ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo review the surgical technique of the endoscopic subperiosteal midface lift and present our clinical outcome in 22 consecutive patients.MethodsWe retrospectively evaluated the clinical outcomes of 39 endoscopic subperiosteal midface lifts in 22 consecutive patients. Of the 39 sides, 21 had a lower eye conjunctival spacer graft inserted (15 hard palate mucosal graft, 6 AlloDerm). The success of the procedure was graded based on the aesthetic and functional results. Subjective and objective assessments were made using history, examination, and photos.ResultsResults for the clinical outcome were graded as excellent, good, fair, or poor. Among the 39 sides, indications for the procedure included facial rejuvenation (41%), postblepharoplasty lower eyelid retraction (26%), eyelid retraction secondary to midfacial ptosis (15%), severe cicatricial ectropion (13%), and paralytic ectropion secondary to 7th nerve palsy (5%). The operating surgeons evaluated the clinical outcome as “excellent” in 24 sides (61%), “good” in 10 sides (26%), “fair” in 2 sides (5%), and “poor” in 3 sides (8%). The procedure was successful at increasing malar projection, improving lower eyelid fullness, and elevating the lower eyelid in cases of lower eyelid retraction. The procedure was less effective in decreasing the prominence of the deep nasolabial fold.ConclusionsThe endoscopic subperiosteal midface lift is an effective method for elevating the midface. A more youthful appearance is achieved with the procedure, and when necessary, recruitment of anterior lamella allows elevation of the lower eyelid to correct retraction.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeThe use of systemic antibiotic prophylaxis in lacrimal drainage surgery is controversial. Some studies have reported high rates of postoperative infection and surgical failure after lacrimal drainage surgery when systemic antibiotic prophylaxis was not routinely administered. Many ophthalmologists have traditionally used antibiotics only in selected patients undergoing dacryocystorhinostomy (DCR), and this study evaluates the success of this strategy.MethodsThis was a retrospective interventional case series of 138 consecutive patients who underwent 163 external DCR procedures. Antibiotics were given only when inflammatory signs were present in the medial canthal region or when purulent material was noted during surgery. Patients with persistent external medial canthal inflammatory signs received amoxicillin/clavulanate or cephalexin orally 3 to 7 days before and 1 week after surgery. Patients in whom purulent lacrimal sac material was noted during surgery received cefazolin intravenously.ResultsPostoperative results were evaluated in terms of wound infection and related complications and surgical success. Systemic antibiotics were given in 15 of 163 (9%) cases. Nine (6%) cases received intraoperative (intravenous) antibiotics; 5 (3%) cases received perioperative (oral) antibiotics; and 1 (1%) case received both. None of the patients had postoperative deep soft tissue infection (cellulitis). Skin changes compatible with superficial wound infection occurred in 2 (1%) cases and responded well to topical treatment. Surgery was successful in 157 of 163 (96%) cases. Of 6 failures, none were associated with postoperative wound infection.ConclusionsSelective use of antibiotics limited to patients with signs of lacrimal sac inflammation appears sufficient to prevent soft tissue infection after DCR.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeThis prospective study tested a simple formula for selecting an implant size for patients undergoing enucleation, evisceration, and secondary implantation. The formula axial length−2 mm=implant diameter (subtract 1 mm from implant diameter for evisceration and for hyperopia) was tested by the outcome measures, superior sulcus deformity, enophthalmos, and volume of the prosthesis.MethodsFifty-four patients undergoing primary or secondary implant surgery after enucleation or evisceration received implants based on the above formula. The volume of the eye, volume of the implant, volume of the prosthesis, and the total percent volume replacement were recorded for each patient. Outcome measures considered clinically acceptable were <2 mm enophthalmos and less than grade 1 superior sulcus deformity, which is defined as barely perceptible deepening of the medial superior sulcus.ResultsThe average volume replacement was 101%; average prosthetic volume was 2.1 mL; average grade of superior sulcus deformity was 0.6; and average enophthalmos was 1.2 mm.ConclusionsThis formula allows 100% replacement of the volume removed, leaves space for a prosthesis 1.5 to 2.5 mL, and eliminates clinically unacceptable superior sulcus deformity and enophthalmos in 85% of patients. Patients with a history of infection, radiation, buphthalmos, or large orbital fractures (15%) had residual superior sulcus deformity greater than grade 1 and enophthalmos ≥2 mm despite 100% volume replacement. Further study will elucidate the histopathologic processes responsible for residual superior sulcus deformity and enophthalmos in the latter subgroup of patients.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo analyze a new bioresorbable orbital implant (open-celled polylactic acid, also known as OPLA).MethodsThe implants were examined macroscopically, with chemical analysis (Fourier transform infrared spectroscopy), and microscopically with scanning electron microscopy. Animal implantation of OPLA implants was carried out in 9 adult male New Zealand albino rabbits. Implant vascularization was evaluated by histopathologic sectioning.ResultsThe OPLA implant is porous and lightweight but fragile. Histopathologically it stimulated primarily a multinucleated giant cell granulomatous reaction with little fibrovascular ingrowth seen at 4 and 8 weeks. By 20 and 24 weeks, the implant was replaced predominantly by necrotic debris and peripheral giant cells.ConclusionsThe OPLA implant is not an acceptable alternative to other currently available orbital implants.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeThe orbit can be viewed as comprising four surgical sectors, with several alternative incisions and dissection paths to each. Large tumors in the medial intraconal sector pose particular problems of access, exposure, and removal without functional compromise. We report the use of the lower fornix approach for excision of large tumors in this high-risk sector.MethodsThe surgical technique is described. Its application to biopsy or subtotal resection of infiltrative lesions in the medial intraconal sector is noted. Its use for complete excision of solid, circumscribed lesions in this sector is presented in a retrospective, consecutive, noncomparative interventional case series of 5 large, medial intraconal cavernous hemangiomas.ResultsThe lower fornix approach provided adequate exposure for the goal of surgery in each case. Among the 5 patients with large, medial intraconal lesions, 4 had postoperative improvement in vision and 1 maintained his preoperative central acuity of 20/20. No patient had persistent symptomatic diplopia after surgery. Ease or difficulty of tumor dissection was related to the tenacity of apical fibrous attachments, a factor that appeared to be independent of the surgical approach.ConclusionsThe lower fornix approach to the orbit, an established technique for other indications, can be applied to the removal of large, medial intraconal tumors whose inferolateral poles protrude in the inferior surgical sector.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo study the anatomic and radiographic features of the inferomedial orbital strut (IOS), with particular emphasis on the region of the posterior IOS.MethodsCadaver dissection study of the IOS was performed on 20 orbits of 10 fresh-frozen cadaver specimens. Radiographic volumetric analysis was performed on CT scans of 20 orbits to measure the volume available for decompression in the region of the posterior IOS.ResultsThe anterior IOS provided bony support to the orbit and served as a site of attachment for globe-supporting suspensory ligaments. The midportion of the IOS demonstrated a contiguous anatomic relation to the maxillary sinus ostium. The posterior IOS consisted of two components: the intraorbital process of the palatine bone and ethmoidal air cells that extended inferior and posterior to the IOS. Radiographic volumetric analysis demonstrated that there was an average of 2.1 mL of volume available for decompression in the region of the posterior IOS (range, 1.2 to 3.3 mL).ConclusionsThe findings of this anatomic and radiographic study of the inferomedial orbital strut support the concept of a posterior inferomedial orbital decompression. The region of the posterior IOS appears to offer significant volume for axial globe mobilization while minimizing the risk of globe dystopia and/or impairment of the maxillary sinus drainage.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo describe the technique and results of frontalis muscle flap advancement for correction of ptosis associated with jaw-winking.MethodsFour cases of unilateral jaw-winking ptosis were corrected with frontalis muscle flap advancement after excision of levator muscle on the affected side.ResultsThree of the 4 patients achieved good results with the correction within 1 mm of the opposite eyelid. The residual asymmetry on downgaze after follow-up of 4 to 18 months ranged from 1 to 5 mm. The main complication was mild forehead hypoesthesia in 2 patients, which resolved over a period of 1 month.ConclusionsFrontalis muscle flap advancement is an effective procedure when performed unilaterally for jaw-winking ptosis. It is simple, safe, and involves a single surgical field. Eyelid lag on downgaze improves considerably over time, and the remaining asymmetry between the two eyelids is cosmetically acceptable to most patients.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo describe and present the results of a modified surgical technique to repair floppy eyelids.MethodsA case series of 5 patients who were treated with the modified technique is presented. This technique uses the relaxed skin tension lines to tighten the lids in an aesthetically minded reconstruction.ResultsAll patients had relief of symptoms and good cosmetic and functional results. Average follow-up was 39 months. Complications were minor and easily treated.ConclusionsThis modified surgical technique provides excellent long-term structural integrity of the wound with a potentially more acceptable camouflaged scar.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo discuss the relation between congenital upper eyelid coloboma and cryptophthalmos and to present a new grading for both conditions.MethodsObservational case series study. Twenty-six children (age range, one day after birth to 15 years old) were included in the study: 19 with upper eyelid coloboma, 4 with classic cryptophthalmos, and 3 with both eyelid coloboma and cryptophthalmos.ResultsOf the 19 cases of upper eyelid coloboma, 5 occurred in isolation, 11 were associated with facial deformities, and 3 were part of a first arch syndrome (according to the Mustardé classification). All cases of classic cryptophthalmos were sporadic and nonsyndromic. All patients with coloboma with facial deformities, cryptophthalmos, and both eyelid coloboma and cryptophthalmos had similar associated facial abnormalities.ConclusionUpper eyelid colobomas with facial deformities and cryptophthalmos can be considered as one anomaly. A new grading for this anomaly has been suggested. Grade 1: Coloboma without cryptophthalmos. Grade 2: Coloboma with abortive cryptophthalmos. Grade 3: Coloboma with complete cryptophthalmos. Grade 4: Classic cryptophthalmos (absence of all eyelid structures and the eye is completely covered with skin). Grade 5: Severe cryptophthalmos (with severe deformity of the nose and ectropion of the upper lip).

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID