Advanced single-stage eyelid reconstruction: anatomy and techniques.

BACKGROUND: Skin cancers of the periocular tissue present formidable reconstructive challenges because of anatomic complexity, vital function, and cosmetic significance. OBJECTIVE: To review eyelid anatomy and reconstructive techniques from an oculoplastic surgery perspective. RESULTS: Eyelid structure and function are intimately linked, and good working knowledge is a prerequisite for successful reconstructive efforts. We discuss periocular anatomy, patient evaluation, and single-stage repair of both anterior lamellar and full-thickness defects. CONCLUSION: Despite the challenges of periocular skin cancer reconstruction, excellent cosmetic and functional results can be achieved with appropriate technique.

Treatment strategies in mucous membrane pemphigoid.

Mucous membrane pemphigoid (MMP) is an autoimmune blistering disorder that is characterized by subepithelial bullae. Various basement membrane zone components have been identified as targets of autoantibodies in MMP. Considerable variability exists in the clinical presentation of MMP. Mucous membranes that may be involved include the oral cavity, conjunctiva, nasopharynx, larynx, esophagus, genitourinary tract, and anus. A multidisciplinary approach is essential in the management of MMP. Early recognition of this disorder and treatment may decrease disease-related complications. The choice of agents for treatment of MMP is based upon the sites of involvement, clinical severity, and disease progression. For more severe disease, or with rapid progression, systemic corticosteroids are the agents of choice for initial treatment, combined with steroid-sparing agents for long-term maintenance. Due to the rarity of this disease, large controlled studies comparing the efficacy of various agents are lacking.

Optic canal decompression: a cadaveric study of the effects of surgery.

PURPOSE: To simulate a transphenoidal medial optic canal decompression and determine the anatomic effect on the optic nerve. METHODS: A medial optic canal decompression was performed on 5 cadaveric optic canals within 12 hours of death. Two canals were decompressed under direct visualization and 3 were decompressed by a transphenoidal endoscopic approach. The optic canal was subsequently removed en bloc, beginning at the annulus of Zinn and extending to the optic chiasm. Each specimen was processed and examined grossly. Serial coronal step sections of the entire length of the intracanalicular optic nerve were assessed histologically. RESULTS: Microscopic examination of the intracanalicular portion of optic nerve revealed incision in an extraocular muscle at the annulus, incomplete bone removal, fraying of the dural sheath, incomplete dural/arachnoid release, and incision in the pia and optic nerve. CONCLUSIONS: Transphenoidal medial wall decompression of the optic nerve canal with dural sheath opening may induce physical damage to the nerve. Any hypothetical value in dural-arachnoid sheath opening must be weighed against the potential for harm to the optic nerve caused by the surgical intervention.