안검하수에서 세 갈래로 가른 전두근판전위술과 전두근-근막판전진술의 사진계측학적 비교

Abstract

Lately, both the frontalis muscle flap transposition and the frontalis myofascial advancement flap have been used mainly for the correction of blepharoptosis with poor levator function. Therefore, the purpose of this study is to know the functional differences of these two methods by objective method. During the past 16 years, the 43 patients, aged 5 to 68 years(mean 32.4 years) have been undergone the tripartite frontalis muscle flap transposition(unilateral 16 patients; bilatral 12 patients, 24 eyelids) and the frontalis myofascial advancement flap(unilateral 8 patients; bilateral 7 patients, 14 eyelids). To compare these two methods, this study was done with the anthropometry using photogrammetric analysis with an average follow-up of 5.5 years. Ptosis ratio on the primary gaze and the upward gaze, and the height of palpebral fissure on the downward gaze and the closing eyes were measured. The results were statistically analysed using Wilcoxon signed ranks test. In conclusion, there is no difference on the primary gaze, the downward gaze, and the closing eyes between the tripartite frontalis muscle flap transposition and the frontalis myofascial advancement flap, but ptosis degree on the upward gaze was less severe in the tripartite frontalis muscle flap transposition. This difference may result from disparity in contractile power of the frontalis muscle due to not only anatomical structure but also size of the flap. Second, the orbicularis oculi muscle is atropied by denervation of the temporal branch of the facial nerve in frontalis myofascial advancement flap.

저자들은 상안검거근 기능이 4mm 미만인 안검하수를 교정하기 위하여 주로 사용되고 있는 전두근판전위술과 전두근-근막판전진술을 정면주시와 상방주시 때는 안검하수율을 하방주시때 나타나는 안검지체와 누워서 눈을 감았을 때 나타나는 토안은 안검렬 높이를 사진계측법을 이용하여 측정비교하였을 때 정면주시, 하방주시, 누워서 눈을 감았을 때에는 통계학적 차이가 없었으나 좀 더 역동적인 상안검의 작용이 필요한 상방주시때에는 전두근-근막판전진술에서 안검하수가 더 심함을 알 수 있었다. 따라서 전두근판전위술이 전두근-근막판전진술보다 상방주시 때 기능적인 면에서 더 우수한 것을 얻을 수 있었다.