wound healing, orbit, eye, eyelid anatomy wound …methods of wound closure primary intention...
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Anatomy CourseAnatomy CourseWound healing, orbit, eye, eyelid anatomy Wound healing, orbit, eye, eyelid anatomy including orbital fissures, optic muscles, including orbital fissures, optic muscles,
optic nerve and its relation to the optic nerve and its relation to the paranasalparanasalsinuses. Anatomy of the nose. sinuses. Anatomy of the nose.
Drs. Drs. LaBrunaLaBruna & & JourdyJourdy
Wound HealingWound Healing
PhasesPhasesInflammatory Phase/Coagulation: Inflammatory Phase/Coagulation: neutrophilsneutrophils predominate predominate during the first 24during the first 24--48 hours48 hoursMigratory Phase: macrophages replace Migratory Phase: macrophages replace neutrophilsneutrophils as the as the most prevalent cell type approximately 2most prevalent cell type approximately 2--4 days later4 days laterProliferativeProliferative Phase: collagen formation by fibroblasts Phase: collagen formation by fibroblasts begins around day 3begins around day 3--5 and continues for 25 and continues for 2--4 weeks4 weeksWound remodeling: Around day 21 scar remodeling occursWound remodeling: Around day 21 scar remodeling occurs
Methods of Wound ClosureMethods of Wound Closure
Primary intention Primary intention –– skin edges approximated skin edges approximated using any acceptable closure methodusing any acceptable closure methodSecondary intention Secondary intention –– wound heals via wound heals via epithelializationepithelialization and contractionand contractionThird intention/delayed primary intention Third intention/delayed primary intention ––wound left open for short period of time and wound left open for short period of time and then closed by primary intentionthen closed by primary intentionSkin graft Skin graft –– epidermis + part of dermisepidermis + part of dermisFlaps Flaps –– rotation flap versus free flaprotation flap versus free flap
Factors that Inhibit Wound HealingFactors that Inhibit Wound Healing
Malnutrition (Especially Malnutrition (Especially VitVit C, C, VitVit A, and A, and Zinc)Zinc)SteroidsSteroidsRadiationRadiationSmoking (poor oxygenation)Smoking (poor oxygenation)DiabetesDiabetesAge (Elderly have decreased cell proliferation Age (Elderly have decreased cell proliferation and metabolic activity)and metabolic activity)
OrbitOrbit
Four Walls of the Orbit + ApexFour Walls of the Orbit + Apex
OrbitOrbit
EyelidsEyelids
OrbitOrbit
LacrimalLacrimal ApparatusApparatus
OrbitOrbit
Optic NerveOptic Nerve
Blood supply/drainageBlood supply/drainage
OrbitOrbit
EOMsEOMs
OrbitsOrbits
Orbital FissuresOrbital Fissures
BlepharoplastyBlepharoplasty
Please see Please see handout for handout for additional additional diagrams & diagrams & picturespictures
BlepharoplastyBlepharoplasty
Physical ExamPhysical ExamCareful assessmentCareful assessmentProptosisProptosisOphthalmologic examinationOphthalmologic examinationSchrimerSchrimer testtestEvaluation of lower lidEvaluation of lower lid
Snap testSnap testRetraction testRetraction testPinch testPinch test
BlepharoplastyBlepharoplasty
Upper lid Upper lid blephblephLower lid Lower lid blephbleph
TranscutaneousTranscutaneousTransconunctivalTransconunctival
PreseptalPreseptal approachapproachRetroseptalRetroseptal approachapproach
BlepharoplastyBlepharoplasty
ComplicationsComplicationsOrbital hemorrhage and blindnessOrbital hemorrhage and blindnessEctropionEctropionMiliaMiliaLagothalmosLagothalmos
NoseNose
SkeletonSkeleton
NoseNose
Internal Internal Nose: Nose: Medial Medial WallWall
NoseNose
Internal Nose: Lateral WallInternal Nose: Lateral Wall
NoseNose
Blood supplyBlood supplyOphthalmic artery Ophthalmic artery anterior/posterior anterior/posterior ethmoidalethmoidalarteries (superior/middle arteries (superior/middle meatusmeatus, , midnasalmidnasal septum)septum)Maxillary artery Maxillary artery sphenopalatinesphenopalatine artery artery posterior lateral nasal and posterior posterior lateral nasal and posterior septalseptal branchesbranchesMaxillary artery Maxillary artery descending palatine artery descending palatine artery greater palatine artery (lower part of nasal septum)greater palatine artery (lower part of nasal septum)Facial artery Facial artery lateral nasal branch lateral nasal branch superior labial superior labial artery artery septalseptal branchesbranches
RhinoplastyRhinoplasty
Please see Please see handout for handout for additional additional diagrams & diagrams & picturespictures
Thank youThank you