Dynamic reanimation of severe blepharoptosis using the neurotized omohyoid muscle graft.

BACKGROUND: Attempts at dynamic reconstruction of the upper eyelid either by neurotization or direct muscle replacement have been scarce. Substitution of the levator palpebrae superioris muscle requires the use of extremely small and pliable structures. As a proof of concept/pilot study, we present a consecutive series of patients who underwent blepharoptosis correction using the neurotized omohyoid muscle graft. METHODS: Retrospective analysis of patients receiving a neurotized omohyoid muscle graft for levator palpebralis substitution between January and December 2019. RESULTS: Five patients were operated (2 male, 3 female); median age was 35.5 years. Median palpebral aperture was 0 mm and levator function was< 1 mm in all cases. Median denervation time for the levator muscle was 9 years. All surgeries were uneventful, and no postoperative complications were seen. Twelve months after the procedure, all patients presented with adequate palpebral aperture on activation of the spinal nerve. Median palpebral aperture was 6.5 mm Postoperative electromyography revealed muscle contraction when stimulation was applied to the spinal nerve. CONCLUSION: This study introduces the concept of severe blepharoptosis correction using the omohyoid muscle. We believe that with time and further technical refinements it could become an invaluable tool in eyelid reconstruction surgery.

Caudal Septal Extension Graft Sutured with Absorbable Material and Not Fixed to the Nasal Spine Region Compared with the Conventional Fixation Method: A Retrospective Study.

BACKGROUND: The caudal septal extension graft (CSEG) is a predictable method for positioning the tip and columella during rhinoplasty, and it is commonly performed using permanent sutures and in some cases fixating the graft to the nasal spine region (NSR) (conventional method). Whether this predictability is preserved when using absorbable sutures has yet to be determined. METHODS: We performed a retrospective assessment of 1146 patients who underwent rhinoplasty performed by the same surgeon using the CSEG method from 2008 through 2017 in an academic setting. We utilized a computer-based patient record system for automatic data collection comparing outcomes of two groups: a group of patients who were operated on using the conventional fixation method (2008-2011) (group 1) with a second group in which absorbable sutures were used without fixation to the NSR (2011-2017) (group 2). The average follow-up period was 33.2 months. Patients operated on using a combination of methods and patients with less than 6 months of follow-up were excluded. All cases had the same septum-to-extension graft suturing technique with either permanent or absorbable suture material. This technique was side-to-side fixation with simple interrupted stitches. RESULTS: Outcomes were measured in terms of reoperation rates and complication rates grouped in 10 categories. There were no statistical differences in complication or reoperation rates between group 1 and group 2 except for suture extrusion and/or foreign body reaction (3.9% and 0.2%, respectively, P < 0.0001). Tip deprojection was of rare and similar occurrence in both groups (0.9% and 0.8%, respectively, P 0.88). CONCLUSION: Suturing CSEG with absorbable material and not fixing it to the NSR is a reliable variation in the conventional technique. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .