RU2610218C1 - Elimination method of lagophthalmos - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to the medicine, particularly, to the oral and maxillofacial surgery, and, especially, to the method of elimination of the lagophthalmos. A cutaneous-subcutaneous-fat flap of an upper eyelid is stripped, and an implant site is formed by means of the harvesting of a levator tendon superficial part from an upper tarsal plate. The modelled ear autotransplant is placed between the edge of the tarsal plate of the upper eyelid and the levator tendon superficial part. It is fixed starting from the medial angle of an eye: to the levator tendon superficial part, from the top; to the upper part of the tarsal plate of the upper eyelid, from the bottom. A tunnel, through which a thread is brought to a lower eyelid, is formed at the lateral angle of the eye. Further, the thread is brought along the center of the tarsal plate of the lower eyelid by means of successive injections and outjections, moreover, each following injection matches the previous outjection. The thread ends at the medial angle of the eye are tied and fixed to the periosteum.

EFFECT: elimination method of the lagophthalmos allows creation of counteraction to the levator of the upper eyelid, narrowing of the eye fissure along the vertical axis, improvement of tissue tightness of the periorbital area, and achieving of the adaptation of the eyelids to the eyeball.

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Description

This invention relates to medicine, namely to maxillofacial surgery, and, in particular, to a method of eliminating lagophthalmos.

Lagophthalmos (incomplete closure of the eyelids) is not only a cosmetic defect that causes discomfort to the patient, it also reduces the protection of the anterior segment of the eyeball, which can lead to a number of ophthalmic diseases, up to and including loss of vision.

There is a method of eliminating lagophthalmus with paralysis of the circular muscle of the eye by injecting a needle with a silicone thread subperiosteally above the external ligament of the eyelid, holding it from under the periosteum above the internal ligament, holding the thread in the same tunnel in the thickness of the eyelid in the opposite direction, flashing of the external ligament of the eyelid and puncturing at the injection point [a.s. No. 1296151, A61F 9/00, 1984].

The disadvantage of this method is the possible teething.

There is also a known method for eliminating paralytic lagophthalmus by forming two vertical tunnels in the medial and lateral third of the century between the intermarginal space and the lower orbital margin, placing graft strips from allochondral cartilage with a width twice that of the intermarginal space, half its thickness and half the length of the tunnel, and fixing them to the periosteum of the lower orbit [Patent No. 20088864, A61F 9/00, 1991].

The disadvantage of this method is the reduction of the palpebral fissure due to the placement of allochondral cartilage in the lower eyelid and the risk of transplant migration due to its fixation to the lower orbital edge.

Closest to the proposed is a method of eliminating lagophthalmus by suturing the ear autograft (flap from the auricle). A skin-cell-cartilaginous flap is cut out on the posterior surface of the auricle in the projection of the scaphoid cartilage, on the cartilaginous plate of which notches are applied to give shape and relief. An autograft is fixed to the tarsal cartilage, and its skin is sutured to the skin of the eyelid [Patent No. 2405476, A61B 17/24, 2010].

The disadvantages of this method are the lysis of the skin-cellulose part of the ear autograft, its contouring and migration due to fixation with a polypropylene thread.

The technical result of this invention is the creation of counteraction to the levator of the upper eyelid, narrowing of the palpebral fissure along the vertical axis, improving turgor of tissues of the periorbital region and adaptation of the eyelids to the eyeball.

The technical result is achieved by the fact that in the method of eliminating lagophthalmus by performing an incision along the fold of the upper eyelid, peeling off the flap, fixing the simulated ear autograft to the tarsal plate of the upper eyelid, a distinctive feature is that the skin-subcutaneous-fatty flap is peeled off, and the receptive bed is formed by separation the surface of the levator tendon from the upper tarsal plate, a simulated ear autograft is placed between the upper edge of the tarsal plate ki of the upper eyelid and the surface part of the levator tendon, then it is fixed, starting from the medial corner of the eye from above to the surface part of the levator tendon, and from below to the upper part of the tarsal plate of the upper eyelid, then a tunnel is formed at the lateral corner of the eye through which the thread is passed to the lower eyelid , then the thread is carried out in the middle of the tarsal plate of the lower eyelid by successive injections and punctures, with each subsequent injection coinciding with the previous puncture, the ends of the thread at the medial corner of the eye are tied and fixed they hinder to the periosteum.

The method is as follows (Fig. 1, 2, 3).

After hydrotreating the tissues of the periorbital region with physiological saline with the addition of adrenaline in a ratio of 1: 400, a linear incision is made along the fold of the upper eyelid, then the receiving bed is formed by separating (1) the surface part of the levator tendon (2) from the upper tarsal plate (3), and a bed for auto-cartilage, then a pre-modeled ear auto-cartilage (4) is placed between the upper edge of the tarsal plate (3) of the upper eyelid and the surface of the levator tendon (2), then from the medial angle (5) of the eye the ear autocartilage (4) is copied from above to the surface of the levator tendon (2), from below to the upper part of the tarsal plate (3) of the upper eyelid using a thread based on polytetrafluoroethylene 6-0, then a tunnel (6) is formed at the lateral angle of the eye (7) through which the thread is passed to the lower eyelid (8), on the lower eyelid (8), the thread is carried out in the middle of the tarsal plate (9) of the lower eyelid in the opposite direction to the medial corner (5) of the eye by the method of successive injections, provided that each subsequent injection (10) coincides with the previous puncture, in the medial gla (5) eyes, the ends of the thread are tied and fixed to the periosteum.

Next, an intradermal suture is applied to the edges of the wound with a 7-0 polypropylene thread. On the skin are sterile strips Steri-Strip.

Thus, a single design is obtained that creates a reaction and lengthens the levator of the upper eyelid, replenishes the volume of the upper eyelid and increases the tissue turgor of the periorbital region.

Example

Patient D., 27 years old, was admitted to the FSBI Central Research Institute for Hygiene and Chronic Illness of the Ministry of Health of Russia with complaints of lack of facial movements of the right half of the face, facial asymmetry, and the impossibility of complete closure of the eyelids of the right eye. This disease is noted as a complication after an acute respiratory viral infection.

Objectively: at rest, the right palpebral fissure is 3 mm wider than the left. Lagophthalmus 11 mm. The lower eyelid is located below the limb by 3 mm, the retraction of the upper eyelid is 4 mm.

The patient underwent surgical treatment to eliminate lagophthalmus according to the proposed method.

After hydrotreating the tissues of the periorbital region with physiological saline with the addition of adrenaline in a ratio of 1: 400, a linear incision was made along the fold of the upper eyelid, the skin and subcutaneous tissue were mobilized, then a receptive bed for the ear autocartilage was formed, and the surface part of the levator tendon was separated from the upper tarsal plate.

Ear autochondral cartilage was obtained as follows.

On the posterior surface of the auricle, a flap was marked in the projection of the scaphoid cartilage. Performed the hydraulic preparation of the tissues. We performed an incision in the skin, subcutaneous fat, retreating 1 mm from the skin site, and cut out cartilage. The cartilaginous flap was mobilized from the underlying tissues and removed. The ear autocartilage was resected and modeled under the receptive bed.

Next, a pre-modeled ear autocartilage was placed between the upper edge of the tarsal plate of the upper eyelid and the surface part of the levator tendon, then, from the medial corner of the eye, the autocartilage was fixed from above to the surface part of the levator tendon, from below to the upper part of the tarsal plate of the upper eyelid with 6-0 polytetrafluoroethylene thread.

Then a tunnel was formed at the lateral angle of the eye, through which a thread was passed to the lower eyelid.

On the lower eyelid, the thread was drawn in the middle of the tarsal plate in the opposite direction to the medial corner of the eye by the method of successive injections so that each subsequent injection coincided with the previous puncture. At the medial corner of the eye, the ends of the thread were tied and fixed to the periosteum.

During the operation, hemostasis was provided. Next, an intradermal suture was applied to the wound edges with a 7-0 polypropylene thread.

When examining a patient 6 months after surgical removal of lagophthalmus, the right slit on the right is symmetrical to the left slit. When closing the eyelids on the right - complete closure.

The advantage of this method of eliminating lagophthalmus is not only a narrowing of the palpebral fissure along the vertical axis, but also an increase in the turgor of tissues of the periorbital region, the creation of counteraction to the levator of the upper eyelid, which eliminates the retraction of the eyelid, as well as increasing the adaptation of the eyelid to the eyeball.

Claims (1)

A method for eliminating lagophthalmus by performing an incision along the fold of the upper eyelid, peeling off the flap, fixing the simulated ear autograft to the tarsal plate of the upper eyelid, characterized in that the skin-subcutaneous fat flap is peeled off, a receptive bed is formed by separating the surface of the levator tendon from the upper tarsal plate, a simulated ear autograft is placed between the upper edge of the tarsal plate of the upper eyelid and the surface of the levator tendon, then o fix, starting from the medial angle of the eye from above to the surface of the levator tendon, and from below to the upper part of the tarsal plate of the upper eyelid, then at the lateral corner of the eye form a tunnel through which the thread is passed to the lower eyelid, then the thread is carried out in the middle of the lower tarsal plate by successive injections and punctures, with each subsequent injection coinciding with the previous puncture, the ends of the thread at the medial corner of the eye are tied and fixed to the periosteum.

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