levator muscle shortening

Lifting the diaphragm shortening is one of the main clinical procedures for the treatment of congenital and acquired ptosis. It maintains the original walking and moving direction of the muscle, and it is more in line with physiological requirements, so it can achieve better cosmetic purposes. However, the success rate of surgery is often reduced by the occurrence of complications. Curing disease: Indication Congenital, senile, traumatic or other types of ptosis of the upper iliac muscles above 4 mm. Contraindications Lift the muscles of the diaphragm muscles. Preoperative preparation 1. The calculation of the shortening amount cannot mechanically calculate the amount of shortening based on the amount of sag. Because the amount of sag is the same and the muscle strength is different, after the same shortening amount, the weaker muscle strength is not as strong as the muscle strength. Therefore, the determination of the amount of shortening is mainly determined by the strength of the muscles. (1) The amount of shortening of the tendon muscle strength is less, and the shortening amount is more. (2) The type of ptosis: congenital shortening should be more, senile should be much less, trauma is between congenital and senile, should be close to congenital. (3) Degree of sagging: The heavier the sag, the more the amount of shortening, the lighter the sag, and the less the amount of shortening. (4) Lifting the elasticity of the diaphragm: After cutting the external and internal angles, if the elasticity of the upper jaw is found to be very good or good, it means that the upper part of the upper jaw is too tight by the outer corner and the inner angle is limited by the upper jaw. . At this time, the amount of shortening can be reduced by 1 mm compared with the expected amount. (5) The degree of correction required: Progressive extraocular muscle paralysis, such as correction to normal height, is likely to produce exposed keratitis. If there is no Bell phenomenon or delay in the upper jaw, the correction should be conservative. Generally, the amount of sag for each correction is reduced by 4 to 6 mm. Congenital ptosis muscle strength of 4mm, need to shorten 20 ~ 24mm; muscle strength of 5 ~ 7mm, shortened 14 ~ 18mm; muscle strength of 8mm or more, shortened 10 ~ 12mm. The senile ptosis should not be more than 10mm, and the congenital should not be less than 10mm. The upper diaphragm shortening is different from the frontal muscle suspension, because the muscle strength of the latter is below 3mm, and the position of the upper jaw gradually decreases with time. The lifting of the diaphragm is based on different muscle strength shortening criteria, and the position of the upper jaw can continue to increase, unchanged or decrease. Berke suggested that congenital ptosis in one eye, different muscle strength, surgical correction of the upper jaw height. The following describes the transcutaneous extraction of the diaphragm. This method exposes the anatomical landmarks clearly, and the shortening amount is easy to adjust. It is convenient to treat the incision, varus or sacral margin of the sacral margin during operation. This procedure is the most commonly used one. 2. Preoperative examination In addition to the routine general examination before surgery, the partial examination of the eye includes the following items: (1) Vision (corrected vision) and refractive conditions: Although ptosis itself rarely produces amblyopia, it is often accompanied by imbalance of extraocular muscles or abnormal eyeball development and may cause amblyopia, so for each cooperative child Vision and refractive measurements should be performed. (2) degree of sagging: including measuring the height of the cleft palate, the amount of corneal covering the upper eyelid, the distance between the eyebrows and the muscle strength of the upper eyelid. 1 Measurement of cleft palate: one hand thumb oppresses the patient's eyebrow arch, the other hand holds the ruler in front of the patient's eye, let the patient look forward, up and down, respectively, measuring the cleft palate height, and comparing the sides. 2 Measure the amount of corneal covering the upper eyelid: avoid looking up or using the frontal muscle during the measurement. In normal head-up, the upper temporal margin covers the upper cornea 2 mm, and if it covers 6 mm, the sag is 4 mm. According to the measurement results, the ptosis points are: mild (1 ~ 2mm), moderate (3mm) and severe drooping (4mm or more). 3 Measure the distance between the eyebrows and the eyebrows: The distance from the lower edge of the eyebrows to the upper rim of the eyebrows is 18.09±1.95mm. 4 Measure the muscle strength of the diaphragm: let the patient look straight ahead, the examiner presses the eyebrow bow horizontally with the thumb, so that the connection between the frontal muscle and the upper jaw is interrupted, and the patient tries to look down. At this time, the scale is zero. At the center of the edge, then the patient is trying to look up, and the amplitude of this movement is to lift the muscles of the diaphragm. It contains the role of Müller muscle and the effect of the eyeball on the upper jaw 0 ~ 2mm. When the normal person does not use the frontal muscle, the average amplitude of the upper jaw movement is 13.37±2.55mm. The muscle strength of the upper jaw is generally divided into three levels. The good upper jaw movement amplitude is 8mm, the medium is 4~7mm, and the weak one is 0~3mm. (3) The function of the superior rectus muscle and other external eye muscles: Lift the upper eyelids, let the patient's eyes move in all directions, and compare the eyes to each other to observe the function of the external and upper rectus muscles. If the upper rectus paralysis or incomplete paralysis, and even the Bell phenomenon disappears, it is not appropriate to do the correction of the ptosis first, the dysfunction of the superior rectus muscle or extraocular muscle should be treated first. (4) Determination of extraocular muscle balance: Lift the upper eyelids and let the eyeballs move in all directions to observe whether they are consistent, with or without strabismus and diplopia. (5) Let the patient do a chewing exercise: Exclude the Marcus Gunn phenomenon. (6) Eyelid and ocular fracture shape: The normal position of the upper palate is 2 to 3 mm from the iliac crest, and the central part is about 3 to 4 mm from the iliac crest. The elderly are slightly lower. Attention should be paid to the position of the upper fold and the bilateral symmetry. (7) Measurement of the width of the tarsal plate: especially in cases where surgery has been performed, the eyelid should be turned over to measure the height of the rim to the rim of the iliac crest. (8) Whether there is stagnation of the upper jaw: The delay of the upper jaw refers to the downward movement of the eyeball, and the upper jaw cannot move down with the eyeball. (9) Other inspections: 1 neostigmine test: exclude myasthenia gravis. 2 Adrenaline and cocaine cotton test: If the cleavage is too positive, sympathetic drooping can be ruled out. 3 corneal sensory test: check the cornea for other unhealthy conditions. 4Müller muscle function test: with 10% phenylephrine adrenal gland adrenaline, the upper eyelid can be improved, indicating that Müller muscle has function. (10) The front part of the front of the operation is photographed and prepared for reference. Surgical procedure 1. In the methylene blue, the upper eyelid fold of the eye is drawn, and the upper eyelid fold of the eye should be consistent with the curvature of the upper eyelid of the contralateral healthy eye and the distance from the temporal margin. If the contralateral healthy eye has no upper eyelid folds, the upper eyelid folds should be performed at the same time as the surgical eye. 2. Use a 1-0 suture to make a traction suture at the junction of the outer 1/3 and the middle 1/3 of the rim. Flip the upper palate and expose the conjunctiva. 3. The subconjunctival injection of 2% lidocaine 0.5 ml in the Qianlong section, on the one hand, anesthesia, on the other hand, the Mü-ller muscle and the conjunctiva of the iliac crest were separated. The needle should be shallow when injecting. 4. A 5 mm long longitudinal incision was made in the conjunctiva of the medial and lateral iliac crest. The blunt-headed scissors were used to extend into the conjunctiva. The conjunctiva of the iliac crest was separated from the Müller muscle and placed in the rubber band to the inner conjunctival incision. 5. Eyelid reduction, in the skin methylene blue line (3 ~ 5mm from the gingival margin) cut the skin, subcutaneous tissue deep into the tarsal plate, use scissors to separate the orbicularis muscle on the tarsal plate, to expose the full length of the tarsal plate And the anterior aponeurosis of the iliac crest. 6. Cut the aponeurosis in the longitudinal direction of the upper and lower jaws above the edge of the tarsal plate. 7. Clamp the Müller muscle with the muscle spasm and lift the diaphragm and septum of the diaphragm and lock the muscles. 8. Cut the septum between the upper edge of the humerus and the muscle spasm, lift the diaphragm of the diaphragm and Müller muscle, and pull out the exposed rubber band. 9. Continue to separate upwards in front of the aponeurosis and under the Müller muscles, and cut the outer and inner corners. 10. Separate and expose the Whitnall ligament in front of the diaphragm to separate the diaphragm from the ligament. Pull the muscles down and test for muscle elasticity. 2mm above the iliac chopping line, and 3 sutures were ligated, and the sacral muscles were cut along the line to cut with straight scissors. 11. Three sutured sutures (ligated) are sutured on the tarsal plate, the suture is tightened and the knot is alive, the height and curvature of the palate are observed and adjusted. After satisfactory, the iliac muscle is fixed. On the seesaw. 12. The lower lip of the skin incision cuts a thin strip of rim muscle, and the upper lip of the incision cuts off an excess skin. 13. The sutures that suture the skin should pass through the tarsal plate to form the upper crease. 14. If the conjunctival prolapse of the Qianlong is obvious, use a 3-0 silk thread to insert the needle from the conjunctiva, wear it from the upper eyelid skin, and make 3 pairs of sutures. If the cleft palate is incomplete, use the No. 0 line to make the Frost suture at the proximal iliac crest to close the cleft palate and fix the suture to the forehead with a tape. Conjunctival sac coated antibiotic eye ointment with one eye bandage.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.