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Supramaximal Levator Resection for Poor Function Congenital Ptosis

Bernardini, Francesco P. M.D.

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Ophthalmic Plastic and Reconstructive Surgery: September/October 2019 - Volume 35 - Issue 5 - p e126
doi: 10.1097/IOP.0000000000001341

The video (see Video, Supplemental Digital Content 1, available at https://drive.google.com/open?id=10uuVCNADWhLRWo_EE8gx5GK2nqz5mATW) demonstrates the technique previously described in the report by Cruz et al. for correction of poor levator function (<4 mm) congenital ptosis.1 Supramaximal levator resection refers to resection of the muscle above the Whitnall ligament. The amount of resection is based on the severity of the ptosis and the measured levator function: the more severe the ptosis and poorer the levator function, the more muscle resection required. The end-point of the surgery is to have the eyelid margin rest 1 to 2 mm below the super limbus with the patient under general anesthesia. In the author’s practice, supra-maximal levator resection has become the procedure of choice for unilateral, poor levator function congenital ptosis.

The figure demonstrates the isolated combined levator/Müller muscle flap grasped with forceps all the way up inside the orbit. The supramaximal technique consists in dissecting the levators flap above the Whitnall ligament, proportionally to the severity of the ptosis and inversely to the eyelid excursion. The poorer the function and the more severe the ptosis, the greater the dissection and excision required.

REFERENCES

1. Cruz AA, Akaishi PM, Mendonça AK, et al. Supramaximal levator resection for unilateral congenital ptosis: cosmetic and functional results. Ophthalmic Plast Reconstr Surg 2014;30:366–71.
© 2019 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.