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Accurate Application of the levator Palpebrae Superioris Anterior Migration and Shortening Technique in Blepharoptosis Correction Surgery

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Chinese Journal of Plastic and Reconstructive Surgery 2020年第1期2卷 1-7,34页

作者： Peng XU Huizhen HUANG Jun YANG Yuanyuan DU Department of Plastic Surgery Mylike Medical Cosmetic HospitalShanghaiChina Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghaiChina

Background Accurate preoperative evaluation of the levator palpebrae superioris(LPS)strength is required for specific calculation of anterior migration or *** information serves as a surgical reference for more accurate correction of *** Between June 2017 and June 2019,155 eyes of 97 patients were *** were divided into the following 3 groups based on the ptosis degree:mild(28 cases),moderate(53 cases),and severe(16 cases).The LPS strength was evaluated preoperatively and used to calculate LPS anterior migration and *** LPS aponeurosis and Müller’s muscle(L-M)complex was separated from the upper margin of the tarsal plate to the calculated height according to the levator muscle suspension system retention *** complex was subsequently fixed to the planned tarsal plate *** upper eyelid margin(UEM)height,eyelid morphology,eyelid closure,eye symmetry,exposure keratitis status,and patient satisfaction were evaluated at 1 week and at 1 and 6 months *** In all cases,the UEM positions were normal,and only patients with severe ptosis exhibited lagophthalmos in the early posterative *** months postoperatively,13%of eyes in the severe group had residual ptosis;all mild and moderate cases exhibited good surgical *** eyelids closed well with no exposure *** patients were satisfied with the eyelid *** Accurate LPS anterior migration and aponeurosis shortening can eliminate various factors affecting surgical blepharoptosis *** procedures not only reduce operation time but also enhance the stability of postoperative correction.

关键词： Ptosis Suspensory system of the levator palpebrae superioris(LPS) LPS shortening LPS anterior migration levator-Müller(L-M)complex

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Treatment of mild and moderate congenital ptosis via the levator imbrication technique

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Chinese Journal of Plastic and Reconstructive Surgery 2023年第4期5卷 173-177页

作者： Feixue Ding Xuran Zhu Li Yang Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s HospitalShanghai Jiaotong University School of MedicineShanghai 200011China Department of Plastic and Aesthetic Surgery Second Affiliated Hospital Zhengzhou UniversityZhengzhou 450014China

Background:To correct mild and moderate congenital ptosis,traditional surgical techniques usually include dissection of the Müller’s ***,both the levator palpebrae superioris and the Müller’s muscle play a synergistic role to elevate the upper ***,to protect the Müller muscle and minimize injury,we developed and applied a levator imbrication technique in patients with mild and moderate congenital ptosis and followed it up to evaluate its clinical ***:This retrospective case series included 53 patients with mild and moderate congenital ptosis,all of whom had undergone ptosis correction using the levator imbrication technique at the Plastic and Aesthetic Department of the Second Affiliated Hospital of Zhengzhou University between June 2018 and June *** outcomes of correction,upper eyelid appearance,and operative complications were observed and *** postoperative follow-up was 3–12 ***:Fifty cases of ptosis were fully corrected,and the bilateral double eyelids were smooth and *** eyelids of 20 patients were incompletely closed immediately after the operation but were able to close spontaneously within 2 *** serious complications such as exposure keratitis were *** patients with undercorrection underwent reoperation 3 months after the first operation,and ptosis was ***:The levator imbrication technique for mild and moderate congenital ptosis is simple to perform and shortens the operation time with less damage,stable postoperative outcomes,and no long-term complications.

关键词： Ptosis levator Imbricate suture

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The Perineal Membrane: Its Composite Fibers and Nerve Content, and Relationship to the levator Ani and Deep Transverse Perineal Muscles

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Open Journal of Obstetrics and Gynecology 2014年第7期4卷 405-415页

作者： Tetsuji Kurokawa Nobuyuki Hinata Hiromasa Sasaki Gen Murakami Masato Fujisawa Shin-Ichi Abe Yoshio Yosida Department of Anatomy Tokyo Dental College Tokyo Japan Department of Obstetrics and Gynecology Fukui University School of Medicine Fukui Japan Department of Urology Kobe University Graduate School of Medicine Kobe Japan Division of Gynecology and Obstetrics Ishikawa Prefectural Central Hospital Kanazawa Japan Division of Internal Medicine Iwamizawa Kojin-kai Hospital Iwamizawa Japan

The perineal membrane (PM) is a thick, elastic fiber-rich, smooth muscle-poor membrane extending along the vestibule and lower vaginal wall and embedding the urethrovaginal sphincter and compressor urethrae muscles. To provide a better understanding of the topographical relationship between the PM and the levator ani muscle, we examined histological sections from 15 female cadavers. The composite fibers of the PM were usually continuous with that of a fascia covering the inferior or lateral surface of the levator ani (fascia diaphragmatis pelvis inferior) rather than the endopelvic fascia covering the superior or medial surface of the latter muscle. However, this fascial connection was sometimes interrupted by a venous plexus. The deep transverse perineal muscle was consistently adjacent to the posterolateral aspect of the PM, but whether it extended superficially or deeply to the PM depended on size of the muscle. In contrast to the endopelvic fascia embedding abundant middle-sized nerves (cavernous and sphincter nerves;0.05 - 0.1 mm in thickness), the PM contained very thin nerves: many in 10 cadavers but few in 5 cadavers. Most of the nerves seemed to be sensory on the basis of immunohistochemistry. The levator ani muscle was considered likely to provide traction force to the PM, but active elevation appeared to be difficult because of the highly elastic nature of the PM and the interrupting venous plexus. Loss of nerves in the PM might be one of a number of factors that can accelerate pelvic organ prolapse.

关键词： Vagina levator Ani Muscle Perineal Membrane Smooth Muscles Elastic Fibers Nerves

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Evaluation of the levator Palpebrae Superioris Muscle Plication in the Treatment of Ptosis (About 12 Cases)

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Open Journal of Ophthalmology 2019年第3期9卷 125-133页

作者： Aziz El Ouafi Adil Bouzidi Fatine El Alami Said Iferkhass Abdelkader Laktaoui Mohammed Moumine Ophthalmology Service Moulay Ismail Military Hospital Meknes Morocco

Introduction: The ptosis is a fall of the upper eyelid in relation to a deficit of the levator device of this one. In practice, it poses two major problems, the first one is the eminent risk of amblyopia during severe congenital ptosis, and the second is of an aesthetic nature, representing the main reason for consultation. The aim of this work is to evaluate the interest of the levator palpebrae superioris muscle plication in the ptosis surgery. Materials and Methods: We collected 12 patients who received a correction of their ptosis by plication of the levator palpebrae superioris muscle over a period of 3 years from January 2012 to December 2014. Result: The mean age at treatment was 22 years;the ptosis was congenital in 8 cases, and acquired in 4. The ptosis was major in 67% and moderate in 33% of the cases. Muscle plication was the basic surgical technique in all patients in our series. The function and aesthetic results were satisfying in 6 cases (50%), good in 4 cases (34%), acceptable in 1 case and bad in 1 case (8%). Discussion: The comparative study has shown that the plication of the levator palpebrae superioris muscle is a possible alternative for the correction of ptosis whatever the type of ptosis with results comparable to the reference technique compared to the degree of correction, whereas the operative follow-up is simpler and more minor complications. Conclusion: The surgical treatment of ptosis should be done after a systematic clinical examination and after very precise indications. However, the plication of the levator muscle of the upper eyelid has shown its functional and aesthetic efficiency in congenital ptosis and in the ptosis of the adult.

关键词： Congenital Ptosis Acquired Ptosis Placation of the levator Palpebrae Superioris Muscle

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Evolution of the Incision Technique to Construct a Superior Palpebral Fold

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Chinese Journal of Plastic and Reconstructive Surgery 2020年第1期2卷 44-50页

作者： Fei LIU Jun YANG Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghaiChina

The construction of superior palpebral fold gained popularity in the far East and at the present time is the most frequently performed aesthetic operation in the *** incisional techniques have been reported to form upper eyelid crease,which also a confusion for plastic surgeons who lack clinical *** is essential to review the evolution of these incision techniques and outlined the pros and cons of each *** study reviewed the anatomy theory of superior palpebral fold,and reported incision techniques according to different connecting tissue utilized.

关键词： Eyelid levator muscle Orbital septum Tarsal plate

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Supportive tissues of the vagina with special reference to a fibrous skeleton in the perineum: A review

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Open Journal of Obstetrics and Gynecology 2014年第3期4卷 144-157页

作者： Hiromasa Sasaki Nobuyuki Hinata Tetsuji Kurokawa Gen Murakami Department of Obstetrics and Gynecology Fukui University School of Medicine Fukui Japan Department of Urology Kobe University Graduate School of Medicine Kobe Japan Division of Gynecology and Obsterics Ishikawa Prefectural Central Hospital Kanazawa Japan Division of Internal Medicine Iwamizawa Kojin-kai Hospital Iwamizawa Japan

With the aid of immunohistochemistry, the present review attempts to demonstrate the composite fibers and nerve topographical anatomy in the vaginal supportive tissues. Along the tendinous arch of the pelvic fasciae, distal parts of the pelvic plexus extend antero-inferiorly and issue nerves to the internal anal sphincter as well as the cavernous tissues. At the attachment of the levator ani muscle to the rectum, smooth muscles in the endopelvic fascia lining the levator ani merge with the longitudinal smooth muscle layer of the rectum to provide the conjoint longitudinal muscle coat or the longitudinal anal muscle (LAM: smooth muscle). However, at the rectovaginal interface, the longitudinal smooth muscle layer of the rectum continues to the LAM without any contribution of the endopelvic fascia. The bilateral masses of the perineal smooth muscles (PSMs) are connected by the perineal body, and the PSMs receive 1) the longitudinal anal muscle, 2) the internal and external anal sphincters and, 3) the perineal membrane lining the vestibular wall. Tensile stress from the levator ani seems to be transferred to the PSMs via the LAM. Because of their irregularly arrayed muscle fibers, instead of a synchronized contraction in response to nerve impulses, the PSMs are likely to act as a barrier, septum or protector against mechanical stress because, even without innervation, such smooth muscle fibers resist (not absorb) pressure, in accordance with Bayliss’ rule. The external anal sphincter, a strong striated muscle, inserts into the PSMs and seems to play a dynamic role in supporting the rectovaginal interface to maintain the antero-posterior length of the urogenital hiatus. However, we do not think that smooth muscles play an active traction role without cooperation from striated muscle. The fibrous skeleton composed of smooth muscle in the female perineum is explained in terms of a “catamaran” model.

关键词： Vagina levator Ani Muscle Perineal Membrane Smooth Muscles Elastic Fibers Nerves Pelvic Floor Anatomy

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