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Dacryocystitis
CURRENT LITERATURE Abstracts Histological Localization of Myxoid Tissue in Normal Human Palatal Mucosa and Its Glycosaminoglycans. Pedlar J. Arch Oral Biol 32:195. 1987 This article provides evidence of the presence of myxoid areas beneath the palatal rugae. True myxoid tissue has been thought not to occur in the normal adult with the possible exception of the vitreous body of the eye. The palatal rugae may therefore be unique in this regard. Eighteen specimens of palatal mucosa were taken from 17 human subjects. Paraffin-wax sections stained by routine methods demonstrated the presence of glycosaminoglycans (GAG). Beneath all rugae, there were also myxoid areas varying in size and marginal definition. Collagen fibers were few in number, and elastic and reticulin fibers were numerous in some sections; the presence of hyaluronic acid was confirmed beneath the rugae. The exact function of the rugae is unknown. Both hyaluronic acid and proteoglycan aggregates swell by absorption of water. This unusual zone of loose connective tissue may thus act as a physical buffer resisting the local effects of high loads by allowing reversible extrusion of water. Myxoid changes do occur in some diseases and myxoid may also arise in neoplasia either as part of a complex tumor or as a true myxoma. Thus, the identification of myxoid tissue as a normal component of palatal mucosa is relevant to the histologic diagnosis of palatal lesions.JOHN BAMONTE Reprint requests to Dr. Pedlar: Department of Oral and Maxillofacial Surgery, University of Manchester Dental School, Higher Cambridge Street. Manchester, Ml5 6FH, England. UK.
concentrations. At higher epinephrine levels. alpha stimulation becomes predominant producing vasoconstriction. It is also noted that the injection of epinephrine into a wound has been shown to lower the tensile strength and to increase the wound’s susceptibility to infection. The authors conclude that infiltration with I :200,000 epinephrine gives optimal intensity and duration of vasoconstrictive effects in skin while minimizing the toxic potential of epinephrine.-JAMES R. HUPP Reprint requests to Dr. Larrabee: The Mason Clinic. Seattle, WA 98 I 1I.
BOX
900.
Lacrimal Intubation in the Primary Repair of Midfacial Fractures. Harris GJ, Fuerste FH. Ophthalmology 941242, 1987 Midfacial trauma may cause fracture of the lacrimal sac fossa and lacrimal canal that compromises tear drainage. This damage may pass unrecognized until epiphora and dacryocystitis occur as a late sequelae. Bony and membranous separation should be suspected if a lacrimal probe emerges from anywhere other than the osteum of the nasolacrimal duct in the inferior meatus. An operative intubation of the lacerated nasolacrimal duct with placement of a silicone stent should be performed and maintained for a period of four to six months. In this study, 1I disrupted distal pathways were intubated as part of the primary interdisciplinary repair of midfacial fractures which resulted in maintained tear outflow patency after long-term follow-up.-STEVEN F. RECK Reprint requests to Dr. Harris: Eye Institute, 8700 W. Wisconsin Avenue. Milwaukee, WI 53226.
Effect of Epinephrine on Local Cutaneous Blood Flow. Larrabee WF Jr, BJ Lanier, D. Miekle. Head Neck Surg 9:287, 1987
Dacryocystitis. Mauriello JA, Fiore PM, Ketch M. Ophthalmology 94:248. 1987
An animal study was performed to try to quantitate the effect of subcutaneous infiltration of various concentrations of epinephrine with and without lidocaine. Test substances consisted of saline, saline with epinephrine (1:50,000, l:lOO,OOO, 1:200,000, and 1:400.000), I% lidoCaine, and 1% lidocaine with epinephrine (1:50,000 to 1:400,000). One ml of each test substance was infiltrated subcutaneously in various areas of the trunk of piglets under general anesthesia. A laser Doppler was used to quantify the local cutaneous blood flow. The results showed no difference in onset of vasoconstriction between the various epinephrine concentrations, with the maximal response occurring by five to seven minutes in most cases. With respect to intensity of vasoconstriction. the 1:400.000 concentration of epinephrine was significantly less effective than all other concentrations while there was no significant difference in intensity between the other concentrations. Blood flow began to return to normal 30 minutes after injection of 1:400,000 epinephrine, but did not even begin to return to normal with the I: 100,000 and 1:200,000 concentrations until between 60 and 120 minutes. By 120 minutes the 1:50,000 concentration injection site had still not begun to return to normal. The presence or absence of lidocaine did not affect the results. The authors note that although skin. mucosa and kidney arteries display vasoconstriction due to alpha receptor effects of epinephrine. in muscle, vasodilating beta 2 stimulation occurs initially with low epinephrine
Fifteen years after repair of an orbital floor fracture with a silastic implant, inflammation of the lacrimal sac unresponsive to medical therapy developed. Orbital and radiographic examination revealed obstruction of the nasolacrimal sac at the floor of the orbit by the implant. The condition was treated by implant removal and dacryocystorhinostomy. Dacryocystitis as a late complication of orbital floor fracture repair with an implant has not been previously reported. It should be included with the other possible complications such as implant migration anteriorly resulting in orbital tissue prolapse or posteriorly against the optic nerve causing vision loss. infection especially after maxillary oral and sinus surgery and infections, hemorrhage causing proptosis, and diplopia. The authors recommend securing the implant to prevent migration, creating perforations in the implant to allow for fibrous tissue ingrowth, protecting patients with orbital floor implants who are having oral surgery with prophylactic antibiotics, and placing the smallest size implant that still accomplishes its purpose away from the nasolacrimal sac .- STEVEN E RECK Reprint requests to Dr. Mauriello: Eye Institute of New Jersey. I5 South 9th Street, Newark, NJ 07107.
Treatment of Hemifacial Spasm with Transcutaneous Electrical Stimulation. Yamomoto E. et al. Laryngoscope 97:458, 1987 1082
concentrations. At higher epinephrine levels. alpha stimulation becomes predominant producing vasoconstriction. It is also noted that the injection of epinephrine into a wound has been shown to lower the tensile strength and to increase the wound’s susceptibility to infection. The authors conclude that infiltration with I :200,000 epinephrine gives optimal intensity and duration of vasoconstrictive effects in skin while minimizing the toxic potential of epinephrine.-JAMES R. HUPP Reprint requests to Dr. Larrabee: The Mason Clinic. Seattle, WA 98 I 1I.
BOX
900.
Lacrimal Intubation in the Primary Repair of Midfacial Fractures. Harris GJ, Fuerste FH. Ophthalmology 941242, 1987 Midfacial trauma may cause fracture of the lacrimal sac fossa and lacrimal canal that compromises tear drainage. This damage may pass unrecognized until epiphora and dacryocystitis occur as a late sequelae. Bony and membranous separation should be suspected if a lacrimal probe emerges from anywhere other than the osteum of the nasolacrimal duct in the inferior meatus. An operative intubation of the lacerated nasolacrimal duct with placement of a silicone stent should be performed and maintained for a period of four to six months. In this study, 1I disrupted distal pathways were intubated as part of the primary interdisciplinary repair of midfacial fractures which resulted in maintained tear outflow patency after long-term follow-up.-STEVEN F. RECK Reprint requests to Dr. Harris: Eye Institute, 8700 W. Wisconsin Avenue. Milwaukee, WI 53226.
Effect of Epinephrine on Local Cutaneous Blood Flow. Larrabee WF Jr, BJ Lanier, D. Miekle. Head Neck Surg 9:287, 1987
Dacryocystitis. Mauriello JA, Fiore PM, Ketch M. Ophthalmology 94:248. 1987
An animal study was performed to try to quantitate the effect of subcutaneous infiltration of various concentrations of epinephrine with and without lidocaine. Test substances consisted of saline, saline with epinephrine (1:50,000, l:lOO,OOO, 1:200,000, and 1:400.000), I% lidoCaine, and 1% lidocaine with epinephrine (1:50,000 to 1:400,000). One ml of each test substance was infiltrated subcutaneously in various areas of the trunk of piglets under general anesthesia. A laser Doppler was used to quantify the local cutaneous blood flow. The results showed no difference in onset of vasoconstriction between the various epinephrine concentrations, with the maximal response occurring by five to seven minutes in most cases. With respect to intensity of vasoconstriction. the 1:400.000 concentration of epinephrine was significantly less effective than all other concentrations while there was no significant difference in intensity between the other concentrations. Blood flow began to return to normal 30 minutes after injection of 1:400,000 epinephrine, but did not even begin to return to normal with the I: 100,000 and 1:200,000 concentrations until between 60 and 120 minutes. By 120 minutes the 1:50,000 concentration injection site had still not begun to return to normal. The presence or absence of lidocaine did not affect the results. The authors note that although skin. mucosa and kidney arteries display vasoconstriction due to alpha receptor effects of epinephrine. in muscle, vasodilating beta 2 stimulation occurs initially with low epinephrine
Fifteen years after repair of an orbital floor fracture with a silastic implant, inflammation of the lacrimal sac unresponsive to medical therapy developed. Orbital and radiographic examination revealed obstruction of the nasolacrimal sac at the floor of the orbit by the implant. The condition was treated by implant removal and dacryocystorhinostomy. Dacryocystitis as a late complication of orbital floor fracture repair with an implant has not been previously reported. It should be included with the other possible complications such as implant migration anteriorly resulting in orbital tissue prolapse or posteriorly against the optic nerve causing vision loss. infection especially after maxillary oral and sinus surgery and infections, hemorrhage causing proptosis, and diplopia. The authors recommend securing the implant to prevent migration, creating perforations in the implant to allow for fibrous tissue ingrowth, protecting patients with orbital floor implants who are having oral surgery with prophylactic antibiotics, and placing the smallest size implant that still accomplishes its purpose away from the nasolacrimal sac .- STEVEN E RECK Reprint requests to Dr. Mauriello: Eye Institute of New Jersey. I5 South 9th Street, Newark, NJ 07107.
Treatment of Hemifacial Spasm with Transcutaneous Electrical Stimulation. Yamomoto E. et al. Laryngoscope 97:458, 1987 1082