Saturday, May 21, 2011

What I did this Week.

Has been a hectic week, so not much time to update this blog until now. Did 15 cataracts, 3 pterygium and 9 oculoplastic cases. Here were the two tumour cases I did this week. Case 1 was a dark lesion in the lower eyelid referred as melanoma but could be anything until the histology confirms the diagnosis. Case 2 was a tumour of the lacrimal gland, the patient was supposed to have it done 6 months ago but the son objected then the tumour grew bigger and she could not open the eye so the daughter brought her in for removal again not sure of the exact diagnosis may be benign but may be malignant but the whole thing is now removed.

Case 1
A large black lesion occupying about 1/3 of the lid.

The tumour was removed via full thickness eyelid excision.

In order to close the defect, the outer aspect of the eyelid was
cut (canthotomy and cantholysis).

The tumour was sent off for analysis and the defect closed
with 6/0 vicryl.

Case 2

A progressive enlarging mass in the left superotemporal
aspect pushing the eye downward.

CT scan showed a lacrimal mass.

CT scan showing the lacrimal tumour extended backward.

The upper eyelid was marked along the skin crease
with some extensivion.

The upper eyelid was open along the skin crease.
Tumour was identified and removed.

Further manipulation was needed due to the extension
to the back of the orbit.

A large cavity was left after the tumour removal.

The wound was closed as marked.

The tumour measured 4.5cm in length and was sent
off for histology.

Sunday, May 15, 2011

The Man who was Given Face after Losing Face. 丟面, 沒面, 爭面, 給面, 留面

The face is such an important part of our body, even if he could not see a new face makes all the difference to him and the people around him. In Chinese, the word face has the connotation with honour in daily usage and this man can say to have gone through the following stages:
丟面 (losing face = humiliation)
沒面 (without face = shameless)
爭面   (fighting or looking for face = keeping up with your comtemporary or keep up with the Jones')
給面   (giving face =  showing respect)
留面 (retain face = give somebody the leeway or avoid embarrasing somebody)

Monday, May 9, 2011

Doctor, I always look sleepy!

This patient complained of appearing sleepy all the time. He has problem reading because the eyelid always cover his eyes and get constant headache because he needs to life his eyebrow constantly using his forehead muscle to keep his eyes open.

Preoperative appearance.

This condition is called ptosis (from the Greek word means falling down) and is a commonly seen condition in the elderly patients. It is caused by weakness of the muscle that open the eyes (levator and Muller's muscles). The treatment of choice in this patient is to shorten the muscle so that the eyelid can be wider open. There are several ways of approaching these muscles, one of the ways is to do it from behind the eye so that there are no scars on the outside of the eyelids.

In this patient, I removed the Muller's muscle from behind the eyelid and the patient was happy with the result as he could now read without having to lift his eyelids with his fingers and the headache was gone. Below show the stages of this operation.

The eyelid was everted after instilling some local anesthesia
into the eyelid.

Local anaesthesia was injected into the space between
the Muller muscle and the levator muscle.

The conjunctiva together with the Muller muscle was cut
just above the tarsal plate border.

The Muller muscle and conjunctiva were stripped
from the levator muscle.

The desired amount of conjunctiva and Muller muscle
were excised.

The cut end of the Muller muscle and conjunctiva were sutured
to the edge of the tarsal plate.

The sutures were tied on the eyelid to avoid irritating the eyes
and the height of the eyelid adjusted.

At the end of the operation. Both eyes underwent the same

One week after the operation. Note he not longer needs
to use the forehead muscles to lift his eyelids.