| OBJECTIVE: To explore the relationship between superior septum and mild ptosis,and to provide a scientific basis for better use of septal correction for mild ptosis.METHODS: This study will be used in the outpatients of the outpatients who underwent the incision blepharoplasty in the period from May 2018 to December 2018 in accordance with the "Chinese Medical Journal" The ptosis classification method was divided into normal group and mild ptosis group,and the septal observation was performed.The observation index is the connection between the superior septum and the peripheral structure,the location of the septal and levator aponeurosis fusion,and the histological structure of the septum.First,the observation of the connection between the septum and the surrounding structure.During the operation,the upper eyelid skin was removed along the marking line,the orbicularis muscle was removed,and the septum was exposed.The tissue was cut laterally by a width of about2 mm,and the cut tissue was left as a specimen for histological observation.After cutting off the septal tissue,the fat in the sputum bulges,and the connection between the septum and the rouge capsule,septum and levator aponeurosis is observed.Is there any adhesion and septum between the septum and the rouge capsule? Whether there is a restriction ligament between the levator aponeurosis and the result is filled in the septum observation table.The chi-square test analyzed the incidence of adhesion between the septum and the rouge capsule between the two groups,and whether there was a difference in the rate of ligament between the septum and the levator aponeurosis.Second,the position of the septum and the levator aponeurosis fusion part of the upper eyelid.There are three types of positions: the fusion portion is higher than the upper tarsal plate,the fusion portion is equal to the upper tarsal plate,and the fusion portion is lower than the upper tarsal plate.After exposing the fusion portion,the width of the upper tarsal plate and the height of the fusion portion(accurate to 0.5 mm)were measured with a scale,and the results were filled in the septum observation table.The chi-square test analyzed the incidence of adhesion between the septum and the rouge capsule between the two groups,and whether there was a difference in the rate of ligament between the septum and the levator aponeurosis.Third,Histological observation of the septum.Ten cases(5 cases in the normal group and 5 cases in the sagging group)were treated with paraffin-embedded tissue.The structure of the septal tissue was observed by HE staining.The structural differences between the two groups were compared.The muscle structure was searched by Masson staining.And compared the difference in muscle structure between the normal group and the mild ptosis group.The SMA staining confirmed whether the muscle structure was smooth muscle,and compared the content of smooth muscle fibers and the difference of the smooth muscle fibers in the normal group and the mild ptosis group.RESULTS:First,The connection between the septum and the rouge capsule and the levator aponeurosis.In both groups,the septum was found to be continuous with the levator aponeurosis.In the normal group of 190 eyes,the number of adhesions between the septum and the rouge capsule was 32 eyes,44 eyes were found between the septum and the levator aponeurosis,and 18 eyes were found in the mild ptosis group.The number of adhesions between the septum and the rouge capsule was 15 eyes,and 13 eyes were found between the septum and the levator aponeurosis.In the mild ptosis group,the incidence of septal adhesion and the abnormal adhesion of the sacral capsule was higher than that in the normal group(X2=41.562,P<0.05).The levator palpebral ligament in the mild ptosis group was lower than that in the normal group.The incidence was high(X2=19.896,P<0.05).Second,The position of the septum and the fusion of the levator aponeurosis.The overall fascia width was 11.055±0.630 mm,the normal group was 11.055±0.625 mm,and the mild ptosis group was 11.056±0.685 mm.There was no significant difference in the width of the tarsal plate between the normal group and the mild ptosis group(t=0.006,P=0.995).The overall fusion height was 11.082±0.664 mm,the normal group was 11.029±0.657 mm,and the mild ptosis group was 11.639±0.435 mm.The position of the fusion part of the mild ptosis group was higher than that of the normal group(t=3.855,P<0.05).The distribution of the septal position was not significantly different between the two groups(X2 = 2.392,P = 0.302).Third,The septum of the two groups is mainly connective tissue structure and can be divided into two layers.The front layer is looser and the back layer is denser.Compared with the normal group,the mild ptosis group had less and more loose connective tissue fibers,indicating that the sacral tissue of the mild ptosis group was weaker.Masson staining showed no muscle tissue structure in the normal group and the mild ptosis group.The results of SMA staining showed that the SMA staining of the normal group and the sag group was negative except for the blood vessels passing through the septum.No smooth muscle structure was found between the two groups.Conclusion: The incidence of adhesion between the septum and the rouge capsule in the mild ptosis group,the rate of ligament sac between the septum and the levator aponeurosis is higher than that in the normal group;the septum in the mild ptosis group The height of the fusion with the levator aponeurosis was higher than that of the normal group.The septum of the mild ptosis group was weaker than that of the normal group.Therefore,the adhesion between the septum and the rouge capsule,the restriction of the ligament between the septum and the levator aponeurosis,and the position of the septal and levator aponeurosis fusion may be the cause of mild ptosis.It is suggested that the treatment of the septum in clinical surgery may have the effect of treating mild ptosis. |
