The Lymphatic Anatomy of the Lower Eyelid and Conjunctiva and Correlation with Postoperative Chemosis and Edema

Shoukath, Sajna; Taylor, G. Ian; Mendelson, Bryan C.; Corlett, Russell J.; Shayan, Ramin; Tourani, Saam S; Ashton, Mark W.

doi:10.1097/prs.0000000000003094

Cited by 47 publications

(38 citation statements)

References 32 publications

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“…This is usually a normal and expected complication that will dissipate promptly if the patients strictly adhere to the postoperative instruction. Furthermore; the avoidance of orbital septum incorporation in the incision would result in a more patent lymphatic drainage which may lessen the degree of postoperative periorbital edema (17).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Y-Shaped Modification of the Transconjuctival Approach in Open Reduction of Zygomatic Maxillary Complex Fracture (Clinical Trial)

Yassin

Shaaban

Noureldin

2021

Alexandria Dental Journal

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Introduction:Conventional incisions that are commonly used for the exposure of lower eyelid and treatment of Zygomaticomaxillary Complex (ZMC) fractures, includes both transcutaneous and transconjunctival approaches.The decision between the incisions is based on the need for adequate exposure of the fracture site and a desired aesthetically acceptable incision. A "Y" shaped technique was claimed to fulfill both adequate exposure and esthetic outcomes.Aim: This study was conducted to evaluate the Y-shaped modification of the transconjunctival in the management of zygomatic maxillary complex fracture. Materials and Methods:This study was based on seventeen patients with zygomaticomaxillary complex fractures. Post-operative patient evaluation was performed with consideration to intraoperative accessibility, exposure duration, postoperative pain and edema, post-operative wound healing and infection, scarring, and postoperative orbital movement and ocular complications. Results:The average exposure duration was (20:00±03:41) minutes, and the fractures were accessible in all of the operated cases. No scars were detected in all cases 6 weeks post-operatively. There was a significant difference between post-operative pain status in different intervals (p<0.001). A significantly high percentage of cases didn't have post-ocular complications 15(88.2%) (p<0.001). Conclusion:The modification of the transconjunctival approach with a cutaneous Y-shaped incision provides commodious surgical exposure for ZMC fractures.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Y-Shaped Modification of the Transconjuctival Approach in Open Reduction of Zygomatic Maxillary Complex Fracture (Clinical Trial)

Yassin

Shaaban

Noureldin

2021

Alexandria Dental Journal

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“…A layer of thick cream was also applied to protect the eye during the night. Refractory chemosis can be treated with a cortisone injection (acetonide of triamcinolone, 1/10 of a ml diluted 2 times), in the preperiosteal zone, at the inferior extremity of the mid-cheek furrow, where deep and superficial lymphatics of the lower eyelid converge [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Concentric Malar Lift in the Management of Lower Eyelid Rejuvenation or Retraction: A Clinical Retrospective Study on 342 Cases, 13 Years After the First Publication

Louarn¹

2018

Aesth Plast Surg

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BackgroundLower eyelid rejuvenation can, unfortunately, induce scleral show even if the lower eyelid procedure is limited. This study was designed to assess the effectiveness and reliability of the concentric malar lift technique in two scenarios: the first, in rejuvenation of the mid-face and, the second, in reconstructive surgery for correction of congenital or acquired eyelids malposition.MethodsThe concentric malar lift technique was first published by Le Louarn (Aesthet Plast Surg 28(6):359–372, 2004). This retrospective study was carried out by analyzing data on patients operated on between January 2010 and January 2016. Patients operated on before 2010 were excluded because barbed thread sutures were not used in the first version of the technique. Patients after January 2016 were excluded to ensure adequate follow-up, and so 342 patients are included in the study. A total of 256 cases (75%) were for aesthetic mid-face lifting, and 86 cases (25%) were reconstructive surgeries for lower eyelid retraction. A spacer graft was used in 30 of these reconstructive cases (35%). The mean follow-up time was 13.6 months. All the concentric malar lifting procedures included strengthening the lateral canthus, which is a key element of the procedure.ResultsNone of the patients developed secondary eyelid malposition, and all the cases of lower eyelid retraction displayed marked improvement both functionally and aesthetically. Two patients experienced loss of sensitivity of part in the infra-orbital nerve distribution for 4 months after the procedure.ConclusionThe concentric malar lift procedure enables the recruitment of a significant amount of skin into the lower eyelid: between 10 and 30 mm. It ensures better rejuvenation of the mid-face with minimal risk of lower eyelid malposition. In reconstruction of the lower eyelid lid, the concentric malar lift is able to reduce the need for skin grafting and a skin flap reducing the risks of visible scarring.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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“…Although there are only a few tracing studies, the parotid lymph node appears to receive lymphatic drainage from the conjunctiva and periocular tissues, and the middle and inner ear, with subsequent drainage to the retropharyngeal and mandibular lymph nodes. [35][36][37] The oral cavity , which includes the lacrimal gland (LG), lacrimal punctum (LP), lacrimal canaliculus (LC) between the LP and lacrimal sac (LS), and nasolacrimal duct (NLD) that drains into the nasal cavity at the NLD ostium (NLDO). In the ear, lymphoid tissue may be present in the middle ear (ME; 3) and eustachian tube (ET; 4).…”

Section: Functional Integration Of the Lymphoid Tissues Of The Headmentioning

confidence: 99%

“…Although there are only a few tracing studies, the parotid lymph node appears to receive lymphatic drainage from the conjunctiva and periocular tissues, and the middle and inner ear, with subsequent drainage to the retropharyngeal and mandibular lymph nodes. 35 –37 The oral cavity is less well endowed with lymphoid tissue than the nasal cavity, and there are marked species differences 25 with no oral lymphoid tissue in rodents but various combinations of palatine tonsils and PR tonsils in larger mammals (see Figure 1). Inflammation of the PR tubal tonsils near the pharyngeal opening of the eustachian tube may contribute to eustachian tube dysfunction and OM in children.…”

Section: Functional Integration Of the Lymphoid Tissues Of The Headmentioning

confidence: 99%

Mucosa-Associated Lymphoid Tissue and Tertiary Lymphoid Structures of the Eye and Ear in Laboratory Animals

Schuh¹

2020

Toxicol Pathol

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Mucosa-associated lymphoid tissue (MALT) of special senses is poorly described and can be confused with nonspecific mononuclear cell infiltrates and tertiary lymphoid structures (TLS). In the eye, MALT consists mostly of conjunctiva-associated lymphoid tissue (CALT) and lacrimal drainage-associated lymphoid tissue (LDALT). In humans, CALT and LDALT are important components of the normal eye-associated lymphoid tissue (EALT), but EALT is less frequently described in ocular tissues of animals. The EALT are acquired postnatally in preferential mucosal sites, expand with antigenic exposure, form well-developed lymphoid follicles, and are reported to senesce. Lymphoid follicles that are induced concurrently with chronic inflammation are more appropriately considered TLS but must be differentiated from inflammation in MALT. Less understood is the etiology for formation of lymphoid tissue aggregates in the ciliary body, limbus, or choroid of healthy eyes in animals and humans. In the healthy eustachian tube and middle ear of animals and humans, MALT may be present but is infrequently described. Concurrent with otitis media, lymphoid follicles in the eustachian tube are probably expanded MALT, but lymphoid follicles in the middle ear may be TLS. The purpose of this comparative review is to familiarize toxicologic pathologists with MALT in the special senses and to provide considerations for differentiating and reporting eye and ear MALT from immune or inflammatory cell infiltrates or inflammation in nonclinical studies, and the circumstances for reporting TLS in compartments of the eye and ear.

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The Lymphatic Anatomy of the Lower Eyelid and Conjunctiva and Correlation with Postoperative Chemosis and Edema

Cited by 47 publications

References 32 publications

Evaluation of the Y-Shaped Modification of the Transconjuctival Approach in Open Reduction of Zygomatic Maxillary Complex Fracture (Clinical Trial)

Evaluation of the Y-Shaped Modification of the Transconjuctival Approach in Open Reduction of Zygomatic Maxillary Complex Fracture (Clinical Trial)

Concentric Malar Lift in the Management of Lower Eyelid Rejuvenation or Retraction: A Clinical Retrospective Study on 342 Cases, 13 Years After the First Publication

Mucosa-Associated Lymphoid Tissue and Tertiary Lymphoid Structures of the Eye and Ear in Laboratory Animals

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