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Biomedical subjects

A M Putterman

Publications and source records attributed to A M Putterman.

At least 37 records · Page 2Linked to original sources
PubMed1989

Custom orbital implant in the repair of late posttraumatic enophthalmos.

We repaired late, posttraumatic enophthalmos in 21 patients by inserting a large, soft, Silastic block through a lower eyelid flap and transconjunctival approach to the orbit. These blocks were hand carved at the time of surgery to match bony defects as characterized by hypocycloidal tomographic biometry. Enophthalmos and hypo-ophthalmos were ameliorated with acceptable appearance in all cases. No implant rejections, migrations, or infections were found. Complications included upper eyelid blepharoptosis, lower eyelid retraction, and conjunctival prolapse. The improvements were stable over a median follow-up of 13 months.

Adult↗
PubMed1989

Reconstruction of nasal fistulas of the medial canthus.

Invasive carcinomas of the medial canthus may require the removal of skin, subcutaneous tissue, and nasal bone, which can result in a nasal fistula of the medial canthus. I applied a nasolabial flap on the inside of the fistula and a forehead flap on the outside to reconstruct such a fistula. This technique was successful in three patients.

Aged↗
PubMed1989

Conjunctival flap-cosmetic shell-ptosis procedure. Treatment of blepharoptosis in severe keratopathy.

The correction of marked blepharoptosis in patients with severe or potential keratopathy will worsen the keratopathy and possibly lead to the complications of corneal ulceration and endophthalmitis. The conjunctival flap--cosmetic shell--ptosis procedure is well suited to this difficult management problem. Patients are initially treated with a conjunctival flap to protect their cornea. Subsequently they are fit with a cosmetic shell, and finally they undergo surgery to correct their ptosis. This three-stage procedure has produced excellent cosmetic and functional results in two patients, one of whom had ptosis and severe radiation-induced keratopathy following the treatment of a rhabdomyosarcoma; the other patient had severe ptosis associated with lack of corneal sensation and orbicularis function following removal of a cerebral meningioma.

Blepharoptosis↗
PubMed1989

Recurrent Jones tube extrusions successfully treated with a modified glass tube.

Displacement or extrusion of the standard glass Jones tube causes conjunctivodacryocystorhinostomy to fail in many cases. Patients who have had trauma, a tumor excised, or have received radiation therapy in the medial canthal area are particularly susceptible to this complication. Gladstone and Putterman developed a modified glass tube that has a second flange 3 to 6 mm from the top flange. The second flange anchors the tube and reduces its mobility. Eleven patients who could not retain a standard Jones tube were fitted with a modified glass tube. Seven of these patients were able to wear the originally placed modified tube comfortably. Two additional patients extruded the originally placed modified tube but were able to retain a shorter modified tube. Follow-up ranged from 3 weeks to 49 months (average, 22.4 months).

Conjunctiva↗
PubMed1989

Cicatricial entropion: an analysis of its treatment with transverse blepharotomy and marginal rotation.

Transverse blepharotomy with marginal rotation is a simple and effective procedure to treat cicatricial entropion of diverse etiology in upper and lower eyelids. The surgeon can vary the site of incision and suture placement to control the amount of marginal rotation required. We treated 152 eyelids (98 patients) with this technique, obtaining an 85% overall success rate. Eleven recurrences were found in 7 of 18 lids with ocular pemphigoid; the success rate for this subgroup was 39% compared with 92% for all others. We recommend this procedure as a technically easy treatment for cicatricial entropion not caused by ocular pemphigoid.

Entropion↗
PubMed1986

Evaluation of lubricants for the prosthetic eye wearer.

We evaluated the need for additional lubrication in 200 consecutive patients using an ocular prosthesis. Of these patients, 154 (77%) required no additional lubrication, while 46 patients (23%) required supplemental lubrication. Enuclene, the only product manufactured specifically for the patient with an ocular prosthesis, has been reported by the majority of our patients to be inadequate for comfort and wearability. Other solutions for contact lens use were compared with Enuclene and found to be far superior by patients using an ocular prosthesis.

Adolescent↗
PubMed1979

Müller's muscle excision and levator recession in retracted upper lid. Treatment of thyroid-related retraction.

The results of excision of Müller's muscle with or without recession of the levator palpebrae superioris aponeurosis were examined in 61 upper eyelids of 40 patients. The cosmetic results were acceptable in 35 patients (56 upper eyelids). Another five patients had a subsequent unilateral partial (nasal) or total ptosis, which was successfully treated with additional surgery. Overcorrections (ptosis) have ceased to be a problem since modifications to the original technique have been used. Only one undercorrection was encountered, and it was treated successfully with a simple surgical procedure. We believe that the described procedure is desirable for the treatment of thyroid-related upper eyelid retraction because it is simple, is based on anatomic and physiologic principles, is tailored to the individual patient intraoperatively and yields consistently good results.

Adult↗
PubMed1979

Frozen section control in the surgery of basal cell carcinoma of the eyelid.

Two groups of patients, 37 with primary basal cell carcinoma of the eyelid and 16 with basal cell carcinoma of the eyelid previously treated by other physicians were reviewed. All of the tumors were excised with at least 3 to 4 mm of normal-appearing tissue at each margin of resection. All of the excised specimens were submitted for frozen section studies of the margins. A total of 20 (54.04%) of the previously untreated tumors and eight of the previously treated tumors had at least one margin involved with tumor cells. Repeated excisions under frozen section control were done until all of the margins were free of tumor cells. To date, none of the patients treated in this manner had a recurrence of the tumor.

Adult↗
PubMed1979

Lower eyelid full-thickness vertical lengthening.

Two cases of lower eyelid retraction caused by loss of full-thickness eyelid components were successfully treated with a tarsal-confunctival flap and skin graft procedure. One patient also had upper eyelid retraction, which was decreased by excising Müller's muscle and recessing the levator aponeurosis simultaneously with the lower eyelid surgery.

Adult↗
PubMed1979

Ocular asymmetry measuring device.

An instrument that measures ocular, eyebrow, canthal, and lower eyelid asymmetries accurately is useful for evaluating various deformities before oculoplastic surgery is performed. The ocular asymmetry measuring device comprises a headband, a ruler, and a T-shaped crosspiece. When the band is placed around the patient's head at forehead level, it fixes the ruler vertically over the midforehead. The metal rod is aligned with whatever eyelid, eyebrow, eye, or canthus is lower and is then elevated until it transects a similar structure on the opposite side. The degree of asymmetry is measured in millimeters. The device is useful in determining the degree of correction needed in various conditions that result from orbital fracture, facial paralysis, and congenital anomalies.

Eye Abnormalities↗
PubMed1979

Orbital tumor evaluation.

The key tests in the evaluation of orbital pathology--orbital roentgenograms, CT scans, and ultrasonography--are defined.

Humans↗
PubMed1979

Reconstruction of absent lacrimal puncta.

A previously described technique to isolate absent lacrimal puncta is reemphasized. The procedure has been modified, whereby the entire punctal and vertical canalicular walls are removed with a Holth sclerectomy punch and by silastic intubation of the passages. This has led to increased permanent patency of the lacrimal puncta and a greater, successful resolution of epiphora. A modified pigtail probe with a narrowed tip has been developed to facilitate passage of the silastic tubing without it slipping off the probe.

Humans↗
PubMed1978

Viable composite grafting in eyelid reconstruction.

I reconstructed eyelids in two patients by successfully using a new technique to increase the viability of a composite, full-thickness eyelid graft. Splitting the graft into two components of tarsal-conjunctival-margin and skin and placing each component against a viable skin and orbicularis flap, respectively, facilitated the acceptance of the graft and increased the success of the reconstruction.

Adult↗
PubMed1978

Ectropion of the lower eyelid secondary to Müller's muscle-capsulopalpebral fascia detachment.

A patient developed severe lower eyelid ectropion after a bilateral levator aponeurosis and Müller's muscle advancement-and-truck blepharoptosis procedure and bilateral attachment of the lateral canthi to the lateral canthal tendons. The cause of this ectropion was detachment of Müller's muscle and capsulopalpebral fascia from the inferior tarsus and recession of these tissues into the orbit. This left the inferior tarsal border with only redundant conjunctiva attached to it, which could not maintain it in a downward direction; thus, an ectropion occurred. Müller's muscle and capsulopalpebral fascia were detached from the inferior tarsus and recessed 15 mm into the orbit. Reattaching Müller's muscle and capsulopalpebral fascia to the inferior tarsus relieved the ectropion.

Aged↗
PubMed1978

Müller's muscle-conjunctival resection ptosis procedure.

The Müller's muscle-conjunctival resection procedure is a relatively simple means of relieving ptosis in patients whose upper eyelids elevate to a normal level with phenylephrine instillation. The Müller's muscle-conjunctival resection procedure has advantages over the Fasanella operation because tarsus is preserved, and over the levator aponeurosis advancement and tuck operation because the results are more predictable.

Adult↗
PubMed1977

Deep ocular socket reconstruction.

A technique to reconstruct totally contracted sockets forms spacious, deep ocular fornices to accommodate ocular prostheses. Fixation of the midperiphery of mucous-membrane-lined, custommade conformers to the superior and inferior orbital rims secures the posterior periphery of the conformer deep in the orbit. The method restores the normal anatomy of the ocular fornices that not only extends to the orbital rims but also penetrates deeply into the orbit along its roof and floor. The procedure contrasts with conventional, frequently unsuccessful methods of socket reconstruction that form fornices only to the superior and inferior orbital rims without extending posteriorly into the orbit. Using this technique, we reconstructed deep, spacious sockets in five patients with serious socket contracture, allowing the patients to retain cosmetically acceptable artificial eyes. The principles advocated apply to all contracted sockets.

Adolescent↗