title: The role of frontalis orbicularis oculi muscle flap for correction of blepharoptosis with poor levator function.
abstract: On the basis of the close anatomical interdigitation between the longitudinal-oriented frontalis muscle and the horizontal-oriented orbicularis oculi muscle (OOM), frontalis OOM (FOOM) flap was developed to treat blepharoptosis. Retrospective study during an 11-year period, 66 patients with 81 poor levator function ptotic eyelids accepted FOOM flap shortening (65 lids; 80.2%) or double-breasted FOOM flap advancement (16 lids; 19.8%) to correct blepharoptosis. There were 51 (77.3%) patients with unilateral ptosis and 15 (22.7%) patients with bilateral ptosis. Severity of blepharoptosis included severe type in 72 (88.9%) lids, moderate type in 5 (6.2%) lids, and mild type in 4 (4.9%) lids. The underlying etiology included congenital origin in 43 (65.1%) patients, involutional change in 19 (28.8%) patients, and neurologic origin in 4 (6.1%) patients. Marginal reflex distance 1 and lid slit distance improved from -1.6 (2.0) to 3.3 (1.2) and 3.2 (2.0) to 7.2 (1.4) mm, respectively, after operation. The postoperative outcome includes good results in 54 (81.8%) patients, fair results in 10 (15.2%) patients, and poor results in 2 (3.0%) patients. The undercorrection or recurrence rate is 14.8%, and secondary revision rate is 11.1%. Positive Hering law is 17.6% among patients with unilateral ptosis. Overall patients' satisfaction rate is 95.1%. Both FOOM flap shortening and double-breasted FOOM flap advancement are effective to treat poor levator function blepharoptosis. Double-breasted FOOM flap advancement is highly recommended because of the more natural contour and minimal lagophthalmos postoperatively, because of the maximal preservation of OOM.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital; and †Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chung-Sheng
authors.initials: CS
authors.lastname: Lai
authors.forename: Kao-Ping
authors.initials: KP
authors.lastname: Chang
authors.forename: Su-Shin
authors.initials: SS
authors.lastname: Lee
authors.forename: Tung-Ying
authors.initials: TY
authors.lastname: Hsieh
authors.forename: Hsin-Ti
authors.initials: HT
authors.lastname: Lai
authors.forename: Yu-Hao
authors.initials: YH
authors.lastname: Huang
authors.forename: Ya-Wei
authors.initials: YW
authors.lastname: Lai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001763:Blepharoptosis / Q000151:congenital / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology; D011182:Postoperative Care; D012189:Retrospective Studies; D013524:Surgical Flaps; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome; D055815:Young Adult