Whitnall's sling for poor function ptosis
R. L. Anderson, D. R. Jordan and J. J. Dutton
Department of Ophthalmology, University of Utah School of Medicine, Salt Lake City.
Severe unilateral ptosis with poor levator function has previously been
treated with maximal levator muscle resection or bilateral or unilateral
frontalis suspension. One of us (R.L.A.) has developed a technique called
"Whitnall's sling," where only the levator aponeurosis is resected,
preserving Whitnall's ligament and its attachments. Whitnall's ligament and
the underlying resected levator muscle are sutured to the superior portion
of the tarsal plate. This surgery preserves levator muscle, Muller's
muscle, and Whitnall's ligament without altering the structures that
produce the three-layer tear film. In 69 eyelids operated on between July
1976 and July 1986, in which a minimum of 1 year of follow-up by one of use
was obtained, results have been satisfactory and directly related to
levator function. We believe this technique to be anatomically and
physiologically superior to "maximal levator resection" with similar
long-term results. More recent results have shown that the addition of a
5-mm superior tarsectomy provides an additional elevation of 1 to 1.5 mm.
Whitnall's sling is best suited for cases where the opposite fissure height
is 9 mm or less and levator function of the ptotic eyelid is 3 to 5 mm.
