Superior Tarsectomy Augments Super-Maximum Levator Resection in Correction of Severe Blepharoptosis with Poor Levator Function

Pak, John; Shields, Marc; Putterman, Allen M.

doi:10.1016/j.ophtha.2006.01.032

Cited by 30 publications

(37 citation statements)

References 16 publications

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“…In contrast, its hyperactivity may produce exophthalmia, as seen in hyperthyroidism. The anatomy of the Müller's muscle is directly associated with surgical correction of blepharoptosis-a common complaint of eyelid drooping in which the upper eyelid cannot be fully elevated as occurs in a healthy person (Shields and Putterman 2003;Pak et al 2006;Patel et al 2008). The Müller's muscle-conjunctival resection (MMCR) procedure is a technique in which the STM is partially resected and advanced (Morax et al 2005).…”

Section: Discussionmentioning

confidence: 99%

The human superior tarsal muscle (Müller’s muscle): a morphological classification with surgical correlations

et al. 2009

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The superior tarsal muscle (STM) is a smooth muscle that originates from the undersurface of the levator palpebrae superioris muscle (LPSM) and inserts onto the superior tarsal plate (STP) of the upper eyelid. We have performed a morphometrical investigation of the STM in 49 adult human cadavers (34 males, 15 females). Histological analysis has shown a transitional area between the skeletal striated muscle (LPSM) and the adjacent smooth muscle (STM). We propose an original morphological classification based upon the attachment of STM to the upper border of the STP. Accordingly, we describe four patterns of STM. Pattern 1 (P1) consists of STM attachment to the central portion of the STP. Pattern 2 consists of both medial (P2M) STM attachment to both the central and medial regions of the STP and lateral (P2L) STM attachment to both the central and lateral regions of the STP. Pattern 3 (P3) consists of STM attachment along the whole extent of the STP. Pattern 3 was the most frequently observed pattern (63.27%) followed by patterns P2M (24.49%), P2L (8.16%) and P1 (4.08%). P3 was the predominant pattern in males (73.52%), while in females, both patterns P2M (46.66%) and P3 (40.00%) were equally prevalent. The analysis of paired specimens revealed a symmetrical arrangement in 72.20% of all cases, with the remaining cases (27.80%) displaying left-right STM asymmetries. To the best of our knowledge, this is the first description of the STM asymmetries in the medical literature. This innovative classification provides anatomical parameters for interpreting morphological variations of the STM with relevant applications in both plastic surgery and ophthalmology.

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Section: Discussionmentioning

confidence: 99%

The human superior tarsal muscle (Müller’s muscle): a morphological classification with surgical correlations

et al. 2009

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“…Methods to repair ptosis include frontalis slings and levator advancement with or without resection as well as posterior approaches such as Fasanella-Servat (FS) or muller's muscle and conjunctiva resection (MMCR). 1-23 The applications of these aforementioned techniques have frequently been limited to various subsets of blepharoptosis. For example, frontalis slings are utilized for severe ptosis with poor levator function while FS and MMCR have classically been reserved for mild to moderate ptosis with good levator function.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Muller’s Muscle and Conjunctiva Resection With or Without Tarsectomy for the Treatment of Severe Involutional Blepharoptosis

Patel

Aakalu

Setabutr

et al. 2017

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose To determine if muller's muscle and conjunctiva resection (MMCR) with or without tarsectomy is an efficacious procedure for the treatment of severe involutional blepharoptosis. Methods A retrospective chart review was performed of all consecutive patients with severe involutional blepharoptosis during a twelve-year period treated by a single surgeon (AMP) with a MMCR with or without tarsectomy. The inclusion criteria was good levator function (≥10mm eyelid excursion), adequate response to phenylephrine (change in eyelid height ≥1.5mm) and severe involutional blepharoptosis (margin-to-reflex-distance-1 ≤0mm). Results 100 eyelids of 69 patients were identified that met the inclusion criteria. Mean preoperative margin-to-reflex-distance-1 was −0.65mm and mean postoperative margin-to-reflex-distance-1 was 3.00mm for all patients. For patients treated with MMCR without tarsectomy, mean preoperative and postoperative margin-to-reflex-distance-1 was - 0.51mm and 2.98mm with 97.5% of the patients obtaining a lift greater than 1.5mm. Conclusions Our results demonstrate that MMCR with or without tarsectomy does provide another alternative to the surgeon for the management of severe involutional blepharoptosis.

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“…[5][6][7] Some people, however, advocate the use of supramaximal levator resection in these cases. [8][9][10] Excellent functional and aesthetic results have been demonstrated using both techniques. 11 Ptosis is significantly reduced in most patients; however, none of Video available online at www.archophthalmol.com the patients with simple severe congenital ptosis with poor LF have shown an increase in LF after their surgery.…”

Section: Discussionmentioning

confidence: 91%

Increased Levator Muscle Function by Supramaximal Resection in Patients With Blepharophimosis-Ptosis–Epicanthus Inversus Syndrome

Decock

Shah²,

Delaey

et al. 2011

Arch Ophthalmol

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To study the efficacy and clinical and anatomical results of supramaximal levator resection in patients with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) with severe congenital ptosis with poor levator function (LF).Methods: Eleven patients with molecularly proven BPES underwent supramaximal levator resection. Palpebral fissure height and LF were measured preoperatively and postoperatively.Results: All patients showed an excellent reduction in ptosis with a single intervention resulting in a clear visual axis. Palpebral fissure height improved from mean (SD) 3.3 (0.7) mm preoperatively to 7.1 (0.9) mm postoperatively (P value Ͻ.001). Four patients underwent additional surgery because of cosmetic issues with eyelid height asymmetry. All patients showed a marked, consistent, and lasting improvement in LF, going from mean (SD) 1.9 (0.9) mm preoperatively to 7.4 (1.1) mm postoperatively (P value Ͻ.001). This improvement could be attributed to the presence of a very long and thin tendon, as well as a striated muscle belly. This elongated aponeurosis inhibits the levator muscle from having sufficient impact on the vertical eyelid excursion. Conclusions:We demonstrated that supramaximal levator resection performed in patients with BPES not only results in good cosmetic appearance in terms of ptosis reduction in the majority of cases but also in a significant increase of the levator palpebrae superioris function. An anatomical substrate was found to explain these findings. To our knowledge, this is the first study to provide evidence of a marked increase in LF in BPES due to resection of the elongated tendon with reinsertion of the muscle belly.

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Superior Tarsectomy Augments Super-Maximum Levator Resection in Correction of Severe Blepharoptosis with Poor Levator Function

Cited by 30 publications

References 16 publications

The human superior tarsal muscle (Müller’s muscle): a morphological classification with surgical correlations

The human superior tarsal muscle (Müller’s muscle): a morphological classification with surgical correlations

Efficacy of Muller’s Muscle and Conjunctiva Resection With or Without Tarsectomy for the Treatment of Severe Involutional Blepharoptosis

Increased Levator Muscle Function by Supramaximal Resection in Patients With Blepharophimosis-Ptosis–Epicanthus Inversus Syndrome

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