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Glabellar Flap

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This narrated video was prepared by Dr Meydan Ben Ishai and narrated by Dr Sarah Dollinger. It demonstrates reconstruction of a medial canthal defect from tumour excision surgery, with a glabellar flap 오버워치 핵 무료 다운로드. It is a versatile and relatively straightforward reconstructive technique. The video explores the technique, modifications of the traditional procedure and complications 유려체 다운로드.

Congenital nasolacrimal duct cyst

This narrated video demonstrates congenital nasolacrimal duct obstruction resulting in cystic expansion in the nasal cavity. This in turn obstructs nasal breathing, impeding breast feeding and resulting in failure to thrive 소화기 사용법 동영상 다운로드. The video shows nasolacrimal probing into the cysts as well as the nasal endoscopic view of the cysts with incision and removal of the cysts. It also explores how these cystic expansions may develop 다운로드.

This was video was prepared by Mr Pav Gounder, oculoplastic surgeon, Perth Australia with illustrations prepared by Mr Yarrow Scantling-Birch, ophthalmology registrar Xml download.

Labial mucosa graft harvest

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This narrated video demonstrates the harvest of labial mucosa from the inner lower lip. It reviews the surgical technique, relevant anatomy and possible complications 다운로드. In this case the mucosal graft will be used for inferior fornix reconstruction post thermal injury, which is shown in another video on this website.

This video has been edited and narrated by Dr Pav Gounder, oculoplastic  surgeon 알피스 네오 다운로드.

Threading a silicon in reverse directions through the sleeve

This narrated video demonstrates how to pass or thread the silicon sling that is used for frontalis sling or brow suspension ptosis surgery through the sleeve in reverse directions, when the pre-attached needles have been removed in order to use the Wright fascia needle 마이 백 페이지. The standard silicon sling set comes with needles at either end of the length of silicon, but many surgeons remove these, finding it easier to to pass the sling between lid and brow with the Wright fascia needle which has a curve to facilitate passage in the correct post-septal/pre-apo plane and has a finger holder to stop it rotating 다운로드. However, once the needles have been removed, it can be tricky to pass the flexible silicon through the sleeve and even more so if one prefers to pass the silicon sling ends in reverse directions 다운로드. It is probably more common to pass the sling ends through the sleeve in the same direction, but it is possible that the sling is easier to tighten and with less counter tension causing it to loosen if the sling ends are passed in reverse directions 타카네노 하나 다운로드. However – although we know that silicon slings can be prone to slippage – at present there is a lack of evidence as to exactly how slippage occurs or might be minimised or prevented 다운로드.

This video was prepared by Ms Mena Al Whouhayb and Dr Radhika Dashputra

 

Orbital Sling Technique

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The orbital sling technique may be employed to reduce the risk of post operative diplopia during endoscopic medial orbital wall decompression.  This video was produced and narrated by Mr Huw Oliphant, oculoplastic surgeon 다운로드.

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Nasal preparation for endoscopic DCR surgery

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This narrated video demonstrates nasal preparation for endoscopic dacryocystorhinostomy (DCR) surgery. It explores the use of different decongesting and vasoconstricting preparations and the technique of placing them in the nasal cavity 다운로드. We also discusses the safe doses of the different preparations.

This video was produced and narrated by Mr Huw Oliphant, oculoplastic surgeon

영화 원더 다운로드

Lacrimal gland ductule marsupialisation for recurrent bacterial dacryoadenitis

워크래프트3 맵 다운로드

This narrated video demonstrates the marsupialisation of a dilated lacrimal gland ductule of a patient suffering from recurrent bacterial dacryoadenitis 다운로드. It shows the technique of probing a a ductule and explores the anatomy of the lacrimal gland and its two lobules and ducts

This video was edited and narrated by Mr Huw Oliphant, oculoplastic surgeon

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Marginal strip intraoperative margin control in periocular tumour excision surgery

This narrated video demonstrates the use of the ‘marginal strip’ for intraoperative margin control during periocular tumour excision surgery 다운로드. The marginal strip is a thin strip of tissue that is excised separately from the main tumour specimen and immediately examined histopathologically to confirm the margin is clear before reconstruction 다운로드. It provides the opportunity for en-face tumour examination, rather than ‘bread loaf’ slicing of the specimen. In en-face examination the whole surface is examined, giving much greater confidence that the margin is truly clear, compared to breadloaf slicing in which as little as 10% of the edge is actually examined 다운로드.

The video show how to excise the strip as well as covering labelling of the strip and shows histopathological slides of the tumour specimen and the clear marginal strip 드라마 시티헌터 다운로드.

This video has been prepared by Dr Hanbin Lee, ophthalmologist, Sussex Eye Hospital and the histopathological slides and expertise provided by Dr Mara Quante  and Dr Michael Koenig, histopathologists, Brighton and Sussex University Hospital 다운로드.

Transconjunctival lower lid fat and skin pinch blepharoplasty

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This narrated video demonstrates a transconjunctival approach lower lid fat blepharoplasty with skin pinch skin excision. It explores patient marking, lower lid anatomy, surgical technique and potential complications as well as covering some of the potential challenges with this procedure 다운로드.

This video has been edited and narrated  by Mr Huw Oliphant, oculoplastic surgeon.

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Everting the upper lid over a Desmarres retractor

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This narrated video demonstrates the technique of everting the upper eyelid over a Desmarres retractor. This is a very useful manoeuvre for securing the eyelid in the everted position for posterior approach surgery such as a Hughes flap reconstruction and posterior approach ptosis or lid lowering surgery 위키독스 다운로드.

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Posterior approach Mullerectomy upper lid lowering

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This narrated video demonstrates a posterior approach Mullerectomy lid lowering procedure. It demonstrates the surgery and the relevant anatomy as well as exploring the range of outcomes and modifications that can be used 다운로드.

스미스 차트 다운로드

Posterior approach Conjunctival-Mullers resection ptosis surgery (Putterman procedure)

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This narrated video demonstrates posterior approach Conjunctival-Mullers resection ptosis surgery, also known as the Putterman procedure. This procedure is quick and relatively straightforward and in our experience retains a natural and aesthetically pleasing upper lid contour although we find it to be most effective for lesser degrees of ptosis 다운로드.

A pre-operative phenylephrine test can help to guide the outcome of posterior approach Conjunctival-Mullers resection ptosis surgery, although we have found the surgery to be effective even in negative tests 쌉니다 천리마 마트 웹툰 다운로드.

This video and voiceover was edited and prepared by Miss Valerie Juniat, oculoplastic surgeon.

Fornix reconstruction with dried amniotic membrane graft (Omnigen)

유튜브 차단 된 동영상 다운로드

This narrated video demonstrates the reconstruction of an inferior fornix with a dried amniotic membrane graft (Omnigen). This patient had complete cicatrical loss of the fornix from childhood Stevens-Johnson syndrome and was unable to accommodate a prosthesis 탑건 영화 다운로드. The video demonstrates the use of Omigen and discusses the potential ways in which it might work to promote or support epithelialisation of the expanded fornix 국토 지리 정보원 dem.

This video has been edited and narrated by Dr Huw Oliphant

Direct excision of lower lid festoons and lateral canthopexy

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This narrated video demonstrates the direct excision of lower lid/upper cheek festoons and reviews the anatomy and pathogenesis of festoons and the medical and surgical management and potential complications 다운로드. This video has been created by Dr Valerie Juniat.

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Nasofacial sulcus island pedicle (V to Y) advancement flap

xinetd rpm download This narrated video demonstrates a nasofacial sulcus island pedicle (V to Y) advancement flap for reconstruction in the periocular region. This versatile flap is not widely used in the periocular area, but can be an effective way of recruiting skin from an area of laxity to the periocular area and leave a discrete scar in the nasofacial sulcus 다운로드. The formation of an island flap is unfamiliar to many oculoplastic surgeons; this video guides one through it and explores aspects of technique and possible complications. vocaloid4

Upper lid skin only blepharoplasty

죽은시인의사회 다운로드 This narrated video demonstrates upper eyelid skin only blepharoplasty surgery and discusses the different techniques for incising the skin and the hypothesised advantages and disadvantages of excising orbicularis muscle. 다운로드 다운로드

Cheek rotation (Mustarde) flap

emacs This narrated video demonstrates a cheek rotation flap for the reconstruction of a large periocular defect. This versatile flap can be used to reconstruct large defects in a wide range of locations in the periocular and upper cheek area 용의자 다운로드. This video explores the technique, the path of the facial nerve and the possible complications and adverse outcomes. mp4 변환기

Congenital lacrimal sinus (fistula/accessory punctum) excision

This narrated video demonstrates the excision of an accessory lacrimal sinus or fistula and the insertion of a mini Monoka stent to protect the normal canaliculus 배니쉬드. It discusses the different surgical options for this rare condition.

 

Voiceover

This procedure is being done under the operating microscope to aid visualisation 다운로드.

The normal punctum and canaliculus are assessed. The accessory punctum or sinus is assessed and in particular its direction and length

Saline syringed through the normal punctum emerges freely from the accessory sinus, as this is the path of least resistance 라따뚜이 영화 다운로드. Hence this patient has epiphora.

A Bowman probe is inserted into the normal canaliculus. The metal probe can be seen down the accessory, confirming that in this case, the sinus is relatively short and that great care will need to be taken to avoid damaging the normal canaliculus during excision of the sinus 다운로드.

A biopsy punch can be used to core out the accessory sinus. However, the 2mm punch is a little too large for this sinus.

A Bowman probe is inserted into the sinus and the sinus excised down to the level of the probe that is in the inferior canaliculus 다운로드. It is probably possible to excise it in one circular core, but it is difficult because of the mobility of the tissue, obscuration by blood and caution for the normal canaliculus 세인츠 로우 4 캐릭터 다운로드. It is excised piecemeal.

Dispersive viscoelastic gel is instilled from time to time to protect the cornea.

A mini Monoka stent is placed in the inferior canaliculus 다운로드. It has been cut to around 20mm and with a tapered end. Siting them can be frustrating as they keep bouncing back off the medial wall of the lacrimal sac 인텔 mkl 다운로드. However, with repeated attempts at different orientations it almost always will turn the corner in the lacrimal sac and not bounce back. The plug at the proximal end is pushed into the punctum 다운로드.

The defect created by the excision of the sinus is closed. Here we are using a 7-0 vicryl horizontal mattress suture.

The mini Monoka was removed 2 months later and there was no evidence of recurrence of the sinus 6 months post-operatively 다운로드.

Alternative surgical interventions have been used for accessory lacrimal sinus excision. Excision of the mouth of the sinus and then closure of the conjunctiva across the sinus is the least interventional has minimal risk of damaging the normal canaliculus but probably has high recurrence rates because of tears passing into the residual portion of the sinus and gradually the sinus re-epithelialising towards the surface. DCR surgery with sinus excision is also described. The DCR is actually downstream of the aberrant anatomy, but the reduced resistance to flow of the shortened drainage system may facilitate tears passing down the normal canaliculus and help prevent recurrent of the sinus.

 

References

Satchi K, McNab AA. Double lacrimal puncta: clinical presentation and potential mechanisms of epiphora. Ophthalmology. 2010;117(1):180-3 e2.

Sullivan TJ, Clarke MP, Morin JD, Pashby RC. The surgical management of congenital lacrimal fistulae. Aust N Z J Ophthalmol. 1992;20(2):109-

 

Inferomedial orbital strut removal in endoscopic medial wall orbital decompression surgery

This narrated video demonstrates the down-fracture and removal of the inferomedial strut during endoscopic medial wall decompression surgery. It show this being carried out mechanically with a curette and it being thinned with a burr prior to down-fracturing 다운로드. The excellent view of the strut and the relative ease of removal, as well as the option to titrate how much is removed according to the patient are strengths of the endoscopic approach to medial wall decompression What is justice downloaded.

This video has been prepared by Dr Laura Abbeel

 

Voiceover Text

The inferomedial orbital strut or maxillo-ethmoid junction is a bony structure located in the medial orbital wall Asp net excel download.

The posterior part of the strut can be removed during medial wall and orbital floor decompression to increase the orbital volume further.

The anterior portion of the IOS is formed from the thick maxillary bone 다운로드. It probably provides structural support to the globe. Anteriorly it lies just lateral to the nasolacrimal duct

The midportion of the strut is a thickening of bone at the junction between the maxillary bone of the orbital floor and the ethmoid bone of the medial wall 다운로드. The bony support to this area of the strut is from the bulla and middle concha of the ethmoid bone, which is less robust than the support to the anterior portion of the strut 웹툰 통 다운로드. Therefore, the strut can be down fractured in this area during decompression.

The posterior portion of the strut is formed by the junction of the palatine and the ethmoid bone 다운로드.

During endoscopic decompression less robust struts can be fractured and removed mechanically. Here the ethmoids and lamina papyracea have been removed to expose the periorbita 펌프잇업 가정용 다운로드.

An angled curette is being used to down fracture the strut. Care is taken not to damage, or accidentally incise the periorbita.

The strut is removed with a Blakesley forceps 메이즈러너 데스큐어 자막.

Sturdier struts need to be thinned first. It is being drilled down with the diamond DCR burr (arrow). It is now thin enough to be down fractured with the curette and again removed with Blakesley forceps 다운로드.

Fascial attachments join the periorbita to the anterior strut, which may contribute to the support of the globe. Therefore, typically only the mid section and posterior strut are removed to minimise the risk of inferomedial displacement of the globe with consequent strabismus and diplopia.

Once the strut has been removed the infero-orbital space can be accessed for further removal of the floor up to the infero-orbital nerve, depending on the required extent of decompression

 

References

  1. Kim JW et al. The inferomedial orbital strut: an anatomic and radiographic study. Ophthal Plastic and Recon Surgery 2002. 18 (5): 355–364

Subtenons orbital fat herniation excision

다운로드 This narrated video demonstrates excision of herniated subtenons fat. It discusses the mechanism by which the orbital fat may herniate and the difference between subconjunctival and subtenons herniated fat and reviews different techniques for safely excising herniated fat 다운로드. This video was made by Dr David Curragh. Navicat download

Congenital ptosis levator advance surgery

This narrated video demonstrates an anterior approach levator advance procedure for the correction of congenital ptosis. It discusses relevant aspects of the anatomy of the levator muscle as well as skin crease reformation 다운로드.

 

Voiceover

Congenital Ptosis, Levator Advance

 

 

In congenital ptosis, the skin crease is often less pronounced or absent as in this case, presumably because of the reduced function or insertions of the muscle 다운로드. The crease is marked at 8mm centrally, 5mm above the lateral canthus and 4mm above the medial canthus

A blepharoplasty is not being undertaken as there is no skin redundancy 복음성가 무료.

 

The skin is incised.

A high temperature cautery or hot wire is being used for dissection.

The tarsal plate is exposed. Identifying the dissection plane to the tarsal plate can be more difficult with the cautery than scissors, but the haemostatic effect is a big advantage 윈도우10 1803 다운로드. If the skin and orbicularis are grasped and retracted inferiorly and away from the globe, one can usually see a small pucker deep to the orbicularis, through where dissection will lead to the tarsal plate 다운로드.

 

Dissection at the lower end of septum exposes the inferior end of the levator aponeurosis. This is inferior to the pre-aponeurotic fat pad which although a useful landmark for ptosis surgery does not need to be exposed to identify the inferior end of the aponeurosis 다운로드.

 

The posterior surface of the retractors is dissected free from the underlying conjunctiva. One can either dissect between levator and Mullers to create a levator flap or between Mullers and conjunctiva to create a flap consisting of both retractors 다운로드. While there is no evidence to guide the choice, intuitively it seems prudent to use both retractors in congenital ptoses given the reduced levator function and sometimes a levator only flap does not appear to adequately elevate the lid 다운로드.

 

The lateral horn is the fan like extension of levator aponeurosis that attaches to the lateral retinaculum and lateral tubercle just inside the orbital rim 다운로드. It is transected at angle of 45 degrees medially and superiorly which avoids the lacrimal ductules. This allows levator to advance more freely

Similarly the medial horn which passes over superior oblique tendon and attaches to the posterior portion of the medial canthal tendon and the posterior lacrimal crest, is partially transected slui exe.

 

A quick check of the lid contour and the position of its peak aids suture placement.

A double ended 6-0 vicryl suture is passed partially thickness in the tarsal plate. The lid is everted to ensure it is not full thickness.

Each of the two needles is passed from the posterior to the anterior surface of the levator.

The suture is tied on a bow and the lid position checked.

 

The lid is marginally too high. The sutures are placed a couple of millimetres lower on the levator aponeurosis. The lid position is better. The levator has not been advanced a huge amount and just a small amount of its terminal end and adjoining orbicularis is resected.

 

This patient had no skin crease on this side. In this case, the orbicularis of the inferior incision edge is being sutured to the terminal end of the levator aponeurosis in a few places. This is thought to create a soft or less dense skin crease. This contrasts with the more widely used technique in Caucasian eyes of including a small bite of levator in the skin closure. There is very limited evidence for different skin crease reformation techniques and their outcomes in Caucasian eyes, but there are theoretical downsides to including levator in the skin closure. Firstly it may be at greater risk of slipping with resultant loss of the skin crease or change in its position because of the repeated pull on the closure from blinking. Secondly it is contrary to usual surgical teaching to include some internal tissues between skin edges. Finally, electron microscopy studies have questioned whether there are indeed slips of levator that attach to skin. The skin is closed with a running 6-0 suture.

 

O’Donoghue stents for internal ostium fibrosis DCR failure

This narrated video demonstrates the endoscopic insertion of O’Donoghue nasolacrimal stents into a patient whose DCR has failed because of internal ostium fibrosis php.

 

Voiceover Text: O’Donoghue stents for internal ostium fibrosis DCR failure

DCR failure is typically from fibrosis over the external ostium 말하는 고양이 무료. However, sometimes and in some series in as many of 50% of DCR failures(1), fibrosis only occurs over the internal ostium, or common canalicular opening as in this case 다운로드.

 

Secondary O’Donoghue tubes are being placed to overcome and stent the obstruction.

 

Endoscopic visualisation enables close observation of the internal ostium to ensure that a false passage is not made 스택독 다운로드. Multiple gentle attempts are made to pass the stents before they are successfully passed through the ostium. It is very tempting to try and force the stents through, which invariably creates a false passage, but delicate angulation, allows the ostium to be found 바탕화면 메모.

 

The stents are secured with a small segment of size 8 feeding tube and a couple of liger clips. Whilst the tube is being secured, the position of the loop of the stent at the medial canthus is carefully checked or gently lifted with an instrument such as a ball probe to ensure that it is not pulled tight risking cheese wiring of the puncta macos 모하비.

 

There is no evidence to guide how long the stents should be left in situ. However, it is probably prudent to leave them at least for a couple of months, and if the epiphora resolves and there are no adverse effects from the stents being in situ, they can probably be left indefinitely 다운로드.

 

References

 

  1. Lin GC, Brook CD, Hatton MP, Metson R. Causes of dacryocystorhinostomy failure: External versus endoscopic approach 아이언맨2 자막 다운로드. Am J Rhinol Allergy. 2017;31(3):181-5.
  2. Ali MJ, Psaltis AJ, Wormald PJ. Dacryocystorhinostomy ostium: parameters to evaluate and DCR ostium scoring 인크레더블 더빙 다운로드. Clin Ophthalmol. 2014;8:2491-9.

 

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Conjunctivochalasis, excision and scleral tacking

This narrated video demonstrates the excision of redundant conjunctiva (conjunctivochalasis) with scleral tacking closure sutures that can be used for refractory cases 실행 중인 어플리케이션 다운로드. The video reviews the technique and possible complications. Alternative techniques are shown in other videos on this website

 

Conjunctivochalasis excision: cut and tack technique

 

Tacking the conjunctiva to the sclera may be beneficial in refractory conjunctivochalasis 월리를 찾아라 다운로드. The surgical field is prepared with topical anaesthetic and povidone iodine.

 

A speculum exposes the inferior conjunctiva and by stretching the conjunctiva minimises the risk of over-zealous excision 영화 생활의 발견 다운로드. However, it makes it harder to determine the location and degree of redundancy, which should be assessed and can be marked prior to placing the speculum 다운로드.

 

Marking the area the redundant fold is not essential, but can help ensure a neat elipse is excised.

The procedure can be done under topical anaesthetic but a small injection of subconjunctival anaesthetic may make it more comfortable and raise the conjunctiva to be excised 윈도우 10 사운드 드라이버 다운로드.

 

The redundant conjunctival fold is excised.

 

Buried 8-0 vicryl are being placed that enter from the internal surface of the superior edge and exit on the external conjunctival surface 다운로드. They re-enter through the external surface of the inferior edge and exit on the inside of the incision and then a cautious bite of the sclera is taken to tack the conjunctiva down before the suture is tied with the knot buried 드래곤 길들이기 3 더빙판 다운로드. A spatulated needle is probably the best balance between relatively easy penetration and passage through the sclera without the increased risk of penetration of the cutting needle and even more so of the reverse cutting needle 다운로드.

 

A couple more tacking sutures and a couple of simple conjunctiva closure sutures are placed.

 

The procedure does carry a risk of complications including ocular penetration, fornical shallowing, cicatricial entropion, globe restriction particularly of upgaze, granuloma formation and persistent inflammation or giant papillary conjunctivitis 다운로드.

 

 

Flap Formation in Endoscopic DCR

This narrated video demonstrates the formation of lacrimal sac and nasal mucosal flaps in endo DCR and reviews the different instruments that can be used for these steps of endo DCR and the way that the flaps should sit after they have been formed and opened out 다운로드.

Voiceover Text

 

Forming anterior and posterior lacrimal sac flaps can be one of the more challenging stages of endoscopic DCR 다운로드.

 

The lacrimal sac is tented up with a Bowman probe. The exquisitely sharp disposable cataract keratome is being used to make a longitudinal, vertical incision in the lacrimal sac 의천도룡기 2019 한글자막 다운로드.

 

The full vertical height of the sac is incised; this can be continued with the keratome taking great care not to damage the canalicular opening, also known as the internal ostium and the lateral mucosal surface of the lacrimal sac 다운로드. Alternatively an angled spear knife can be used to continue the incision; it is less sharp so may reduce the risk of damage to the sac and ostium but sometimes tears the sac a little

 

A hooked micro sickle knife is being used to make the horizontal transverse cuts at the top and bottom of the anterior lacrimal sac flap 코코 더빙판 다운로드. This can be an unsatisfactory step because they are frequently blunt and the lack of counter traction, can tear rather than cut the lacrimal sac.

 

Straight Belucci microscissors are being used to make the transverse cuts at the top and bottom of the posterior lacrimal sac flap 다운로드.

 

Sometimes the lacrimal sac mucosa is thickened, perhaps from chronic inflammation or even occasional lymphoproliferative disease. In this case the microbite lusk forcep can be used to make the transverse incisions at the top and bottom of the posterior lacrimal sac flap 다운로드. This throughbiting instrument is generally sharp and cuts well but does excise a bit of tissue, which may reduce the mucosal apposition at the top and bottom slightly my summer car.

 

Depending on one’s endo DCR technique the raised and reflected nasal mucosal flap can be too large to neatly abut the end of the posterior lacrimal sac flap 다운로드. It is being trimmed here with a microbite Lusk forcep. This nice instrument cuts well when the jaws are being closed whilst simultaneously pulling the flap towards you to create couter-traction office 365 학생.

 

The flaps should open freely, without a tension pulling them forward or closed again, rather like opening an old book with a very worn spine.  The anterior lacrimal sac is reflected anteriorly to rest against the lateral nasal wall but does not adjoin a nasal mucosa flap end to end like in external DCR. The posterior flap is reflected backwards and can be positioned to abut the end of the raised and later trimmed nasal mucosa so as to create a continuous mucosal lining. This may reduce the risk of subsequent fibrosis and osteal closure. Most endoscopic DCR surgeons do not suture the flaps and while this can be done studies that have found similar recurrence rates for endo and external DCR report endo DCR without flap suturing.

 

Extraocular muscle biopsy

다운로드 This narrated video demonstrates extraocular muscle biopsy. It reviews the technique, the possible complications and also explores the possible causes of extraocular muscle enlargement 다운로드.

 

  mp4 샘플 동영상

Sliding tarsoconjunctival flap reconstruction of the upper eyelid

This narrated video demonstrates a sliding tarsoconjunctival flap reconstruction of a post tumour excision shallow upper eyelid defect. If the full height of the upper lid has been excised, this technique can be used to reconstruct up to around 50% of the lid 하얀새 다운로드. If the full height has not been excised then the residual tarsal plate can be slid into wider defects.

 

Voiceover text

 

Residual superior upper lid tarsus can be slid into an upper lid defect to reconstruct the posterior lamella nsp 파일.

 

Around 50% of the upper lid has been excised. However, when the lid is everted and the tarsus assessed, there is around 4-5mm of residual tarsus superior to the defect 다운로드. This can be advanced in a similar fashion to a Hughes flap to the lower lid, but of course just into the upper lid defect.

 

The merged septal-retractor fibres are dissected off the tarsal plate

 

The edges of the defect are continued as vertical incisions into the residual superior tarsal plate 공인중개사 pdf.

 

The flap is further released, until it can be advanced into the defect without any tension. As with a lower lid tarsoconjunctival flap, this dissection can be between Mullers and levator or between Mullers and conjunctiva which may be preferable as the attachment to conjunctiva alone probably increases its mobility and reduces tension that may cause lid retraction 다운로드.

 

The flap is sutured in situ. It is sutured a couple of millimetres advanced of the neighbouring host tarsus as it tends to retract a little 다운로드.

 

The advancement flap should have a little horizontal tension to keep the upper lid architecture and contour and In this case it is a little too wide so is trimmed 빵집3.

 

The other side is sutured to the host tarsus.

 

An anterior lamella advancement flap is also created, utilising pre-existing dermatochalasis 마이 백 페이지. The skin advancement flap is sutured 2-3mm recessed of the lid margin as it will advance and the tarsal flap will retract.

 

The reported complications and adverse outcomes of the sliding upper lid tarsoconjunctival flap are upper lid retraction, upper lid entropion and lagophthalmos 다운로드.

 

 

 

This technique can also be used to reconstruct eyelid colobomas

 

References

 

  1. Hashish A, Awara AM 다운로드. One-stage reconstruction technique for large congenital eyelid coloboma. Orbit 2011;30(4):177-9. doi: 10.3109/01676830.2011.582979
  2. deSousa JL, Malhotra R, Davis G. Sliding tarsal flap for reconstruction of large, shallow lower eyelid tarsal defects. Ophthal Plast Reconstr Surg 2007;23(1):46-8. doi: 10.1097/IOP.0b013e31802dd415
  3. Malik A, Shah-Desai S. Sliding tarsal advancement flap for upper eyelid reconstruction. Orbit 2014;33(2):124-6. doi: 10.3109/01676830.2013.814681
  4. Morley AM, deSousa JL, Selva D, et al. Techniques of upper eyelid reconstruction. Surv Ophthalmol 2010;55(3):256-71. doi: 10.1016/j.survophthal.2009.10.004

 

 

 

Surgical approaches to the orbit

로코모션 This narrated video demonstrates the most widely used surgical approaches to the orbit that are employed for procedures such as anterior and lateral orbitotomy and decompression surgery 다운로드. Each of these procedures is reviewed in more detail in specific videos, but this video gives an overview which may help more junior orbital surgeons to start to develop an understanding of how different areas of the orbit can be accessed 다운로드

Paediatric Endoscopic DCR

This narrated video focuses on the challenges of and surgical technique for paediatric endoscopic DCR surgery.

DCR is sometimes required for paediatric congenital or acquired nasolacrimal duct obstruction. Paediatric Endoscopic and external DCR have similar success rates of around 83-96%.

The anatomy and technique of endo DCR in general is explored in more detail in other videos on this website 다운로드.

Voiceover

Endoscopic DCR has the significant advantage in children of avoiding a skin incision with risk of scarring and does not disrupt the medial canthal tendon. It also enables visualisation of the nasal anatomy and ostium, providing the opportunity to address turbinate abnormalities, membranes, polyps and other abnormal findings 다운로드.

The nasal mucosa has already been decongested either with co-phenilcaine or cocaine soaked neuropatties. It is infiltrated with lignospan. The weight adjusted doses must be calculated pre-operatively and carefully adhered to. The safe doses are extremely low in young children.

Similarly, the maximum allowable blood loss should be calculated prior to commencing the procedure and in small children is a surprisingly small volume of blood 톰캣 7 다운로드. The use of the monopolar needle to create the nasal mucosa is of benefit in paediatric DCR as there is less bleeding than when the blade is use.

The nasal space is narrower in children than in adults. Therefore paediatric endoscopic DCR is technically more challenging than in adults. In adults narrow spaces can be improved with septoplasty, but this is contraindicated in children as it may impact on nasal growth and cosmesis 카티아 학생용 다운로드. However, although the space starts of seeming very narrow, it generally accommodates a 4mm scope comfortably after the nasal mucosa is raised and the bony ostium formation commenced. If the 4mm scope is not easily passed, or risks repeated trauma to the nasal septum, then a 2.7mm rigid 30 degree scope should be available for use.

The nasal flap is raised on a posterior base and then reflected over the middle turbinate to keep it out of the way Winxp download. Some surgeons prefer to make a much smaller nasal flap which has the advantage of needing less or no trimming to abut the posterior lacrimal sac flap, but may get in the way during surgery.

The bony ostium is formed initially mechanically with the Hajak koffler. The superior aspect is enlarged with the Malhotra nibbler. It is completed with the DCR burr 실시간티비 다운로드. As with adults the ostium in enlarged until it exposes the entire lacrimal sac, but the created ostium is smaller in children than in adults; typically around 10 x 10mm in younger children and 10mm wide by 15mm high in older children. The vertical height of the nasal cavity is smaller in children. This may increase the risk of a CSF leak if the proximity of the skull base to the surgical site is not considered 다운로드.

The thin lacrimal bone is flaked away from the lacrimal sac.

The inferior canaliculus is probed. The probe is used firstly to assess if there is any canalicular pathology, by feeling if there are any obstructions or a sensation of tightness around it. The lid must be on lateral tension whilst this is assessed, otherwise folds are easily mistaken for membranes and canalicular obstructions, which are in fact extremely rare in children 스카이림 엘더스크롤 다운로드. Secondly the probe is used to tent up the lacrimal sac to minimise the risk of trauma to the internal ostium and internal mucosal lining of the sac when it is incised with the exquisitely sharp cataract keratome.

The keratome and then hooked sickle are used to form anterior and posterior lacrimal sac flaps which are reflected anteriorly and posteriorly respectively 천재교육 교사용 cd 다운로드.

The nasal flap is trimmed to abut the posterior lacrimal sac flap. It is still too large and The is reduced further
The flaps are manipulated into a good position well clear of the internal ostium. Generally, they seem to remain where they are placed intraoperatively, so it is worth spending a bit of time ensuring they are well located and without any tension on them that might pull them out of position 왕좌의 게임 시즌 1 다운로드.
The internal ostium is checked for canalicular restriction or tightness. The role of nasolacrimal stents remains uncertain, but there does not seem to be any benefit to using them if the cause of obstruction is exclusively distal to the internal ostium, that’s to say the pathology is in the nasolacrimal duct, or lacrimal sac, which will of course be bypassed.. Omission of stents is of particular benefit in children in whom the removal of the stents may require another general anaesthetic.

Supporting literature1 2

1. Al-Nuaimi D, Inkster C, Lobo C. Paediatric powered endonasal dacryocystorhinostomy. Eur Arch Otorhinolaryngol 2011;268(12):1823-8. doi: 10.1007/s00405-011-1605-z
2. Leibovitch I, Selva D, Tsirbas A, et al. Paediatric endoscopic endonasal dacryocystorhinostomy in congenital nasolacrimal duct obstruction. Graefes Arch Clin Exp Ophthalmol 2006;244(10):1250-4. doi: 10.1007/s00417-006-0273-y

Canaliculotomy for canaliculitis

컷위자드 다운로드 This narrated video demonstrates a canaliculotomy for canaliculitis with removal of multiple casts. It also contains teaching slides exploring the aetiology and management of canaliculitis and footage of the use of dacyroendoscopy for the management of canaliculitis 다운로드.
This video was produced by Dr Huw Oliphant 다운로드

Propeller flap, tarsal graft and periosteal flap

Propeller or subcutaneous island skin flap provide a versatile options for anterior lamellar reconstruction. They can support a posterior lamellar graft facilitating one stage reconstruction of big eyelid defects 타카네노 하나 다운로드.
This narrated video demonstrates the repair of a large defect with a free tarsal graft harvested from the contralateral upper eyelid and a periosteal flap to secure the lateral margin of the tarsal graft 다운로드. The anterior lamella is reconstructed with a propeller flap, which will support the graft, allowing this to be a one stage reconstruction of the lower lid in contrast to the more widely used Hughes procedure 피크닉 다운로드.

Voiceover Text

The propeller flap is positioned to recruit tissue from an area of sufficient laxity with an appropriate skin match and preferably siting scars along relaxed skin tension lines or on borders of cosmetic subunits 레고마인드스톰 ev3. It is also positioned to minimize the amount of rotation required although unlike conventional skin pedicle flaps it can be rotated 180 degrees or even slightly more if required 구글 플레이스토어.
The location of the pedicle is determined by the site of the defect and the positioning of the flap, but is typically one quarter of the flap diameter away from the defect 다운로드. In general, an inferior pedicle is preferred, to enhance lymphatic drainage and possibly reduce the risk of postoperative oedema or trapdooring.

The full circumference of the flap is incised and the flap is dissected free in either the subcutaneous or suborbicularis plane as per the desired flap thickness 다운로드. As the pedicle area is approached dissection is in the sub-orbicularis plane and an orbicularis pedicle is fashioned. A wide pedicle is created initially and it is gradually reduced whilst checking the rotation after each reduction, until a pedicle is created with the maximum diameter that will will allow adequate rotation without excessive torque 다운로드. The pedicle length can be increased by dissecting out more orbicularis, but again should be the minimum length required to allow the flap to reach the defect without tension on the pedicle 알피스 네오 다운로드. Typically a pedicle of diameter 6-10mm diameter and length 10-14mm is created. The flap is rotated and transposed into the defect, taking care not to accidentally rotate the pedicle any more than required 다운로드. The flap can be rotated and transposed slowly or in stages to maintain perfusion; the donor site can be sutured during this time. The flap is sutured into position and the placement of tacking sutures to secure the base of the flap is advisable.

The technique of propeller flap creation is discussed in more detail in another video on this website.

The upper eyelid is everted over a desmarres retractor. A free tarsal graft is harvested, ensuring at least 4 to 5mm of inferior tarsal plate is left in situ to maintain upper lid stability. The size of the graft is estimated according to the defect size with the edges of the defect held together on tension. The medial edge of the tarsal graft is sutured to the residual medial tarsal plate. The entire lateral tarsal plate and lateral canthal tendon has been excised. Therefore a periosteal flap is raised. It is secured to the lateral edge of the tarsal graft.

The flap is rotated and transposed into the defect, taking care not to accidentally rotate the pedicle any more than required. The flap can be rotated and transposed slowly or in stages to maintain perfusion; the donor site can be sutured during this time. The flap is sutured into position and the placement of tacking sutures to secure the base of the flap is advisable.

Trapdooring or persistent oedema under the flap is one complication that may be encountered which may settle in time or require further intervention.

Lower eyelid anterior lamella propeller flap reconstruction

Xml download Propeller or subcutaneous island skin flap provide a versatile options for anterior lamellar reconstruction. They can support a posterior lamellar graft facilitating one stage reconstruction of big eyelid defects 소화기 사용법 동영상 다운로드. They are only rarely described for periocular tumour surgery, but make a very useful addition to the periocular reconstructive armamentarium.
This narrated video demonstrates the raising of a propeller flap to replace the anterior lamella of a complete lower eyelid defect 다운로드. This flap supports a free tarsal graft posterior lamella reconstruction. This obviates the need for a two stage procedure such as a Hughes flap.

Eyelid Biopsy

인터뷰 다운로드 This narrated video demonstrates incisional, punch and shave techniques of eyelid biopsy and explores the advantages and disadvantages of each. 오른팔과 소녀 다운로드 다운로드 다운로드 포우 버그 판 다운로드

Ritleng bicanalicular nasolacrimal stent insertion

코분투 다운로드 This narrated video demonstrates the endoscopically assisted insertion of the Ritleng bicanalicular nasolacrimal stent. It explores the technique of insertion using the Ritleng introducer and how to secure the knot in the nasal cavity 다운로드. It also briefly reviews the anatomical location of the terminal end of the nasolacrimal duct under the inferior turbinate. 다운로드

Endoscopic optic canal decompression

다운로드 This narrated video demonstrates endoscopic decompression of the intracanalicular section of the optic nerve in the sphenoid sinus. It explores the surgical anatomy with particular attention to the lateral wall of the sphenoid sinus 천국보다 아름다운 다운로드. It also briefly shows the standard FESS access to the sphenoid sinus all the pre-operative CT anatomy assessment of the sinuses and the FESS approach are explored in detail in other videos on this website 다운로드.

Keywords
endoscopic optic canal decompression, optic nerve decompression, intracanalicular optic nerve, sphenoid sinus, carotid artery, posterior nasal artery, optic strut

Dermolipoma excision

This narrated video demonstrates the excision of a dermolipoma. The excision of these periocular choristomas can result in complications particularly to the lateral rectus and the palpebral lobe of the lacrimal gland and its ductules 다운로드. This video demonstrates identification of these structures and slinging of the lateral rectus to minimise the risk of trauma and facilitate complete excision of one lobe of the dermolipoma exerd 개인.

Useful References
Early results of surgical management of conjunctival dermolipoma: partial excision and free conjunctival autograft
Youn Joo Choi, In Hyuk Kim, Jeong Hoon Choi, Min Joung Lee, Namju Kim,
Ho-Kyung Choung, Sang In Khwarg, BJO 2015

Clinical features and surgical management of dermolipomas
Alan A 다운로드. McNab, John E. Wright , Anthony G. Caswell, Aus NZ J of Ophth 1990

Management of a narrow nasal space in endoscopic DCR

다운로드 This narrated video demonstrates techniques for managing a narrow nasal space in endoscopic DCR. It shows how to use instruments to increase the nasal cavity space and access to the region overlying the lacrimal sac and briefly shows septoplasty surgery. 마운트앤블레이드 모드 다운로드

Secondary orbital ball implant and buccal mucosa fornix reconstruction

씨 브라우저 다운로드 This narrated video demonstrates secondary orbital ball implant surgery and buccal mucosa fornix reconstruction. The exact procedure will need to be tailored to the specific patient considering the degree of volume loss, the amount of scarring, tissue loss and fornix shortening, the nature of the original trauma, the presence or absence of an existing implant and donor materials and numerous other factors 다운로드.

This video shows a complex secondary ball implant and buccal mucosa fornix reconstruction for patient with pronounced post-enucleation socket syndrome, profound orbital volume loss and forniceal shortening and previous reconstructive skin grafts to the orbit 다운로드.

Buccal mucosa harvest

다운로드 This narrated video demonstrates the harvesting of buccal mucosa and reviews the anatomy of the region, surgical technique and potential complications 다운로드. Buccal mucosa is a versatile autologous lining material that is used in various surgical specialties including ophthalmology, urology, gynaecology and plastic surgery 다운로드. In ophthalmology it is used in eyelid and socket reconstruction.

Lateral cantholysis for retrobulbar haemorrhage

매거진 This narrated video demonstrates lateral cantholyis for the management of an acute orbital compartment syndrome from retrobulbar haemorrhage. It shows the compromised retinal vasculature prior to and the resolution of normal venous pulsation after acute management. 저스티스리그 다운로드 쿠키 런 다운로드

Lateral orbital wall decompression, rim sparing, ab-interno

다운로드 This narrated video demonstrates the rim sparing ab-interno approach to lateral orbital wall decompression, which may minimise temporalis trauma and haemorrhage thereby probably reducing the risk of temporalis hollowing and masticatory oscillopsia 무료 찬송가 다운로드.
뮤턴트 워 다운로드

Caruncular orbital approach

순풍산부인과 다운로드 This narrated video demonstrates the caruncular approach to the medial orbit which provides excellent medial orbital exposure for a range of procedures, such as medial orbital wall and orbital floor decompression and cauterisation of a bleeding ethmoidal artery. aoa 심쿵해 다운로드 다운로드

Orbital floor decompression

다운로드 This narrated video demonstrates orbital floor decompression for thyroid eye disease. It also briefly shows the swinging lower eyelid approach to the orbital floor 오늘도 빛나는 너에게 mr 다운로드. 다운로드

Orbital fat decompression

다운로드 This narrated video demonstrates the excision of supero-medial and infero-lateral orbital fat as part of orbital decompression surgery for thyroid eye disease. 2018 9월 모의고사 다운로드 다운로드

Ultrasonic aspirator bone removal in lateral orbital wall decompression

임베디드 다운로드 This short narrated video demonstrates the use of the Sonopet ultrasonic aspirator for fragmenting and removing the bone of the lateral wall of the orbit 커피프린스1호점 다운로드. 다운로드

CSF leak In lateral wall orbital decompression

npdf This narrated video demonstrates a CSF leak during the drilling out of the trigone in a lateral wall orbital decompression. The anatomy of the trigone and the locations where the dura can be breached, as well as the management of CSF leaks in this region are reviewed 시로 오니 다운로드. 펀치히어로 1.3.8 다운로드

Lateral Orbitotomy Tumour Excision

원펀맨 1기 다운로드 This narrated video demonstrates a lateral orbitotomy approach with removal of the lateral orbital rim to access and remove a large lacrimal gland tumour sims 3. 다운로드

Upper lid lateral tarsal strip, anterior lamella repositioning and blepharoplasty for floppy eyelid syndrome

헤비 거너 다운로드 This narrated video demonstrates an upper lid lateral tarsal strip, anterior lamella repositioning and blepharoplasty for floppy eyelid syndrome.
엘리자베스 하베스트 다운로드 네이버 블로그 동영상 고화질 스타트컴퍼니 다운로드 안드로이드 8.0 오레오 다운로드

Modified endoscopic DCR and Lester Jones tube insertion

다운로드 This narrated video demonstrates a modified endoscopic DCR and Lester Jones lacrimal bypass tube insertion, which is also known as conjunctivodacryocystorhinostomy facebook 비공개 동영상 다운로드. The modified endoscopic DCR has a nasal mucosal window instead of a flap and a smaller rhinostomy that may provide better bony support for the tube. 게임 데브 타이쿤