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At least 595 records · Page 33Linked to original sources
PubMed1983

Orbital fistula. Causes and treatment of 20 cases.

A retrospective analysis of 20 cases of orbital fistula in Shanghai showed the causes to be trauma with foreign-body retention, osteomyelitis, mucocele, and dermoid cyst. Half the patients were children younger than 10 years old. Cicatricial ectropion, ptosis, and extraocular motility disturbance constituted the common clinical findings. Treatment according to the various causes included surgical removal of the foreign body, oral administration of antibiotics combined with local irrigation, radical extraction of all the epithelium lining the fistula, and excision of the fistula.

Adolescent↗
PubMed1984

Treatment of essential blepharospasm. I. Comparison of facial nerve avulsion and eyebrow-eyelid muscle stripping procedure.

Benign essential blepharospasm is an incurable disease for which many treatment modalities have been suggested. The two surgical procedures that have been used most commonly are avulsion of the facial nerve and stripping of the protractor muscles of the eyelid and brow. We compare two matched series of 22 patients; one group underwent facial nerve avulsion ("Reynold's" procedure), and the other underwent "muscle stripping" ("Anderson's" procedure). We noted the number of procedures required for the patient to obtain a functional visual result and the side effects produced. Additional surgical procedures required by patients undergoing facial nerve avulsion were additional facial nerve avulsion, repair of ectropion, and correction of dermatochalasis and brow droop. Additional procedures required in patients who had muscle stripping were excision of lower lid orbicular fibers or residual brow fibers. The Reynold group required 16 additional procedures (38 separate procedures) to obtain functional results, as opposed to the four additional procedures (26 separate procedures) required in the Anderson group. Two patients in the Reynold group who needed surgery have not yet undergone it at this writing. If they did, that would boost the total number of procedures to 40. Secondary procedures are needed 4.5 times more often with the Reynold procedure than with the Anderson procedure. The patient's subjective response to and acceptance of the procedure are much greater for the Anderson procedure.

Adult↗
PubMed1985

The use of a periosteal strip for eyelid reconstruction.

Strips of periosteum from the zygoma were used to reconstruct very extensive lateral canthal and temporal eyelid defects in 11 patients. The strips were reflected nasally, sutured to residual tarsal stumps, and covered anteriorly with myocutaneous flaps. After a minimum follow up of one year, cosmesis was excellent in five patients, satisfactory in five, and poor in one. Minor complications related to this procedure included ectropion and low lateral contour (one patient each), blunting of the lateral canthal angle (three patients), eyelid notching and dehiscence (one patient each), and symblepharon formation (one patient). However, only one patient had a complication that was significant enough to require a second surgery. This technique allows for one-stage reconstruction, an open palpebral fissure, and the ability to reconstruct extensive loss of the temporal portion of two adjacent eyelids when sharing techniques are not possible.

Adenocarcinoma↗
PubMed1985

Hemifacial spasm treated with botulinum A toxin injection.

Fifteen patients with hemifacial spasm were treated with botulinum A toxin injections. All patients experienced relief from spasm, with the effect lasting an average of 12.2 weeks. Complications were tearing in four patients, inability to close the involved eye in three patients, corneal exposure in one patient, and ectropion in one patient. All complications were transient and deemed minor by the patients.

Adult↗
PubMed1986

Blastomycosis of the eyelid.

An 84-year-old man had a verrucous lesion of the left lower eyelid that caused progressive ectropion. Cultures of the lesion taken at the time of surgical excision demonstrated Blastomyces dermatitidis. Histologically, the excised tissue demonstrated pseudoepitheliomatous hyperplasia, a characteristic change of cutaneous blastomycosis.

Aged↗
PubMed1986

Orbicularis muscle mobilization in eyelid reconstruction.

Mobilization of the orbicularis oculi muscle into recipient skin-graft beds was performed in seven patients. Following tumor resection, five eyelids were reconstructed using the Hughes procedure. Two eyelids had orbicularis muscle mobilization in preparation for the recipient graft site for correction of cicatricial ectropion following trauma. All skin grafts were viable and eyelid motility was enhanced. No complications were encountered.

Basal Cell Carcinoma↗
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

Cellular mechanisms of iris neovascularization secondary to retinal vein occlusion.

We developed an animal model that allows the early phases of iris neovascularization to be studied in detail. Three major retinal branch veins were occluded with the argon laser in five eyes of cynomolgus monkeys, after which the eyes were enucleated at various time intervals. We observed three phases of the neovascular process in the iris. The early phase was characterized by vessel dilation and intense uptake of tritiated thymidine in the vascular endothelial cells. In the intermediate phase, prominent new vessels, ectropion uveae, peripheral anterior synechiae, and elevated intraocular pressure developed. Also noted were a decrease in tritiated thymidine uptake of the endothelial cells, a remarkable increase in stromal cell tritiated thymidine activity, and the formation of a neovascular membrane in association with the anterior migration of stromal cells. The late phase was marked by a further reduction of tritiated thymidine uptake and regression of the neovascular membrane.

Animals↗
PubMed1989

The lateral tarsal strip revisited. The enhanced tarsal strip.

The lateral tarsal strip procedure was originally designed for the treatment of upper and lower eyelid laxity, or lateral canthal tendon laxity or malposition. Despite the excellent results with a standard tarsal strip procedure for those eyelids with laxity and excess skin, we have encountered a number of patients with lower eyelid or canthal malpositions or both who would benefit from a tarsal strip, but who do not have lax tissues (especially skin), and may in fact have a shortage of skin. These include cases of lower lid retraction or canthal malposition following trauma, blepharoplasty, or other operations, and patients with tendency toward or having cicatricial ectropion. Any anterior lamella removal in such patients would aggravate the lid malposition and weaken the lateral canthal tissues to be sutured. We suggest a modification of the tarsal strip (developed by one of us [R.L.A.]) to treat many such patients without requiring additional anterior lamella (skin graft) or more formidable procedures. We refer to this technique as the "enhanced tarsal strip" technique, and we use this technique more frequently than the original tarsal strip procedure.

Adult↗
PubMed1997

Complications of the transconjunctival approach. A review of 400 cases.

OBJECTIVE: To review the intraoperative and postoperative complications of the transconjunctival approach, as well as their prevention, management, and outcomes. DESIGN: A retrospective study of the complications in 400 patients who underwent the transconjunctival approach to the lower eyelid or orbit for treatment of orbital trauma or the aging face. SETTING: Academic tertiary referral medical center. RESULTS: There were 8 cases of conjunctival granuloma, 2 cases of entropion, and 1 case each of hematoma, ectropion, prolonged chemosis, conjunctival inclusion cyst, lower eyelid laceration, and avulsion with lacrimal system injury. CONCLUSIONS: Complications of the transconjunctival approach are uncommon. When they do occur, proper management results in a successful outcome.

Adult↗
PubMed1983

Reconstruction of full-thickness defects of the cheek.

Six patients required reconstruction of full-thickness defects of the cheek and underlying maxilla. We preferred to use a technique employing local cervicofacial rotation advancement flaps. The advantages of this technique include an excellent color match and placement of the line of closure in natural junction zones of the face. Problems that must be dealt with include correction of ectropion and revision of the lower portion of the nose. An alternative means of reconstruction consists of prosthetic management and the use of a regional pedicle flap. Careful monitoring of the soft-tissue margins, evaluation for possible cranial nerve involvement, and the use of postoperative irradiation therapy are important therapeutic considerations.

Adult↗
PubMed1986

The management of eyelid laxity during lower eyelid blepharoplasty.

Lower eyelid and lateral canthal angle malposition or frank ectropion are the most common complications of lower eyelid blepharoplasty. Although these complications may result from excessive skin excision, from surgical imbrication of the orbital septum or lower eyelid retractors, or from scar formation within the eyelid, failure to correct preexisting lower eyelid laxity is the most common cause. Recently published data have established laxity at the lateral canthus as the primary cause of involutional lower eyelid laxity. We review the pathophysiology of lower eyelid laxity and present an anatomic approach for the correction of lower eyelid laxity during blepharoplasty.

Aging↗
PubMed1988

Blepharoplasty. Avoiding plastic eyelids.

The goal of a facial plastic surgeon should be to correct the undesirable conditions for which he has been consulted and to avoid leaving his mark on the patient. By embracing the concept that prevention is better than cure, it is generally possible to avoid the "operated-on look" following cosmetic surgery. We describe a number of safeguards we use to preserve natural-looking eyes following lower lid blepharoplasty in men and women. The most common, permanent complication described following conventional lower lid blepharoplasty is the round eye. The condition is readily identified by an increase in scleral show between the limbus and lower lash margin. Closer evaluation will reveal inferomedial displacement of the lateral commissure, increased slope of the lateral third of each eyelid, a flattened, unanimated, pretarsal component, and an unnatural infralash crease produced by the healed incisional scar. These findings are one step short of ectropion; therefore, the methods herein described should help reduce the incidence of this more dreaded and serious complication of blepharoplasty.

Eyelids↗
PubMed1990

Management of the paralyzed lower eyelid by implanting auricular cartilage.

The success of a procedure to reanimate paralyzed eyelids is determined by the functional and cosmetic results. When the cornea is covered during blinking and sleeping, function has been restored, while a pleasing cosmetic result has been achieved if the eyes appear symmetrical when the lids are open. Several procedures have been developed to restore closure of the paralyzed upper eyelid (implantation of gold weights or open wire springs) or to correct lower lid lagophthalmos and ectropion (lower lid tightening with a Bick procedure or insertion of a closed eyelid spring). In some cases, even a combination of the Bick procedure and insertion of a spring may be insufficient to correct lower lid droop; therefore, we developed a technique to place cartilage into the lower eyelid to correct lid droop. The procedure, suggested by one of us (D.B.S.), has been performed on 51 patients to date. This article reviews our experience with these 51 consecutive patients.

Ear Cartilage↗
PubMed1991

Treatment of 813 zygoma-lateral orbital complex fractures. New aspects.

A 10-year experience with surgical treatment of 813 zygomalateral orbital complex fractures is reviewed. Regardless of the type or severity of the fracture pattern, concomitant fractures of the orbital floor and rim were approached exclusively through the transconjunctival approach without a lateral canthotomy. The advantages of this approach compared with the subciliary access are the avoidance of a visible scar and markedly reduced incidence of postoperative lower eyelid complications such as ectropion and edema. Implants of lyophilized dura or cartilage and autogenous bone were used to reconstruct orbital floor defects. Malar asymmetry is a frequent complication of zygoma fractures resulting from inadequate three-dimensional reduction. Methods for accurate reduction and stabilization, indications for closed and open reduction, and management of the fractured infraorbital rim are emphasized. The indications for miniplates vs wire ligatures for the infraorbital rim are discussed. Long-term follow up and evaluation of the results with regard to the fracture pattern, complications, maxillary sinus dysfunction, and facial and orbital symmetry are presented.

Bone Plates↗
PubMed1991

Preexcision blepharoplasty.

Numerous techniques have been described for lower lid blepharoplasty. Over the past 15 years, a preexcision (pinch) technique with preservation of the pretarsal orbicularis oculi muscle has been used in more than 1000 cases presenting with dermatochalasis and pseudoherniated fat without lateral skin redundancy. The amount of lower lid skin to be excised is estimated by pinching the skin. Preservation of the pretarsal orbicularis oculi muscle adds support to the tarsoligamentous complex. This technique aids in preventing the development of both postoperative ectropion and rounding of the lower lid. Technical considerations of the preexcision (pinch) technique and a description of alternative techniques are outlined. Indications, complications, and patient satisfaction are discussed.

Eyelids↗
PubMed1992

The perichondrial cutaneous graft. A 12-year clinical experience.

The perichondrial cutaneous graft is a reliable and versatile composite graft that possesses unique properties for reconstructive surgery. The graft consists of epidermis, dermis, scant subcutaneous tissue, and the perichondrial layer. Our clinical experience completely mirrors our findings from animal studies. A clinical study of 112 perichondrial cutaneous grafts includes patients whose ages ranged from 7 days to 92 years. The various clinical applications for use of the perichondrial cutaneous graft include repair of auricular deficits, ectropion, certain facial defects, and a variety of nasal reconstructive situations. A review of our clinical experience demonstrates excellent cosmesis and no contraction of any of the graft. The graft is routinely harvested from the anterior conchal bowl, and the donor defect is closed after cartilage resection with a postauricular interpolated skin island ("flip-flop flap"). Numerous situations present many options for reconstructive surgery. The perichondrial cutaneous graft provides such an alternative, offering great reliability and superb cosmesis.

Adolescent↗
PubMed1996

Management of the orbit during anterior fossa craniofacial resection.

OBJECTIVE: To determine the postoperative ocular function in patients undergoing anterior fossa craniofacial resection with preservation of the orbit. DESIGN: Retrospective medical chart review of patients treated from January 1, 1973, to July 31, 1994. Median follow-up was 38 months (range, 1-210 months). SETTING: Tertiary referral center. PATIENTS: Fifty-eight consecutive patients undergoing anterior fossa craniofacial resection with orbital preservation for tumors involving the anterior skull base. MAIN OUTCOME MEASURES: Assessment of orbital complications of treatment, need for further surgical intervention to correct these complications, and determination whether functional vision was retained at last follow-up examination, and tumor recurrence within preserved orbits. INTERVENTIONS: Anterior craniofacial resection with orbital preservation. Postoperative radiation therapy was administered to selected patients. RESULTS: Overall, 25 patients (43%) had some ocular sequelae of their treatment. This consisted of epiphora in 21 patients, diplopia in 8, vision loss in 6, and pain and enophthalmos in 2. Twelve patients required revision surgery consisting of dacryocystorhinostomy in 8, ectropion repair in 3, drainage of orbital mucocele in 1, and corneal transplant in 1. Ocular complications were more common and vision loss occurred only in patients treated with postoperative radiation therapy. Functional vision in the ipsilateral eye was retained in 50 of the 58 patients. CONCLUSIONS: When the orbit is preserved during anterior fossa craniofacial resection, ocular sequelae are frequent and may require revision surgery. Functional vision can be preserved in most patients.

Adolescent↗