The septal pulley in frontalis suspension.

Archives of Ophthalmology (Impact Factor: 4.49). 12/1986; 104(11):1707-10. DOI: 10.1001/archopht.1986.01050230145051
Source: PubMed

ABSTRACT We present a modification of the frontalis suspension for blepharoptosis, first described in 1937, that eliminates many of the drawbacks of traditional brow suspension techniques. Functional and cosmetic problems with standard suspension procedures are related to the superficial location of the sling in the eyelid, which leads to unsatisfactory geometric tenting of the pretarsal and preseptal skin, obliteration of the lid crease, and a pulling away of the upper lid from the globe with brow elevation. Eyelid height is also limited by the upper lid being pulled away from the globe. By anchoring the suspensory material behind the superior orbital septum near the arcus marginalis, more physiologic vectors of elevation are transmitted to the upper eyelid. This modification has yielded good cosmetic and functional results in 96 cases of frontalis suspension using both autogenous and allosplastic materials, and it deserves to be more widely used.

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    ABSTRACT: This study was conducted to review the results of the open sky approach to frontalis suspension surgery for upper eyelid ptosis and reduced levator function. A retrospective, non-comparative audit in which all patients undergoing open sky approach frontalis suspension surgery with full-thickness skin crease incision and tarsal fixation of suspension material (SM). Outcomes reported include: upper eyelid height, pretarsal show, skin crease depth and contour based on postoperative standardised photographs. We reviewed 616 consecutive ptosis procedures over a 5-year period, of which 31 involved frontalis suspension (18 patients: seven female, 11 male). Mean age was 45.7 ± 26.7 years. SMs used included: silicon rod (n = 21), autogenous fascia lata (n = 8) and polytetrafluoroethylene (n = 2). Upper eyelid height significantly improved from 1.12 ± 1.2 to 3.2 ± 1.3 mm post-surgery (P ≤ 0.0001). Pretarsal show was significantly higher preoperatively (7.4 ± 2.3 mm) compared to postoperative measurements (5.6 ± 2.4 mm) (P = 0.005). Of the total cases, 84% had an improvement in skin crease depth, with 40.6% having postoperative symmetry with the contralateral eyelid. A sectoral droop, flattened and normal contour were seen in 12.9%, 22.9% and 58.1% post-surgery compared with 22.9%, 61.3% and 12.9% pre-surgery. The surgical revision rate was 16.1%, indications included: undercorrection (n = 3), stitch granuloma (n = 1) and wound dehiscence (n = 1). All cases requiring revision surgery had undergone unilateral surgery with silicon rod. The open sky approach significantly improves upper eyelid height and pretarsal show. In addition, the depth and height of the skin crease are improved and in cases of both unilateral and bilateral surgery this technique produces good symmetry.
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    ABSTRACT: PURPOSE: To compare nylon monofilament suture with polytetrafluoroethylene sheet for frontalis suspension surgery to treat eyes with congenital ptosis. DESIGN: Retrospective, nonrandomized, comparative, interventional case series. METHODS: We reviewed the medical records of 49 patients who had undergone 79 eyelid frontalis suspension surgeries to treat congenital ptosis. All of the patients were younger than 16 years and had congenital ptosis with poor levator muscle function. They were treated with frontalis suspension surgery with either a nylon suture or a polytetrafluoroethylene sheet and were followed up for at least 1 year. A single rhomboid loop sling was used for the nylon suture surgery. For the polytetrafluoroethylene sheet, an incision was made in the eyelid crease, and one end of the sheet was fixed to the tarsus and the other was fixed to the frontalis muscle. The main outcome measures were postoperative recurrences and complications. RESULTS: We evaluated 37 eyelids of 25 patients after nylon suture surgery and 42 eyelids of 31 patients after polytetrafluoroethylene sheet surgery. Among these, 9 eyelids of 7 patients were included in both groups. The median postoperative follow-up period was 32 months in both groups. The recurrence rates were 62.2% for the nylon suture group and 0% for the polytetrafluoroethylene sheet group (P < .001). The postoperative complication rates were 0% for the nylon suture group and 7.1% for the polytetrafluoroethylene sheet group (P > .05). CONCLUSIONS: Frontalis suspension using a polytetrafluoroethylene sheet with direct tarsus and frontalis muscle fixation is a reasonable technique with low rates of recurrences and complications.
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