Mullerectomy: is it very much complicated/complex/uncommon?

Question

I'm 22 and I'm supposed to have a mullerectomy due to an acquired Horner's syndrom. I talked to some doctors, ophtalmologists and neurologists, and not all of them know about this kind of surgery. I wonder if mulerectomy is a very uncommon/complex surgery... If you would classificate the difficulty the surgeon has when performing a mullerectomy, from 1 (very easy) to 10 (very difficult), which grade would it be? In other words, how mullerectomy is seen from the surgeon's point of view?

Kenneth D. Steinsapir, MD · Answer

The other common ptosis surgery is an anterior levator aponeurosis resection ptosis repair (ALR). The conjunctival muellerectomy resection ptosis repair (CMR) is performed behind the eyelid.  It is not considered a complicated surgery and is more predictable than the ALR.  Unfortunately not everyone is a candidate for the CMR.  In Horner's syndrome the innervation to the  Mueller's muscle is blocked.  The CMR should be the ideal surgery for this situation.  However, this needs to be confirmed during consultation with the neosynephrine test.  Although the surgery is straight forward, I strongly recommend that it be performed by a fellowship trained oculoplastic surgeon with a great deal of experience.  Judgement is required to decide how much resection should be performed and if the CMR is the optimal approach for a given individual.  Despite the predictability and easy of the CMR, I would rather perform a more complicated procedure to get an optimal result.  I encourage you to get some other opinions with oculoplastic surgeons.  The American Society for Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) maintains a regional directory on their website which can help you in this endeavor.

John J. Martin, Jr., MD · Answer

There is no surgery that is risk-free or free of possible complications.  A mullerectomy is a fairly straight forward procedure and is most often performed by an oculoplastic surgeon.  Any oculoplastic surgeon should be experienced with this procedure.  Other plastic surgeons may not know how to do it. A proper evaluation including a neo-synephrine test will determine if you are a good candidate for this surgery.  The surgery is performed from the inside of the lid so there are no external scars.  If you don't have any bruising you can heal up pretty quickly.  Some patients will complain of eye irritation for a few days since the incision is on the inside of the eyelid.  Compared to some of the other surgeries we perform,  a mullerectomy is one of the best in terms of predictable outcomes and in speed of healing.

Mullerectomy: is it very much complicated/complex/uncommon?

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