This video demonstrates a surgical procedure to obtain a biopsy of the lacrimal gland. The surgical steps were:
• Lid crease incision
• Sub-orbicularis dissection to reach the orbital septum
• Periosteal incision and subperiosteal dissection to superolateral orbit
• Opening of periorbita to expose the lacrimal gland
• Biopsy of the lacrimal gland
Surgeon: Dr. David Della Rocca, New York Eye and Ear Infirmary of Mount Sinai
Additional Authors: Dr. Bella Wolf and Dr. Harsha S. Reddy, New York Eye and Ear Infirmary of Mount Sinai
Dr. Reddy: Two 4-0 silk sutures are placed full thickness through the lid margin, and a hemostat is used to provide inferior traction. A 15 blade is used to incise the skin. A Westcott scissors is used to carefully dissect through just the orbicularis. Westcott scissors along with anterior counter traction with the other hand are used to dissect in the sub orbicularis preseptal plane, until the orbital rim is reached and palpated. Using a DeMar retractor and a malleable retractor to spread the tissues, the monopolar cautery is used to carefully dissect through the periosteum to reach the bone.
The periosteum is further cleaned off using a combination of cottonoid sponges, gauze, and the freer periosteal elevator to expose the rough surface of the bone. Holding the lip of the periosteal incision edge, the freer periosteal elevator can now be used to dissect into the orbit superolaterally. The cottonoid or neuropatty can be used to continue the safe blunt subperiosteal dissection by having the sponge hug the bone and not open the periorbital prematurely. The lacrimal gland can be appreciated through the still intact periorbita and local anesthetic is given. As the periorbita is open, the lacrimal gland prolapses forward. This can be aided by gentle retropulsion on the globe.
In this frame, both the pink lacrimal gland and the yellow preaponeurotic fat pad inferior and attached to it, are visible. This orbital lobe of lacrimal gland is directly grasped and clamped using a curved mosquito hemostat. The biopsy is then obtained by cutting the tissue above the clamp with a Wescott scissors. The distinction between the pink lacrimal gland and the often attached yellow fat is clearly noted. For hemostasis, the cautery is applied above the clamp prior to releasing the hemostat. As there is no tension on the wound, either permanent or dissolvable sutures can be used in either a continuous or interrupted fashion. Please note that this video did not demonstrate a lacrimal gland repositioning, or dacryopexy. Please see our separate video for that procedure.
March 23, 2020