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Biomedical subjects

N Shorr

Publications and source records attributed to N Shorr.

At least 37 records · Page 2Linked to original sources
PubMed1997

The Jones IE test: cobalt blue endoscopic primary dye test of lacrimal excretory function.

A cobalt blue filter adapter was constructed to fit between a rigid nasal endoscope and its halogen light source. Flooding the nasal cavity with the blue light illuminates the fluorescein-stained tears for more accurate examination of lacrimal function. We call our protocol the Jones IE test and used this new technique to examine 99 nasolacrimal systems of epiphora patients over a 15-month period. The results of this study show a six-fold increase in the ability of the Jones IE test to detect fluorescein dye within the nasal cavity over the conventional Jones I test.

Adult↗
PubMed1997

Maximal, three-wall, orbital decompression through a coronal approach.

BACKGROUND AND OBJECTIVE: Only limited volume expansion is offered by traditional lateral orbital decompressions in which the anterior segment of the lateral wall is removed to allow lateral soft tissue prolapse. A great deal of additional soft tissue expansion can be obtained, not only laterally, but also posteriorly by removing the deep portion of the sphenoid wing. The authors report their experience in removing this bone through a coronal approach. PATIENTS AND METHODS: The authors performed maximal, three-wall, orbital decompressions through a coronal approach for 20 patients with thyroid-related orbitopathy. A disfiguring proptosis resulting from stable Graves' disease orbitopathy was the indication for surgery in all cases. Through a coronal approach, the lateral rim was left in place and thinned, augmented with specialized orbital rim onlay implants, or repositioned with osteosynthesis systems. The bone over the lacrimal fossa was sculpted to form a "keyhole" for the lacrimal gland, thereby providing additional orbital expansion. Once the medial canthal tendon and lacrimal sac had been elevated from their periosteal attachment, excellent exposure was obtained for medial and inferior orbital decompression. RESULTS: The authors report the results of 20 coronal orbital decompressions during a period of 44 months. Seven cases included lateral rim advancement. Up to 6 mm of retrodisplacement was achieved without rim augmentation, 9 mm with rim augmentation. DISCUSSION: The deep lateral orbital wall can provide significant room for volume expansion. The authors found that up to 6 mm of proptosis reduction can be obtained using the lateral wall alone. The coronal approach provides access to all four orbital walls for deep orbital decompression. The authors' philosophy of treatment in cases without compressive optic neuropathy is evolving toward the use of the lateral wall as the first approach with the incorporation of additional walls as needed.

Adult↗
PubMed1996

Draining cutaneous fistula associated with infection of hydroxyapatite orbital implant.

The implantation of an orbital hydroxyapatite implant was complicated by conjunctival dehiscence, cutaneous fistula formation, and infection with Staphylococcus aureus. Pathologic examination of the sphere 2 years after its implantation revealed reduction in the size of the implant, peripheral lamellar bone formation and central necrosis. This is the first report of this constellation of complications with hydroxyapatite spheres positioned in the orbit. The 2-year interval between implantation and removal of the sphere is the longest reported in a case with histopathologic analysis.

Adult↗
PubMed1995

Infraorbital pigmented skin. Preliminary observations of laser therapy.

BACKGROUND: The presence of infraobital dark skin, often known as dark circles under the eyes, is a frequent cosmetic concern. There has been little reported on therapy of this condition. One group of patients was determined to have dermal melanin deposition, which we treated with a Q-switched ruby laser. OBJECTIVE: Our study evaluated the clinical and histological appearance of infraobital skin pigment in 17 patients with dermal melanin deposition treated with a Q-switched ruby laser. METHODS: Seventeen patients with melanin deposition were treated with the Q-switched ruby laser (694 nm) with a pulse width of 28 nanoseconds and fluences of 7.5 J/cm2. Response to treatment was assessed by an independent investigator with patient and photograph evaluation. Skin Biopsies were obtained in nine of the 17 patients. RESULTS: Of those patients treated with one Q-switched ruby session, 23.5% achieved a greater than 50% response. Of those treated twice, 88.9% achieved greater than 50% response. In postreatment skin biopsies there was reduction of dermal melanin deposition. CONCLUSIONS: Patients with infraobital pigmented skin due to dermal melanin deposition may be considered candidates for Q-switched Ruby laser treatment.

Adult↗
PubMed1995

Orbital decompression for non-Graves' orbitopathy: a consideration of extended indications for decompression.

Orbital decompression is typically indicated for Graves' orbitopathy. Other causes of proptosis can also be safely and effectively addressed surgically with orbital decompression. Patients with prominent globes can have significant discomfort related to exposure keratopathy, lagophthalmos, and inefficient function of the globe-eyelid interface. We present six cases of non-Graves' proptosis that were addressed with orbital decompression. Indications for surgery included hypoplastic malar eminence with scleral show, enlarged globes, and congenital shallow orbits. Successful reduction of proptosis was achieved by orbital decompression with subsequent relief of presenting symptoms. Graded balanced orbital decompression was used to minimize shifts of the muscle cone. In some cases osteotomies and advancement of the lateral wall and malar region were also employed. Complications included transient esotropia, esotropia requiring surgery, and microplate granuloma. Orbital decompression should be considered for patients with relative proptosis and related eyelid malpositions regardless of the underlying etiology.

Adult↗
PubMed1994

Management of exposed hydroxyapatite orbital implants.

BACKGROUND: Porous coralline hydroxyapatite orbital implants have gained significant popularity for use in anophthalmic sockets. Several reports have noted increased rates of early implant exposure. METHODS: Six patients with exposure complications of primary hydroxyapatite implants after enucleation or evisceration were studied. RESULTS: The hydroxyapatite implant exposures occurred 2 to 8 weeks after implantation. Magnetic resonance imaging scans with gadolinium enhancement obtained in two patients demonstrated a "cold" zone anteriorly with failure of fibrovascular ingrowth in the region of anterior exposure. Several different surgical procedures were used to regain implant coverage, including freshening the edge of the conjunctival defect and observing for spontaneous closure, burring away the anterior surface of the hydroxyapatite implant, and placing autogenous free tissue grafts of hard-palate mucosa or thin dermis-fat graft over the exposed hydroxyapatite. Repeated exposure after free graft was noted in several patients, and three of the six patients followed have an intact surface but very thin conjunctiva overlying hydroxyapatite spicules. CONCLUSION: Although small areas of hydroxyapatite exposure (< 3 mm) may close spontaneously, larger defects do not tend to close spontaneously and should be actively managed. Based on our experience, optimal results are obtained with free autogenous tissue grafts combined with burring of the anterior hydroxyapatite surface. Steps should be taken at the time of primary implantation to minimize implant exposure, including choosing appropriately sized implants and obtaining careful coverage with good vascularized tissue under minimal tension.

Adult↗
PubMed1994

Medical and surgical management of chemosis after blepharoplasty.

Chemosis--conjunctival edema--occurs frequently after direct surgical or accidental trauma. In most cases, it resolves spontaneously. We report three patients with a spectrum of persistent chemosis after lower blepharoplasty. Etiologic factors are presented, and the management is reviewed.

Adult↗
PubMed1993

Oculoplastic uses of cranial bone grafts.

Cranial bone grafting for craniofacial reconstruction has gained wide acceptance in recent years and is being used with increasing frequency by ophthalmic plastic surgeons. Alloplastic materials (particularly newer materials such as porous polyethylene, hydroxyapatite, and rigidly fixated metal alloys) have a clear role in orbital reconstruction, and in many oculoplastic applications are the material of choice. However, in certain applications cranial bone grafts may be superior, eg, in managing large posttraumatic or postsurgical orbital defects or orbito-sinus defects in the milieu of chronic sinusitis. We describe our current techniques for harvesting full-thickness outer-table grafts and split-thickness periosteally-bound "fish-scale" grafts. Harvesting cranial bone grafts is not without risk and donor site morbidity, and we do not advocate the use of cranial bone grafts in those cases that might be managed as well (or better) with alloplastic material. At the same time, ophthalmic surgeons involved in orbital reconstruction should be familiar with the indications for bone grafts and comfortable with harvesting techniques so that they are not limited when circumstances warrant the use of autogenous material.

Bone Transplantation↗
PubMed1992

The medical orbital strut in the prevention of postdecompression dystopia in dysthyroid ophthalmopathy.

Ocular dystopia with inferomedial displacement of the globe is an unusual but well-recognized complication of bony orbital decompression. It is caused by displacement of the muscle cone and orbital connective tissue system into the maxillary and ethmoidal sinuses. We illustrate a surgical variation of bony orbital decompression leaving intact a strut of bone at the maxillary-ethmoid junction. This bony strut reduces inferomedial displacement of the muscle cone and provides a medial supporting "ledge" in cases requiring late orbital reconstruction.

Eye Diseases↗
PubMed1992

Eyelid reconstruction with hard palate mucosa grafts.

Hard palate mucosa grafts are an excellent replacement for tarsus and conjunctiva in eyelid reconstruction. Twenty-five eyelids from 18 patients underwent eyelid reconstruction using hard palate mucosa grafts. Patients were treated for a variety of disorders including postblepharoplasty lower eyelid retraction, cicatricial entropion, eyelid retraction secondary to thyroid eye disease, and lagophthalmos following surgery for paralytic ptosis. Surgical results were evaluated, grafts were measured for postoperative shrinkage, and donor site healing was recorded. Several patients had hard palate biopsy specimens evaluated. One of these patients also had a graft biopsied after it had been in place for 3 months. A review of hard palate anatomy and histology and a discussion of surgical technique are presented.

Adult↗
PubMed1992

Considerations in aesthetic eyelid surgery.

BACKGROUND: Successful aesthetic eyelid surgery is based upon multiple complex factors that, when put together, yield a pleasing result. Beauty is inherently related to normal eyelid function and symmetry. OBJECTIVE: To review the critical issues facing the aesthetic surgeon, and to propose a systematic method of assessing the patient preoperatively. METHODS: This article first examines the general considerations for aesthetic eyelid surgery, followed by specific concerns within each anatomic area. RESULTS AND CONCLUSION: The critical task in aesthetic eyelid surgery is to reconstitute or preserve the normal structure and function of the eyelids. This is especially true in the multicontoured areas. It is essential for the surgeon to define the problems in a hierarchal fashion, and plan the surgery accordingly. Thus, not all patients can achieve the desired results in one sitting. The goal of aesthetic surgery is to avoid the telltale signs of surgery and to help the patient attain a youthful and energetic appearance for his or her age bracket.

Eyebrows↗
PubMed1992

"Vertical slat" chalazion excision.

We describe a technique of chalazion excision in which multiple vertical incisions spaced approximately 1 mm apart are used to provide wide exposure of the chalazion. The entire extent of lipogranulomatous tissue can be excised under direct visualization, sparing normal tissues. No tarsoconjunctival tissue is extirpated. The vertical slats heal quickly, and horizontal incisions, which may cut across meibomian glands, are avoided.

Chalazion↗