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Biomedical subjects

D R Kulwin

Publications and source records attributed to D R Kulwin.

At least 19 recordsLinked to original sources
PubMed1999

Spontaneous resolution of upper eyelid retraction in thyroid orbitopathy.

This study was conducted to document in the literature case reports of spontaneous resolution of eyelid retraction in patients with thyroid orbitopathy. Two cases of thyroid orbitopathy associated with eyelid retraction were observed without surgical treatment. Spontaneous resolution of upper eyelid retraction occurred during an 8- to 12-month period.

Adolescent↗
PubMed1998

Hering's law and eyebrow position.

A patient with bilateral but asymmetrical brow ptosis is presented in whom the frontalis action on the relative position of the eyebrows could be demonstrated to obey Hering's law of equal innervation. The neurological basis for this finding is discussed, along with the implications for the surgical management of brow ptosis.

Blepharoptosis↗
PubMed1998

The modified rhomboid transposition flap in periocular reconstruction.

The traditional rhomboid transposition flap has been widely used in reconstructive surgery. The authors have modified the original technique by eliminating the creation of the rhomboid defect and by directly transposing the flap into the original postexcisional defect. These changes allow maximum flexibility in flap design and minimize normal tissue loss. The authors retrospectively reviewed the charts of patients who underwent periocular reconstruction with flaps from 1990 through 1995. The authors selected those patients in whom the modified rhomboid flap was used. Functional and cosmetic results and complications were reviewed. Two hundred thirty-two patients were identified in whom 242 flaps were performed. The modified rhomboid flap was used in 101 patients (41.7%). Complications occurred in 23 patients (23%), 19 of whom (19%) were treated medically and four of whom (4%) required an additional surgical procedure. Cosmetic and functional results were classified as very good or excellent in 96 patients (96%). The use of a modified rhomboid flap in the reconstruction of the periocular area offers ample versatility in flap design and minimal normal tissue loss. Functional and cosmetic results are satisfactory in the vast majority of cases.

Blepharoplasty↗
PubMed1997

Criteria for selective management of the orbital rim and floor in zygomatic complex and midface fractures.

OBJECTIVE: To develop objective criteria with which to identify patients with zygomatic complex (ZMC) or midface fractures who require a surgical exploration and treatment of the orbital component of their fracture to prevent postoperative enophthalmos, diplopia, or malar depression. DESIGN: Nonrandomized, prospective management of facial trauma patients. SETTING: Urban, university referral center. PARTICIPANTS: Ninety-seven patients with facial fractures (72 with ZMC fractures and 25 with midface fractures) who presented to the maxillofacial and oculoplastics trauma teams at the University of Cincinnati, Cincinnati, Ohio, for management. INTERVENTION: The decision whether to include an orbital exploration as part of the management plan was made based on a specific set of physical and radiological criteria that are detailed in the text. OUTCOME MEASURE: Patients were evaluated postoperatively for possible complications related to the orbital and periorbital portions of their fractures. RESULTS: Thirty-four percent of the study patients (30% of the patients with ZMC fractures and 44% of the patients with midface fractures) underwent orbital rim exposure and orbital floor exploration as part of their fracture management. Sixt-six percent of these patients (70% of the patients with ZMC fractures and 56% of the patients with midface fractures) were managed without orbital exploration. Postoperatively, none of the patients who did not undergo exploration experienced diplopia or enophthalmos and only 1 patient had a residual malar depression. CONCLUSIONS: The criteria reported herein allow surgeons to identify the minority of patients with midfacial and ZMC fractures who require an orbital exploration for optimal fracture management. Orbital exploration, and its potential complications, can be avoided in the majority of patients with ZMC and midface fractures without significantly increasing the risk of morbidity related to the orbital component of their fractures.

Adult↗
PubMed1997

Accuracy of clinical diagnosis of cutaneous eyelid lesions.

PURPOSE: Previous studies of cutaneous eyelid lesions have been retrospective using multiple contributing surgeons. The purpose of this study was to determine prospectively the accuracy of the clinical diagnosis of benign, premalignant, and malignant cutaneous eyelid lesions and to determine if all clinical diagnoses require histopathologic confirmation, or if an experienced clinician can reliably distinguish benign from malignant lesions on the basis of history and clinical examination alone. METHODS: This prospective study was conducted between January 1988 and January 1995. All patients presenting during this time with periocular cutaneous eyelid lesions were evaluated and a specific clinical diagnosis made in each case before biopsy and histopathologic evaluation. The lesions were categorized prospectively as benign, premalignant, or malignant, and histopathologic evaluation then correlated to determine the accuracy of the clinical diagnosis. Only patients who presented without previous biopsy were eligible for inclusion in the study. RESULTS: A biopsy was done on a total of 864 eyelid lesions during the 85 month study period. One hundred fifty-three lesions clinically were thought to represent malignancies. Of these, 140 (91.5%) were found to have malignant histopathologies. Nineteen lesions clinically were thought to represent premalignant processes. Histopathologic evaluation of these 19 lesions showed 16 to be actually premalignant, 1 to be a malignancy, and 2 to be benign. Six hundred ninety-two lesions clinically were thought to be benign. Of these, 13 (1.9%) proved on histopathologic evaluation to be malignant. These included 10 basal cell carcinomas, 1 squamous cell carcinoma, 1 non-Hodgkin lymphoma, and 1 adenoid cystic carcinoma. Three (0.4%) of the 692 clinically benign lesions were found to be premalignant. The 13 missed malignancies were distributed among a number of different clinical diagnoses, including papilloma, epidermal inclusion cyst, melanocytic nevus, hydrocystoma, and trichoepithelioma. Of the 153 clinically malignant lesions, 6 lesions that clinically were highly suspicious for malignancy had initial benign histopathologic diagnoses. Rebiopsy results in all of these six subsequently confirmed the suspected malignant diagnosis. CONCLUSIONS: Malignant eyelid lesions may masquerade as a number of different clinically benign conditions. The authors conclude that all excised eyelid lesions should be submitted for histopathologic confirmation because it is not possible to obtain 100% accuracy in diagnosing eyelid lesions on clinical grounds alone. However, strong clinical suspicion of a malignancy is highly significant, and if initial histopathologic evaluation does not agree with the malignant clinical diagnosis, repeat biopsy should be performed.

Adult↗
PubMed1997

The role of enophthalmos in involutional entropion.

Relative enophthalmos is often cited as a causative factor in the development of involutional entropion. However, the association between enophthalmos and involutional entropion is largely anecdotal; no patient population study has been performed to determine if a causal relationship exists. This prospective clinical study compares exophthalmometric values in a population of patients with involutional entropion to an age- and sex-matched control group. Hertel exophthalmometric measurements were obtained on 56 patients with involutional entropion presenting over a 2-year period. Exophthalmometric measurements were also obtained in a group of 53 age- and sex-matched control patients presenting for evaluation and management of unrelated periocular disorders. Fifty-three patients presented with unilateral entropion and three patients presented with bilateral lower lid entropion. The mean of exophthalmometric measurements was within 16.0 mm in the entropion group and 16.15 mm in the control group. Eyes with involutional entropion are no more likely to have enophthalmos than is the uninvolved contralateral eye or normal eyes of an age- and sex-matched control population. Enophthalmos does not appear to play a role in the development of involutional entropion.

Aged↗
PubMed1996

"One-stitch" canalicular repair. A simplified approach for repair of canalicular laceration.

BACKGROUND: It has been widely believed that direct microsurgical re-anastomosis of the canalicular epithelium is necessary for satisfactory repair of canalicular lacerations. However, because repair is carried out in conjunction with placement of an indwelling silicone stent, this stent should keep the canalicular edges adequately approximate without the need for suturing. The authors report their results in repairing canalicular lacerations using a single, fine, horizontal, mattress suture to re-approximate the overlying pericanalicular orbicularis muscle and eliminate direct microsurgical re-anastomosis of the canalicular epithelium. METHODS: The authors retrospectively reviewed the charts of 67 patients who underwent repair of lacerated canaliculi with one-stitch re-approximation of the overlying orbicularis muscle in conjunction with bicanalicular silicone tube intubation. Stents were left in place for 3 months postoperatively and then removed. Probing across the lacerated portion of the canaliculus was carried out at the time of stent removal to ensure patency. Dye disappearance testing with 2% fluorescein and irrigation through the canaliculus then was performed 6 weeks to 3 months after stent removal. RESULTS: Of the 67 patients, 59 were followed to stent removal. Probing with a 00 probe showed canalicular patency in all 59 patients. Irrigation resulted in reflux in two patients, indicating unrelated nasolacrimal duct obstruction. Of these 59 patients, 45 complied with scheduled follow-up 6 weeks to 3 months after stent removal. Dye disappearance testing using 2% fluorescein demonstrated delay in lacrimal outflow in 6 of the 45 patients. Only two patients had symptomatic epiphora, and in both patients there was an underlying nasolacrimal duct obstruction confirmed by irrigation. CONCLUSIONS: Simple re-approximation of the lacerated overlying soft tissue combined with bicanalicular silicone intubation proved highly successful in managing canalicular lacerations. Probing through the lacerated canaliculus demonstrated patency in 100% of the 59 patients followed to stent removal. Only 4% of patients had symptomatic epiphora postoperatively, and 13% demonstrated some delay in outflow with dye disappearance testing. This compares very favorably with previous reported series in which lacerated canaliculi were microsurgically re-anastomosed.

Adolescent↗
PubMed1995

Management of canalicular injury associated with eyelid burns.

PURPOSE: To develop a protocol for treatment of injuries to the puncta and canaliculi associated with eyelid burns. METHODS: We retrospectively reviewed the records of seven patients who required treatment of punctal and canalicular stenosis caused by burns to the medial eyelids. RESULTS: Seven patients were treated within 5 days of injury: one by punctal dilation and six by surgical debridement, punctoplasty or canaliculoplasty, and silicone intubation. All remained free of epiphora. CONCLUSIONS: Early evaluation and treatment of punctal and canalicular burn injuries are beneficial. If the puncta are only slightly stenotic, close observation with serial lacrimal testing and punctal dilation is recommended. If the puncta and lateral canaliculi are severely stenotic or obliterated, surgical débridement and punctoplasty or canaliculoplasty followed by placement of a silicone stent effectively prevents permanent lacrimal stenosis and epiphora.

Adult↗
PubMed1995

Acquired ptosis in the young and middle-aged adult population.

PURPOSE: The authors studied the etiology of acquired ptosis in the young to middle-aged adult population with specific attention to the role of rigid contact lens use. METHODS: The study consisted of all patients between the ages of 15 and 50 years with acquired ptosis who presented between April 1986 and May 1994. Potential factors responsible for acquired ptosis were investigated in all patients with specific attention directed to history and duration of contact lens wear. RESULTS: In the consecutive series of 91 young to middle-aged adults with acquired ptosis, we found contact lens wear to be the only identifiable cause in 47% of patients. This was the most common cause for acquired ptosis in this age group. Trauma was a distant second cause, accounting for 19% of patients. Of the contact lens-induced ptosis, 58% were unilateral and 42% were bilateral. Of the 25 patients who wore contact lenses and had unilateral ptosis on examination, manual elevation of the ptotic lid showed an unsuspected contralateral ptosis to be manifest in seven patients due to Hering's law. Ptosis was overwhelmingly associated with rigid contact lens wear, and levator aponeurosis disinsertion was found in the large majority at the time of surgical repair. CONCLUSION: This study suggests that contact lens-induced ptosis is a much more common cause of acquired ptosis in young and middle-aged adults than has been suspected previously. The ptosis is primarily due to levator aponeurotic disinsertion, presumably due to recurrent traction on the aponeurosis during rigid contact lens removal.

Adolescent↗