Orbital Fat Prolapse Research Articles

Transconjunctival orbital fat repositioning: transposition of orbital fat pedicles into a subperiosteal pocket.

Rejuvenation of the lower eyelid complex is based on the principle that the contour changes characterizing aging involve not only prolapse of orbital fat but also descent of the cheek tissues, resulting in accentuation of the orbital rim and tear trough groove. When a deep groove is present along the orbital rim in the area of the tear trough deformity, it is advantageous, rather than removing orbital fat, to reposition the fat over the orbital rim through the opened arcus marginalis onto the superior face of the maxilla. Orbital fat repositioning can be accomplished through a transconjunctival approach. The arcus marginalis is exposed and incised, and a subperiosteal pocket is created over the superior face of the maxilla. The subperiosteal pocket shape and location are customized based on the desired location of the orbital fat pedicle; often the origins of the levator superioris labialis and the levator alae nasi muscles are partially dissected. Medial and central fat pedicles are created and rotated over the orbital rim into the subperiosteal pocket. A 6-0 polypropylene externalized sutured is used to fixate the fat pedicle in position. The suture can be removed after 3 to 5 days. Twenty-four patients were followed clinically after orbital fat repositioning, with follow-up ranging from 6 to 30 months. Although the fat pedicle undergoes some variable resorption, the viability of the graft, the texture and contour of the repositioned fat after a healing period of 1 to 2 months, and the excellent patient acceptance are indicative of the viability of orbital fat repositioning.

Subconjunctival fat prolapse.

Subconjunctival orbital fat prolapse has been rarely described in the literature and is frequently confused with other conjunctival tumours, such as dermolipoma. The purpose of the present study was to describe the clinical features and treatment of a series of patients with subconjunctival orbital fat prolapse. Review of clinical records. Twelve patients with subconjunctival orbital fat prolapse were identified. Eight had a superotemporal prolapse and five of these were bilateral. All but one were male and most were elderly and tended to be obese. Five of these patients underwent surgical excision of the prolapsed fat for symptoms of discomfort or for cosmesis. Four atypical unilateral cases were seen in younger patients with fat prolapse occurring superonasally in three and inferiorly in one. In one case there was a history of trauma Subconjunctival orbital fat prolapse typically occurs superotemporally in obese elderly males and is easily differentiated from other lesions, such as dermolipoma. The prolapsed orbital fat may be excised via the conjunctiva.

Fat Repositioning in Lower Blepharoplasty to Maintain Infraorbital Rim Contour

The objective of facial rejuvenative surgery is to restore a youthful contour. With age, changes occur in the lower eyelid and cheek that involve descent of the cheek tissues as well as prolapse of orbital fat in the lower eyelid. This often results in the formation of a tear trough groove at the level of the inferior orbital rim. Lower eyelid rejuvenation surgery can then be achieved through the transposition of this fat over the orbital rim on to the superior face of the maxilla. In this article describe the transconjunctival approach to orbital fat repositioning.

Everting sutures in involutional entropion

Involutional entropion is the commonest cause of entropion in the elderly population. Many surgical procedures have been described to correct it. The everting suture technique is simple and quick and can be undertaken in the clinic or even away from a medical setting. However, it has been regarded as a temporary cure, especially in the presence of horizontal lower lid laxity. We reviewed the results of everting sutures in 55 lids of 50 patients. The minimum follow-up was 18 months. 78% of patients had no recurrence of their entropion. Our results suggest that horizontal eyelid laxity may not be the only major factor in recurrent entropion following everting sutures. Dermatochalasis with orbital fat prolapse may also contribute.

BLEPHAROPLASTY AND PERIORBITAL SURGERY

Blepharoplasty is one of the most successful aesthetic surgical procedures. Careful preoperative planning and conservative tissue resections can help to minimize complications and optimize results. Although some young patients request blepharoplasty specifically because of age-related changes in the eyelid skin, the surgery is that of sculpture and contouring of the entire aesthetic unit. The aging process in the eyelid complex is characterized by skin texture changes with loss of elasticity and formation of wrinkles, fat redistribution, enophthalmos, and anterior displacement of fat with a lower eyelid orbital fat prolapse. Once the etiology of the deformity and the associated periorbital anatomy are recognized, a local assessment and surgical treatment plan can produce optimal results.

Orbital fat prolapse in the dog

Five dogs presented with varying degrees of subconjunctival swelling and enophthalmos. Biopsy revealed the subconjunctival tissue to be fat. Surgical excision in two cases resulted in resolution of the clinical signs and demonstrated that the fat came from the retrobulbar region.

Epiphora Secondary to Punctal Apposition in the Setting of Gravesʼ Orbitopathy

The authors describe a patient who had epiphora and lacrimal outflow obstruction associated with proptosis and prolapse of orbital fat into the eyelids. The patient's puncta remained opposed throughout the blink cycle. A bilateral transcutaneous orbital fat decompression was done via upper eyelid crease and lower eyelid infraciliary incisions. Significant extraconal fat was removed. Two months after surgery, the epiphora had completely resolved, and proptosis and eyelid fullness had decreased.

Medial orbital wall fractures: classification and clinical profile.

This article reports our experience and proposes a clinical classification regarding medial orbital wall fractures. After a retrospective analysis of 2741 patients with facial fractures, we were able to evaluate 273 patients with 304 medial orbital wall fractures. The male-to-female ratio was 5:1, and most injuries involved the left orbit. Most fractures were caused by personal altercations, but more complex injuries were noted with automobile accidents and falls. Fractures were divided into types based on location and severity of injury: type I (confined to the medial orbital wall), type II (medial orbital wall continuous with floor), type III (medial orbital wall with floor-malar fractures), and type IV (medial orbital wall and complex midfacial injuries). Although visual loss (2%), diplopia (41%), and enophthalmos (12%) were seen, diplopia and enophthalmos were commonly observed with type II injuries. Imaging studies showed that about 52% of the fractures were associated with prolapse of orbital fat, but only 43% could be diagnosed with plain x rays. Type I fractures were generally explored through a frontoethmoid incision; other types were treated with subciliary or transconjunctival approaches. The usual treatment consisted of repositioning the fragments and repair of the wall with polyethylene mesh or cranial bone graft. Type I and type II fractures seemed best explained by the hydraulic mechanism of injury, whereas the type III and type IV fractures best fitted the buckling theory.

Medial orbital wall fractures: Classification and clinical profile

This article reports our experience and proposes a clinical classification regarding medial orbital wall fractures. After a retrospective analysis of 2741 patients with facial fractures, we were able to evaluate 273 patients with 304 medial orbital wall fractures. The male-to-female ratio was 5:1, and most injuries involved the left orbit. Most fractures were caused by personal altercations, but more complex injuries were noted with automobile accidents and falls. Fractures were divided into types based on location and severity of injury: type I (confined to the medial orbital wall), type II (medial orbital wall continuous with floor), type III (medial orbital wall with floor-malar fractures), and type IV (medial orbital wall and complex midfacial injuries). Although visual loss (2%), diplopia (41%), and enophthalmos (12%) were seen, diplopia and enophthalmos were commonly observed with type II injuries. Imaging studies showed that about 52% of the fractures were associated with prolapse of orbital fat, but only 43% could be diagnosed with plain x rays. Type I fractures were generally explored through a frontoethmoid incision; other types were treated with subciliary or transconjunctival approaches. The usual treatment consisted of repositioning the fragments and repair of the wall with polyethylene mesh or cranial bone graft. Type I and type II fractures seemed best explained by the hydraulic mechanism of injury, whereas the type III and type IV fractures best fitted the buckling theory. (OTOLARYNGOL HEAD NECK SURG 1995;112:549-56.)

Orbital fat prolapse and dermolipoma: two distinct entities.

A subconjunctival orbital fat prolapse is frequently confused with a dermolipoma clinically. These two entities have similar clinical appearances, but are clearly distinct. The clinical features, differential diagnosis, and treatment modalities of subconjunctival orbital fat prolapse and dermolipoma are discussed.

Ultrasound biomicroscopy as a diagnostic tool in space-occupying lesions of the superotemporal conjunctival fornix

Ultrasound biomicroscopy (UBM) is a new non-invasive method of obtaining cross-sectional images of the intact anterior globe to 4 mm depth at microscopic resolution. The authors have applied this technology in evaluating lesions of the superotemporal conjunctival fornix in situ and have elaborated differentiating characteristics on UBM in four common clinical entities: orbital fat prolapse, subconjunctival lipodermoid, prolapsed lacrimal gland and lacrimal gland ductal cyst.When the clinical diagnosis of these lesions is equivocal, UBM may add valuable diagnostic information to guide the selection of appropriate management.

Margins of safety with transantral orbital decompression.

This study involves evaluation of the surgical limits of transantral orbital apex decompression (as described by Ogura) by performing the operation on 17 cadaveric half-heads. Measurements were then made of the proximity of bone removal to several vital structures including the optic nerve, carotid artery siphon, cavernous sinus, and frontal lobe dura. Entrance into the sphenoid sinus was found to be routine. Adequate decompression requires maximum removal of bone at the orbital apex and incision of the periorbita without damage to the adjacent vital structures. This requires; 1. knowledge of ethmoid and sphenoid sinus anatomy and recognition of anatomic variations, 2. removal of bone under direct visualization, and 3. incisions of the periorbita be made most posteriorly first to prevent prolapse of orbital fat anteriorly which obscures vision of the critical orbital apex periorbita.

Subconjunctival orbital fat prolapse.

Subconjunctival orbital fat prolapse is a benign entity in which fat herniates through Tenon's capsule. It is often confused with other lesions such as lacrimal gland tumors, lymphoid tumors and lipodermoids. The clinical and computed tomographic findings in a series of 15 patients are presented, and the features that are helpful in the differential diagnosis are discussed.

Endoscopic findings of maxillary sinus after middle face fractures

Of 93 patients with fractures of the mid-face who appeared for postoperative check-up, 25 were selected by chance for sinuscopy of the maxillary sinus. Chronic inflammatory mucosal changes occurred in 35 per cent; other pathological sequelae included solitary polyps, mucocele, scarry synechia, and prolapse of orbital fat and osteoma. In spite of these findings, all patients were free of complaints. The primary surgical revision was therefore declined in favour of a waiting attitude. For the diagnostic clarification of late complications, sinuscopy with Hopkin's optics offers a simple and efficient procedure, which should be routinely utilised.

Endoscopic findings of maxillary sinus after middle face fractures

Of 93 patients with fractures of the mid-face who appeared for postoperative check-up, 25 were selected by chance for sinuscopy of the maxillary sinus. Chronic inflammatory mucosal changes occurred in 35 per cent; other pathological sequelae included solitary polyps, mucocele, scarry synechia, and prolapse of orbital fat and osteoma. In spite of these findings, all patients were free of complaints. The primary surgical revision was therefore declined in favour of a waiting attitude. For the diagnostic clarification of late complications, sinuscopy with Hopkin's optics offers a simple and efficient procedure, which should be routinely utilised.