War surgery of the faceA treatise on plastic restoration after facial injury by John BRoberts ..Prepared at the suggestion of the subsection on plastic and oral surgery connected with the office of the surgeon generalIllustrated with 256 figures . whichrolls the eyeball upward. Perhaps a better method in the severe cases of ptosis is thatwhich shortens the suspensory ligament of the lid by means oftwo buried mattress sutures. By these stitches the tarso-orbitalfascia and the tendon of the elevator muscle are shortened bymaking horizontal gathers. These structures are uncovered bya horizontal c
War surgery of the faceA treatise on plastic restoration after facial injury by John BRoberts ..Prepared at the suggestion of the subsection on plastic and oral surgery connected with the office of the surgeon generalIllustrated with 256 figures . whichrolls the eyeball upward. Perhaps a better method in the severe cases of ptosis is thatwhich shortens the suspensory ligament of the lid by means oftwo buried mattress sutures. By these stitches the tarso-orbitalfascia and the tendon of the elevator muscle are shortened bymaking horizontal gathers. These structures are uncovered bya horizontal cut about two inches long upon the upper orbitalridge just within the eyebrow. The skin and orbicular muscle REPAIR OF TRAUMATIC DEFORMITIES OF EYELIDS AND GLOBE. 393 are raised to expose the tarsal cartilage and its suspensory silk or chromicized catgut mattress sutures are then intro-duced through the cartilage near its upper edge, are carriedupward through the suspensory ligament, or fascia, and thetendon of the elevator muscle, and are then tightened and skin wound is closed over the knots after the stitches haveshown that the suspensory ligament and aponeurosis of the weakelevator muscle have been shortened Fig. 225.— Diagram of Robertss muscle substitution operation for ptosisof upper eyelid. CHANGING THE SIZE OF THE PALPEBRAL OPENING. Because of malformations of the lid, paralysis of the orbicularmuscle, or protrusion of the eyeball, it may be necessary to makea smaller palpebral opening. This should not be done for cos-metic reasons unless the palsy, the exophthalmic goiter, or other 394 WAR SURGERY OF THE FACE. general cause, has been cured, or at least relieved as much as islikely to be possible, by medical treatment. Suture of the external canthus is a simple procedure andgreatly relieves the staring look often remaining after attacks ofexophthalmic goiter. It is not available when the exophthalmosis due to abscess or orbital tumors. The
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