- Email: [email protected]
Operative Correction of Senile Entropion
NOTES, CASES, INSTRUMENTS Postoperative care. The skin sutures were removed on the sixth day. There was no un due reaction to the surgery and the recovery was uneventful. SUMMARY
A case of osteoma arising from the right ethmoidal region is reported. There was also
617
a small similar lesion in the area of the left frontal bone not large enough to require removal. Adequate exposure was obtained by making the incision above the inner canthal ligament and the patient had an uneventful recovery following removal of the newgrowth. 213-215 Martin Building.
REFERENCES 1. Reese, A. B . : Am. J. Ophtb., 24 :497, 1941. 2. Forrest, A. W . : Arch. Ophth., 41:198, 1949. 3. Duke-Elder, W. S.: Textbook of Ophthalmology. St. Louis, Mosby, 1952, v. 5, p. 5596.
OPERATIVE CORRECTION OF SENILE ENTROPION J A N P . SZLAZAK,
M.D.
Regina, Saskatchewan, Canada The mechanism of the development of spastic entropion must be clearly understood, as it explains the etiology of the deformity of the eyelid and dictates the technique for the corrective operative procedure. Senile atrophy will not only cause a back ward displacement of the eye, but a slacken ing and elongation of the orbicularis muscle. These two factors will change the normal physiologic relationship between the eye and the eyelid. W h e n the patient closes his eye tightly, the central portion of the orbicularis which is stronger will invert the eyelid, as shown in Figure 1. The frequently used thermocautery needling along the lower edge of the tarsal plate may improve entropion but not infrequently a surgical correction is necessary. Wheeler, 1 in 1938, described an operation for entropion with shortening of the orbicularis muscle along the lower edge of the tarsal plate. The following modification of the opera tive procedure has been found to be very easy and successful.
sharp small pointed scissor is used to dis sect the skin downward, and widely medially and laterally. The muscle is then freely sepa rated from the tarsal plate. T h e orbicularis, which is now free, is cut in the middle ob liquely from the upper edge to the level of the lower edge of the tarsal plate, as shown in Figure 2. T h e free ends of the divided muscle are adjusted with two pairs of tissue forceps in such a way that the eyelid is placed in a normal relationship to the eye. One fine catgut suture is used to secure the upper edge. The shortening along the upper portion may be approximately one or two mm. with an overlapping of the muscle.
OPERATIVE PROCEDURE
T h e skin incision is made along the upper edge of the eyelid, below the eyelash line. A
Fig.
1 (Szlazak). Typical senile entropic eyelid.
N O T E S , CASKS,
618
Fig. 2 (Szlazak). Illustrates the oblique division of the orbicularis muscle on the whole width, held by mosquito forceps.
Using tissue forceps again, the lower edges of the muscle are adjusted, so that they will have a normal pressure on the lower edge of the tarsal plate. T w o sutures of fine cat gut are then tied at this level, each one on the free end at the line of division, and cor responding with the overlapping portion of
INSTRUMENTS
the muscle. I n this way, the divided orbicu laris is secured by three catgut sutures, one at the top and two at the bottom, and the overlapping portion of the muscle will nearly form a right angle. If the overlapping along the upper edge should require a slight short ening only, the lower portion of the muscle, which is thinner, will be shortened consider ably. T h e skin is then sutured intradermally with 5-0 nylon with the free ends secured by a small adhesive tape to the cheek, as shown in Figure 3. The suture will be re moved in four or five days (fig. 4 ) . SUMMARY
firt&:.. "r
- \
■£.
.-■r? Fig. 3 (Szlazak). After suturing of the skin intradermally.
The operative correction of senile entropion is presented with shortening of the orbicularis muscle in its whole width and thickness. The skin incision is made near the edge of the eyelid, so that when healed will result in an inconspicuous scar. The shortening of the orbicularis along the upper and lower edges will restore a normal physi ologic relationship between the eye and the eyelid. T h e shortening along the upper edge is to a lesser degree than that at the lower edge, which presses on the tarsal plate. An oblique division of the muscles gives a better adjustment for a shortening, and the over lapping edges of the divided and sutured muscle will form a stronger support, without causing the eyelid to bulge. 2125 11th Avenue.
REFERENCES
1. Wheeler, ). M.: The use of the orbicularis palpebrarum muscle in surgery of the eyelid. Am. J. Surg., 42:7, 1938.
A case of osteoma arising from the right ethmoidal region is reported. There was also
617
a small similar lesion in the area of the left frontal bone not large enough to require removal. Adequate exposure was obtained by making the incision above the inner canthal ligament and the patient had an uneventful recovery following removal of the newgrowth. 213-215 Martin Building.
REFERENCES 1. Reese, A. B . : Am. J. Ophtb., 24 :497, 1941. 2. Forrest, A. W . : Arch. Ophth., 41:198, 1949. 3. Duke-Elder, W. S.: Textbook of Ophthalmology. St. Louis, Mosby, 1952, v. 5, p. 5596.
OPERATIVE CORRECTION OF SENILE ENTROPION J A N P . SZLAZAK,
M.D.
Regina, Saskatchewan, Canada The mechanism of the development of spastic entropion must be clearly understood, as it explains the etiology of the deformity of the eyelid and dictates the technique for the corrective operative procedure. Senile atrophy will not only cause a back ward displacement of the eye, but a slacken ing and elongation of the orbicularis muscle. These two factors will change the normal physiologic relationship between the eye and the eyelid. W h e n the patient closes his eye tightly, the central portion of the orbicularis which is stronger will invert the eyelid, as shown in Figure 1. The frequently used thermocautery needling along the lower edge of the tarsal plate may improve entropion but not infrequently a surgical correction is necessary. Wheeler, 1 in 1938, described an operation for entropion with shortening of the orbicularis muscle along the lower edge of the tarsal plate. The following modification of the opera tive procedure has been found to be very easy and successful.
sharp small pointed scissor is used to dis sect the skin downward, and widely medially and laterally. The muscle is then freely sepa rated from the tarsal plate. T h e orbicularis, which is now free, is cut in the middle ob liquely from the upper edge to the level of the lower edge of the tarsal plate, as shown in Figure 2. T h e free ends of the divided muscle are adjusted with two pairs of tissue forceps in such a way that the eyelid is placed in a normal relationship to the eye. One fine catgut suture is used to secure the upper edge. The shortening along the upper portion may be approximately one or two mm. with an overlapping of the muscle.
OPERATIVE PROCEDURE
T h e skin incision is made along the upper edge of the eyelid, below the eyelash line. A
Fig.
1 (Szlazak). Typical senile entropic eyelid.
N O T E S , CASKS,
618
Fig. 2 (Szlazak). Illustrates the oblique division of the orbicularis muscle on the whole width, held by mosquito forceps.
Using tissue forceps again, the lower edges of the muscle are adjusted, so that they will have a normal pressure on the lower edge of the tarsal plate. T w o sutures of fine cat gut are then tied at this level, each one on the free end at the line of division, and cor responding with the overlapping portion of
INSTRUMENTS
the muscle. I n this way, the divided orbicu laris is secured by three catgut sutures, one at the top and two at the bottom, and the overlapping portion of the muscle will nearly form a right angle. If the overlapping along the upper edge should require a slight short ening only, the lower portion of the muscle, which is thinner, will be shortened consider ably. T h e skin is then sutured intradermally with 5-0 nylon with the free ends secured by a small adhesive tape to the cheek, as shown in Figure 3. The suture will be re moved in four or five days (fig. 4 ) . SUMMARY
firt&:.. "r
- \
■£.
.-■r? Fig. 3 (Szlazak). After suturing of the skin intradermally.
The operative correction of senile entropion is presented with shortening of the orbicularis muscle in its whole width and thickness. The skin incision is made near the edge of the eyelid, so that when healed will result in an inconspicuous scar. The shortening of the orbicularis along the upper and lower edges will restore a normal physi ologic relationship between the eye and the eyelid. T h e shortening along the upper edge is to a lesser degree than that at the lower edge, which presses on the tarsal plate. An oblique division of the muscles gives a better adjustment for a shortening, and the over lapping edges of the divided and sutured muscle will form a stronger support, without causing the eyelid to bulge. 2125 11th Avenue.
REFERENCES
1. Wheeler, ). M.: The use of the orbicularis palpebrarum muscle in surgery of the eyelid. Am. J. Surg., 42:7, 1938.