Blepharoptosis Repair by Selective Use of Superiorly Based Muscle Flaps

Abstract

Thirty-three patients with severe blepharoptosis were treated by the superiorly based orbicularis oculi muscles, interdigitated orbicularis oculi-frontalis muscle flaps, or frontalis muscle flaps. The superiorly based muscle flaps are modifications of direct transplantation of the frontalis muscle to the tarsal plate on the basis of anatomic study that the frontalis muscle and its fascia are connected with the orbicularis oculi muscle at the eyebrow region. The selection of muscle flaps is based on the extent of levator function of patients. When eyelid excursion is moderate (3 to 5 mm), the orbicularis oculi muscle flap technique was effective. For patients with weak eyelid excursion (2 to 4 mm), the interdigitated orbicularis oculi-frontalis muscle flap was the procedure of choice. For patients with minimal eyelid excursion (less than 2 mm), frontalis muscle flap technique is indicated. The majority of patients recorded as satisfactory results according to the criteria of Souther and Jordan after an average follow-up period of 18.5 months. Even though four patients showed undercorrection, there has been no complete failure or laxity of the advanced flaps in our series. The orbicularis oculi muscle technique or the interdigitated orbicularis oculi-frontalis muscle flap technique offers several advantages over the conventional frontalis muscle flap technique, such as being a simple technique with a good operative field, single incision on supratarsal fold, no depression on the forehead, no risk of neurovascular injury, and relatively easy technique with less complication. The frontalis muscle flap technique is better in patients with less than 2-mm eyelid excursion to avoid recurrence even if the superiorly based frontalis muscle flap technique has some inherent shortcomings.

Direct Tarsus to Frontalis Muscle Sling without Flap Creation for Correction of Blepharoptosis with Poor Levator Function

“…Even though all of our patients had poor (<4 mm) levator function and the procedure was performed in a similar fashion, outcomes of surgery were worse in eyes with weaker levator function. This finding has not been noted with conventional sling procedures but reported by investigators using a similar procedure (Tsai et al, 2000;Park et al, 1998). Zhang et al (1999) believe that for complete frontalis muscle development, the patient must be at least 5 years of age, nevertheless we observed no correlation between patient age and outcomes of the procedure.…”

A Dynamic Technique for the Treatment of Severe or Recurrent Blepharoptosis: Frontalis-Orbicularis Oculi Muscle Flap Shortening

“…One is the use of superiorly based orbicularis oculi muscle flap that is continuous with the orbital septum and the frontalis muscle. Baik et al [12], Park et al [13], and Tsai et al [10] are included in this category. Baik prepared one orbicularis oculi muscle flap with no need of cutting the muscle.…”

“…Based on the anatomic study and literature review [9,10,11,12,13,14,15], we discovered that there exists a very close linkage between the longitudinally oriented frontalis muscle and the horizontally oriented orbicularis oculi muscle. We designed the frontalis-orbicularis oculi (FOO) muscle flap as an entity to treat severe or recurrent blepharoptosis with satisfactory results.…”

Study of the Outcome of Various Surgical Procedures for Simple Congenital Blepharoptosis

“…Failure of skin excision methods led to the modern, muscle-based surgical techniques. [10][11][12][13] Maintenance of correct eyelid position is an important consideration when selecting a technique to correct congenital ptosis. Other considerations which have shaped the evolution of these surgical techniques include the need for cosmetically acceptable results, preservation of the normal eyelid crease, maintenance of the normal tear film, and prevention of exposure keratopathy by prevention of over correction.…”