Stiglmayer N., Tojagic M., Juri J.

Department of Ophthalmology, Faculty of Medicine, Clinical Hospital Center, Kišpaticeva 12, HR 10000 Zagreb, Croatia

Purpose: The authors are presenting their long term results in ptosis correction by frontalis muscle flap operated since 1984.
Method: Patients with very weak or absent levator muscle action have been operated suspending the upper lid with m. frontalis lobe. All operated patients had congenital ptosis and were between the age of 9 months and 18 y. Of 146 patients that had been operated on, 123 had unilateral and bilateral ptosis. Children younger of 14 had been operated in general anesthaesia and the rest had local anesthaesia.
Operative technique: Two incision are made. One in tarsal groove, 8 -10 mm of the free lid margin. The other incision is made right below the eyebrow in the mid third to inner third part of the eye brow. The incision is about 10 mm long. Two third of the lenght and 1 - 1,5 cm of width of frontal muscle is liberated of surrounding tissues. Thus formed muscle flap is fixated to the anterior upper tarsus margin.
Results: Of 146 patients that had been operated on, 18% needed a reoperation and 1% needed third corrective operation. Ratio of bilateral and unilateral ptosis in that number was equal.
Discussion: A lot of published papers are describing different suspension methods for ptosis correction with rather short follow-up period. The authors of this paper find frontalis muscle flap suspension results satisfactory in early postoperative period as well as in long term follow up. The permanence and the succes of the method is due to validity of the muscle flap. If circulation needed for muscle preservation is compromised, fibrous tissue proliferation occurs. That is the situation when we expect to have a recurrent ptosis.

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