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Biomedical subjects

B N Lemke

Publications and source records attributed to B N Lemke.

At least 37 records · Page 2Linked to original sources
PubMed1997

Eyelid splitting with excision or microhyfrecation for distichiasis.

Distichiasis is a rare congenital or acquired condition in which an accessory row of eyelashes arises from the posterior lamella of the eyelid margin. Previously described surgical techniques to treat distichiasis can result in complications including trichiasis, loss of normal eyelashes, cicatricial entropion, and eyelid margin deformities. We describe a new technique in which the eyelid margin is split to expose the distichiasis eyelash follicles. Each aberrant eyelash follicle is individually excised or microhyfrecated and then removed. Seventeen eyelids in 5 patients with congenital or acquired distichiasis have been treated. We have achieved excellent functional and cosmetic results using this new technique.

Adolescent↗
PubMed1997

Orbital cysticercosis.

BACKGROUND: Human cysticercosis is secondary to an infestation by cysticercus cellulosae, the larval form of Taenia solium. Cysticercosis is endemic to regions with poor sanitation. The purpose of this report is to present a large series of patients with orbital cysticercosis and to discuss the current treatment. METHODS: A retrospective chart analysis of all patients with orbital cysticercosis from an urban practice in southern India was performed. The clinical features, the results of investigations, the therapies instituted, and the outcomes realized were recorded. RESULTS: Twenty patients diagnosed with orbital cysticercosis were identified (11 female and 9 male). Their ages ranged from 5 to 25 years with a mean age of 12.5 years. Nine patients manifested subconjunctival cysts. Eight were excised and 5 of these were densely adherent to the adjacent extraocular muscle (EOM). The remaining 11 patients had a cyst in a single EOM. The EOM cysts had proptosis, restricted motility, recurrent inflammation, and blepharoptosis. Two of the EOM cysts were excised surgically and four extruded spontaneously. Six patients with EOM cysts were treated medically: they all received oral corticosteroids and, additionally, five were given oral albendazole and one was given oral praziquantel. CONCLUSIONS: Excisional biopsy is recommended for subconjunctival cysticercosis. Idiopathic cystic myositis can present like EOM cysticercosis, but is differentiated by resolution with corticosteroid treatment. Medical therapy in orbital cysticercosis with oral albendazole and corticosteroids can arrest recurrent inflammation and improve ocular motility.

Adolescent↗
PubMed1997

Donor site complications of hard palate mucosal grafting.

The use of hard palate mucosal grafts (HPG) in eyelid surgery is becoming increasingly popular. We present two palatal donor site complications that have not been previously reported. The first is an oro-nasal fistula discovered 1 week following surgery. The second is oral candidiasis, which compromised healing of the palatal donor site. With appropriate treatment, both complications resolved shortly after surgery. Careful preoperative evaluation and postoperative follow-up is recommended to recognize and manage these complications.

Adult↗
PubMed1996

Lateral extensions of the Müller muscle.

OBJECTIVES: To define the lateral extension of the Müller muscle and to elucidate its involvement in the development and surgical treatment of Graves (thyroid) eye disease. METHODS: Twelve lateral halves of orbits exenterated from patients with medial or posterior orbital neoplasms were fixed, embedded, and step sectioned at 250-microns intervals to produce histological sections. Gross anatomical dissections of human cadaver heads were also used to corroborate the histological findings. RESULTS: Histological analysis revealed that the Müller muscle extended laterally between the orbital and palpebral lobes of the lacrimal gland in all specimens. The smooth muscle fibers were found to interdigitate with lacrimal ducts passing from the orbital to palpebral lobe and to extend close to the ductal orifices at the conjunctival surface. Gross dissections confirmed that the Müller muscle accompanied the levator aponeurosis lateral extension, which is known to pass between the orbital and palpebral lobes of the lacrimal gland. CONCLUSIONS: Our anatomical findings suggest that the Müller muscle may contribute to the temporal flare frequently seen in eyelid retraction associated with thyroid eye disease. They may also explain the difficulty of treating lateral eyelid retraction in thyroid eye disease and indicate the need for new surgical approaches for severe lateral eyelid retraction.

Eye Enucleation↗
PubMed1996

Relations of the superficial musculoaponeurotic system to the orbit and characterization of the orbitomalar ligament.

The orbital and eyelid relationships of the superficial musculoaponeurotic system (SMAS) were studied in human cadavers. Using gross and microscopic techniques, the SMAS was found to be intimately related to the eyelids and orbicularis oculi muscle, and to have distinct orbital bony attachments. Sub-SMAS fat in the malar region was found to be continuous with the submuscular fat in the eyebrow region. The malar sub-SMAS fat continued superiorly into the lower eyelid above the inferior orbital rim, as a postorbicularis layer. A bony attachment emanating from the inferior orbital rim, the orbitomalar ligament, traveled through the orbicularis oculi muscle in a lamellar fashion prior to inserting into the dermis. The cutaneous insertion of this attachment corresponds to the malar and nasojugal skin folds. With aging, relaxation of the orbitomalar ligament allows inferior migration of orbital fat, in addition to the anterior migration that occurs through an attenuated orbital septum. These findings have implications not only in cosmetic surgery but also in the understanding of facial soft tissue changes that occur with aging.

Adult↗
PubMed1996

Cystic lesions of the extraocular muscles.

Cystic lesions of the extraocular muscles (EOMs) are uncommon. Six patients with a cystic lesion in an extraocular muscle, as observed by computerized tomography (CT) scanning, were retrospectively identified from the practice of one of the authors (G.C.S.), and their clinical course was reviewed. All the patients were treated initially with oral corticosteroids. Those who did not respond to this therapy underwent surgical exploration. Four patients demonstrated complete resolution of clinical signs and symptoms with oral steroid therapy. Posttreatment CT scans performed in two of these patients showed resolution of the cystic lesion with residual muscle thickening in one. The two patients not responding to steroids underwent surgical excision and histopathology confirmed the diagnosis of cysticercosis. Cysticercosis is a previously reported cause of a cystic lesion in an EOM. To the best of our knowledge, cystic lesions of the EOMs resolving with steroids have not been previously reported. Response to oral steroids in four of our patients is suggestive of myositis with a cystic change in the muscle. We recommend a trial of oral steroid therapy in patients with a cystic EOM lesion before surgical exploration is performed.

Adolescent↗
PubMed1994

Results of endonasal laser-assisted dacryocystorhinostomy.

BACKGROUND: Endonasal laser-assisted dacryocystorhinostomy has been a subject of much interest since its introduction in 1990, offering the potential advantages of decreased postoperative morbidity and the lack of a cutaneous scar. In this study, the authors report the results of 46 endonasal laser-assisted dacryocystorhinostomy procedures performed on 42 patients between February 1991 and July 1992. METHODS: The medical records of all patients undergoing endonasal laser-assisted dacryocystorhinostomy procedures were reviewed retrospectively in detail. Patients undergoing laser-assisted external dacryocystorhinostomies or conjunctivo-dacryocystorhinostomies and those with follow-up periods less than 4 months were not included in the study. RESULTS: A total of 46 endonasal laser-assisted dacryocystorhinostomy procedures were performed. Of these, 32 were successful and 14 failed after a single attempt, yielding a success rate of 70% (32/46). Of the 14 patients with failed procedures, 6 underwent a second endonasal laser-assisted dacryocystorhinostomy. Of these, five were successful. The success rate calculated on the basis of one or two attempts was 80% (37/46). CONCLUSIONS: The science and technology of endonasal laser-assisted dacryocystorhinostomy is undergoing a continuous process of evolution as a number of modifications are introduced, including better patient selection, more complete tissue removal at the osteotomy site, and the adjunctive use of mitomycin C. As this process continues, it is likely that the success rates in this modality will improve, making it an increasingly attractive alternative to external dacryocystorhinostomy.

Dacryocystorhinostomy↗
PubMed1994

Oculinum injection-resistant blepharospasm in young patients.

Botulinum toxin has recently been used as a nonsurgical treatment for blepharospasm and other facial dyskinesias. This report describes four patients between the ages of 32 and 37 years who failed to respond to botulinum injections for severe blepharospasm. Other than age, no other features could be identified in these patients that would differentiate this group. Particularly early age of onset for essential blepharospasm might be an indicator of failure to respond to the injections.

Adult↗
PubMed1994

Progressive infraorbital nerve hypesthesia as a primary indication for blow-out fracture repair.

Traumatic blow-out fractures of the orbital floor are a common injury that can lead to significant morbidity. Accepted indications for surgical repair include displaced fractures consisting of a defect > 50% of the orbital floor, extraocular muscle entrapment, and clinically significant enophthalmos. Although infraorbital nerve hypesthesia has been reported as an indication for repair of fractures of the zygomatic complex and is often encountered as an associated finding in fractures of both the orbital floor and inferior orbital rim, it has not been generally regarded as a primary indication for blow-out fracture repair. We report two patients in whom severe, progressive infraorbital nerve hypesthesia served as the primary indication for surgical repair. Both patients experienced improvement in infraorbital nerve function following surgical repair, accompanied by persistent pain and paresthesias in the distribution of the infraorbital nerve. We suggest that progressive infraorbital nerve hypesthesia should be considered a primary indication for blow-out fracture repair in selected patients in whom hypesthesia is both severe and progressive.

Adult↗
PubMed1993

Levator aponeurosis elastic fiber network.

This light and electron microscopic study demonstrates an elastic fiber network (EFN) for the levator palpebrae superioris muscle complex, which forms an intricate insertion into the upper eyelid. The EFN is examined in the monkey, in a fresh exenteration specimen, and in fresh frozen cadaver specimens from both sexes of different age groups. Multiple elastic insertions of the levator aponeurosis and Muller's muscle attachment with well-organized elastic fibers are demonstrated using special staining techniques and serial microscopic sectioning. Transmission electron microscopy (TEM) confirms the ultrastructure of "mature" elastin fibers in Muller's muscle tendon and their close relationship with the elastin-related fiber, oxytalan. Current thinking concerning the nature of elastic fibers and their possible implications in acquired involutional blepharoptosis is discussed. This microscopic study of the EFN of the upper eyelid focuses attention on the multiple elastic fiber insertions of the levator muscle complex that includes the levator aponeurosis, the conjoined fascia, the lid crease area, and Muller's muscle tendon, which have not been previously described.

Adult↗
PubMed1993

Unilateral ptosis and eye dominance.

We studied the relationship between eye dominance (Scobee test) and upper lid level (MRD) in 54 patients with unilateral ptosis or asymmetric bilateral ptosis (> or = 2 mm difference in MRD) using the phenylephrine test. A contralateral lid drop was measured in 12/54 patients after instillation of 2.5% phenylephrine in the more ptotic eye and occurred in both congenital (3) and acquired (9) ptosis cases. A contralateral lid drop was seen in 7/14 (50%) patients whose ptosis was greater in the dominant eye and in 5/40 (12.5%) patients whose ptosis was greater in the nondominant eye (p = .01). Contralateral lid drops > or = 1 mm were present in 7/54 patients, and 6/14 (43%) of them had greater ptosis on the dominant side and 1/40 (2.5%) on the non-dominant side (p = .001). There was no association between contralateral pseudoretraction and either visual acuity or severity of ptosis. These results suggest that levator muscle tone is influenced by eye dominance when ptosis is present. The preoperative evaluation of unilateral or asymmetrical bilateral ptosis cases should include the Scobee and phenylephrine tests to unmask contralateral upper lid pseudoretraction.

Adolescent↗
PubMed1993

Identification of orbital lymphatics: enzyme histochemical light microscopic and electron microscopic studies.

The presence of orbital lymphatics in the primate model is demonstrated using light and electron microscopic enzyme histochemistry. In addition, strictly morphological definitions of lymphatics, such as discontinuous basal lamina, thin and irregular walls, anchoring filaments, and attenuated endothelial cell cytoplasm, were applied. This study confirmed the presence of conjunctival lymphatics reported by others. It also clearly demonstrated the presence of orbital arachnoid and lacrimal gland lymphatics that have not been previously described. A few areas of the extraocular muscles and connective tissue at the orbital apex also showed evidence of the presence of lymphatic vessels. Additional work is needed to define the nature and extent of orbital lymphatics as well as their connection to the extraorbital lymphatic system.

Adipose Tissue↗
PubMed1992

Sympathetic nerve anatomy in the cavernous sinus and retrobulbar orbit of the cynomolgus monkey.

We present new information regarding the sympathetic nerve anatomy in the cavernous sinus and retrobulbar orbit of the cynomolgus monkey. Postganglionic sympathetic nerves were identified using an immunoperoxidase technique in which the primary antiserum was directed against tyrosine hydroxylase, the rate-limiting enzyme in norepinephrine synthesis. Our work is unique in adapting this staining method to paraffin-embedded tissue. This technique allows sympathetic nerve fibers to be distinguished from other autonomic, sensory, and motor nerves. A large sympathetic nerve bundle lateral to the internal carotid artery in the cavernous sinus gave off one or more branches that leave the artery to encircle the abducens nerve. Further division occurs within the cavernous sinus, but all sympathetic nerve fibers destined for the orbit entered it through the superior orbital fissure. None pass through the optic canal. In the orbit, sympathetics were associated with the ophthalmic artery and some of its branches and with the sensory root to the ciliary ganglion. After entering the ganglion, the sympathetic fibers were lost to detection in most specimens, but they were again seen in a single short ciliary nerve in one instance. Sympathetic nerve fibers were not detected adjacent to several structures identified in the human anatomy literature, such as the intracranial and intracanalicular segments of the ophthalmic artery, the nasociliary nerve, the long ciliary nerves, the nerve to the inferior oblique muscle, or the lacrimal artery and nerve.

Animals↗
PubMed1991

Problems associated with conjunctivodacryocystorhinostomy.

Fifty-eight patients (69 eyes) underwent conjunctivodacryocystorhinostomy for lacrimal canalicular obstruction. The cause of lacrimal obstruction and the results and complications of the operation were analyzed. Trauma and idiopathic disease were the most common causes of lacrimal canalicular obstruction in 24 of 69 (34.8%) eyes each. Relief of epiphora was achieved in 68 of the 69 eyes (98.5%). The complications included tube displacement in 40 of the 69 eyes (57.9%), tube obstruction in 19 of the 69 eyes (27.5%), and infection of the lacrimal sac in four of the 69 eyes (5.8%). Despite frequent complications, most Jones tubes can be made to function satisfactorily. Conjunctivodacryocystorhinostomy remains the best surgical treatment at this time for permanent loss of canalicular function.

Adolescent↗