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At least 955 records · Page 53Linked to original sources
PubMed1994

Precise repair of orbital maxillary zygomatic fractures.

OBJECTIVE: To demonstrate the techniques, advantages, indications, and potential pitfalls of the transconjunctival approach with lateral canthotomy, sublabial approach, and coronal approach in the treatment of complex trimalar fracture with associated blow-out fractures. DESIGN: All patients diagnosed as having complex trimalar fractures with or without blow-out treated by either of us over a 2-year period were included. Follow-up ranged from a minimum of 6 months to 2 years. SETTING: All patients were treated with December 1989 to December 1991 at either Louisiana State University Medical Center, Shreveport, or University of Kansas Medical Center, Kansas City. PATIENTS: Eighteen patients with complex trimalar fractures were included in this study. Eight patients had associated orbital blow-out fractures. Simple isolated arch fractures were excluded. INTERVENTION: All subjects underwent a transconjunctival approach with lateral canthotomy. Seven subjects also had associated sublabial flaps. Five patients required hemicoronal or coronal approaches. RESULTS: There were seven minor complications. Ninety-three percent (14/15 [three didn't respond to the survey]) of patients surveyed were either very satisfied or satisfied with their functional and cosmetic results. CONCLUSION: The management of complex trimalar fracture with blow-outs is greatly facilitated by the rational application of the described techniques.

Aged↗
PubMed1995

Comprehensive management of the eye in facial paralysis.

OBJECTIVE: To determine guidelines for the management of paralyzed eyelids following facial palsy, including surgical indications, timing, and type of procedure(s). DESIGN: Prospective analysis of 60 patients diagnosed as having complete facial palsy. Follow-up ranged from 18 to 36 months. PATIENTS: All subjects had a complete unilateral facial palsy of various origins. Ages ranged from 6 to 81 years. INTERVENTIONS: Forty patients underwent evoked electromyography and blink reflex testing of the facial nerve. Twenty additional patients had a known fifth-degree nerve injury that did not require testing. MAIN OUTCOME MEASURE: Lack of interval improvement in clinical results of examination and/or evoked electromyography, coupled with length of time from injury, were used to determine surgical candidacy. All patients with fifth-degree nerve injury were considered surgical candidates, with clinical examination results of eyelid function used to determine which procedure(s) to be performed. RESULTS: Of the 60 patients evaluated with facial palsy, 43 patients required surgical restoration of eyelid function. Forty-one patients required gold weight implants; 18 of these also required shortening of the lower eyelid. Two additional patients underwent eyelid shortening without gold weight implantation. Seventeen patients were treated only with corneal lubricants and moisturizers. No gold weights extruded; there were no infections. Two patients required revision of their lower eyelid surgery owing to progressive laxity. Four patients have had their gold weights removed an average of 9.5 months following insertion. CONCLUSIONS: The degree of neural injury and its associated regeneration time, determined clinically and by evoked electromyography, are useful factors to assist in patient selection, surgical timing, and type of procedure(s) necessary to fully rehabilitate the upper and lower eyelids following facial paralysis.

Adolescent↗
PubMed2005

[Botulinum toxin injection-treatment of upper lid retraction in thyroid eye disease].

OBJECTIVE: Upper lid retraction associated with thyroid eye disease may result in conjunctival and corneal exposure as well as in an esthetic problem. We evaluated the effect of botulinum toxin injections in order to lower the upper lid. METHODS: This prospective study included 19 eyes of 13 female patients presenting with scleral exposure aged 28-50 years. We injected 5-15 IE botulinum toxin A (Botox) transconjunctivally into the levator muscle. Lid position, negative side effects, and patient satisfaction were evaluated. RESULTS: Lid retraction improved from 2.4 mm (+/-1.4 mm) prior to injection to 0.5 mm (+/-2.3 mm) 4 weeks after injection. In 11 of 19 eyes 4 weeks after injection and in 8 of 14 eyes 12 weeks after injection scleral exposure had resolved. Diplopia did not occur and tear production was not influenced. Two eyes had transient ptosis. Lid lag increased from 0.34 (+/-0.6 mm) to 0.84 mm (+/-0.9 mm). Of 13 patients, 8 were satisfied with the result. CONCLUSION: Botulinum toxin A injection provides effective treatment especially in mild lid retraction and as a temporary solution for patients with unstable thyroid disease.

Adult↗
PubMed2000

[Long-term results of implantation of hydroxylapatite as artificial eye].

BACKGROUND: Since its first implantation as an eyeball replacement in the United States in 1985, hydroxyapatite has been rarely used as an orbital implant in Germany. The aim of the study was to collect data on long-term tolerance, postoperative complications and the cosmetic end results. PATIENTS AND METHODS: In the spring of 1997, 52 patients underwent a follow-up examination at our hospital. The average post-operative follow-up period was 23 (12-41) months. RESULTS: The subjective tolerance was considered good by 3/4 of the patients. In the comparison of position and prominence of the artificial eye, 8 patients achieved complete equalization. As regards defective lid position, 8 patients had a ptosis, 6 an ectropium, and there was one case of entropium. Changes in conjunctiva stretched from muciferous secretion to follicular squamous hyperplasia. There was no case of implant extrusion in the series examined. With reference to the method of implantation, far superior motility was observed in primary implantations. Statistically significant motility differences could not be shown regarding muscle attachment because of the small number of the cases. CONCLUSIONS: In the series examined, hydroxyapatite proved to be a generally well-tolerated orbital implant with few postoperative complications and good motility. Primary implantation with attachment of all six eye muscles gave the best results.

Biocompatible Materials↗