TONES- Pushing boundaries!

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.

A Nose to Remember!

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.

Finding a road to the fistula

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.

The Dumbbell on the Eyelid

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.

Eyebags of Worry- Trans-conjunctival Lower lid Blepharoplasty

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”.

Blepharoplasty- Eyelid Lift Surgery

Blepharoplasty is the removal and repositioning of the skin, muscle and fat of the upper and/or lower eyelid. In the upper eyelid the incision is made and hidden in the natural lid crease. 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.

When will Artificial Intelligence replace Human Doctors?

AI robots will be complementary to human doctors and won’t be a zero-sum game for a long time to come. AIs will help us reduce our mistakes, decrease our workload, make us work more sane hours and in turn manage our work-life balance- but at least in the foreseeable future they aren’t going to replace us. Maybe it will lead to lot of us doing less mundane, repetitive jobs and with doctors doing much higher intellectual level work.

The rodent that dug into the eyelid! Basal Cell Carcinoma

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 Dog and the Eyebrow! Eyebrow Reconstruction

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.

Guidelines for the Oculoplastic and Ophthalmic Trauma Surgeon during the COVID-19 era – An APOTS & APSOPRS Document

The outbreak of COVID-19 pandemic is changing the infection, transmission and safety practices of medical establishments globally. From evidence that is available presently, the risk of transmission of this virus is high amongst medical personnel involved in procedures and surgeries around the head and neck region- Ophthalmology, Otorhinolaryngology, Craniomaxillofacial surgery, Head and Neck Oncology, Neurosurgery including Anesthesiology. The field of Oculoplastic Surgery has risk factors common to both ophthalmology and all of the above craniofacial subspecialties. While clear directives and strategies to handle elective, urgent and emergency surgeries in SARS-Cov2 positive patients is constantly evolving, we herewith attempt to consolidate various guidelines from various relevant professional global medical societies which will be beneficial to the orbit, oculoplastic and ophthalmic trauma surgeon and also their hospital administrators.