Maximal Levator Muscle Resection for Primary Congenital Blepharoptosis with Poor Levator Function

Abstract

Maximal levator resection may be a good alternative method to frontalis suspension in congenital blepharoptosis patients with poor levator function.

Surgical treatment of unilateral severe simple congenital ptosis

“…[ 1 5 14 18 19 ] Some oculoplastic surgeons have advocated maximal levator resection as the first choice of surgery even in ptosis patients with poor levator function. [ 20 21 22 23 24 25 26 27 28 ] However, there is always concern that levator resection in patients with poor levator function would result in undercorrection, even with maximal levator dissection and resection. [ 29 30 ] This would naturally result in some surgeons preferring frontalis suspension in cases of severe ptosis.…”

“…Patients with unilateral surgery unconsciously adjust relatively well to unilateral lagophthalmos and lid lag, both becoming less apparent by voluntary orbicularis contraction with time. [ 12 ] Unilateral frontalis suspension[ 18 32 35 ] and maximal levator resection[ 20 21 22 26 27 28 34 ] have been recommended as approaches that intervene only on the deficient side.…”

“…[ 20 ] Many surgeons have since performed maximal levator resection for severe congenital ptosis with satisfactory outcomes rates of 28.6% to 100% [ Table 1 ]. [ 20 21 22 23 24 25 26 27 34 54 55 56 ] For unilateral ptosis cases, reported success rates have ranged from 63.6% to 100% [ Figure 1 ]. [ 20 22 24 26 56 ]…”

“…[ 26 34 ] A large retrospective and a prospective study, in fact, showed maximal levator resection without tarsectomy to have a significantly higher success rate in severe unilateral congenital ptosis patients than that with tarsectomy. [ 27 28 ]…”

“…[ 22 ] Recently, however, some surgeons have preferred to preserve the horns for providing vertical support to the eyelid and allow better eyelid contour. [ 27 28 ] Transection of the medial and lateral horns can result in the destruction of the normal structures of the lacrimal gland and reflected tendon of the superior oblique muscle. [ 59 ] It has been proposed that complete dissection of the levator aponeurosis and Muller's muscle from the tarsal plate and conjunctiva to above the level of Whitnall's ligament until the desired intraoperative lid height is obtained is the crucial step to obtaining a good surgical outcome, rather than transection of the levator horns per se .…”