Evaluation of Mehta's modification of the Crawford technique for Frontalis Sling Surgery with Silicon rod in Severe Ptosis Evaluation of Mehta's modification of the Crawford technique for Frontalis Sling Surgery with Silicon rod in Severe Ptosis
Main Article Content
Keywords
Eyelid ptosis, Silicon rod, Mehta's Modification of Crawford technique, frontalis sling, blepheroptosis, Baghdad
Abstract
Background: Ptosis is the drooping of the upper lid margin below its normal anatomic position due to the levator complex dysfunction. In this condition, the aesthetic and functional abnormality is obvious and is accompanied by severe visual field defect. Ptosis surgery is one of the most common oculoplastic procedures with different surgical procedures. The decision for an appropriate surgical procedure and the material used to minimize the incidence of complication depends on proper evaluation of the patient.
Aims of study: To evaluate Mehta's Modification of the Crawford technique for frontalis sling surgery with silicon rod in sever ptosis.
Patients and Methods: We considered 10 patients (12 lids) who were treated between February 2017 and June 2018. There were seven males and three females; two patients were bilateral and three patients had negative Bell's phenomenon, which was surgically treated with Mehta's modification of the Crawford technique for frontalis sling surgery with silicon rod. The patients’ age ranged from 4 to 30 years; they all had severe eyelid ptosis (>4mm) with poor levator function (≤4 mm).
Results: Our patients' postoperative results were good, functional, and aesthetic, showing a clear visual field, with smooth and regular eyelid margin and no notching. Nine out of 10 patients achieved good results according to the above-mentioned criteria, and in addition to that, both patient and parents' satisfaction were taken into consideration. Only one patient had developed recurrence (1- month postop.)
Conclusions: Mehta's modification of the Crawford technique for frontalis sling surgery with silicon rod in sever ptosis used for the treatment of severe ptosis with poor levator excursion is an easy and simple procedure that promises good postoperative results.
References
2. Arnab Biswas. Ptosis surgery, 1st ed, New Delhi: Jaypee Brother Medical publisher(p)Ltd; 2010. pp. 35, 60.
3. Evan H. Black, Frank A. Nesi, Christopher J. Calvano, Geoffrey J. Glastone, Mark R. Levine. Smith and Nesis's Ophthalmic Plastic Surgery, 3rd ed. New York: Springer; 2012. pp.420, 421, 422.
4. Matayoshi S, Pereira IC, Rossato LA. Surgical treatment of congenital blepharoptosis. Revista Brasileira de Oftalmologia. 2014 Jul 1;73(4).
5. Barry N. Wasserman, MD, Derek T. Sprunger, MD, Eugene M. Helveston, MD. Comparison of materials used in frontalis suspension. AMA Arch Ophthalmol., 2001;119:687–691.
6. S Al Mansory A. Comparative study between local and general anesthesia in the management of sever blepharoptosis by use of straight needle threading technique as frontalis suspension. The Medical Journal of Basrah University. 2017 Dec 28;35(2):59-70.
7. Collin R. Fundamentals of Clinical Ophthalmology. BMJ Books; 2001.pp. 3. 34, 41.
8. Mehta A, Abrol S, Garg P. Mehta’s modification of Crawford’s technique for frontalis sling surgery with silicone rod. The Official Scientific Journal of Delhi Ophthalmological Society. 2015 Oct 5;26(2):115-7.
9. Carter SR, Meecham WJ, Seiff SR. Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy. Ophthalmology. 1996 Apr 1;103(4):623-30.
10. Etezad Razavi M, Khalifeh M, Yazdani A. Comparing open and closed techniques of frontalis suspension with silicone rod for the treatment congenital blepharoptosis. Orbit. 2014 Apr 1;33(2):91-5.
11. Nucci P, Lembo A, Santangelo E, Fogagnolo P, Serafino M. Five-year follow-up of a 30-month trial of stability of silicone band frontalis suspension for the treatment of severe unilateral upper eyelid ptosis in infants. InSeminars in Ophthalmology 2016 May 3 (Vol. 31, No. 3, pp. 215-218). Informa Healthcare.
12. Mehta A, Garg P, Naik M, Kumari A. Congenital ptosis repair with a frontalis silicon sling: comparison between Fox's single pentagon technique and a modified Crawford double triangle technique. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2017 S1091-8531(17):30061-7
13. Goldberger S, Conn H, Lemor M. Double rhomboid silicone rod frontalis suspension. Ophthalmic Plastic & Reconstructive Surgery. 1991 Mar 1;7(1):48-53.