Frontalis Muscle Suspension Research Articles

Congenital ptosis repair in children: comparison of frontalis muscle suspension surgery and levator muscle surgery.

Comparing the surgical and refractive outcomes of congenital ptosis repair by different surgical techniques. This longitudinal cohort study reviewed medical records of 101 patients who underwent congenital ptosis repair, from 2006 to 2022 in a single center. Analysis was performed for demographic background, co-morbidities, pre-operative and post-operative ocular examinations and refraction, complications, reoperations, and success rates. Following exclusion criteria, we remained with 80 patients (103 eyes) who underwent either frontalis muscle suspension surgery (FMS) (55 eyes) or levator muscle surgery (LM) (48 eyes). Patients in the FMS group were younger (mean age of 3.1 vs. 6.0years, p < 0.001) and had worse pre-operative ocular assessments including prevalence of visual axis involvement, chin-up head position, ptosis severity, and levator muscle function (LF) (p < 0.001). Both groups had a 25% rate of reoperation, however while in the LM group reoperation was required solely due to undercorrection, in the FMS group various indications prompted reoperation. Success rate was higher in the FMS group (87.3% vs. 60.4%, p = 0.002). While pre-operative astigmatism was higher in the LM group (p = 0.019), no significant differences were observed post-operatively. Spherical and spherical equivalent changes over time were significant only in the FMS group (p = 0.010 and p = 0.004, respectively). Within our cohort, a higher success rate of congenital ptosis repair was observed among patients who underwent FMS compared to LM, despite similar reoperation rates. In cases of severe ptosis and moderate LF, LM demonstrated a lower-than-anticipated success rate. Astigmatic changes following ptosis repair were not consistent in either group.

Improved Eyelid Muscle Tension Balance With Refined Frontalis Muscle Flap Suspension in the Treatment of Severe Ptosis.

The tension balance of the upper eyelid following ptosis repair is crucial to a successful postoperative outcome. To improve on existing surgical techniques, the authors developed a new refined frontalis muscle flap suspension (FMFS) for severe ptosis repair and explored the balancing effect between the orbicularis muscle and frontalis muscle following surgery. Forty-three patients (47 eyes) with a mean age of 6.07 ± 2.55 years old were diagnosed with severe congenital ptosis and underwent refined FMFS with complete orbicularis preservation between January 1, 2010 and December 31, 2017 in the Wenzhou Eye Hospital, Wenzhou, China. The outcomes measured include upper eyelid margin reflex distance (MRD1), degree of lagophthalmos, and cosmetic outcome (lash angle, eyelid contour, and crease). Surgical complications were also recorded. The preoperative mean MRD1 was -1.29 ± 0.88 mm and preoperative levator function was 1.87 ± 0.82 mm (ranged from 0 to 3.0 mm). Following surgery, lagophthalmos was observed in all cases in the first week with a mean palpebral fissure height of 1.68 ± 0.40 mm and diminished over 3 months. The MRD1 improved to +3.04 ± 0.68 mm at 6 months following surgery. All cases showed excellent cosmetic outcomes. There were no significant complications. The refined FMFS is a safe and reliable surgery in treating severe ptosis. The eye-closing power of the intact orbicularis muscle is sufficient at countering the lifting power of the frontalis muscle suspension, achieving a balanced blink mechanism and eyelid closure.

Efficacy of Modified Shortening of Levator Palpebrae Superioris Muscle on Patients with Ptosis

To explore the efficacy of modified shortening of levator palpebrae superioris muscle on patients with ptosis. A total of 78 patients with mild or moderate ptosis admitted to our hospital were enrolled and assigned to a control group and an observation group. Patients in the control group were treated with frontalis muscle suspension and those in the observation group were treated with modified shortening of levator palpebrae superioris muscle and the efficacy on ptosis of patients in the two groups was compared. The effective correction rate of the observation group was significantly higher than that of the control group ( 92.59 % vs. 78.72 %) and at 1st and 7th d after operation, compared with the control group, the observation group experienced significantly more blinking times and significantly less eyelid closure insufficiency. After operation, the two groups suffered from complications including interbrow hematoma, symblepharon, eyelid entropion, ectropion or angulation, poor upper eyelid radian, exposure keratitis and the incidence of complications in the observation group was not significantly different from that in the control group. In addition, during the follow-up period, the upper eyelid retraction of the observation group was significantly less than that of the control group (all p<0.05). The modified shortening of levator palpebrae superioris muscle can provide reliable efficacy for patients with ptosis and it results in less complications and smaller upper eyelid retraction.

Clinical efficacy of conjoint fascial sheath suspension and frontalis muscle suspension in treating moderate or severe congenital ptosis and the effects on ocular surface and refractive status.

Clinical efficacy of conjoint fascial sheath suspension and frontalis muscle suspension was explored in treating moderate or severe congenital ptosis and their effects on ocular surface and refractive status. A total of 75 patients with moderate or severe ptosis (108 eyes) treated in Yidu Central hospital from June 2014 to June 2019 were enrolled in this study, and divided into group A and group B. Group A was treated with conjoint fascial sheath suspension (n=38, 55 eyes), while group B was treated with frontalis muscle suspension (n=37, 53 eyes). The following data of the two groups were compared: General baseline data, total correction efficiency, satisfaction, and ocular surface after surgery, refractive status, and complications at three months after surgery. The two groups showed no significant difference in general data (P>0.05), but group A showed higher total correction efficiency and satisfaction, and less complications than those in group B (all P<0.05). In addition, the two groups had no difference in terms of ocular surface, tear break-up time, or Schirmer test level after surgery (all P>0.05), and showed no refraction changes after surgery (P>0.05). In terms of refractive status and ocular surface, the two surgery methods are not very different, but in terms of efficacy, conjoint fascial sheath suspension is more advantageous than frontalis muscle suspension, and it brings less complications, and enjoys a higher satisfaction, so it is worthy of promotion.

Frontalis suspension using autogenous temporal fascia by Fox technique

IntroductionSevere ptosis of more than 4mm with poor levator function of less than 4mm is treated via the frontalis muscle suspension technique using autogenous temporal fascia. Technical noteThe surgery was performed under general anaesthesia. The eyelid crease was incised and the tarsus exposed. An incision centered on the mid-pupillary level was then made just above the eyebrow with exposure of the frontalis muscle. The temporal fascia strip was sutured to the tarsus at three points. Every free end of the strip was then slid through the adjacent forehead subcutaneous tunnel to emerge together through the medial forehead incision. The eyelid crease was re-formed by suturing the skin with the graft. DiscussionFrontalis suspension using autologous material is a harmless procedure, which does not alter the upper eyelid structures. It is an effective procedure in the long-term.

Comparison on the efficacy between combined fascial sheath suspension and frontalis muscle suspension for severe congenital blepharoptosis

Objective To compare the clinical efficacy between combined fascial sheath suspension and frontalis muscle suspension for the treatment of severe congenital blepharoptosis. Methods The data of 76 eyes of 60 cases with severe congenital blepharoptosis were collected.All cases were divided randomly into two groups.The observation group contained 39 eyes of 32 cases and control group 37 eyes of 28 cases.Observation group were treated with combined fascial sheath suspension, the control group underwent frontalis muscle suspension. The therapeutic efficacies of two groups were compared. Results In the observation group the effective rate was 92.30%, and in the control group was 89.20%. The difference between two groups was not significant(P=0.638). The rate of complication and recurrence in observation group were 10.25% and 2.78%; the control group were 35.14% and 18.18%.The difference were staristically significant(P=0.009, 0.034). Conclusion Combined fascial sheath suspension is an effective method for the treatment of severe congenital blepharoptosis. It can improve function of the upper eyelid, with little injury, less complication and low recurrence rate. Key words: Blepharoptosis, congenital, severe; Suspension surgery, combined fascial sheath, frontalis muscle

A new technique of check ligament suspension for severe congenital blepharoptosis

Objective To invastigate the clinical efficacy of check ligament suspension for severe congenital blepharoptosis. Methods Sixty-four eyes of 48 patients of severe congenital blepharoptosis were divided randomly into trial group, suspension of the eyelid to the check ligament(34 eyes of 24 cases); and control group, frontal muscle suspension surgery (30 eyes of 24 cases). The clinical efficacy was compared according to the condition of the palpebral height, eyelid margin radian, edema, palpebral fissure closure and lid lag after surgery. Results After following up for 6-24 months, eyelids were all raised and appearance was improved in both groups. In trial group, the edema was less, the eyelid was more natural and lid lag was less. In control group, 4 of the 24 patients were undercorrection, 1 patient's eyelid margin radian was not good and 1 patient got trichiasis. Patients in control group had more severe edema and obvious lid lag. Two patients' palpebral fissure closure was delayed. Lagophthalmos in 6 eyes still existed 6 months after surgery. Conclusion The suspension of the check ligament instead of musculi levator palpebrae superioris has reliable efficacy. The movement of upper eyelid is identical to the physical status, and the appearance of eyelids is more natural after surgery. Key words: Blepharoptosis, congenital, severe; Check ligament suspension

Clinical efficacy of frontalis muscle suspension through the orbital septum tunnel

Objective To evaluate the clinical efficacy of orbital septum tunnel frontal muscle flap suspension surgery for congenital blepharoptosis. Methods One hundred and twenty-four eyes of 108 cases with congenital ptosis were randomly divided into control group and observation group (62 eyes in each group). The patients in control group underwent levator advancement correction, and the patients in observation group were treated with posterior orbital septum tunnel frontalis muscle suspension. The curative effects and complications of two groups were compared. Results The satisfactory rate of observation group was higher than that of control group. No complications happened in observation group. The incidence rate of complications in control group was 14.5%, and the difference between two groups was statistically significant. Conclusion The posterior orbital septum tunnel frontal muscle flap suspension surgery is effective for congenital ptosis correction. Key words: Ptosis, congenital; Surgery, frontalmuscle flap suspension; Efficacy; Complications

Intra-eyebrow frontalis suspension using inverted Y-shaped short autogenous fascia lata for blepharoptosis with poor levator function

Frontalis suspension using autogenous fascia lata is a common procedure for blepharoptosis with poor levator function. However, donor-site morbidity associated with fascia lata harvest cannot be ignored. In conventional procedures, the required length of the fascia lata is usually >5-12cm with a lateral thigh skin incision of approximately 5cm or more. The present study introduces a new frontalis suspension procedure in which the required size (length and width) of the fascia lata and length of lateral thigh incision is much smaller. The harvested fascia lata is tailored to an inverted Y shape and the separated caudal legs are fixed to the tarsus while the cephalic end is grafted inside the eyebrow through a suborbital septum tunnel. In the present study, 11 patients who underwent the new procedure with a minimum of 6 months of follow-up were evaluated. The average length and width of the harvested fascia lata in unilateral ptosis cases were 2.85 and 0.89cm, respectively. The average length of the lateral thigh incision was 1.25cm. The margin reflex distance improved in all cases at 6 months postoperatively. The cosmetic result was graded as good to excellent in most of the patients. Trichiasis, widened donor scar, and eyebrow notch were noted as complications. The present method is a good alternative for the treatment of blepharoptosis with poor levator function. It potentially reduces donor-site morbidity as compared with conventional frontalis muscle suspension procedures using autogenous fascia lata.

The Use of a Pleated Strip of Autogenous Temporalis Fascia Graft for Frontalis Suspension in Recurrent Poor Levator Function Ptosis in Adult Patients

Purpose: Poor levator function (LF) blepharoptosis can be corrected surgically using frontalis muscle suspension with a variety of materials. Autogenous grafts such as fascia lata are commonly used. The need for a remote surgical site and the risk of an unattractive leg scar makes the use of an autogenous temporalis fascia (ATF) graft appealing as the scar is concealed in the hair. We describe the use of a pleated, lengthened ATF graft that is easy to prepare and insert, and provides a cosmetically acceptable outcome.Methods: Prospective case series describing six patients with previous multiple failed lid surgeries and recurrent poor (≤5 mm) LF (mean 2.87 ± 1.72 mm) ptosis. The pleated graft technique was used to yield a strip of ATF up to 18-cm long from a short 2-cm temporal incision. Eight eyelids then underwent ATF graft frontalis suspension surgery using the modified Fox pentagon technique. Outcomes included eyelid measurements with 4.5-year follow-up.Results: All patients achieved good functional and esthetic outcome. The mean central palpebral aperture 6 weeks postsurgery was 7.14 ± 1.67 mm, equating to a mean increase of 3.27 mm (p < 0.05 using the paired t-test). The improvement in eyelid height was maintained at the 4.5-year follow-up in all patients, except one who died of unrelated cause.Conclusion: A pleated strip of ATF graft provides a simpler alternative to fascia lata grafting for frontalis suspension in poor LF ptosis in adult patients with good long-term results.

Treatment of congenital ptosis by modified frontal muscle suspension

Objective To observe the effect of modified frontal muscle suspension for congenital ptosis.Methods 59 cases (73 eyes) with severe congenital ptosis were operated with modified frontal muscle suspension,male 35 (44 eyes),female 24(29 eyes); monocular 45 cases,binocular 14 cased; mild ptosis 6 cases (6 eyes),moderate ptosis 18 cases (20 eyes),severe ptosis 35 cases(47 eyes).Results The effect rate was 90.41％ (66 eyes),the improvement rate was 9.59％ (7 eyes).In early postoperative time,lagophthalmos were often observed in the most cases but gradually disappeared after 3 months.During the 6 months to 3 years of follow-up,no relapse or serious complication was observed.Conclusion The frontal muscle holds not only rich blood-support and innervation,but also enough strength to raise the upper eyelid.The modified frontalis muscle suspension technique is a safe and effective method for congenital ptosis. Key words: Ptosis; congenital ; Frontal muscle suspension; modified

Estudio comparativo de diferentes materiales empleados en la suspensión al frontal en casos de ptosis palpebral

The aim of this study was to compare the results of three materials used for frontal muscle suspension in the treatment of palpebral ptosis. Sixty-six eyes in 46 patients with palpebral ptosis were operated with a modified Fox technique. The suspension was performed with autologous fascia lata in 18 cases (group 1), cryopreserved fascia lata in 23 cases (group 2), silicone in 15 cases (group 3), and PTFE in 20 cases (group 4). The results were evaluated according to the height symmetry of the palpebral opening and the improvement in visual capacity. The results were considered satisfactory in 16 patients (88%) in group 1, 19 cases (82%) in group 2, 12 cases (80%) in group 3, and 18 cases (90%) in group 4. Complications included the loss of correction with recurrent palpebral ptosis requiring revision surgery, or foreign body granuloma formation. The highest complication rate occurred in group 4 (40%), and the lowest in group 1 (5%). Two thirds of the patients with recurrent ptosis were included in the group of younger patients. Autologous or homologous fascia lata is superior to silicone or PTFE when used as a suspension material in the treatment of palpebral ptosis.

Alternating ptosis after bilateral frontalis muscle suspension for congenital ptosis

PURPOSE: To report an unusual response to bilateral frontalis suspension surgery for congenital ptosis. METHODS: Case report. RESULTS: A 6-year-old child with infantile esotropia and bilateral congenital ptosis received a homologous fascia lata frontalis suspension. After surgery, the patient exhibited an alternating ptosis, caused by alternating unilateral frontalis muscle contraction, which has persisted throughout 3 years of postoperative observation. CONCLUSION: Symmetric frontalis muscle activation may not always occur after bilateral frontalis muscle suspension surgery for congenital ptosis. Amblyopia, strabismus, or fixation preference may predispose patients to use unilateral brow elevation, despite bilateral frontalis muscle suspension surgery.