Biomedical subjects
Publications and source records attributed to W A Cies.
A modified gold weight has been developed for use in paretic upper eyelids following seventh nerve damage. The modified weight is implanted in the pretarsal space. The weight was developed to enhance lid blinking, minimize extrusion, provide better cosmesis, and to provide a good upper lid blinking mechanism.
The Wies procedure may be complicated by an overcorrection, which is in effect a cicatricial ectropion. Four cases of such a complication are presented. The mechanism of an overcorrection is related to the level of the incision in the lid and to the suture placement. Correction of this complication primarily involves lysing cicatricial bands maintaining the overcorrection. Placement of sutures maintains the lid in a normal position.
To prevent corneal damage, the central lid margin must have a normal skin-conjunctiva interface following the lid reconstruction. A two-step procedure may be employed: In the lower lid an initial Hughes reconstruction should be tried. If this is unacceptable, a subsequent block excision of the segment is performed. The important step in both phases is a thorough lateral cantholysis. In the upper lid, the central defect is immediately reconstructed by sliding the lateral lid remnant to the medial remnant. The resulting lateral defect is reconstructed with a Hughes procedure. In both cases, a physiologic lid margin is insured, because normal lid is sutured to normal lid.
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We used two surgical procedures to treat upper eyelid retraction in ten patients: either a posterior myectomy or the anterior levator muscle recession technique. Our choice was usually based on the amount of retraction. We used the posterior myectomy technique to treat up to 2 mm of retraction or localized retractions (five cases), particularly after blepharoptosis surgery. We used the anterior recession method to treat more than 2mm of retraction (five cases), particularly when associated with dysthyroid ocular disease. Complex eyelid contour abnormalities were treated with a combined recession-resection approach to the aponeurosis of the levator palpebrae superioris muscle (one case).
In situations requiring a conjunctival flap to cover a corneal defect, the racquet flap technique is a simple relatively noninvasive method. Less conjunctiva is sacrificed and yet the flap is fully maintained by the one pedicle. The bulbar conjunctiva is maintained in an essentially normal state.
Cosmetic rhinoplasty and maxillary sinus surgery are rare causes of lacrimal obstruction. The lacrimal sac is quite vulnerable to damage by the lateral osteotomy of the rhinoplasty. While obstruction from such damage usually resolves in three months, these three cases illustrate the risk of perisitent obstruction, particularly in complicated cases. The nasoantral window in the Caldwell-Luc may damage the distal lacrimal opening if it is placed too high, or made too large. Occasionally, the duct will extend more anterior and inferior and be quite vulnerable to damage by the nasal antrostomy.
The Wies procedure may be complicated by an overcorrection, which is in effect a cicatricial ectropion. Four cases of such a complication are presented. The mechanism of an overcorrection is related to the level of the incision in the lid and to the suture placement. Correction of this complication primarily involves lysing cicatricial bands maintaining the overcorrection. Placement of sutures maintains the lid in a normal position.
We performed surgery on 107 patients primarily with blepharoptosis and eyelid fold abnormalities, between 1973 and 1974. Production of an eyelid fold at the time of an initial blepharoptosis procedure should be a primary goal. Lack of a distinct symmetrical upper eyelid fold constituted a cosmetic blemish and necessitated revision.
Seven patients with basal cell epithelioma of the eyelids, canthi, or periorbital skin who were initially treated by Mohs' chemosurgery or by fresh-staged excisions developed complications directly referable to the initial method of excision. Five patients achieved excellent results. Methods of one-staged complete excision and plastic reconstruction were used when tumor excision was incomplete. When excision was complete, secondary reconstructive surgery was sometimes necessary to assuage the effects of healing by granulation.
In congenital microphthalmos and anophthalmos, the socket and lids are often underdeveloped. Progressive dilation of the socket often does not increase the horizontal lid aperture or permit the use of a larger prosthesis. The authors present two cases in which a modified Mustarde cheek flap, lined with a tarsal-conjunctival graft, was used to reconstruct and lengthen the lower lid. This procedure results in a larger horizontal lid aperture and permits a larger prosthesis to be contained in the socket.
Reconstruction of the lower lid often is a greater task than originally anticipated in preoperative evaluations. The Mustardé and Hughes methods are commonly used for extensive lower lid reconstruction. Certain difficulties encountered in these methods may be minimized by variations in the basic techniques. Structural support for a Mustardé flap may be provided by a free tarsal conjunctival graft rather than a nasal septal cartilage mucosa graft. Late complications following the Hughes procedure include upper lid retraction and entropion. These may be minimized by removing Mueller's muscle from the flap at the time of the original dissection. The Hughes flap may be lysed in 3 to 4 weeks. Lid margin abnormalities, which occur occasionally, are corrected with minor modifications.