CO₂ Laser Excision of a Mole Above the Medial Canthus: Anatomical Challenges and the Role of the Supratrochlear Artery 眼內角(鼻內眥)上方痣之 CO₂ 雷射切除：解剖學挑戰與眶上滑車動脈的角色
激光脫墨－位於鼻樑右邊的一粒淺啡色的突出的墨痣
Laser removal of a mole on medial side of the right eyelid close to the medial eyebrow (actually quite close to the nose bridge)
位於右邊眉毛下，近鼻側的一粒巨大墨痣。
激光脫墨前
另一個角度
側面近鏡，可見其突出的狀態。
脫墨後的傷口。傷口近鏡，可見傷口陷入皮膚內。
數星期後，傷口復原。傷口復原後，近鏡，可見傷口平整，並無凹陷，只有少量色素沉著。此等色素會隨時間而變淡。
超近鏡，可見傷口復原後，仍然有毛髮長出，眉毛不受影響。
CO₂ Laser Excision of a Mole Above the Medial Canthus: Anatomical Challenges and the Role of the Supratrochlear Artery
The removal of a mole located just above the medial canthus of the right eye is a technically demanding procedure. This region is not only cosmetically sensitive but also anatomically complex, with the supratrochlear artery emerging nearby. CO₂ laser excision in this position requires heightened precision to balance complete lesion removal with preservation of vascular integrity and aesthetic outcome.
Anatomical Considerations
- The supratrochlear artery emerges from the orbit near the supratrochlear notch, ascending into the subcutaneous tissue of the medial forehead.
- Its proximity to the mole’s position means that careless ablation risks arterial injury, leading to bleeding, hematoma, or compromised blood supply to the forehead flap region.
- The artery runs alongside the supratrochlear nerve, so inadvertent damage may also cause sensory disturbance in the medial forehead.
Vascular Considerations
- The supratrochlear artery must be preserved to maintain forehead vascularity.
- Injury to the artery can cause persistent bleeding, complicating the procedure and obscuring the operative field.
- In reconstructive contexts, the supratrochlear artery is vital for forehead flaps; damage may compromise future surgical options.
Conclusion
CO₂ laser excision of a mole just above the medial canthus is challenging due to the close relationship with the supratrochlear artery, cosmetic sensitivity of the periorbital region, and technical demands of laser surgery. Success depends on precise depth control, careful preservation of vascular structures, and vigilant postoperative care. When performed skillfully, scars can fade to near invisibility, but the procedure requires heightened awareness of both medical and aesthetic factors in this delicate location.
CO₂ 雷射切除鼻內眥(眼內角)上方痣：解剖學挑戰與眶上滑車動脈的角色
位於右眼鼻內眥上方的痣切除是一項技術要求極高的手術。此區域不僅在美容上極為敏感，且解剖結構複雜，眶上滑車動脈正好在附近出現。進行 CO₂ 雷射切除時，必須高度精準，以在完整去除病灶的同時，維持血管完整性並兼顧美觀效果。
解剖學考量
- 眶上滑車動脈自眶內滑車切跡附近出現，並上行進入前額的皮下組織。
- 由於其位置接近痣，若汽化過程不慎，可能造成動脈損傷，引發出血、血腫，甚至影響前額皮瓣的血液供應。
- 該動脈與眶上滑車神經並行，若誤傷亦可能導致前額內側的感覺障礙。
血管考量
- 必須保護眶上滑車動脈以維持前額的血流。
- 動脈損傷可能造成持續性出血，增加手術難度並遮蔽術野。
- 在重建手術中，眶上滑車動脈對前額皮瓣至關重要；若受損，可能影響未來的手術選擇。
結論
CO₂ 雷射切除位於鼻內眥上方的痣具有挑戰性，原因在於其與眶上滑車動脈的密切關係、眼眶周圍區域的美容敏感性，以及雷射手術的技術要求。成功的關鍵在於精確的深度控制、謹慎保護血管結構，以及嚴密的術後照護。若操作得當，疤痕可逐漸淡化至幾乎不可見。