Frontalis suspension in congenital ptosis using Lyodura

Silicone sling frontalis suspension for congenital ptosis: Outcome of 174 consecutive cases

BACKGROUND

Frontalis suspension (FS) is the treatment of choice in congenital ptosis with poor levator function. We report the surgical outcome of FS using a double triangle configuration of silicone slings in children.

METHODS

A retrospective cohort study of all paediatric patients with simple myogenic congenital ptosis repaired with FS over a 12-year period (2009-2020). Each silicone sling was secured by simple knots. Pre- and post-operative margin reflex distance (MRD₁ ) measurements were determined from clinical photographs using ImageJ Software. Main outcome measures were improvement in eyelid height, eyelid asymmetry, reoperation rate and timing.

RESULTS

One hundred and thirty nine patients (174 eyes) were included, with 35 (25%) having bilateral surgery. Mean (±SD) age was 1.4 ± 1.9 years. Mean follow up time was 32 ± 20.5 months. Sixteen patients (11%) had a history of previous ptosis repair surgery. Mean MRD₁ improved by an average of 1.5 mm. The final MRD₁ in the group of patients who did not have a second procedure was a mean of 2.1 mm. The MRD₁ difference between both eyes in all unilateral cases improved from 2.5 mm preoperatively to 1.2 mm at final visit (p < 0.001). In the 123 cases without a history of previous ptosis surgery, repeat ptosis repair was performed in 37 (30%) patients, 34.9 ± 19.9 months after the initial procedure. Overall, repeat repair was performed in 47 patients (34%).

CONCLUSIONS

Double triangle silicone sling frontalis suspension has a favourable outcome in two-thirds of paediatric patients with simple myogenic congenital ptosis. Failed cases can be addressed with a second repair, using either autogenous fascia lata or a second silicone sling.

Foreign Body in the Nasal Septum: Lyodura Extrusion

In otorhinolaryngologic fields, Lyodura had been used mainly in otological procedures, such as tympanoplasty, myringoplasty, and mastoidectomy. However, so far in rhinologic area, there is only 1 report that Lyodura was used for closure of cerebrospinal fluid leaks. This report describes a 54-year-old woman presented with recurrent purulent discharge for 4-month duration because of Lyodura extrusion from the septum. On the basis of authors' experience, the authors highlight that the complete removal of exposed Lyodura from the nasal septum may be difficult because of adhesion to the surrounding septal mucosal flap. So, the authors suggest unilaterally wide mucosal incision using mucosal defect site may be necessary for completely removing Lyodura.