Generality
Ptosis is the term by which doctors mean any downward displacement of one or more parts of an organ.
Ptosis depends on the force of gravity and can be a consequence of aging, obesity or neurological, muscular or neuromuscular conditions.
The best known and most widespread type of ptosis is eyelid ptosis, also called drooping eyelid or blepharoptosis.
What is ptosis?
Ptosis is the medical term for any downward shift (prolapse) of one or more parts of an organ.
The word "ptosis" comes from "ptosis” (πτῶσις), an ancient Greek word that means "fall".
Causes
Dependent on the force of gravity (which induces downward displacement), episodes of ptosis can be the consequence of aging, obesity or neurological, muscular or neuromuscular conditions.
Types
There are numerous types of ptosis.
The best known and most widespread type is certainly the eyelid ptosis.
However, here also deserve mention: renal ptosis, gastric ptosis, intestinal ptosis, visceral ptosis, breast ptosis and cardiac ptosis.
EYEBRAL PTOSIS OR FALLING EYELET
Also known as drooping eyelid or blepharoptosis, eyelid ptosis is the abnormal drooping of one or both upper eyelids.
This particular ocular condition can be a congenital problem - therefore present from birth - or a problem that appears in the course of life, due to some specific reasons.
Eyelid ptosis that occurs from birth is called congenital eyelid ptosis, while eyelid ptosis that occurs only at a certain age is known as acquired eyelid ptosis.
The causes of eyelid ptosis are numerous.
Congenital forms can result from:
- Poor development of the muscles that lift and close the eyelid (levator muscle, orbicularis muscle of the eye and superior tarsal muscle);
- Genetic / chromosomal defects;
- Congenital neurological dysfunctions;
The acquired forms, on the other hand, can be a consequence of:
- Aging. As we age, the muscles of the human being weaken, including the muscles that govern the opening and closing of the upper eyelids;
- Separation or stretching of the levator (eyelid) tendon
- Cataract interventions. In these situations, eyelid ptosis is a surgical complication;
- Ocular trauma affecting the muscles responsible for the movement of the upper eyelids (eg: paralysis of the upper tarsal muscle);
- Neurological disorders affecting the nerves responsible for controlling the eyelid muscles (eg oculomotor nerve paralysis, Horner's syndrome, stroke, etc.);
- Neuromuscular diseases, such as the myasthenia gravis;
- Ocular tumors;
- Systemic diseases, such as diabetes;
- Taking high doses of opioid drugs (morphine, oxycodone, etc.);
- Drug abuse (eg heroin).
The typical sign of eyelid ptosis is the sagging of one or both upper eyelids.
The failure can be barely noticeable (less severe cases) or particularly evident (more severe cases). In the presence of severe eyelid ptosis, both the pupil and the iris are covered (by the eyelid) and the patient may experience vision problems.
In children, eyelid ptosis is a condition that is quite frequently associated with amblyopia (lazy eye) or strabismus.
The diagnosis of eyelid ptosis and its triggering causes may require the execution of numerous tests, including tests for the evaluation of the muscular capacity of the eyelids, tests for the evaluation of the eyelid nerve functions, etc.
The treatment of eyelid ptosis is mainly based on two elements: the triggering factors - this explains why their precise identification, in the diagnosis phase, is important - and the severity of the eyelid droop.
- Congenital eyelid ptosis. If mild, periodic medical observation is sufficient.
If particularly severe, it represents a typical ideal condition for resorting to blepharoplasty. - Eyelid ptosis due to aging. What has been said previously applies: if it is mild, periodic observation by the doctor is sufficient; if severe, however, it requires blepharoplasty.
- Eyelid ptosis due to myasthenia gravis. There myasthenia gravis it is a disease for which there is no specific treatment, but only symptomatic therapies (i.e. focused on treating the symptoms). To reduce the eyelid ptosis induced by myasthenia gravis, the cholinesterase inhibitors pyridostigmine and neostigmine, the corticosteroids prednisone and derivatives and the immunosuppressive drugs azathioprine, cyclosporine and methotrexate are useful.
The prognosis in case of eyelid ptosis depends on the severity of the triggering causes: the less severe and more easily treatable is the condition that determines the drooping of the eyelids, the higher the probability of improving the appearance of the affected eyelid (s).
It mainly concerns those affected by myasthenia gravis and myotonic dystrophy.
It is typical of those suffering from oculomotor nerve palsy.
KIDNEY PTOSIS OR NEPHROPTOSIS
Renal ptosis, or nephroptosis, is the abnormal lowering of one or both kidneys, which occurs when the affected person moves from a supine to a standing position.
Doctors would like to point out that a renal ptosis is considered as such, when the kidney or kidneys, moving downwards, make a movement of at least 5 centimeters or at least two vertebral bodies.
Renal ptosis is particularly widespread in the female population (especially among women of slender build), it affects the right kidney more frequently (even if 20% of cases are bilateral) and it seems to affect more than 20% of young people.
Currently, the precise causes of nephroptosis are unknown. According to some experts, the problem in question is due to a weakening of the so-called renal fascial complex (or renal fascia). The renal fascial complex is a set of serous sheets that delimit and hold the kidneys in place.
In most cases, renal ptosis is asymptomatic, meaning it does not cause any symptoms. More rarely, it is responsible for: flank pain, nausea, hypertension, chills, hematuria and / or proteinuria.
Following the obstruction that the kidney makes to the damage of the renal tracts, the pain in the side has the particularity of easing if the patient lies down.
Typically, the diagnostic process for detecting renal ptosis includes a thorough physical examination and intravenous urography. In doubtful cases, renal scintigraphy, abdominal CT and / or abdominal ultrasound may be required. .
Today, the only cases of renal ptosis undergoing treatment are symptomatic. For patients who do not feel any kind of ailment, in fact, the so-called medical observation is opted for.
The treatment of symptomatic cases of renal ptosis consists in the "laparoscopic nephropexy operation. Laparoscopic nephropyxis is a surgical procedure, performed in laparoscopy, which involves the repositioning of the kidney in its natural location and its fixing, by means of sutures, to some anatomical structures neighboring.
GASTRIC PTOSIS OR GASTROPTOSIS
Gastric ptosis, or gastroptosis, is the abnormal movement of the stomach into the lower abdomen.
Typically, gastric ptosis sufferers complain of digestive problems, abdominal pain and constipation, but it cannot be considered life threatening.
More common in the female population, gastric ptosis can be a condition present from birth (congenital gastroptosis) or a condition that arose at some point in life (acquired gastroptosis).
Gastroptosis depends on a weakening of the anterior abdominal wall, which, in normal conditions, also has the task of keeping the organs of the abdomen in place.
In cases of congenital gastroptosis, the weakening of the abdominal wall depends on an inappropriate development of the muscles that constitute it; in cases of acquired gastroptosis, however, the weakening of the abdominal wall can have various causes, including:
- A sudden loss of abdominal fat, following a strict diet;
- Abdominal surgery. In such situations, gastroptosis is a surgical complication;
- Childbirth;
- Vitamin and / or protein deficiencies.
Depending on the extent of the decrease, doctors distinguish gastric ptosis into: first degree gastroptosis, second degree gastroptosis and third degree gastroptosis.
Gastroptosis is of the first degree in which the stomach, after its downward displacement, resides 2 centimeters above the so-called pectine crest of the iliac bone.
Gastroptosis in which the stomach has moved to the same level as the pectin crest of the iliac bone are of the second degree.
Finally, the gastroptosis in which the stomach has lowered to the point of being below the pectin crest of the iliac bone are of the third degree.
Usually, only third-degree gastroptosis is symptomatic; in these situations, the symptoms appear more frequently after meals.
To diagnose a condition such as gastric ptosis, the following are essential: medical history, physical examination with palpation of the abdomen and an abdominal ultrasound.
Treatment of gastroptosis is usually conservative; recourse to surgery, in fact, is reserved for a few cases, in this case the more serious ones that do not respond to conservative treatment.
Conservative therapy for gastric ptosis includes:
- The use of a special abdominal restraint band (it is a kind of girdle);
- Physiotherapy exercises to strengthen the anterior abdominal wall;
- Pain relievers;
- Proper diet, broken down into many small meals.
VISCERAL PTOSIS OR VISCEROPTOSIS
Visceral ptosis, or visceroptosis, is the prolapse of the abdominal viscera. Therefore, in those suffering from visceral ptosis the viscera of the abdomen are located in a different position from the natural one, more precisely below.
More common among women, visceroptosis is usually the consequence of multiple pregnancies or a sudden weight loss, for example due to serious diseases. These two conditions - multiple pregnancies and sudden weight loss - cause visceral ptosis, because they induce a loss of abdominal muscle tone and relaxation of the ligaments, which hold the abdominal viscera in place.
Typical symptoms consist of: loss of appetite, heartburn, constipation or diarrhea, abdominal distension, headache, dizziness, stomach pain and lack of sleep.
Treatment of visceral ptosis is usually conservative. The use of surgery, in fact, is reserved for a few cases, generally the most serious.
Conservative therapy for visceral ptosis includes:
- The application of a containment bandage around the abdomen or, alternatively, the use of a special abdominal band with a containing effect;
- Rest from heavy physical activities (ex: lifting weights);
- Physiotherapy exercises to strengthen the abdominal wall;
- Proper diet, broken down into many small meals.
INTESTINAL PTOSIS OR ENTEROPTOSIS
Intestinal ptosis, or enteroptosis, is the prolapse of the intestine. In fact, it is a particular case of visceral ptosis, in which the affected abdominal viscera is only the intestine.
In light of this, for the causes, symptoms and treatment, the reader can refer to the previous sub-chapter, relating to visceroptosis.
BREAST PTOSIS
Breast ptosis is the collapse, with subsequent downward displacement, of a woman's breasts.
Breast ptosis is a natural consequence of aging, to which various factors can contribute, including:
- Cigarette smoke;
- A large number of pregnancies;
- The constant practice of physical activities that cause the breasts to move in multiple dimensions of space;
- A high body mass index;
- The sudden and marked loss or gain of weight.
The breasts of women who develop breast ptosis change in at least 3 points of view: in position, volume and size.
Breast ptosis causes no symptoms and is not life-threatening. However, it is still a condition of considerable medical interest, as its appearance involves a certain aesthetic discomfort in several women.
Cosmetic surgeons measure the severity of breast ptosis in 4 degrees: grade I, grade II, grade III and grade IV.
Grade I corresponds to episodes of mild breast ptosis; grade II to episodes of moderate breast ptosis; grade III to episodes of advanced breast ptosis; finally, grade IV for episodes of severe breast ptosis.
Currently, the most common treatment to improve the appearance of a breast affected by breast ptosis is plastic surgery known as mastopexy. Breast lift is the lifting breast.
CARDIAC PTOSIS OR CARDIOPTOSIS
Cardiac ptosis, or cardioptosis, is the downward displacement of the heart.
Due to a relaxation of the structures that keep the heart in its natural location, cardiac ptosis is often associated with heartbeat and tachycardia.
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