Surgical approach to repair of traumatic avulsion and external herniation of the levator palpebrae superioris aponeurosis

Abstract

This report describes the unusual case and surgical repair of avulsion and external herniation of the levator palpebrae superioris (LPS) aponeurosis and attached muscle fibres associated with superior tarsal plate fracture in an 8-year-old Indigenous girl. To the authors' knowledge, isolated and complete levator palpebrae superioris avulsion with external herniation in trauma is previously unreported. Open injury to LPS requires swift surgical repair, and an anterior ptosis repair approach may facilitate identification of anatomical structures to prevent upper eyelid ptosis. Ultimately, the surgical repair in this case prevented further ptosis surgery and complications in a paediatric patient.

Keywords: Blepharoptosis; Eye injuries; Levator palpebrae superioris; Ocular surgery; Oculomotor muscles.

Fig. 1

Initial examination demonstrating a left upper lid laceration with tissue herniation.

Fig. 2

Intraoperative images of the LUL injuries. A, demonstration of the tarsal plate fracture; B, demonstration of the herniating LPS fibres with the muscle belly split in two, through the LUL laceration; C, lid crease incision with identification and re-positioning of LPS aponeurosis to the tarsal plate.

Fig. 3

Post-operative images taken; A, at postoperative week one, demonstrating a mild ptosis of the LUL; B, at six-months post-operation, demonstrating resolution.