Levator transposition procedure: A review of 35 cases

Abstract

Background. Levator transposition is used as a unilateral procedure for patients with both ptosis and aberrant movements of the eyelid. Muscular neurotisation occurs in the transposed levator muscle and thus some levator function is restored. Method. We reviewed 35 patients who had undergone a levator transposition procedure. Results. Twenty-eight patients had jaw-winking ptosis, three had cyclic oculomotor palsy and four had a third nerve palsy with aberrant regeneration. The follow-up period was between 1 and 39 months (mean 12 months). Eighteen patients were followed up for at least 12 months and their results were analysed as a separate group. Conclusions. The levator function attained following transposition is related to the pre-operative voluntary function and this relationship is statistically significant (Wilcoxon test p < 0.001). Maximal levator function may not be achieved until 12 months post-operatively. The procedure is successful in abolishing aberrant eyelid movements and treating ptosis but the majority of patients require an additional levator resection to achieve a satisfactory lid height.