The Clinical Application Of Orbital Septum Swelling In Open Double Eyelid Surgery

Part I Investigation on safety and efficacy of conventional orbital septum open method in shallow qualified orthopaedic physiciansObjective:To investigate the safety and efficacy of the most widely used orbital septum opening method(that is,the orbital septum opening method mentioned by Wang Wei-in Plastic Surgery)when used by shallow plastic surgeons.Methods:A total of 19 problems were designed by using the questionnaire of"safety and effectiveness" of conventional orbital septum treatment in the method of double eyelid operation with incision method with shallow qualified plastic surgeon as the research object.The grouping criteria of this survey refer to the method of years for clinical medical professional title assessment,that is,junior physician promotion to intermediate physician minimum age is 4 years.In this survey,whether the physician worked in plastic and cosmetic surgery for 4 years was divided into observation group(junior plastic surgeons)and control group(senior plastic surgeons).The questionnaire was distributed randomly through the online enclosed.Descriptive analysis of demographic data and questionnaire data was carried out.Results:The most difficult identification of anatomical structure during double eyelid operation with incision method was the Muller muscle,63.2%of the people chose the structure,followed by the levator aponeurosis,the selection of 42.1%people,and the number of orbital septum selection is only 15.8%,ranked third,without identifying the difficulties of only 10.5%.In the observation group,52.6%of those who had no experience of double eyelid surgery as a surgeon thought that opening the orbital septum was easy to damage the surrounding tissues,the negative attitude was only 13.2%,and the 34.2%people chose the neutral attitude.In the observation group,22.2%of the people who had the experience of double eyelid surgery as a surgeon had damaged the surrounding tissue when the orbital septum was opened,while the control group reached 60%.55.2%of the people in the observation group thought that opening the orbital septum was easy to damage the levator aponeurosis,44.8%of the people thought it was orbital fat,and 37.9%of the people chose retro-orbicularis oculus fat.In both the observation group and the control group,62.8%thought that the use of conventional orbital septum opening method to open orbital septum bleeding little or very little,34.9%of people choose moderate bleeding.Only 34.5%of those without experience of double eyelid surgery as a surgeon in the observation group were able to find the orbital septum accurately,and 65.5%could not find the orbital septum accurately,while the control group could accurately find the orbital septum up to 100%.In the observation group,100%of the people with surgeon experience thought that opening the orbital septum was easy,but only 11.1%of them were able to open the orbital septum all at once.Conclusion:The conventional orbital septum opening method may have some safety hidden trouble when used by junior plastic surgeons and cannot effectively open the orbital septum.Part 2 The clinical application of orbital septum swelling in open double eyelid surgeryBackground:Orbital septum is an important anatomical structure of upper eyelid,and the orbital septum opening method commonly used in open double eyelid surgery is the orbital septum opening method mentioned by Wang Wei in Plastic Surgery.However,this method has certain safety risks when used by Shallow qualifications plastic surgeon,and cannot effectively open the orbital septum.Objective:To explore a more anatomic and physiological method of orbital septum opening to improve the safety and effectiveness of Shallow qualifications plastic surgeon in opening the orbital septum.Method:160 patients admitted to our hospital for open double eyelid surgery from April 2017 to July 2018 were selected.The patients had no previous history of upper blepharotomy or trauma.Double eyelid surgery incision by conventional cut method,cut skin,remove the orbicularis oculi muscle,appropriate exposure of orbital septum,hemostatic,about 0.3ml of epinephrine anesthetic fluid was injected into the orbital septum from the outside to the inside,a small fusiform opening about 5mm long was cut from the lateral orbital septum,expose the lower orbital fat or the levator aponeurosis,then open the orbital septum along the fusiform opening and expose the levator aponeurosis,when it is necessary to remove the orbital fat herniation properly,8-0 nylon thread was used to suture the levator aponeurosis with the orbicularis oculi muscle of the lower lip through the incision,suture the skin incision 8-0 nylon thread.Results:100 cases of patients,intraoperative using orbital septum swelling and lateral approach through the orbital septum,all can obtain clear anatomical level,less bleeding,thus exposed orbital fat and levator aponeurosis are safely and efficiently.Conclusion:Using orbital septum swelling and lateral approach through the orbital septum during the incisional double eyelid operation has three obvious advantages:?Intraoperative anatomical level more clearly;?Safe and effective exposure of levator aponeurosis and orbital fat;?Open the orbital septum quickly.