pulley of orbital septum for correction of severe blepharoptosis.</p><p><b>METHODS</b>57 eyes in 52 cases with congenital severe blepharoptosis were treated in recent two years. After the frontalis muscle fascial flap was prepared beneath the orbicularis oculi muscle, the pulley was created by two parallel horizontal incision on the orbital septum at the upper orbital rim and 1 cm under the upper rim. The frontalis muscle fascial flap was then pulled down behind the pulley and out to be attached to the upper margin of tarsal plate.</p><p><b>RESULTS</b>The following-up period was 3-6 months. Satisfactory cosmetic result was achieved in 52 eyes. Three eyes had ptosis relapse and 2 eyes had unnatural contour of the palpebral margin which required another corrective operation. No other complication was observed.</p><p><b>CONCLUSIONS</b>The pulley created by the orbital septum makes the traction lines of the frontalis muscle fascial flap in a similar direction as the natural movement of levator muscle. So both the postoperative static and dynamic appearance of the upper lid is more natural. The technique is very practicable in correction of blepharoptosis.</p>

Reconstruction of orbital deformity after radiotherapy with transcranial orbitotomy advancement combining free flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study clinic therapeutic effect about reconstruction of severe orbital and cul-de-sac deformity after the radiotherapy with transcranial orbitotomy advancement combining cascade free flap both dorsum pedis flap and anterior tibial fascial flap.</p><p><b>METHODS</b>Five cases was subjected to orbital and cut-de-sac severe deformities after both operation and radiotherapy because of retinoblastoma. The technique included transcranial orbital advancement by anterior orbital osteotomy and rigid fixed with titanic plate by coronal incision, and meanwhile incising the cul-de-sac which would be extended circumference around the central incision separation, and then designing extent of cascade flap consisted of dorsum pedis flap and anterior tibial fascial flap according to the size of cul-de-sac defect and extent of temporal depression. Then, the aforementioned two parts of cascade flap were transplanted into cul-de-sac and temple respectively. There is either the superficial temporal artery and vein or facial artery and jugular vein to chose vascular anastomosis.</p><p><b>RESULTS</b>All flaps survived. After 3 to 6 months following up, the results showed satisfactory orbital contour and temporal depression improved significantly in all cases. After the conjunctival sac were fixiformed with prefabricated eye prosthesis mode about 3 months. 3 cases have good appearance with wearing eye prosthesis and the other 2 cases' appearance is poor. One of the poor appearance cases, with depressed eye socket, have orbital implant underlying conjunctival sac in secondary operation. The other one, with swallowed inferior fornix, is transplanted autogenous hard palatal mucosa into inferior fornix in secondary operation. In addition, delayed healing in donor site of dorsum pedis occurred in one of the 4 cases.</p><p><b>CONCLUSIONS</b>It is a reliable procedure about reconstruction of severe orbital and cul-de-sac deformity after both the operation and radiotherapy with transcranial orbitotomy advancement combining cascade free flap both dorsum pedis flap and anterior tibial fascial flap. All deformity was corrected by one staged procedure which lessen patient's suffering and shorten patient's hospital stay and spare patient's costs.</p>

Modified transcranial orbitotomy for treating exophthalmic intraorbital tumor / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the feasibility of the modified osteotomy of transcranial orbitotomy in the treatment of intraorbital tumor.</p><p><b>METHODS</b>We treated 8 patients with intraorbital tumor during six years. By the bicoronary incision, all cases underwent double bone flap osteotomy on the frontal bone: the superior orbital rim bone flap and roof flap instead of single fronto-orbital bone flap in the conventional transcranial orbitotomy. After removal of bone flaps, intracranial and intraorbital operation was performed. Then, two bone flaps were reduced respectively and fixated with titanic micro-plates and nails. At last, the scalp flap was sutured.</p><p><b>RESULTS</b>The operative field was very well exposed. It was found that the retrobulbar tumor was located at the superolateral, median and superonasal area respectively, which was coincided with the preoperative CT and MRI. The tumor included adenocarcinoma of the lacrimal gland, neurinoma, meningioma, and cavernous hemangioma. Four patients had blood transfusion during the operation. No other postoperative complications happened except 3 cases of diplopia and one case of blindness. After 3 to 6 months follow up, diplopia of the 3 cases gradually disappeared. Of the 8 cases, 6 reached the same visual acuity as the preoperative state. One decreased visual acuity and one lost light perception. There was well-balanced fronto-orbital appearance and eyeball position compared with the healthy side in all cases.</p><p><b>CONCLUSIONS</b>This surgical method for the treatment of intraorbital tumor is safe with well-exposed operative field. It has advantages not only in simpleness and less trauma, but also in keeping orbital roof and anterior fossa intact and decreasing complications.</p>