Stephen Bosniak

The Diagnosis and Management of Epithelial Tumors of the Lacrimal Sac

Five primary epithelial lesions of the lacrimal sac representing a range of epithelial tumors are presented. The benign lesions initially presented without pain or significant mass but with epiphora and a bloody discharge. The malignant lesions presented insidiously, were large, firm masses and displayed overlying skin telangiectasis rather than the diffuse erythema of dacryocystography revealed a sac partially obstructed by a subtotal space-occupying mass in benign tumors and completely obstructed with malignant lesions.

Dermis-Fat Orbital Implantation: 118 Cases

During the previous six years the authors have performed 118 dermis-fat orbital implants. Fifty-one were primary implantations performed at the time of enucleation. Nineteen grafts were implanted after migrated implants were removed, and 19 grafts were used to correct superior sulcus deformities. Nine dermis-fat grafts expanded contracted sockets. It is becoming increasingly clear that these autogenous implants are effective in maintaining orbital volume while preserving the fornicies and conserving the conjunctiva. Although significant atrophy of primary grafts does not occur very frequently, it is more common in cases of secondary implantation, particularly in cases of chemically injured severely contracted sockets (3 of 9 cases). We have noted only one case of significant atrophy following a primary procedure. This occurred two and a half years following an apparently successful primary graft.

An Autogenous Kinetic Dermis-Fat Orbital Implant: An Updated Technique

Abstract Autogenous grafts of dermis and fat may be used as orbital implants, and during the last four years 46 of these have been performed. The results have been impressive, the complications infrequent and minor. This technique conserves conjunctiva, preserves the fornices, and supplies additional orbital volume, with little chance of extrusion or atrophy.

Definition of the tear trough and the tear trough rating scale

Background  Nasojugal groove and tear trough are interchangeably used terms by many authors in the literature despite the fact that they describe distinct and different anatomic entities. In the same vein, there are multiple descriptions of treatments and techniques for the cosmetic improvement of these anatomic areas without specifically addressing the anatomic difference between them.

Recognition and management of acute noninfectious dacryocystic retention

Eleven female and 4 male patients presented with 20 documented episodes of acute noninfectious dacryocystic retention. This syndrome complex consists of severe pain and tearing with minimal but tender distention of the lacrimal sac, without signs of inflammation. It is caused by impaction of a dacryolith in the nasolacrimal duct. In our group of patients, the mean age when seen was 39 ± 14 years, and the mean onset of symptoms occurred at age 35 ± 13 years. Six episodes resolved spontaneously, and the rest responded to interventional therapy. In six, irrigation relieved the symptoms. One patient each responded to probing, lacrimal intubation, and primary dacryocystorhinostomy (DCR). In three patients, a new technique of percutaneous nasolacrimal duct dilatation using angiographie techniques relieved symptoms. One patient each failed irrigation and percutaneous dilatation and required secondary DCR. Recognition of this presentation permits differentiation of this syndrome from infectious lacrimal obstruction and allows appropriate therapy. In at least some patients, percutaneous nasolacrimal duct dilatation may offer both a method of accurate diagnosis and an initial alternative to more extensive surgery.

Nonsurgical fat removal in cosmetic blepharoplasty: a new technique.

A new technique of minimally invasive fat removal during cosmetic blepharoplasty is described. This lipolytic diathermy technique has been used successfully in more than 100 patients during the last 3 years and is compared with routine excisional fat removal. The main advantage of this technique lies in its ability to dissolve the fat without surgical excision, thus obviating the inherent complications that arise from such dissection. The technique uses a diathermy unit to cause lipolysis of the fat pockets within their intact septal compartments and can be used for both upper and lower lid herniated fat. This procedure has been found to be exceptionally efficient and predictable and adds another level of safety to cosmetic blepharoplasty.

Combination Therapies in Oculofacial Rejuvenation

The oculo-facial surgeons quest for non-invasive procedures is a response to increasing patient demands for enhanced results without any downtime. Technology has obliged us with multiple injectable and light therapeutic modalities that tighten skin, relax and fill in wrinkles, and improve skin dyspigmentation and texture. When these techniques are combined, the results are superior to the use of individual therapies alone. The foundation for combination therapies are: botulinum toxin, filling agents, chemical peels, intense pulsed light, non-ablative and ablative lasers.

Re-Examining the Tarsal Kink Syndrome: Considerations of its Etiology and Treatment

A severe corneal ulceration that is evident shortly after birth and persists in spite of adequate medical therapy, may be secondary to a congenital entropion. A vertically kinked tarsus is an unusual and frequently overlooked form of congenital entropion. Prompt recognition of this entity is essential to avoid severe corneal injury and amblyopia. We present a technique of tarsal stabilization which corrected this upper lid deformity in one case.

Temporalis Muscle Transfer: A Vascular Bed for Autogenous Dermis-Fat Orbital Implantation

Nine patients with contracted avascular sockets who were unable to wear prostheses, and whose prospects for maintaining viable autogenous dermis-fat grafts were diminished, underwent temporalis muscle transfer into the orbit through a window in the lateral orbital wall. The temporalis transposition was used as a vascular bed for dermis-fat orbital implantation. Postoperatively, seven of nine patients were able to wear satisfactory prostheses and four of nine patients had amelioration of their superior sulcus deformities.

Reconstruction of the Horizontal Palpebral Aperture After Failed Ectropion Surgery with Temporal Migration of Punctum

&NA; Involutional ectropion of the lower lid is the result of progressive stretching and elongation of the lid margin and medial and lateral canthal tendons. The relative laxities of the components of the lower lid‐canthal tendon complex will determine the location and extent of the ectropion. Whereas inadequate canthal tightening or horizontal lid shortening will result in recurrent ectropion, overzealous lid shortening without tendon plication will result in a noticeably narrower horizontal palpebral fissure, a persistent ectropion, or temporal migration of the punctum. We used lateral cantholysis, medial canthal tendon plication, and punctal rotation to return the punctum to its normal position and temporalis muscle to support the lower lid in eight cases in which previous procedures had failed to correct the lid malposition. In all eight cases there was improvement of the lid position. In one case of severe medial ectropion, the punctal eversion was not completely corrected. This technique is not recommended as an initial procedure for ectropion repair. It is only used to manage previous surgical failures. It is a new application and combination of wellaccepted techniques.