[Sialic acids in endocular fluids].
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I believe that if one follows the precautions outlined, including a time-tested surgical technique and thorough clinical history and physical examination, the operation of blepharoplasty should prove to be one of the most gratifying aesthetic operations.
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Congenital eversion of the eyelids is a rare condition which has never had a proven anatomic etiology. A one-day-old male presented with severe congenital eversion of both upper eyelids. Medical therapy was unsuccessful. At surgery, adipose tissue was found beneath the tendon of the levator palpebrae and extended anterior to the tarsus because the orbital septum was not attached inferiorly. The defect was repaired. In this case, non-attachment of the orbital septum may have induced eversion of the upper eyelids.
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Reconstruction of eyelids following burns has two fold objective: functional and esthetic. Except in the must severe forms (carbonization) eyelids' burns usually involve only superficial lesions. Surgery, by means of a skin graft only, may be required after initial medical treatment. The choice of a graft among those considered standard, (full-thickness skin graft for the lower lid, thinner graft for the upper lid) should be guided by anatomophysiological considerations. Treatment in each case varies according to the anatomic type and the stage of evolution of the burn; whether the orbicularis muscle has been affected or not, should determine the choice of the graft. Certain points of this surgical technique have to be emphasized: the need for respecting esthetic unity; for careful dissection sparing the orbicularis; for fixation of the graft on the medial canthus, and lastly, the necessity of performing surgery of upper and lower lids in two stages so that the lid is "in surocclusion" during each operative procedure. Treatment of eyelids' burns as described above, is well established. It is very different from that for total facial burns, which requires total operative strategy.
A new technique of full-thickness skin graft fixation utilizing central and paracentral sutures between the graft and the depths of the recipient bed is described. The intrinsic fixation provided by these sutures eliminates the potential dead space, and the shearing strains that jeopardize a successful take. The validity of Hering's law in levator surgery and other clinical implications of reciprocal innervation of the levator muscles of the two upper eyelids are demonstrated. The traditional teaching of oculoplastic surgery considers it obligatory that defects created by margin-including full-thickness excisions of the lower eyelids be surgically reconstructed immediately, but it is shown that spontaneous reformation after such excisions gives satisfactory results.
A procedure is described for externalizing residual lower canaliculus in an "ostomy" manner after lower lid resection. As little as one-fourth residual canaliculus can be used. The basis of this technique involves intubation of the residual canalicular stump and the upper canaliculus with silicone tubing after the method described by Quicker-Dryden, the micro-dissection of the canalicular remnant and its placement on the internal edge of the eyelid margin. This canaliculostomy technique may be combined with different eyelid reconstructive procedures. The technique has been applied to patients undergoing eyelid resection for neoplastic disease, patients with medial cicatrical canthal deformity and congenital eyelid abnormalities. Following the canaliculostomy procedure all patients were symptomatically free from epiphora; however, in certain cases which were available, physiologic flow of tears through the new canalicular opening was documented by performing the Jones No 1 dye test with occlusion of the upper punctum with ointment.
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