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@#AIM:To observe the clinical effect of retrograde lacrimal duct drainage tube(RS-1 type)in the treatment of lacrimal canaliculus rupture in children.<p>METHODS: The clinical data of 37 cases(37 eyes)with lacrimal canaliculus rupture admitted to Handan Eye Hospital and Handan Central Hospital from March 2016 to November 2019 were retrospectively analyzed. New silicone tubes were retrograde implanted in all patients during the operation. 8-0 absorbable sutures were used to anastomose the broken end of the lacrimal canaliculus, 6-0 absorbable sutures were used to anastomose the “medial canthus ligament-orbicularis” complex intermittently, and muscle, subcutaneous tissue, skin wounds and conjunctival wounds were sutured intermittently. The catheter was extubated 2-3mo after operation, and the lacrimal passage patency and lacrimal ectorrhea were observed for 6-12mo. <p>RESULTS: Totally 31 eyes(84%)were cured, 5 eyes(14%)were improved, and 1 eyes(3%)was ineffective. The total effective rate reached 97%. None of the patients had lacrimal dot tearing, abnormal location of lacrimal dot, angulation deformity and other related complications, and 1 invalid eyes(3%)was combined with bone lacrimal tubule fracture, without obvious lacrimal ectorsion symptoms.<p>CONCLUSION: The new type of silicone tube combined with retrograde catheterization has the characteristics of simple operation, light postoperative stimulation, safe catheterization state and significant anastomosis effect. The retrograde catheterization can better protect the small lacrimal spots.
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Objective@#To discuss the surgical method and clinical effect of applying the facial artery perforator-based nasolabial para-nasal advanced flap to repair the medial canthus and inner lower eyelid skin defects.@*Methods@#The advance nasolabial para-nasal perforator flap supplied by facial artery, was used to repair the medial canthus and inner lower eyelid skin defects, caused by dermatoma excision.@*Results@#All 18 flaps completely survived. The detects in the medial canthus andinner lower eyelid, and the donor sites in the nasolabial fold were primary healed.The medial canthus and inner lower eyelid were recovery satisfactorily.The flaps were not bloated, and the contour and texture of flaps were similar to adjacent tissue, with no need of secondary repair.The donor site was successfully hidden in the nasolabial dermatoglyph.@*Conclusions@#Nasolabial para-nasal perforator flap is easily obtained, reliable in blood supply, and flexible in transfer. It has a wide range of movement and is easy to advance, so as to repair medial canthus andinner lower eyelid defect. With above advantages, this flap is worthy towidely popularize.
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Objective To investigate the effects of preset medial canthus ligament relaxation sutures in traumatic inferior canalicular laceration anastomosis.Methods A retrospective study was conducted in 32 patients (32 eyes) with inferior lacrimal canaliculus laceration who admitted to the Department of Ophthalmology from September 2014 to September 2016.In the procedures,after the broken end of the lower lacrimal canaliculus was found,4-0 suture was immediately placed between the ends of medial canthus ligament.After ensuring the satisfaction of the broken ends of the duct,the preset suture was released and the lacrimal stents were implanted.Anastomosis of lacrimal canaliculus laceration was performed with 8-0 absorbable suture,and subcutaneous tissue and skin were sutured with 6-0 absorbable suture.Then the lacrimal stents were removed 2-3 months after the operation.The patients were followed up 6-12 months for analysis of success rate and complications.Results Totally 29 patients were cured,2 patients improved,and 1 patient did not get better,with cure rate of 90.62％ and the effective rate of 96.88％.After surgery,lacrimal point tear presented in 2 eyes (6.25％),and notch within medial canthus was found in 1 eye (3.12％).Conclusion Medial canthus ligament relaxation suture can create a low tension healing environment for lacrimal canalicular laceration and improve the cure rate of canalicular laceration anastomosis.
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Objective: To evaluate the effectiveness of a new type of sutured titanium wire combined with titanium nail internal fixation in correction of serious old medial canthus deformity. Methods: Between March 2012 and June 2015, 18 patients with unilateral serious old medial canthus deformity were treated. There were 14 males and 4 females. The patient's age ranged from 23 to 62 years (mean, 42 years). The causes of deformity included accident injury in 10 cases, boxing injury in 4 cases, sharp device scratching in 3 cases, and animal bite in 1 case. All patients had been treated with suture or steel wire fixation in other hospitals to correct the medial canthus deformity and the deformity recurred. The interval between this operation and the first operation was 6 months to 2 years (mean, 16 months). The nasal root or medial canthus skin scar incision was used as the operative approach, and the adhesion of the medial canthus ligament to the adjacent tissues was fully loosened, then the tail end of the new type sutured titanium wire was fixed to the residual end of the medial canthus ligament. After passing through the scar tissue, the needle end of wire was fixed on the titanium nail in the bone wall of anterior lacrimal crest. The position and shape of the medial canthus angle was determined by adjusting the tightness of titanium wire. Results: All incisions healed by first intention. All patients were followed up 6-12 months (mean, 10 months). In 16 cases, the medial canthus deformity was obviously corrected, and the appearances of bilateral eyes were basically symmetrical, without exposure of titanium nail and titanium wire. The medial canthus was retreated at 2 mm after 6 months in 2 cases, who were satisfied with their appearance without reoperation. Conclusion: Application of the new type of suture titanium wire combined with titanium nail in the correction of serious old medial canthus deformity can achieve good effectiveness with the low recurrence rate.
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PURPOSE: To report 2 cases of skin necrosis over the medial canthus following canaliculodacryocystorhinostomy in young women diagnosed with canalicular obstruction. CASE SUMMARY: (Case 1) A 31-year-old female presented to our clinic with epiphora in the right eye that had developed 2 years prior. On examination, a right upper and lower canalicular obstruction was noted and the patient underwent canaliculodacryocystorhinostomy with silicone tube intubation. Topical 0.04% mitomycin-C eyedrops were applied twice a day from postoperative day 1 for 7 days. The patient revisited our emergency center with swelling, redness, and tenderness in the medial canthal region that developed 3 days after the initial surgery. Furthermore, a skin ulceration had developed followed by an exudative oozing with crust. (Case 2) A 23-years-old female visited our clinic with epiphora in the right eye that had developed 3 months prior. Ophthalmic examinations revealed a common canalicular obstruction in the right eye and canaliculodacryocystorhinostomy with silicone tube intubation was performed. Seven days postoperatively, the patient developed mild pain and tenderness over the right lacrimal sac and medial canthal erythema with purulent discharge was noted. Furthermore, a localized skin necrosis had developed. CONCLUSIONS: Localized skin necrosis may rarely develop after canaliculodacryocystorhinostomy in young women. If localized skin symptoms develop postoperatively, the patient should be closely monitored.
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Adult , Female , Humans , Emergencies , Erythema , Intubation , Lacrimal Apparatus Diseases , Mitomycin , Necrosis , Ophthalmic Solutions , Silicones , Skin Ulcer , SkinABSTRACT
Retiform hemangioendothelioma (RH) is a distinct entity in the spectrum of vascular tumors with a high local recurrence rate. It is considered a low‑grade, well‑differentiated cutaneous angiosarcoma with low metastatic potential. We report here for the first time a case of medial canthus recurrent RH. It may be helpful in our practice to include RH as a differential diagnosis of eyelid lesions. It is noteworthy that the progressive course and recurrence tendency of RH might be misdiagnosed as angiosarcoma or basal cell carcinoma (BCC), if not expected and carefully evaluated by the pathologist.
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Knowledge of the location of the maxillo-facial foramina is essential for regional nerve blocks and endoscopic surgical procedures to avoid nerve injury passing through these foramina. The purposes of this study were to determine the locations of the supraorbital foramen (SOF) and the infraorbital foramen (IOF) related to medial canthus (MC), and to analyze the morphology of these foramina. Thirty-two embalmed cadavers (64 sides, mean age: 64.1 years) and 33 dry skulls (66 sides) were used. The distances from the SOF, IOF, and MC to facial midline were directly measured on the cadavers using digital Vernier caliper. The vertical and horizontal distances of the SOF and IOF relative to the medial canthus were indirectly measured on the digital photographs using image analyzer software. The vertical and horizontal diameters of the IOF, and its location in relation to maxillary tooth were evaluated on the dry skull. Statistical analysis was performed using one-way ANOVA with declaration of significant difference when P<0.05. The mean distances of SOF, MC, and IOF to the facial midline were 24.13 mm, 15.00 mm, and 29.11 mm, respectively. The SOF was located 18.99 mm superior and 9.05 mm lateral to the medial canthus. The distance between the medial canthus and the SOF was 22.67 mm, and the vertical angle (Angle 1) between these structures was 24.36degrees superolaterally. The IOF was located 26.69 mm inferior and 13.53 mm lateral to the medial canthus. The distance between the medial canthus and IOF was 30.82 mm and the vertical angle (Angle 2) between these structures was 26.59degrees inferolaterally. In the this study, spraorbital notch (SON) was found more frequently than the SOF. The mean vertical and horizontal diameters of IOF were 3.36 mm, 3.45 mm, respectively. IOF was most commonly found in the same vertical plane with the second upper premolar. In conclusion, these results are important for performing local anesthetic, facial plastic surgery, and other invasive procedures in the forehead and periorbital region to prevent injury of neurovascular bundles passing through these foramina.
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Cadaver , Endoscopy , Forehead , Nerve Block , Skull , Surgery, Plastic , ToothABSTRACT
Dermoid tumors in the medial canthal area are rare, but when present they commonly adhere to the lacrimal canaliculi. Three patients presented with a mass in the medial canthal area. The authors performed excisional biopsies, and the masses were diagnosed as dermoid tumors. In two patients, canalicular lacerations were found after mass excision, which suggested that the masses had been firmly adherent to the lacrimal canaliculi. The lacerated canaliculi were repaired after bicanalicular silicone intubation. In the remaining patient, lacrimal silicone intubation was performed at the beginning of surgery, and the mass was successfully dissected from the canaliculi, leaving them intact. Excision of dermoid tumors in the medial canthal area requires careful dissection to avoid canalicular laceration. Bicanalicular silicone intubation at the beginning of surgery is helpful for the identification of the canaliculi and for the prevention of canalicular laceration during dermoid tumor excision.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Dermoid Cyst/pathology , Intubation , Lacrimal Apparatus Diseases/pathology , Orbital Neoplasms/pathology , Postoperative Care , Preoperative Care , SiliconesABSTRACT
PURPOSE: To evaluate the effect of modified simple excision for epicanthal folds. METHODS: Eight patients with the epicanthal folds were treated using a modified simple excision method from June to December 2005. After medial traction of the epicanthal fold to expose the medial canthus, parabola-shaped marking was done near mucocutaneous junction. Under local anesthesia, incision of skin, dissection of subcutaneous tissue and excision of subcutaneous fibrous tissue and orbicularis oculi muscle were done. After marking the medial canthus on the skin, a wedge-shaped excision of the extra skin was done. Fixation sutures to the medial canthal tendon and skin sutures were then performed. RESULTS: Eight participants were evaluated (four males and four females) with a mean age of 16.71+/-8.34 years. The mean follow-up period was 42.86+/-5.80 days. After the operation, the skin scar was not visible due to its deep position, and no complication, such as damage to the lacrimal canaliculus or sac, was observed. CONCLUSIONS: Modified simple excision for epicanthal folds is an effective method that does not leave a visible scar.