Atlas of Clinical and Surgical Orbital Anatomy , livre ebook

Atlas of Clinical and Surgical Orbital Anatomy
Second Edition

Jonathan J. Dutton, MD, PhD, FACS
Professor and Vice Chair of Ophthalmology, The University of North Carolina, Chapel Hill, North Carolina, USA
Saunders
Front matter
Atlas of Clinical and Surgical Orbital Anatomy
Commissioning Editor: Russell Gabbedy
Development Editor: Nani Clansey
Editorial Assistant: Kirsten Lowson
Project Manager: Glenys Norquay/Nancy Arnott
Designer: Charles Gray
Illustrator: Thomas G. Waldrup, MSMI
Marketing Manager(s) (UK/USA): Gaynor Jones/Helena Mutak

Atlas of Clinical and Surgical Orbital Anatomy
Second Edition
Jonathan J. Dutton MD, PhD, FACS, Professor and Vice Chair of Ophthalmology , The University of North Carolina, Chapel Hill, North Carolina, USA
Illustrations by:
Thomas G. Waldrop, MSMI
Copyright

© 2011, Elsevier Inc. All rights reserved.
First edition 1994
Second edition 2011
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions .
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Saunders
British Library Cataloguing in Publication Data
Dutton, Jonathan J.
Atlas of clinical and surgical orbital anatomy. – 2nd ed.
1. Eye-sockets–Anatomy–Atlases. 2. Eye-sockets–
Surgery–Atlases.
I. Title
611.8′4-dc22
ISBN-13: 978-1-4377-2272-7
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress.
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedication
“The learning and knowledge that we have is, at the most, but little compared with that of which we are ignorant.”
Plato, 428-348 BC
“The known is finite, the unknown infinite, intellectually we stand on an islet in the midst of an illimitable ocean of inexplicability. Our business in every generation is to reclaim a little more land.”
T.H. Huxley, 1887
With the second edition of this book, we continue to explore further into the realm of orbital anatomy. We hope thereby that we are able to contribute, however slightly, to Huxley’s precious intellectual land.
About the Authors
JONATHAN J. DUTTON, M.D., Ph.D. is currently Professor and Vice Chair of Ophthalmology at The University of North Carolina at Chapel Hill. He completed his masters and doctorate degrees in zoology, evolutionary biology, and vertebrate paleontology at Harvard University in 1970, and joined the faculty of Princeton University as Sinclair Professor of Vertebrate Paleontology from 1970 to 1973. Between 1965 and 1973 he conducted ten research expeditions to East Africa and published widely on vertebrate morphology and mammalian evolution. After returning to school and receiving his M.D. degree in 1978, and going on to residency training at Washington University Medical School, he completed a research fellowship in glaucoma at Washington University, and another fellowship in oculoplastic and orbital surgery at the University of Iowa. From 1983 to 1999 he was Professor of Ophthalmology and head of the Oculoplastic and Orbital Service at Duke University Medical Center. He served as CEO and Medical Director of the Atlantic Eye and Face Center in Cary, NC from 2000-2003 and then joined the full-time faculty at the University of North Carolina at Chapel Hill, where he is currently Professor and Vice Chair. Dr Dutton is senior preceptor of an ASOPRS-approved fellowship program that has trained 15 fellows. He specializes in oculoplastic reconstructive and orbital surgery, thyroid eye disease, and periorbital and intraocular ophthalmic oncology.
THOMAS G. WALDROP, M.S.M.I. received his Master of Science degree in medical illustration from the Medical College of Georgia in 1978. He directed the ophthalmic photography and ultrasound section of the Retina Institute in St Louis before establishing his medical illustration service in Hillsborough, North Carolina in 1980. Since then, he has worked closely with the Duke University Eye Center producing ophthalmic illustrations for publication, and he has collaborated with Dr. Dutton on several major atlases of ophthalmic surgery.
Preface to the First Edition

Jonathan J. Dutton, Thomas G. Waldrop
Few areas in ophthalmology have proven to be as elusive or difficult to teach as orbital anatomy. The grasp of clinical diagnostic techniques, and the development of sophisticated surgical skills seem far removed from the mundane and often boring tasks of plowing through pages of descriptive anatomic detail. Idealized artistic drawings have often failed to accurately portray true anatomic relationships with other structures. Photographs of clinical dissections are usually so cluttered with extraneous structures as to make interpretation of individual anatomic systems impossible. The result has been a poor understanding of orbital anatomy, not only among ophthalmologists, but also among neurosurgeons and otolaryngologists who frequently pursue lesions into the orbit.
During the past decade there has been a renewed interest in clinical eyelid and orbital anatomy. Detailed dissections and reinterpretations have markedly altered our concepts of functional morphology of such structures as Whitnall’s ligament, the medial canthal tendon, orbital fascial septa, the lower eyelid retractors, and the levator aponeurosis. This has resulted in the development of new surgical procedures based on such concepts, and the resurrection and successful modification of older, long abandoned operations. With the growing appreciation of anatomical and functional relationships, older, non-physiologic procedures are slowly giving way to those directed at the site of pathology, and aimed at the restoration of normal anatomic structure and physiology. Without an intimate knowledge of the anatomy of these regions, the modern surgeon dealing with orbital and eyelid disorders can no longer function adequately. Nor can progress occur in the evolution of newer and even more physiologically appropriate therapeutic techniques.
Of all the subjects in medicine, the study of anatomy is perhaps the most visual. Few of us can easily commit to memory the numerous and frequently antiquated names given to anatomic structures. Even more confusing are the spatial relationships of different anatomic systems and their common variants. Often we rely on simple images, mental drawings that depict key landmarks in familiar juxtapositions that can be recalled during clinical evaluations or surgical operations. Most of us have divined various tricks to visually reconstruct complex anatomic detail from two-dimensional artistic renderings, or from confusing cadaver dissections. It is this very process of conjuring up prepackaged eidetic images that led to the concept of the present book.
The illustrations presented in the following pages combine the best features of several different techniques. Anatomic details and relationships are based on several human orbits cut into 300 histologic sections at 150 microns thickness. For each anatomic system (e.g. bones, arteries, nerves, etc.) each section was projected to 3X magnification and traced onto a transparent mylar sheet. Accurate registration was assured through the use of precut feduciary markings within the blocks, and adjustments for differential shrinkage and warpage were made visually. The mylar sheets were then stacked in layered fashion and the resulting three-dimensional reconstructed images were used to prepare the final illustrations. Translation into various orientations was performed