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Biomedical subjects

D R Jordan

Publications and source records attributed to D R Jordan.

At least 145 records · Page 8Linked to original sources
PubMed1990

Amelanotic malignant melanoma of the conjunctiva with local metastasis to the eyelid.

Conjunctival melanomas are uncommon. The amelanotic variety is extremely rare. We describe a patient with an amelanotic melanoma of the superior conjunctiva that was primarily excised, followed by extensive conjunctival resection and liquid nitrogen cryotherapy applied to the tumour bed. Eight months later a local metastatic lesion was noted in the lower eyelid. Eyelid metastasis in conjunctival melanoma is uncommon but may occur owing to the rich lymphatic vasculature within the conjunctiva.

Aged↗
PubMed1990

Lacrimal gland prolapse in craniosynostosis syndromes and poor function congenital ptosis.

Lacrimal gland prolapse is an important, though uncommon, feature found in craniofacial abnormalities as well as in cases of poor function congenital ptosis. It occurs secondary to a number of conditions, including increased posterior pressure secondary to decreased orbital volume; also, supportive structures of the gland often may be weak in conjunction with a poor function ptosis or as a result of trauma at the time of major reconstruction. Recognition of the prolapsed gland and its replacement into the lacrimal gland fossa in craniosynostosis syndromes, as well as in cases of poor function congenital ptosis in general, allows the temporal eyelid to approach a more normal position, yielding an improved functional and cosmetic result.

Blepharoptosis↗
PubMed1990

Acquired oculomotor-abducens synkinesis.

The authors present a rare case of bilateral aberrant oculomotor regeneration following severe head trauma with the unusual finding of unilateral palpebral fissure widening on abduction with normal lateral rectus function (oculomotor-abducens synkinesis). The findings do not match the usual syndromes of either acquired oculomotor synkinesis or acquired Duane's retraction syndrome and seem to represent a unique case of aberrant regeneration involving the third and sixth cranial nerves.

Abducens Nerve↗
PubMed1990

The aponeurotic approach to congenital ptosis.

Using a surgical technique directed at the levator aponeurosis, we successfully corrected 228 cases of congenital ptosis. The advantages of this approach are: normal anatomic planes and structures of the eyelid are maintained; basic and reflex tear secretion, goblet cells, or meibomian glands remain undisturbed, allowing maintenance of the three-layered tear film; any aponeurotic defects may be explored and repaired relatively easily; all elevating structures are preserved (aponeurosis rather than muscular levator is removed, Mueller's muscle is left intact, Whitnall's ligament is not violated); posterior sutures, which may irritate the cornea, are avoided; no tarsus or conjunctiva are removed.

Blepharoptosis↗
PubMed1990

Apraxia of lid opening in blepharospasm.

Apraxia of lid opening is a nonparalytic motor abnormality characterized by difficulty in initiating the act of lid elevation. It has been reported with extrapyramidal disorders, including Parkinson's disease, Huntington's chorea, progressive supranuclear palsy, and Shy-Drager syndrome. We found seven cases (7%) of functionally disabling apraxia of lid opening in 100 consecutive blepharospasm patients studied. It is important for physicians treating blepharospasm to be aware of the association between these two visually debilitating disorders.

Apraxias↗
PubMed1989

Tarsoconjunctival flap for upper eyelid reconstruction.

Reconstruction of large, full-thickness upper eyelid defects is a challenge to the ophthalmic plastic surgeon. Ideally, the defect should be reconstructed with tissues similar or identical to those that have been lost. We present a procedure similar to the Hughes tarsoconjunctival flap technique for lower eyelid reconstruction. However, our technique was used for upper eyelid reconstruction. A remnant of tarsus at least 3 mm wide must be available to be advanced inferiorly in the upper eyelid. We have performed this procedure on 13 patients over ten years (1977 to 1987) with good to excellent results.

Conjunctiva↗
PubMed1989

The lateral tarsal strip revisited. The enhanced tarsal strip.

The lateral tarsal strip procedure was originally designed for the treatment of upper and lower eyelid laxity, or lateral canthal tendon laxity or malposition. Despite the excellent results with a standard tarsal strip procedure for those eyelids with laxity and excess skin, we have encountered a number of patients with lower eyelid or canthal malpositions or both who would benefit from a tarsal strip, but who do not have lax tissues (especially skin), and may in fact have a shortage of skin. These include cases of lower lid retraction or canthal malposition following trauma, blepharoplasty, or other operations, and patients with tendency toward or having cicatricial ectropion. Any anterior lamella removal in such patients would aggravate the lid malposition and weaken the lateral canthal tissues to be sutured. We suggest a modification of the tarsal strip (developed by one of us [R.L.A.]) to treat many such patients without requiring additional anterior lamella (skin graft) or more formidable procedures. We refer to this technique as the "enhanced tarsal strip" technique, and we use this technique more frequently than the original tarsal strip procedure.

Adult↗
PubMed1989

Epicanthal folds. A deep tissue approach.

Epicanthal folds are seen in infants and young children of all races, and they appear as a normal finding in Orientals of all ages. The formation of these folds seems to be related to tension from excessive underlying muscle in many cases. Surgically, a number of techniques have been suggested for their correction, but many of these techniques result in unsightly scars. A technique has been devised for the correction of epicanthal folds that involves an incision on the fold and removes muscle beneath the fold while attaching the skin edges to deep tissues in an attempt to create a crease, which may extend into normal creases. This technique has delivered good functional and cosmetic results in 9 of 10 consecutive cases treated in this manner.

Adolescent↗
PubMed1989

Chondroid syringoma of the eyelid.

Chondroid syringoma (mixed tumour of the skin) is a rare cutaneous neoplasm of probable eccrine sweat gland origin. It occurs most commonly in the head and neck as a firm intradermal or subcutaneous nodule. Occurrence in the periocular tissues is unusual. We describe a 74-year-old woman with chondroid syringoma of the upper eyelid that arose as a painless, slowly enlarging subcutaneous mass. Histologically the lesion consisted of epithelial cell-lined tubular branching lumina that were scattered in an abundant fibrous stroma. Local excision appears to be adequate treatment, although malignant transformation may rarely occur.

Adenoma, Sweat Gland↗
PubMed1989

Unicanalicular stent for nasolacrimal duct obstruction.

The authors describe a method for silicone intubation of a single patent canaliculus associated with a nasolacrimal duct obstruction. Although bicanalicular intubation is always preferable when possible, unicanalicular stenting is necessary when only one canaliculus is patent. A chief advantage of this technique is that the lacrimal stent is inaccessible to the child and thus cannot be accidentally pulled out.

Child, Preschool↗
PubMed1989

Acute visual loss due to a calcified optic nerve glioma.

Optic nerve gliomas are slow-growing tumours most commonly seen in children under 10 years of age. Rapidly progressive proptosis and rapid visual deterioration are uncommon but may occur owing to accumulation of mucoid material, necrosis or hemorrhage. We describe a patient with an optic nerve glioma who manifested sudden proptosis and blindness caused by hemorrhage within the optic nerve sheath. The visual acuity returned to 20/25 after surgical decompression of the nerve and high-dose steroid therapy. Histopathological examination was required to establish the diagnosis of optic nerve glioma with extensive calcification. Optic nerve decompression or short-term high-dose steroid therapy, or both, may be helpful in recovering visual function in selected patients with optic nerve gliomas who have acute visual loss.

Adult↗
PubMed1989

Intractable orbicularis myokymia: treatment alternatives.

Orbicularis myokymia frequently occurs in young, otherwise health individuals. The intermittent muscle fasciculations are transient and generally disappear with time. If the myokymia is persistent or progressive, neurologic assessment and investigation may be necessary. Muscle relaxants, botulinum-A toxin, and surgical myectomy are methods of treatment that only occasionally need to be considered. We present limited orbicularis myectomy and botulinum-A toxin injections as efficacious treatments in five selected intractable cases of orbicularis myokymia.

Adult↗
PubMed1988

Full-thickness unipedicle flap for lower eyelid reconstruction.

We developed a technique for lower eyelid reconstruction using a full-thickness unipedicle flap from the upper tarsal portion of the upper eyelid. The lost tissue is replaced with identical tissue from the ipsilateral upper eyelid. The technique is best suited to shallow defects of the temporal lower eyelid. The levator aponeurosis and Müller's muscle are recessed to avoid upper eyelid retraction. The key to performing this operation is a thorough knowledge of eyelid anatomy and preservation of its microvascular supply. This procedure has produced satisfactory to excellent results in 17 patients and offers the reconstructive surgeon several advantages over other techniques.

Eyelid Neoplasms↗
PubMed1988

Orbital emphysema: a potentially blinding complication following orbital fractures.

A case of visual loss due to orbital emphysema secondary to a blow-out fracture of the orbit is presented. Because vision returned to 20/20 following an optic nerve decompression procedure, we hypothesize that our patient developed a compressive optic neuropathy with ischemia due to the emphysema. Essential instructions concerning the injury that the emergency physician should give the patient suffering an orbital blow-out are also presented.

Adolescent↗