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Spadaro JZ, Patel N, Kahana A. Frontalis muscle flap eyelid reanimation technique in adults with severe ptosis or apraxia of eyelid opening. Orbit 2024:1-8. [PMID: 39072581 DOI: 10.1080/01676830.2024.2381240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Assessment of the frontalis muscle flap eyelid reanimation surgical technique for adults with severe ptosis and apraxia of eyelid opening. METHODS A retrospective case series of 30 eyes with severe ptosis or apraxia of eyelid opening. Outcomes were assessed for margin to reflex distance 1 (MRD1), lagophthalmos, complications, and need for subsequent surgical intervention. A paired t-test was used to compare preoperative and postoperative scores of a quality-of-life questionnaire. RESULTS Thirty eyes of 19 patients underwent surgery, 16 (53%) with combined frontalis + levator-Muller muscle flap and 14 (46%) with frontalis muscle flap alone. There were 14 female and 5 male patients, with an average age of 55 years (range, 18-76). Mean preoperative MRD1 was -0.6 mm (range, -5 to 2) with mean levator excursion of 7.1 mm. Seventeen eyes had a myogenic etiology, five had a paralytic etiology, six had blepharospasm with apraxia of lid opening, and two had a neurodegenerative etiology. Nineteen eyes (63%) had previously undergone ptosis repair. Mean postoperative MRD1 was 2.5 mm (range, 0.5 to 5) at mean follow-up of 63.3 days. There were no serious surgical complications; minor complications included ocular surface keratopathy and one patient who required surgical revision. Results of the QOL questionnaire indicated significant improvement in vision-related symptoms postoperatively (p = 0.02). CONCLUSIONS Use of the frontalis muscle flap eyelid reanimation technique, with or without a levator-Muller retractor muscle flap, was very effective in this case series and provided good upper eyelid position with acceptable corneal protection and high patient satisfaction.
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Affiliation(s)
- Jane Z Spadaro
- Ophthalmology, Kahana Oculoplastic and Orbital Surgery, Livonia, Michigan, USA
- Department of Ophthalmology, Beaumont Eye Institute, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Nikita Patel
- Department of Ophthalmology, Beaumont Eye Institute, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Alon Kahana
- Ophthalmology, Kahana Oculoplastic and Orbital Surgery, Livonia, Michigan, USA
- Department of Ophthalmology, Beaumont Eye Institute, William Beaumont Hospital, Royal Oak, Michigan, USA
- Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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Meer E, Ahmad M, Lifton J, Mosenia A, Ashraf DC, Grob S, Vagefi MR, Winn BJ, Kersten RC. Outcomes for expanded polytetrafluoroethylene strip in frontalis suspension surgery. Orbit 2024; 43:307-315. [PMID: 38236954 DOI: 10.1080/01676830.2023.2300793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/22/2023] [Indexed: 06/13/2024]
Abstract
PURPOSE This study evaluates surgical outcomes and complication rates of frontalis suspension with expanded polytetrafluoroethylene (ePTFE). METHODS This retrospective cohort study reviewed all patients undergoing frontalis suspension surgery using ePTFE as the sling material from January 1 2012 to March 3 2020 by a single surgeon at a single academic center. Two different surgical techniques were evaluated in the placement of the sling material. Demographic, clinical, and operative data were extracted. Outcome data including postoperative lid height, reoperation, and complication rate were extracted for the cohort and compared between the two surgical techniques. Descriptive statistics were utilized. RESULTS Sixty-four eyes from 49 unique patients were included in this study. Forty-three (67.2%) patients had isolated congenital blepharoptosis; 14 (21.9%) had blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES); and 2 (3.1%) had cranial nerve III palsy. Fifty-one (79.7%) patients had no prior blepharoptosis surgery. Lid crease incision and stab incision techniques were utilized for 24 (37.5%) and 40 (62.5%) eyes, respectively. Overall, 21 (32.8%) eyes required reoperation with ePTFE to achieve appropriate eyelid height or contour. Only one patient experienced implant infection, requiring removal of ePTFE sling after a second reoperation. There were no cases of implant exposure or granuloma formation noted during the study period. CONCLUSION An ePTFE strip soaked in cefazolin prior to utilization in surgery is a viable material for frontalis suspension surgery, with a lower infectious or inflammatory complication rate than previously reported. However, reoperation rate was still relatively high.
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Affiliation(s)
- Elana Meer
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Meleha Ahmad
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Jacob Lifton
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Arman Mosenia
- Department of Ophthalmology, University of Texas, Austin, Texas, USA
| | - Davin C Ashraf
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Seanna Grob
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, California, USA
| | - M Reza Vagefi
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, California, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA
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Xavier NF, Garcia DM, Cruz AAV. Spontaneous Blinking Kinematics After Frontalis Muscle Flap Advancement. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00372. [PMID: 38534073 DOI: 10.1097/iop.0000000000002654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE To measure the spontaneous blinking metrics after blepharoptosis correction with frontalis muscle flap advancement. METHODS A video system was employed to measure the amplitude and velocity of spontaneous blinking of 24 eyelids after the frontalis muscle flap surgery for blepharoptosis correction. A control group with no eyelid disorders was also measured. The data of 13 eyelids who had frontalis slings with autogenous fascia, which were previously collected with the same method in another study, were used for comparison. Digital images were used to measure the superior margin reflex distance and the presence of lagophthalmos during a gentle closure of the palpebral fissure. Superficial keratitis was assessed by corneal biomicroscopy. RESULTS The mean amplitude of spontaneous blinking was 6.3 mm in controls, 2.6 mm in the frontalis flap patients, and 2.1 mm in the fascia sling group. The mean blink velocity was 133.8 mm/second in controls, 39.0 mm/second (3.7 standard error) after the frontalis flap, and 36.3 mm/second in patients with frontalis sling with fascia. For these 2 parameters, there was no statistical difference between the surgical groups, but a significant reduction when compared with the control group. No significant association was found between lagophthalmos and keratitis and the surgical procedure. CONCLUSIONS There is no difference between the blinking metrics of eyelids operated using the frontalis muscle flap advancement technique or frontalis sling with autogenous fascia. The presence of lagophthalmos and keratitis also does not differ between the 2 procedures.
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Affiliation(s)
- Naiara F Xavier
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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Cang ZQ, Liu CH, Cui JB, Fan X, Chen YJ, Song BQ, Hao DY, Peng P, Cao J. Extended Frontalis Muscle Advancement Technique for Severe Congenital Blepharoptosis. Plast Reconstr Surg 2023; 152:885e-894e. [PMID: 36877618 DOI: 10.1097/prs.0000000000010368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The conventional frontalis muscle advancement technique still has some disadvantages, such as residual lagophthalmos, eyebrow ptosis, eyelid contour abnormality, and undercorrection. This article describes the authors' extended frontalis muscle advancement technique, which takes extensive subcutaneous separation through the eyelid crease incision for the treatment of severe congenital blepharoptosis. METHODS A retrospective review was performed that included patients with severe congenital ptosis who underwent extended frontalis muscle advancement technique from April of 2019 to April of 2021. Preoperative evaluation included age, sex, and margin reflex distance 1, levator function, and lagophthalmos. Postoperative evaluation including correction result, closure function of eyelid, and cosmetic result was performed at the last follow-up. RESULTS From April of 2019 to April of 2021, a total of 102 patients (137 eyes) who underwent extended frontalis muscle advancement technique were included in the study. The mean postoperative margin reflex distance 1 in unilateral and bilateral ptosis patients was 3.84 ± 0.60 mm and 3.86 ± 0.56, respectively, and 126 eyes (92.0%) showed successful correction. Postoperatively, the mean residual lagophthalmos was 0.88 ± 1.40 mm, and 127 eyes (92.7%) showed excellent or good eyelid closure function. The average score of cosmetic results was 8.29 ± 1.34, and 94 patients (92.2%) had an excellent or good cosmetic result. CONCLUSIONS Extensive subcutaneous separation relieves the mutual restriction between the forehead skin and frontalis muscle. The extended frontalis muscle advancement technique is effective in correcting severe congenital ptosis, and minimizes undercorrection, residual lagophthalmos, eyelid contour abnormality, and eyebrow ptosis. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Zheng-Qiang Cang
- From the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University
| | - Chao-Hua Liu
- From the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University
| | - Jiang-Bo Cui
- From the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University
| | - Xiao Fan
- From the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University
| | - Yong-Jun Chen
- From the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University
| | - Bao-Qiang Song
- From the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University
| | - Dong-Yue Hao
- From the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University
| | - Pai Peng
- From the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University
| | - Jiao Cao
- From the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University
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Ortega-Evangelio L, Araújo-Miranda R, Raga-Cervera J, Romo López Á, Díaz-Céspedes RA, Peris-Martínez C. Evolution of the «frontal flap advancement» in congenital ptosis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:572-582. [PMID: 35637109 DOI: 10.1016/j.oftale.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/02/2021] [Indexed: 06/15/2023]
Abstract
The treatment of congenital ptosis with poor levator activity is often based upon the union of the superior eyelid to the frontalis muscle by using different materials as potential grafts. Nevertheless, theses grafts may lead some complications. In order to avoid them, a new technic has been described using an advancement flap of the frontalis muscle, that is tided to the upper tarsus, eliminating the need of a graft. Although, it is not yet a standard procedure, reason why many variants has been recently described with the objective of improve the aesthetical and functional results. The goal of this systematic review is to conscientiously evaluate these variants with the propose of determine which one gives the best results in terms of safety, functional and aesthetical outcomes. From the review of the published procedures, we conclude that the best technique in terms of functional and aesthetical results is: sub-orbicularis dissection via lid crease incision reaching the orbital margin, followed by blunt dissection of the frontalis muscle and creation of a "U" shaped flap (that might be associated to a levator advancement in severe cases), finally, the frontalis flap is stitched to the upper end of the tarsus taking care to maintain a symmetrical contour when compared to the contralateral eye. The final eyelid margin height should be 1.5 mm above the sclero-corneal limbus.
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Affiliation(s)
- L Ortega-Evangelio
- Fisabio-Oftalmología Médica (FOM), Valencia, Spain; Clínica Baviera, Valencia, Spain.
| | | | | | | | | | - C Peris-Martínez
- Fisabio-Oftalmología Médica (FOM), Valencia, Spain; Clínica oftalmológica Aviñó Peris, Valencia, Spain; Facultad de Medicina, Departamento de Cirugía, Universitat de València, Valencia, Spain
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Combined levator and frontalis muscle advancement flaps for recurrent severe congenital ptosis. Eye (Lond) 2022; 37:1100-1106. [PMID: 35469061 PMCID: PMC10102021 DOI: 10.1038/s41433-022-02071-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To evaluate the outcomes of combined levator resection and frontalis muscle advancement for surgical management of recurrent severe congenital ptosis. DESIGN Retrospective, nonrandomized interventional case series. METHODS A retrospective review was performed of patients who underwent combined levator resection and frontalis muscle advancement for recurrent congenital ptosis between 2017 and 2020. Inclusion criteria were levator function of 4 mm or less and margin reflex distance 1 (MRD1) of 0 mm or less. Main outcome measures were postoperative MRD 1, lagophthalmos, lash angle, and grades of eyelid contour and crease. The outcomes were assessed by reviewing medical charts and photographs. RESULTS Thirty-one patients (35 eyelids) met the inclusion criteria. The mean preoperative MRD1 was -1.14 ± 1.56 mm, which improved to 3.93 ± 0.52 mm with an average lagophthalmos of 0.91 ± 0.74 mm at the last follow-up. A total of 91.4% of eyelids had excellent eyelid contour, crease, and eyelash angle at the final follow-up. One eyelid required revision surgery. There were no other significant complications. CONCLUSIONS For poor function recurrent congenital ptosis, combining levator resection and frontalis muscle advancement is an effective method that results in long-term correction with cosmetically pleasing outcomes and minimal complications.
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Human Frontalis Muscle Innervation and Morphology. Plast Reconstr Surg Glob Open 2022; 10:e4200. [PMID: 35317455 PMCID: PMC8932476 DOI: 10.1097/gox.0000000000004200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Abstract
Due to its clinical importance and due to a suggestion regarding the afferent innervation, the microscopic appearance of the frontalis muscle was investigated.
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Liu N, He A, Wu D, Zhang J, Song N. Modified Maximal Levator Palpebrae Superioris Shortening in Correcting Congenital Severe Ptosis in Children. Ann Plast Surg 2021; 87:523-527. [PMID: 34469913 DOI: 10.1097/sap.0000000000002867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to evaluate the clinical effect of modified maximal levator palpebrae superioris shortening method for severe congenital ptosis. METHODS A retrospective case series was performed including 66 eyes from 62 patients who underwent modified maximal levator palpebrae superioris shortening surgery to treat severe congenital ptosis between February 2015 and November 2018. Preoperative and postoperative margin reflex distance 1 and levator muscle function were recorded. The surgical results were graded as good, satisfied, and poor for functional and cosmetic improvement of the eyelids, and the incidence of complications was also documented. RESULTS The mean patient age at the time of surgery was 4.6 ± 1.8 years (2-9 years), and the mean follow-up time was 36.3 ± 14.1 (12-55 months). A mean significant improvement in margin reflex distance 1 and levator function after operation was noted (P < 0.01). The eyelid height and symmetry were satisfied in 59 patients, with success rate of 95.2%. For the patients in the levator function (≤2 mm) group, the success rate was 87.5%. Moreover, the levator function (≤2 mm) group had a higher rate of poor results than levator function (2-4 mm) group (12.5% vs 2.2%). Overcorrection (6.5%) and eyelid fold deformity (11.3%) were the most frequent postoperative complications. CONCLUSION Modified maximal levator palpebrae superioris shortening was effective and endurable in the treatment of severe congenital ptosis with poor levator function, including in patients whose levator function was less than 2 mm.
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Affiliation(s)
- Ninghua Liu
- From the Department of Facial Plastic and Reconstructive Surgery, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
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Zhu X, Ma Y, Woo DM, Lin Y, Chen B, Liu J, Chen X. Improved Eyelid Muscle Tension Balance With Refined Frontalis Muscle Flap Suspension in the Treatment of Severe Ptosis. Ophthalmic Plast Reconstr Surg 2021; 37:534-540. [PMID: 33782325 DOI: 10.1097/iop.0000000000001933] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The tension balance of the upper eyelid following ptosis repair is crucial to a successful postoperative outcome. To improve on existing surgical techniques, the authors developed a new refined frontalis muscle flap suspension (FMFS) for severe ptosis repair and explored the balancing effect between the orbicularis muscle and frontalis muscle following surgery. METHODS Forty-three patients (47 eyes) with a mean age of 6.07 ± 2.55 years old were diagnosed with severe congenital ptosis and underwent refined FMFS with complete orbicularis preservation between January 1, 2010 and December 31, 2017 in the Wenzhou Eye Hospital, Wenzhou, China. The outcomes measured include upper eyelid margin reflex distance (MRD1), degree of lagophthalmos, and cosmetic outcome (lash angle, eyelid contour, and crease). Surgical complications were also recorded. RESULTS The preoperative mean MRD1 was -1.29 ± 0.88 mm and preoperative levator function was 1.87 ± 0.82 mm (ranged from 0 to 3.0 mm). Following surgery, lagophthalmos was observed in all cases in the first week with a mean palpebral fissure height of 1.68 ± 0.40 mm and diminished over 3 months. The MRD1 improved to +3.04 ± 0.68 mm at 6 months following surgery. All cases showed excellent cosmetic outcomes. There were no significant complications. CONCLUSION The refined FMFS is a safe and reliable surgery in treating severe ptosis. The eye-closing power of the intact orbicularis muscle is sufficient at countering the lifting power of the frontalis muscle suspension, achieving a balanced blink mechanism and eyelid closure.
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Affiliation(s)
- Xiuying Zhu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yingjie Ma
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - David M Woo
- Sydney Hospital & Sydney Eye Hospital, Sydney, Australia
| | - Yanyan Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ben Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jia Liu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xi Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Kasai S, Shimizu Y, Ohara H, Kiuchi T, Ihara J, Kishi K. Use of an Orbital Septum Flap for Correcting Severe Blepharoptosis. Aesthetic Plast Surg 2021; 45:1593-1600. [PMID: 33433668 DOI: 10.1007/s00266-020-02087-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/29/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several surgical procedures are available for the treatment of severe blepharoptosis with poor levator function. However, the procedures have advantages and disadvantages. Particularly, complications such as lagophthalmos and lid lag are commonly observed after conventional interventions. Thus, the present study aimed to introduce a surgical technique that uses an orbital septum flap without the orbital oculi muscle for the correction of severe blepharoptosis. METHODS The technique utilizes the orbital septum flap, which is connected with the frontalis muscle via the galea aponeurosis and frontal periosteum, to suspend the tarsal plate. In this case series, the technique was used for the correction of blepharoptosis in 16 eyes from 12 patients. RESULTS The margin reflex distance in all patients improved at 6 months after surgery. Two patients presented with lagophthalmos and three with mild recurrence. However, revision surgery was not required, and none of patients presented with lid lag. CONCLUSIONS For the correction of blepharoptosis, the use of the orbital septum flap without the orbital oculi muscle can be easily selected compared with other conventional methods that are more likely to cause overcorrection and closure disorders. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Shogo Kasai
- Department of Plastic Surgery, Ryukyu University School of Medicine, 207 Uehara Nishihara-cho Nakagami-gun, Okinawa, 903-0215, Japan.
| | - Yusuke Shimizu
- Department of Plastic Surgery, Ryukyu University School of Medicine, 207 Uehara Nishihara-cho Nakagami-gun, Okinawa, 903-0215, Japan
| | - Hirotoshi Ohara
- Department of Plastic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoki Kiuchi
- Department of Plastic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Jun Ihara
- Department of Plastic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuo Kishi
- Department of Plastic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
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Frontalis Suspension Using Autologous Fascia Lata in Children Under 3 Years Old. Ophthalmic Plast Reconstr Surg 2021; 37:377-380. [PMID: 33237671 DOI: 10.1097/iop.0000000000001882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze functional results and complications of the use of autologous fascia lata in frontalis suspension in children under 3 years old and to confirm its technical viability. METHODS A retrospective review of 8 patients (12 eyes) who underwent frontalis suspension using autologous fascia lata sling. RESULTS Twelve eyes of 8 patients were analyzed, with an average age of 1.8 ± 0.6 years. Preoperatively, the mean margin-to-reflex distance 1 was -0.17 ± 0.577 mm. Postoperatively the mean margin-to-reflex distance 1 was 2.66 ± 0.492 mm without any graft donor site or corneal complications. No recurrence was recorded in the follow-up period (mean follow-up period 28.5 ± 32.33 months). CONCLUSIONS Autologous fascia lata is an eligible material in frontalis suspension in children under 3 years old, despite the traditional oculoplastic dogma that advises against.
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Minimal Dissection Direct Frontalis Muscle Advancement Flap for Congenital Ptosis Repair. J Craniofac Surg 2021; 32:2358-2361. [PMID: 34054081 DOI: 10.1097/scs.0000000000007761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Frontalis flap advancement is an alternative means of congenital ptosis repair from frontalis suspension utilizing autologous fascia or allogenic implants. Variations in technique, including flap division, location and number of skin incisions, and dissection planes, are described in the literature. MATERIALS AND METHODS A retrospective case series of patients with congenital myogenic ptosis treated with simplified, minimal dissection frontalis flap advancement involving a single upper eyelid crease incision with dissection in the preseptal and subcutaneous planes without division to mobilize the frontalis flap. Inclusion criteria: pediatric patients age < 18 years with either primary or recurrent congenital ptosis following previous surgical repair. Exclusion criteria: ptosis of neurogenic etiology or postoperative follow-up < 3 months. Primary outcome measures were postoperative margin-reflex distance 1 (MRD1), the difference in MRD1 between surgical and nonsurgical eyelids in unilateral ptosis, and lagophthalmos. Secondary outcome measures included recurrence and complications. RESULTS Twenty-six patients met inclusion criteria, 24 males and 2 females. Mean postoperative MRD1 at last follow-up was 2.9 ± 1.2 mm and the mean difference in MRD1 between surgical and nonsurgical eyelids at last follow-up was 1.1 ± 1.0 mm. Average lagophthalmos at postoperative month 2 to 5 was 0.6 ± 0.7 mm. One patient demonstrated postoperative lid retraction that required re-operation. Four of 31 eyelids (12.9%) demonstrated ptosis recurrence at 5, 12, or 24 months. CONCLUSIONS In this retrospective series, the authors report clinically and statistically significant surgical eyelid height improvement and symmetry between nonsurgical and surgical eyelids in congenital ptosis patients treated with minimal dissection direct frontalis flap advancement.
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Treatment of Congenital Ptosis in Infants With Associated Amblyopia Using a Frontalis Muscle Flap Eyelid Reanimation Technique. Ophthalmic Plast Reconstr Surg 2021; 37:67-71. [PMID: 32467524 DOI: 10.1097/iop.0000000000001697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the efficacy of a frontalis muscle flap eyelid reanimation technique for correction of severe congenital ptosis and associated amblyopia in infants. METHODS The authors performed a retrospective chart review of patients 12 months of age or younger with unilateral or bilateral congenital ptosis and associated amblyopia or deemed at high risk for amblyopia due to visual deprivation. Following ptosis repair via a frontalis muscle flap technique, primary outcomes of postoperative eyelid position and amblyopia reversal were assessed. RESULTS Seventeen eyes of 12 participants were included for study. Seven of these patients had simple congenital ptosis, and the remainder had ptosis as part of a syndrome. Nine were diagnosed with amblyopia preoperatively, and the remaining 3 were too young for acuity testing but had occlusion of the visual axis by the ptotic eyelid in primary gaze. Postoperatively, the mean margin-to-reflex distance 1 was 2.4 mm (range: 0.0-4.0), and 9 patients (75%) demonstrated no evidence of amblyopia. Only 2 patients had eyelid asymmetry greater than 2 mm, which in both cases was due to lack of frontalis activation by the patient secondary to ongoing visual impairment. The most common complication was lagophthalmos in 6 eyes (35.3%), with no significant associated surface keratopathy. CONCLUSIONS The frontalis muscle flap technique may offer a new and effective approach to treating infants with severe congenital ptosis causing poor eyelid excursion and associated amblyopia while avoiding use of an implant.
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