Biopsy of the Parietal Branch of the Superficial Temporal Artery for the Diagnosis of Giant Cell Arteritis.

BACKGROUND: Biopsy of the superficial temporal artery (STA) is central to the diagnosis of giant cell arteritis (GCA), but determining the ideal biopsy site along the course of the STA continues to be a challenge. Traditionally, the frontal branch or preauricular region of the STA is biopsied because of their accessibility, but biopsy at these locations can produce visible cosmetic defects and social disruption that can be distressing to patients, as well as increase the likelihood of adverse events such as injury to the facial nerve. The authors describe a surgical technique of biopsy of the parietal branch of the STA to improve the patient's perioperative and postoperative experience. METHODS: In this retrospective review, 24 patients with clinical suspicion of GCA who underwent biopsy of the parietal branch of the STA were identified. Patients underwent mapping of the branches of the STA with Doppler ultrasound before the procedure. Biopsy of the parietal branch of the STA was conducted using a CO 2 laser. RESULTS: Twenty-four patients underwent biopsy of the parietal branch of the STA. Two patients were diagnosed on histopathology with GCA. All patients tolerated the procedure well and without complications. CONCLUSION: Application of preoperative Doppler ultrasound mapping, use of a CO 2 laser for incisions and hemostasis, and selection of the parietal branch allowed for improved cosmetic outcomes, no associated adverse events, and improved overall patient experience. The authors advocate biopsy of the parietal branch of the superficial temporal artery for the diagnosis of GCA in the absence of contraindications.

Lacrimal canalicular transplantation with composite eyelid graft.

PURPOSE: To describe a new surgical approach for secondary repair of canalicular lacerations using a full-thickness en bloc eyelid transplantation. METHODS: This a single case report of full-thickness en bloc eyelid transplantation. The patient presented with symptomatic epiphora several years after traumatic laceration of the left lower canalicular system. The canalicular system of the right upper eyelid, including the punctum and a section of the canaliculus, was resected and transplanted to repair a dysfunctional left lower eyelid. The primary outcome measure was the functionality of the transplanted canalicular system. RESULTS: The transplanted lacrimal system was patent by irrigation at multiple visits postoperatively. In addition, the patient was asymptomatic and was pleased with the cosmetic result. CONCLUSION: This is the first reported case of successful canalicular transplantation. Although a single case report, the authors anticipate future success with this technique.