Dr.Sonal Chaugule, Dr.Santosh G Honavar
Aponeurotic ptosis is the most common type of acquired ptosis. It occurs due to stretching, attenuation or detachment of the levator (LPS) aponeurosis from its tarsal attachment. Any of these can be associated with inherent weakening of the levator by fat infiltration. The principle for management of aponeurotic ptosis includes reattachment of LPS aponeurosis to the appropriate tarsal site with non-absorbable sutures. The results of levator reinsertion procedure can be unpredictable. We found the consideration of obvious intraoperative factors such as: differential tightness of medial and lateral horns, amount of fat infiltration in the muscle, unrolling of the rolled-up aponeurosis edge to avoid suturing the pseudo-edge and identification of the extent of shrinkage of the aponeurosis; to be of immense help in judging the placement of sutures. This video demonstrates these intraoperative findings and their incorporation in deciding the level of LPS reinsertion.
Leave a Comment