Muller's Muscle-Levator Aponeurosis Advancement Procedure for Blepharoptosis

Baik, Bong Soo; Kim, Tae Bum; Hong, Wang Kwang; Yang, Wan Suk

Abstract

Muller's muscle-levator aponeurosis advancement procedure was performed to correct mild to moderate congenital blepharoptosis with moderate to good levator function and to correct severe aquired blepharoptosis with poor levator function. Through the blepharoplasty incision, the upper half of the tarsal plate was exposed and the orbital septum was opened to show the levator aponeurosis. The Muller's muscle was dissected from the superior margin of the tarsal plate and from the posteriorly located conjunctiva with sharp scissors. The Muller's muscle and levator aponeurosis were advanced on the anterior surface of the tarsal plate as a composite flap and fixed approximately 3 to 4mm inferior to the upper edge of the tarsal plate with three horizontal 6-0 nylon mattress sutures. The amount of advancement of the composite flap was controlled by the location of the upper eyelid margin 2mm below the upper limbus in primary gaze after the first suture in the middle portion of the flap. The excess flap was trimmed off with scissors, but trimming was usually not necessary in cases of mild to moderate ptosis. Nine cases underwent this Muller's muscle-levator aponeurosis advancement procedure from September 2003 to September 2004. Five cases were congenital blepharoptosis with 2-4mm ptosis and more than 5mm of levator function, but three of the four acquired ptosis cases had more than 4mm ptosis with poor levator function. The age of the patients ranged from 7 to 81 years. In operative results, all patients except one traumatic case were within 1mm of the desired eyelid height in primary gaze. This procedure can provide not only tightening of the Muller's muscle but also advancement and firm fixation of the levator aponeurosis to the tarsal plate, yielding predictable results.