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GL Zigiotti, L Scorolli, RA Meduri; Transposition of the Elevators for the Fitting of a Prosthesis Without an Orbital Implant . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3047.
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Purpose: The authors’ aim was to create a prosthesis providing a good cosmetic result in cases of poorly fitted orbital implants. Nowadays, when an orbital implant is too small, the prosthesis is generally built thicker to avoid an enopthalmic appearance. However, this causes it to become heavy and the outcome is often unsatisfactory. An alternative solution might be to anchor the prosthesis with an anterior gutter to the superior margin of the orbital cavity, but this interferes with the mobility of the levator palpebrae superioris muscle.Transposing the levator to the frontalis muscle, which is our treatment of choice in blepharoptosis with poor function of the levator, may be the best solution in such cases, because it offers the possibility of designing a prosthesis with an anterior gutter to be anchored to the orbital rim. Methods: The newly designed prosthesis may be applied one month after the surgical transposition of the levator [The technique consists in the proximal resection of the retractors of the upper eyelid (levator palpebrae superioris muscle and Muller's muscle), and in the transposition of their distal segment through a supraperiostial frontal tunnel, with final suture to the frontalis muscle]. The upper edge of the prosthesis in normally fitted in the superior fornix, but has two nasal and temporal frontal projections with a transversal gutter which embrace the superior orbital rim. The lower edge is fitted in the inferior fornix. Results: The Authors present a new prosthetic design suitable for application following transposition of the levator and describe the surgical technique for fitting the prosthesis. Conclusion: This kind of prosthesis does not require an orbital implant as a support. It may be applied in cases where the orbital implant is inadequate in terms of volume or position and when there is no mobility. This prosthesis might change our outlook with regard to orbital implants: in fact, an orbital implant is rendered unnecessary for the support of the prosthesis and the orbital cavity may be filled with a simple tissue expander.
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