Balanced Tucking of the Levator Muscle and Muller's Muscle in Blepharoptosis

ABSTRACT

The levator and Muller's muscle balanced tucking was performed to correction myogenic or aponeurotic blepharoptosis. Through the blepharoplasty incision, the upper half of tarsal plate was exposed and the orbital was opened to show the levator aponeurosis. the Muller's muscle dissected from the upper border of the tarsal plate and from the posteriorly located conjunctiva with sharp scissors. Muller's muscle was advanced about 3 mm to 8 mm on anterior surface of the tarsal plate and fixed approximately upper one third of the tarsal plate with three horizontal 6-0 Nylon mattress sutures. The amount of tucking of Muller's muscle was controlled by the location of the upper eyelid margin 2 mm below the upper limbus in primary gaze after first temporary fixations suture in the maximum superior point of the limbus. The amount of advancement of levator aponeurosis was controlled by the location of the upper eyelid margin 1 mm below the upper limbus in primary gaze after first temporary fixations suture in the maximum superior point of the limbus. And then levator aponeurosis was fixed with three horizontal 6-0 Nylon mattress on beside the point that was tucked Muller's muscle. We have been thirty cases with levator and Muller's muscle balanced tucking from January 2004 to Jun 2005. 3 cases were traumatic blepharoptosis with 3-5 mm ptosis and poor levator function. 27 cases were myogenic or aponeurotic blepharoptosis with 2-5 mm ptosis with and more than 4 mm of levator function. the age of the patients ranged from 6 to 78 years. The levator aponeurosis and Muller's muscle tucking procedure can reduce the amount of the levator and Muller's muscle resection, and improve discomfort when the patients open eyes.