Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
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12-MARCH-2011 RAGHAD NABEEL JUMMAA 3 YEARS
POSTTRAUMATIC BONY DISFIGUREMENT OF THE LEFT NASOLACRIMAL AREA WITH OBSTRUCTION
OF THE LEFT LACRIMAL DUCT.
was operated by me
for severe head injury with laceration of the
brain and complete destruction of the bony
alignments of the forehead and she survived.
patient then came 08-October-2009 and she was
neurologically free, but has slight
disfigurement of the left naso-lacrimal area.
The patient was sent for neuroradiologic
investigations, but she disappeared.
patient then came 08-August-2010 and the father
claiming that the tears of the left eye are
coming out and the bony disfigurement became
more pronounced. CT-scan of the orbits was done
09-August-2010 and she was sent for
examination: the patient is neurologically free
and there is closure of the left lacrimal ducts
with bony disfigurement of the left
Limited Lynch incision was performed over the
most prominent bony elevation in the deformed
left naso-lacrimal area. The medial canthal
ligament identified and dissected off the
deformed bony prominences. All the bony
deformities were corrected and the lacrimal sac
was decompressed of all bony compression. The
lacrimal canal of the left maxillary bone was
partially opened to ensure that it is free. The
posterior wall of the canal was pushed
posterior. Inspection for any bony prominences
was negative and the comparison with the
contralateral side showed complete symmetry. The
medial canthal tendon was sutured to the
periosteum and routine closure of the wound.
closure of the wound. Smooth postoperative
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The transcaruncular approach
is not appropriate for this case, because the
aim of surgery is not only cosmetic, but also to
decompress the lacrimal duct, caused by the bony
elements. This approach is ideal for the medial
wall of the orbit to lesions behind the lacrimal
The Lynch approach has its disadvantages,
but in this case it was the most appropriate one, to resolve
all the problems of the patient.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .