Treatment of Children With Congenital Severe Blepharoptosis by Frontalis Aponeurosis Flap Advancement Under General Anesthesia in a Single Incision

Abstract

Frontalis aponeurosis flap advancement could be used to treat congenital severe blepharoptosis with good short-term effects.

“Extended Frontalis Muscle Advancement Technique for Severe Congenital Blepharoptosis”

“…The frontalis muscle advancement technique is a popular technique and has been proven effective for severe congenital ptosis, especially in Asian countries, where it is common to correct severe ptosis by advancing the frontalis muscle into the orbit and attaching it directly to the tarsus. 6–17 It was first reported by Fergus in 1901, 6 and reintroduced by Song and Song in 1982. 7 Different from the original eyelid crease and infrabrow double incisions, 6–11 the eyelid crease single-incision has become the most popular incision design over the past decade because of fewer scars.…”

“…3,10 The subcutaneous separation range of the conventional frontalis muscle flap is usually limited and does not exceed 1 cm above the superior margin of the eyebrow because of the limited visualization and uncertainty with the surgical anatomy of the forehead, as seen through the eyelid crease incision. [13][14][15][16][17][18][19] Recent understanding of the forehead anatomy, in particular, the description of the forehead compartments, 20 has provided the knowledge to harvest extended frontalis muscle flap with more certainty, safety, and predictability through the eyelid crease incision. The superficial forehead compartments are located in the subcutaneous fat layer of the forehead.…”

“…1,3,5 The frontalis muscle advancement technique is a popular technique and has been proven effective for severe congenital ptosis, especially in Asian countries, where it is common to correct severe ptosis by advancing the frontalis muscle into the orbit and attaching it directly to the tarsus. [6][7][8][9][10][11][12][13][14][15][16][17] It was first reported by Fergus in 1901, 6 and reintroduced by Song and Song in 1982. 7 Different from Background: The conventional frontalis muscle advancement technique still has some disadvantages, such as residual lagophthalmos, eyebrow ptosis, eyelid contour abnormality, and undercorrection.…”

“…Plastic and Reconstructive Surgery • November 2023 886e the original eyelid crease and infrabrow double incisions, [6][7][8][9][10][11] the eyelid crease single-incision has become the most popular incision design over the past decade because of fewer scars. [12][13][14][15][16][17][18][19] However, the conventional frontalis muscle advancement technique still has some disadvantages, such as residual lagophthalmos (RL); eyebrow ptosis; eyelid contour abnormality; and especially, undercorrection, with a median value of 12.2%. 3,[10][11][12][13][14] Insufficient separation leads to poor flap mobility, which may be the main reason of RL, eyebrow ptosis (Fig.…”

Efficacy of Modified Shortening of Levator Palpebrae Superioris Muscle on Patients with Ptosis

“…At 1 st and 7 d after the operation, compared with the control group, the observation group treated with modified shortening of levator palpebrae superioris muscle experienced significantly increased blinking times and significantly less eyelid closure insufficiency and after operation, both groups suffered from complications including interbrow hematoma, symblepharon [24] , eyelid entropion, ectropion or angulation, poor upper eyelid radian and exposure keratitis [25] , and the incidence of complications in the observation group was not significantly different from that in the control group, indicating that the safety of the two surgical methods is equivalent. Furthermore, during the follow-up period after operation, the upper eyelid retraction of the observation group was significantly less than that of the control group, implying that modified shortening of levator palpebrae superioris muscle has better long-term effect, can effectively prevent upper eyelid retraction after operation and ensure the surgical effect.…”