By Jack Rootman, Bruce Stewart, Robert Alan Goldberg
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Extra resources for Orbital Surgery: A Conceptual Approach, 1st Edition
It had a low-density center and was suspicious for histiocytosis X (eosinophilic granuloma). A needle biopsy proved the diagnosis; so the patient underwent exploration with evacuation of the lesion using the CUSA followed by irrigation with corticosteroids and systemic steroid therapy, which led to resolution of the mass. 45 46 Chapter 4 Osteosynthesis Current-generation osteosynthesis systems utilize plates and screws made of titanium or biocompatible alloys. These plates can be molded into position to join bony segments disarticulated by trauma or by surgical osteotomies.
In the vasculitides, there is often a change in adjacent tissues with telangiectasia, effusion, and thickening. Necrosing Lesions ~ k s i o n sthat are characterized by necrosis can be divided into multifocal necrosis and large, more diffuse necrotic lesions. As mentioned, the diffusely necrotic lesions such as Mucor or Wegener's granulomatosis may be associated with a cheesy, almost crumbling pale to bright yellow surface. Micronecrotic lesions, on the other hand, for example, any vasculitis in which there has not been a large confluent area of necrosis, tend to have focal fine yellow spotty change associated with them, as if they are sprayed with yellow paint.
Exposure, hemostasis, and visualization are critically important, as outlined earlier. The biopsy must be a representative portion of the lesion, and this requires knowledge of both the anatomic localization and the suspected pathology of the tumor. The biopsy specimen must be gently handled to avoid crush artifact. It should be harvested with the minimal possible disruption to normal structures. Finally, the biopsy specimen must be processed rapidly to avoid drying artifact and placed in the proper fixative (or wrapped in saline gauze as a fresh specimen) to enable accurate histologic preparation.