Feasibility Analysis Of Application Of Levator Muscle Rsection On Severe Blepharoptosis Patients

Congenital blepharoptosis is a common disease. It is divided into three grades according to the extent of ptosis. It is recognized as severe ptosis if height of palpebral fissure is lesser than 4mm and strength of levator muscle of upper eyelid is below 4mm. Operative treatment falls into three parts.â‘ The use of the strength of superior rectus which was rejected because of its affection on muscle function,bad long-term effect, many complicationsâ‘¡Application of frontal muscleâ‘¢Shortening or reinforcing strength of levator muscle. At present, ventrofixation of frontal muscle flap is used to treat severe ptosis. This paper is to prove the feasibility and curative effect of levator muscle resection, and to compare it with other operative methods, and to offer both theoretical and clinical evidence to clinical works. We chose 32 cases ,38 eyes of ptosis in our hospital from August 2005 to February 2007 which have gone through levator muscle resection, and did follow-up and clinical analysis to discuss the effect of levator muscle resection on treating severe ptosis.All patients were congenital simple ptosis, with one or two diseased eyes. The ages ranged from 8 to 30 years old. In severe ptosis the strength of levator muscle is under 4mm,with normal fuction of superior rectus(Bell phenomenon exists), and without upper eyelid hysteresis. Among the patients, 24 (29 eyes)have gone through levator muscle resection, while the other 8 (9 eyes) frontal muscle ventrofixation. In the past, we have been choosing operative method by measuring the strength of levator muscle before operation. However,it is now considered that poor muscle strength before operation is not only caused by muscle dysplasia, thus it is can not be the contraindication of shortening operation. In the operations, we liberated levator muscle sufficiently, and stretched it downside with maximum strength, then observed the extruded length putting zero graduation of steel rule on the superaorbital margin. After that relax the muscle to see the scale of the end of muscle on the steel rule. Muscle elasticity is the difference of the two length.Results display that in group that was done shortening operation, after six months, the incidence of insufficient rectification and hysteresis of upper eyelid is lower than that of ventrofixation. Meanwhile ,success rate of operation after 6 months is higher in former group than that of latter one. Although shortening of levator muscle of upper eyelid cannot be applied to all severe ptosis, we have got good postoperation effect on patients with good elasticity of muscles.There are many factors influencing postoperation effect, such as decurtated amount, elasticity of levator muscle, weight of tarsal plate, unnecessary skin in nasal angle area, etc. it is paramount to do temporary adjustment according to palpebral fissure in operation by over- rectificating 2-3mm. By applying many kinds of suture, the size and shape of palpebral fissure could be adjusted to elevate rectification effect and to improve shape of eyelids.Traditional ventrofixation is an easy way to improve the size of palpebral fissure effectively for severe congenital ptosis. However, the opening of upper eyelid is straight-directed and the anatomic change of regional tissue makes eye sockets more shallow, and also causes inversion, eversion ,and thickening of eyelids which makes it unable to reach good aesthetic effect causing fat and clumsy eyelids. worsely, the palpebral fissure becomes smaller in long term which is one big defect of the operation. Shortening of levator muscle of upper eyelid lifts upper eyelid to normal height,and makes radian of double eyelid more natural.it cause no hysteresis of upper eyelid in long term, mild lagophthalmos which disappears after 6 months. The most important is that levator muscle moves upper eyelid upward and astern, sticked to eyeball closely. The movement of eyelid is in line with physiological phenomenon which makes it beautiful. Levator muscle resection meets physiology and anatomy. It holds the function of eyelid, and also reaches aesthetic outlook. It is the most ideal operative method in rectifying severe congenital ptosis in clinical works, if the patient's muscle elasticity is good enough.It is concluded that if elasticity of levator muscle permits, levator muscle resection is suitable to severe congenital ptosis; for severe ptosis patients, shortening operation shows superiority over the operative method of frontal muscle fascial flap,by recovering physiological function of eyelid and improving the outlook...