External Levator Advancement vs Müller’s Muscle–Conjunctival Resection for Correction of Upper Eyelid Involutional Ptosis

Simon, Guy Ben; Lee, Seongmu; Schwarcz, Robert; McCann, John D.; Goldberg, Robert A.

doi:10.1016/j.ajo.2005.03.033

Cited by 141 publications

(106 citation statements)

References 27 publications

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“…1 There is only one comparative study of anterior levator advancement vs MMCR for the correction of involutional ptosis, which reported a 22% lower revision rate for MMCR vs anterior levator advancement and a statistically better cosmetic outcome. 15 This is consistent with other reports of Muller's muscle resection, which suggest a generally higher success rate (85-98%) compared with that for anterior approach levator advancement. [10][11][12]16 To our knowledge, the current series is the largest to date assessing the success of isolated Muller resection.…”

Section: Resultssupporting

confidence: 82%

Open-sky isolated subtotal Muller’s muscle resection for ptosis surgery: a review of over 300 cases and assessment of long-term outcome

Peter

Khooshabeh

2013

Eye

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Purpose To evaluate short-and long-term success rates on isolated subtotal Muller resection in over 300 cases of ptosis over a 10-year period. Methods Clinical records were retrospectively evaluated for aetiology and severity of ptosis, levator function, response to phenylephrine, pre-and postoperative margin reflex distance of the upper lid (MRD1), postoperative lid contour and symmetry, complications and follow-up duration. Main outcome measures: change in MRD1 and eyelid contour. Surgical success: postoperative MRD1 Z2 and r4.5 mm, symmetry to within 1.0 mm and satisfactory contour. All patients were also sent patient satisfaction questionnaires, and invited to attend for a longer-term assessment of their surgical outcome. Results In total, 92 and 95% of 309 eyelids met all three criteria for success after an average follow-up of 4 and 47 months, respectively. Mean improvement in MRD1 was 2.56 mm. In all, 97% had postoperative MRD1 of Z2 and r4.5 mm and over 99% had an excellent contour. Altogether, 95 and 89% were within 1.0 and 0.5 mm symmetry of the fellow eye, respectively. In total, 51% of eyelids continued to rise, 17% maintained the same initial postoperative height, and 32% dropped by 1 mm or less. In all, 92% felt that their initial postoperative eyelid height had been maintained. Only 2% required repeat surgery and minor complications occurred in 4%. Conclusions Isolated subtotal Muller's resection is safe and effective for the repair of the majority of ptosis with moderate-togood levator function. It results in a more predictable height, which is maintained over time, less frequent contour abnormalities, and lower re-operation rates compared with anterior levator advancement.

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Section: Resultssupporting

confidence: 82%

Open-sky isolated subtotal Muller’s muscle resection for ptosis surgery: a review of over 300 cases and assessment of long-term outcome

Peter

Khooshabeh

2013

Eye

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“…Surgeries for the correction of dysfunctions in the elevation of the upper eyelid usually incise the STM along with the LPSM (Shields and Putterman 2003), although some case reports have shown unsuccessful results using similar surgical techniques (Ben Simon et al 2005). We have analyzed some of the patterns of anatomical variations involving the human STM and, based upon our morphometrical analyses of carefully dissected specimens, we propose an original morphological classification of the STM.…”

Section: Introductionmentioning

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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“…The only comparative study of anterior approach levator advancement vs MMCR revealed that patients who underwent anterior levator advancement had significantly lower preoperative MRD but were able to attain similar postoperative outcomes as the MMCR group. 2 The result from this study implied that advancement of the levator aponeurosis with intraoperative adjustment of eyelid height is a more powerful surgical procedure than MMCR that could be performed in any degree of involutional ptosis with adequate LF. The aponeurosis was thought to be the main transmitter of contraction of the levator to the tarsus, and to ignore the aponeurotic defect was considered an illogical solution for correcting involutional ptosis.…”

Section: Discussionmentioning

confidence: 89%

“…A comparative study of anterior levator advancement vs MMCR reported a 22% lower revision rate for MMCR and a statistically better outcome. 2 On the basis of the theory that the aponeurosis is the main transmitter of contraction of the levator to tarsus, techniques for levator aponeurosis advancement through posterior approach have been previously described. [3][4][5][6][7] These techniques avoid resection of conjunctiva which prevents dry eyes, and may be more effective in patients with negative response to phenylephrine test as well as correcting severe ptosis.…”

Section: Introductionmentioning

confidence: 99%

Minimal incision posterior approach levator plication for aponeurotic ptosis

Chan

2015

Eye

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External Levator Advancement vs Müller’s Muscle–Conjunctival Resection for Correction of Upper Eyelid Involutional Ptosis

Cited by 141 publications

References 27 publications

Open-sky isolated subtotal Muller’s muscle resection for ptosis surgery: a review of over 300 cases and assessment of long-term outcome

Open-sky isolated subtotal Muller’s muscle resection for ptosis surgery: a review of over 300 cases and assessment of long-term outcome

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

Minimal incision posterior approach levator plication for aponeurotic ptosis

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