levator muscle shortening and advancement

Applicable to partial ptosis. Treatment of diseases: eyelid closure, ptosis Indication Applicable to partial ptosis. Preoperative preparation To do a good job of ptosis correction, you must know the following points before surgery: 1. Upper levator levator function: The physician presses the patient's eyebrow with the thumb of both hands, and the patient squats downwards and looks upwards. If the eyelids are completely motionless, it means that the function of the diaphragm is lost. For example, when the method is up, the eyelids can be lifted slightly, indicating that the levator muscle function is weakened. 2. Upper rectus function: lift the upper eyelids, and the patient looks upward to understand the function of the superior rectus. When the patient closes his eyes, the physician opens the patient's upper jaw and observes the position of the eyeball, such as the cornea is still in place, indicating the lack of bell. Postoperative eyelid regurgitation, corneal exposure, prone to complications. 3. Mandibular blinking movement: When the patient chews or moves the lower jaw to the sides, observe the joint movement of the blink reflex. If the above phenomenon is not suitable for the levator palpebral shortening surgery. 4. Neostigmine test: Except for dying muscle weakness. 5. Cocaine test: In addition to diplomatic sag. 6. Pay attention to eye position, eye movement, presence or absence of double vision. Patients with more obvious internal suture should be corrected first. The timing of surgery for children with ptosis is generally scheduled to be carried out after the age of 3, because the age of the child is too small, and the development of various parts is not perfect, which is likely to lead to failure. Unilateral ptosis should be given as soon as possible after 3 years of age, otherwise amblyopia may occur. Bilateral partial ptosis can be temporarily not operated. Both sides of the complete upper ptosis can be treated surgically, avoiding the special posture of wrinkle, eyebrows and head tilting. Once developed, it is not easy to correct. Surgical procedure Correction of levator palpebral muscle and pre-migration surgery with conjunctival combined incision 1. The eyelid hook is turned over the upper eyelid, fully exposed to the upper iliac crest, and a 0.5 ml local anesthetic is injected under the conjunctiva of the iliac crest with a tb needle. A small incision of the conjunctiva was made on both sides of the conjunctiva, and the length was about 5 mm. Use an iris restorer to enter through a conjunctival incision. The sinus separation between the conjunctiva of the Qianlong and the müller muscle below. Extending from the other side of the conjunctival incision. The upper edge of the iliac crest is separated downward and reaches the top of the iliac crest, but the conjunctiva is not separated. 2. Infiltrating anesthesia between the orbicularis oculi muscle and the tarsal plate, and thus injecting a proper amount of local anesthetic into the levator palpebral direction about 3 ml. The conjunctival sac is built into the metal pad, and the skin and the orbicularis muscle are cut according to the contralateral eyelid line or the normal coveted position, and the tarsal plate is exposed. The orbicularis muscle below the incision is removed. The septum is separated upward by the tarsal plate, the septum is cut horizontally, the sputum fat is separated, and the levator aponeurosis is exposed. 3. Use a blunt-head scissors to make a penetrating small incision on both sides of the upper levator ani muscle. The straight vascular clamp clamps the levator aponeurosis of the upper iliac crest and cuts the levator aponeurosis on the iliac crest. 4. The surgeon holds the vascular clamp in the left hand and gently pulls it outwards to make the levator levator tense. Use the curved scissors to extend the levator muscles into both sides of the levator, cut the inner and outer angles on both sides of the upper levator palpebral and control. The ligaments, as the ligaments are gradually cut, the surgeon feels that the upper levator muscles gradually loosen outward. The surgeon can use his fingers to extend into the sputum on both sides of the levator palpebra, and touch the presence or absence of a sling to extend on both sides of the levator palpebra. If there is no such feeling, the ligament has been completely cut. People open their eyes and look straight ahead. Place the upper edge of the eye on the eyelid at the appropriate position. The levator levator is placed on the surface of the tarsal plate and gently tightened to restore muscle tone. Mark the length of the muscle that should be removed. 5. Make a three-needle rifling loop at this point. The loops on both sides should be slightly forward of the center loop. 6. Fix the upper levator musculature in the central part of the tarsal plate and first hit the knot. Remove the vascular clamp and the eyelid hook and observe whether the splitting of the two eyes is symmetrical. Generally, the splitting of the eye should be slightly larger than the healthy eye by 1 to 2 mm. The position of the wire loop can be corrected when overcorrection or undercorrection. Finally ligature the suture and cut the short line. Cut excess levator levator 2mm below the suture. 7. Check the position of the gingival margin and the eyelashes. If there is no varus and the direction of the eyelashes is appropriate, the tarsal plate for suturing the skin in situ is fixed. Under the local anesthesia, a two-needle traction suture is placed under the local anesthesia, and the lower jaw is pulled upward to protect the cornea. Apply antibiotic eye ointment to the conjunctival sac, cover the eye pad, and compress the dressing. Epiphyseal shortening and pre-migration surgery for conjunctival incision 1. Use the eyelid hook to flip the upper jaw, fully expose the upper iliac crest, and inject 0.5ml of local anesthetic between the conjunctiva and müller muscle. The position should be shallow. The conjunctiva of the iliac crest was cut at the parallel margin of the iliac crest, and the müller muscle below it was finely separated upward to reach the top of the iliac crest. 2. The upper conjunctival wound edge is evenly made into a three-needle loop, temporarily not ligated, and the suture is clamped by a vascular clamp and fixed on the surgical towel. A three-needle suture is also applied to the levator aponeurosis on the upper edge of the iliac crest. After ligation, the levator aponeurosis is cut off at the iliac crest, and then carefully separated upwards to completely separate the aponeurosis from the septum. 3. Cut the inner and outer corners and the ligaments on both sides of the upper levator muscle with a curved shear. As the ligament is cut, the upper levator ligament can be smoothly pulled out of the iliac crest. 4. Regarding the amount of excision of the levator levator, there is no unified understanding so far. According to factors such as the development of the levator muscle, muscle strength, and preoperative cleft palate, the amount of muscle resection is determined, generally 16 to 20 mm. The 3-needle loop of the upper conjunctival wound edge was passed 2 mm below the expected muscle resection. 5. Make 3 pairs of upper levator ani muscle sutures at 2 to 3 mm above the above 3 pairs of sutures, pass through the orbicularis oculi muscles, and pierce the skin at the upper palate. The aforementioned conjunctival surface is passed through the levator ligament 3 needle suture through the tarsal wound edge and the orbicular ridge, and the skin surface is worn out on the edge of the eyelash. Check the effect of the operation, adjust the position of the suture loop if necessary, preferably the upper edge of the upper edge is 1 to 2 mm higher than the healthy side. If the corrective effect is ideal, remove the excess levator levator. The suture of the skin suture is ligated with a rubber sheet. Under the local anesthesia, make a 2-needle traction suture, tighten it upwards, and fix the suture with a tape on the eyebrow to close the cleft palate to protect the cornea. Epiphyseal shortening and pre-migration surgery for skin incision 1. Cut the skin and the orbicularis muscle at the fold of the upper eyelid and expose the seesaw. The orbicularis muscle below the incision is removed. The sputum plate is separated upwards, the septum is cut horizontally, the sputum fat is separated, and the levator muscle is exposed. 2. Make a vertical small incision on both sides of the upper levator musculature, about 5mm long, and use the iris restorer to sneak between the müller muscle and the conjunctiva. Try not to tear the conjunctiva too much, separate the upper edge of the upper jaw and separate it up to the top of the dome. 3. The straight vascular clamp is inserted into a small incision from one side, and protrudes from the other small incision. The iliac crest membrane is placed on the upper edge of the iliac crest and cut off. Care should be taken to avoid incision of the conjunctiva. 4. Use the above-mentioned method to cut into the iliac crest and cut the inner and outer corners of the upper levator ani muscle and the ligament, so that the upper levator ani muscle can be loosely pulled out of the iliac crest. 5. Cut the upper levator muscle about 2mm as required, make a 3-needle loop evenly, and fix it in the center of the tarsal plate, and cut off the excess levator levator. 6. The skin incision is fixed with 3 to 5 needles, which makes the appearance of beautiful double defects.