Monocanalicular nasolacrimal duct intubation.
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Biomedical subjects
Publications and source records attributed to H J Glatt.
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In the presence of a full-thickness lower eyelid defect too large for reconstruction with a tarsoconjunctival flap alone, the posterior lamella is often reconstructed with a free graft of nasal septal cartilage and mucosa, ear cartilage, or hard palate mucosa. In this series, an alternative approach was taken: a tarsoconjunctival flap of maximum horizontal dimension was created to reconstruct the majority of the posterior lamella defect. A second reconstruction technique, such as a periosteal flap or a Tenzel semicircular flap, was then used to supplement the tarsoconjunctival flap and reconstruct the remainder of the posterior lamella defect. Tarsoconjunctival flap supplementation yielded favorable results in eight patients and is advocated for the reconstruction of large posterior lamella defects too large for reconstruction with a tarsoconjunctival flap alone.
Facial fractures that result in lacrimal drainage obstruction may add complexities to lacrimal surgery. The role of preoperative assessment of lacrimal obstruction after facial fractures using computed tomography (CT) or CT dacryocystography was assessed in this study. Consecutive patients (n = 13) with symptomatic lacrimal obstruction after facial fractures underwent radiologic evaluation prior to lacrimal surgery. The first three patients underwent CT alone. The subsequent 10 patients underwent CT dacryocystography, in which radio-opaque dye was instilled into the lacrimal sac prior to CT. Radiographic findings pertinent to surgical management were present in 11 of the 13 patients and included alterations in bony anatomy, plates or wires adjacent to the lacrimal sac, nasal septal deviation, sinusitis, anterior ethmoid air cells, and anteriorly located middle turbinates. CT or CT dacryocystography prior to lacrimal surgery in patients with previous facial fractures may facilitate preoperative planning and intraoperative execution. It is recommended that the cost of these studies be minimized by adherence to streamlined protocols widely used in sinus CT.
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We examined and treated four patients with anophthalmic socket pain. Conditions responsible for this problem in this series included scleritis after evisceration, amputation neuroma, pain from a skull-base meningioma, and chemical dependency with drug-seeking behavior. The pain associated with the scleritis after evisceration responded to removal of the scleral remnant. The pain associated with the amputation neuroma responded to removal of the orbital implant and its pseudocapsule in which the amputation neuroma was embedded. The pain associated with the meningioma was intractable. The pain associated with the chemical dependency remained a persistent problem. A careful history and physical examination are critical in the evaluation of anophthalmic socket pain. Computed tomography or magnetic resonance imaging may be helpful in some cases.
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Two hundred thirty-six periocular basal-cell carcinomas were resected under conventional frozen-section control. Only two tumors recurred, yielding a success rate of 99.2%. The mean follow up was 56 months. Eighty-one of the 236 patients were followed for at least 5 years; the 5-year cure rate was 97.5%. To our knowledge, this is the largest reported series of periocular basal-cell carcinoma resected under conventional frozen-section control; also, we believe the follow-up data are superior to those of previous series. The high success rates with conventional frozen-section techniques in this and other series are comparable to those reported for the Mohs micrographic techniques.
In two patients with keratoconjunctivitis sicca, epiphora did not occur after temporary canalicular occlusion with collagen implants, but did occur after subsequent permanent punctal occlusion. This suggests that collagen implants may not always produce total occlusion. Patients should be warned of this possibility.
Five patients with dacryocystorhinostomy failures were examined with computed tomography or computed tomographic dacryocystography. In computed tomographic dacryocystography, radiopaque dye was instilled into the lacrimal sac before computed tomography to show its shape, location, and relation to surrounding structures. Problems with the bony ostium were detected in all five patients. Recurrent nasal polyposis, a retained metallic clip, and an unresected ethmoid air cell were also identified. Computed tomography and computed tomographic dacryocystography provided important information that facilitated reoperation after dacryocystorhinostomy failure.
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Medial maxillectomy can result in lacrimal obstruction and the need for subsequent dacryocystorhinostomy. Computed tomographic dacryocystography is a technique in which radiopaque dye is instilled in the lacrimal sac and computed tomography is subsequently performed. Computed tomographic dacryocystography facilitated the management of a patient with lacrimal obstruction after medial maxillectomy by helping to exclude recurrent tumor and sinusitis, and by providing a surgical "roadmap" in the presence of altered anatomy.