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Case 1.13
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
How will you perform the lateral canthotomy and cantholysis?I will first identify the lateral canthus. There is no need for LA in an intubated patient.I will crush the lateral canthus with artery forceps for 1–2 minutes to reduce incisional bleeding, then, cut through the crushed tissue with tenotomy scissors to perform the canthotomy.I will then pull the lower eyelid away from the globe with straight artery forceps.Next, I will ‘strum’ the tissue under the canthotomy with the scissors to identify the inferior crus of the lateral canthal ligament and divide it with tenotomy scissors. This will feel like a ‘band under tension’ prior to division.
Cosmetic Facial Interventions
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Pre-operative planning should include accurate documentation of patient concerns, medical photographs, a complete ophthalmic assessment and a plan to define and alleviate the anatomical cause of the eyelid abnormality, and an informed discussion. Any additional procedures that may be required such as repositioning of the lacrimal gland, correcting the brow ptosis and lateral canthal procedures should be discussed. Surgery may be carried out under local anaesthetic with sedation or general anaesthetic.
Non-Melanoma Skin Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Irene De Francesco, Sean Whittaker, Stephen L. Morris
There is compelling epidemiological data implicating UV radiation exposure in BCC tumorigenesis. Sixty-six per cent of BCCs occur on the head and neck. The incidence is much greater in those with fair skin and Fitzpatrick skin type I, the tumor only very rarely occurring in African-Americans.61 The incidence of BCCs in Caucasian patients increases with decline in latitude, being highest in Australia.62 However, the anatomical distribution of BCCs does not correspond well to the area of maximum exposure to UV. BCC is very common on the head and neck, consistently with a derivation from follicular keratinocytes, but unusual on other light-exposed areas such as the backs of the hands and forearms, unlike actinic keratoses and SCCs, which occur on all light-exposed areas. The inner canthus and eyelids, which are more shielded from sunlight than other parts of the face, are frequently involved. BCC commonly affects the trunk, and rare cases of vulval BCC also occur. The occurrence of BCCs in relatively sun-protected sites suggests that other cofactors may be important and is consistent with regional concentration of follicular sebaceous units. One series found that 7.3% of 1774 cases of BCC had a previous history of trauma to the site of the BCC.63 BCCs may arise in congenital nevus sebaceus, skin damage by x-irradiation, burns, or vaccination scars. Arsenic salts used as tonics in the 1930s were also an important etiological factor. Arsenic-induced tumors are usually multiple, occur mainly on the trunk, and may also cause arsenical keratoses on acral sites.64
Non-contact infrared assessment of human body temperature: The journal Temperature toolbox
Published in Temperature, 2021
Josh Foster, Alex Bruce Lloyd, George Havenith
The inner canthus of the eye typically represents the warmest spot on the face and is therefore considered the most suitable site for tracking Tcore [4]. Assessment of inner canthus temperature (Tcanthus) requires a thermal imaging camera, unlike Tforehead which only requires a spot measurement. In a study involving 191 children (18 febrile), Tcanthus was the best predictor of fever compared with Tforehead and tympanic temperature [25]. In that study, fever was diagnosed with an axillary temperature > 37.6°C, a site which is relatively stable in varying ambient conditions [16]. In support, data from facial temperatures of nonfebrile (healthy) children show that Tcanthus is the least variable skin site compared with the Tforehead and nose, which supports its use for Tcore tracking [68]. The International Standardization Committee (IEC 80601-2-59, 2020 [13]) suggest using this site, based on a study comparing several Tcore and Tskin measurement sites under different ambient conditions [16]. In that study, Tcanthus was stable between 21°C and 26°C ambient temperature, but dropped significantly at 15°C, highlighting the importance of using a thermoneutral environment during assessment. The optimal room conditions are highlighted in Table 1.
Reconstruction of giant full-thickness lower eyelid defects using a combination of palmaris longus tendon with superiorly based nasolabial skin flap and palatal mucosal graft
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Wangshu Wang, Hao Meng, Shujian Yu, Tianyi Liu, Ying Shao
Previous studies suggest that common complications of lower eyelid reconstruction may occur from lack of lower eyelid support or insufficient anchoring of the reconstructed tarsal plate structure at the inner and outer canthus [6,7,10]. Therefore, restoring the “layer-by-layer” structure and anchoring of tissue at canthus could provide the lower eyelid with support, thus avoid such common complications. Previous studies have demonstrated that tendon has sufficient tension to support a thick reconstructed tissue, and share similar structure as that of the inner and outer canthus [11,12]. Furthermore, the functions of wrist and palm are not affected after the removal of palmaris longus tendon. Therefore, in this study, we generated a novel “three-layer structure” tissue by combination of palmaris longus tendon with superiorly-based nasolabial skin flap and palatal mucosal graft, which may provide better long-term support for the lower eyelid and restore anchoring function the inner and outer canthus. We then applied the tissue in eyelid reconstruction surgery in 34 patients with giant full-thickness lower eyelid defects. After follow-up for a mean of 15 months, the satisfaction scores were assessed in each patient to evaluate their cosmetic and functional outcomes.
Multiple lacrimal drainage anomalies in proboscis lateralis
Published in Orbit, 2021
Nandini Bothra, Milind Naik, Mohammad Javed Ali
Proboscis lateralis (PL) is a very rare congenital anomaly with the incidence being less than 1:1,00,000 to 1:1,000,000 live births.1,2 This condition is characterized primarily with a nose-like tubular appendage which commonly arises from the medial canthal region, but can also arise from the lateral canthus, lateral supraorbital ridge, mid-upper eyelid, root of the nose, and chin.3 PL was divided into four groups by Khoo in 1985.4 Group 1 is PL with normal nose and is the least common. Group 2 is PL with ipsilateral deformed nose. Group 3 is PL with ipsilateral deformed nose with additional ocular and its adnexal deformities and is the most common. Group 4 consists of deformities in Group 3 with an addition of cleft lip or palate.4 Embryologically, many theories have been proposed to explain the development of PL. The two widely accepted theories are either imperfect fusion of the lateral nasal and maxillary processes or aberrant fusion of the maxillary process of the affected side to the medial nasal process (globular process).3 The lacrimal drainage anomalies in this condition, to the best of authors’ knowledge, have been described only once previously.5 The present report is a case of Group 4 PL in a 9-year-old girl with multiple lacrimal drainage anomalies in addition to the other anomalies. This report adheres to the Tenets of Declaration of Helsinki and the patient consent for publication of photographs has been obtained.