McNab AA, Galbraith JE, Friebel J, Caesar R
Pre-Whitnall levator recession with hang-back sutures in Graves orbitopathy. [Journal Article]
Ophthal Plast Reconstr Surg 2004 Jul; 20(4):301-7.
PURPOSE: To describe a technique for lengthening the levator palpebrae muscle at the level of the transverse orbital ligament (Whitnall ligament) by using hang-back sutures in cases of upper eyelid retraction in Graves orbitopathy, and to report its results.
METHODS: A cohort of consecutive patients undergoing this procedure by a single surgeon was analyzed. The surgical technique involved division of the levator muscle high up, at the level of the transverse orbital ligament, with lengthening of the muscle by a graded amount with the use of nonabsorbable hang-back sutures. The length of the sutures was twice the amount of desired lowering of the eyelid.
RESULTS: Surgery was performed on 38 eyelids of 21 patients. The mean preoperative eyelid retraction was 4.7 mm (range, 3 mm to 8 mm). Thirty-two eyelids (84%) were within 1 mm of the desired postoperative position. One patient required reoperation for significant undercorrection (2 eyelids), another 4 had ptosis repairs for overcorrection (5 eyelids, one of which was only 1-mm overcorrected). One eyelid required medial contour repair, but none needed lateral contour correction.
CONCLUSIONS: This procedure gives a relatively predictable result in patients with moderate to severe upper eyelid retraction and avoids the postoperative complication of contour deformities, especially lateral flare.
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