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Alternating ptosis after bilateral frontalis muscle suspension for congenital ptosis
J E Egbert1, N J Lucchese, R K Dortzbach
1Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, USA.
Insights
Bilateral frontalis suspension surgery for congenital ptosis can lead to unusual responses. Some patients may develop alternating ptosis due to unilateral brow elevation, particularly those with strabismus.
Area of Science:
- Ophthalmology
- Pediatric ophthalmology
- Surgical outcomes
Background:
- Congenital ptosis is a common condition requiring surgical correction.
- Frontalis suspension surgery is a standard procedure for congenital ptosis.
- Bilateral frontalis suspension aims to achieve symmetrical eyelid elevation.
Observation:
- A case report details an unusual outcome in a 6-year-old child with infantile esotropia and bilateral congenital ptosis.
- The patient underwent bilateral frontalis suspension using homologous fascia lata.
- Postoperatively, the child developed alternating ptosis due to unilateral frontalis muscle contraction.
Findings:
- The observed alternating ptosis persisted for 3 years.
- This suggests that symmetric frontalis muscle activation is not guaranteed after bilateral surgery.
- Pre-existing conditions like amblyopia, strabismus, or fixation preference may influence muscle activation patterns.
Implications:
- This case highlights the potential for atypical responses to frontalis suspension surgery.
- It suggests that pre-existing strabismus may predispose patients to unilateral brow elevation.
- Further research is needed to understand and predict such responses to optimize surgical outcomes in pediatric ptosis patients.
Purpose:
To report an unusual response to bilateral frontalis suspension surgery for congenital ptosis.
Methods:
Case report.
Results:
A 6-year-old child with infantile esotropia and bilateral congenital ptosis received a homologous fascia lata frontalis suspension. After surgery, the patient exhibited an alternating ptosis, caused by alternating unilateral frontalis muscle contraction, which has persisted throughout 3 years of postoperative observation.
Conclusion:
Symmetric frontalis muscle activation may not always occur after bilateral frontalis muscle suspension surgery for congenital ptosis. Amblyopia, strabismus, or fixation preference may predispose patients to use unilateral brow elevation, despite bilateral frontalis muscle suspension surgery.