Fibrin glue assisted amniotic membrane graft reconstruction of conjunctival fornix and canthus following excision of conjunctival tumours

Conjunctival tumors involving non?limbal locations, such as the fornix and canthus, are typically excised using a “non?touch” technique, often with a wide surgical margin. Reconstruction of these large defects can be difficult due to the contour of the ocular surface and are often complicated by shortening of the fornix, symblepharon formation, and restriction of eye movements. In our experience, the use of amniotic membrane grafts combined with the sealant properties of fibrin glue such as Tisseel® has improved our surgical outcomes during the reconstruction phase. We would like to highlight and describe our surgical technique using fibrin glue and squint hooks to aid amniotic membrane graft reconstruction for surgically challenging locations in the fornix and canthus following excision of conjunctival lesions, with excellent surgical outcomes.

Investigation of morphometric measurement of the eyelid and ocular axial position in Mongolian adults / Шинэ санаа Шинэ нээлт

Background@#The shapes of the eye and upper eyelid are distinctive facial landmarks. The palpebral fissure is composed of the free edges of upper and lower eyelids the lateral and medial canthus. Many researchers confirmed that the morphometric characteristics of the palpebral fissure, canthal distance and exophthalmometirc value (EV) vary according to race, ethnicity, age and sex and normative values which may serve as a reference in the index population. Knowledge of normal dimensions, the existence of asymmetry of the palpebral fissure is of value in several clinical specialties including ophthalmology, plastic and reconstructive surgery and traumatology, where it plays a part in the patient evaluation, management and outcomes.@*Methods@#This cross-sectional study was conducted in the Ophthalmological Department, Third State Central Hospital between January 2022 and August 2022. We included participants who are above 18 years, no history of congenital or traumatic craniofacial deformities, any orbital fractures, tumors and surgeries. All measured values that represent eyelid shape and EV were calculated by mean and standard deviation for statistical analysis.@*Results@#A total of 103 participants aged 19-86 were included in the study, of which 44 (42.7%) were male and 59 (57.3%) were female. The distance between the lateral and medial canthus ranged from 20 to 35 mm, and the mean of the right and left side was 28.30+3.23 mm and 28.05+2.99 mm, respectively (p=0.561). The palpebral fissure height ranged from 5 to 13 mm, and the mean of the right and left side was 8.85+1.65 mm and 8.80+1.65 mm, respectively (p=0.816). The mean distance between the lateral canthi were 90.39+5.57 (range: 80-105 mm), whereas the mean distance between the medial canthi were 63.75+4.25 (range: 53-73 mm). The orbital height varied between 27-43 mm (33.73+3.72) and 26-44 mm (33.78+3.73) on the right and left sides, while the orbital width varied between 26-47 mm (36.75+4.53) and 27-45 mm (36.72+4.42) on the right and left sides, respectively. When measuring the exophthalmometric value (EV), the axial position of the eyeball, with the Hertel’s exophthalmometer, it ranged from 8 to 20 mm on both sides (mean value 13.68+3.01 and 13.71+3.00 on the right and left sides, respectively), and there was no statistically significant difference in symmetry (p=0.94).@*Conclusion@#The results are determined different from the findings of Chinese, Korean, Afro-American and Caucasian population based studies. Thus further evaluation is required to represent the normative value of Mongolian index population, that is highly beneficial for clinical assessment, diagnosis and management.

Clinical effect of new silicone tube retrograde catheterization in the treatment of lacrimal canaliculus rupture in children / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Recent progress in cosmetic lateral canthoplasty / 中华整形外科杂志

The lateral canthus is the junction of the upper and lower eyelids, which is located at the temporal side. The distance from the lateral orbit rim to the lateral canthal angle is 5-7 mm. Cosmetic lateral canthoplasty, as an important surgical method for the rejuvenation of the eyes, was developed in recent year. Along with the development of anatomic study of the lateral canthus, the cosmetic lateral canthoplasty was modified and improved. The purpose of this review is to summarize the anatomy of the lateral canthus, indications for cosmetic lateral canthoplasty and surgical procedures, so as to provide a useful reference for clinicians.

Clinical application of modified kite flap in treatment of divided nevus of lateral canthus / 中国修复重建外科杂志

Objective: To investigate the effectiveness of modified kite flap in repair of soft tissue defect after divided nevus of lateral canthus excision. Methods: Between October 2010 and April 2018, 20 children (20 eyes) with divided nevus of lateral canthus were admitted. There were 13 boys and 7 girls, with an average age of 7.9 years (mean, 4-14 years). There were 11 cases of moderate range lesions (maximum diameter, 1.5-2.0 cm) and 9 cases of small range lesions (maximum diameter, <1.5 cm). After excising the divided nevus of lateral canthus, the area of soft tissue defect ranged from 0.72 to 3.23 cm2。The modified kite flap was used to reconstruct the structure and shape of lateral canthus. Results: There were 16 cases of mixed nevus and 4 cases of intradermal nevus. The flaps survived and the incisions healed by the first intention. The patients were followed up 12-22 months (mean, 13.6 months). There was no malformation, valgus, exposure keratitis, or obvious scar. No malignant transformation occurred or nevus recurred during follow-up. At last follow-up, the effectiveness was rated as excellent in 16 cases, good in 3 cases, and poor in 1 case. Conclusion: The modified kite flap can repair the soft tissue defect after excising the divided nevus of lateral canthus, and obtain the good appearance and function of lateral canthus.

Using the facial artery perforator-based nasolabial para-nasal advanced flap to repair the medial canthus and inner lower eyelid skin defects / 中华整形外科杂志

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.

The application of drill hole lateral canthoplasty and canthopexy in correction of lower eyelid malposition / 中华整形外科杂志

Objective@#To investigate the lateral canthoplasty and canthopexy with bone drilling to correct lower eyelid malposition and its benefit.@*Methods@#From January 2014 to January 2019, lateral canthopexy with bone drilling technique was used to repair 56 patients with lower eyelid malposition in Department of Plastic and Reconstructive Surgery of Changhai Hospital. Forty-four patients with lower eyelid ectopic had multiple previous surgeries, and 12 patients had congenital lower eyelid retraction. For patients without lower palpebral margin extension, lateral canthopexy with bone drilling technique was applied. For patients with lower palpebral margin extension, the lateral canthus angle was exposed to shorten the lower eyelid margin. For congenital lower eyelid retraction, the lateral canthus tendon was completely cut off, and then fixed with double armed sutures.@*Results@#Operations were successfully performed on all 56 patients, and the patients were followed up for 1-38 months. Forty-nine patients achieved good eyelid shape and satisfied with the operative effects (87.5%). Malposition was ameliorated in 6 patients (10.7%). One remained uncorrected (1.8%).@*Conclusions@#Lateral canthopexy with bone drilling technique could obtain firm suspension force. For lower eyelid malposition, especially for patients with recurrent malposition or congenital lower eyelid retraction, satisfied function and appearance could be achieved.

New type of sutured titanium wire combined with titanium nail internal fixation for correction of serious old medial canthus deformity / 中国修复重建外科杂志

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.

Effects of medial canthus ligament relaxation suture in anastomosis of lacrimal canaliculus laceration / 眼科新进展

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.

Use of a pipettor for blood collection from the inner canthus of mice / 中国比较医学杂志

Objective To explore the practical value of a modified method for blood collection from the inner canthus of mice using a pipettor. Methods A total of 20 male C56BL/6J mice were divided into two groups,the pipettor group and the capillary group(10 mice in each group). Blood samples were taken 3 times from the inner canthus of the mice with a pipettor or glass capillary, respectively, and the time-consumption and success rate of the two groups were recorded and compared. Results The success rates of both the blood collection methods were 100%. However, in the pipettor group, the blood collection was completed faster than the capillary group with a significant difference(P <0.05). Conclusions It is a relatively simple and safe method for blood collection from the inner canthus of mice using a pipettor.

Cosmetic Lateral Canthoplasty: Preserving the Lateral Canthal Angle

Cosmetic lateral canthoplasty, in which the size of the eye is increased by extending the palpebral fissure and decreasing the degree of the eye slant, has become a prevalent procedure for East Asians. However, it is not uncommon for there to be complications or unfavorable results after the surgery. With this in mind, the authors have designed a surgical method to reduce complications in cosmetic lateral canthoplasty by preserving the lateral canthal angle. We discuss here the anatomy required for surgery, the surgical methods, and methods for reducing complications during cosmetic lateral canthoplasty.

Two Cases of Skin Necrosis after Canaliculodacryocystorhinostomy in Young Women

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.

Medial canthus retiform hemangioendothelioma.

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.

Clinical effect of surgical reconstruction of Ⅱ and Ⅲ degree cicatricial ectropion in 46 patients / 局解手术学杂志

Objective To improve the detail of the surgery for cicatricial ectropion,and the the effect was investigated. Methods Based on 46 patients withⅡ,Ⅲdegree cicatricial ectropion admitted to our department,choose the junction of normal skin and scar tissue as the incision line according to the degree of ectropion and local situation,and to reserve and recover the orbicularis oculi muscle as possible. The released areas exceeded separately the external canthus and reached the level of eye fissure,take advantage of full-thickness skin graft to correct the parallel lines and make fixation to the eyelid ectropion fusion skin graft on external canthal ligament. Results After followed up for 6 months to 2 years,46 cases of eyelid skin grafts survived completely and eyelids were in good reduction,with none case of incomplete eyelid closure. Conclusion Choose the surgical incision and the released areas in a proper way to reserve the structural integrity of orbicu-laris muscle and make skin graft fixation to inner and external canthal skin can prevent effectively the recurrence of ectropion and improve surgical progress.

Application of Lateral Tarsal Strip Procedure in Operation of Lower Eyelid Lesions / 昆明医科大学学报

Objective To evaluate the application of the lateral tarsal strip procedure for lower eyelid lesions. Methods We retrospectively analyzed 64 eyelids of 48 patients with lower eyelid laxity, ectropion, retraction, lagophthalmus and lateral canthus displacement from February 2010 to August 2013. All the patients were treated with the lateral tarsal strip procedure as the main surgical style, of which some combined with the surgery of lower-eyelid tarsal constrictor,some implanted with high porous polyethylene lower eyelid spacers (Medpor LES), and few cases of eyelid ectropion underwent transplantation or transposition of flap. The effect of relocation of lower eyelid and appearance improvement were evaluated after surgery. The degree of the low eyelid retraction, lagophthalmus and the lateral canthus displacement were examined quantitatively before and after operation, while the change of the low eyelid ectropion and laxity were done qualitatively. Results After two weeks of operation, eyelids of all the patients were relocated well except two cases of ectropion under mild correction. The quantitative evaluation showed there was significant difference between pre and post operation ( <0.001),while the qualitative effect of correction was satisfied after operation. Conclusion The lateral tarsal strip procedure had positive effects in the treatment of most sorts of lower eyelid diseases.

The relationship of maxillary canines to the facial anatomical landmarks in a group of Thai people

PURPOSE: The objective was to evaluate canine positions, intercanine tip width (ICTW) and width of distal surface of canine (WDC), related to facial landmarks including interalar width (IAW), intercommissural width (ICoW), and distance between left and right projection lines drawn from inner canthus of eyes to alae of the nose (DPICa) in a group of Thai. MATERIALS AND METHODS: One hundred Thai subjects aged 18-35 years were selected. IAW and ICoW were measured on subject's face using digital vernier caliper. Irreversible hydrocolloid impression of the upper arch was taken, and a cast was poured with dental stone. Silicone impression material was used to take imprint of the incisal edge of upper six anterior teeth. DPICa was obtained from the subject's face using custom-made measuring equipment and marked on the silicone incisal imprint. The marks were then transferred from the imprint to the stone cast and measured with digital caliper. The ICTW and WDC were also measured on the stone cast. Pearson's correlation was used to determine the correlation. RESULTS: The results revealed that the correlation between ICTW-ICoW was 0.429 and ICTW-DPICa was 0.573. The correlation between WDC-ICoW was 0.426 and WDC-DPICa was 0.547. However, IAW did not show any correlation with ICTW or WDC (P>.05). CONCLUSION: The correlation between canine position and facial landmarks was found. ICTW and WDC had relationship with ICoW and DPICa. DPICa showed stronger correlation with the position of maxillary canine than that of ICoW.

Morphometric Analysis of the Supraorbital and Infraorbital Foramina Based on the Medial Canthus in Koreans / 체질인류학회지

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.

Clinical efficacy of subcutaneous pedicle flap from temporal region in treatment of lower eyelid ectropion / 中华医学美学美容杂志

Objective To investigate a new method and to observe the clinical effect of repairing the lower eyelid ectropion assisted with the subcutaneous pedicle flap from temporal region. Methods Since 2007, 24 patients with lower eyelid ectropion were treated with the subcutaneous pedicle flap from temporal region which was the donor area without hairs, including 8 cases of scar infection, 6 cases of trauma, and 10 cases of tumor removal. Among the 24 cases of the flap, the maximum area was 5. 5 cm× 1. 5 cm,and the minimum was 4. 0 cm × 1.0 cm. Results All patients were followed up for 6 months to 3 years.All flaps survived completely with excellent texture and appearance. The donor site was hidden and no obvious malformation of the donor site was observed. Conclusions Because the blood supply of flap is reliable and the incision in the donor site is hidden, the subcutaneous pedicle flap from temporal region pedicled with arterial network of the outer canthus is an ideal donor site for repairing the lower eyelid ectropion with full thickness defects.

A Case of Low Grade Malignant Fibrous Histiocytoma in Lateral Canthus

PURPOSE: To report a case of malignant fibrous histiocytoma of the lateral canthal area that was diagnosed clinically as a benign epidermal inclusion cyst. CASE SUMMARY: A 49 year-old man presented with a cutaneous mass involving the lateral canthal area. A 0.7-cm cystic lesion was freely movable and non-inflamed. After excisional biopsy, the results of immunohistochemical staining led to a final diagnosis of low-grade malignant fibrous histiocytoma. The specimen from excisional biopsy had margins positive for malignancy; the patient underwent a second procedure for complete resection, and that specimen had tumor-free margins. CONCLUSIONS: Fibrous histiocytoma is a rare disease but may occur in the eyelid. Therefore, when an eyelid tumor progresses rapidly, malignant fibrous histiocytoma should be considered as a diagnosis.

Reproducibility and reliability of head posture obtained by the outer canthus indicator / 대한치과교정학회지

OBJECTIVE: The purposes of this study were to evaluate the reproducibility and reliability of head posture obtained by registering outer canthus as a soft tissue landmark with the Outer Canthus Indicator (OCI). METHODS: Twenty-one adults with normal facial morphology were enrolled in this study (mean age 27.5 +/- 1.72 years). To register initial head posture, height of the outer canthus from the ear rod plane was measured using OCI. Head posture was reproduced by moving the head upwards and downwards until the outer canthus was in a straight line with the indicator set at a registered height. After the head posture is reproduced by two operators after two days, lateral photographs were taken. Computerized photometric analyses of the photographs were performed. RESULTS: The head rotations around the transverse axis were 0.69 +/- 0.43degrees, 0.98 +/- 0.65degrees from each of the two operators. Standard errors were 0.09degrees and 0.14degrees each, which were similar to results from past research findings. There were no significant differences between the data from the two operators (p > 0.05). There were no correlations between the head rotation around the horizontal and vertical axes (p > 0.05). CONCLUSIONS: The present study suggests that OCI-registered head posture may minimize errors from vertical head rotation in cephalometry and photometry.