Use of the Levator Muscle as a Frontalis Sling in Monocular Elevation Deficiency

ABSTRACT

PURPOSE: For the correction of ptosis in monocular elevation deficiency (MED) patients, levator resection or frontalis sling operation with various materials has been used. The authors present a case of a monocular elevation deficiency patient who was treated for ptosis using the levator muscle as a frontalis sling. CASE SUMMARY: A six-year-old male patient with left monocular elevation deficiency underwent a frontalis sling operation using a levator muscle. The patient had received left inferior rectus recession, left medial rectus resection and left lateral rectus recession with transposition. An upper eyelid skin crease incision was made, and the anterior surface of the levator muscle was exposed as far as the Whitnall ligament. A levator muscle flap was then formed from aponeurosis by incising the full width of the levator horizontally, just below the Whitnall ligament and anchored to the frontalis muscle. The surgical result was satisfactory as the preoperative MRD1 was 0.5 mm and the postoperative MRD1 was 2.5 mm. There were no complications such as keratitis or wound problems. CONCLUSIONS: The levator muscle flap can be an effective frontalis suspension material to correct ptosis in an MED patient with poor levator function.