Three Different Anesthesia Approaches in Blepharoptosis Surgery

Ziyi Guo, MD; David Dae Hwan Park, MD, PhD; Kisoo Park, MD; Naiqiang Guo, MD

Disclosures

Plast Reconstr Surg Glob Open. 2019;7(4):e2136 

In This Article

Discussion

The Müller aponeurosis composite flap advancement and frontalis muscle transfer is the most common method for blepharoptosis correction.[5] The levator muscle is the main cause of blepharoptosis because it lifts the upper eyelid main muscles. Therefore, regardless of the anatomy or physiology, the Müller aponeurosis composite flap advancement to treat ptosis is an ideal choice, and has been used in recent years for patients with severe ptosis with a good curative effect.[4]

Under the Müller aponeurosis composite flap advancement approach, 3 anesthesia approaches are available for the surgeon: local, general, and sedative anesthesia (see video, Supplemental Digital Content 1, which displays steps in a blepharoptosis surgery, http://links.lww.com/PRSGO/B16).

Video Graphic 1.

See video, Supplemental Digital Content 1, which displays steps in a blepharoptosis surgery. This video is available in the "Related Videos" section of the Full-Text article on PRSGlobalOpen.com or available at http://links.lww.com/PRSGO/B16.

Patients with local anesthesia can remain awake during surgery, so the surgeon can determine the upper eyelid levator muscle strength and observe the upper eyelid position during surgery, which can help the surgeon avoid postoperative under correction and eyelid asymmetry. The disadvantage is that the patient may suffer more pain and discomfort during the operation than under general anesthesia. On the other hand, under general anesthesia, the patient can feel more comfortable and relax, but the preoperative anesthesia group requires preoperative fasting for a long time and the patients are unable to cooperate intraoperatively. In addition, the surgeon cannot observe the MRD1 or measure the upper eyelid levator muscle strength, and it is difficult to determine the upper eyelid margin and amount of lift. During general anesthesia, the eyes are under the quiet eye position, slightly separate and showing supravergence, and the eyeballs show mild extorsion at the supine position.[7] Severe congenital ptosis has been reported in children who underwent surgery under general anesthesia because the palpebral fissure height was measured based on the upper eyelid muscle strength and frontal muscle strength, and combined with general anesthesia, the depth and eye position were used to evaluate the curative effects.[8] Others also reported local anesthesia to be a feasible option for pediatric frontalis sling surgery.[10]

The sedative groups had both advantages. First, the anesthetic technique ensures that the patients can be woken at any time in the operation, same as the local anesthesia group, and it is easy to perform an observation and assessment. Second, the sedative provides good comfort and decreases the tension and discomfort, which can reduce the time of surgery. The patients do not need to fast for a long time, which will reduce the burden on patients.

These results show that in the sedative anesthesia group, the change in the postoperative MRD1 was slightly higher than in the other 2 groups (Table 3) with statistical significance, and the CEA change was slightly better (Table 6 and Table 7). This might have been caused by its essential grouping or that the sedative anesthesia approach has some beneficial effects on blepharoptosis. On the other hand, the difference in MRD1 among the 3 groups was not significant (P > 0.05).

Figure 1.

Müller aponeurosis composite flap advancement procedure with the general anesthesia approach. A, Preoperative view of a 21-year-old man with congenital severe bilateral blepharoptosis. Preoperative evaluation (right eye: MRD1, 0 mm; CEA, 57% and left eye: MRD1, −1 mm; CEA, 49%). B, Three-month postoperative evaluation (right eye: MRD1, 3.52 mm; CEA, 83% and left eye: MRD1, 2.37 mm; CEA, 62%).

Figure 2.

Müller aponeurosis composite flap advancement procedure with local anesthesia approach. A, Preoperative view of a 25-year-old man with congenital severe bilateral blepharoptosis. Preoperative evaluation (right eye: MRD1, −1 mm; CEA, 63% and left eye: MRD1, −1 mm; CEA, 62%). B, Three-month postoperative evaluation (right eye: MRD1, 3.87 mm; CEA, 82% and left eye: MRD1, 3.68 mm; CEA, 81%).

Figure 3.

Müller aponeurosis composite flap advancement procedure with the sedative anesthesia approach. A, Preoperative view of an 18-year-old woman with congenital severe bilateral blepharoptosis. Preoperative evaluation (right eye: MRD1, 0.5 mm; CEA, 66% and left eye: MRD1, 2 mm; CEA, 79%). B, Three-month postoperative evaluation (right eye: MRD1, 3.69 mm; CEA, 83% and left eye: MRD1, 3.73 mm; CEA, 80%).

In this study, the authors could significantly refine the indications for the Müller aponeurosis composite flap advancement for the correction of blepharoptosis using the 3 anesthesia approaches. Sedative anesthesia may be a better choice if the patient's feeling can be measured.

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