Lacrimal gland biopsy and repositioning
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This is Richard Allen at the University of Iowa. This video demonstrates biopsy and repositioning of the lacrimal gland. This patient has an enlarged lacrimal gland that has prolapsed anteriorly. An incision is made along the upper eyelid crease marking and a small blepharoplasty marking with a 15 blade. Westcott scissors are then used to excise a flap of skin. The monopolar cautery is then used to dissect through the orbicularis muscle to the orbital septum. The orbital septum is opened and the underlying preaponeurotic fat is identified. The lacrimal gland is then identified lateral to the preaponeurotic fat. The gland is mobilized and Westcott scissors are used to take a biopsy. The specimen is sent to the pathologist for evaluation. Due to the prolapse of the lacrimal gland, the gland will be repositioned so that it sits posterior to the superior orbital rim. This is performed by engaging the inferior aspect of the orbital lobe of the lacrimal gland with a double armed 5-0 nylon suture. Each end of the nylon suture then engages the posterior portion of the periosteum of the superior orbital rim. It is important to engage the inferior portion of the gland so that when the sutures are tightened, the superior portion of the gland sits posterior to the superior orbital rim. The sutures are tied. Inspection of the area shows that the lacrimal gland is repositioned well. The preaponeurotic fat is then placed in its normal anatomic position. The incision is then closed with a running subcuticular suture with 6-0 prolene suture. I prefer this closure in patients who are darkly pigmented to prevent noticeable suture tracks through the skin. This is performed by engaging the dermis and running a mattress suture. The patient returns in approximately one week for suture removal. Antibiotic is placed over the incision three times per day.