Anatomy Of The Upper Eyelid Conjoint Fascial Sheath And Its Application In The Correction Of Moderate Or Severe Congenitial Blepharoptosis

Objective:Studying on the anatomic structure of conjoint fascial sheath of upper eyelids.Providing anatomical foundation for the clinical selection of CFS suspension met hod to correct congenital moderate or severe blepharoptosis.Applicating in the cor rection of moderate or severe blepharoptosis.Evaluating the therapeutic effect of this procedure.Providing a new option for the treatment of congenital moderate or severe blepharoptosis.Methods:1?Using 5 formalin fixed adult cadaveric brains(10 eyelids).Anatomical observation and measurement of CFS were performed by dissecting and exposing CFS.2?Using the anatomy as a foundation,From Jun 2015 to Dec 2016 included24 patients(29 eyelids,)with moderate or severe ptosis who underwent suspension of conjoint fascial sheath with tarsus and double-eyelid blepharoplasty.Postoperative follow-up of 3 months to 12 months(average 6 months),using the following indicators to examine,evaluate and analyze surgery: ?position of upper lid rim?arc of upper palpebral rim?upper eyelid closed normally degree?double fold crease ?phenomenon of lagophthalmos in down-gaze?Conjunctival prolapse?exposure keratitis ?Satisfaction of patients Results:1?The anatomical outcome showed that the upper eyelid CFS was located between the levator palpebrae superioris(LPSM)and the superior rectus muscle(SRM).CFS is connected anteriorly to the LPSM and posteriorly to the SRM.CFS is a white dense layer of sheath tissue.Posteriorly,it was extended from the fascia of the LPSM and SRM.it was extended forward to the superior conjunctival fornix.CFS was11.3±2.3mm(8-14.8mm)length and1.0±0.28mm(0.5-1.5mm)thick.It was located 3.7±0.9mm(2.2-5.4mm)posterior to the fornix.The shape was equilateral trapezoid with a longer base anteriorly.2?The satisfying correction was achieved in all 24 patient cases(29 eyelids)during the following time for at least 3 months to 12 months.The hypophasis existed in the earlier time after operation,but it can recovered after 1-6 months postoperatively.Including 3 patients(3 eyelids)undercorrection,2 patients(3 eyelid) had prolapse of conjunctival,1 patients(1 eyelid)had exposure keratitis.No patients with recurrence,the curvature of the eyelid are satisfactory.Conclusion:1?CFS is connected anteriorly to the LPSM and posteriorly to the SRM.It was extended forward to the superior conjunctival fornix.When Pulling the check ligament,CFSpulls the LPSM and the SRM.In turn,through the CFS connection,the SRM can assist the LPSM to lift the eyelid muscle.2?Upper eyelid CFS suspension treatment of congenital moderate or severe ptosis,simple operation,injury is small,rapid postoperative recovery,eyelid movement close to the physiological state,on the basis of functional correction at the same time to obtain cosmetic results,it is a proper surgery for correct moderate or severe ptosis.