Adam J. Cohen – Evaluation and Management of Blepharoptosis

Автор: Adam J. Cohen
Название книги: Evaluation and Management of Blepharoptosis
Формат: PDF
Жанр: Пластическая хирургия
Качество: Изначально компьютерное, E-book

Written by experts in the fields of oculofacial plastic surgery and neuro-ophthalmology, Evaluation and Management of Blepharoptosis is an up-to-date, practical guide to the treatment of adults and children with ptosis. This comprehensive reference covers all aspects of blepharoptosis in an organized fashion. The book begins with evaluation of the patient to determine if true ptosis or pseudoptosis exists. The various categories of blepharoptosis are thoroughly and succinctly reviewed, along with suggested approaches to clinical management. Detailed descriptions of the various surgical techniques are replete with pearls provided by leading ptosis surgeons, along with advice regarding perioperative anesthesia and analgesia. Every surgeon should know how to handle the various surgical complications and surgical failure. Nevertheless, familiarity with surgical techniques is not enough. One must learn to identify risk factors and red flags that suggest a modified or conservative approach, or perhaps that surgery may be unwise. When surgery is unwarranted or unsuccessful, then one may consider nonsurgical therapeutic strategies. Regardless of treatment, the physician-patient relationship and detailed discussion with the patient prior to surgery regarding potential risks, complications, and realistic expectations impact patient satisfaction immeasurably. All of these issues are discussed in detail in this invaluable resource for the clinician.

Blepharoptosis (ptosis) is a widely prevalent disorder that is encountered by
virtually every clinician, whether one is working with an adult or pediatric
population. Therefore, it behooves the medical practitioner to be familiar with
this condition from the diagnostic standpoint, particularly with respect to identifying
a serious underlying disorder, such as an aneurysm, tumor, carotid
artery dissection, or myasthenia gravis. Any surgeon who manages ptosis
should be well-acquainted with the various surgical approaches to repair since
different techniques are often particularly applicable to certain scenarios.
Landmark treatises on ptosis, such as Beard’s Ptosis, are unfortunately
out-of-print. Furthermore, while certain aspects of this subject, such as the
general technique for external levator resection surgery, may not have
changed significantly over the years, there have been major advances in our
understanding of the underlying genetics and our ability to identify and classify
disorders based on the genetic analysis. This is especially relevant to the
various inherited myopathies that are often associated with ptosis, which are
reviewed in this book. Admittedly, a comprehensive discussion of myopathic
disorders is beyond the scope of this text, and we have condensed that subject
to a review of myopathies relevant to the ophthalmologist and ptosis
surgeon. As scientific research progresses, we have no doubt that there will
be much more to say about pathophysiology and genetics of ptosis in the
future.
While many books have been published in the field of oculoplastic surgery,
most provide only a limited discussion of blepharoptosis, emphasizing
the key points of diagnosis and surgical management. It was our intent to
provide a practical reference that offered a 360° view of blepharoptosis –
from etiology to management. We begin with a historical perspective, then
move on to a review of relevant eyelid anatomy and physiology, how to
evaluate the ptosis patient, and then differential diagnosis. Other ocular and
periocular disorders may be confused with ptosis, and these are discussed in
the chapter on pseudoptosis. After reviewing the various categories of ptosis,
classified based on etiology, we cover the management of ptosis, including
nonsurgical modalities and the various surgical procedures for ptosis
correction, as well as tips regarding anesthesia and analgesia during surgery
in order to optimize the surgical experience for both the patient and the surgeon.
The significance of patient ethnicity and gender is reviewed. The book
would not be complete without a discussion of surgical complications and
the basis for surgery failure and its management. The chapter entitled
“Perspective of a Risk Manager” provides a thoughtful analysis of the physician–
patient relationship, with suggestions regarding how to establish a
favorable rapport with the patient and reduce the likelihood of an unhappy
patient, regardless of the outcome of surgery.
This is a multiauthored textbook that is written by experts in the fields of
oculofacial plastic surgery and neuro-ophthalmology. This subject matter is
relevant to physicians and surgeons in all disciplines that deal with eyelid
ptosis, from both a diagnostic and therapeutic perspective. It is our hope that
this reference text will be helpful to clinicians in a wide range of specialties
and ptosis surgeons, from the novice to the expert.