Biomedical subjects
Publications and source records attributed to M H Quickert.
Nonincisional suture techniques are used for the treatment of epiblepharon and congenital entropion. An explanation for the unstable eyelid seems to involve similar developmental anomalies of the eyelid retractor. Congenital entropion has been treated promptly in the past. Contrary to tradition, symptomatic epiblepharon should also be treated early.
Symmetry in severe unilateral ptosis, the jaw-winking syndrome, and ptosis with aberrant third-nerve regeneration is best achieved with bilateral frontalis suspension. However, the levator function needs to be removed in the normal side with unilateral ptosis and bilaterally with the paradoxically innervated levator. Levator transposition to the arcus marginalis is a reversible methods of establishing a complete ptosis. the reversibility of the procedure is demonstrated in the rhesus monkey. The procedure, when combined with frontalis suspension in humans, demonstrates the needed elimination of levator function.
Surgical exploration of the upper eyelid was undertaken in two patients who developed blepharoptosis after cataract extraction. Disinsertion of the aponeurosis of the levator palpebrae superioris muscle from its epitarsal attachments was discovered and repaired in each patient to correct the blepharoptosis.
Indications for the procedure of aponeurotic repair are nearly all of the ptoses that have 8 mm or more of elevation from downward to upward gaze. Such cases have a levator with an adequate striated part, an inadequate superior tarsal (Müller) muscle, and an aponeurosis that has involutional changes such as a dehiscence or disinsertion. Local anesthesia is advised. The incision is made 7 mm above the lash-line, through the skin and pretarsal muscle only. Blunt dissection upward is used until the preaponeurotic fat pad is uncovered. The upper part of the aponeurosis is picked up under the fat pad and sutured to the lower part of the aponeurosis with 5-0 chromic gut. Fifty-seven eyelids in thirty-four patients have been operated on, with excellent results and minimal trauma.
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A total of 157 eyelid basal cell carcinomas were surgically excised during an 18-year period. All lesions were submitted for histologic examination to determine the adequacy of excision and 72% had frozen section evaluation at the time of surgery. Complete resection was attained in 97.5% of cases. There were no recurrences reported. Postoperative problems occurred in 8% of patients but all were corrected by secondary surgical procedures.
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