1. Surgical features:
The suspension of frontalis muscle in children with ptosis in our hospital adopts American polymer suspension material or silica gel. Compared with the traditional frontalis muscle flap suspension, the micro-tunnel technique (TCP) has the dual advantages of "minimally invasive and adjustable", which minimizes the intrusion on undeveloped eyelid tissues (skin, fascia, muscle, fat, etc.). ) children. After operation, the eyelid radian is natural and smooth, the appearance is stable and reliable, and the eyelid activity is obviously better than other traditional frontalis muscle suspension operations.
2. Operation purpose:
Children's blepharoptosis surgery is different from adult plastic surgery. First of all, we should focus on protecting the normal development of the baby's binocular visual function, avoiding habitual tilt caused by eyelid occlusion, leading to abnormal development of visual function such as strabismus and amblyopia, and protecting the normal physiological curvature of the cervical spine.
Second, avoid problems such as autism and inferiority in the process of baby's psychological development. According to research, children after 2 years old gradually have the concept of "beauty and ugliness" and begin to care about the external evaluation of their own defects. By repairing the eyelid appearance in time, the baby can smoothly integrate into the normalized social environment, and at the same time, the anxiety of parents is greatly alleviated.
Third, through the repair of eyelid appearance, the eyelid fascia system around the baby's double eyelids can develop equally.
3. Postoperative effect:
Children's blepharoptosis surgery is different from adult plastic surgery. Children's postoperative appearance is natural, such as "first sight", which is not noticed by outsiders, so that the healthy growth of the baby's body and mind is not disturbed by the outside world. According to the developmental characteristics of children's eyelids in China, small entropion is common after blepharoptosis surgery, and the radian and height of eyelids will be determined individually according to the type of baby's orbital bone development. Under normal circumstances, we don't recommend children to do "European eye and net red eye". The "false, large and wide" double eyelids after operation will increase the trauma of eyelids, and the appearance is unnatural.
For severe blepharoptosis with frontalis muscle suspension, there will be problems such as incomplete eyelid closure, white eyes downward and decreased blinking movement in the early postoperative period. With the passage of time, the above situation will gradually improve, but a few patients will have the above problems for a long time.
4. Postoperative care:
We often say "three-point operation, seven-point care", and postoperative care of ptosis is very important. Efficient postoperative nursing is the guarantee of long-term stable effect.
Congenital ptosis in children is mainly a myogenic disease. Before the operation, eyelid lifting was weak. After operation, eyelid activity is reduced due to extraction, and eyelid closure is incomplete during sleep, which is easy to cause corneal dryness. Therefore, it is very necessary to adopt the family nursing method of "point medicine and seal eyes" early after operation to protect corneal health.
Prescribing medicine as required and wearing wet room glasses can double protect the cornea.
Before the baby falls asleep (as long as he falls asleep, no matter how long he sleeps), gently pull the skin of the lower eyelid on the temporal side of the operation eye to expose the conjunctiva of the eyelid, apply the eye ointment with the size of "mung bean" on the conjunctiva sac of the operation eye, and then gently press the skin of the lower eyelid to make the ointment disperse and be easy to absorb. After sticking to the cheek near risorius, pull the adhesive tape inward and upward to fix the skin in the middle of Yumei's forehead and observe whether the eyelids are completely closed. If it is too loose or too tight, adjust the tension of the tape in time. If the baby is very uncooperative, parents should try to get up every 2 hours at night to observe the baby's eyes and apply eye ointment every 2 hours if necessary.
5. Possible complications:
Rejection is a possible complication of this operation, which usually occurs within 7 days after operation. The symptoms are persistent swelling and pain of eyelids and even wound rupture. If you have similar refusal, please contact the beauty and ophthalmology staff in time. The doctor will initially judge whether it is a normal postoperative reaction or rejection according to the baby's condition. If it is rejection, relevant treatment will be done. The incidence of rejection is 0.2%-0.3%, which is a minimal probability complication, so don't worry too much. When rejection occurs, it is often necessary to take out the material first, and then take other surgical schemes. (It is recommended to participate in the worry-free plan to ensure that in the event of complications, the cost of follow-up treatment is fully guaranteed by the plan, and patients do not need to pay new fees. )
6. Preoperative and postoperative instructions:
① Please refer to the "Instructions for preoperative and postoperative medication" for perioperative medication.
② Operation process:
On the day of the operation, the nurse will make preoperative preparations for the baby, such as taking temperature, changing surgical gown, intravenous indwelling needle, etc. -Enter the observation room and wait for the operation.-After the anesthesiologist, nurse and parents verify all the information twice, guide the baby into the operating room for operation.-After the operation, the baby will be resuscitated in the intensive care unit of the operating room (it is safer to monitor the baby's vital signs).-After the baby is in good condition, transfer to the observation room outside the operating room. Family members should try not to disturb the baby's rest and keep quiet when accompanying him-if the baby doesn't cry or vomit after waking up for half an hour, you can feed some water or liquid food under the guidance of the nursing staff-after the baby leaves the operating room for 2-3 hours, his observation is in good condition and he can be safely discharged from the hospital (back to the hotel) with the confirmation of the doctor-after 6 pm, the medical staff will visit the baby's postoperative situation (designated hotel) to help solve the postoperative problem. If it is not convenient to visit the baby after operation, you can observe it in the clinic for 3 hours before leaving. Routine postoperative review needs to be reviewed for 2 days, and the baby in special circumstances may be extended.
③ Early after operation, the baby will cry because of anesthesia recovery and eye dressing, which is a normal reaction. Parents should actively and optimistically appease and encourage their children. As the baby gradually adapts to the postoperative environment, the crying situation will improve rapidly. Every baby's postoperative reaction is different, and it is normal to be quiet or cry.
④ Postoperative nursing is very important. Parents should not put eyelashes into their eyes when applying eye ointment to their baby before going to bed. Every morning, after taking off the eye-sealing tape, they should check whether the eyelashes are lodging. For example, please gently brush off eyelashes with a cotton swab dipped in normal saline, otherwise the cornea will be scratched by eyelashes when the eyeball rotates, and even corneal inflammation will occur. If trichiasis affects corneal health, you must come to the hospital for treatment.
⑤ If the baby has undergone trichiasis correction surgery (suture is needed, and stitches need to be removed after operation), the lower eyelid skin should be sutured seven days after operation. If the baby can't match the stitches under the face, it needs to be removed under general anesthesia.