title: Pre-Whitnall levator recession with hang-back sutures in Graves orbitopathy.
abstract: OBJECTIVE
  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.
authors.affiliation: Orbital, Plastic, and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia. amcnab@bigpond.com
authors.forename: Alan A
authors.initials: AA
authors.lastname: McNab
authors.forename: J E K
authors.initials: JE
authors.lastname: Galbraith
authors.forename: Justin
authors.initials: J
authors.lastname: Friebel
authors.forename: Ric
authors.initials: R
authors.lastname: Caesar
mesh_terms: D000328:Adult; D000368:Aged; D005128:Eye Diseases / Q000601:surgery*; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D008022:Ligaments / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D013536:Suture Techniques