B N Lemke

University of Wisconsin, Madison, Madison, MS, United States

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Publications (59)99.79 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: : To examine with histology the anatomical location of hyaluronic acid gel injected to the infraorbital hollows of cadaver specimens. : The authors dissected 5 fresh hemifacial cadaver specimens following preperiosteal injection of hyaluronic acid gel to the infraorbital hollows. Following tissue fixation, full-thickness soft tissue sections were obtained along the medial, central, and lateral lower eyelid/midface of each specimen. Histologic examination of the anatomical location of hyaluronic acid gel was performed using hematoxylin and eosin and Hale colloidal iron stains. : Histologic examination of the central and lateral lower eyelid/midface sections revealed a significant portion of hyaluronic acid gel in either a postorbicularis or a subcutaneous plane in 8 of 10 sections. Only 2 sections displayed hyaluronic acid gel solely within a preperiosteal plane. The medial sections revealed hyaluronic acid gel resting in either a preperiosteal or an intraorbicularis plane. Soft tissue structures such as deep fat compartment septa and the orbicularis oculi muscle appeared to play a significant role in influencing the resting position of hyaluronic acid gel. : In most specimens, the location of a significant portion of hyaluronic acid gel following injection to the infraorbital hollows differed from the intended injection plane. Soft tissue structures including fat compartment septa and the orbicularis oculi muscle appear to influence the resting position of hyaluronic acid gel. Careful attention should be used to avoid overfilling the thin soft tissue layers of the medial infraorbital hollows or tear trough.
    Ophthalmic plastic and reconstructive surgery 01/2013; 29(1):35-9. · 0.69 Impact Factor
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    ABSTRACT: purpose Normal eyelid and orbital structures were studied without any disturbance in three positions of gaze and during Bell's phenomenon (eyes closed). methods Seven orbits were imaged using a high-resolution magnetic resonance imaging program and a surface coil. They were analyzed with sub-millimetric resolution in a series of contiguous vertical planes parallel to the orbital axis. The three positions of gaze (downgaze, straight ahead and up-gaze) were reproduced using the same fixation device. results Between upgaze and downgaze, a volume of intraconal fat is cleared away from the path of the optic nerve and can be measured semi-quantitatively. Concurrently, significant volumetric changes occur in the fat compartment comprised between a rectus muscle and its arc of contact with the sclera. The superior and inferior extraconal fat pads follow the movements of the corresponding eyelid retractor complex. Along with the relative movements of the intraconal and extraconal fat pads, the bulging of the contracting extraocular muscles and thinning of the relaxing ones, a translatory movement of the globe opposite to the direction of gaze is seen. The courses of Whitnall's and Lockwood's ligaments are demonstrated in relation to their retractor muscle complex and extraconal fat pads, allowing refined observation of the elastic and inelastic components of their attachments. In Bell's phenomenon, the levator and superior rectus muscles are seen sliding in opposite directions as the levator relaxes and the superior rectus contracts. How other structures are affected by this complex movement is illustrated. conclusions Multipositional high-resolution magnetic resonance imaging is useful in furthering the understanding of the functional anatomy of the human orbit.
    07/2009; 16(3):159-184.
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    ABSTRACT: The authors present 2 cases of eyelid dermoid cyst attached to tarsus in pediatric patients. Both patients were infants who presented with a firm, nontender upper eyelid mass firmly adherent to tarsus. In both cases, the lesion was excised en bloc, and histopathology revealed a dermoid cyst. To the authors' knowledge, there are no previously reported cases of tarsal dermoid cyst. These cases demonstrate the importance of including dermoid cyst in the differential diagnosis of a tarsus-based eyelid mass. Misdiagnosis may lead to incision and curettage, resulting in spillage of cyst contents and the risk of severe inflammation and scarring.
    Ophthalmic plastic and reconstructive surgery 02/2009; 25(2):146-7. · 0.69 Impact Factor
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    ABSTRACT: To perform a quantitative analysis of adipocyte viability after fat processing during autologous fat transfer, comparing the processing methods of washing, centrifuging, and sedimentation. An experimental study was conducted in which 24 fat samples were obtained after processing from 22 patients undergoing autologous fat transfer. Histologic analysis of periodic acid-Schiff-stained specimens was then performed. Cell counts per high-powered field of intact adipocytes and nucleated adipocytes and adipocyte cross-sectional area were significantly greater in samples processed by sedimentation, compared with those by centrifuging or washing. Of the various processing techniques currently used during autologous fat transfer, sedimentation appears to yield a higher proportion of viable adipocytes than does washing or centrifuging.
    Ophthalmic Plastic and Reconstructive Surgery 01/2006; 22(3):195-200. · 0.67 Impact Factor
  • Cat Nguyen Burkat, Bradley N Lemke
    Otolaryngologic Clinics of North America 11/2005; 38(5):825-56. · 1.46 Impact Factor
  • Cat N Burkat, Bradley N Lemke
    Archives of Ophthalmology 10/2005; 123(9):1260-2. · 3.83 Impact Factor
  • Cat N Burkat, Bradley N Lemke
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    ABSTRACT: To describe the demographics, symptoms, and findings of acquired lax eyelid syndrome and to assess the efficacy of the 4-eyelid tarsal strip-periosteal flap technique to treat horizontally lax upper and lower eyelids. A retrospective, case-series review of 80 patients (320 eyelids) evaluated from January 2000 to April 2004 for lax upper and lower eyelids causing chronic irritation was performed. Ten patients with diagnosed floppy eyelid syndrome or obstructive sleep apnea were excluded. Height and weight of all patients were recorded to calculate body mass index. Lateral tarsal strip fixation of all 4 eyelids to periosteal flaps based inside the orbital rim was performed to achieve horizontal tightening. Postoperative follow-up ranged up to 52 months. Preoperative/postoperative symptoms and examination findings of upper and lower eyelid distraction, keratopathy, and conjunctival inflammation were compared. The most common presenting symptoms were epiphora (85.7%) and irritation (80%). The most common examination findings were upper and lower eyelid horizontal laxity and palpebral conjunctival injection (100% patients). Thirteen of 70 patients (18.6%) were obese, based on body mass index; 26 of 70 patients (37.1%) were mildly overweight; 29 of 70 patients (41.4%) were normal weight; and 2 of 70 patients (2.9%) were underweight. After surgery, 91% of patients had improved or resolved symptoms and signs; 2.5% of dehiscences occurred with the use of the 4-eyelid technique. Gradual continued improvement was observed for up to 1 year. Evaluation of patients presenting with chronically irritated eyes should include distraction of both the upper and lower eyelids and examination for conjunctival inflammation. Acquired lax eyelid syndrome is similar to floppy eyelid syndrome; however, 43.3% of patients were normal weight or underweight. The 4-eyelid tarsal strip-periosteal flap fixation is a rapid and effective technique for correction of this syndrome.
    Ophthalmic Plastic and Reconstructive Surgery 02/2005; 21(1):52-8. · 0.67 Impact Factor
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    ABSTRACT: Ocular sebaceous carcinoma (SC) is a rare tumor of the eyelids. Clinically it frequently involves the upper lid in older women. Microscopically it tends to extend far beyond its assessed clinical margins. SC is characterized by a variety of tissue invasion mechanisms. It may spread by direct extension, be multifocal in advanced cases, and develop "skip areas" after trauma. Despite its ability to develop discontinuity, over the past two decades there have been several favorable case reports of SC treated by Mohs micrographic surgery (MMS). To illustrate by case report the clinical presentation and management of patients with SC and to document our series of SC patients treated by MMS over the last 14 years. A retrospective study was conducted of all cases of sebaceous carcinoma involving the ocular adnexa treated at the University of Wisconsin Mohs Surgery Clinic from 1987 to 2001. We also reviewed the accumulated medical literature of SC treated by MMS. In our series, there were nine cases of periocular SC. Five cases originated on the upper lid and four on the lower lid. Five of nine patients (55%) showed epithelial invasion. One patient developed a local recurrence 1.5 years later and was treated by orbital exenteration. This patient has had no evidence of disease for 5 years. Eight of nine patients (88%) had no evidence of local recurrence with a follow-up of 1-14 years. In our literature review we found 40 additional cases of orbital SC treated by MMS. Intraepithelial spread of SC was found in 50% of patients (24 of 48). Six patients developed local recurrence. The overall local cure rate following MMS is 87.8% (43 of 49), with a mean follow-up of 3.1 years. The regional metastatic rate was 8% (4 of 49). There were no deaths reported. We present nine new cases of SC. The age, sex, and site distribution are compatible with other SC cases reported in the literature. We reviewed the medical literature and compiled 49 cases of SC treated by Mohs surgery. Intraepithelial spread was discovered in 50% of the cases. Multifocal disease or discontinuity was present in 6% (3 of 49). Mohs surgery appears to be an effective method for excising the microscopic ramifications of primary SC. When feasible, we recommend in SC cases where intraepithelial pagetoid spread has been observed, that removal of another Mohs layer should be considered in order to provide an additional assurance layer against local tumor recurrence.
    Dermatologic Surgery 08/2002; 28(7):623-31. · 1.87 Impact Factor
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    ABSTRACT: To investigate the Cynomolgus monkey eyelid as an experimental model for oculoplastic surgery Eyelid and periocular tissue were removed from Cynomolgus monkeys being euthanized. After fixation, the macroscopic and microscopic characteristics of the Cynomolgus monkey eyelid were studied. Macroscopic and microscopic characteristics of the Cynomolgus monkey eyelids were described. The Cynomolgus monkey eyelid bears resemblance to the human eyelid in its compartmentalization and complexity. The Cynomolgus monkey eyelid is a suitable experimental research model. Its compartmentalization resembles that of the human eyelid both microscopically and macroscopically.
    Ophthalmic Plastic and Reconstructive Surgery 06/2002; 18(3):183-9. · 0.67 Impact Factor
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    ABSTRACT: To study the lymphatic drainage of the cynomolgus monkey through the use of lymphoscintigraphy. Lymphoscintigraphy with 500 microCi of 99mTechnetium sulfur colloid injected at specific sites around the eyelids was performed with five cynomolgus monkeys in lateral and ventral positions. Lymphoscintigraphy of the monkey eyelid and periocular tissue revealed lymphatic drainage to the parotid lymph nodes from the entire upper eyelid, medial canthus, and lateral lower eyelid and drainage to the submandibular lymph nodes from the medial and central lower eyelid. In addition to draining to the parotid lymph nodes, the central upper eyelid was also seen to drain to the submandibular lymph nodes. Lymphoscintigraphy of the cynomolgus monkey eyelids reveals discrete lymphatic drainage pathways for the upper and lower eyelids and a dual pathway for the central upper eyelid. Future studies will help to clarify the lymphatic drainage pathways of human eyelids.
    Ophthalmic Plastic and Reconstructive Surgery 04/2002; 18(2):99-106. · 0.67 Impact Factor
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    ABSTRACT: To study the lymphatic drainage of the cynomolgus monkey and human eyelid and periocular tissue by means of histochemistry. Eyelid and periocular tissue from three cynomolgus monkeys undergoing sacrifice for glaucoma and retina research purposes and discarded tissue from a wedge resection of one human eyelid were used for histochemical analysis. Lymphatic capillaries were distinguished histochemically in monkey and human eyelids by light microscopy with a 5'-nucleotidase (5'-Nase) staining method. Identification of lymphatic vessels was based on strict morphologic criteria combined with specific 5'-Nase staining. Histochemical analysis with 5'-nucleotidase revealed a subcutaneous and pretarsal lymphatic plexus in both the human and monkey. Histochemical results demonstrate similar lymphatic plexi in the monkey and human. Future studies will help to clarify the lymphatic drainage pathways of monkey and human eyelids.
    Ophthalmic Plastic and Reconstructive Surgery 02/2002; 18(1):18-23. · 0.67 Impact Factor
  • Bradley N. Lemke, Briggs E. Cook, Mark J. Lucarelli
    Ophthalmic Plastic and Reconstructive Surgery - OPHTHALMIC PLAST RECONSTR SUR. 01/2002; 18(4):311-312.
  • B E Cook, M J Lucarelli, B N Lemke
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    ABSTRACT: To describe the gross and microscopic anatomy of the depressor supercilii muscle and to discuss its cosmetic implications. The depressor supercilii muscle was studied in detail with the use of gross anatomic dissections carried out on eight sides of four fresh cadaver heads and ten sides of five preserved cadaver heads. Histological analysis was performed on parasagittal sections of one side of a preserved cadaver head. Measurements were taken on cadaver specimens to determine the insertion point of the depressor supercilii muscle on the undersurface of the skin. The depressor supercilii muscle is distinct from the corrugator supercilii muscle and the medial head of the orbital portion of the orbicularis oculi muscle. The depressor supercilii muscle was noted to be superior in orientation and redder in color than the orbicularis oculi muscle. The depressor supercilii muscle arose from the frontal process of the maxilla approximately 1 cm above the medial canthal tendon and appeared to originate from two distinct heads in most specimens, a novel finding. In specimens containing two heads of the depressor supercilii muscle, the angular vessels passed between the two muscle heads. In specimens containing one muscle head, the angular vessels were found anterior to the muscle. The insertion of the depressor supercilii muscle in the dermis lay approximately 13 to 14 mm superior to the medial canthal tendon. The origin, insertion, and anatomy of the depressor supercilii muscle help it to act as a depressor of the eyebrow. Histologically, the depressor supercilii muscle arises distinctly from bone and has a unique insertion. The depressor supercilii muscle appears to be distinct from the corrugator supercilii and the orbicularis oculi muscles.
    Ophthalmic Plastic and Reconstructive Surgery 12/2001; 17(6):404-11. · 0.67 Impact Factor
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    ABSTRACT: Lower eyelid involutional entropion is a significant disorder of the aging population resulting from horizontal eyelid laxity, overriding orbicularis oculi muscle, and attenuation of the lower eyelid retractors. The purpose of this study is to describe the long-term results of transconjunctival entropion repair. Interventional noncomparative case series. Thirty-six eyelids in 31 patients. Charts were reviewed of all transconjunctival entropion repairs, which included myectomy, retractor fixation, and horizontal shortening performed by three oculoplastic surgeons between January 1993 and January 1999. Cases with less than 12 months follow-up were excluded. Entropion recurrence. Thirty-six lids in 31 patients were followed for mean of 31.5 months (12.5-79). Six of 36 lids (16.7%) had postoperative complications. Recurrent entropion occurred in 3 of 36 lids (8.3%) an average 16.3 months (7-35) after surgery. An average of 6 trichiasis lashes (1-10) occurred in 4 of 36 lids (11.1%) at a mean of 2.25 months (1-4) after surgery. There were no overcorrections. Three of 36 lids (8.3%) required additional surgery. Entropion recurrence after three-step transconjunctival repair is within the 0% to 30% reported recurrence for other repair techniques but more frequent than reported for a similar transcutaneous procedure. The 8.3% recurrence rate might have resulted from inadequate myectomy, inadequate retractor fixation, cicatricial changes directly related to the transconjunctival incision, or progressive involutional changes. Trichiasis was the most frequent complication. Transconjunctival entropion repair may be slightly less effective than transcutaneous repair.
    Ophthalmology 06/2001; 108(5):989-93. · 5.56 Impact Factor
  • B N Lemke, B E Cook, M J Lucarelli
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    ABSTRACT: To describe a novel surgical technique for lower eyelid ectropion repair that avoids canthotomy and cantholysis and can be used in combination with external levator repair and/or in combination with blepharoplasty. A retrospective analysis of lower eyelid procedures with the use of the canthus-sparing technique between January 1, 1998, and December 31, 1999, was performed. The canthus-sparing approach was used in 198 eyelid procedures for the correction of lower eyelid ectropion. Seventy-four (37.4%) procedures involved the correction of lower eyelid ectropion alone and 25 (12.6%) procedures involved the correction of lower eyelid ectropion during upper eyelid small-incision external levator repair. In these cases, an incision was made lateral to the lateral canthus and a periosteal flap was created at the lateral orbital rim. The inferior crus of the lateral canthal tendon was then attached to this full-thickness elevated periosteum. Twenty (10.1%) procedures involved the correction of ectropion during upper blepharoplasty and 79 (39.9%) procedures involved the correction of ectropion during combined upper eyelid ptosis repair and blepharoplasty. In these cases, the inferior crus of the lateral canthal tendon was attached to a periosteal flap created through the lateral portion of the blepharoplasty incision. The mean age of patients undergoing ectropion repair was 74.3+/-9.3 years (range, 42-93 years). The average duration of symptoms (most commonly tearing and/or ocular irritation) was 20+/-14 months (range, 3-84 months). Recurrences of lower eyelid ectropion or symptoms occurred in 4 (2%) eyelids. The average follow-up interval was 54+/-65 days (range, 3-330 days). The canthus-sparing approach to ectropion repair promotes a secure adhesion to the lateral orbital wall with minimal violation of normal anatomic structures and relations. It is time-efficient and reduces postoperative morbidity.
    Ophthalmic Plastic and Reconstructive Surgery 06/2001; 17(3):161-8. · 0.67 Impact Factor
  • Archives of Ophthalmology 03/2001; 119(2):301-3. · 3.83 Impact Factor
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    ABSTRACT: Granular cell tumors are rare tumors of the periorbital region, and we present the second such case in the lacrimal sac. The natural history and clinical behavior of these tumors is reviewed. Case report. The clinical presentation, workup, surgical approach, and pathology of a case of granular cell tumor of the lacrimal sac are presented. There has been no recurrence of the lacrimal sac tumor with incomplete resection. This case history further adds to the understanding of the biologic behavior of granular cell tumors in the periorbital region.
    Ophthalmology 12/2000; 107(11):1992-4. · 5.56 Impact Factor
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    ABSTRACT: To investigate the anatomic and histologic changes present in midfacial ptosis. Experimental study applying gross anatomic and histologic techniques to formalin-preserved and fresh-frozen cadaver heads with and without midfacial ptosis. High-resolution surface coil magnetic resonance imaging (MRI) was performed to obtain radiologic correlations. The orbitomalar ligament was further characterized by identification of a well-developed lateral component in the sub-superficial musculoaponeurotic plane; abnormalities of this important supporting structure were present in the subcutaneous plane in 8 of 10 specimens with midfacial ptosis. The zygomatic and masseteric cutaneous ligaments also were further characterized on a gross anatomic level, and histologic evidence of these two structures was produced. The subcutaneous components of the zygomatic and masseteric cutaneous ligaments were attenuated or not identifiable in 40% and 30% of specimens with midfacial ptosis, respectively. High-resolution surface coil MRI provided exquisite correlations of midfacial anatomy. The lateral component of the orbitomalar ligament provides major osteocutaneous midfacial support. Subcutaneous attenuation of the orbitomalar, masseteric cutaneous, and zygomatic ligaments was associated with midfacial ptosis.
    Ophthalmic Plastic and Reconstructive Surgery 02/2000; 16(1):7-22. · 0.67 Impact Factor
  • Source
    S Jeong, B N Lemke, R K Dortzbach
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    ABSTRACT: Postoperative upper lid asymmetry is a common problem following ptosis surgery. Recently we performed multiple ptosis operative procedures to correct lid asymmetry in the management of a patient with bilateral acquired upper eyelid ptosis. The patient's eyelids were corrected successfully after five procedures. We retrospectively reviewed the treatment of this patient with unsatisfactory results. The medical literature was reviewed for further insight into the common problem of reoperation after ptosis surgery.
    Korean Journal of Ophthalmology 01/2000; 13(2):125-7.
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    ABSTRACT: Objective Granular cell tumors are rare tumors of the periorbital region, and we present the second such case in the lacrimal sac. The natural history and clinical behavior of these tumors is reviewed.
    Ophthalmology 01/2000; 107(11):1992-1994. · 5.56 Impact Factor

Publication Stats

617 Citations
99.79 Total Impact Points

Institutions

  • 1987–2005
    • University of Wisconsin, Madison
      • Department of Ophthalmology and Visual Sciences
      Madison, MS, United States
  • 2000
    • Chonnam National University Hospital
      Sŏul, Seoul, South Korea
  • 1997
    • University of California, San Diego
      • Department of Ophthalmology
      San Diego, CA, United States
  • 1991–1997
    • L V Prasad Eye Institute
      • Ophthalmic Plastic Surgery, Orbit & Ocular Oncology
      Bhaganagar, Andhra Pradesh, India
  • 1993
    • Albany Medical College
      • Department of Ophthalmology
      Albany, NY, United States