内眦赘皮的矫正 —“ 开眼角”

1. 内眦赘皮的矫正—“开眼角” 河北省人民医院 张芾男

2. 研究意义 • 眼睛的功能 • 视觉器官 • 表达情感的重要器官，流露出心灵深处极为丰富、细致的情感。 • 外在美的重要标志，在面部美学中具有重要的作用。 • 内眦赘皮的影响 • 内眦赘皮是内眦角前方呈斜向或垂直向分布的半月形皮肤蹼状皱襞，在亚洲人群中发生率约为50%。 • 内眦赘皮使正常内眦角被掩盖，眼裂变短，两眼间距过宽，严重影响眼部的美观。 • 重度内眦赘皮遮挡部分视野。 Company Logo

3. 研究进展 • 内眦赘皮的形成原因 • 内眦部眼轮匝肌肌纤维的错位 • 内眦部皮肤在垂直方向的张力过大 • 常见手术方法 • 横切纵缝法、 mustarde法、 V-W成形、鼻侧腱膜固定、z成形、Y-V推进 等 Company Logo

4. Y-V advancement EpicanthoplastyF.C. Li 2008年 • Point a is marked on the edge of the epicanthal fold at the level of the mid-caruncle. • From point a, a horizontal line is drawn medially on the outer surface of the epicanthal fold up to point b. • the nasal skin is pulled medially to completely expose the lacrimal lake. From point a, two lines are made. The line on the upper eyelid corresponds with the planned line for the double eyelid fold. The line on the lower eyelid locates along the lower eyelid border. Company Logo

5. palpebral margin incisionEpicanthoplastyWen Chen 2009年 • Point A was marked 1 mm medial to the lacrimal lake. Extending from point A, two lines along the ciliary margins were marked. The lengths of AB (supraciliary) and AC (subciliary) were made 5 mm and 2 mm. • Incisions were made along AB and AC. By cutting and dissecting the dense connective tissue located between skin and orbicularis oculi muscle in the medial canthal area. • Double eyelidplasty was then performed. After the double eyelidplasty procedure, the end point of the double eyelid fold in the medial canthus was marked as A’. Company Logo

6. The line from point A to A’ was incised and the point A was sutured to point A’. • The excessive skin of the medial canthus in the subciliary was trimmed off along the subciliary incision. Company Logo

7. Inverted V-Y advancement EpicanthoplastyLiQiang Liu2011年 • Point A is marked in the apex of the caruncula fornix just near the skinemucosal junction while the medial semilunar skin is pulled medially to expose the lachrymal lake. • Point Bis located at the new desired medial canthus and is projected onto the surface of the medial semilunar skin when in the natural state of tension. • Point C is located at the supralateral edge of the semilunar skin by making the length of AC equal to that of BC. • Lines AC, BC and AB form a vertical inverse V-shaped skin flap. • Point D is on the subciliary line, the length of AD can be adjusted by the extension of the inverse V-shaped skin flap. Company Logo

8. the vertical V-shaped skin flap is elevated by sharp dissection in the plane superficial to the orbicularis oculi muscle. The excision of the underlying orbicularis oculi muscles should be individualised, continuing to undermine the base of the V-shaped flap. The vertical inverse V flap was released fully and retracted to the inferior area of “bd” line. • Points B and A are sutured together on the medial canthus. The tip of the V flap superior to the level of line BD is trimmed. Company Logo

9. 我的方法 • 术前 • 术后5个月 Company Logo

10. 我的方法 • 术前 • 术后11个月 Company Logo

11. 理想手术方法的要素 • 内眦赘皮矫正彻底。 • 手术瘢痕更不明显。 • 设计简单、定点明确。 • 设计灵活。 • 手术操作简便。 • 手术方法的选择 • 患者内眦赘皮的形态特点 • 术者最为熟练的方法 Company Logo

12. 谢 谢 ！