Postoperative Margin Reflex Distance Research Articles

Mueller's Muscle Conjunctival Resection With Skin-Only Blepharoplasty: Effects on Eyelid and Eyebrow Position.

To determine the effect of concurrent blepharoplasty and Mueller's muscle conjunctival resection (MMCR) surgery on eyelid position and eyebrow height. Clinical data from 274 eyes that met inclusion criteria for this study were reviewed. Mueller's muscle conjunctival resection surgery was performed alone in 198 eyes and was performed with concurrent blepharoplasty in 76 cases. In this study blepharoplasty consisted of only skin removal, leaving the muscle, fat, and tarsus intact. Preoperative and postoperative pupil to eyebrow, and eyelid margin to eyebrow distances were calculated and compared. Preoperative margin reflex distance 1 (MRD1) was similar for both groups of patients (p > 0.05) as was the postoperative MRD1 (p > 0.05). The change in MRD1 was similar between patients undergoing MMCR alone versus those undergoing MMCR with blepharoplasty (1.5 mm vs. 1.3 mm, respectively, p = 0.36). For similar amounts of tissue resection, the postoperative change in MRD1 was similar for patients undergoing MMCR-only surgery and MMCR with blepharoplasty (p > 0.05). Eyebrow height significantly decreased following both MMCR with blepharoplasty (0.73 mm, p < 0.05) and MMCR-only surgery (0.87 mm, p < 0.05), and this change in eyebrow height was not significantly different between the 2 groups. Combining MMCR surgery with skin-only blepharoplasty does not significantly alter eyelid height when compared with MMCR surgery alone for the correction of upper eyelid ptosis. This may assist in preoperative planning for combined MMCR with skin-only blepharoplasty.

Comparison of two- and three-point sutures for advancing the levator aponeurosis in Asian eyelids.

To compare the functional and cosmetic outcomes of two- and three-point sutures for advancing the levator aponeurosis in blepharoptosis surgery on Asians. This retrospective study examined 60 Asian patients with blepharoptosis who had undergone advancement of the levator aponeurosis: 34 patients (46 eyelids) had ptosis correction using the two-point suture technique and 26 patients (41 eyelids) had ptosis correction using the three-point suture technique. The postoperative marginal reflex distance (MRD1), lid height difference, and eyelid contour were evaluated. Twenty-seven (79.4%) of the 34 patients in the two-point group and 19 (73.1%) of 26 patients in the three-point group had a postoperative MRD1 of 2-4 mm, lids within 0.5 mm of each other, and a satisfactory eyelid contour; this difference was not significant. The rate of reoperation did not differ significantly between the two groups. Two- and three-point sutures for advancing the levator aponeurosis were equally effective for correcting blepharoptosis in Asians.

A Modified One-Stage Early Correction of Blepharophimosis Syndrome Using Tutopatch Slings

Purpose: To investigate the efficacy of a one-stage early correction of blepharophimosis-ptosis-epicanthus inversus syndrome (BPES), using bovine pericardium derived membrane (TUTOPATCH®) for the frontalis suspension.Methods: We prospectively studied 12 eyes from 6 patients (median age 14 months) affected by BPES with severe ptosis. All patients were submitted to a one-stage early correction of ptosis (frontalis suspension with TUTOPACH®) and telecanthus and epicanthus inversus. Upper margin reflex distance (MRD), nasal inner intercanthal distance (IICD), horizontal fissure length (HFL), and IICD/HFL ratio were evaluated using photographs.Results: The Wilcoxon signed-rank test showed a statistically significant difference between pre- and post-operative MRD, IICD, HFL, and the IICD/HFL ratio.Conclusion: An early TUTOPATCH-assisted frontalis suspension, together with the correction of telecanthus and epicanthus inversus, is an effective procedure for BPES cases with severe ptosis.

Porcine dermal collagen in lower eyelid retraction repair.

To describe clinical outcomes of patients receiving porcine dermal matrix implants for lower eyelid retraction repair. A retrospective review of all patients who underwent lower eyelid retraction repair with porcine dermal matrix implantation between June 2007 and July 2013 at a tertiary care center was conducted. Patient demographics, procedure(s) performed, preoperative and postoperative marginal reflex distance, inferior scleral show, and complications were reviewed. Patients with a prior history of lower eyelid surgery were excluded. The study is Health Insurance Portability and Accountability Act compliant, institutional review board approved, and adherent to the Declaration of Helsinki. One hundred patients (160 eyelids) received porcine dermal collagen implants. Fifty-six patients had thyroid eye disease, 23 had midface descent, 10 had seventh nerve palsies, and 11 had other etiologies of retraction. The average preoperative marginal reflex distance was 7.64 mm in the OD and 7.17 mm in the OS, compared with 6.40 mm in the OD and 6.22 mm in the OS postoperatively. The average preoperative inferior scleral show was 2.04 in the OD and 1.70 in the OS compared with 0.81 mm in the OD and 0.65 mm in the OS postoperatively. Follow up ranged from 1.46 to 66.04 months, with an average of 14.06 months and median of 8.84 months. Nineteen eyelids had implant-related complications: 7 with cyst formation, 7 with exposure/rejection, 2 with long-term pain, 2 with transient inflammation, and 3 with irregular implant contour. Porcine dermal matrix implants provide reliable support, integration, and function in lower eyelid retraction repair without significant resorption or complications in the majority of patients.

Minimal incision posterior approach levator plication for aponeurotic ptosis.

To assess the efficacy and predictability of a minimal incision posterior approach levator plication technique for correction of involutional ptosis. Retrospective chart review of patients with involutional aponeurotic ptosis underwent minimal incision posterior approach levator plication technique between August 2013 and June 2014 by a single surgeon. The upper lid was double everted, and the conjunctiva and Muller's muscle layers were incised vertically until the levator aponeurosis could be identified. The incision(s) was similar to performing incision and curettage of chalazion, except that the site was above the tarsal plate and extended towards the fornix. Then insertion of aponeurosis was dissected away from the anterior tarsal surface, and the more superiorly located levator was plicated on it with double arm suture(s). No tissue was excised in this procedure. Surgical success was defined as a postoperative margin reflex distance (MRD)>2 mm and<4.5 mm, interlid height<1 mm and satisfactory contour. Forty-four lids of 27 patients were included. Preoperative mean MRD was 0.48 +/- 0.56 mm. Severe ptosis of MRD<1 mm was present in 34/44 patients (77.3%). The postoperative mean MRD was 2.49 +/- 0.53 mm, and mean improvement was 2.02 +/- 0.61 mm, which was statistically significant (P<0.001). The overall success rate was 38/44 (86.4%). Minimal incision posterior approach to levator plication was effective for the correction of aponeurotic ptosis with moderate to good levator function.

Posterior approach levator aponeurosis advancement in aponeurotic ptosis repair

Purpose The aim of the study was to investigate the efficiency, advantages, and disadvantages of posterior approach advancement of the levator aponeurosis in the repair of aponeurotic ptosis. Patients and methods This is a prospective interventional study, which included 27 eyelids of 20 patients with aponeurotic ptosis. The study included only cases with good levator function of 11 mm or more. Patients with significant dermatochalasis were excluded from the study. All patients were treated by posterior approach levator aponeurosis advancement under local anesthesia. Patients were evaluated 1 week, 1 month, 3 months, and 6 months postoperatively for margin reflex distance 1 (MRD1), eyelid symmetry, and eyelid crease and contour. Results The study included 27 eyelids of 20 patients with aponeurotic ptosis. The patients' mean age was 44.36 ± 14.47 years. The mean preoperative MRD1 was 1.6 ± 0.5 mm, whereas the mean levator function was 12.6 ± 1.1 mm. The mean operative time was 32.6 ± 5.4 min. The postoperative MRD1 showed significant improvement to 3.7 ± 0.6 mm (P Conclusion Posterior approach aponeurotic advancement is an effective procedure for correction of aponeurotic ptosis. It has the advantages of high success rate, good natural-looking eyelid contour, and short operative time, and the results are independent of the response to phenylephrine.

Long-term tear volume changes after blepharoptosis surgery and blepharoplasty.

To evaluate long-term changes in tear volume by using video meniscometry following blepharoptosis surgery and upper blepharoplasty. Forty-three eyes of 27 patients with blepharoptosis and 29 eyes of 18 patients with dermatochalasis without lacrimal duct obstruction or other eyelid diseases underwent anterior approach levator advancement or blepharoplasty. Tear volume was evaluated by measurement of tear meniscus radius (R), using video meniscometry preoperatively and at 1.5, 3, and 6 months postoperatively. Margin reflex distance-1 (MRD-1) was measured before and after surgery by using photographs. After blepharoptosis surgery, the mean MRD-1 was significantly increased: 0.45 mm preoperatively, 3.64 mm at 1.5 months, 3.56 mm at 3 months, and 3.57 at 6 months postoperatively (P < 0.001), and the average R value was significantly decreased: 0.29 mm preoperatively, 0.22 mm at 1.5 months, 0.23 mm at 3months, and 0.24 mm at 6 months postoperatively (P < 0.05). Preoperative R was significantly correlated to the reduction rate of R (ΔR). A higher preoperative R was more likely to be decreased (P < 0.01). Postoperative MRD-1 and change in MRD-1 were not correlated to ΔR. After blepharoplasty, the preoperative mean MRD-1 (3.11 mm) was significantly decreased at 1.5 months (2.47 mm; P < 0.01) and 3 months (2.71 mm; P < 0.05) but recovered at 6 months (3.14 mm). However, the average R was not changed: 0.31 mm preoperatively, 0.34 mm at 1.5 months, 0.31 mm at 3 months, and 0.33 mm at 6 months postoperatively. Long-term tear volume was not changed after blepharoplasty but was decreased after blepharoptosis surgery, and even more so in cases with an initial high tear volume.

Under-through levator complex plication for correction of mild to moderate congenital ptosis.

Congenital ptosis is most commonly of mild to moderate severity, with good to fair levator function. The appropriate procedures for this condition are levator resection or levator aponeurosis approaches. Among the latter, the levator plication method has received little attention because of a relatively high rate of ptosis recurrence secondary to weak adhesion. In this study, the authors described and retrospectively analyzed the results of an alternative plication technique, the "under-through levator complex plication" method. This method differs from conventional levator plication primarily by the posterior part of the levator complex being advanced to the tarsal plate to produce strong adhesion. Five hundred and ten eyelids of 255 consecutive patients who underwent the under-through levator complex plication for congenital bilateral symmetrical ptosis were included in this study. Final outcomes were assessed at more than 5 months after surgery. The mean preoperative and postoperative marginal reflex distance 1 (MRD1) were 1.73 and 3.71 mm, respectively, and the mean amount of levator plication for every 1-mm increase in MRD1 was 3.31 mm. After the levator complex was plicated by the amount planned preoperatively, 65.1% of eyelids were at the target height. After subsequent intraoperative adjustments of the amount of plication, the overall surgery success rate was 94.5%. Recurrent ptosis due to relapse was not observed. The newly described surgical technique has overcome the limitations of conventional levator plication, by increasing the success rate and markedly reducing the relapse rate, while preserving the advantages of the conventional technique.

Clinical Outcomes of Conjunctiva-Müller Muscle Resection

The aim of this study was to investigate the clinical outcomes of conjunctiva-Müller muscle resection (CMMR) in patients with mild to moderate ptosis, the factors related to successful procedures, and the influence of CMMR on dry eye symptoms and signs. In a tertiary university hospital, the medical records of 30 patients who had CMMR were retrospectively reviewed, including the detailed preoperative and postoperative eyelid measurements, surgical outcomes, and dry eye evaluations. Inclusion criteria included older than 18 years, acquired ptosis, and no previous eyelid surgery or trauma. The surgery had a success rate of 86.7%. In the patients who responded to phenylephrine application with a marginal reflex distance 1 (MRD1) increase of more than 2 mm, the postoperative MRD1 correction was 2.41 ± 0.84 mm, whereas the postoperative MRD1 correction was 1.19 ± 0.78 mm in the group with responses of less than 2 mm. The postoperative MRD1 correction was 1.21 ± 0.80 mm in the group with a negative response. Seven patients complained of dry eye symptoms and showed a transiently significant aggravation in the Schirmer test and ocular surface disease index score after the procedure, which normalized within 2 months postoperatively. Responsiveness to phenylephrine is directly correlated with the postoperative results. Nevertheless, even in the patients with negative phenylephrine response, some degree of eyelid elevation can be expected. Damage to goblet cells after the procedure may result in defective tear production, leading to transient aggravation of dry eye symptoms.

Prospective Audit of Ptosis Surgery at the Singapore National Eye Centre

To evaluate the demographics, presentation, and surgical outcomes of patients undergoing ptosis surgery in an Asian population in a prospective manner. A prospective ptosis audit was conducted over a 2-year period from January 2010 to December 2011 in a tertiary eye hospital in Singapore. All patients undergoing ptosis surgery by, or under the supervision of, an oculoplastic-trained consultant in the institution were included. Institutional Review Board approval was obtained for the study. This study comprises 302 patients, of which 236 were acquired and 66 were congenital ptosis cases. Levator repair (77.2%) was the most commonly performed procedure, followed by levator resection (13.9%) and brow suspension (8.9%). Forty-seven (10.1%) eyes had readjustment within 2 weeks, the reasons for readjustment being eyelid height undercorrection (n = 35), eyelid height overcorrection (n = 9), and unsatisfactory eyelid contour (n = 4). Postoperatively, 93.8% of patients showed an increase in marginal reflex distance-1 (MRD1), 91.3% achieved symmetry or <1 mm of asymmetry in MRD1, 98.5% had good eyelid contour, and 74.3% had symmetric eyelid crease. On a scale of 1 to 10, 83.1% of patients gave a subjective grade of 7 or better. This study is the first prospective ptosis surgery audit in an Asian population and takes a leading step in assessing both subjective and objective surgical outcomes in a prospective manner. With the continuation of this audit in years to come, it will allow us to generate clinical outcomes in a robust manner and allow for more reliable benchmarking with major centers elsewhere.

Open-sky isolated subtotal Muller’s muscle resection for ptosis surgery: a review of over 300 cases and assessment of long-term outcome

To evaluate short- and long-term success rates on isolated subtotal Muller resection in over 300 cases of ptosis over a 10-year period. Clinical records were retrospectively evaluated for aetiology and severity of ptosis, levator function, response to phenylephrine, pre- and postoperative margin reflex distance of the upper lid (MRD1), postoperative lid contour and symmetry, complications and follow-up duration. change in MRD1 and eyelid contour. Surgical success: postoperative MRD1 ≥2 and ≤4.5 mm, symmetry to within 1.0 mm and satisfactory contour. All patients were also sent patient satisfaction questionnaires, and invited to attend for a longer-term assessment of their surgical outcome. In total, 92 and 95% of 309 eyelids met all three criteria for success after an average follow-up of 4 and 47 months, respectively. Mean improvement in MRD1 was 2.56 mm. In all, 97% had postoperative MRD1 of ≥2 and ≤4.5 mm and over 99% had an excellent contour. Altogether, 95 and 89% were within 1.0 and 0.5 mm symmetry of the fellow eye, respectively. In total, 51% of eyelids continued to rise, 17% maintained the same initial postoperative height, and 32% dropped by 1 mm or less. In all, 92% felt that their initial postoperative eyelid height had been maintained. Only 2% required repeat surgery and minor complications occurred in 4%. Isolated subtotal Muller's resection is safe and effective for the repair of the majority of ptosis with moderate-to-good levator function. It results in a more predictable height, which is maintained over time, less frequent contour abnormalities, and lower re-operation rates compared with anterior levator advancement.

Müller's muscle–conjunctival resection for upper eyelid ptosis: correlation between amount of resected tissue and outcome

AimsTo explore the relationship between the amount of resected Müller's muscle–conjunctiva (MMCR) and clinical outcome in patients undergoing upper eyelid ptosis surgery.Methods49 patients underwent 87 MMCR surgeries. The total areas...

Blepharoptosis Repair Outcomes From Trainee Versus Experienced Staff as the Primary Surgeon

To compare outcomes of conjunctival Müllerectomy with or without tarsectomy versus external levator advancement for correction of upper blepharoptosis when performed by trainee versus staff surgeons. Retrospective, nonrandomized, interventional, consecutive case series. Charts of patients undergoing conjunctival Müllerectomy with or without tarsectomy and external levator advancement blepharoptosis repair from January 2006 through December 2009 were reviewed. Main outcome measures included age, gender, preoperative and postoperative use of artificial tears, preoperative and postoperative marginal reflex distance, surgical complications, surgeon (trainee or staff surgeon), and anesthesia time. The Student t test was used for statistical analysis. A total of 170 patients underwent 248 surgeries (154 conjunctival Müllerectomies with or without tarsectomy and 94 external levator advancements). There were 108 female and 62 male patients. Mean patient age was 62 years (range, 3 to 94 years). Forty-one (24%) patients (26 conjunctival Müllerectomies with or without tarsectomy and 15 external levator advancements) underwent concurrent eyelid surgery, such as blepharoplasty. Trainees performed surgery on a total of 88 (35%) eyelids in 60 patients (35%). There was no significant difference in the percentage of cases undergoing concomitant surgery between trainee and staff surgeons (P= .18). The mean postoperative marginal reflex distance difference was 0.53 and 0.59 for trainee and staff surgeons, respectively. Mean overall anesthesia time was 26.8minutes and 30.3minutes for trainee and staff surgeons, respectively. Complications, including increase in dry eye or irritative symptoms and reoperation, occurred in 8 (13%) of 60 patients undergoing surgery by a trainee surgeon and in 22 (20%) of 110 patients undergoing surgery by staff surgeon. There was no significant difference in eyelid symmetry (P=.55), mean anesthesia time (P= .14), complication rate (P= .26), or reoperation rate (P= .17) when surgery was performed by a trainee versus a staff surgeon. There is no significant difference in mean postoperative marginal reflex distance, mean anesthesia time, complication rate, or reoperation rate between either conjunctival Müllerectomy with or without tarsectomy or external levator advancement blepharoptosis repair performed by trainee versus staff surgeons.

Primary bilateral silicone frontalis suspension for good levator function ptosis in oculopharyngeal muscular dystrophy

AimTo evaluate outcomes of patients with oculopharyngeal muscular dystrophy (OPMD) with levator function (LF) ≥10mm who underwent primary bilateral silicone frontalis suspension.Methods31 patients with OPMD satisfied the following inclusion criteria:...

Surgical Outcomes in Patients with Bilateral Ptosis and Hering's Dependence

To assess whether sequential or simultaneous ptosis repair yields a better postoperative outcome in patients with documented preoperative Hering's dependency. Retrospective, case-control study. Of the 216 patients who underwent bilateral ptosis surgery, 109 patients with documented Hering's dependency constituted the study group and the 107 patients with no Hering's dependency constituted the control group. The charts of patients who underwent levator advancement ptosis surgery between April 2002 and December 2004 by the same surgeon (R.C.K.) were reviewed retrospectively. Data regarding patient demographics, preoperative and postoperative margin-reflex distance values, levator function, presence of Hering's dependency, side of the initial operation, and reoperation status were collected from the charts. Patients demonstrating preoperative Hering's dependency of eyelid position operated simultaneously and sequentially were compared for postoperative symmetry and reoperation rates. Postoperative asymmetry was defined as a more than 1-mm difference between upper eyelid heights. Postoperative asymmetry and reoperation rates. In the Hering's dependency group (n = 109), 64 sequential surgeries that yielded 15 asymmetric results (23.4%) and 7 reoperations (10.9%) compared with the 45 simultaneous operations, which revealed 1 case of asymmetry (2.2%; P = 0.002) and 1 case of reoperation (2.2%; P = 0.137). Compared with the control group, sequentially operated Hering's dependency patients still showed higher postoperative asymmetry (P = 0.011), and the reoperation rate was similar (P = 0.134). Hering's dependency patients who had the initial operation on the left side demonstrated a significantly higher rate of postoperative asymmetry (42.3% vs. 10.5%; P = 0.006). Bilateral ptosis cases with documented Hering's dependency yield better results when both eyes are operated in the same session, rather than delaying surgery for the second eyelid. Ocular dominance probably has a significant impact on Hering's dependency and postoperative outcome after unilateral operations.

A Histological Analysis of the Müllerectomy: Redefining Its Mechanism in Ptosis Repair

The goals of this study were to determine whether the surgical target amount of Müller's muscle removed is consistent with the histological amount obtained, to assess the clinical outcome of ptosis repair based on these amounts, and to evaluate the role of the levator aponeurosis in the procedure. The Müllerectomy procedure was performed on eight eyelids of four cadavers and eight eyelids of seven patients (six unilateral, one bilateral). Histologically, the dimensions of the Müller and levator muscles were measured in the specimens removed. If present, the elastic fiber network of the levator aponeurosis was noted. Ptosis measurements were analyzed according to the target amount of resection and histologic amount obtained. The median percentage of Müller's muscle histologically measured compared with the target tissue resection obtained was 23.25 percent (0 to 37.5 percent, n = 8) in cadavers, compared with 31.13 percent (2.8 to 58.8 percent) in patient specimens. Levator aponeurosis was identified in all cadaver specimens (n = 8) and all patient specimens (n = 8). Elastin stain identified the elastic fiber network of the levator aponeurosis. There was no statistically significant difference between amount of resection and presence of the Müller or levator muscle in cadaver (p > 0.05) or patient specimens (p > 0.05). There is a consistent presence of levator aponeurosis that may play a role in ptosis repair via aponeurosis advancement and resection using a modified internal Müllerectomy approach. Using the authors' surgical technique, there is no correlation of the histologically measured amount of Müller's muscle to the postoperative marginal reflex distance-1 change in the operative eyelid. The levator aponeurosis may play a greater role in ptosis repair using an internal Müllerectomy approach than previously thought.

Outcomes of levator resection in blepharoptosis patients with grafted corneas

To present the surgical results of, and postoperative complications after, resection of the levator aponeurosis as a treatment for aponeurotic blepharoptosis in patients with grafted corneas. Nine eyes with grafted corneas displaying aponeurotic blepharoptosis were investigated. Undercorrective resection of levator aponeurosis was performed on all nine patients. The margin reflex distance 1 (MRD1) values prior to the operation and at 7 days and 6 months after the operation were compared. The postoperative MRD1 values of patients with both poor and fair levator function were also evaluated. Differences in visual acuity and visual field before and after surgery were also assessed. The MRD1 values at 7 days and 6 months after the surgery were higher than before surgery, and there was no difference between the MRD1 values of patients with poor and fair levator function at these time points. Levator function 6 months after surgery improved compared with that before surgery. Neither visual acuity nor the visual field changed after the blepharoptosis surgery. There was no preoperative corneal problem in any patient, and postoperative corneal erosion in some patients resolved with only conservative care. In blepharoptosis patients with grafted corneas, the undercorrection of blepharoptosis by levator resection showed satisfactory surgical results regardless of levator function status (poor or fair), and did not adversely affect the survival of grafted corneas.

Highlights of Archives of Facial Plastic Surgery

Archives of Facial Plastic SurgeryVol. 12, No. 1 Free AccessHighlights of Archives of Facial Plastic SurgeryPublished Online:1 Jan 2010AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Nimodipine and Acceleration of Functional Recovery of the Facial Nerve After Crush InjuryFacial nerve injury often results in devastating emotional and functional impairment. Commonly, a patient must endure a challenging and protracted recovery period in which further ocular, nutritional, and expressive complications may develop. Robin W. Lindsay, MD, and colleagues present their findings of accelerated facial nerve recovery in the rat animal model with nimodipine administration. Statistically significant improvements in whisking amplitude, velocity, and acceleration were observed in comparison with control animals. These findings demonstrate the first pharmacologic therapy to improve facial nerve recovery in an animal model that is safe for routine clinical use.See page 49Reconstruction of the Nasal Septum Using Polydioxanone PlateAs the central divide of the nasal cavity, the nasal septum is an integral component in air passage and structural support. Abnormalities in nasal airflow and external nasal appearance are often intimately related to architectural deviations or disruption of this important structure. Miriam Boenisch, MD, PhD, and Gilbert J. Nolst Trenité, MD, PhD, review their 10-year experience using the polydioxanone plate as a scaffold for septal reconstruction in 396 patients with severe nasal deformities. In their modification of the extracorporeal septoplasty, the authors remodeled and secured the quadrangular cartilage to the resorbable matrix prior to reimplantation. They present their notable functional and cosmetic outcomes as well as variations in their novel operative technique.See page 4Mandibular Distraction Osteogenesis Used to Treat Upper Airway ObstructionThe facial skeleton is an integral element in the establishment and maintenance of a patent airway. To this end, congenital and syndromic causes of mandibular deficiency often result in oropharyngeal narrowing and a variable degree of upper airway obstruction. Tracheostomy is required in nearly 25% of these patients but not without associated risks. Craig W. Senders, MD, and colleagues investigate mandibular distraction osteogenesis (MDO) as an alternative to tracheostomy tube placement in micrognathic patients with tongue-based obstruction. Multiplanar advancement was performed with the application of an external distractor in newborn patients and those with long-standing tracheostomies. The findings observed reveal the significant impact of MDO in the treatment of upper airway obstruction in select pediatric patients.See page 11Orbicularis Suspension Flap and Its Effect on Lower Eyelid Position: A Digital Image AnalysisAge-related changes of the lower eyelid tissues often produce redundancy in eyelid skin, pseudoherniation of orbital fat, and a ptotic laxity of the orbicularis oculi muscle. Some individuals also display a hollowing along the inferior orbital rim. It is this subset of patients that represent a complex challenge in periorbital rejuvenation. Christopher I. Zoumalan, MD, and colleagues discuss changes in lower eyelid position as related to performing an orbicularis suspension flap in combination with an inside-out blepharoplasty in this patient population. Digital analysis of 68 patients revealed a statistically significant decrease in postoperative margin reflex distance in addition to a more natural anatomic position of the lower eyelid.See page 24Hope by Sir Edward Coley Burne-Jones (1833-1898).See page 76This issue's Highlights were written by James Ridgway, MD.FiguresReferencesRelatedDetails Volume 12Issue 1Jan 2010 InformationCopyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Highlights of Archives of Facial Plastic Surgery.Archives of Facial Plastic Surgery.Jan 2010.3-3.http://doi.org/10.1001/archfaci.2009.112Published in Volume: 12 Issue 1: January 1, 2010PDF download

Müller Muscle Conjunctival Resection for Blepharoptosis in Patients With Poor to Fair Levator Function

It has been suggested that Müller muscle conjunctival resection might not be a good procedure for the treatment of blepharoptosis in patients with less than optimal levator function. This case series includes four eyelids (three patients) that had fair preoperative levator function (4 to 8 mm) and good response to phenylephrine. The mean preoperative levator function was 6.25 mm and the mean amount of resection was 10.25 mm. The mean preoperative marginal reflex distance was -0.50 mm and the mean postoperative marginal reflex distance was 3.38 mm. Müller muscle conjunctival resection may be effective for treating patients with fair levator function and satisfactory response to phenylephrine.

Changes of Contralateral Eyelid Position after Unilateral Blepharoptosis Repair

Purpose: To evaluate the effect of unilateral blepharoptosis repair on contralateral eyelid position. Methods: The medical records of 39 patients who had undergone unilateral blepharoptosis repair were reviewed for preoperative and postoperative margin reflex distance (MRD). Results: Of the 39 patients, 28 (71.8%) had congenital ptosis and 11 (28.2%) revealed acquired ptosis. Twenty-two (56.4%) patients were male and 17 (43.6%) were female. Ages ranged from 3 to 55 years (mean 15.3±20.1 years). After unilateral blepharoptosis repair, the postoperative mean (±SD) change in MRD of nonoperated eye was -0.3±0.7 mm at week one, -0.3±0.6 mm at three months, and -0.2±0.7 mm at six months. Conclusions: After unilateral blepharoptosis repair, 35.9% of patients had a decrease in contralateral eyelid height at postoperative 3 months and amount of decrease was 0.2±0.7 mm.