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Modified Levator Resection Technique for Moderate Congenital Blepharoptosis

  • Original Article
  • Oculoplastic
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Abstract

Background

For moderate ptosis associated with fair levator function (LF), the levator resection is the most commonly used procedure. However, the levator resection technique still has some disadvantages, such as residual lagophthalmos (RL), undercorrection, conjunctival prolapse, and eyelid contour abnormality. To solve the above problems, our team have made modifications to the levator resection technique in three aspects: releasing the levator muscle sufficiently, preserving the supporting structure of the conjunctiva, and placing multiple suture sites.

Methods

Fifty-seven patients (81 eyes) underwent the modified levator resection technique and were enrolled in the study. Preoperative data collected included age, sex, margin reflex distance 1 (MRD1), and LF. Postoperative data collected included MRD1, RL, patient satisfaction, complications, and length of follow-up.

Results

Mean MRD1 significantly increased from 1.45 ± 0.65 mm preoperatively to 3.57 ± 0.51 mm postoperatively. Mean LF significantly increased from 6.49 ± 1.12 mm preoperatively to 9.48 ± 1.39 mm postoperatively. Successful correction was obtained in 77 eyes (95.1%). Mean RL was 1.09 ± 0.57 and 72 eyes (88.9%) showed excellent or good eyelid closure function. Fifty-four patients (94.7%) were completely satisfied with the final result. Complications such as hematoma, infection, conjunctival prolapse, suture exposure, corneal abrasion, and keratitis were not found in any cases during follow-up.

Conclusion

This modified levator resection technique introduced in this study is effective in correcting moderate congenital blepharoptosis, while minimizing RL, undercorrection, conjunctival prolapse, eyelid contour abnormality by releasing the levator muscle sufficiently, preserving the supporting structure of the conjunctiva, and placing multiple suture sites.

Level of Evidence IV

This journal requires that authors 42 assign a level of evidence to each article. For a full 43 description of these Evidence-Based Medicine ratings, 44 please refer to the Table of Contents or the online 45 Instructions to Authors www.springer.com/00266.

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References

  1. Finsterer J (2003) Ptosis: causes, presentation, and management. Aesthet Plast Surg 27(3):193–204

    Article  Google Scholar 

  2. Emsen IM (2008) A new ptosis correction technique: a modification of levator aponeurosis advancement. J Craniofac Surg 19(3):669–674

    Article  PubMed  Google Scholar 

  3. Martin TJ, Yeatts RP (2000) Abnormalities of eyelid position and function. Semin Neurol 20(1):31–42

    Article  CAS  PubMed  Google Scholar 

  4. Allard FD, Durairaj VD (2010) Current techniques in surgical correction of congenital ptosis. Middle East Afr J Ophthalmol 17(2):129–133

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hao DY, Cang ZQ, Cui JB, Fan X, Ding JK, Wei SM et al (2022) Simultaneous double eyelid blepharoplasty and blepharoptosis correction with levator aponeurosis plication technique: clinical experience of 108 cases. Ann Plast Surg 88(6):606–611

    Article  CAS  PubMed  Google Scholar 

  6. Putterman AM, Urist MJ (1975) Müller muscle-conjunctiva resection: Technique for treatment of blepharoptosis. Arch Ophthalmol 93(8):619–623

    Article  CAS  PubMed  Google Scholar 

  7. Liu MT, Totonchi A, Katira K, Daggett J, Guyuron B (2012) Outcomes of mild to moderate upper eyelid ptosis correction using Müller’s muscle-conjunctival resection. Plast Reconstr Surg 130(6):799e–809e

    Article  CAS  PubMed  Google Scholar 

  8. Zhu X, Ma Y, Woo DM, Lin Y, Chen B, Liu J et al (2021) Improved eyelid muscle tension balance with refined frontalis muscle flap suspension in the treatment of severe ptosis. Ophthalmic Plast Reconstr Surg 37(6):534–540

    Article  PubMed  Google Scholar 

  9. Huang SH, Lee CC, Lai HT, Takahashi H, Wang YC, Lai CS (2021) The Function-preserving frontalis orbicularis oculi muscle flap for the correction of severe blepharoptosis with poor levator function. Aesthet Surg J 41(6):NP260–NP266

    Article  PubMed  PubMed Central  Google Scholar 

  10. Liu HP, Shao Y, Li B, Yu X, Zhang D (2015) Frontalis muscle transfer technique for correction of severe congenital blepharoptosis in Chinese patients: an analysis of surgical outcomes related to frontalis muscle function. J Plast Reconstr Aesthet Surg 68(12):1667–1674

    Article  PubMed  Google Scholar 

  11. Carroll RP (1980) Preventable problems following the Fasanella-Servat procedure. Ophthalmic Surg 11(1):44–51

    CAS  PubMed  Google Scholar 

  12. Kumar S, Kamal S, Kohli V (2010) Levator plication versus resection in congenital ptosis–a prospective comparative study. Orbit 29(1):29–34

    Article  PubMed  Google Scholar 

  13. Berlin AJ, Vestal KP (1989) Levator aponeurosis surgery: a retrospective review. Ophthalmology 96(7):1033–1036

    Article  CAS  PubMed  Google Scholar 

  14. Al-Faky YH, El-Eneen MAA, Selim KM, Ali HA (2020) A Modified levator resection to improve postoperative lagophthalmos and eyelid lag. Ophthalmic Plast Reconstr Surg 36(1):38–44

    Article  PubMed  Google Scholar 

  15. Zuo L, Wang XX, Huang XY, Zhang JL, Du YY (2017) A modified levator resection technique involving retention of the levator palpebrae superioris muscle suspension system for treatment of congenital ptosis. Aesthetic Plast Surg 41(4):856–862

    Article  PubMed  Google Scholar 

  16. Zigiotti GL, Delia G, Grenga P, Pichi F, Rechichi M, Jaroudi MO et al (2016) Elevator muscle anterior resection: a new technique for blepharoptosis. J Craniofac Surg 27(1):201–203

    Article  PubMed  Google Scholar 

  17. Dortzbach RK (1994) Ophthalmic plastic surgery: prevention and management of complications. Raven Press, New York, pp 65–90

    Google Scholar 

  18. Ahmad SM, Della Rocca RC (2007) Blepharoptosis: evaluation, techniques, and complications. Facial Plast Surg 23(3):203–215

    Article  CAS  PubMed  Google Scholar 

  19. Kakizaki H, Takahashi Y, Nakano T, Ikeda H, Selva D, Leibovitch I (2011) Whitnall ligament anatomy revisited. Clin Exp Ophthalmol 39(2):152–155

    Article  PubMed  Google Scholar 

  20. Parsa FD, Wolff DR, Parsa NN, Elahi E (2001) Upper eyelid ptosis repair after cataract extraction and the importance of Hering’s test. Plast Reconstr Surg 108(6):1527–1536

    Article  CAS  PubMed  Google Scholar 

  21. Zoumalan CI, Lisman RD (2010) Evaluation and management of unilateral ptosis and avoiding contralateral ptosis. Aesthet Surg J 30(3):320–328

    Article  PubMed  Google Scholar 

  22. Lukas JR, Priglinger S, Denk M, Mayr R (1996) Two fibromuscular transverse ligaments related to the levator palpebrae superioris: Whitnall’s ligament and an intermuscular transverse ligament. Anat Rec 246(3):415–422

    Article  CAS  PubMed  Google Scholar 

  23. Zhuang W, Fang S, Fan H, Zhu W, Chen Y, Tang W et al (2019) Anatomical study of the extraocular check ligament system. J Plast Reconstr Aesthet Surg 72(12):2017–2026

    Article  PubMed  Google Scholar 

  24. Holmström H, Bernström-Lundberg C, Oldfors A (2002) Anatomical study of the structures at the roof of the orbit with special reference to the check ligament of the superior fornix. Scand J Plast Reconstr Surg Hand Surg 36(3):157–159

    Article  PubMed  Google Scholar 

  25. Hwang K, Shin YH, Kim DJ (2008) Conjoint fascial sheath of the levator and superior rectus attached to the conjunctival fornix. J Craniofac Surg 19(1):241–245

    Article  PubMed  Google Scholar 

  26. Jordan DR, Anderson RL (1990) The aponeurotic approach to congenital ptosis. Ophthalmic Surg 21(4):237–244

    CAS  PubMed  Google Scholar 

  27. Cruz AAV, Akaishi PMS, Mendonça AKTS, Bernadini F, Devoto M, Garcia DM (2014) Supramaximal levator resection for unilateral congenital ptosis: cosmetic and functional results. Ophthalmic Plast Reconstr Surg 30(5):366–371

    Article  PubMed  Google Scholar 

  28. Hickson-Curran S, Brennan NA, Igarashi Y, Young G (2014) Comparative evaluation of Asian and white ocular topography. Optom Vis Sci 91(12):1396–1405

    Article  PubMed  Google Scholar 

  29. Zhou J, Chen W, Qi Z, Jin X (2019) Minimally invasive conjoint fascial sheath suspension for blepharoptosis correction. Aesthetic Plast Surg 43(4):956–963

    Article  PubMed  Google Scholar 

  30. Xing Y, Wang X, Cao Y, Ding X, Lin L, Li J et al (2019) Modified combined fascia sheath and levator muscle complex suspension with Müller muscle preservation on treating severe congenital ptosis. Ann Plast Surg 82(1):39–45

    Article  CAS  PubMed  Google Scholar 

  31. Chu CC, Pratt L, Zhang L, Hsu A, Chu A (1993) A comparison of a new polypropylene suture with prolene. J Appl Biomater 4(2):169–181

    Article  CAS  PubMed  Google Scholar 

  32. Kyrillos R, Harissi-Dagher M (2011) Prolene monofilament suture in Boston Keratoprosthesis surgery. Digit J Ophthalmol 17(1):6–8

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. Zheng-Qiang Cang, Yun-Xia He, and Chao-Hua Liu have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, Shaanxi, China

    Zheng-Qiang Cang, Yun-Xia He, Chao-Hua Liu, Xiao Fan, Li-Ming Sun, Na Ma, Bao-Qiang Song, Dong-Yue Hao, Pai Peng & Jiao Cao

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  1. Zheng-Qiang Cang
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Correspondence to Dong-Yue Hao, Pai Peng or Jiao Cao.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Cang, ZQ., He, YX., Liu, CH. et al. Modified Levator Resection Technique for Moderate Congenital Blepharoptosis. Aesth Plast Surg 47, 1430–1438 (2023). https://doi.org/10.1007/s00266-023-03382-3

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