The Septal Pulley in Frontalis Suspension

Archives of Ophthalmology (Impact Factor: 4.4). 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: From an inexact origin of trial and error, blepharoptosis surgery has become a ­scientific art. The arc of its technical development parallels that of anatomical discoveries and surgical materials. Approaches have varied, as have the tissues of interest, and with increasingly reliable results in the reconstructive domain came greater expectations and the development of its cosmetic counterpart. That said, for some diseases associated with blepharoptosis, an ideal surgery remains elusive. This chapter provides a chronological account of the treatment of ­blepharoptosis with attention paid to the tissues involved. The rich history of blepharoptosis surgery provides a fertile matrix for the field of oculofacial plastic surgery, and in return, the field continues to evolve blepharoptosis’ surgical treatment.
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    ABSTRACT: We reviewed retrospectively 170 cases of congenital and acquired oculomotor nerve palsy to determine the effectiveness of surgery in the treatment of blepharoptosis in oculomotor nerve palsy. Twenty patients had had surgical repair of the blepharoptosis. Patients with congenital oculomotor palsy were more often selected for blepharoptosis surgery than patients with acquired blepharoptosis because of the absence of diplopia caused by suppression in congenital cases. There was complete recovery in 72 of 109 patients (66%) with acquired oculomotor palsy. Results were judged with regard to functional improvements and cosmetic improvement. Primary functional disability was relieved by lifting the eyelid above the pupil in ten of 12 patients (83%). Primary cosmetic disability was relieved in six of six patients. Corneal complications occurred in six of 20 patients (30%) who were treated surgically.
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    ABSTRACT: To compare two sling designs (single loop or double pentagon) and a variety of suture material that was used in frontalis suspension surgery for correction of upper eyelid ptosis. Retrospective, nonrandomized, comparative interventional case series. Medical record review of 99 patients (164 surgeries) who underwent frontalis suspension surgery for upper eyelid ptosis was conducted at the Jules Stein Eye Institute in 1996 to 2002. Functional and cosmetic success, margin reflex distance (MRD) and lagophthalmos were evaluated. MRD increased an average of 1.1 mm after the operation (P < .001). Ptosis recurrence was noticed in 42 cases (26%); polytetrafluoroethylene achieved the lowest recurrence rate (15%), although not statistically significant. No difference in functional success, ptosis recurrence, or change in MRD was noticed between single loop and double pentagon design. A better cosmetic outcome was noted in cases in which nylon suture was used. Complications included four cases (2.4%) of over-correction, three cases (1.8%) of suture infection (all in polytetrafluoroethylene), two cases of pyogenic granuloma (1.2%), and two cases (1.2%) of suture exposure. Frontalis suspension for upper eyelid ptosis resulted in 26% ptosis recurrence after a mean of 12 months from first surgery. Polytetrafluoroethylene showed the lowest incidence of ptosis recurrence. No statistically significant difference was found between different suture materials or loop shape that was used in the surgical technique. A better cosmetic outcome, as graded by different observers, was noted in cases in which a nylon sling was used.
    American Journal of Ophthalmology 11/2005; 140(5):877-85. DOI:10.1016/j.ajo.2005.05.031 · 3.87 Impact Factor
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