Abstract
Purpose: Frontalis sling suspension is the treatment of choice for drooping eyelids (congenital ptosis) which are associated with poor levator function. The materials used include autologous fascia lata (muscle grafts), palmaris longus (a small muscle visible as a tendon) and artificial materials. However, harvesting autologous material is often not possible in young children. A retrospective case series analysis to elucidate the clinical outcomes using 3-0 Ethilon, autologous fascia lata and palmaris longus tendon was performed. Additionally, a cost analysis of the various methods was performed. Methods: A consecutive case series of patients who underwent frontalis sling procedures for congenital ptosis between October 2010 and May 2017 was retrospectively analysed. The cost analysis was conducted using NHS Tariffs. Results: The outcomes of 23 procedures from 15 patients were also analysed. Median age at first frontalis sling surgery was 9.2 years (interquartile range: 14.8). Median follow-up before discharge was 26.6 months (interquartile range: 25.5). Materials included Ethilon (n=19 procedures), autologous fascia lata (n=1) and palmaris longus (n=3). Satisfactory cosmetic correction was achieved in all patients at 12-month review after initial surgery. Five frontalis sling suspension slips occurred in Ethilon cases following trauma, each requiring frontalis sling redo, one of which slipped again following trauma. Cost analysis revealed that operations using synthetic materials cost less as a single operation but more overall if one or more repeat operation is required. Conclusions: Ethilon, autologous fascia lata, and palmaris longus are safe and effective materials for use in frontalis sling suspension in the correction of congenital ptosis. Synthetic material costs less as a single operation but cost effectiveness suffers when repeat operations are required. Treatment should be individually tailored to the patient.
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