Geoffrey J. Gladstone

Management of paralytic lagophthalmos with a modified gold-weight implantation technique.

Summary: A modified gold‐weight implantation technique was used to treat paralytic lagophthalmos in 15 patients. Three patients had suffered extrusions of previously placed gold‐weight implants, two had other complications necessitating reoperation, and 10 had no previous surgery. The surgical modifications were intended to reduce the incidence of implant extrusion, postoperative ptosis, and implant visibility beneath the skin. The important changes in the surgical technique included (a) advancing the levator aponeurosis over the implant and (b) adjusting the final eyelid height intraoperatively with levator myotomies. Follow‐up ranged from 6 to 11 months. None of the patients in this study had postoperative problems associated with ptosis, implant extrusion, or implant visibility. Mild, prolonged, postoperative edema was noted in several patients. This resolved spontaneously. Mild eyelid retraction and lagophthalmos were seen postoperatively in two patients. This was caused by a failure to perform marginal myotomies at the time of the initial surgeries.

Eyelid sensation after supratarsal lid crease incision.

Purpose To determine the severity and duration of the loss of eyelid sensation after upper eyelid crease incision. Methods This clinic-based case study was performed by analyzing observational measurements of patients undergoing upper blepharoplasty or ptosis surgery. Eighty-three eyelids of 50 patients were studied. A Cochet-Bonnet filament-type aesthesiometer was used to obtain all measurements. Preoperative and postoperative measurements were recorded at 1 week, 1 month, and final (2–6 months) time periods. Statistical analysis evaluated the degree and duration of the sensory loss and the extent of recovery during the evaluation period. Recovery of sensation was defined as a numerical reading within one point of baseline. Results The mean aesthesiometry reading was calculated at the preoperative (3.45), 1-week (1.20), 1-month (1.56), and final postoperative (2.56) periods. Paired t testing showed a decreased but significant difference in sensation measurement at each comparison. Recovery of sensation to within one point occurs at the preoperative to late time period comparison. All but 4 of the 68 eyelids tested at the 1-week postoperative time period had a measured loss of sensation. Of the 44 eyelids tested at the final time period, all but 1 had regained some or all of this sensory loss. Conclusions Loss of skin sensation in the eyelid after upper eyelid crease incision blepharoplasty or blepharoptosis repair occurs in most patients and should be considered an expected outcome of the procedure. Partial to complete recovery of eyelid sensation over 2 to 6 months should also be expected, though in rare instances this does not occur.

A solution to the Jones tube continuous positive airway pressure (CPAP) dilemma

A 49-year-old woman, who had previously undergone bilateral Jones tube placement, began nasal continuous positive airway pressure for obstructive sleep apnea. The patients use of continuous positive airway pressure was limited by intolerance of the transfer of air through the Jones tube to her ocular surface resulting in irritation and discomfort. A change from nasal continuous positive airway pressure to a full face mask, including both Jones tubes in the pressure circuit, resolved the problem.

Aggressive Glabellar Angiomyxoma with Orbital Extension

A 62-year-old male presented with a large non-tender mass in the glabella, extending into the right orbit that had been steadily growing for 6 months. Imaging revealed a 2.5 x 1.8 cm cystic mass with extension into the right anterior orbit. Biopsy with microscopic examination revealed a predominantly myxoid stroma containing spindle-shaped cells with bipolar cigar-shaped nuclei and small caliber capillary-type vascular proliferations. These findings are consistent with an angiomyxoma. Although angiomyxomas typically present in the pelvic region or peritoneum in female patients, there have been rare examples of angiomyxomas with orbital involvement.

Necrotizing sialometaplasia of the lacrimal sac mimicking squamous cell carcinoma: Necrotizing dacyocystometaplasia

ABSTRACT Introduction: Necrotizing sialometaplasia is thought to represent an inflammatory reaction directed against an ischemic insult or local trauma within a glandular tissue and is most commonly observed in the minor salivary glands of the oral mucosa. The importance of this condition arises from the fact that its clinical and histological aspects may raise issues of differential diagnosis with malignant neoplasms. The authors present a case of necrotizing sialometaplasia involving the lacrimal sac simulating a well-differentiated squamous cell carcinoma. Case: A 52-year-old man presented with epiphora in the left eye after having sustained an orbital blowout fracture during a motor vehicle accident. During subsequent external dacryocystorhinostomy, an abnormal lacrimal sac mucosa was observed and analyzed histologically revealing a well-differentiated squamous cell carcinoma. However, the subsequent biopsies of the lacrimal sac were negative for malignancy; in view of these findings, two pathologists reviewed the first specimen and immunohistochemical staining was performed allowing us to arrive at a diagnosis of necrotizing sialometaplasia. We suggest the term necrotizing dacryocystometaplasia for the involvement at this site. Conclusion: Although exceedingly unusual, necrotizing dacryocystomeplasia should be considered in patients presenting with epiphora in the appropriate clinical context. Notably, this condition can be mistaken for a malignant disease, presenting a diagnostic challenge both clinically and histopathologically.

Upper Eyelid Blepharoplasty: The Evaluation

Avoiding complications in performing a lower eyelid blepharoplasty may be based on the evaluation of the patient. By combining a thorough evaluation with proper history taking, many complications that result from this surgical procedure can be avoided.

A simplified marking technique for eyebrow reconstruction using composite grafts.

Eyebrows can be damaged in facial burns, trauma, skin cancer, herpes zoster and other conditions. Some of these patients will demand eyebrow reconstruction surgery. This can be done using free composite grafts from the scalp or flaps from the temporal area. Both techniques require time-consuming planning, marking and shaping of the graft or flap in order to achieve a good cosmetic result. In an attempt to make free graft reconstructions faster and easier, we modified the technique. We describe an easy way of obtaining a template that simplifies the procedure and enhances symmetry.