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Oculoplastic Surgery Videos
August 30 at 2:12 PM ·
The approach for a lateral orbitotomy can be performed through a number of incisions including a superior lid crease, extended superior lid crease (Kronlein), coronal/hemi-coronal, sub-brow (Stallard-Wright) and lateral canthal. I prefer the lateral canthal incision with an inferior and superior cantholysis. I believe it gives me good access to the entire lateral orbit, the closure is simple, and the cosmetic result is great.
For a written transcript of this video, please see below:
This is Richard Allen at the University of Iowa. This video demonstrates a lateral orbitotomy using a lateral canthal incision in a patient with a presumed cavernous hemangioma.
A lateral canthotomy and inferior and superior cantholysis are performed with the needle tip cautery.
4-0 silk suture is then placed through the lateral upper and lower lid to provide traction during the case.
Dissection is carried out to the lateral orbital rim.
Desmarres and malleable retractors provide exposure to the rim. The periosteum of the lateral orbital rim is incised with the monopolar cautery.
The periosteum is then elevated off of the lateral orbital rim and lateral orbital wall with the Freer periosteal elevator.
Along the lateral orbital wall one often encounters the zygomaticofacial and zygomaticotemporal neurovascular bundles. This tumor is in the inferior lateral quadrant.
Westcott scissors are used to make an incision through the periorbita in this quadrant.
Blunt dissection is then carried out with narrow malleable retractors through the orbital septa to expose the orbital fat.
The malleable can usually palpate the tumor and blunt dissection with the malleables as well as cotton tip applicators results in exposure of the tumor.
The tumor is visualized, and in this case, a cryo tip will be used to engage the tumor and slowly deliver it from the orbit.
The tumor has the gross appearance of a cavernous hemangioma which was confirmed by the pathologist.
Repair of the cantholysis is performed by engaging the periosteum of followed by the lateral lower lid, followed by the lateral upper lid, and finally the periosteum again.
This is a 4-0 Vicryl suture on a P-2 needle which, when tied, repositions the lateral canthus appropriately.
The lateral canthotomy is then closed with a deep interrupted 4-0 Vicryl suture followed by superficial interrupted 5-0 fast absorbing sutures.
Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
YouTube link to this site: https://youtu.be/i107OYza7kE
Oculoplastic Surgery Videos
August 23 at 7:09 PM ·
The challenge: how many surgeries can be done with as few external incisions as possible? In this video, an upper blepharoplasty, MMCR, browpexy, and canthoplasty are performed. I am doing more and more browpexies and canthoplasties through the blepharoplasty incision to stabilize both the brow and lower lid. Other procedures also to consider through the blepharoplasty incision would be transection of the corrugators and mid-face elevation.
For a written transcript of this video, please see below:
This is Richard Allen at the University of Iowa. This video demonstrates a blepharoplasty with a trans-blepharoplasty browpexy, canthopexy, and Muller muscle-conjunctival resection (MMCR). The blepharoplasty is marked and a needle tip cautery is used to make an incision along the blepharoplasty marking. A flap of skin and orbicularis muscle is removed. The medial fat pad is exposed and mobilized. The fat pad usually needs to be anesthetized due to the pain during its excision. The same is then performed on the other side. The fat pad is mobilized and anesthetized and each side is then conservatively excised. I don't feel the need clamp fat in these areas. I think careful excision of the fat can be performed without clamping it. Dissection is then carried out superiorly along the surface of the orbital septum to the superior rim. Dissection is then carried out superior to the superior orbital rim in a pre-periosteal fashion with the Freer periosteal elevator. The area is measured above the superior orbital rim which is usually about 12 millimeters. The spot is then engaged with a 4–0 Vicryl suture. The same measurement is then made from the superior skin edge to the brow fat pad. This area is then engaged with the 4–0 Vicryl suture. The suture is then tied which results in placement of the upper blepharoplasty incision edge at the superior orbital rim.
A trans-blepharoplasty canthopexy will then be performed. This is performed with a 4–0 Prolene suture which is placed through the blepharoplasty incision laterally to exit out the lateral canthus at the level of the tarsus of the lower lid. The suture is then replaced and directed posteriorly where it engages the periosteum of the superior lateral orbital rim. The suture is then retrieved. Tightening the suture will result in tightening of both the upper and lower lid. The sutures are left untied at this point. The browpexy is then performed on the opposite side. The brows appear to be in good position. The trans-blepharoplasty canthopexy is then performed on the opposite side. Again the suture enters at the blepharoplasty incision and exits out the lateral canthus at the level of the tarsus of the lower lid. The suture then reenters adjacent to the exit point. The suture is directed posteriorly to engage the lateral canthal tendon which then engages the periosteum of the superior lateral orbital rim. The suture is then retrieved. Again the suture will be left untied to facilitate performance of the MMCR.
Attention is then redirected to the upper lids where the MMCR will be performed. 4-0 silk sutures are placed through the upper lids at the level of the tarsus. The amount of conjunctival resection is marked with the needle point cautery. Forceps fixate the markings followed by placement of the Putterman clamp. A 6-0 chromic suture is then placed in a mattress fashion along the edge of the Putterman clamp. I don't place these sutures trans-blepharoplasty just due to the fact that I had some problems with bleeding when I placed the suture through the blepharoplasty incision. Therefore, I will place this with the knot at the conjunctiva. Often I place a contact lens postoperatively to prevent any irritation. Realistically, with the knot laterally, usually it does not cause much irritation. The same is performed on the other side with the MMCR. Attention is then directed to the canthopexy sutures which are tied. This is performed on each side. The blepharoplasty incisions will then be closed with interrupted and running 6–0 Prolene suture. At the conclusion of the case, the patient will use erythromycin ophthalmic ointment 3 times a day for a week. The patient will follow-up in approximately 1 week for suture removal and reevaluation.
Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
YouTube link to this video: https://youtu.be/Fef3rlp-ztc
To all my patients, friends and family:
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To all my patients and friends
