Orbital Sling Technique
다운로드The 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.
빵집3Marginal 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.
Nasofacial sulcus island pedicle (V to Y) advancement flap
vocaloid4This 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 xinetd rpm 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.
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.
The skin is incised.
A high temperature cautery or hot wire is being used for dissection.
The tarsal plate is exposed 다운로드. 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. 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 복음성가 무료.
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.
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 윈도우10 1803 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.
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.
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 다운로드. 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 다운로드. 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 다운로드. 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 다운로드. 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 slui exe. The skin is closed with a running 6-0 suture.
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
- 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
- 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
- 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
- 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
로코모션This 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