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Biomedical subjects

R C Kersten

Publications and source records attributed to R C Kersten.

At least 55 records · Page 3Linked to original sources
PubMed1992

Tarsotomy for the treatment of cicatricial entropion with trichiasis.

Transverse tarsotomy and lid margin rotation is a simple procedure that is effective in repositioning the entropic lid margin without requiring external incisions or grafting. We report the results of this procedure in 81 eyelids of 58 patients with cicatricial entropion and trichiasis who were followed up for a minimum of 6 months after surgery. Fifty-nine (94%) of sixty-three eyelids with mild to moderate cicatricial entropion were cured with this procedure. Patients with severe cicatricial entropion had a lower success rate with initial tarsotomy (55%), but in these patients the procedure had minimal complications and repeating the operation resulted in a higher success rate. Tarsotomy and lid margin rotation produces excellent cosmetic and functional results when used to treat patients with mild to moderate cicatricial entropion. In cases of more severe cicatricial entropion, we still recommend it as the initial procedure after which more complex modalities may be used if needed.

Adolescent↗
PubMed1992

Medial canthoplasty with microplate fixation.

Six patients with malpositioned or surgically excised medial canthal tendons underwent repair with titanium microplate, and two patients underwent repair with titanium miniplate fixation. The T-shaped rigid fixation plates were chosen for medial canthal reconstruction to allow for stabilization of the plate along the anterior lacrimal crest and extension of the plate over the posterior lacrimal crest. The medial canthal tissue was reattached to the titanium plate with 3.0 polypropylene (Prolene) suture. This technique appears to be safer, faster, and, in many cases, more effective than traditional techniques for reconstruction of the medial canthus after tendon avulsion or loss from excision of cutaneous carcinoma.

Aged↗
PubMed1992

Extended access/internal approaches for the management of facial trauma.

The two most significant recent developments in the treatment of facial trauma are the introduction of plating systems, which provide rigid internal fixation and the development of surgical approaches that allow wide exposure of the entire facial skeleton while minimizing external incisions. These approaches (referred to as extended access/internal approaches) are hemicoronal and coronal flaps, the sublabial approach to the midface, the transconjunctival approach to the orbital floor and orbital rim, and the intraoral management of mandibular fractures. These approaches work well, and have become standard techniques for managing facial trauma; however, each one has definite technical points that need to be adhered to to assure their success. Additionally, there are situations where these approaches are not appropriate and, in fact, may even be detrimental. This article outlines our approach to facial trauma using these extended access/internal approaches and discusses the important technical factors of each approach. Our experience in treating 113 patients with 119 fractures and 161 approaches over the last 2 years is presented and the role extended access/internal approaches have played is reviewed. The indications, limitations, and possible complications associated with each approach are outlined.

Facial Bones↗
PubMed1991

Congenital entropion with intact lower eyelid retractor insertion.

Congenital lower eyelid entropion is generally considered to result from improper development of the retractor aponeurosis insertion to the inferior portion of the tarsal plate. We treated three patients with this uncommon disorder. At operation, aponeurotic defects were anticipated and specifically sought, but in each case the lower eyelid retractors were inserted normally. In two patients, entropion was relieved by surgical disinsertion and then advancement of the retractors. In the third patient, who also had multiple concomitant facial and systemic developmental anomalies, improvement in the lower eyelid malpositions required a combination of procedures. The intraoperative findings in our patients demonstrate that disinsertion of the lower eyelid retractors is not a universal etiologic mechanism in congenital entropion.

Entropion↗
PubMed1991

Lipomatous hamartoma of the orbit.

Proliferations of mature adipose tissue, while common in retroperitoneal and subcutaneous sites, rarely occur in the orbit. We describe the clinical, radiographic, and histopathologic findings of a nonencapsulated lipomatous tissue overgrowth of the right orbit in a 35-year-old man. The mass had caused proptosis since childhood and was apparently present since birth. Due to the age at onset, the histologic similarity to normal orbital fat, and the lack of encapsulation or choristomatous elements, we propose the term lipomatous hamartoma for this entity.

Adult↗
PubMed1990

Management of congenital lacrimal sac fistula.

Fourteen patients who were treated for symptomatic congenital lacrimal sac fistula were retrospectively reviewed to evaluate surgical success. Excision of the fistula alone was performed on 9 patients and excision with nasolacrimal intubation on 5 patients (to our knowledge, the latter has not been previously described in the English literature). None of the 14 patients were symptomatic postoperatively during a mean follow-up of 16 months, with a range from 3 to 39 months. We conclude that dacryocystorhinostomy is usually not necessary to successfully treat symptomatic congenital lacrimal sac fistula.

Adolescent↗
PubMed1990

Management of lower-lid retraction with hard-palate mucosa grafting.

Lower eyelid retraction is frequently managed by recession of the lower-lid retractors and interposition of a "spacer graft." We have used hard-palate mucosa as our spacer material in 25 eyelids of 18 patients. A graft twice the height of the measured amount of lid retraction was used and resulted in predictable, satisfactory results. The hard-palate mucosa was easily obtained and the donor site healed well in all patients, with minimal care.

Adult↗
PubMed1990

Combined approach to orbital decompression.

Upon occasion, surgical orbital decompression is indicated to treat thyroid ophthalmopathy. Of the various approaches described, we feel a combined ophthalmic-otolaryngologic technique is the safest and most effective means of decompressing the orbit.

Exophthalmos↗
PubMed1989

An orbital hemangiopericytoma recurrent after 33 years.

A middle-aged woman developed a recurrent orbital hemangiopericytoma 33 years following its initial removal. Preoperative computed tomographic and magnetic resonance imaging scans revealed a well-circumscribed superotemporal orbital mass. A tumor that appeared grossly encapsulated was removed intact via a lateral orbitotomy. Histopathological examination showed a hemangiopericytoma with hypercellularity and a moderate number of mitotic figures. A review of the initial pathologic report confirmed the diagnosis of hemangiopericytoma with histological features similar to those of the recurrent mass. To our knowledge, this case represents the longest reported interval to recurrence of any hemangiopericytoma and demonstrates the extended follow-up needed in patients with hemangiopericytoma.

Female↗
PubMed1989

Cryotherapy for trichiasis in trachoma.

Trichiasis secondary to trachoma was treated in 137 eyelids from 64 patients in Saudi Arabia. Cryotherapy with high-flow nitrous oxide was applied to the lid margin for 45 seconds in a freeze-thaw-freeze cycle. The success rate of treated eyelids was 56% after one treatment and increased to 90% after a second treatment. Hypopigmentation of the highly pigmented eyelids of the Saudi population was our most significant complication (8% of treated lids). Because cryotherapy is portable and cost-effective and can be administered by paramedical personnel, it is ideal for use in regions where trachoma is endemic.

Adolescent↗