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Maximal Levator Muscle Resection for Severe Congenital Ptosis With Poor Bell's Phenomenon
Chenhao Zhang1, Zhenzhen Zhang
1Department of Facial Plastic and Reconstructive Surgery, Eye and ENT Hospital of Fudan University, Shanghai, China.
Insights
Maximal levator muscle resection effectively treats severe congenital ptosis with poor Bell's phenomenon (BP) in children. This surgical approach offers improved cosmetic results with a low complication rate for pediatric ptosis patients.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Oculoplastics
Background:
- Severe congenital ptosis often presents challenges, particularly when accompanied by poor Bell's phenomenon (BP).
- Effective surgical correction is crucial for visual development and cosmetic improvement in affected children.
Purpose of the Study:
- To evaluate the efficacy of maximal levator muscle resection for severe congenital ptosis with poor BP in pediatric patients.
- To analyze surgical outcomes and complications associated with this technique.
Main Methods:
- Retrospective analysis of 32 eyelids in 25 children with severe congenital ptosis and poor BP.
- Maximal levator muscle resection was performed, with outcomes graded and complications analyzed postoperatively.
Main Results:
- Satisfactory results achieved in 90.63% of cases (29/32 eyelids), with 78.13% excellent outcomes.
- Mean marginal reflex distance 1 (MRD1) significantly improved from -1.43 mm to 3.18 mm.
- Levator muscle resection length was a key factor in surgical success; low complication rate observed.
Conclusions:
- Maximal levator resection is an effective surgical option for severe congenital ptosis with poor BP in children.
- The procedure offers improved cosmesis with minimal severe complications.
- Precise assessment of levator muscle resection length is vital for optimal surgical outcomes.
Objective:
To evaluate the efficacy of maximal levator muscle resection in the treatment of severe congenital ptosis with poor Bell's phenomenon (BP) in children.
Methods:
Thirty-two eyelids (25 cases) of severe congenital ptosis in children with poor BP were treated with maximal levator muscle resection, the postoperative surgical results were graded as excellent, good and poor, and postoperative complications were retrospectively analyzed.
Results:
The follow-up ranged from 6 to 35 months, with an average of 14.82±3.27 months. At the last follow-up, satisfactory results were obtained in 29 of 32 eyelids (90.63%), of which 25 (78.13%) were excellent, 4 (12.5%) were good, and 3 (9.38%) were poor. The mean marginal reflex distance1 (MRD1) increased from -1.43±1.23 mm preoperatively to 3.18±0.61 mm postoperatively. Between the successful and unsuccessful surgical outcome groups, the length of the resected levator muscle is a significant factor affecting the correction outcomes. Postoperatively, 1 eye developed mild exposure keratopathy and was cured conservatively; 2 eyes experienced recurrent ptosis and were successfully repaired by frontal muscle suspension.
Conclusion:
The maximal levator resection is an effective procedure for severe congenital ptosis with poor BP, provides improved cosmesis, and with severe complications. Cautious and precise assessment of the resection length of the levator muscle in operation ensures the surgical effects.
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