The Orbits—Anatomical Features in View of Innovative Surgical Methods
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Lacrimal Obstruction
Yung_edit_final_Layout 1 01/09/2009 15:19 Page 81 Lacrimal Obstruction Proximal Lacrimal Obstruction – A Review Carl Philpott1 and Matthew W Yung2 1. Rhinology and Anterior Skull Base Fellow, St Paul’s Sinus Centre, St Paul’s Hospital, Vancouver; 2. Department of Otolaryngology, Ipswich Hospital NHS Trust Abstract While less common than distal lacrimal obstruction, proximal obstruction causes many cases of epiphora. This article examines the aetiology of proximal lacrimal obstruction and considers current management strategies with reference to recent literature. The Lester Jones tube is the favoured method of dealing with most cases of severe proximal obstruction; other methods have been tried with less success. Keywords Proximal lacrimal obstruction, epiphora, canalicular blockage, Lester Jones tube Disclosure: The authors have no conflicts of interest to declare. Received: 31 March 2009 Accepted: 14 April 2009 DOI: 10.17925/EOR.2009.03.01.81 Correspondence: Matthew W Yung, The Ipswich Hospital, Heath Road, Ipswich, Suffolk, IP4 5PD, UK. E: [email protected] Obstruction of the lacrimal apparatus commonly causes sufferers to dominant fashion.3 Where absence of the punctum and papilla present with symptoms of epiphora, for which they are commonly (congenital punctal agenesis) occurs, it is likely that more distal parts referred to ophthalmology departments. In those units where of the lacrimal apparatus are obliterated. collaboration with otorhinolaryngology occurs, the distal site of obstruction is usually dealt with. -
Volume 1: the Upper Extremity
Volume 1: The Upper Extremity 1.1 The Shoulder 01.00 - 38.20 (37.20) 1.1.1 Introduction to shoulder section 0.01.00 0.01.28 0.28 1.1.2 Bones, joints, and ligaments 1 Clavicle, scapula 0.01.29 0.05.40 4.11 1.1.3 Bones, joints, and ligaments 2 Movements of scapula 0.05.41 0.06.37 0.56 1.1.4 Bones, joints, and ligaments 3 Proximal humerus 0.06.38 0.08.19 1.41 Shoulder joint (glenohumeral joint) Movements of shoulder joint 1.1.5 Review of bones, joints, and ligaments 0.08.20 0.09.41 1.21 1.1.6 Introduction to muscles 0.09.42 0.10.03 0.21 1.1.7 Muscles 1 Long tendons of biceps, triceps 0.10.04 0.13.52 3.48 Rotator cuff muscles Subscapularis Supraspinatus Infraspinatus Teres minor Teres major Coracobrachialis 1.1.8 Muscles 2 Serratus anterior 0.13.53 0.17.49 3.56 Levator scapulae Rhomboid minor and major Trapezius Pectoralis minor Subclavius, omohyoid 1.1.9 Muscles 3 Pectoralis major 0.17.50 0.20.35 2.45 Latissimus dorsi Deltoid 1.1.10 Review of muscles 0.20.36 0.21.51 1.15 1.1.11 Vessels and nerves: key structures First rib 0.22.09 0.24.38 2.29 Cervical vertebrae Scalene muscles 1.1.12 Blood vessels 1 Veins of the shoulder region 0.24.39 0.27.47 3.08 1.1.13 Blood vessels 2 Arteries of the shoulder region 0.27.48 0.30.22 2.34 1.1.14 Nerves The brachial plexus and its branches 0.30.23 0.35.55 5.32 1.1.15 Review of vessels and nerves 0.35.56 0.38.20 2.24 1.2. -
Endoscopic Supraorbital Eyebrow Approach for the Surgical Treatment of Extraaxial and Intraaxial Tumors
See the corresponding editorial in this issue (E21). Neurosurg Focus 37 (4):E20, 2014 ©AANS, 2014 Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxial and intraaxial tumors ROBERTO GAZZERI, M.D.,1,2 YUYA NISHIYAMA, M.D., PH.D.,1,3 And CHARLES TEO, M.D.1 1Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia; 2Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy; and 3Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake, Japan Object. The supraorbital eyebrow approach is a minimally invasive technique that offers wide access to the anterior skull base region and parasellar area through a subfrontal corridor. The use of neuroendoscopy allows one to extend the approach further to the pituitary fossa, the anterior third ventricle, the interpeduncular cistern, the an- terior and medial temporal lobe, and the middle fossa. The supraorbital approach involves a limited skin incision, with minimal soft-tissue dissection and a small craniotomy, thus carrying relatively low approach-related morbidity. Methods. All consecutive patients who underwent the endoscopic supraorbital eyebrow approach were retro- spectively analyzed for lesion location, pathology, length of stay, complications, and cosmetic results. Results. During a 56-month period, 97 patients (mean age 58.5 years) underwent an endoscopic eyebrow ap- proach to resect extra- and intraaxial brain lesions. The most common pathologies treated were meningiomas (n = 41); craniopharyngiomas (n = 22); dermoid tumors (n = 7); metastases (n = 4); gliomas (n = 3); and other miscel- laneous frontal, parasellar, and midbrain (n = 23) lesions. The median length of postoperative hospital stay was 2.7 days (range 1–8 days). -
New Theory on Facial Beauty: Ideal Dimensions in the Face and Its Application to Your Practice by Dr
New Theory on Facial Beauty: Ideal Dimensions in the Face And its application to your practice By Dr. Philip Young Aesthetic Facial Plastic Surgery 2015 Bellevue, Washington American Brazilian Aesthetic Meeting • Hello my presentation is on studying some further elements of a new theory on facial beauty called the Circles of Prominence. • Specifically we are going to be studying some key dimensions in the face that I think could possibly help your practice. • I’m from Bellevue Washington Home of Bill Gates, Microsoft and Starbucks. Beauty In my opinion Beauty is the most important trait that we have and it is the one trait that can have the most dramatic impact in our lives. Obviously finding the answer for Beauty is essential in our industry. The answers have alluded us: the magic number of Phi, cephalometrics, the neo classical canons by Leonardo Da Vinci, the averageness theory, etc. have all come short in finding what makes a face beautiful. • The Circles of Prominence is a theory that I discovered in 2003-2005 and was published in the Archives of Facial Plastic Surgery in 2006 and Received the Sir Harold Delf Gillies Award from the American Academy of Facial Plastic Surgery. The Circles of Prominence • Original published Archives FPS 2006 • Based on the idea that there is an ideal • Everything on the face has an ideal as well • Because we spend so much time looking at the iris • All dimensions of the face are related to the width of the iris • Obviously with a better definition of beauty our results in plastic surgery can be improved • The circles of prominence is based on the belief that there is an ideal. -
Chapter 18 EYELID and ADNEXAL INJURIES
Eyelid and Adnexal Injuries Chapter 18 EYELID AND ADNEXAL INJURIES KIMBERLY PEELE COCKERHAM, MD* INTRODUCTION HISTORY, EXAMINATION, AND ANCILLARY TESTING SURGICAL MANAGEMENT OF EYELID LACERATIONS Anesthesia Preoperative Preparation Superficial Eyelid Lacerations Eyelid-Margin Involvement Levator Injury Complex Eyelid Injuries Total Avulsion SURGICAL MANAGEMENT OF ADNEXAL INJURIES Eyebrow Injuries Canalicular Injuries Medial Canthal Injuries Lateral Canthal Injuries Lacrimal Sac and Lacrimal Gland Injuries POSTOPERATIVE WOUND CARE SUMMARY *Director, Ophthalmic Plastics, Orbital Disease and Neuro-Ophthalmology, Allegheny General Hospital, 420 East North Avenue, Pittsburgh, Pennsylvania 15212; Assistant Professor, Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102; formerly, Major, Medical Corps, US Army; Director, Neuro-Ophthalmology, Orbital Disease, and Plastic Reconstruction, Depart- ment of Ophthalmology, Walter Reed Army Medical Center, Washington, DC 291 Ophthalmic Care of the Combat Casualty INTRODUCTION Eyelid lacerations are a common emergency injuries are not considered true emergencies, and room challenge. The primary repair, which should in triage settings, life-threatening and actual sight- be the definitive surgery, is too often performed by threatening injuries (ie, open globes) should take medical students or physicians without ophthalmo- precedence. Eyelid lacerations can be closed up to logical training.1 Whether the setting is a civilian 72 hours after the injury without a great impact on emergency room or a battlefield, ophthalmologists functional or aesthetic outcome. Canalicular injury should be involved as early as possible. Inadequate can also be delayed (up to 48 hours), allowing the repair can lead to ocular irritation, pain, and even all-important primary closure to be performed by loss of the eye in cases of severe eyelid dysfunc- an experienced ophthalmologist. -
Anatomy of the Periorbital Region Review Article Anatomia Da Região Periorbital
RevSurgicalV5N3Inglês_RevistaSurgical&CosmeticDermatol 21/01/14 17:54 Página 245 245 Anatomy of the periorbital region Review article Anatomia da região periorbital Authors: Eliandre Costa Palermo1 ABSTRACT A careful study of the anatomy of the orbit is very important for dermatologists, even for those who do not perform major surgical procedures. This is due to the high complexity of the structures involved in the dermatological procedures performed in this region. A 1 Dermatologist Physician, Lato sensu post- detailed knowledge of facial anatomy is what differentiates a qualified professional— graduate diploma in Dermatologic Surgery from the Faculdade de Medician whether in performing minimally invasive procedures (such as botulinum toxin and der- do ABC - Santo André (SP), Brazil mal fillings) or in conducting excisions of skin lesions—thereby avoiding complications and ensuring the best results, both aesthetically and correctively. The present review article focuses on the anatomy of the orbit and palpebral region and on the important structures related to the execution of dermatological procedures. Keywords: eyelids; anatomy; skin. RESU MO Um estudo cuidadoso da anatomia da órbita é muito importante para os dermatologistas, mesmo para os que não realizam grandes procedimentos cirúrgicos, devido à elevada complexidade de estruturas envolvidas nos procedimentos dermatológicos realizados nesta região. O conhecimento detalhado da anatomia facial é o que diferencia o profissional qualificado, seja na realização de procedimentos mini- mamente invasivos, como toxina botulínica e preenchimentos, seja nas exéreses de lesões dermatoló- Correspondence: Dr. Eliandre Costa Palermo gicas, evitando complicações e assegurando os melhores resultados, tanto estéticos quanto corretivos. Av. São Gualter, 615 Trataremos neste artigo da revisão da anatomia da região órbito-palpebral e das estruturas importan- Cep: 05455 000 Alto de Pinheiros—São tes correlacionadas à realização dos procedimentos dermatológicos. -
SŁOWNIK ANATOMICZNY (ANGIELSKO–Łacinsłownik Anatomiczny (Angielsko-Łacińsko-Polski)´ SKO–POLSKI)
ANATOMY WORDS (ENGLISH–LATIN–POLISH) SŁOWNIK ANATOMICZNY (ANGIELSKO–ŁACINSłownik anatomiczny (angielsko-łacińsko-polski)´ SKO–POLSKI) English – Je˛zyk angielski Latin – Łacina Polish – Je˛zyk polski Arteries – Te˛tnice accessory obturator artery arteria obturatoria accessoria tętnica zasłonowa dodatkowa acetabular branch ramus acetabularis gałąź panewkowa anterior basal segmental artery arteria segmentalis basalis anterior pulmonis tętnica segmentowa podstawna przednia (dextri et sinistri) płuca (prawego i lewego) anterior cecal artery arteria caecalis anterior tętnica kątnicza przednia anterior cerebral artery arteria cerebri anterior tętnica przednia mózgu anterior choroidal artery arteria choroidea anterior tętnica naczyniówkowa przednia anterior ciliary arteries arteriae ciliares anteriores tętnice rzęskowe przednie anterior circumflex humeral artery arteria circumflexa humeri anterior tętnica okalająca ramię przednia anterior communicating artery arteria communicans anterior tętnica łącząca przednia anterior conjunctival artery arteria conjunctivalis anterior tętnica spojówkowa przednia anterior ethmoidal artery arteria ethmoidalis anterior tętnica sitowa przednia anterior inferior cerebellar artery arteria anterior inferior cerebelli tętnica dolna przednia móżdżku anterior interosseous artery arteria interossea anterior tętnica międzykostna przednia anterior labial branches of deep external rami labiales anteriores arteriae pudendae gałęzie wargowe przednie tętnicy sromowej pudendal artery externae profundae zewnętrznej głębokiej -
Tunica Interna (Nervosa) Retina
Visual system 2 and accessory visual structures Organum visuale et structurae oculi accessoriae David Kachlík Tunica interna (nervosa) Retina • pars caeca – pars iridica – pars ciliaris • ora serrata • pars optica – 10 layers – pigmented part – sensory part Retina – pigmented part • stratum pigmentosum • simple cuboid epithelium on basal lamina = Bruch‘s membrane • cells (pigmentocytus) connected by tight junctions • apical parts contain melanin granules • microvilli separate the outer segments of rods and cones • interphotoreceptor matrix (IRBP) • nutrition of rods and cones, photopigment resynthesis, degradation of membranous discs, barrier „blood-retina“ Retina – sensory part • light-sensitive neurons (transducers) – rods and cones • trasmission neurons (integraters) – bipolar and ganglionic cells • association neurons – horizontal and amacrinne cells • suppoting cells (glia) – radial glial cells (Müller´s cells) Section of eyball layers Rods = Neura bacillifera • rod = bacillum retinae • spherula – synaptic terminal • axonal process • nucleus black-abd-white vision • inner segment – GA, ER, MIT; synthesis of ATP and rhodopsin – myoideum (glycogen) + ellipsoideum (mitochondria) • connecting cilium (cilium connectens) – modified cilium • outer segment (segmentum externum) – membranous discs with photopigment – migrate externally and are released Cones = Neuron coniferum • cone = conus retinae • synaptic pedicle (pes terminalis) • photopigment is iodopsin • outer segment – membranous discs with photopigment • communicate with surroundings • color vision – 3 types of cones – according to wave-length – „blue“ – 420 nm – type S – „green“ – 535 nm – type M – „red“ – 565 nm – type L Retina – Transmission neurons • Bipolar neurons (Neuron bipolare) – rod bipolar neurons (n.b. bacillotopicum) – cone bipolar neurons (n.b. conotopicum) • midget (n.b.c. nanum) – macula lutea (no convergence = 1 : 1 : 1) • diffuse (n.b.c. diffusum) – convergence of signal – contact with retinal ganglion cells • Retinal ganglion cells (N. -
Surgical Microanatomy of the Müller Muscle-Conjunctival Resection
ORIGINAL ARTICLE Surgical Microanatomy of the Mu¨ller Muscle-Conjunctival Resection Ptosis Procedure Marcus M. Marcet, M.D.*†, Pete Setabutr, M.D.‡, Bradley N. Lemke, M.D.§, Megan E. Collins, M.D.*, James C. Fleming, M.D.ʈ, Ralph E. Wesley, M.D.¶, Jayant M. Pinto, M.D.*, and Allen M. Putterman, M.D.‡ Departments of *Surgery and †Pathology, University of Chicago; ‡Department of Ophthalmology, University of Illinois, Chicago, Illinois; §Department of Ophthalmology, University of Wisconsin, Madison, Wisconsin; ʈHamilton Eye Institute, University of Tennessee, Memphis; and ¶Vanderbilt University Eye Institute, Nashville, Tennessee, U.S.A. exact mechanism by which the surgery lifts the eyelid has been Purpose: To assess for alterations in the microscopic anat- unclear.2–4 It has been postulated to be secondary to a number omy that occur as a result of the Mu¨ller muscle-conjunctival of factors, including resection and advancement of Mu¨ller resection (MMCR) ptosis procedure and to better understand muscle (MM) and advancement of the levator aponeurosis.2,5 the mechanisms by which MMCR elevates the eyelid. This study uniquely uses a cadaveric model to charac- Methods: Sixteen orbits from 8 fresh frozen Caucasian terize the microanatomic alterations produced with the MMCR cadaver heads, ranging from 38 to 100 years of age were used. procedure. By visualizing the altered microscopic anatomy, we For each head, MMCR was performed on one side. The contralat- hoped to gain insight into the mechanism of action of the eral, unoperated orbit served as an anatomic control. Each exen- surgery. In seeking a visually integrated depiction of collagen, terated orbital contents and excised MMCR specimen was evalu- muscle, and elastic fibers for the histopathologic evaluation, a ated. -
Simultaneous Advancement of the Levator Aponeurosis and Müller's
The Open Ophthalmology Journal, 2010, 4, 71-75 71 Open Access Transcutaneous Blepharoptosis Surgery: Simultaneous Advancement of the Levator Aponeurosis and Müller’s Muscle (Levator Resection) Kazunami Noma1, Yasuhiro Takahashi2, Igal Leibovitch3 and Hirohiko Kakizaki*,2 1Noma Eye Clinic, Kokutaiji, Naka-ku, Hiroshima 730-0042, Japan 2Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi 480-1195, Japan 3Division of Oculoplastic and Orbital Surgery, Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel Abstract: Transcutaneous blepharoptosis surgery with simultaneous advancement of the levator aponeurosis and Müller’s muscle (levator resection) is a popular surgery which is considered effective for all types of blepharoptosis except for the myogenic type. Repair of ptosis cases with good levator function yields excellent results. A good outcome can be also obtained in cases with poor levator function, however, in such cases; a large degree of levator advancement may be required, which may result in postoperative dry eyes, unnatural eyelid curvature and astigmatism. These cases are therefore better treated with sling surgery. With the right patient selection, the levator resection technique is an effective method for ptosis repair. Keywords: Transcutaneous blepharoptosis surgery, levator aponeurosis, Müller’s muscle, levator resection. INTRODUCTION muscle is divided into 2 branches in the periphery: the superior branch which continues to the levator aponeurosis, Blepharoptosis surgery is one of the most popular and the inferior branch from which Müller’s muscle operations in the field of ophthalmic plastic and originates. Although the thickness of each branch is almost reconstructive surgery. The specific surgical method for identical, the superior branch tends to be thicker than the repairing blepharoptosis is selected according to the degree inferior branch. -
Acquired Etiologies of Lacrimal System Obstructions
5 Acquired Etiologies of Lacrimal System Obstructions Daniel P. Schaefer Acquired obstructions of the lacrimal excretory outfl ow system will produce the symptoms of epiphora, mucopurulent discharge, pain, dacryocystitis, and even cellulitis, prompting the patient to seek the ophthalmologist for evaluation and treatment. Impaired tear outfl ow may be functional, structural, or both. The causes may be primary – those resulting from infl ammation of unknown causes that lead to occlusive fi brosis—or secondary, resulting from infections, infl amma- tion, trauma, malignancies, toxicity, or mechanical causes. Secondary acquired dacryostenosis and obstruction may result from many causes, both common and obscure. Occasionally, the precise pathogenesis of nasolacrimal duct obstruction will, despite years of investigations, be elusive. To properly evaluate and appropriately treat the patient, the ophthal- mologist must have knowledge and comprehension of the lacrimal anatomy, the lacrimal apparatus, pathophysiology, ocular and nasal relationships, ophthalmic and systemic disease process, as well as the topical and systemic medications that can affect the nasolacrimal duct system. One must be able to assess if the cause is secondary to outfl ow anomalies, hypersecretion or refl ex secretion, pseudoepiphora, eyelid malposition abnormalities, trichiasis, foreign bodies and conjunctival concretions, keratitis, tear fi lm defi ciencies or instability, dry eye syn- dromes, ocular surface abnormalities, irritation or tumors affecting the trigeminal nerve, allergy, medications, or environmental factors. Abnormalities of the lacrimal pump function can result from involu- tional changes, eyelid laxity, facial nerve paralysis, or fl oppy eyelid syndrome, all of which displace the punctum from the lacrimal lake. If the cause is secondary to obstruction of the nasolacrimal duct system, the ophthalmologist must be able to determine where the anomaly is and what the cause is, in order to provide the best treatment possible for the patient. -
The Lacrimal System Terms
The Lacrimal System Lynn E. Lawrence, CPOT, ABOC, COA, OSC Terms • Etiology – the cause of a disease or abnormal condition • Dacryocystitis – inflammation of the lacrimal sac • Epiphora – watering of eyes due to excess secretion of tears or obstruction of the lacrimal passage Tear Film Layers oil aqueous snot What functions does each layer of the tear perform? Lacrimal System: Tear Film Layers LIPID DEFICIENCY ‐ evaporates TEAR DEFICIENCY – fails to hydrate properly oil aqueous snot What functions does each layer of the tear perform? What are functions of tears? Tear Components • Lipid Layer – prevents evaporation • Aqueous Layer ‐ hydration • Mucus Layer – sticks tear to the eye • Other components Lacrimal Apparatus • Sometimes a person cannot produce natural tears they might need punctal plugs to prevent the tears from draining off the eye. • Faucet • Action • Drain Obstructive – vs‐ non‐obstructive Tear Production – Secretory • Lacrimal gland – Reflex tearing – Too much tearing…epiphora • Gland of Krause – Superior fornix • Gland of Wolfring – Superior tarsal plate Two Primary Forms of Dry Eye 800 nm 8,000 nm 100 nm The two primary forms of dry eye are Evaporative Dry Eye, also known as Meibomian Gland Dysfunction or MGD and Aqueous Dry Eye. The majority of dry eye sufferers have MGD. Oil & Water Remember science class? Oil floats. Oil does not mix with water, but rather sits on top of water. Oil is what keeps water from evaporating. Need three volunteers TEST TIME http://optometrytimes.modernmedicine.com/optometrytimes/news/treating‐dry‐eye‐ lipid‐based‐eye‐drops Lipid Secretion: Meibomian Glands Left: Transillumination of eyelid showing meibomian glands Right: Secretion of lipid at lid margin • The lipid layer restricts evaporation to 5‐10% of tear flow – Also helps lubricate Mucin Secretion: Goblet Cells Superficial layer of bulbar conjunctiva.