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To develop and evaluate a minimally invasive technique of lateral orbitotomy that provides improved orbital access with fewer complications.A cadaver study was undertaken to develop a technique of transconjunctival lateral orbitotomy that preserves the structural integrity of the eyelid support system and provides extended access to the orbit from floor to roof. We then evaluated the procedure in an outcome study of 30 consecutive patients.The cadaver investigations demonstrated that a transconjunctival lateral retrocanthal approach is technically possible and provides improved direct access to the lateral orbit. In the study of 30 consecutive procedures, there were no complications resulting from the surgical access. The wound healing was rapid, without tissue distortion or scars. The exposure was ample for all surgical interventions.Lateral retrocanthal orbitotomy is a new approach that provides extended access to the entire lateral orbit. The technique is rapid and can be extended in a single continuous incision to the medial orbit. The structural integrity of the lateral retinaculum is preserved, which appears to improve the postoperative cosmetic and functional result.

Objectives: We describe the manifestations, diagnosis, and treatment of rare head and neck infections caused by Mycobacterium chelonae, including a case of maxillary osteitis and skull base osteomyelitis. Methods: A comprehensive literature search (MEDLINE from 1951; BIOSIS from 1969; EMBASE from 1980) was performed for the presentation, diagnostic evaluation, and outcomes of patients with M chelonae infections. Results: We report 4 cases of M chelonae infection, including a nasal abscess following septorhinoplasty with a cartilaginous graft, a case of chronic unilateral nasal obstruction, and the first reported cases of skull base osteomyelitis and maxillary osteitis secondary to M chelonae. All 4 cases involved immunocompetent individuals. Conclusions: Mycobacterium chelonae should be considered in cases of abscesses that persist despite broad-spectrum intravenous antibiotics, and in cases of maxillary sinusitis with bony involvement that do not respond to traditional treatment methods.

Objectives: To describe a new method of postoperative eyelid suspension used for the prevention of eyelid malposition and to report its efficacy through an outcome study. Study Design: An outcome study was performed on 10 patients who would potentially need postoperative eyelid suspension. Candidates included patients with entropion, ectropion, or orbital fractures requiring transconjunctival approaches. Patients were photographed pre- and postoperatively and followed for signs of eyelid malposition. Methods: At the conclusion of the surgical procedure, a sheet of Xeroform gauze was folded into 6 overlapping layers and cut to conform to the shape of the inferior orbital rim. The superior edge of the gauze was sutured to the lower eyelid using interrupted 5-0 nylon suture. Sutures were placed at the medial and lateral canthi to raise the eyelid above the inferior limbus and along the inferior orbital rim. The splint was removed between postoperative days 7 and 14. Results: There were no perioperative complications related to the surgery or placement of the splint. No cutaneous marks persisted after healing. No complications such as shifting of the splint, ocular damage, or recurrent eyelid malposition occurred. One patient had asymptomatic restriction of lower eyelid elevation on upward gaze, which resolved at 6 months. Conclusions: The lower eyelid splint appears effective in maintaining lower eyelid position postoperatively. There were no complications with its use, and the splint was tolerated well. Benefits of the splint over the Frost suture include less risk of corneal abrasion, ability to check visual function, and ability to use the splint bilaterally.

Publisher Summary Ozone (O 3 ) is best known for its role in the stratosphere where it filters out much of the short-wave spectrum of solar ultraviolet (UV) radiation that would otherwise penetrate the earth. However, it is also well-known that this protective “ozone layer,” if placed at ground level (troposphere), would be highly toxic and would react with various molecules susceptible to oxidative attack. Because of the breakdown of the stratospheric ozone layer in conjunction with industrial emission, tropospheric ozone has become a major environmental pollutant. Increased exposure to this powerful oxidant has various health implications currently under investigation. Ozone is well known to exert profound effects on the respiratory tract. Studies suggest that ozone also induces biochemical changes in murine skin. Due to its barrier structure and function, the skin is highly susceptible to external oxidative agents. More specifically, the outermost layer of the skin, the stratum corneum (SC), has been identified as the primary target for ozone-induced damage. This chapter discusses a highly sensitive method for detecting antioxidants in murine SC before and after in vivo ozone exposure.

In mice, the yolk sac appears to play a crucial role in nourishing the developing embryo, especially during embryonic days (E) 7-10. Lipoprotein synthesis and secre- tion may be essential for this function: embryos lacking apolipoprotein (apo) B or microsomal triglyceride transfer protein (MTP), both of which participate in the assembly of triglyceride-rich lipoproteins, are apparently defective in their ability to export lipoproteins from yolk sac endoderm cells and die during mid-gestation. We therefore analyzed the embryonic expression of apoB, MTP, and a -tocopherol transfer protein ( a -TTP), which have been associated with the assembly and secretion of apoB-containing lipoproteins in the adult liver, at different developmental time points. MTP expression or activity was found in the yolk sac and fetal liver, and low levels of activity were detected in E18.5 placentas. a -TTP mRNA and protein were detectable in the fetal liver, but not in the yolk sac or placenta. Ultrastruc- tural analysis of yolk sac visceral endoderm cells demon- strated nascent VLDL within the luminal spaces of the rough endoplasmic reticulum and Golgi apparatus at E7.5 and E8.5. The particles were reduced in diameter at E13.5 and reduced in number at E18.5-19. The data support the hypothesis that the yolk sac plays a vital role in provid- ing lipids and lipid-soluble nutrients to embryos during the early phases (E7-10) of mouse development. —Terasawa, Y., S. J. Cases, J. S. Wong, H. Jamil, S. Jothi, M. G. Traber, L. Packer, D. A. Gordon, R. L. Hamilton, and R. V. Farese, Jr. Apolipoprotein B-related gene expression and ultrastruc- tural chracteristics of lipoprotein secretion in mouse yolk sac during embryonic development. J. Lipid Res. 1999. 40: 1967-1977.