Please any help would be greatly appreciated. Doc is calling this an orbiotomy seems more like levator repair to me. Thanks in advance for any help.
Operation Performed 1: Orbitotomy, w/o bone removal.
2: Graft of an allogenic materal to left upper lid.
Procedure:
A lid crease incision was performed, dissection down deep into the orbital tissue until Whitnall's ligament. This was then dissected cleam. Multiple areas of scar tissue, dehiscence, and shredding of levator aponeurosis was identfied, in addition at the branching point of the levator aponeurosis and the superior rectus muscle. This was clearly delineated. There was no clear extension of the levator aponeurosis down to the trasal plate, just areas of scar tissue. The tarsus was then fashioned to the area just inferior to Whitnall's ligament and whatever moving part of the levator muscle itself I could identify. This was attached with both running and interrupted 6-0 silk sutures. Next, portions of the tarus AlloDerm material was then trimmed and dissection was carried down to the portion where the tarsal plate had been, but after his multiple surgeris is now very fragmented and scarred and undergoing involutional changes. The residual tarsus was then approximated to the position where I though that would take care of his ptosis. Next the LMA was removed and we waited 20 minutes to let the patient wake up. Ath that time I could determine that the levator muscle was moving and accordingly the tarsus was then trimmed and attached to the remnant tarsal plate with multiple interrupted 6-0 silk sutures.
Operation Performed 1: Orbitotomy, w/o bone removal.
2: Graft of an allogenic materal to left upper lid.
Procedure:
A lid crease incision was performed, dissection down deep into the orbital tissue until Whitnall's ligament. This was then dissected cleam. Multiple areas of scar tissue, dehiscence, and shredding of levator aponeurosis was identfied, in addition at the branching point of the levator aponeurosis and the superior rectus muscle. This was clearly delineated. There was no clear extension of the levator aponeurosis down to the trasal plate, just areas of scar tissue. The tarsus was then fashioned to the area just inferior to Whitnall's ligament and whatever moving part of the levator muscle itself I could identify. This was attached with both running and interrupted 6-0 silk sutures. Next, portions of the tarus AlloDerm material was then trimmed and dissection was carried down to the portion where the tarsal plate had been, but after his multiple surgeris is now very fragmented and scarred and undergoing involutional changes. The residual tarsus was then approximated to the position where I though that would take care of his ptosis. Next the LMA was removed and we waited 20 minutes to let the patient wake up. Ath that time I could determine that the levator muscle was moving and accordingly the tarsus was then trimmed and attached to the remnant tarsal plate with multiple interrupted 6-0 silk sutures.