Success of the Fasanella-Servat Operation Independent of Müller's Smooth Muscle Excision

Buckman, Gila; Hyde, Kenneth J.; Lisman, Richard D.; Hornblass, Albert; Harrison, Winston

doi:10.1016/s0161-6420(89)32876-4

Cited by 72 publications

(48 citation statements)

References 6 publications

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“…9 The Fasanella-Servat is a blind approach only suitable for mild ptosis, and rarely excises Mü ller's muscle. 6 Putterman's technique is more precise in that Mü ller's is pulled off the underlying levator, but still requires a clamp and does not allow direct visualisation of Mü ller's in its separation from levator. 7 Closure on the conjunctival surface may irritate the surface of the eye and does not allow per-or postoperative adjustment.…”

Section: Discussionmentioning

confidence: 99%

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Open sky Müller's muscle–conjunctiva resection for ptosis surgery

Lake

Mohammad-Ali

Khooshabeh

2003

Eye

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Purpose We describe a surgical technique for ptosis correction in moderate to good levator function involving resection of Mü ller's muscle of the upper eyelid. This is a substantial modification of the technique described by Putterman. We then present our experience of and the results from this method. Methods A subtotal resection of Mü ller's muscle plus underlying conjunctiva is performed under direct visualisation. The muscle stump is reattached to the tarsus and the sutures passed through to the skin crease. In those cases where the phenylephrine test was positive to a level less than the desired lid height, a 1 mm of strip of tarsus is included in the tissue resection. The sutures are removed between 5 days and 3 weeks postoperatively allowing control over lid height and contour. A total of 61 eyes of 48 patients underwent this procedure. Results Of 61 eyelids, 56 undergoing this procedure were within 0.5 mm of the desired end point, giving a success rate of 92%. Of 61 eyelids, 60 were within 1 mm of the desired height. Preoperative phenylephrine 10% was highly predictive of postoperative lid height (58/61). An excellent lid contour was noted in all cases (61/61). Conclusions We present a new approach to ptosis correction using Mü ller's muscle. It has a high success rate and good cosmetic outcome. It is technically straightforward and easy to learn.

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Section: Discussionmentioning

confidence: 99%

“…5 Histopathology of the excised tissues has shown that usually tarsus is excised with no or minimal Mü ller's muscle. 6 This may produce instability of the upper lid or poor lid contour.…”

Section: Introductionmentioning

confidence: 99%

Open sky Müller's muscle–conjunctiva resection for ptosis surgery

Lake

Mohammad-Ali

Khooshabeh

2003

Eye

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“…[5][6][7] Posterior approach surgery was further popularised utilising Muller's muscle and tarsoconjunctival resection. 8 Resection of Muller's muscle together with overlying conjunctiva (MMCR) was first reported by Putterman, where he dissected Muller's blindly off its bed on the aponeurosis with the aid of a special clamp. 9 This technique has been shown to be safe and effective with 90% of eyelids achieving within 1.5 mm symmetry of the fellow eye.…”

Section: Introductionmentioning

confidence: 99%

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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“…The Fasanella-Servat approach was initially regarded as a form of levator resection [9]. Several authors have since reported excellent success rates without resection of the levator aponeurosis or Müller's muscle, positing that the effect of the Fasanella-Servat procedure is achieved by shortening of the vertical posterior lamella, wound contracture, and advancement of Müller's muscle along the tarsus [4,6].…”

mentioning

confidence: 99%

“…Conventionally, the Fasanella-Servat operation has been employed for minimal ptosis with good levator function, and this is reflected in the published literature regarding outcomes of the Fasanella-Servat procedure [1][2][3][4][5]7,10]. We were curious regarding the utility of this operation in patients with moderate to severe ptosis, and we hereby present our experience with the Fasanella-Servat surgical repair of blepharoptosis in these patients.…”

mentioning

confidence: 99%

Fasanella-Servat Operation for Moderate to Severe Blepharoptosis

Gonzalez¹

2017

OCR

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Success of the Fasanella-Servat Operation Independent of Müller's Smooth Muscle Excision

Cited by 72 publications

References 6 publications

Open sky Müller's muscle–conjunctiva resection for ptosis surgery

Open sky Müller's muscle–conjunctiva resection for ptosis surgery

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

Fasanella-Servat Operation for Moderate to Severe Blepharoptosis

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