RESUMO
BACKGROUND: Eyebrow tail ptosis is usually associated with dermatochalasis of the upper eyelid, and it is necessary to treat them together. For these associated procedures to be incorporated as a routine in upper eyelid surgeries, they should preferably be less invasive with consequent fewer complications. OBJECTIVE: We describe a minimally invasive technique for the correction of mild-to-moderate eyebrow tail ptosis corrected together with superior dermatochalasis through the blepharoplasty incision. METHODS: A phase 2 clinical trial was conducted from February 2020 to December 2021. A total of 50 patients underwent conventional upper blepharoplasty surgery associated with the proposed eyebrow lift technique: internal pexia in the periosteum, dissection, and posterior fixation of the orbicularis muscle to the arcus marginalis, removal of the lateral part of the orbicularis muscle, and loosening of the orbital retention ligament. Evaluation of the height of the eyebrow tail was performed with digital photography in the initial consultation and at 30-90 days postoperatively and analyzed with ImageJ software. RESULTS: Mean difference in brow height at 1-month and 3-month postoperative evaluations compared to the preoperative period was 3.45-3.33 mm, respectively. CONCLUSION: Our study demonstrated a minimally invasive surgical technique for the treatment of mild-to-moderate eyebrow ptosis with significant eyebrow tail lift results that remained stable during the study period. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Assuntos
Blefaroplastia , Ritidoplastia , Ferida Cirúrgica , Humanos , Blefaroplastia/métodos , Estudos Prospectivos , Estudos Retrospectivos , Pálpebras/cirurgia , Ritidoplastia/métodos , Sobrancelhas , Ferida Cirúrgica/cirurgiaRESUMO
Resumo Paciente de 69 anos evoluiu com entrópio palpebral severo após cirurgia de correção de ptose palpebral pela técnica de reinserção da aponeurose do músculo levantador da pálpebra superior. Realizada reintervenção onde foi diagnosticado uma fixação da aponeurose em uma posição muito inferior e feita uma refixacação no 1/3 superior do tarso, com melhora do quadro funcional e estético com boa satisfação da paciente. Devido às suturas em topografia mais inferior, o tarso adquire forma de U em decorrência do dobramento no centro da placa tarsal e da rotação inferior da sua metade superior resultando no entrópio. Este caso ressalta a importância do cuidado quanto a localização da inserção da aponeurose do MLPS, principalmente nos paciente idosos, como forma de evitar o encurvamento vertical do tarso.
Abstract Sixty-nine (69) year old patient with severe upper eyelid entropion following surgical correction of ptosis through levator muscle aponeurosis advancement and reinsertion. The aponeurosis advancement appeared to be much lower than typically intended, and surgical repair was performed via aponeurosis re-fixation into the superior 1/3 of the tarsal plate, with subsequent improvement in the aesthetic and functional outcome, and a satisfied patient. Due to the inferiorly located tarsal sutures, the tarsal plate acquires a U-shape due to a central fold and an inferior rotation of its upper half, resulting in entropion formation. This case highlights the importance of taking great care when advancing the levator muscle in ptosis due to levator aponeurosis dehiscence, particularly in elderly patients, so as to avoid vertically folding the superior tarsal plate.
Assuntos
Humanos , Feminino , Idoso , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Blefaroplastia/efeitos adversos , Entrópio/etiologia , Reoperação , Blefaroptose/cirurgia , Blefaroplastia/métodos , Entrópio/cirurgia , Músculos Oculomotores/cirurgiaRESUMO
Resumo A doença relacionada ao IgG4 é uma condição imunomediada caracterizada pela presença de lesões com reação inflamatória associada à fibrose e à infiltração linfoplasmocitária rica em plasmócitos tissulares IgG4 positivos, compondo um espectro de doenças fibroproliferativas. A patogênese da DRIgG4 ainda é pouco compreendida e o tratamento é empírico. Relatamos o caso de um homem de 50 anos com lesões amareladas palpebrais associadas a edema local, diagnosticadas previamente como processo alérgico, até que biópsia com estudo imuno-histoquímico e dosagem de IgG4 sérico aventaram a hipótese de doença relacionada ao IgG4. Foi iniciado tratamento com corticoide e rituximabe, observando-se estabilização do quadro e sem apresentação de outras formas clínicas da doença.
Abstract IgG4-Related Disease is an immunomediated condition that is characterized by the presence of inflammatory lesions associated with fibrosis and lymphoplasmacytic infiltration rich in positive IgG4 tissue plasmocytes, forming a spectrum of fibroproliferative diseases. The pathogenesis of IgG4-RD is still poorly understood and the treatment is empirical. We report the case of a 50-year-old man with yellow eyelid lesions associated with local edema, previously diagnosed as an allergic process, until biopsy with immunohistochemical study and serum IgG4 dosage revealed the hypothesis of IgG4 related disease. Treatment with corticoid and rituximab was initiated, showing stabilization of the condition, without presenting other clinical forms of the disease.
