Frontalis Muscle Flap Versus Maximal Anterior Levator Resection as First Option for Patients With Severe Congenital Ptosis

Medel, Ramón; Molina, Salvador; Vásquez, Luz María; Visa, Josep; Wert, Ana; Wolley-Dod, Charlotte

doi:10.1097/iop.0000000000001105

Cited by 20 publications

(8 citation statements)

References 5 publications

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“…Lastly, recurrence is a potential complication of all frontalis suspension approaches. We observed a recurrence rate of 12.9% at postoperative time points of 5 months, 12 months, or 24 months and a previous long-term study reported a recurrence rate of 20% to 23% over 10 years 27,29 …”

Section: Discussionsupporting

confidence: 74%

“…We observed a recurrence rate of 12.9% at postoperative time points of 5 months, 12 months, or 24 months and a previous long-term study reported a recurrence rate of 20% to 23% over 10 years. 27,29 This study has several limitations. It is retrospective in nature and as such patients were followed for varying postoperative intervals making it difficult to generalize the long-term durability of the effect.…”

Section: Discussionmentioning

confidence: 96%

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Minimal Dissection Direct Frontalis Muscle Advancement Flap for Congenital Ptosis Repair

Dallalzadeh¹,

Park

Korn

et al. 2021

Journal of Craniofacial Surgery

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Background: Frontalis flap advancement is an alternative means of congenital ptosis repair from frontalis suspension utilizing autologous fascia or allogenic implants. Variations in technique, including flap division, location and number of skin incisions, and dissection planes, are described in the literature. Materials and Methods: A retrospective case series of patients with congenital myogenic ptosis treated with simplified, minimal dissection frontalis flap advancement involving a single upper eyelid crease incision with dissection in the preseptal and subcutaneous planes without division to mobilize the frontalis flap. Inclusion criteria: pediatric patients age < 18 years with either primary or recurrent congenital ptosis following previous surgical repair. Exclusion criteria: ptosis of neurogenic etiology or postoperative follow-up < 3 months. Primary outcome measures were postoperative margin-reflex distance 1 (MRD1), the difference in MRD1 between surgical and nonsurgical eyelids in unilateral ptosis, and lagophthalmos. Secondary outcome measures included recurrence and complications. Results: Twenty-six patients met inclusion criteria, 24 males and 2 females. Mean postoperative MRD1 at last follow-up was 2.9 AE 1.2 mm and the mean difference in MRD1 between surgical and nonsurgical eyelids at last follow-up was 1.1 AE 1.0 mm. Average lagophthalmos at postoperative month 2 to 5 was 0.6 AE 0.7 mm. One patient demonstrated postoperative lid retraction that required re-operation. Four of 31 eyelids (12.9%) demonstrated ptosis recurrence at 5, 12, or 24 months.Conclusions: In this retrospective series, the authors report clinically and statistically significant surgical eyelid height improvement and symmetry between nonsurgical and surgical eyelids in congenital ptosis patients treated with minimal dissection direct frontalis flap advancement.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 96%

Minimal Dissection Direct Frontalis Muscle Advancement Flap for Congenital Ptosis Repair

Dallalzadeh¹,

Park

Korn

et al. 2021

Journal of Craniofacial Surgery

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“…The frontalis muscle, an important muscle tissue for raising the upper lid, works with the levator muscle to lift the upper lid, and plays an important role in cases of poor levator muscle strength. The frontal muscle flap belongs to the autologous tissue, which is not only rich in blood supply, but also has innervation and strong muscle strength, and because it is interwoven with the surrounding tissues, it is less prone to flap relaxation, which facilitates the ideal effect of frontal muscle flap repair, but can cause some damage to the patient’s frontal muscle strength after surgery ( 20 , 21 ). The present results showed that the frontal muscle strength of the affected side was higher in the observation group than in the control group at 1, 6 and 12 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

Application of e-PTFE Frontalis Suspension in the Treatment of Congenital Ptosis in Children

Zhang

Liu

et al. 2022

Front. Surg.

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PurposeAnalysis of the value of expanded polytetrafluoroethylene (e-PTFE) frontalis suspension applied to children with congenital ptosis.MethodsEighty clinical cases of children with congenital ptosis from October 2019 to October 2021 were randomly selected from our hospital. All children were divided into the observation group (n = 44) treated with e-PTFE frontalis suspension and the control group (n = 36) treated with frontalis flap suspension according to the treatment procedure. Comparison of eyelid condition [palpebral fissure height, margin reflex distance (MRD), eyelid closure time], ocular surface status [corneal fluorescein staining (CFS) score, tear film breakup time (TBUT), surgical eye lacrimal river height (LRH), sehirmer test I (STI)], frontal muscle strength of affected side, cosmetic results and complications in both groups at 1, 6 and 12 months postoperative follow-up.ResultsAt 1, 6 and 12 months after surgery, there was no significant difference in terms of palpebral fissure height and MRD between both groups (p > 0.05); After surgery, the eyelid closure time was shorter in the observation group than in the control group (p < 0.05). At 1, 6 and 12 months after surgery, the CFS scores were lower in the observation group than in the control group (p < 0.05); At 6 and 12 months after surgery, the TBUT was longer and the surgical eye LRH was higher in the observation group than in the control group (p < 0.05); At 1, 6, and 12 months after surgery, there was no significant difference in STI between both groups (p < 0.05). At 1, 6 and 12 months after surgery, the frontal muscle strength of affected side was higher in the observation group than in the control group (p < 0.05). At 1, 6, and 12 months after surgery, there was no significant difference in cosmetic results between both groups (p > 0.05). The overall complication rate in the observation group (6.82%) was lower than that in the control group (25.00%) (p < 0.05).ConclusionThe surgical and cosmetic results of e-PTFE frontalis suspension and frontalis flap suspension applied to congenital ptosis are comparable, but the former has the advantage of faster postoperative recovery, better ocular surface status, less frontali muscle strength damage and fewer complications.

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“…Nevertheless, it has been found that FMF may cause more examples of aesthetic and functional complications, which can be reduced with MLR. [ 25 26 ]…”

Section: Discussionmentioning

confidence: 99%

Maximal levator resection versus Gore-Tex® sling for congenital blepharoptosis with poor levator function

Dawood

Hassan

Sayed

2021

Oman Journal of Ophthalmology

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BACKGROUND: Treating congenital blepharoptosis is often mandatory to clear the visual access and avoid amblyopia; however, when the levator function is poor, achieving a satisfactory long-term outcome is challenging. This study aimed to compare the outcomes of maximal levator resection (MLR) with those of frontalis suspension (FS) using Gore-Tex ®, in the treatment of congenital blepharoptosis with poor levator function. PATIENTS AND METHODS: The study included 102 eyelids of 66 patients of mean age 4.3 ± 1.6 standard deviation (SD) years, randomly divided into two groups (51 eyes each). Group A: FS using Gore-Tex ®, Group B: MLR. Postoperative outcomes were evaluated at 1, 6 and 12 months. Patients' ophthalmic examination including margin-reflex distance (MRD1) before and after surgery and postoperative complications were recorded. RESULTS: At the end of the follow-up, the mean MRD1 increased from 0.3 ± 0.7 SD mm in Group A, 0.4 ± 0.8 SD mm in Group B preoperatively, to 2.7 ± 0.5 SD mm and 2.9 ± 0.7 SD mm, respectively (P < 0.001 in both groups). Results of Group B were significantly higher than Group A (P = 0.047). Success was achieved in 77 eyelids (75.4%), distributed as follows: 36 eyelids (70.6%) in Group A, and 41 eyelids (80.1%) in Group B. The total recurrence rate was 6.9% (seven eyes), while other complications were recorded in 23 eyes (22.5%). CONCLUSION: MLR, compared to FS with Gore-Tex® sling, can be a more efficient surgical option to correct congenital blepharoptosis with poor levator excursion. Prominent postoperative lagophthalmos warrants close ocular surface observation in early follow-up weeks.

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Frontalis Muscle Flap Versus Maximal Anterior Levator Resection as First Option for Patients With Severe Congenital Ptosis

Abstract: Good functional and aesthetic results were obtained with both surgical techniques. FMF required fewer reoperations compared with maximal ALR, offering a better long-term result without residual ptosis.

Cited by 20 publications

References 5 publications

Minimal Dissection Direct Frontalis Muscle Advancement Flap for Congenital Ptosis Repair

Minimal Dissection Direct Frontalis Muscle Advancement Flap for Congenital Ptosis Repair

Application of e-PTFE Frontalis Suspension in the Treatment of Congenital Ptosis in Children

Maximal levator resection versus Gore-Tex® sling for congenital blepharoptosis with poor levator function

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