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Case 1.13
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
I will call my Ophthalmology colleague for support but in the meantime, I will perform an emergency lateral canthotomy and cantholysis, which is a bedside release of the inferior crus of the lateral canthal ligament to decompress the orbital nerve.
Pinnaplasty
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
Stenström described one of the initial cartilage-incising/scoring techniques.2 The scapha cartilage is incised in a C shape and is dissected off the anterior skin and perichondrium. The cartilage is then scored by making parallel incisions caudally from the inferior crus, which allows the antihelical fold to be developed. This technique can be used even when the cartilage is thicker, as in older individuals. With this technique, there is a greater risk of haematoma formation and infection due to significant skin elevation, so intra-operative haemostasis and post-operative dressings are vital to prevent complications.
Microtia and External Ear Abnormalities
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The pinnae are paired structures with a cartilaginous framework. The inferior part of the pinna (lobule) does not have a cartilaginous framework and is only supported by a fibrofatty matrix. The helix is the outermost cartilaginous curvature of the pinna. The curve of the antihelix runs inside and parallel to the curve of the helix. The antihelix divides superiorly to forms two crura: the superior crus and the inferior crus. The depression between the two crura is called the triangular fossa. Anterior to the antihelix is the concave depression called the concha. The conchal bowl is subdivided into the cymba concha superiorly and the concha cavum inferiorly. The elevation of cartilage anterior to the entrance of the external ear canal is called the tragus. The antitragus is the inferior-most prominence of the antihelix curvature opposite the tragus, and the gap between the tragus and the antitragus is called the intertragal notch. The cartilage of the pinna is continuous with the cartilaginous ear canal, thereby fixing it to the temporal bone along with muscles and ligaments (anterior, posterior and superior ligaments). The intrinsic muscles of the pinna are poorly developed; the extrinsic muscles (anterior, posterior and superior) may be well developed in some individuals.
Corneal Topographic Analysis in Patients with Involutional Lower Eyelid Entropion
Published in Seminars in Ophthalmology, 2021
Tatsuya Yunoki, Atsushi Hayashi, Shinya Abe, Mitsuya Otsuka
The LTS procedure was performed at the same time as the posterior layer advancement of the LER in patients who had a positive pinch test result. Local anesthesia was performed subcutaneously and subconjunctivally with 1% lidocaine containing a 1: 100,000 dilution of epinephrine. An approx. 15-mm skin incision was made along the lateral canthal rhytids. A lateral canthotomy was performed, and the inferior crus of lateral canthal tendon was incised. The lower eyelid was incised 7 mm with a gray line from the temporal side to separate the anterior lamellae and posterior lamellae. The conjunctiva and the LER attached to the tarsal plate were incised 7 mm from the temporal side, and the temporal tarsal was made free. The conjunctiva of the separated posterior lamellae was scraped off from the tarsal strip, and the tarsal plate was fixed to the periosteum of the lateral orbital wall with 5–0 nylon. Finally, the skin was sutured with 7–0 nylon.
Efficacy of vertical lid split versus lateral canthotomy and cantholysis in the management of orbital compartment syndrome
Published in Orbit, 2021
Julia Elpers, Christopher Areephanthu, Peter J. Timoney, William R. Nunery, H.B. Harold Lee, Roxana Fu
While many studies focus on only inferior eyelid release in OCS, this study compares combined superior and inferior cantholysis with upper and lower VLS. Opponents of superior cantholysis state that the release of the superior crus is generally unnecessary and poses a greater risk of hemorrhage due to the location of the lacrimal gland, as well as risk of damage to the gland itself.11 While it is true that most often lysis of the inferior crus alone is adequate, Haubner found that 20% of cadaveric orbits required a superior cantholysis after lateral canthotomy and inferior cantholysis to achieve adequate decompression.4 Considering the gravity of inadequate OP reduction, the authors recommend emergency room physicians who are inexperienced in LC/C decompress the orbit by performing a vertical lid split to the upper and lower eyelid, as described here, when immediate ophthalmic care is unavailable.
Association between oral fluoroquinolone use and lateral canthal tendon rupture: case report
Published in Orbit, 2018
Rashed N. Alhabshan, Tamer N. Mansour
Ocular exam revealed 20/30 vision in the right eye and 20/20 in the left eye. She was noted to have severe right lower eyelid (RLL) ectropion and rupture of the inferior crus of the LCT, whitish discharge, moderate to severe conjunctival injection, chemosis, and keratinization of almost the entire lower eyelid palpebral conjunctiva (Figure 1A and B). The stump of the inferior crus of the LCT was visible. Slit lamp examination demonstrated significant punctate fluorescein staining of the conjunctiva temporally greater than nasally and mild-to-moderate corneal punctate staining primarily temporally. The rest of the ocular exam was unremarkable in both eyes.