Biomedical subjects
D R Jordan
Publications and source records attributed to D R Jordan.
Complications associated with alloplastic implants used in orbital fracture repair.
BACKGROUND: The treatment of orbital wall fractures involves observation and/or surgical reduction with repositioning of herniated orbital tissues. To prevent reherniation of tissue and development of enophthalmos, the orbital floor or wall defect is commonly covered with an alloplastic implant. Complications associated with these implants are infrequent and generally appear as isolated case reports. METHODS: The authors reviewed the files of four consultative oculoplastic surgeons and searched for individuals with complications secondary to their alloplastic implants used during orbital fracture repair. FINDINGS: Seventeen patients were identified with a variety of complications related to their alloplastic implant. CONCLUSION: Although these implants are relatively inert and develop a fibrous capsule walling them off from the surrounding orbit, they remain foreign bodies and are thus subject to possible complications at any time. The authors review the spectrum of complications occurring with various alloplastic implants.
Ectropion following entropion surgery: an unhappy patient and physician.
Ectropion following entropion surgery is an uncommon situation that creates an unhappy patient and physician when it occurs. The precipitating events that lead to this situation may be related to a faulty understanding of the pathophysiology of the entropic process, utilization of an inappropriate technique, overcorrection of entropion repair, bleeding into the operative field with subsequent scarring of the lid, or a combination of the above. Correction of this situation requires restoration of the normal anatomy where possible, release of any scar bands, and often a lid-tightening procedure.
Microblepharon.
We describe a child with microblepharon and corneal exposure secondary to lagophthalmos. Surgical reconstruction utilizing full-thickness skin grafts to all four lids corrected the lagophthalmos and relieved her symptoms.
Blepharochalasis syndrome: a proposed pathophysiologic mechanism.
The blepharochalasis syndrome is an uncommon disorder seen in young people that is characterized by recurrent episodes of eyelid edema. After repeated episodes various eyelid supportive structures are stretched, giving rise to the characteristic features of thin excess lid skin, blepharoptosis, pseudoepicanthal folds, and disinserted lateral canthal tendons. Surgical repositioning and reconstruction are often required. The author describes 10 patients with this disorder and suggests a relation to angioedema, a common dermatologic condition with numerous triggering mechanisms.
Modifications to the semicircular flap technique in eyelid reconstruction.
The most common reconstructive procedure in the upper and lower eyelid is direct closure of the lid margin. When additional mobilization of tissue is needed to close a defect, lateral canthotomy and cantholysis is suggested. Mobilization of tissue beyond the lateral orbital rim is occasionally required. We have found that in the lower eyelid the mobilized tissue is much better supported if the initial incision is made vertically toward the eyebrow rather than temporally, as is suggested with the semicircular flap technique. We describe modifications to this technique, which we refer to as the vertical-temporal advancement flap, and present the results in 28 consecutive patients followed for 8 months to 3 years.
Psammomatoid ossifying fibroma of the orbit.
Psammomatoid ossifying fibroma of the orbit is a distinctive solitary fibro-osseous lesion of the orbital bones that histologically has characteristic small, round structures resembling psammoma bodies within a benign spindle cell stroma. We describe a 19-year-old woman with this uncommon orbital tumour.
Avoiding blood loss in outpatient dacryocystorhinostomy.
The control of perioperative hemorrhage is a concern in dacryocystorhinostomy, which has traditionally been done as an inpatient procedure, often with general anesthesia. The trend now is toward outpatient surgery under local anesthesia. With proper patient selection and education, adequate anesthesia, and a meticulous surgical technique aimed at preventing blood loss, complications related to outpatient dacryocystorhinostomy can be minimal and associated with a high degree of patient acceptance. This article reviews my technique and experience in preventing blood loss in 434 procedures over 3 years.
The medial tarsal strip.
Medial canthal malpositions and marked medial ectropion due to laxity, scarring, or trauma can be difficult to correct. Medial canthal tendon publications have been advocated but they do not achieve adequate posterior and medial placement of the medial canthal angle and they lack permanence. One of us (R.L.A.) has developed a surgical technique for correcting these problems that is a modification of the lateral tarsal strip procedure used to correct lateral canthal tendon laxity and malposition. The medial tarsal strip procedure repositions and tightens the medial lower or upper eyelid, establishing a normal anatomic appearance. Its use is indicated in cases of medial canthal malposition or marked medial ectropion associated with a nonfunctioning canalicular system or in those cases in which loss of function of a patent canaliculus is acceptable or desirable. The advantages of the medial tarsal strip are as follows: (1) surgery is directed at the site of the defect; (2) recurrence of canthal tendon laxity and elongation is avoided; (3) a more medial and posterior positioning of the medial eyelid can be obtained; (4) any amount of eyelid laxity can be corrected simultaneously; (5) the almond-shaped canthal angle is preserved or reestablished; and (6) the procedure is fast and easily performed.
Whitnall's sling for poor function ptosis.
Severe unilateral ptosis with poor levator function has previously been treated with maximal levator muscle resection or bilateral or unilateral frontalis suspension. One of us (R.L.A.) has developed a technique called "Whitnall's sling," where only the levator aponeurosis is resected, preserving Whitnall's ligament and its attachments. Whitnall's ligament and the underlying resected levator muscle are sutured to the superior portion of the tarsal plate. This surgery preserves levator muscle, Müller's muscle, and Whitnall's ligament without altering the structures that produce the three-layer tear film. In 69 eyelids operated on between July 1976 and July 1986, in which a minimum of 1 year of follow-up by one of use was obtained, results have been satisfactory and directly related to levator function. We believe this technique to be anatomically and physiologically superior to "maximal levator resection" with similar long-term results. More recent results have shown that the addition of a 5-mm superior tarsectomy provides an additional elevation of 1 to 1.5 mm. Whitnall's sling is best suited for cases where the opposite fissure height is 9 mm or less and levator function of the ptotic eyelid is 3 to 5 mm.
The Blepharochalasis syndrome.
Explore the source record for details and available documents.
The pigtail probe, revisited.
Choosing a method for repair of a canalicular laceration can be a challenge for the ophthalmic surgeon. Important principles to consider include direct anastomosis of the severed canalicular ends, endocanalicular support, and avoiding trauma to the uninvolved portions of the nasolacrimal system. The round-tipped, eyed pigtail probe has been found to be a safe, effective instrument in identifying and repairing a canalicular laceration. The authors also found it helpful in reconstructing partially excised canaliculi after tumor removal with Mohs' surgery. A high degree of anatomic and functional success was achieved using this instrument in a careful and meticulous technique.
The tarsal tuck procedure: avoiding eyelid retraction after lower blepharoplasty.
Eyelid retraction and ectropion are the most common complications of lower blepharoplasty. These complications often occur as a result of removing excessive skin and muscle in the face of a lax lower eyelid. The tarsal tuck technique tightens and stabilizes the lower eyelid, thereby minimizing these complications. The lateral canthus and lower eyelid are elevated with the tarsal tuck, which reduces the amount of skin removal required and avoids the "round eye" appearance.
Bilateral hemifacial spasm.
Explore the source record for details and available documents.
An unusual case of orbital cellulitis.
Munchausen's syndrome, an unusual disorder related to malingering and hysteria, is occasionally seen by the ophthalmologist. Munchausen patients deliberately deceive and attempt to manipulate physicians 'through factitious signs and symptoms. They know they are acting, yet appear unable to control their actions. Unnecessary medical workups and inappropriate surgical interventions are common with this perplexing syndrome. An unusual case of orbital cellulitis that illustrates a number of these features is illustrated and the syndrome is reviewed.