By David T. Tse MD
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Extra resources for Color Atlas of Oculoplastic Surgery
More extensive canthotomy and incision of orbicularis muscle laterally are required to fully expose medial wall fractures. Lid Cre as e Appro ach The lower lid crease is marked across the width of the lid, and forced ductions of each eye are performed and compared, to establish a baseline. An incision of the lower lid crease is made with a size 15 Bard-Parker blade or straight iris scissors. This begins medially at the punctum and extends laterally to a point at or just beyond the lateral canthus.
Multiple factors contribute to the effect, including intracellular ice crystal formation and recrystallization, disruption of intracellular membranes and cell walls, intracellular pH changes, vascular thrombosis, and a posttreatment inﬂammatory response. S URGICAL ANATOMY The normal eyelashes arise in the anterior lamella of the eyelid and consist of a few irregular rows exiting the skin anterior to the intermarginal sulcus. The normal follicles lie in the pretarsal space near the marginal arterial arcade.
After approximately 10 minutes, the vasoconstricting effects of the epinephrine will help to further reduce bleeding tendencies and hematoma formation. Injection of anesthetics in the periorbital region, excluding the eyelids, should be in the subcutaneous plane. The use of a 25- or 27-gauge needle may facilitate its passage in these thicker tissues. 15 16 SECTION 1 OVERVIEW Tab le 2-1 Lo cal Ane st he t ic Ag e nt s Ag e nt (Brand Name ) O nse t Durat io n (min) Typ e Maximum Co nce nt rat io n (mg ) Procaine (Novocain) Fast 60–90 Este r 1,000 Low-p ote ncy, short d uration Lid ocaine (Xylocaine ) Fast 90–200 Amid e 500 Most wid e ly use d ag e nt b e cause of rap id onse t Me p ivacaine Fast (Carb ocaine ) 120–240 Amid e 500 Slig htly long e r d uration of action than lid ocaine Bup ivacaine (Marcaine ) 180–400 Amid e 200 Long d uration, mixe d with lid ocaine to achie ve rap id onse t Slow Re marks Regional nerve blocks have a limited role in ophthalmic plastic surgery because the eyelids have an overlapping sensory distribution.
Color Atlas of Oculoplastic Surgery by David T. Tse MD