title: The 18-gauge needle:  an innovative simple tool for frontalis sling surgery.
abstract: OBJECTIVE
  The aim of this study was to introduce the use of the 18-gauge hypodermic needle as a simple and cost-effective alternative tool in frontalis silicone suspension ptosis surgery.
  
  
  METHODS
  A retrospective, interventional, noncomparative case study was performed by reviewing 64 patients (82 eyes) who underwent this technique between February 2010 and January 2011. Patients with simple, severe congenital ptosis with poor levator excursion were included in the study. Patients with prior sling and levator resection surgery were excluded. All patients underwent unilateral or bilateral frontalis sling surgery with a silicone rod placed via a closed-incision pentagonal configuration. All surgeries were performed by a single surgeon at a tertiary referral institute using the 1.5 inch hypodermic 18-gauge needle as an insertion guide for the silicone rod. Intraoperative technique, ease of surgical maneuverability, operative time, and postoperative results and complications were noted.
  
  
  RESULTS
  The mean patient age was 10.3 years (range: 1-28 years). Fifty-six of 64 patients (87.5%) were between the ages of 1 and 18 years (mean: 8.5 years), and 8 of 64 (12.5%) between 9 and 28 years (mean: 23 years). Forty-two of 64 (65.7 %) patients were female and 22 of 64 (34.4%) were male. Forty-six of 64 (71.9%) patients underwent unilateral frontalis sling surgery and 18 of 64 (28.1%) patients underwent bilateral surgery. Follow up ranged from 12 to 18 months. In 2 of the 82 eyes (2.4%), the sharp end of the needle cut the silicone rod while introducing the needle from the medial suprabrow stab incision to the eyelid margin end in a closed technique, requiring replacement of the silicone rod. Average surgical time was 15 minutes for unilateral cases and 30 minutes for bilateral cases. The main advantages noted intraoperatively were the small incisions that allowed for less operative time and minimal bleeding, easy maneuverability and control of the needle during tissue passage, and smooth threading of the silicone rod. Blunting of the tip is also eliminated as the needles are disposable.
  
  
  CONCLUSIONS
  The 18-gauge hypodermic needle is a simple and cost-effective alternative to other needles used in frontalis silicone sling ptosis surgery. Its low cost and easy accessibility make it a particularly quick and useful option in community-based practices, tertiary referral centers, and large medical eye camps globally.
authors.affiliation: Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India. drshubhragoel@gmail.com
authors.forename: Shubhra
authors.initials: S
authors.lastname: Goel
authors.forename: Cat N
authors.initials: CN
authors.lastname: Burkat
mesh_terms: D000293:Adolescent; D000328:Adult; D019882:Blepharoplasty / Q000295:instrumentation*; D001763:Blepharoptosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005206:Fascia Lata / Q000637:transplantation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009339:Needles; D009801:Oculomotor Muscles / Q000601:surgery; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D012826:Silicone Elastomers; D055815:Young Adult
chemical_list: D012826:Silicone Elastomers