Advances in ophthalmic plastic and reconstructive surgery最新文献

Patients who have worn an ocular prosthesis for many years often develop laxity of the lower eyelid and deepening of the superior sulcus caused by downward displacement of the orbital contents. Herein we describe our technique and results with the lateral canthal sling and subperiosteal room temperature vulcanizing (RTV) silastic volume augmentation procedure performed through a single incision in the lateral canthus.

There are many different procedures to camouflage the superior sulcus deformity that occurs after an evisceration or enucleation. We have studied 5000 anophthalmic patients. In every case the previous adaptation of the prosthesis was satisfactory. We noted the frequency of the superior sulcus deformity, and we would like to discuss silicone oil infiltration and a modified polymethyl-methacrylate (PMMA) banana superior sulcus implant. The silicone oil infiltration is easily performed and the results are permanent.

Major criticisms of quasi-integrated implants, such as the Iowa Implant, have been the time-consuming surgical technique needed to implant the prosthesis, and the high rate of extrusion. The Universal Implant (Oculo-Plastik, Montreal) is designed with these concerns in mind. In addition, those qualities that produce the motility advantages of a quasi-integrated implant and the ease of placement of a sphere have been incorporated into the design of the Universal Implant. The Universal Implant also (1) uses a faster implantation technique at surgery, (2) avoids cleaning the muscles, (3) has smaller mounds that are lower and more rounded, and should decrease the late extrusion rate, (4) can be used as an evisceration implant, enucleation implant, or secondary implant, and (5) has a larger girth and radius on the posterior surface that, in turn, helps support orbital fat and tissues and results in a more natural superior sulcus. It is recommended that the Universal Implant be used by surgeons who were pleased with the Iowa Implant, as the Universal implant represents an excellent alternative with major advantages over most other enucleation implants.

In the post enucleation and evisceration patient, we must continually seek to resolve the functional and cosmetic defects that occur following surgery. Fitting a prosthesis that appears to be symmetrical with the fellow eye is the measuring stick of our success. The success or failure in achieving this cosmetic symmetry will determine to a great degree the rehabilitation of the patient. It is important for the ocularist to have at least a basic understanding of the anatomic changes that have resulted in the anophthalmic socket to correctly assess and treat these changes. The authors suggest a method detailing the steps involved in making an accurate clinical assessment of the patient. The authors will also outline the defects normally associated with post enucleation syndrome, their usual causative effects, and provide a suggested reading list supplying information on both surgical and prosthetic correction for each of these areas.

Trimalar fractures of the zygoma are not infrequent midfacial injuries and are a distinct clinical entity. Specific clinical findings include infraorbital anesthesia, trismus, diplopia, enophthalmos, palpable bony suture line abnormalities, flattened malar eminences, and superior sulcus deformities. Six radiologic subgroups have been described. Optimal surgical management and treatment depend on the type of fracture. Three general surgical approaches are currently used: the Gillies technique, the supraorbital approach, and the maxillary sinus approach.