Frontalis Muscle Advancement: A Dynamic Structure for the Treatment of Severe Congenital Eyelid Ptosis

Abstract

Forty-two consecutive patients have had severe eyelid ptosis corrected by intraorbital frontalis flap advancement as a motor unit to substitute for the function of the levator muscle. This technique has avoided the need for the linking structure necessary in the standard frontalis sling approach and has improved the direction of pull to more closely mimic that of a normal levator. This simple technique includes elevation of the innervated frontalis muscle flap and the creation of a pulley near the insertion of the orbital septum at the superior orbital rim, which redirects the lid movement along the surface of the globe rather than lifting it from the globe's surface toward the brow. This type of displacement is produced because the muscle is directed posteriorly by the pulley, so that it conforms to the plane of the levator aponeurosis all the way down to the tarsal plate. In addition, to improve the remaining function of the levator muscle (if any) and to facilitate voluntary positioning of the eyelid, the levator aponeurosis is shortened by plication. Symmetry is created by intervention on the contralateral eyelid to provide symmetrical supratarsal creases.

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

“…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.…”

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

“…In our study, ptosis was due to a variety of causes and surgery was successful in all patients; therefore, this type of surgery can be used for both congenital and acquired ptosis irrespective of etiology (Kniz, 1996;Park and Choi, 2002;Ramirez and Peña, 2004). According to previous reports, frontalis sling can be used for recurrent ptosis following sling procedures or levator resection (Tsai et al, 2003;Park and Choi, 2002;Lai et al, 2009;Tong et al, 2000;Zhou and Chang, 1988;Leibsohn, 1995;Han and Kang, 1993;Park et al, 2007).…”

Frontalis Transfer and Closed Silicone Rod Frontalis Suspension

“…In the PFL group, later recurrence is known to be related to absorption of the fascia [8,16]. Fascia lata is not always a feasible option for all patients, as the patient needs to be at least 3 years old in order to have sufficient length to provide suitable fascia lata [17]. Some studies have recommended using silicone rods [18,19].…”