Classificação clínica de ptose da cauda do supercílio / Clinical classification of brow ptosis

INTRODUÇÃO: O estudo do supercílio se emoldura como um grande desafio para a cirurgia plástica por sua complexa relação com as estruturas faciais. O objetivo é descrever uma classificação clínica de ptose da cauda do supercílio. MÉTODOS: Estudo transversal, com pacientes de ambos os sexos, com idade de 18 a 100 anos, subdivididos em três grupos segundo a faixa etária. Grupo 1: 18 a 30 anos, Grupo 2: 31 a 60 anos e Grupo 3: 61 a 100 anos. Realizaram-se três medidas de cada lado por examinadores distintos, sem que cada um soubesse o valor da aferição dos demais. RESULTADOS: Total de 90 pacientes, com idades variando entre 18 e 94 anos, sendo 39 (43,3%) do sexo masculino e 51 (56,7%)do sexo feminino. As medidas do Grupo 1, considerado como normal, com média de idade de 26,7 anos, e com média de 2,14 cm em relação a medidas da ptose da cauda do supercílio. Já no Grupo 2, média da faixa etária foi de 44,2 anos e a média foi de 1,9 cm. No Grupo 3, média de idade de 72,6 anos com média de 1,27 cm. A tabela com a Classificação da Ptose da Cauda do Supercílio, em que se atribuiu a cada intervalo um grau de ptose, variando de grau I ao grau IV. Cada grau foi correlacionado com um intervalo numérico em que: > 1,8 cm representa a normalidade; 1,7-1,5 cm o grau I de ptose; 1,4-1,2 cm o grau II de ptose;1,1-0,9 cm o grau III de ptose e < 0,8 cm o grau IV de ptose. Em referência à indicação cirúrgica, essa teve sua indicação nos graus II, III e IV. CONCLUSÃO: A medida objetiva da posição da cauda do supercílio possibilitou classificação do grau de ptose e orientação quanto à necessidade de intervenção cirúrgica.

INTRODUCTION: The study of the eyebrow is a great challenge for plastic surgery because of its complex relationship with facial structures. The present study aims to describe a clinical classification of brow ptosis. METHODS: A cross-sectional study with patients of both sexes and ages ranging from 18 to 100 years, subdivided into 3 groups according to age. Group 1: 18 to 30 years of age, Group 2: 31 to 60 years of age, and Group 3: 61 to 100 years of age. Three measurements were taken on each side by different examiners blinded to each other's results. RESULTS: A total of 90 patients, with ages ranging from 18 to 94, including 39 (43.3%) men and 51 (56.7%) women, were studied. Group 1, with a mean age of 26.7 years was considered normal, with mean brow ptosis of 2.14 cm. In Group 2, with a mean age of 44.2 years, the mean brow measurement was 1.9 cm. In Group 3, the mean age was 72.6 years and the mean brow measurement was 1.27 cm. The table outlining the brow ptosis classification assigns a degree of ptosis to each interval, ranging from I to IV. Each degree was correlated with a numerical range in which > 1.8 cm is normal, 1.7-1.5 cm corresponds to degree I ptosis, 1.4-1.2 cm to degree II ptosis, 1.1-0.9 cm to degree III ptosis, and < 0.8 cm to degree IV ptosis. Surgery was indicated for degrees II, III, and IV. CONCLUSION: The objective measurement of brow tail position enabled classification of the degree of ptosis and guides surgical decision-making.

Sling materials for management of congenital ptosis - a major review

Blepharoptosis affects individuals of all ages, races and genders. It has a significant impact on a patient's functional and psychological status and may cause poor visual development in childhood. Since the Italian anatomist and surgeon Antonio Scarpa's publication of Practical Observations on the Principle and Disease of the Eye in 1806, ptosis surgery has undergone many revolutions as the knowledge of anatomy and physiology progressed and as types of materials expanded. It is essential that a multidisciplinary approach, encompassing pediatric ophthalmology, oculplastics surgeon, and orthoptic department work closely to optimize patient management. Correction of congenital ptosis is one of the most difficult challenges ophthalmologists face. Ptosis surgical correction techniques depend on the degree of ptosis and the levator muscle action. Multiple surgical procedures are available including frontalis sling, levator advancement, Whitnall sling, frontalis muscle flap, and Mullerectomy. In cases with severe levator muscle dysfunction, the choice of surgery is a sling procedure. Materials which have been used for this purpose are widely variable and divided into non synthetic and synthetic. Non synthetic include fascia lata [both autogenous and allogenic], palmaris longus tendon and temporalis fascia, while synthetic include mersilene mesh, silicone rods and sutures [prolene, nylon, silk and Gortex]

Abordaje anterior versus posterior en la cirugía de la ptosis palpebral / Anterior vs posterior approach in palpebral ptosis surgery

La ptosis palpebral se define como la caída del párpado superior. Analizar los resultados obtenidos con su corrección quirúrgica y determinar la efectividad terapéutica con diferentes técnicas y vías de abordaje. Se realizó un estudio descriptivo, prospectivo y longitudinal con una casuística de 32 pacientes (50 ojos) operados de ptosis entre mayo de 2005 a marzo de 2006. La técnica y vía de abordaje quirúrgico que se aplicó la en cada caso, según el grado de severidad clínica (ligera moderada o severa) y su efectividad, se evaluó según la disminución en mm de la distancia margen-reflejo posoperatoria. Las técnicas quirúrgicas fueron: reforzamiento y reinserción de la aponeurosis, supramáxima, suspensión al frontal y abordaje posterior. La distancia margen-reflejo posoperatoria disminuyó de 1,2, 2,2 y 3,5 mm en ptosis ligeras moderadas y severas respectivamente. Si se selecciona adecuadamente la vía de abordaje, ambas aportan buenos resultados en la corrección de la ptosis.

Palpebral ptosis is defined as the upper eyelid fall. To analyze the results of the surgical correction of palpebral ptosis and to determine its therapeutical effectiveness with various techniques and approach methods. A prospective, longitudinal and descriptive study was performed on 32 patients (50 eyes) operated on from ptosis covering May, 2005 through March, 2006. The surgical technique and approach method applied to each case, taking clinical severity into account (slight, moderate and severe), and their effectiveness were evaluated based on postoperative margin-reflex distance reduction in mm. The surgical techniques were reinforcement and reinsertion of aponeurosis, supramaxima, frontalis suspension and posterior approach. Postoperative margin-reflex distance was reduced by (1.2, 2.2 and 3.5 )mm in slight, moderate and severe ptosis respectively. The right selection of the surgical technique and the approach method helps in achieving good results in ptosis correction.

[Prevalence of different types of ptosis at a referral hospital in Tehran, Iran]

To assess etiology, demography, surgical management and postoperative complications of ptosis in a referral ophthalmologic center. We reviewed records of 233 ptosis patients managed at Labbafinejad Hospital during 1998-2003. Etiology, age, sex, laterality, family history, amblyopia, past medical history, margin reflex distance and levator function, type of surgery, and postoperative complications were evaluated. The study included 117 female and 116 male subjects with mean age of 18.7 +/- 12.8 years. There was past ocular surgery in 85%, female history of ptosis in 3.4% amblyopia in 19.2% and strabismus in 6.9%. Ptosis was unilateral in 85% and bilateral in 15% and was congenital in 79%. The most prevalent type of ptosis is congenital therefore early ditection and referral of affected children is necessary to prevent amblyopi