Case 1.13
Monica Fawzy in 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.
Aesthetic
Tor Wo Chiu in Stone’s Plastic Surgery Facts, 2018
The normal eyebrow shape is as follows: The medial limit forms a ~vertical line joining the inner canthus with the lateral alar groove.The lateral limit forms an oblique line joining the outer canthus with the lateral alar groove.The lateral brow end lies slightly above the medial end. The medial brow is more club shaped, whilst the lateral brow tapers out to a sharper end.The highest part of the eyebrow lies directly above the outer limbus of the iris (junction of medial two-thirds and lateral one-third of the brow).
Non-melanoma skin cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2014
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 skin type I, the tumour only very rarely occurring in African-Americans.57 The incidence of BCCs in Caucasian patients increases with decline in latitude, being highest in Australia.58 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, consistent 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.59 BCCs may arise in congenital naevus sebaceus, skin damage by x-irradiation, burns or vaccination scars. Arsenic salts used as tonics in the 1930s were also an important aetiological factor. Arsenic-induced tumours are usually multiple and occur mainly on the trunk and may also cause arsenical keratoses on acral sites.60
Non-contact infrared assessment of human body temperature: The journal Temperature toolbox
Published in Temperature, 2021
Josh Foster, Alex Bruce Lloyd, George Havenith
In this Temperature Toolbox article, NCIT is an umbrella term which can involve either a spot temperature measurement with an infrared thermometer, or the use of a thermal imaging camera, which visualizes the temperature distribution over a specified target plane. In part 1, we provide an overview of the methodological factors which must be considered when using NCIT to track internal/core temperature (Tcore). In part 2, we report on the physiological confounders that may impact upon the ability of NCIT to track human body temperature. Controlling both the methodological and physiological confounders will improve the ability of NCIT to correctly screen for febrile body temperatures. The primary information in parts 1 and 2 was placed into a new checklist for users of NCIT, providing a simplified, digestible reference, nuanced against the clauses stipulated in ISO80,601 [13], ISO13154 [ISO13154, 14], and the general guidance provided in a consensus document on NCIT [7]. In part 3, we report on the ability of NCIT to track human Tcore in both static (stable environment and with resting subjects) and dynamic (unstable environment and/or active subjects) conditions. We focus specifically on measurements taken at the forehead and the inner eye canthus. The ability of NCIT to track human Tcore is fundamental for the technology to be an effective fever screening tool. Finally, we discuss future research direction which may further improve the performance of NCIT for noninvasive monitoring of human body temperatures.
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.
Efficacy of five-flash intense pulsed light therapy technique in patients with meibomian gland dysfunction
Published in Clinical and Experimental Optometry, 2022
Siamak Zarei-Ghanavati, Samira Hassanzadeh, Abbas Azimi Khorasani, Asieh Ehsaei, Elham Bakhtiari
Tear meniscus height (TMH), non-invasive keratograph tear break up time (NIKBUT), upper and lower lid meibography score (0–3),23 and limbal and bulbar hyperaemia (0–4) were evaluated using a multifunctional topographer (Keratograph 5 M, Oculus Optikgeräte GmbH, Wetzlar, Germany). TMH and NIKBUT values were recorded in triplicate and averaged. Tear volume measurements were performed by tear film meniscometry using SM tube strips (Echo Electricity, Fukushima, Japan). The tip of the strip was immersed into the tear meniscus of the lower eyelid for 5 seconds without touching the conjunctiva. A length of the blue stained column (absorbed tears) lower than 5 mm in 5 seconds was considered abnormal. Tear osmolarity was assessed using the TearLab osmometer (Tear lab, CA., USA). Tear was sampled from the tear meniscus of the lower lateral canthus. Tear osmolarity values between 270 and 315 mOsm/L in either eye were considered normal.24
Related Knowledge Centers
- Cephalometric Analysis
- Commissure
- Eye
- Eyelid
- Nasal Bridge
- Palpebral Fissure
- Telecanthus
- Epicanthic Fold
- Nose
- Canthotomy