Stellate rhytidectomy: superior entropion repair in a dog with excessive facial skin

Coronofrontal rhytidectomy: A new approach for the treatment of severe pseudoptosis and superior entropion in dogs

PURPOSE

To describe the use of coronofrontal rhytidectomy (CFR) for the treatment of severe pseudoptosis and superior entropion in dogs, and to provide guidelines for the selection of surgical technique depending on presentation.

METHODS

A review of medical records of dogs that underwent rhytidectomy from 2002 to 2023 was carried out, including signalment, clinical signs, type of rhytidectomy, concurrent surgical techniques, re-interventions, post-operative complications, follow-up time, and outcome.

RESULTS

Twenty dogs with a median age of 5.1 years were included in this study. English Cocker Spaniel was the most common breed (8 dogs:40%) and males were overrepresented (13 dogs: 65%). Besides pseudoptosis and visual impairment (100%), the other most common clinical signs were entropion and/or ectropion (19 dogs: 95%), conjunctivitis (17 dogs: 85%), euryblepharon (12 dogs: 60%) and non-ulcerative keratitis (10 dogs: 50%). CFR was performed in 12 dogs (60%), frontal rhytidectomy in 5 (25%), coronal in 2 (10%), and modified shared in 1 (5%). Concurrent surgical techniques were performed in 17 dogs (85%), being lateral canthoplasty (13 dogs; 65%), and Celsus-Hotz (10 dogs; 50%) the most common. The median follow-up time was 115 days with no complications and good outcomes reported in all dogs. At last re-recheck, complete correction of the eyelid positioning was obtained in 92% (11/12) and 87.5% (7/8) of the cases that underwent CFR and other rhytidectomy techniques, respectively.

CONCLUSION

CFR is an effective surgical treatment for severe pseudoptosis and superior entropion in dogs. The provided guidelines will assist in the selection of the most appropriate eyelid lifting technique.

Brow rhytidectomy with or without Stades-like procedure for correction of pseudoptosis and trichiasis-entropion of the upper eyelid in Chow Chow and Shar-Pei dogs: A retrospective study of 27 dogs (2019-2022)

PURPOSE

Heavy brows in Chow Chow and Shar-Pei dogs can be associated with pseudoptosis and trichiasis-entropion of the upper eyelids, causing vision impairment and ocular discomfort. This study describes the outcomes of brow rhytidectomy ± Stades-like procedure to address these anatomical abnormalities.

METHODS

Retrospective medical records review (2019-2022).

RESULTS

Twenty-seven dogs (n = 15 Chow Chow, n = 12 Shar-Peis) were included, aged 1.9 ± 1.5 years (0.5-6.5 years). Presenting complaints included recurrent episodes of ocular inflammation (n = 13, 48.1%), blepharospasm (n = 10, 37.0%), corneal ulcers (n = 8, 29.6%), entropion (n = 6, 22.2%), and impaired vision (n = 4, 14.8%). Brow skin was removed as follows: (i) First incision parallel and 10-15 mm dorsal to upper lid, slightly extending beyond medial/lateral canthi; (ii) second incision forming an arc with its apex 15-35 mm dorsal to the first incision; and (iii) standard two or three layers closure. In 22/27 dogs, a Stades-like procedure was performed by removing a 2-4 mm strip of skin above eyelid margin and leaving it to heal by secondary intention (no sutures). At last recheck (follow-up 354.5 ± 187.8 days), 19/27 dogs (70.4%) had an adequate eyelid conformation, 7/27 dogs (25.9%) were considered under-corrected, and 1/27 dogs (3.7%) was over-corrected. Most owners (81.5%) were satisfied with the surgical results. Most cases (96.3%) had no recurrence of the clinical signs during the entire follow-up period.

CONCLUSIONS

Brow rhytidectomy ± Stades-like procedure provide good cosmetic and clinical outcomes in Chow Chow and Shar-Pei dogs, although under correction may occur in severely affected dogs and with advancing time.

Lateral canthal reconstruction for the treatment of macroblepharon/diamond eye conformation in dogs

PURPOSE

To introduce a novel surgical technique for treatment of macroblepharon and diamond eye conformation in dogs.

METHODS

Lateral canthal reconstruction was used in dogs with prominent eyelid malformations resulting in ocular surface disease. Lateral canthus was resected and new lateral canthus was created using a two-layer closure. This technique was performed either alone or in combination with additional procedure(s). Additionally, this technique was used to resect lateral canthal dermoid.

RESULTS

One hundred and fifty-three eyes of 85 dogs were included in the study. Procedure was done for macroblepharon and/or lateral canthal entropion (149 eyes of 81 dogs) or for lateral canthal dermoid (four eyes of four dogs). Procedure was done either alone (n = 68 eyes) or in combination with additional procedure (n = 85 eyes). Favorable cosmetic outcome and client satisfaction was achieved in all dogs. Good to excellent functional outcome was recorded in all but 6 eyes of 4 dogs, which required additional surgery. Most common complications included slight undercorrection or overcorrection.

CONCLUSIONS

Lateral canthal reconstruction is a simple yet effective surgical procedure for macroblepharon and/or lateral canthal entropion. If done early, it prevents development of secondary eyelid malformation ("pagoda defect") in giant breed dogs. If done after severe eyelid malformation has developed, combining this technique with concurrent pagoda resection is recommended to achieve ideal eyelid conformation. None.

Surgical management of bilateral, upper and lower eyelid entropion in 27 Shar Pei dogs, using the Stades forced granulation procedure of the upper eyelid only

Aims: To evaluate the outcome of surgical management of entropion of the upper and lower eyelids in Shar Pei dogs which had previously undergone temporary palpebral tacking, using the Stades forced granulation procedure of the upper eyelid only.Methods: Medical records were retrospectively searched to identify Shar Pei dogs referred for bilateral entropion of both the lower and upper eyelids, and that were treated with the forced granulation procedure of the upper eyelid only. Dogs were included if they had previously undergone unsuccessful temporary palpebral tacking and had at least three follow-up examinations in the 30 days following surgery.Results: Twenty-seven Shar Pei dogs with a median age of 7.9 (min 4, max 24) months were included in the study. Before surgery, all dogs showed signs of severe ocular discomfort with bilateral keratitis and visual deficit due to blepharospasm, enophthalmos and protrusion of the third eyelid. In 13/54 eyes, keratitis was associated with a corneal ulcer. When re-examined 4 weeks after surgery, correction of the upper eyelid entropion and associated trichiasis resolved ocular signs in 50/54 eyes. Mild bilateral lower entropion remained in two dogs postoperatively, which underwent revision surgery with the Hotz-Celsus technique. There were no cases of long-term recurrence of entropion or ocular irritation in the 38 eyes (19 dogs) which were re-examined 1 year after surgery.Conclusion and clinical relevance: The forced granulation procedure performed on the upper eyelid only was effective for correction of entropion in the Shar Pei dogs included in this study. In our experience, it is preferable to operate on the upper eyelid alone, rather than attempting to correct upper and lower entropion during the same surgical operation. The dog can then be reassessed a few weeks later to determine whether the lower entropion is anatomical or secondary to the severe blepharospasm resulting from the painful ocular irritation.

Shared rhytidectomy continued to lateral canthoplasty in a Mastiff with excessive facial folding and macroblepharon

A 3.5-year-old male Neapolitan Mastiff was presented with an obstructed visual axis because of excessive facial skin folds, brow droop, macroblepharon, upper eyelid entropion and lower ectropion-entropion. To address these major defects a technique was performed which combines rhytidectomy with shortening of the palpebral fissure and stabilization of the lateral canthus. Postoperatively the dog showed an unobstructed visual axis with comfortable and symmetrical eyes.

Nonsutured Hotz-Celsus technique performed by CO2 laser in two dogs and two cats

It is described a new version of modified Hotz-Celsus technique performed in four patients, two cats and two dogs. The surgery was carried out using CO(2) laser in order to avoid bleeding and decrease the anesthetic time. Besides, the wound created was not sutured and it healed by secondary intention without any complication. As a conclusion, this modification is a successful alternative to treat entropion in a safe and fast way.

Adnexal surgery in dogs and cats

Abnormalities in eyelid position and function can lead to chronic irritation of cornea and conjunctiva. Corneal ulceration, vascularization and pigmentation are common consequences. Loss of vision, or loss of the globe may be the end result. The combination of ptosis and entropion of the upper eyelid is commonly seen in breeds with abundant forehead skin folds. Treatment options include surgical reduction of skin folds, suspending the brows, enforced secondary granulation of the upper eyelid, or a combination of procedures. Lid-shortening procedures reduce corneal exposure, improve functional blinking and reduce likelihood of traumatic proptosis. Although a lateral canthoplasty is technically easier to perform, a medial canthoplasty is the preferred method of eyelid shortening. An involuted lateral canthus with entropion is seen in certain dog breeds with a broad skull base and redundant facial skin. Surgical correction is by either applying traction to the lateral canthus, or by resection of the lateral canthal ligament. A combination of entropion, ectropion and macroblepharon may result in the presence of diamond shaped eyelids. Surgical correction involves the combination of several procedures. Upper eyelid agenesis is a congenital absence of part of the upper eyelid in cats. Treatment options include a skin-orbicularis flap from the lower eyelid with a conjunctival pedical graft, the transposition of the lower eyelid to the upper eyelid, cross lid flap and subdermal plexus flap, and subdermal collagen injection. Several techniques for reconstruction of upper and lower eyelid defects are described.

Coronal rhytidectomy in conjunction with deep plane walking sutures, modified Hotz-Celsus and lateral canthoplasty procedure in a dog with excessive brow droop

This case report describes a unique technique of rhytidectomy in a Bloodhound to repair excessive brow folding and droop complicating underlying entropion. This case posed specific challenges due to the loose fascial plane connective tissue. A large circular area of coronal skin was excised, followed by placement of deep plane walking fixation sutures for cosmetic realignment and to alleviate brow droop. In addition, a modified Hotz-Celsus procedure and lateral canthoplasty were performed to address the primary entropion. The coronal rhytidectomy was considered a successful approach to repair excessive brow droop in this Bloodhound.