What’s Hiding in the Clamp? A Histopathologic Review of Müller’s Muscle-Conjunctival Resection

Theme: Oculoplastic & reconstructive surgery
What: Oculoplastic & reconstructive surgery
Part of: Oculoplastics II: Cutting edge research in oculoplastics! / Oculoplastie II: Recherche de pointe en oculoplastie!
When: 5/31/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 714 A

Abstract

Purpose: The purpose of this study is to identify the composition of tissue resected during internal ptosis surgery using a Müller’s muscle-conjunctival resection technique.

Study Design: This is a single center, case series performed at a single center with three surgeons using the same surgical technique. Histopathology review was performed under supervision of two ophthalmic pathologists.

Methods: Tissue resected within a Putterman ptosis clamp, while performing Müller’s muscle-conjunctival resection was evaluated and categorized as containing smooth versus striated muscle. Smooth muscle representing Müller’s muscle while striated muscle can be assumed to represent levator muscle. 

Results: 103 procedures were performed, 102 of the samples contained smooth muscle and 1 sample contained both smooth and striated muscle. Additionally, 11 samples contained neither smooth nor striated muscle.

Conclusions: The internal approach to ptosis surgery as described by Drs. Putterman and Ulrist in 1975 has been solidified as a common and effective technique.¹ Histopathologic analysis of the resected tissue has been studied in small samples, including Dr. Putterman himself who found only conjunctiva and Müller’s muscle, with no evidence of levator muscle in 8 samples.¹ In contrast, Morris (n=8 cadaver, n=8 clinical) found striated muscle in all samples while Maheshwari (n=13) found a samples with both smooth and striated muscle.^2,3 Our study provides a significantly larger sample size than otherwise shown in the literature and may offer further insight into the mechanism of Müller’s muscle-conjunctival resection. Further analysis of this data set is being performed to investigate whether resection length and intraoperative use and quantity of conjunctival anesthetic may affect the type and amount of tissue resected.

Presenter(s)

Presenting Author: Carson Schell

Additional Author(s):

Ryan Nugent, University of Calgary

Karim Punja, University of Calgary

Martin Hyrcza, University of Calgary

Andrzej Kulaga, University of Calgary

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