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G.L. Zigiotti, F. Nesi, L. Scorolli, A. Meduri, S. Vismara; Transposition of the levator muscle suturing it to a frontal sliding flap, using a single superior lid crease incision, in blepharoptosis . Invest. Ophthalmol. Vis. Sci. 2004;45(13):264.
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Purpose: In 1999, we introduced the technique of the transposition of the levator suturing this sectioned muscle to the frontalis muscle, for the correction of severe blepharoptosis . This operation was carried out using two skin incisions, one on the superior lid crease and the other at the superior margin of the eyebrow. We demonstrated that the levator muscle becomes reinnervated by the facial nerve of the frontalis muscle . We have been very pleased with this procedure; we have had no infections and no incidence of lagophthlamos. We believe that the only limit to this technique is the ability of the patient to contract the frontalis muscle. This limitation applies to any surgical technique of suspension of the eyelid to the frontalis area. After having performed 22 levator transpositions, utilizing two skin incisions, we performe now the procedure utilizing a single skin incision on the superior lid crease. Methods: The operation is carried out doing a single surgical incision on the superior lid crease. The elevator is isolated from the palpebral conjunctiva and sectioned trasversely near Whitnall’s ligament. With a retractor, that we have developed, the eyebrow is reversed and a frontal sliding flap is prepared. The transversally resected elevator is then sutured to the frontal sliding flap. Results: We started with this kind of operation in 2003 and at the moment we operated 9 cases in 8 patients. The results are very good, as measured with the marginal reflex distance. We had no lagophthalmos at any time. At the same time we had no infections. Conclusions: This operation is the right operation for any patient with blepharoptosis who needs a frontal suspension. The opening of the eyelid is very good and there is no lagophthalmos. With the modification of the former technique, using now a single incision on the lid crease, we believe that this operation should be well accepted by the ophthalmic community.
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