Comparative Study Of Application Of Levator Aponeurosis-müller’s Muscle Complex Reinsertion Combined With CFS Suspension And Frontalis Muscular Flap Transfer On Severe Congenital Blepharoptosis

Objective:A comparison of the clinical outcomes and complications of the levator aponeurosismüller’s muscle complex reinsertion combined with CFS suspension and frontalis muscular flap transfer was undertaken to determine the advantages and disadvantages of the levator aponeurosis-müller’s muscle complex reinsertion combined with CFS suspension and frontalis muscular flap transfer in the correction of severe congenital blepharoptosis.Method:We retrospectively analyzed 32 patients（41 eyes）with severe congenital blepharoptosis.All patients were diagnosed in the Department of plastic and cosmetic surgery of Bethune First Hospital of Jilin University.Among them,19 cases（23 eyes）were treated with levator aponeurosis-müller’s muscle complex reinsertion combined with CFS suspension（group A）and 13 cases（18 eyes）were treated with frontalis muscular flap transfer（group B）.Groups A and B were then grouped twice according to preoperative upper eyelid muscle strength to explore the correction of severe congenital ptosis in the two procedures.Basic patient information,preoperative assessment data and postoperative follow-up data are recorded.Patients were followed up regularly at stitch removal,1 month postoperatively,3 months postoperatively and 6 months postoperatively,and the data were statistically analysed.Results:There were no statistical differences between the two groups of patients included in this study in terms of preoperative basic information such as age,gender,eye category,MRD1,and muscle strength of the levator muscle.There was no statistical difference in terms of treatment outcome,amount of MRD1 improvement,or complication rate of satisfaction at the6-month post-operative follow-up.However,there were significant statistical differences in muscle strength of the levator muscle and the degree of lagophthalmos.The preoperative muscle strength of the levator muscle in group A was 1.84±0.08 mm and that of group B was1.73±0.09 mm.T-test analysis of independent samples showed that P>0.05,so there was no statistical difference in the preoperative muscle strength of the levator muscle.At the 6-month post-operative follow-up,both groups had varying degrees of lagophthalmos,approximately0.73±0.52 mm in group A and 1.20±0.55 mm in group B.The data from both groups were found to be statistically significant as P<0.05 by t-test.The use of comparative study of levator aponeurosis-müller’s muscle complex reinsertion combined with CFS suspension can improve levator muscle strength and reduce the degree of lagophthalmos.After secondary grouping based on preoperative epiglottis muscle strength,MRD1 values were analysed for the different groups at 6 months postoperatively.In the group with 2 mm≤muscle strength<4 mm,the MRD1 values at 6 months postoperatively were 4.18±0.12 mm and 4.12±0.11 mm in groups A and B,respectively,and the two procedures were calculated to be comparable for the correction of severe congenital blepharoptosis with no statistical difference.In the0mm 0mm,<2mm.Conclusion:The frontalis muscular flap transfer is effective and reliable,and this procedure is suitable for the correction of severe congenital ptosis as it is not limited by levator muscle strength prior to surgery.However,this procedure is prone to postoperative incomplete upper eyelid closure and prolonged recovery of upper eyelid closure function;Levator aponeurosismüller’s muscle complex reinsertion combined with CFS suspension offers a new treatment option for severe congenital ptosis,with improved levator muscle strength,faster recovery of upper eyelid closure function and a natural postoperative appearance.The better the preoperative upper eyelid muscle strength,the better the correction.