Bilateral silicone frontalis suspension for congenital ptosis
Richard C. Allen, MD, PhD
Additional Notes: Length 03:36
Posted March 20, 2017
This is Richard Allen at the University of Iowa. This video demonstrates placement of a silicone frontalis sling a child with bilateral congenital ptosis. The upper eyelid creases have been marked on each side and 3 markings have been placed above each brow. A 15 blade is then used to make an incision along the previously noted upper lid crease markings. Stab incisions are then made with the 15 blade above each brow. The stab incisions are bluntly dissected open with a hemostat. The superior incision is bluntly dissected open to create a tunnel superiorly. Attention is then directed to the eyelid crease incision. Dissection is carried out through the orbicularis muscle to the underlying orbital septum. The orbital septum is opened and the preaponeurotic fat is dissected from the underlying levator aponeurosis. The levator aponeurosis is then disinserted from the anterior surface of the tarsus. The silicone sling is then placed on the tarsus and fixated 2mm inferior to the superior border of the tarsus with 5-0 Mersilene suture. The contour is inspected and appears to be appropriate. The frontalis sling is then placed in a retroseptal fashion to exit out the lateral brow stab incision. The same is done for the medial portion of the sling. Each arm the sling is then placed to exit out the superior brow incision. The sleeve that comes with the sling is then placed over the sling. The same procedure is performed on the opposite side. The upper eyelid crease is then closed by incorporating the levator aponeurosis into the closure. This is performed with 5-0 fast-absorbing sutures. Approximate 5 to 6 sutures are placed along the length of the eyelid. The same is then performed for the other side. The eyelid crease is closed by incorporating the levator aponeurosis. Attention is then redirected to the tightening of the sling. In children, this is performed after closure of the upper eyelid crease. After the appropriate height and contour is obtained, a 5-0 Mersilene sutures is placed around the sleeve. An additional 5–0 Mersilene suture is placed around the sling inferior to the sleeve. The redundant portion of the sling is excised. The sling is then placed in the subcutaneous tunnel superiorly. The stab incisions are then closed with 5-0 fast-absorbing sutures placed in a vertical mattress fashion. At the conclusion of the case, erythromycin ophthalmic ointment is placed over the incisions. The patient will follow-up in approximately 1 week for reevaluation.
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