Small-incision levator resection for correction of congenital ptosis: a prospective study

Eshraghi, Bahram; Ghadimi, Hadi

doi:10.1007/s00417-018-4008-7

Cited by 8 publications

(12 citation statements)

References 14 publications

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“…The advantages of this technique include minimal tissue damage, bleeding, and edema, allowing a faster wound healing and recovery and more accurate intraoperative assessment of the eyelid position and a shorter operation time and less scarring, facilitating further dissection if reoperation was indicated in case of unsatisfactory results. [6][7][8][9][10][11] The creation of a proper and persistent double-eyelid crease is considered the primary and important step during blepharoptosis surgery in East Asian patients. 12 For the central small incisional procedure, the fixation of the double-eyelid crease is limited toward the center, and the double-eyelid crease is not fully established in the medial and lateral parts of fuller East Asian upper eyelids, causing lateral eyelid hooding and double-eyelid crease asymmetry.…”

Section: Discussionmentioning

confidence: 99%

Three-Point Vertical Mattress Suture: A Simple Technique for Mild Blepharoptosis Correction in Partial-Incision Double-Eyelid Surgery

Chen

Wang³

2022

Facial Plast Surg

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Purpose: To introduce a simple technique for mild blepharoptosis correction using a three-point vertical mattress suture in partial-incision double-eyelid surgery. Methods: The medical records and preoperative and postoperative images of 57 patients who underwent simultaneous mild blepharoptosis correction and partial-incision double-eyelid surgery from January 2018 to July 2021 were retrospectively reviewed. The surgical procedure mainly involves three small incisions in the proper eyelid crease, levator aponeurosis exposure by conservative dissection, and three-point vertical mattress suture to plicate levator aponeurosis and fix the orbicularis muscle with the plicated levator aponeurosis. Results: All patients underwent bilateral partial-incision double-eyelid surgery: 10 unilateral and 47 bilateral blepharoptosis corrective surgeries. The average age was 25.3 ± 7.4 years. The mean operative and follow-up duration were 50 min and 13 months, respectively. The pre- and postoperative mean marginal reflex distance (MRD1) were 3.04 ± 0.27 mm and 3.75 ± 0.35 mm, respectively. The overall surgical success rate was 93.0%. Complications including undercorrection (5.3%), asymmetry (7.0%), and double-eyelid crease disappearance (5.3%) were reported. Conclusions: Three-point vertical mattress suture is considered an effective, safe, and simple technique for mild blepharoptosis correction in partial-incision double-eyelid surgery.

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Section: Discussionmentioning

confidence: 99%

Three-Point Vertical Mattress Suture: A Simple Technique for Mild Blepharoptosis Correction in Partial-Incision Double-Eyelid Surgery

Chen

Wang³

2022

Facial Plast Surg

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“…Levator recession was performed under local anesthesia. Through a small (⩽10 mm) lid crease incision, 7 levator aponeurosis was exposed, maximally recessed and sutured to the muscular portion of levator palpebrae superioris at the level of Whitnall’s ligament with 6-0 Prolene sutures (Johnson & Johnson Ethicon Inc, Somerville, NJ, USA). In addition, small-size (⩽3 mm) lateral tarsorrhaphy was performed on a case-by-case basis for patients with moderate-to-severe exposure keratopathy.…”

Section: Methodsmentioning

confidence: 99%

Levator recession and minimal lateral tarsorrhaphy for the management of lagophthalmos and corneal exposure in facial palsy

Eshraghi

Ghadimi

Nikdel

2019

European Journal of Ophthalmology

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Purpose: Recession of levator muscle can potentially decrease the severity of corneal exposure by reducing margin-reflex distance 1. The purpose of this study is evaluation of effects of levator recession on lagophthalmos in facial palsy. Materials and methods: In a non-comparative case series of consecutive patients with exposure keratopathy due to facial paralysis between 2012 and 2017, levator recession was performed through lid crease incision. Small-size (⩽3 mm) lateral tarsorrhaphy was performed on a case-by-case basis for those with moderate-to-severe keratopathy. Preoperative and postoperative measurements of margin-reflex distance 1 and lagophthalmos were compared using paired t-test. Results: Thirty-four patients (14 men and 20 women) were enrolled with an average age of 52.3 years. Mean follow-up was 13.3 months (range, 6–36 months). The most common etiology of facial paralysis was Bell’s palsy (22 cases), followed by motor vehicle accident (8), parotid surgery (3), and brain tumor surgery (1). No additional procedure was performed for eight patients, while lateral tarsorrhaphy was performed in 26 cases. Mean margin-reflex distance 1 decreased from 5.0 ± 0.4 mm to 4.0 ± 0.5 mm ( p < 0.001) and mean lagophthalmos decreased from 3.3 ± 0.9 mm to 1.8 ± 0.9 mm ( p < 0.001). Subgroups of patients with additional lateral tarsorrhaphy and without tarsorrhaphy experienced the same amount of reduction in margin-reflex distance 1 and lagophthalmos. Conclusion: Recession of levator muscle was effective in reduction of margin-reflex distance 1 and lagophthalmos in facial palsy patients. This procedure can be added to the surgical armamentarium for management of patients with facial palsy and lagophthalmos.

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“…There is weak direct support by the literature that local anesthesia results in better patient satisfaction and a reduction in complications. 44 In one study, a 24 percent reduction in the need for postoperative revision was observed in patients receiving local anesthesia. 6 Indirect literature did not often differentiate between the types of local anesthetics used.…”

Section: Recommendationsmentioning

confidence: 97%

“…For upper eyelid surgery, preliminary evidence to support one type of anesthesia over the other was confounded by inclusion of pediatric patients who may predominately undergo a procedure under general anesthesia. 44 The surgical approach (i.e., anterior or posterior repair) may be influenced by the degree of eyelid ptosis and thus dictate the type of anesthesia used, evidenced by the higher (albeit small) proportion of posterior repair cases performed under general anesthesia compared to anterior repair cases. 6 The evidence may be confounded, as surgical results and patient satisfaction are related more to the degree of upper visual field deficit correction rather than the type of anesthesia administered.…”

Section: Rationalementioning

confidence: 99%

American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline: Eyelid Surgery for Upper Visual Field Improvement

Kim

Granick

Baum

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: A group of experts from different disciplines was convened to develop guidelines for the management of upper visual field impairments related to eyelid ptosis and dermatochalasis. The goal was to provide evidence-based recommendations to improve patient care. Methods: A multidisciplinary group of experts representing their specialty organizations was selected. A systematic literature review was performed including topics regarding documentation of the underlying cause for visual field impairment, selection of an appropriate surgical repair, assessment of the type of anesthesia, the use of adjunctive brow procedures, and follow-up assessments. The Grading of Recommendations, Assessment, Development, and Evaluation methodology process was used to evaluate the relevant studies. Clinical practice recommendations were developed using BRIDGE-Wiz (Building Recommendations In a Developers’ Guideline Editor) software. Results: Each topic area was assessed. A clinical recommendation was made, and the relevant literature was discussed. Conclusions: The review of the literature revealed varied complication rates and diverse treatment modalities for the correction of upper visual field deficit. Strong recommendations could not be made in most topic areas because of a paucity of methodologically sound studies in the literature. More rigorously designed studies are needed to measure outcomes of interest, with fewer sources of potential error or bias. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

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Small-incision levator resection for correction of congenital ptosis: a prospective study

Abstract: Small-incision levator resection has previously been studied for correction of aponeurotic ptosis and proved to yield successful outcome. The findings of this study suggest that small-incision technique can be effectively used in correction of congenital ptosis, as well.

Cited by 8 publications

References 14 publications

Three-Point Vertical Mattress Suture: A Simple Technique for Mild Blepharoptosis Correction in Partial-Incision Double-Eyelid Surgery

Three-Point Vertical Mattress Suture: A Simple Technique for Mild Blepharoptosis Correction in Partial-Incision Double-Eyelid Surgery

Levator recession and minimal lateral tarsorrhaphy for the management of lagophthalmos and corneal exposure in facial palsy

American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline: Eyelid Surgery for Upper Visual Field Improvement

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