Prediction of Postoperative Lid Height after Frontalis Suspension Using Autogenous Fascia Lata for Pediatric Congenital Ptosis

Abstract

Frontalis suspension surgery is commonly used and very effective treatment for congenital ptosis, especially in patients with poor levator function. However, it is difficult to predict lid height after the surgery, because in the majority of cases, surgery for pediatric congenital ptosis is performed under general anesthesia and therefore, the lid height cannot be adjusted by the open-and-close method in unconscious status. The studies about the desirable lid position during the frontalis suspension surgery and the influencing factors on the postoperative change in lid height are not enough and many surgeons primarily rely on their experience in determine the amount of lid elevation during the surgery. In this study, we observed the change of the palpebral fissure after frontalis suspension using autogenous fascia lata for pediatric congenital ptosis and intended to predict postoperative lid height by assessing the factors influencing the change in lid height following the surgery. Present study is retrospective, observational case series of 54 pediatric patients with congenital ptosis who underwent frontalis suspension using autogenous fascia lata performed under general anesthesia from 2002 through 2005 with a minimum of 6 months of follow-up. The amounts of lid elevation during the surgery and that of postoperative change in lid height were assessed until 6 months postoperatively by review of photographs and medical records. The amount of lid elevation for adjusted lid height was measured from two different baseline lid heights and each amount of lid elevation was compared with the amount of real change in lid height after surgery. The postoperative lid height was stabilized 3 months after surgery. And the amounts of lid elevation during the surgery were 5.91±1.21 mm without considering anesthesia induced lagophthalmos and 3.51±1.00 mm with considering it. The amount of real change in lid height before and after 6 months following surgery was 3.24±1.14 mm. The preoperative palpebral fissure (p=0.002) and anesthesia induced lagophthalmos (p<0.001) were statistically significant factors influencing postoperative lid height. In patients with preoperative palpebral fissure ≥ 4 mm or anesthesia induced lagophthalmos < 3 mm, postoperative lid heights were lowered than adjusted levels. In this study, we found that the postoperative lid height would be more accurately predicted with adjusting lid height from the baseline allowing for lagophthalmos under general anesthesia during frontalis suspension and preoperative palpebral fissure and anesthesia induced lagophthalmos have influence on postoperative lid height.