摘要:

SummaryThe orbital and eyelid relationships of the superficial musculoaponeurotic system (SMAS) were studied in human cadavers. Using gross and microscopic techniques, the SMAS was found to be intimately related to the eyelids and orbicularis oculi muscle, and to have distinct orbital bony attachments. Sub-SMAS fat in the malar region was found to be continuous with the submuscular fat in the eyebrow region. The malar sub-SMAS fat continued superiorly into the lower eyelid above the inferior orbital rim, as a postorbicularis layer. A bony attachment emanating from the inferior orbital rim, the orbitomalar ligament, traveled through the orbicularis oculi muscle in a lamellar fashion prior to inserting into the dermis. The cutaneous insertion of this attachment corresponds to the malar and nasojugal skin folds. With aging, relaxation of the orbitomalar ligament allows inferior migration of orbital fat, in addition to the anterior migration that occurs through an attenuated orbital septum. These findings have implications not only in cosmetic surgery but also in the understanding of facial soft tissue changes that occur with aging.

ISSN:0740-9303    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThis article reports the results of an animal study designed to evaluate the usefulness of butyl 2-cyanoacrylate (Histoacryl) in blepharoplasty skin closure. Bilateral upper and lower lid blepharoplasty skin incisions were made on seven pigs. We compared the wounds closed with 6.0 nylon to those closed with Histoacryl at 1, 2, 4, and 9 weeks postoperatively. The tensile strength of the “glued” incisions was significantly greater than that of the sutured incisions only at the 9-week postoperative interval (p< 0.05). There was no significant difference in bond strength, however, between the two methods at 1, 2 and 4 weeks postoperatively. Histopathologic analyses of sutured and glued wounds were compared at the same designated postoperative periods. No deleterious effects were found in the overall healing of the cutaneous wounds closed with Histoacryl.

ISSN:0740-9303    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryInvolutional entropion is a common eyelid malposition of diverse etiology that may recur after surgical repair. Laxity of the tarsoligamentous complex combined with posteriorly directed rotational force exerted by the orbicularis, in our view, seems to be the most important in the production of entropion. A surgical technique has been developed that is carried out through a standard transcutaneous lower eyelid blepharoplasty incision. It includes tarsoligamentous tightening at the lateral canthus, bolstering of the lateral canthal tendon, and partial orbicularis myectomy. Forty-two procedures in 35 consecutive patients (29% for recurrent entropion) have been performed and evaluated (mean follow-up, 33 months). There have been no recurrences, and the esthetic outcome has been very good.

ISSN:0740-9303    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryWe present a rare case of congenital cystic eye associated with holoprosencephaly and tetralogy of Fallot. The orbital cyst was diagnosed preoperatively by computed tomography (CT) scan, and we present the first magnetic resonance imaging (MR1) finding in such a disorder. The orbital cyst expanded over 7 months of follow-up. The cyst was excised in toto and studied by immunohistochemistry, and its content was analyzed biochemically. The patient achieved an acceptable cosmetic result.

ISSN:0740-9303    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryA retrospective study and review of the literature was performed on the use of demineralized bone implants for the correction of orbital and craniofacial defects. Demineralized bone implants heal by endochondral osteogenesis, inducing a transformation of local cells, as well as by osteoconduction, similar to autogenous grafts. They induce the chemotaxis and transformation of mesenchymal cells into chondroblasts, followed by ossification. They also act as a scaffold, with bone resorption taking place simultaneous with bone formation. This study reviewed 21 patients and 31 orbits, in which demineralized bone was used for orbitocranial reconstruction for congenital deformities (nine patients), after surgery for orbital fractures (seven patients: four floor, three roof), and orbital tumors (five patients). The surgical technique is described, and the results are discussed. The follow-up period averaged 15 months (6 months to 33 months). The overall resorption rate of the demineralized bone implants was estimated based on follow-up radiologie studies (facial films, computed tomography scans, and magnetic resonance imaging scans), as well as clinical examinations. All patients had a satisfactory to excellent result. The demineralized bone and Grafton (Osteotech, Shrewsbury, NJ, U.S.A.) was obtained from the Musculoskeletal Transplant Foundation of Holmdel, New Jersey, and it was all processed and reconstituted in a standard manner with Alloprep System. Surgical complications were cerebrospinal fluid leaks (one patient) with infection, transient chemosis, enophthalmos, and hypophthalmos. There were no complications related to demineralized bone alone. Properly prepared demineralized bone is a safe material for orbital reconstruction that eliminates the need for a second operative site to harvest a bone graft.

ISSN:0740-9303    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe goal of this article is to establish the incidence and scope of adverse reactions to bone wax in a large orbital surgical series. We report two patients with bone wax granulomas of the orbit as a remote surgical complication. These are the first reported cases of adverse reactions to bone wax in the ophthalmic literature. A chart review was conducted on all patients from the University of British Columbia Orbit Clinic that had surgery with temporary or permanent removal of orbital bone. Two patients with bone wax granulomas were identified. In one case, intraoperative cultures grewStaphylococcus aureus, confirming that the wax may indeed act as a nidus for infection. No cases of pseudoarthrosis have occurred. This syndrome of chronic granulomatous giant cell foreign body inflammation has characteristic clinical, radiologie, and histopathologic features. The literature regarding adverse reactions to bone wax is reviewed, and specific implications for orbital surgery are discussed.

ISSN:0740-9303    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryWe prospectively studied 10 patients who were status postenucleation and primary placement of the hydroxyapatite orbital implant. Both the technetium-99m bone scan and gadolinium-enhanced magnetic resonance images (MRI) were obtained on the same day at variable time points in the postoperative period in order to assess the degree of vascularization. Up to 78% of the bone scans were interpreted as being completely vascularized, while only 10% of the corresponding MRI scans were consistent with complete vascularization. Cost analysis showed that MRI was a cost-effective imaging modality. We conclude that contrast-enhanced MRI provides a more accurate assessment of vascularization of the hydroxyapatite orbital implant when compared to bone scan.

ISSN:0740-9303    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe implantation of an orbital hydroxyapatite implant was complicated by conjunctival dehiscence, cutaneous fistula formation, and infection withStaphylococcus aureus.Pathologic examination of the sphere 2 years after its implantation revealed reduction in the size of the implant, peripheral lamellar bone formation and central necrosis. This is the first report of this constellation of complications with hydroxyapatite spheres positioned in the orbit. The 2-year interval between implantation and removal of the sphere is the longest reported in a case with histopathologic analysis.

ISSN:0740-9303    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0740-9303    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryBinocular indirect ophthalmoscopy may be performed in the operating room with a fiberoptic surgical headlight and condensing lens, eliminating the need for the indirect ophthalmoscope headpiece. The resultant aerial inverted stereo image has enhanced stereopsis but is otherwise identical to that obtained with the headpiece. Safe power settings for individual headlights can be determined with a photometer by measuring illuminance from a standard indirect ophthalmoscope and comparing this value to the intensities obtained at each voltage setting of the headlight. Illuminance from four different headlights was measured, and settings that yielded light output equivalent to the average indirect ophthalmoscope were designated for each headpiece. The maximum indirect ophthalmoscope illuminance values were averaged and found to be 2.0 watts/m2(W/m2) for the 20-diopter (D) lens and 1.8 W/m2for the 30-D lens. All of the headlights could be used at transformer settings that produced light intensities at or below the average maximum indirect ophthalmoscope illuminance. A stereoscopic image was obtained with each of the headlights, with both the 20-D and 30-D lenses. We conclude that standard fiberoptic surgical headlights may be used for stereoscopic fundus examination. The average maximal light intensity of fiberoptic surgical headlights is greater than that of the average indirect ophthalmoscope. However, each fiberoptic headlight can be operated at brightnesses equal to or below that of the maximum intensity of the indirect ophthalmoscope, and therefore, retinal toxicity is unlikely for brief retinal evaluations.

ISSN:0740-9303    

出版商:OVID    

年代:1996

数据来源: OVID