Modified Technique and Ptosis Clamp for Surgical Correction of Congenital Pediatric Ptosis by Anterior Levator Resection

Abstract

Congenital ptosis is due to a dysgenesis of the levator complex with the levator muscle being replaced by fatty and fibrous tissue. This dysfunction of the levator muscle gives rise to the classic triad of findings in congenital ptosis, including ptosis in the primary position, lagophthalmos in downgaze, and a poorly formed eyelid crease. There are traditionally two ways to surgically correct congenital ptosis, levator resection and frontalis suspension (by utilizing a myriad of both autogenous and synthetic materials). Although frontalis suspension is the more utilized surgical option for the correction of congenital ptosis, the complication rate due to the use of synthetic materials is not insignificant. Many surgeons feel that the contour and appearance of the eyelid following levator resection is superior to the frontalis suspension technique. Thus, levator resection for congenital ptosis can be one of the most satisfactory and physiologically normal of the ptosis procedures. Surgery for congenital ptosis can however be unpredictable in outcome. We propose a modified technique for levator resection as well as a newly designed and modified Berke ptosis clamp for levator resection surgery. Postoperative results with the modified technique as well as clamp have been very encouraging with excellent postoperative lid contour and height. The author has utilized this clamp and modified technique in over 350 lid surgeries over the past ten years.