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Modified Levator Aponeurotic Advancement With Delayed Postoperative Office Revision

 

作者: Joseph Mauriello,   Ahmed Abdelsalam,  

 

期刊: Ophthalmic Plastic and Reconstructive Surgery  (OVID Available online 1998)
卷期: Volume 14, issue 4  

页码: 266-270

 

ISSN:0740-9303

 

年代: 1998

 

出版商: OVID

 

关键词: Levator advancement;Levator aponeurosis.

 

数据来源: OVID

 

摘要:

Summary:The results of a “modified” levator aponeurotic advancement were reviewed to determine the appropriate indications and optimum timing for office revision after blepharoptosis repair. The levator advancement was modified as follows: 1) elimination of epinephrine from the local anesthetic so as not to stimulate the Müller muscle, 2) use of a 6–0 silk rather than a monofilament nonabsorbable suture to secure the advanced levator to avoid possible cheese-wiring and late recurrence, and 3) excision of a strip of preseptal orbicularis muscle just above the tarsal border to create surgically apposed “raw” surfaces for a firm attachment of the “advanced” levator. Office adjustments were delayed for at least 8 days after surgery and were performed as late as 14 days after surgery. Of the 122 consecutive aponeurotic advancements in 110 patients (12 bilateral cases), five (4.1%) patients were candidates for revision in that the operated eyelid was greater than 1 mm from desired height. All such eyelids were undercorrected by 2.0 mm to 2.5 mm. Four of the five underwent revision at 8, 11, and 14 days (two patients) after surgery. The fifth patient did not undergo revision. Four patients with overcorrections from 2.0 mm to 2.5 mm resolved with eyelid massage. It is concluded that the number of office revisions may be reduced if delayed for at least 8 days after surgery. This delay allows for resolution of postoperative edema and objective prediction of final eyelid position. The advantages of this “modified” levator advancement procedure are discussed.

 

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