After ruling out any connective tissue disorder which could also cause such a condition, I performed the Lateral Canthoplasty (Reconstructing the lateral canthus) thus restoring the ideal almond shape of the palpebral (eyelid) opening. Not just a new lateral canthus needs to be reconstructed, we also have the make sure the eyelid do not stick back together by using silicone bolsters as tissue spacers.
Our team consisting of a Neuro-surgeon, Oculoplastic Surgeon (Me) and Maxillofacial Surgeon operated on him for nearly 10 hours to get this young man back to his pre-accident status. The Neurosurgeon fixed his CSF leak after taking a bi-coronal flap approach and we then painstakingly fixed his frontal bone fractures piece by piece using titanium plates and mesh as a framework. I then repaired both his orbits👀 with pre-fabricated combined medial and floor titanium implants using the trans-conjunctival approach to avoid any extra skin incisions. The left anterior nasal buttress had to be fixed with a titanium mini-plate from an oral incision. The flattened nose 👃still had to be fixed which was then suspended from the frontal bone titanium frame while using internal nasal splints and external POP splint to hold the nasal bones in the desired position. This was perfect team work which reflected in the excellent post-operative outcome.
It is very rare that oculoplastic surgeons are asked to provide access to interventional neuro-radiologists. This is one such case. We have performed such interventions in 3 cases till date at our hospital with similarly successful outcomes. The important thing to remember as a surgeon while accessing the SOV is that the vein is arterialised due to the CCF and bleeding can be very severe is the vessel wall is damaged.
Epidermal Inclusion Cyst (also known as Epidermoid cyst or Sebaceous cyst) is a benign encapsulated, sub-epidermal nodule filled with keratin material. This is one of the commonest masses seen in the eyelid.
Blepharoplasty is the removal and repositioning of the skin, muscle and fat of the upper and/or lower eyelid. In the lower eyelid the incision is made along the skin just beneath the eyelashes or in the moist surface of the eyelid known as conjunctiva. This involves repositioning of prolapsed orbital fat on both sides by draping the fat to the orbital rim area- which gives an aesthetically better appearance. This technique is done with an incision on the inside of the eyelid without a skin incision making the surgery “scarless”.
BCC is one of the commonest eyelid malignancies in India. While in the west, BCC accounts for nearly 90% of the eyelid malignancies, in the Indian subcontinent, BCC cedes it’s top position to Sebaceous cell carcinoma in India. BCC is a non-melanocytic cancer of the skin arising from basal cells of the epidermis. It is mostly seen on sun exposed areas, particularly in the head and neck region. BCC is caused by skin damage caused by prolonged exposure to ultraviolet light thus explaining the preponderance of this cancer in Caucasian skin which does not have the protective effect of melanin.
The Eyebrow is a unique facial aesthetic unit and it’s importance to the face is apparent only when it is disfigured with loss of the hair bearing skin like in this case. Likewise, reconstruction of the eyebrow is challenging because the thickness and direction of the eyebrow hair which is unique and not easy to replicate with hair transplants from other hair bearing areas.
In an earlier era, these tumours would be removed via a craniotomy (brain surgery) by neurosurgeons or a disfiguring open surgery sometimes causing the loss of vision in the involved eye by other surgeons- that’s way too much morbidity for a benign tumour. But with the advent of modern day techniques and skilled oculoplastic surgeons performing orbitotomy today to remove such tumours, this surgery’s risks and complications is very low with the added advantage of a scarless as well as without even having to remove bone. This surgery is followed by a mostly uneventful recovery period.