先天性眼瞼下垂症に対する長掌筋腱による吊り上げ術

Frontalis Suspension Technique Using Palmaris Longus Tendon for Congenital Blepharoptosis

はじめに

　先天性眼瞼下垂に対する前頭筋吊り上げ術は，挙筋機能の有無によらず安定した挙上効果が得られるため広く用いられている。吊り上げ術に用いる移植素材として，当講座では手外科手術の多い背景から長掌筋腱を積極的に選択してきた。そこで手術中の工夫を紹介し，長掌筋腱の特性について述べる。

　Frontalis suspension to correct congenital blepharoptosis provides stable results regardless of the upper levator function. The autologous tissue grafts possess high biocompatibility, but postoperative degeneration and donor scarring can result in some complications. Postoperative shrink has been observed among cases using palmaris longus tendon grafts. However, the shrinkage was minimal, and thus long-lasting effects are expected. The amount of the elevation of the upper eyelid is adjusted at the position where the upper and lower eyelids meet, and this was inferred to be appropriate because there is no record of adverse events such as lagophthalmos or the recurrence of ptosis. In addition, the palmaris longus tendon can be easily harvested through small incisions, which reduces the burden on the patient. Although the palmaris longus tendon seems to be an ideal graft material, it should be noted that the palmaris longus tendon might be absent in some patients, and that infant cases require certain technical experience.