Lower Lid Blepharoplasty—The Transconjunctival Approach: Extended Indications

The transconjunctival blepharoplasty is an elegant and secure technique especially in young people and helps to avoid the hazard of a scar. In older patients, it saves them the possible sequelae such as rounding sclero show or possible ectropion after a classical operation. Because there is no visible scar, the transconjunctival approach respects the integrity of the functional structure of the orbital septum and the orbicular muscle, the active support of the lower eyelid.     

Suturas transconjuntivales del tapete escleral en maculopatía hipotónica tardía tras esclerectomía profunda no perforante

Clinical case

A 63-year-old man presents with late hypotony maculopathy after non-penetrating deep sclerectomy. Hypotonia and visual acuity are improved after transconjunctival suturing of the scleral flap.

The changes in brain surface,intracerebral tissue,and transconjunctival oxygen tension during hypo- and hyperventilation

To evaluate the validity of organ surface oxygen tension monitoring for assessment of cerebral perfusion, the oxygen tension in brain surface (Pbs_{O 2}), intracerebral tissue (Pic_{O 2}), and conjunctiva (Pcj_{O 2}) were measured simultaneously during hypo- and hyperventilation in dogs, and the comparative study was done.Pbs_{O 2} and Pic_{O 2} significantly increased during hypoventilation and decreased during hyperventilation. And the values of Pbs_{O 2} and Pic_{O 2} were correlated to the corresponding Pa_{CO 2} values significantly (P 0.001 in each case). On the contrary, Pcj_{O 2} did not change significantly during hypo- and hyperventilation.These findings indicate that Pbs_{O 2} as well as Pic_{O 2} could reflect the changes in cerebral perfusion caused by induced hyper- and hypocapnia but that Pcj_{O 2} could not.(Arai T, Silvern DA, Gupte PM et al.: The changes in brain surface intracerebral tissue, and transconjunctival oxygen tension during hypo- and hyperventilation. J Anesth 4: 110–115, 1990)     

Transconjunctival Preseptal Approach for Orbital Floor and Infraorbital Rim Fracture

Purpose  

To evaluate the transconjunctival preseptal approach for time required for exposure, adequacy of exposure, intraoperative and postoperative complications.     

Single transconjunctival incision and two-point fixation for the treatment of noncomminuted zygomatic complex fracture

The ultimate goal in treating zygomatic complex fracture is to obtain an accurate, stable reduction while minimizing external scars and functional deformity. The present authors present our experiences with a single transconjunctival incision and two-point (inferior orbital rim and frontozygomatic suture) fixation in 53 patients with zygomatic complex fracture which were not comminuted. All patients had transconjunctival approaches with lateral canthal extensions, and six out of 53 patients also had an additional small (about less than 2 cm) gingivobuccal incision to achieve an accurate reduction. There were 3 minor complications, and the overall esthetics and functional results were satisfactory with a long term follow-up. Our method has the following advantages in the reduction of zygomatic complex fracture; It leaves only an inconspicuous lateral canthal scar. In addition, it provides excellent simultaneous visualization of the inferior orbital rim and frontozygomatic suture area. Hence, two point fixation through a single incision can be performed with a satisfactory stability.     

Surgical advances. A comprehensive approach to surgical rejuvenation of the eyes

Methods to rejuvenate the eye region include shortening of the forehead, raising the brow, improving the upper eyelids by excision of blepharochalasis tissue, and reducing lower eyelid fat pads by a transconjunctival approach and at the same time elevating the stretched lateral canthus by an effective canthopexy. The risks and complications of these procedures are minimal, circumscribing the shortcomings of conventional blepharoplasty.