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Oculoplastics and Orbit

De
Te series Essentials in Ophthalmology was initi- to discuss clinically relevant and appropriate t- ated two years ago to expedite the timely trans- ics. Summaries of clinically relevant information fer of new information in vision science and have been provided throughout each chapter. evidence-based medicine into clinical practice. Each subspecialty area now has been covered We thought that this prospicient idea would be once, and the response to the frst eight volumes moved and guided by a resolute commitment in the series has been enthusiastically positive. to excellence. It is reasonable to now update our With the start of the second cycle of subspecialty readers with what has been achieved. coverage, the dissemination of practical inform- a Te immediate goal was to transfer inform- a tion will be continued as we learn more about tion through a high quality quarterly publication the emerging advances in various ophthalmic in which ophthalmology would be represented by subspecialties that can be applied to obtain the eight subspecialties. In this regard, each issue has best possible care of our patients. Moreover, we had a subspecialty theme and has been overseen will continue to highlight clinically relevant - by two internationally recognized volume edi- formation and maintain our commitment to e- tors, who in turn have invited a bevy of experts cellence. G. K. Krieglstein R. N.
Voir plus Voir moins
Contents
Chapter 1 Repair of Involutional Ectropion and Entropion: Transconjunctival Surgery of the Lower Lid Retractors Markus J. Pfeiffer
1.1 1.2
1.2.1
1.2.2
1.2.3
1.2.4
1.2.5 1.2.6
1.2.7
1.3
1.3.1
1.3.2
1.3.3
1.3.4
1.4
1.4.1
1.4.2
1.4.3
Introductîon . . . . . . . . . . . . . . . .1 Surgîca Anatomy o the Lower Lîd . . . . . . . . . . . . .1 Lower Lîd Posîtîon and the Intercantha Lîne . . . .2 Posterîor Lamea o the Lower Lîd . . . . . . . . . . . . .2 Anterîor Lamea o the Lower Lîd . . . . . . . . . . . . .2 Reatîonshîp Between the Anterîor and Posterîor Lameae . . . . . . . . . . . . . . . . . . . .2 Lower Lîd Crease . . . . . . . . . . . .4 Orbîta Septum and the Orbîtomaar Septum4 Lîd Margîn Shape and the Lîd Margîn Ange at the Lacrîma Punctum . . . . .4 Preoperatîve Evauatîon and Surgîca Pannîng . . . . . . . .4 Evauatîon o the Intercantha Lîne . . . . . .5 Evauatîon o the anterîor and posterîor Surace . . . . . . . .5 Evauatîon o the Three Vectors Inluencîng Lîd Functîon . . . . . . . . . . . . . . . . . . . .5 Evauatîon o the Lîd Margîn and the Punctum . . . . . . . . . . . .5 Surgîca Technîque or Ectropîon Repaîr . . . . . . . . .6 Prîncîpe o Retractor Fîxatîon . . . . . . . . . . . . . . . . . . . . .6 Access to the Medîa Retractors . . . . . . . . . . . . . . . . . .6 Access to the Centra Retractors . . . . . . . . . . . . . . . . . .7
1.4.4
1.4.5 1.4.6
1.5
1.5.1
1.5.2
1.5.3 1.6
1.6.1
1.6.2
1.6.3
Exposure o the Inerîor Tarsa Border . . . . . . . . . . . . . . . .7 Suture Technîque . . . . . . . . . . . .7 Correctîon o Horîzonta Laxîty . . . . . . . . . . . . . . . . . . . . . .9 Surgîca Technîque or Entropîon Repaîr . . . . . . . .10 Prîncîpe o Retractor Fîxatîon . . . . . . . . . . . . . . . . . . . .10 Access to the Lower Lîd Retractors . . . . . . . . . . . . . . . . .10 Suture Technîque . . . . . . . . . . .10 Repaîr o Compîcated Cases and Compîcatîons o Retractor Surgery . . . . . . . .10 Compîcated Invoutîona Ectropîon . . . . . . . . . . . . . . . . . .10 Compîcated Invoutîona Entropîon . . . . . . . . . . . . . . . . . .10 Compîcatîons o Retractor Surgery . . . . . . . . . . . . . . . . . . . .12
Chapter 2 Update on Mohs Micrographic Surgery Techniques for Excision and Reconstruction of Periocular Tumors: A Multidisciplinary Approach Christopher J. Miller, William R. Katowitz
2.1 2.1.1
2.1.2
2.1.3
2.2
Introductîon . . . . . . . . . . . . . . .14 Roe o Mohs Mîcrographîc Surgery în Treatîng the Patîent wîth Perîocuar Maîgnancy . . . . . . . . . . . . . . . .14 Hîstory o Mohs Mîcrographîc Surgery în the Treatment o Perîocuar Maîgnancîes . . . . . . . . . . . . . . .14 Carîicatîon o the Meanîng o Cînîca, Surgîca, and Pathoogîc Margîns . . . . .14 Steps o Mohs Mîcrographîc Surgery . . . . . . . . . . . . . . . . . . . .15
X
Contents
2.2.1
2.2.2
2.2.3
2.2.4
2.2.5
2.2.6
2.2.7
2.3
2.3.1 2.3.2 2.3.3 2.4
2.4.1
2.4.2
2.4.3
2.5
2.6
2.6.1
2.6.2
2.6.2.1
Step 1: Determînatîon o Cînîca Margîns . . . . . . . . . .15 Step 2: Debukîng o the Tumor . . . . . . . . . . . . . . .15 Step 3: Excîsîng the Inîtîa Mohs Specîmen . . . . . . . . . . . .17 Step 4: Gross Sectîonîng and Inkîng the Fresh Tîssue Mohs Specîmen . . . . . . . . . . . .18 Step 5: Mappîng the Mohs Specîmen . . . . . . . . . . . . . . . . . .18 Step 6: Embeddîng, Sectîonîng, and Staînîng the Pîeces o the Mohs Specîmen . . . . . . . . . . . . . . . . . .18 Step 7: Interpretatîon o the Pathoogîc Margîns by the Mohs Surgeon . . . . . . .18 Advantages o Mohs Mîcrographîc Surgery . . . . . . .19 Hîgh Cure Rates . . . . . . . . . . . .19 Tîssue Conservatîon . . . . . . . .20 Optîma Dîvîsîon o Labor . . .20 Dîferences Between Mohs Mîcrographîc Surgery and Common Standard Excîsîon Technîques . . . . . . . .20 Determînîng Approprîate Surgîca Margîns: How Does One Decîde Where to Cut? . .20 Comparîng and Contrastîng Methods o Mîcroscopîc Margîn Evauatîon . . . . . . . . . .21 Dua Vs. Separate Roes o Surgeon and Pathoogîst21 Potentîa Pîtas o Mohs Mîcrographîc Surgery . . . . . . .22 Perîocuar Tumors: Indîcatîons or Mohs Mîcrographîc Surgery . . . . . . .23 Choosîng a Management Pan Based on Rîsk Assessment o the Perîocuar Maîgnancy . . . . . . . . . . . . . . . .23 Mohs Mîcrographîc Surgery or Basa Ce and Squamous Ce Cancers . . . . . . . . . . . . . . . .23 Recurrent Versus Prîmary Tumors . . . . . . . . . . . . . . . . . . . .24
2.6.2.2 2.6.2.3 2.6.2.4
2.6.2.5 2.6.2.6 2.6.2.7 2.6.3
2.6.4
2.7
2.7.1 2.7.2 2.7.3 2.7.3.1
2.7.3.2 2.7.3.3
2.7.3.4
2.8
Hîstory o Prîor Irradîatîon . . .24 Immunosuppressed Patîent24 Addîtîona Hîstorîca Rîsk Factors . . . . . . . . . . . . . . . . . . . .24 Sîze and Locatîon . . . . . . . . . . .24 Hîstoogîc Subtypes . . . . . . . .24 Perîneura Invovement . . . . .25 Mohs Mîcrographîc Surgery or Sebaceous Carcînoma . . .25 Mohs Mîcrographîc Surgery or Meanoma . . . . . . . . . . . . . .26 Reconstructîon o Perîocuar Deects ater Mohs Mîcrographîc Surgery . . . . . . .27 Preoperatîve Consîderatîons27 Perîocuar Reconstructîon . . .27 Eyeîd Reconstructîon . . . . . . .29 Genera Prîncîpes o Eyeîd Reconstructîon . . . . . . . . . . . . .29 Upper Eyeîd Reconstructîon29 Reconstructîon o Lower Lîd Deects Ater Mohs Mîcrographîc Surgery . . . . . . .34 Reconstructîon o Medîa Cantha Deects Ater Mohs Mîcrographîc Surgery . . . . . . .34 Concusîon . . . . . . . . . . . . . . . . .40
Chapter 3 Upper Eyelid Retraction: Current Concepts in Management James Kirszrot, Peter A.D. Rubin
3.1 3.2.
3.3
3.4 3.5
3.6
3.7
3.8
Introductîon . . . . . . . . . . . . . . .45 Dîferentîa Dîagnosîs o Upper Lîd Retractîon . . . . .45 Etîoogy o Thyroîd-reated Upper Lîd Retractîon . . . . . . .46 Physîca Examînatîon . . . . . . .46 Sequeae o Upper Lîd Retractîon . . . . . . . . . . . . . . . . .47 Medîca Management o Thyroîd-reated Upper Lîd Retractîon . . . . . . . . . . . . . . . . .47 Important Consîderatîons Beore Addressîng Surgery or Upper Lîd Retractîon . . . .48 Basîc Prîncîpes or Surgîca Correctîon o Retractîon . . . .48
3.9 3.10
3.11
3.11.1
3.11.2
3.12
Preoperatîve Medîcatîon . . . .50 Surgîca Recessîon: Posterîor Approach . . . . . . . . .51 Surgîca Recessîon: Anterîor Approach . . . . . . . . .54 Levator Dîsînsertîon/ Muerectomy . . . . . . . . . . . . . .54 Graded Fu-Thîckness Anterîor Bepharotomy . . . . .54 Concusîon . . . . . . . . . . . . . . . . .58
Chapter 4 Lower Eyelid Retraction: Current Concepts in Management Scott M. Goldstein
4.1 4.2
4.3
4.4 4.5 4.6 4.7 4.8 4.9 4.10
Introductîon . . . . . . . . . . . . . . .61 Over-actîon o the Upper Lîd Retractors . . . . . . . . . . . . . . . . .61 Facîa Pasy and Lîd Retractîon . . . . . . . . . . . . . . . . .62 Lower Lîd Retractîon . . . . . . . .63 Nonsurgîca Approaches . . . .64 Surgîca Approaches . . . . . . . .66 Recessîon o Retractors . . . . .66 Spacer Grat . . . . . . . . . . . . . . .67 Mîdace Surgery . . . . . . . . . . . .68 Latera Tarsa Strîp . . . . . . . . . .70
Chapter 5 Surgical Orbital Anatomy A. Ducasse
5.1 5.2 5.2.1 5.2.2 5.2.3 5.2.3.1 5.2.3.2 5.2.3.3 5.2.3.4 5.2.4 5.2.4.1 5.2.4.2 5.2.4.3 5.2.4.4 5.2.5 5.2.6
Introductîon . . . . . . . . . . . . . . . Bony Orbît . . . . . . . . . . . . . . . . . Embryoogy . . . . . . . . . . . . . . . . Dîmensîons o the Orbît . . . . . Descrîptîon . . . . . . . . . . . . . . . . Upper Orbîta Wa . . . . . . . . . Latera Orbîta Wa . . . . . . . . . Inerîor Orbîta Wa . . . . . . . . . Medîa Orbîta Wa . . . . . . . . . Orbîta Margîns or Anges . . . Superîor and Medîa Margîn Inerîor and Medîa Margîn . . Superîor and Latera Margîn Inerîor and Latera Margîn . . Orbîta Rîm . . . . . . . . . . . . . . . . Orbîta Apex . . . . . . . . . . . . . . .
73 73 74 74 74 74 74 74 75 75 75 75 76 76 76 76
5.3 5.4 5.4.1 5.4.2 5.4.3 5.4.3.1
5.4.3.2 5.4.3.3 5.4.4 5.4.5 5.4.6 5.4.6.1 5.4.6.2 5.4.6.3
5.4.7 5.4.7.1 5.4.7.2 5.4.7.3 5.4.7.4
5.4.8 5.4.9 5.4.9.1
5.4.9.2
5.4.9.3 5.4.10 5.5
5.5.1 5.5.2 5.5.3 5.5.4 5.5.5 5.6
Contents
Orbîta Perîosteum. . . . . . . . .77 Orbîta Contents . . . . . . . . . . .77 Eyeba . . . . . . . . . . . . . . . . . . . .78 Optîc Nerve . . . . . . . . . . . . . . . .78 Orbîta Musces . . . . . . . . . . . .78 Levator Musce o the Upper Eyeîd (Levator Papebrae Superîorîs Musce) . . . . . . . . . .78 Ocuomotor Musces . . . . . . . .79 Supernumerary Musces . . . .80 Muscuar Fascîas . . . . . . . . . . .80 Maîn Lacrîma Gand . . . . . . . .81 Orbîta Arterîes . . . . . . . . . . . . .81 Ophthamîc Artery . . . . . . . . .81 Inraorbîta Artery . . . . . . . . . .88 Anastomosîs Between the Two Carotîd Systems . . . .88 Orbîta Veîns . . . . . . . . . . . . . . .89 Superîor Ophthamîc Veîn . . .89 Inerîor Ophthamîc Veîn . . . .89 Medîa Ophthamîc Veîn . . . .89 Organîzatîon o Orbîta Venous Draînage . . . . . . . . . . .90 Orbîta Lymphatîcs . . . . . . . . .90 Orbîta Nerves . . . . . . . . . . . . . .90 Intraorbîta Ocuomotor Nerves . . . . . . . . . . . . . . . . . . . . .91 Intraorbîta Branches o the Trîgemîna Nerve . . . . .91 Cîîary Gangîon . . . . . . . . . . . .92 Orbîta Fat . . . . . . . . . . . . . . . . .93 Anatomîca Orbîta Topography . . . . . . . . . . . . . . . .93 Intracona Space . . . . . . . . . . .93 Superîor Extracona Space . .94 Latera Extracona Space . . . .94 Inerîor Extracona Space . . . .94 Medîa Extracona Space . . . .95 Concusîons . . . . . . . . . . . . . . . .95
Chapter 6 Periocular Capillary Hemangioma: New Concepts in Natural History and Response to Glucocorticoids David H. Verity, Geoffrey E. Rose
6.1 6.1.1 6.1.2
Introductîon . . . . . . . . . . . . . .100 Etîoogy . . . . . . . . . . . . . . . . . .100 Investîgatîon . . . . . . . . . . . . . .100
XI
XII
Contents
6.1.3 6.2
6.2.1
6.2.2
6.2.3
6.3
6.3.1
6.3.2
6.4
Management . . . . . . . . . . . . .102 New Insîghts înto the Natura Hîstory o Perîorbîta Capîary Hemangîomas . . . . . . . . . . . .103 How Long and How Sîgnîicant îs the Growth Phase o Capîary Hemangîomas? . . . . . . . . . . .103 What îs the Nature o Invoutîon or Capîary Hemangîomas? . . . . . . . . . . .104 Do Capîary Hemangîomas Undergo Compete Invoutîon? . . . . . . . . . . . . . . .106 Changes în Capîary Hemangîomas Ater Loca Steroîd Therapy . . . . . . . . . . .107 Hemangîoma Characterîstîcs Assocîated wîth Need or Interventîon . . . . . . . . . . . . . .107 Invoutîona Changes în Voume and Veocîty Ater Steroîd Therapy . . . . . .107 Concusîon . . . . . . . . . . . . . . . .108
Chapter 7 Venouslymphatic Malformations (Lymphangioma) of the Orbit: Diagnostic and Therapeutic Challenges William R. Katowitz, Michael Kazim
7.1 7.2 7.3 7.3.1
7.3.2 7.4 7.5 7.5.1 7.5.2 7.5.3 7.5.4 7.5.5 7.5.5.1 7.5.5.2 7.5.5.3
Introductîon . . . . . . . . . . . . . .113 Cassîicatîon . . . . . . . . . . . . . .113 Imagîng . . . . . . . . . . . . . . . . . .116 Magnetîc resonance îmagîng . . . . . . . . . . . . . . . . . .116 Computed Tomography . . . .116 Hîstoogy . . . . . . . . . . . . . . . . .116 Treatment . . . . . . . . . . . . . . . .117 Treatment Overvîew . . . . . . .117 Systemîc Steroîds . . . . . . . . . .117 Surgery . . . . . . . . . . . . . . . . . . .117 Laser Treatment . . . . . . . . . . .117 Scerotherapy . . . . . . . . . . . .117 OK-432 . . . . . . . . . . . . . . . . . . .118 Sodîum Morrhuate . . . . . . . .118 Other Agents . . . . . . . . . . . . .119
7.5.5.4
7.6
Image-guîded Scerotherapy . . . . . . . . . . . . .119 Future Treatment Modaîtîes . . . . . . . . . . . . . . . .119
Chapter 8 Thyroidrelated Orbitopathy: New Immunologic Concepts and Future Implications Raymond S. Douglas, Terry J. Smith
8.1 8.2
8.2.1
8.2.2 8.3
8.3.1 8.3.2
8.3.3 8.4
8.4.1 8.4.2
8.4.3
8.4.4
8.5
8.5.1 8.5.2 8.6 8.6.1 8.6.2
Introductîon . . . . . . . . . . . . . .123 Immunoogîc Characterîzatîon o Dîsease Stages . . . . . . . . . .123 Inlammatîon and Hyauronan Accumuatîon . . . . . . . . . . . . .123 Resoutîon o Inlammatîon124 Autoîmmune Target Epîtopes . . . . . . . . . . . . . . . . . .124 Thyrotropîn Receptor . . . . . .124 Insuîn-îke Growth Factor-1 Receptor . . . . . . . . . . . . . . . . . .125 Addîtîona Autoantîgens . . .125 Centra Roe o Orbîta Fîbrobasts . . . . . .126 Inlammatîon . . . . . . . . . . . . .126 Extraceuar Matrîx and Voume Expansîon . . . . .127 Surace Moecue Expressîon . . . . . . . . . . . . . . . .127 Unîque Capacîty to Dîferentîate . . . . . . . . . . . .128 Impact o Envîronmenta and Genetîc Factors . . . . . . .129 Genetîcs . . . . . . . . . . . . . . . . .129 Envîronment . . . . . . . . . . . . . .129 Therapeutîc Impîcatîons. .130 Immune Subset Depetîon130 Cytokîne Therapîes . . . . . . . .131
Chapter 9 Decompression Surgery for Thyroid Related Orbitopathy: Status of the Art and Unresolved Issues Lelio Baldeschi
9.1
Introductîon . . . . . . . . . . . . . .144
9.2
9.3
9.3.1
9.3.2
9.3.2.1
9.3.2.2
Orbîta Decompressîon: No Technîque Fîts A . . . . . .144 State o the Art and Unresoved Issues . . . . .145 Decompressîon or Functîona Reasons . . . . .145 Decompressîon or Rehabîîtatîve Cosmetîc/Psychosocîa, and Symptomatîc Reasons147 Why Rehabîîtatîve Surgery? . . . . . . . . . . . . . . . . . .147 Rehabîîtatîve Decompressîon Surgery . . .147
Chapter 10 Orbital Volume Augmentation with Injectable Selfinflating Hydrogel Pellet Expanders: A Minimally Invasive Approach Michael P. Schittkowski, Rudolf F. Guthoff
10.1 Introductîon . . . . . . . . . . . . . .153 10.2 Compensatîon or Orbîta Voume Deicîency în Congenîta Dîsease . . . . .154 10.2.1 Congenîta Bînd Mîcrophthamos . . . . . . . . . .154 10.2.1.1 Symptoms . . . . . . . . . . . . . . . .154 10.2.1.2 Method . . . . . . . . . . . . . . . . . .155 10.2.1.3 Resuts . . . . . . . . . . . . . . . . . . .156 10.2.2 Congenîta Cînîca Anophthamos . . . . . . . . . . . .159 10.2.3 Sîde Efects . . . . . . . . . . . . . . .160 10.3 Compensatîon or Orbîta Voume Deicîency în Acquîred Dîsease . . . . . . .160 10.3.1 Acquîred Anophthamîc Enophthamos . . . . . . . . . . . .160 10.3.1.1 Patîents . . . . . . . . . . . . . . . . . .160 10.3.1.2 Method . . . . . . . . . . . . . . . . . . .160 10.3.1.3 Resuts . . . . . . . . . . . . . . . . . . .161 10.3.2 Acquîred Enophthamos Due to Phthîsîs o the Gobe . . . . . . . . . . . . . .161 10.3.3 Sîde Efects . . . . . . . . . . . . . . .161 10.4 Dîscussîon . . . . . . . . . . . . . . . .163 10.4.1 Congenîta Mîcrophthamos . . . . . . . . . .163
10.4.2 10.4.3 10.4.4
Contents
Acquîred Anophthamos . . .165 Voume Cacuatîon . . . . . . . .166 Possîbe Rîsks . . . . . . . . . . . . .167
Chapter 11 Hydroxyapatite Orbital Implant Exposure: Symptoms, Physiopathology, Treatment J.P. Adenis, M.P. Boncoeur Martel, P.Y. Robert
11.1 Introductîon . . . . . . . . . . . . . .171 11.2 Dîagnosîs and Physîopathoogy . . . . . .172 11.3 Treatment . . . . . . . . . . . . . . . .174 11.3.1.1 Autoogous Grats . . . . . . . . .174 11.3.2 Surgîca Technîques or Muer’s Musce Fap . . . .174 11.3.2.1 Conjunctîva–Muer’s Musce Fap Technîque 1 . . . . . . . . . .174 11.3.2.2 Conjunctîva–Muer’s Musce Fap Technîque 2 . . . . . . . . . .174 11.3.2.3 The Tarsoconjunctîva Pedîce Fap . . . . . . . . . . . . . . .177 11.3.3 Remova and Repacement o the Impant . . . . . . . . . . . . .177 11.4 Indîcatîons . . . . . . . . . . . . . . . .177 11.5 Dîscussîon . . . . . . . . . . . . . . . .178 11.6 Concusîon . . . . . . . . . . . . . . . .178
Chapter 12 Dermis Fat Implants Christoph R. Hintschich
12.1 12.2 12.3 12.4 12.4.1 12.4.2 12.5 12.6 12.6.1
12.7 12.7.1
12.7.2
12.8
Introductîon . . . . . . . . . . . . . .181 Hîstory . . . . . . . . . . . . . . . . . . .181 Prîncîpe . . . . . . . . . . . . . . . . . .182 Surgîca Procedure . . . . . . . .182 Prîmary DFG . . . . . . . . . . . . . .182 Secondary DFG . . . . . . . . . . .184 Resuts . . . . . . . . . . . . . . . . . . .185 Compîcatîons . . . . . . . . . . . .186 DFG Pacement în the Upper Eyeîd . . . . . . . .187 Indîcatîons . . . . . . . . . . . . . . . .187 Prîmary Dermîs Fat Transpantatîon . . . . . . . . . . .187 Secondary Dermîs Fat Transpantatîon . . . . . . . . . . .189 Essentîa Concepts . . . . . . . .191
XIII
XIV
Contents
12.8.1 12.8.2
12.8.3 12.8.4
12.8.5
12.8.6
12.8.7 12.8.8 12.8.9
12.9
Sîze o the Dermoat Grat . .191 Shape o the Dermoat Grat . . . . . . . . . . . . . . . . . . . . .191 Donor Sîte . . . . . . . . . . . . . . . .191 Avoîd Pacement o DFG onto Aopastîc Impants . . .191 Avoîd Compressîng the DFG wîth Orbîta Insertîon . . . . . .191 Avoîd Dîssectîon to Expose Extraocuar Musces . . . . . . .191 Fornîces . . . . . . . . . . . . . . . . . .191 Motîîty . . . . . . . . . . . . . . . . . . .192 Rehabîîtatîon Foowîng DFG Impantatîon . . . . . . . . .192 Concusîon . . . . . . . . . . . . . . . .192
Chapter 13 Rehabilitation of the Exenterated Orbit Giulio Bonavolontà, Adriana Iuliano, Diego Strianese
13.1 13.1.1 13.1.2 13.2 13.2.1
13.2.2 13.2.3 13.2.4 13.3
13.3.1
13.3.2 13.3.3 13.3.4
Introductîon . . . . . . . . . . . . . .196 Basîcs . . . . . . . . . . . . . . . . . . . .196 Indîcatîons . . . . . . . . . . . . . . .196 Rehabîîtatîon . . . . . . . . . . . . .196 Temporaîs Musce Transposîtîon . . . . . . . . . . . . .197 Frontaîs Musce Transer . .197 Mîdîne Forehead Fap . . . . .199 Ocuoacîa Prostheses . . . . .201 Cînîca Experîence wîth the Descrîbed Technîque . . . . . . . . . . . . . . . .203 Temporaîs Musce Transposîtîon . . . . . . . . . . . . .203 Frontaîs Musce Transer . . .203 Mîdîne Forehead Fap . . . . .204 Ocuoacîa Prostheses . . . . .204
Chapter 14 Salivary Gland Transplantation Gerd Geerling, Peter Sieg, Peter Raus
14.1 14.1.1
14.1.2.
Introductîon . . . . . . . . . . . . . .208 Background and Surgîca Prîncîpes . . . . . . . . . . . . . . . . .208 Quantîtatîve and Composîtîona Dîferences Between Saîva and Norma Tears . . . . . . . . . .209
14.2
14.2.1 14.2.2 14.3 14.3.1 14.3.2 14.4
14.4.1 14.4.2 14.5
14.5.1 14.5.2 14.5.3 14.6
Mînor Labîa Saîvary Gand Transpantatîon . . . . . . . . . . .210 Surgîca Technîque . . . . . . . .210 Cînîca Resuts . . . . . . . . . . . .211 Parotîd Duct Transposîtîon212 Surgîca Technîque . . . . . . . .212 Cînîca Resuts . . . . . . . . . . . .212 Subîngua Gand Transposîtîon . . . . . . . . . . . . .212 Surgîca Technîque . . . . . . . .213 Cînîca Resuts . . . . . . . . . . . .213 Submandîbuar Gand Transposîtîon . . . . . . . . . . . . .213 Surgîca Technîque . . . . . . . .213 Cînîca Resuts . . . . . . . . . . . .213 Late Compîcatîons . . . . . . . .214 Concusîon . . . . . . . . . . . . . . . .217
Chapter 15 Recent Developments in the Diagnosis and Management of Congenital Lacrimal Stenosis K.H. Emmerich, H.W. MeyerRüsenberg
15.1 Anatomy and Embryoogy219 15.1.1 Anatomy o the Lacrîma System . . . . . . . . . . . . . . . . . . .219 15.1.2 Lacrîma System Varîatîons219 15.1.3 Congenîta Atresîa . . . . . . . . .220 15.1.4 Varîatîons în Canaîzatîon . .220 15.2 Dîagnosîs and Examînatîon220 15.3 Congenîta Nasoacrîma Duct Obstructîon . . . . . . . . . .221 15.3.1 Etîoogy . . . . . . . . . . . . . . . . . .221 15.3.2 Dîferentîa Dîagnosîs o CNLDO . . . . . . . . . . . . . . . . .221 15.3.3 Treatment o CNLDO . . . . . .222 15.3.3.1 Procedures, Probîng, and Irrîgatîon . . . . . . . . . . . . .222 15.3.3.2 Intubatîon o the Lacrîma System . . . . . . . . . . . . . . . . . . .222 15.4 Acute Dacryocystîtîs . . . . . . .223 15.4.1 Cînîca Symptoms . . . . . . . . .223 15.4.2 Therapy . . . . . . . . . . . . . . . . . .223 15.4.2.1 Conservatîve Management223 15.4.2.2 Incîsîon . . . . . . . . . . . . . . . . . . .224 15.4.2.3 Intubatîon o the Lacrîma System . . . . . . . . . . . . . . . . . . .224 15.5.1 Dacryocystorhînostomy în Chîdren . . . . . . . . . . . . . . . .224
15.5.2
15.6 15.7 15.8
Endocanaîcuar Mîcroendoscopîc Procedures . . . . . . . . . . . . . . .224 Remova o Sîîcone Tubîng225 Congenîta Dacryocee . . . . .225 Fîstuas o the Lacrîma System . . . . . . . . . . . . . . . . . . .225
Chapter 16 Cosmetic Rejuvenation of the Lower Face and Neck Alan B. Brackup, Ari D. Abel
16.1. Introductîon . . . . . . . . . . . . . .229 16.1.1 Basîcs . . . . . . . . . . . . . . . . . . . .229 16.2 Pathophysîoogy o Lower Face and Neck Agîng . . . . . .229 16.2.1 Basîcs . . . . . . . . . . . . . . . . . . . .229 16.2.2 Skîn . . . . . . . . . . . . . . . . . . . . . .229 16.2.3 Subcutaneous Sot Tîssue Loss . . . . . . . . . . . . . . . . . . . . .230 16.2.4 Loss o Lîgamentous Support and Fat Deposîtîon231 16.3 Preoperatîve Anaysîs o the Lower Face and Neck232 16.3.1 Photographîc Anaysîs . . . . .232 16.3.2 Skîn . . . . . . . . . . . . . . . . . . . . . .232 16.3.3 Maar Regîon . . . . . . . . . . . . . .232 16.3.4 Jows . . . . . . . . . . . . . . . . . . . . .232 16.3.5 Bucca Fat . . . . . . . . . . . . . . . . .232 16.3.6 Chîn . . . . . . . . . . . . . . . . . . . . . .232 16.3.7 Neck . . . . . . . . . . . . . . . . . . . . .233 16.4. Procedure Seectîon . . . . . . .234 16.4.1 Tumescent Initratîon . . . . .234 16.4.2 Lîmîted Procedures . . . . . . . .234 16.4.2.1 Neck Lîposuctîon . . . . . . . . . .234 16.4.2.2 Chîn Augmentatîon . . . . . . .235 16.4.2.3 Patysmapasty . . . . . . . . . . . .235 16.4.3 Face-ît Surgery . . . . . . . . . . .239 16.4.3.1 Basîcs . . . . . . . . . . . . . . . . . . . .239 16.4.3.2 Aternatîve SMAS Approaches . . . . . . . . . . . . . . .239 16.4.3.3 S-Lîts . . . . . . . . . . . . . . . . . . . .241 16.4.3.4 S-Lît wîth SMASectomy . . .241 16.4.3.5 Face-ît wîth Sot Tîssue Augmentatîon . . . . . . . . . . . .241 16.4.4 Autoogous Fat Transer . . . .241
Chapter 17 Facial Sculpting with Injectable Filler Materials Jean Carruthers, Femida Kherani, Alastair Carruthers
17.1 17.2
17.3 17.3.1 17.3.2 17.3.3 17.3.4 17.4
17.4.1 17.4.2
17.4.3 17.4.4
17.5
Contents
Introductîon . . . . . . . . . . . . . .247 Facîa Scuptîng wîth Injectabe Fîers . . . . . .248 Temporary Fîîng Agents . .248 Hyauronans . . . . . . . . . . . . . .248 Coagen . . . . . . . . . . . . . . . . . .248 Autoogous Fat . . . . . . . . . . . .251 Poy-L-actîc Acîd Impants251 Permanent and Semî-permanent Injectabe Agents . . . . . . . . . . . . . . . . . . .251 DermaLîve/DermaDeep . . . .252 Cacîum Hydroxyapatîte Beads . . . . . . . . . . . . . . . . . . . .252 Poyakyîmîde . . . . . . . . . . . .253 Poymethymethacryate Mîcrospheres . . . . . . . . . . . . .253 Combînatîon Therapy: Botuînum Toxîn and Fîers255
Chapter 18 Overview of Skin Resurfacing Modalities Suzan Obagi, Meena ChaudharyPatel
18.1 Introductîon. . . . . . . . . . . . . .259 18.2 Indîcatîons. . . . . . . . . . . . . . .259 18.3 Pathophysîoogy o Agîng260 18.4 Patîent Assessment . . . . . . . .260 18.5 Hîstory and Physîca. . . . . . .260 18.6 Prîncîpes o Resuracîng . . .262 18.6.1 Pre-resuracîng Skîn Care . .263 18.6.2 Post-resuracîng Skîn Care264 18.6.2.1 Chemîca Pees . . . . . . . . . . . .264 18.6.3 Fractîona Photothermoysîs . . . . . . . . .269 18.6.4 Dermabrasîon . . . . . . . . . . . . .270 18.6.4.1 Dermabrasîon Endpoînts . . .270 18.6.4.2 Compîcatîons o Skîn Resuracîng . . . . . . . . . . . . . . .271 18.7 Concusîon . . . . . . . . . . . . . . . .272
Subject Index. . . . . . . . . . . . . . . . . . 277
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