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At least 379 records · Page 21Linked to original sources
PubMed1975

A modified Fasanella-Servat procedure for ptosis.

This procedure was first suggested for "minimal ptosis of 3-4 mm." However, since the amount of ptosis varies widely with the etiological factors, the true indication in any given case is not the amount of ptosis but the amount of levator action. Hence, unless there is at least 10 mm of levator action, this operation is contraindicated. Since the levator (except that part of the aponeurosis that is adherent to the tarsus) is not involved, the procedure has been simplified accordingly.

Blepharoptosis↗
PubMed1975

Structure of the muscles of the upper eyelid.

The human and monkey orbicularis muscle has fibers that are more uniform in size and structure than those of rectus muscles. They have distinct myofibrils, a moderate number of mitochondria, and a well-developed transverse T-tube system. The levator muscle also has relatively uniform fibers, but the myofibrils are less distinct than those of the orbicularis. Especially noteworthy is the unusual arrangement whereby Muller muscle arises directly from the undersurface of the levator muscle, causing an intimate intermingling of smooth and striated fibers. Muller muscle then inserts on the tarsus, whereas the levator muscle extends by an aponeurosis into the septa of the orbicularis muscle. In surgical specimens from patients with ptosis, the levator fibers show varying degrees of abnormality, whereas Muller fibers are normal.

Adolescent↗
PubMed1977

Surgical treatment of eyelid neurofibromas.

The classical surgical treatment of eyelid neurofibromas has been careful dissection of the tumor with preservation of much of the surrounding abnormal lid tissues. The reported outcome has been uniformly unfavorable. These tumors infiltrate extensively and are impossible to dissect out completely. However, the lateral location of lid neurofibromas allows "en bloc" resection of most of the tumor including the adjacent involved lid tissues. Levator function in these cases is potentially good and the lid will elevate well if the levator aponeurosis is joined to the tarsus laterally at the time of surgery. The four cases presented here indicate that this procedure is technically easier and may produce more acceptable results than other forms of treatment.

Adolescent↗
PubMed1977

The levator aponeurosis. Attachments and their clinical significance.

A detailed knowledge of the anatomy of the levator aponeurosis is required for the aponeurotic approach to ptosis. Yet, many misconceptions regarding the insertional attachments of this important structure are found in the literature. The levator aponeurosis inserts via a fan of fibers. The first insertional attachment curves anteriorly around the orbital septum to form the lid crease. Approximately the anterior half of the aponeurosis inserts into pretarsal orbicularis and the overlying subcutaneous tissue. The remaining posterior half inserts firmly on the lower portion of the tarsus.

Blepharoptosis↗
PubMed1978

Levator aponeurosis disinsertion in the young adult. A cause of ptosis.

Three patients, under the age of 35 years, had acquired ptosis. All patients gave a history of notable eyelid edema during extended periods. The patients underwent surgery under local anesthesia. Four eyelids were explored through the skin route, and a levator disinsertion was found in all cases. Repair was accomplished by reattaching the lower edge of the levator aponeurosis to the tarsus. Since the surgery was done under local anesthesia, the patient could elevate the eyelids during the entire procedure. The amount of eyelid elevation could, therefore, be determined at surgery. Levator aponeurosis disinsertion may be a cause for acquired ptosis following substantial eyelid edema in the young adult.

Adolescent↗
PubMed1979

Giant papillary conjunctivitis with ocular prostheses.

In seven patients who each had either a methyl methacrylate corneal shell, a postenucleation ocular prosthesis, or a keratoprosthesis, giant papillary conjunctivitis of the tarsus of the upper lids developed after prolonged wear. These cases expand the spectrum of disease that was initally described in wearers of hard and soft contact lenses. The papillary changes in prostheses wearers did not always produce symptoms and were not readily reversible. Basophils and mast cells characterized the inflammatory infiltrate, suggestng an antigen-antibody mechanism underlying the response. Increased production of epithelial mucin, in contrast to goblet cell mucin, may play a role in producing symptoms in this syndrome.

Adolescent↗
PubMed1980

The A-frame operation for acquired blepharoptosis.

The A-frame operation has been found effective in the treatment of acquired blepharoptosis. It has the following advantages: (1) it can be done easily, rapidly, and if desired, bilaterally, with a minimum of dissection; (2) corneal irritation is not seen; (3) the tarsus is not disturbed; (4) since it is done through an external incision, it can be done with a concomitant blepharoplasty or other oculoplastic procedure; and (5) the procedure is easily learned. The operation is a block resection of levator aponeurosis, Müller's muscle, and conjunctiva. The term "A-frame" was adopted from the use of temporary traction sutures to pull up the layers to be resected, suggesting an A-frame building. The results in 40 eyelids are presented with two illustrative case histories.

Aged↗
PubMed1980

Levator lengthening by marginal myotomy.

A surgical procedure has been designed for lengthening the levator aponeurosis by two partial-width (marginal) myotomy incisions. This operation does not require complete division or disinsertion of the levator, Müller's muscle, or tarsus. No foreign materials or sclera need to be inserted into the lid. The procedure has been used to treat upper lid retraction due to ophthalmic Graves' disease and for eyelid reconstruction after resection of basal cell carcinoma that involves the lid margin. Since an anterior incision is made through the skin, adhesions between the levator aponeurosis and the overlying tissues may be divided in patients with Graves' disease.

Adult↗
PubMed1983

Superior limbic keratoconjunctivitis associated with soft contact lens wear.

Four cosmetic soft contact lens wearers experienced lens intolerance and mild irritative symptoms. All four displayed changes suggestive of those seen in superior limbic keratoconjunctivitis with papillary hypertrophy and inflammation of the upper tarsus, superior tarsal and bulbar conjunctival fluorescein staining, superior limbal hypertrophy, and upper corneal punctate staining. Three of the four conditions resolved with discontinuance of lens wear alone; the fourth improved, but there was persistence of mild upper bulbar conjunctival and corneal staining for two years. No common causative contact lens-related factors were obvious in the four. Three of the patients were subsequently able to resume lens wear on a modified basis.

Adult↗
PubMed1983

Chronic conjunctivitis associated with 'floppy eyelids'.

The floppy eyelid syndrome represents a chronic conjunctivitis characterized by a triad of (1) a loose upper lid that readily everts on elevating the lid, (2) a soft rubbery tarsus that can be folded on itself, and (3) a diffuse papillary conjunctivitis. Seven cases of this condition are reported, all involving men, and four involving obese patients.

Adult↗
PubMed1986

Tarsal rotational flap for upper eyelid reconstruction.

Reconstruction of full-thickness defects in the upper eyelid presents a special challenge to the oculoplastic surgeon. We present and discuss a new, surgically simple technique for posterior lamella reconstruction of the upper eyelid, which can also be used with other procedures. The surgical technique calls for a vertical strip of tarsus (tarsal flap) to be rotated horizontally and sutured to canthal tendon remnants or periosteum at the orbital rim. This procedure has produced satisfactory to excellent results in our test group, and presents the reconstructive surgeon with several advantages over other techniques.

Adenocarcinoma↗
PubMed1987

Full-thickness bipedicle flap for total lower eyelid reconstruction.

We describe a technique for total lower eyelid reconstruction utilizing a full-thickness bipedicle flap from the upper 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 techniques for preserving its microvascular blood supply. The bipedicle flap requires meticulous surgical technique but has many advantages over standard types of total lower eyelid reconstruction, including the following: excellent tissue match and cosmesis are obtained with single-stage reconstruction; distal flaps and grafts are avoided; open palpebral fissure is maintained, resulting in rapid rehabilitation; posterior lamella of tarsus, rather than substitute, is utilized; anterior lamella of functional orbicularis is utilized for support and closure; pedicles suspend and support the eyelid, decreasing lower eyelid retraction, laxity, and ectropion; allows simultaneous reconstruction of canthal defects; and is faster than other forms of total lower eyelid reconstruction. The results of 14 total lower eyelid reconstructions are presented. Minor canthal deformities, the most frequent complication, are easily corrected. This technique should be considered as an alternative to other procedures in cases of total lower eyelid reconstruction.

Aged↗
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↗
PubMed1993

Whitnall's sling with superior tarsectomy for the correction of severe unilateral blepharoptosis.

The management of severe unilateral blepharoptosis is problematic. In the presence of poor levator function, conventional surgical techniques frequently do not adequately elevate a ptotic eyelid. From May 1988 through July 1991, we used 4- to 5-mm external resections of the superior tarsus in conjunction with a maximal aponeurectomy (Whitnall's sling procedure) to augment blepharoptosis correction in selected cases of severe unilateral blepharoptosis. Seventeen (68%) of 25 patients with poor levator function blepharoptosis who underwent this new surgical procedure achieved a lid height within 1 mm of the opposite lid with good or excellent ocular function, cosmesis, and eyelid crease formation. Mild to moderate degrees of exposure keratopathy developed early in the postoperative period in all patients. This exposure keratopathy ultimately resolved in most patients. Superior tarsectomy safely augments the blepharoptosis correction of a Whitnall sling procedure in severe blepharoptosis, improving the results of aponeurotic surgery in patients with severe unilateral blepharoptosis.

Adolescent↗
PubMed1983

McCord procedure for ectropion repair.

The McCord technique of ectropion repair was used on 85 eyelids of 77 patients who have been observed for six to 34 months. In each instance the ectropion was corrected by resecting part of the stretched lateral canthal tendon and reattaching the tarsus to the lateral orbital rim with a permanent suture. The incision at the lateral canthus avoids lid notching, trichiasis, corneal irritation, and the added stress on the lateral canthal tendon that may occur with conventional wedge sections. The lid position was revised in six patients. A lateral canthal granuloma developed in four patients. One patient had late infection from the permanent stitch. This procedure is particularly useful for patients with ectropion who have an artificial eye or for ectropion after blepharoplasty. Additional steps may be added for more complicated cases, such as skin grafting for cicatricial ectropion or reattachment of the lower lid retractors for tarsal ectropion.

Ectropion↗
PubMed1998

Grebe syndrome: clinical and radiographic findings in affected individuals and heterozygous carriers.

Grebe syndrome is a recessively inherited acromesomelic dysplasia. We studied, clinically and radiographically, 10 affected individuals, originating from Bahia, Brazil. The phenotype is characterized by a normal axial skeleton and severely shortened and deformed limbs, with a proximo-distal gradient of severity. The humeri and femora were relatively normal, the radii/ulnae and tibiae/fibulae were short and deformed, carpal and tarsal bones were fused, and several metacarpal and metatarsal bones were absent. The proximal and middle phalanges of the fingers and toes were invariably absent, while the distal phalanges were present. Postaxial polydactyly was found in several affected individuals. Several joints of the carpus, tarsus, hand, and foot were absent. Heterozygotes presented with a variety of skeletal manifestations including polydactyly, brachydactyly, hallux valgus, and metatarsus adductus. Grebe syndrome is caused by a missense mutation in the gene encoding cartilage-derived morphogenetic protein-1.

Abnormalities, Multiple↗
PubMed1996

New pedal remains of Megaladapis and their functional significance.

New remains of Megaladapis from the caves within the Ankarana Range of northern Madagascar and the cave site of Ankilitelo near Toliara in southwestern Madagascar add considerably to the present sample of pedal remains for this genus. Here we describe and analyze the new pedal material and discuss the function of the Megaladapis foot in terms of positional behavior and substrate use. The northern specimens belong to the M. madagascariensis /M. grandidieri group in terms of size and morphology whereas the new southwestern fossils are assigned to M. madagascariensis. The new specimens demonstrate that the small and intermediate sized M. madagascariensis and M. grandidieri were very similar in anatomy and inferred locomotor function, findings that also support the prior suggestion that they belong to a single widespread subgenus (Megaladapis). The new fossils provide the first examples of many pedal elements and present the first opportunity to analyze the whole pedal complex from associated remains. The foot of Megaladapis is distinctive among primates in numerous features. Intrinsic proportions of the hindlimb indicate that the foot is relatively longer than that of any other primate. The first complete calcanei reveal a large and highly modified hindfoot. The calcaneus is reduced distally, indicating an emphasis on climbing over leaping or quadrupedal walking and running. Proximally, a large, medially directed calcaneal tuberosity suggests both a strong inversion component to plantarflexion and a well-developed abductor mechanism and recalls the calcaneal morphology of the larger lorisines in some respects. Talar shape is consistent with considerable tibial rotation during plantarflexion and dorsiflexion. The subtalar joint is designed to emphasize supination/pronation and medial/lateral rotation over proximodistal translation. The distal tarsals are extremely reduced in length, and they form a high transverse arch and a serial tarsus; this configuration promotes inversion/eversion at the transverse tarsal joint. The phalanges are long and moderately curved, and the hallux is very long, robust, and abducted. Pedal morphology suggests that Megaladapis (subgenus Megaladapis) was well adapted to exploit an arboreal environment.(ABSTRACT TRUNCATED)

Animals↗
PubMed1999

Anatomy of a duplicated human foot from a limb with fibular dimelia.

At birth, a patient presented with a right lower limb featuring preaxial polydactyly and fibular dimelia with a complete absence of the tibia. Radiographic studies of the patient's foot revealed a duplicated tarsus with eight metatarsals and toes. The three preaxial toes were surgically removed at 1 year of age. A hallux and four normal-appearing postaxial toes remained. The foot was amputated when the patient was 3 years old. Dissection of the amputated foot revealed that the muscles of the dorsum were normal, except that the tendon of the extensor hallucis brevis muscle inserted into both the hallux and toe 2, rather than only into the hallux. The few abnormalities observed among the muscles on the plantar surface of the foot included absence of the insertions of the tibialis posterior and the abductor hallucis muscles. In addition, the two heads of the adductor hallucis muscle inserted abnormally into the medial (tibial) side of metatarsal 1, rather than into the lateral side. These various muscular anomalies, in addition to the mirror duplication of the foot with the presence of only a single metatarsal 1, leads us to propose that this metatarsal probably represents two lateral (fibular) halves that form a laterally duplicated bone. Although the dorsalis pedis artery was present on the dorsal surface of the foot, most of its derivatives were absent. This artery did give rise to a supernumerary medial branch that ended abruptly in the connective tissue (presumably postsurgical scar) at the medial border of the foot. This branch may have represented a duplicated dorsalis pedis artery associated with the duplicated preaxial portion of the foot. The arteries on the plantar surface of the foot were normal. Even though some anomalies in the pattern of the cutaneous innervation were observed, the nerves of the foot were largely normal. The gross and radiographic anatomy of this specimen and the radiographic anatomy of the leg suggest that some teratogenic event occurred when developmental specification reached the level of the future knee. The teratogenic event, which probably occurred early in the fifth week of development, may have caused damage that led to a lateral duplication of both the leg and the foot with the absence of some of the most medial structures. Teratology 60:272-282, 1999.

Amputation, Surgical↗