The MRI scan showed a large intraconal well defined mass sitting right next to the optic nerve causing mass effect which in turn was causing diminution of vision. My working differentials going into surgery- based on location and imaging was Cavernous Hemangioma, Fibrous Histiocytoma, Dermoid cyst, Schwannoma among others.
Canalicular lacerations are missed quite often during evaluation of periocular injuries due to Road traffic accidents, assaults and animal bites in busy emergency rooms. At the same time, surgical repair of canalicular laceration can be very frustrating experience as the distal end of the lacerated canaliculi can become very illusive to locate. After locating theContinue reading “(Eye)Lid off with Canal(iculus) in tow!”
The staring look of eyelid retraction in TED can be very awkward for patients while meeting people and in photos of themselves. This eyelid malposition can be easily corrected with a 30 minute procedure done under local anaesthesia with very predictable outcomes. This lady was very pleased with the outcome of the surgery as she’s back to her beautiful Pre-TED self.
There is a mystical hole in the wall – of the orbit. An ancient myth among oculoplastic and maxillofacial surgeons alike-that once an Orbito- zygomatico-maxillary complex (OZM) fracture or commonly known as ZMC fracture is reduced, the orbital floor fracture automatically gets reduced and there is no need to repair the floor of the orbit. This was classic textbook teaching. However, this is true of only a small percentage of ZMC fractures.
Droopy Eyelid Surgery or Ptosis correction surgery is more art than science. I’m sure all Oculoplastic Surgeons agree it is a challenge to treat patients with ptosis. Each case is so different that it is almost feels like you are starting from scratch. While challenging, it is also among the most satisfying Oculoplastic conditions to treat.
Nothing beats the feeling of being able to remove a skull base tumour through a small incision in the upper eyelid crease. This here is after the tumour has been completely excised. This picture shows the amount of exposure we can achieve by just the orbital route and also that’s me admiring the orbital anatomy for a few seconds before closing up.
Facial Trauma can be damaging with tissue loss. Despite accurate and meticulous reconstruction, the scarring can be severe in the face. Scar modulation is an essential part of post trauma care and I often advise patients as much when they come with traumatic injuries of the face.
We managed to fix this post-traumatic meningoencephalocele via TONES. I accessed the superior orbit and roof fracture through the upper eyelid crease incision dissecting in the sub-orbicularis pre-septal plane followed by a periosteal incision on the superior orbital rim. My colleague then repaired the dural tear and CSF leak with a dural substitute. I then repaired the orbital roof fracture with osteomesh- an osteo-integrating mesh implant.
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.