摘要:

PurposeApplication of a grid of electrocautery to the orbital septum to treat anteriorly prolapsed eyelid fat pads during blepharoplasty has been previously described. A review of patients who underwent this technique was performed to determine if this technique led to a higher incidence of postoperative eyelid retraction.MethodsA retrospective case series of patients who underwent application of a grid of electrocautery to the orbital septum during blepharoplasty from 1979 to 1999 was reviewed.ResultsThere were 1492 patients (3018 eyelids) who underwent an application of a grid of electrocautery to the orbital septum during this period. Five hundred twenty-nine patients (1036 eyelids) underwent upper blepharoplasty, 91 patients (174 eyelids) underwent lower blepharoplasty, 149 patients (596 eyelids) underwent combined upper and lower blepharoplasty, and 723 patients (1212 eyelids) underwent a combined upper blepharoplasty and ptosis repair. All patients were followed for at least 3 months. Follow-up ranged from 3 months to 20 years. No patient had postoperative eyelid retraction.ConclusionsThe application of a grid of electrocautery to the orbital septum during blepharoplasty to treat anteriorly prolapsed eyelid fat pads is effective, safe, and does not lead to late postoperative eyelid retraction.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo describe a system of post-Mohs reconstruction that addresses lower eyelid susceptibility to unopposed tractional, cicatricial, and gravitational forces. Large flaps are anchored to fixed tissue to avoid transmitting flap tension to the eyelids.MethodsThis is a retrospective, cohort study drawn from approximately 40 patients with post-Mohs defects of the nonmarginal lower eyelid, cheek, and lateral canthus. Surgical intervention involved horizontally oriented, relaxed skin tension line–designed advancement flaps, usually with eyelid margin stabilization. The use of anchoring sutures and any requirement for flap-graft combinations were based on defect size and the elasticity of adjacent tissues.ResultsAnchoring eyelid and cheek flaps to underlying periosteum permitted broad flap dissection and advancement without distortion, as the semimobile eyelid and canthi were protected from the resulting flap tension. Anticipated defect size limits for flap reconstruction often were exceeded. Defects too broad for flap reconstruction alone could be downsized, leaving a relatively small area for graft resurfacing.ConclusionsAnchored cheek flaps extend recognition of the continuity of the lower eyelid and midface to the primary reconstruction of tumor-free defects, and they address the relation by restoring deep attachments that minimize eyelid and canthal dystopia.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo compare graft contraction rates of acellular dermis versus hard palate mucosa when used as free spacer grafts in lower eyelid surgery and to provide clinical outcome data.MethodsA prospective, nonrandomized clinical trial involving the placement of 19 spacer grafts in the lower eyelids of 14 patients was performed. Indications for spacer graft placement included lower eyelid retraction and mildly contracted socket. Patients with lower eyelid retraction also underwent an endoscopic subperiosteal midface lift. For all procedures, the height of each graft was measured during and after surgery. The amount of contraction was measured for each graft, and a mean was calculated for each spacer material. The clinical success was evaluated for all procedures, based on improvement of the functional concern being addressed.ResultsThe mean graft contraction rate was 57% for the acellular dermis and 16% for the hard palate mucosal grafts (P<0.005). Of the 7 procedures using acellular dermis for lower eyelid retraction, 6 were considered a success, and 1 was considered a partial success. Of the 6 procedures using hard palate for lower eyelid retraction, 5 were considered a success, and 1 was considered a failure unrelated to the graft. Of the 5 procedures with acellular dermis used for mildly contracted socket, 2 were considered a success, 2 were considered a partial success, and 1 was considered a failure because of graft contraction. The one case using hard palate for mildly contracted socket was considered a success.ConclusionsAcellular dermis contracts significantly more than hard palate mucosa when used as a lower eyelid spacer graft. Acellular dermis and hard palate mucosa were both associated with a high rate of clinical success in all categories except for patients with a mildly contracted socket who received acellular dermis; more than 60% of these patients (n=5) had only partial success or failure caused by graft contraction.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo characterize and evaluate treatment options for medial rectus muscle (MR) injury associated with functional endoscopic sinus surgery (FESS).DesignRetrospective interventional case seriesParticipantsA total of 30 cases were gathered from 10 centers.MethodsCases of orbital MR injury associated with FESS surgery were solicited from members of the American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS) through an e-mail discussion group.Main Outcome MeasuresVariables assessed included patient demographics, computerized tomography and operative findings, extent of MR injury and entrapment, secondary orbital/ocular injuries, initial and final ocular alignment and ductions, and interventions.ResultsA spectrum of MR injury ranging from simple contusion to complete MR transection, with and without entrapment, was observed. Four general patterns of presentation and corresponding injury were categorized.ConclusionsMedial rectus muscle injury as a complication of FESS can vary markedly. Proper characterization and treatment are important, particularly with reference to the degree of direct MR injury (muscle tissue loss) and entrapment. Patients with severe MR disruption can benefit from intervention but continue to show persistent limitation of ocular motility and functional impairment. Prevention and early recognition and treatment of these injuries are emphasized.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeDifferent approaches have been proposed to address the aesthetic or reconstructive challenge associated with relatively prominent eyes. Operations that address the soft tissues alone are prone to failure if the underlying orbital bony relationships are not addressed. Orbital rim advancement can serve as a supplement to orbital decompression in this setting or as an alternative for patients who may not maximally benefit from decompression surgery.MethodsWe report our 4-year experience with porous polyethylene orbital rim onlay grafts used to address relative proptosis in 24 patients.ResultsAll patients had some degree of subjective and objective improvement. Proptosis decreased an average of 4.65 mm, with a range of 3 to 9 mm, based on single-observer Hertel exophthalmometry measurements (5.2 mm in those with concomitant decompression). Lagophthalmos was also improved in all patients with preoperative inadequacy in eyelid closure. Interpalpebral fissure size was reduced 1.3 mm on average, with a range of 0.5 to 6 mm (2 mm in those with concomitant decompression). Average follow-up was 41 months, with a range of 7 to 70 months. In 3 cases, we noted postoperative lower eyelid retraction with eyelid adhesion to the implant; possible risk factors for this complication included reoperative cases and simultaneous eyelid reconstruction with hard palate grafts.ConclusionsThe porous polyethylene orbital rim onlay implant offers a relatively simple and effective surgical technique for the treatment of symptomatic relative proptosis. It can be used alone or in combination with other techniques including midface lift, lower eyelid retractor recession, and orbital decompression. To be effective, the implant should be placed so that it is flush with or overlapping the orbital rim; lateral displacement negates the effect of the implant in improving the eyelid/globe relationship. Postoperative eyelid retraction with tethering to the implant is a potential risk of the onlay implant, and although it may not be possible to avoid this in all cases, surgeries should be designed to minimize postoperative eyelid retraction.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo report hydroxyapatite (HA) implant enhancement patterns on magnetic resonance (MR) images at varying time intervals after implantation.MethodsWe retrospectively reviewed the records of 45 consecutive patients(from one author's practice) who underwent an MR imaging study 2 to 157 monthsafter HA orbital implant placement. Implant fibrovascular ingrowth was assessed by analyzing the extent of implant enhancement seen on MR imaging.ResultsOf 21 patients undergoing gadolinium-DTPA T1-weighted MR imaging 2 to 7 weeks after HA placement, 15 had enhancement limited to the implant rim (Grade I or less). Five patients had peripheral foci of enhancement (Grade II), and one patient had foci of enhancement extending to the center of the implant (Grade III). MR imagesobtained 9 to 15 weeks after HA insertion in all 14 patients had some degree of central enhancement (Grade III) and 11 had homogeneous enhancement throughout the implant (Grade IV or V). Seven patients in the homogeneous group were believed to have particularly intense enhancement patterns (Grade V). Of the 10 patients undergoing MR imaging from 31 to 69 weeks after surgery, 5 had Grade III enhancement and 5 had Grade IV enhancement.ConclusionsThis study demonstrated consistent central HA orbital implant enhancement on MR imaging in the 9- to 15-week group and the >31-week postoperative group. HA orbital implant drilling and peg placement should be performed after central vascularization of the spherical implant has occurred. The results of this study support the principle of performing orbital implant drilling and peg placement at least 5 to 6 months after HA implant insertion.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo report the results of a wrapping technique for porous orbital implants by using polyglactin 910 (Vicryl) mesh (Ethicon Inc., Somerville, NJ, U.S.A.)MethodsWe retrospectively reviewed the records of 200 consecutive patients from one author's practice who received a polyglactin 910 mesh–wrapped porous orbital implant after enucleation or as a secondary implant between October 1, 1996, and April 15, 2001. We recorded potential problems that might be attributed to polyglactin 910 mesh both before pegging (excessive inflammatory response to the material, conjunctival thinning, and implant exposure) and after pegging (exposure of the implant around the sleeve, conjunctival thinning, and implant exposure other than adjacent to the peg).ResultsOne hundred twenty-two men and 78 women underwent placement of a polyglactin 910 mesh–wrapped porous orbital implant. The average age at the time of implantation was 48.9 years (range, 11 to 85 years). The average follow-up interval in the 200 patients was 19.4 months (range, 2 to 80 months). Thirteen of the 200 patients had less than 6 months of follow-up, leaving 187 patients with an average follow-up of 20.5 months (range, 6 to 80 months). There were 76 primary enucleations and 124 secondary orbital implants. Thirty-seven patients received a Bio-Eye hydroxyapatite implant (HA) (Integrated Orbital Implants, San Diego, Calif), 97 received a synthetic FCI3hydroxyapatite implant (FCI, Issy-Les-Moulineaux, France), and 66 received a Bioceramic implant (aluminum oxide–Al2O3) (FCI, Issy-Les-Moulineaux, France). One hundred fourteen patients (57%) underwent peg placement. The average time to pegging was 9.9 months (range, 6 to 16 months). Before pegging, 4 of 187 patients (2.1%) had implant exposure. Three of these exposures followed secondary orbital implant placement (2 Bio-Eye HA, 1 synthetic FCI3HA) and one followed an enucleation (synthetic FCI3HA). Two patients required a temporalis fascia graft and one required a scleral patch; the remaining defect closed spontaneously. One patient had conjunctival thinning 6 months after orbital implantation, which remained stable with no frank exposure for 36 months. No patient had excess socket inflammation. After peg placement, 3 additional patients had exposure of the implant around the peg site. There were no cases of conjunctival thinning or exposure of the implant other than adjacent to the peg site.ConclusionsPolyglactin 910 mesh is an excellent option as a wrapping material for porous orbital implants. It is simple to use, readily available, eliminates the need for donor tissue, does not require a second operative site, and it is less expensive than other currently available wrapping materials. We attribute our high success rate to our technique, which emphasizes proper placement of the implant within the Tenon space, suturing the extraocular muscles anterior to their normal anatomic sites, and meticulous closure of the Tenon capsule and conjunctiva in separate layers.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo determine the incidence and risk factors of complications associated with Supramid orbital implants.MethodsA retrospective chart review was performed to document complications in a series of 41 patients receiving Supramid implants during orbital reconstruction or fracture repair. Implant size, duration of time between trauma and implant insertion, and history of prior orbital surgery were examined as possible risk factors for the development of complications.ResultsFour patients had hemorrhage within the implant capsule. An orbital abscess developed in a single patient. All but one complication appeared 7.8 to 10 years after implant insertion. Patients who had complications had a longer duration of time between trauma and implant insertion than those in whom complications did not occur (P=0.0019). Complications were more frequent among patients with larger (>600 mm2) implants and a history of orbital surgery.ConclusionsSpontaneous infection or hemorrhage may occur within the capsules of Supramid orbital implants, even many years after surgery. The insertion of larger implants in the late repair of extensive bony orbital defects may predispose patients to these complications. Implant removal and marsupialization of the implant capsule to the maxillary sinus appears to be curative without causing significant postoperative enophthalmos.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo describe the echographic features of solitary fibrous tumor of the orbit.MethodsA retrospective review of 3 patients with solitary fibrous tumor of the orbit and a literature review were performed.ResultsThree patients with orbital solitary fibrous tumor were studied with standardized echography and 3 other cases of orbital solitary fibrous tumor with ultrasound descriptions were identified in a literature review. Consistent echographic features of the 6 orbital solitary fibrous tumors included firmness, low to medium internal reflectivity, regular internal structure, moderate sound attenuation, and some degree of vascularity.ConclusionsStandardized echography is a useful adjunct in the evaluation of orbital solitary fibrous tumors and can help differentiate these tumors from other orbital lesions.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

We report an effective alternative treatment of profound chronic exposure keratopathy in a proptotic eye due to intraorbital extension of basal cell carcinoma. The corneal surface gradually reepithelialized in a 6-week period after the first application of Tegaderm transparent dressing (3M, St. Paul, MN, U.S.A.) with instillation of antibiotic ointment on the ocular surface. The patient has been comfortable with an intact epithelial surface, a vascularized cornea, and nonirritated surrounding skin after changing the Tegaderm dressing daily for 15 months. There was no evidence of recurrent corneal ulceration or infiltrations. We conclude that Tegaderm represents a useful treatment of exposure keratopathy due to chronic proptosis.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID