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15. Frontalis suspension with silicone rod • Sang-Rog Oh and Bobby S. Korn 104
16. Repair of conjunctival prolapse • Bobby S. Korn 111
17. Upper eyelid retraction repair • Bobby S. Korn 115
18. Levator extirpation and frontalis suspension • Tammy H. Osaki, Midori H. Osaki and Bobby S. Korn 120
19. Upper eyelid loading with platinum weight • Bobby S. Korn and Don O. Kikkawa 132
20. Direct browplasty • Bobby S. Korn and Don O. Kikkawa 138
21. Internal browplasty • Bobby S. Korn, Weerawan Chokthaweesak and Don O. Kikkawa 143
22. Endoscopic browplasty • Don O. Kikkawa and Bobby S. Korn 147
23. Pretrichial browplasty • Bobby S. Korn and Don O. Kikkawa 156
24. Facelift by minimal access cranial suspension (MACS) • Bradford W. Lee and Bobby S. Korn 163
25. Ectropion repair by retractor reinsertion and lateral tarsal strip • Bobby S. Korn and Don O. Kikkawa 176
26. Ectropion repair by medial spindle • Bobby S. Korn and Don O. Kikkawa 182
27. Ectropion repair with full thickness skin grafting • Bobby S. Korn 185
28. Canthus sparing drill hole canthoplasty • Bobby S. Korn and Don O. Kikkawa 194
29. Entropion repair by transconjunctival approach • Bobby S. Korn and Don O. Kikkawa 205
30. Entropion repair by Wies procedure • Don O. Kikkawa and Bobby S. Korn 210
31. Entropion repair by posterior tarsotomy • Karim G. Punja, Bobby S. Korn and Don O. Kikkawa 215
32. Epiblepharon repair • Audrey C. Ko and Bobby S. Korn 220
33. Limited upper eyelid protractor myectomy • Bobby S. Korn and Don O. Kikkawa 227
34. Lower eyelid retraction repair with porcine acellular dermal collagen matrix • Bobby S. Korn and
Don O. Kikkawa 234
35. Lower eyelid retraction repair with dermis fat • Bobby S. Korn and Don O. Kikkawa 247
36. Lower eyelid retraction repair with hard palate grafting • Bobby S. Korn and Don O. Kikkawa 257
37. Lower eyelid wedge resection and reconstruction • Patrick Yang and Bobby S. Korn 265
38. Lower eyelid reconstruction with periosteal flap and upper eyelid rotational flap • Don O. Kikkawa and
Bobby Korn 273
39. Lower eyelid reconstruction with semicircular flap • Don O. Kikkawa and Bobby S. Korn 283
40. Lower eyelid reconstruction with Hughes’ tarsoconjunctival flap • Lee Hooi Lim and Bobby S. Korn 292
41. Lower eyelid reconstruction with Mustardé flap • Richard L. Scawn and Bobby S. Korn 300
42. Lateral canthal reconstruction with rhomboid flap • Bobby S. Korn 307
43. Upper eyelid reconstruction with Cutler-Beard flap and free tarsal graft • Bobby S. Korn and Don O. Kikkawa 315
44. Temporal artery biopsy • Don O. Kikkawa and Bobby S. Korn 333
45. Conjunctival pillar tarsorrhaphy • Bobby S. Korn 340
46. Lateral tarsorrhaphy • Bobby S. Korn and Honglei Liu 347
47. Autologous fat transfer to the tear trough • Morris Hartstein and Bobby S. Korn 352
48. Hyaluronic acid gel filler to the inferior periorbita • Guy G. Massry 359
49. Botulinum toxin treatment for lateral canthal rhytids (crow’s feet) • Michael S. McCracken and Eric M. Hink 364

Contents

vi
50. Botulinum toxin treatment for glabellar rhytids • Michael S. McCracken and Eric M. Hink 369
51. Botulinum toxin treatment for forehead rhytids • Michael S. McCracken and Eric M. Hink 373
52. Thermal conjunctivoplasty • Bobby S. Korn 377

SECTION III Lacrimal system

53. Endoscopic dacryocystorhinostomy • Bobby S. Korn and Don O. Kikkawa 383
54. Endoscopic dacryocystorhinostomy with osteotome • Bobby S. Korn 392
55. Endoscopic dacryocystorhinostomy with lacrimal sac biopsy • Bobby S. Korn and Masashi Mimura 399
56. Endoscopic revision of failed dacryocystorhinostomy • Don O. Kikkawa and Bobby S. Korn 403
57. Endoscopic dacryocystorhinostomy with intranasal flap suturing • Nattawut Wanumkarng 410
58. Endoscopic dacryocystorhinostomy with balloon dacryoplasty • Don O. Kikkawa, Suk-Woo Yang and Bobby S. Korn 417
59. Endoscopic conjunctivodacryocystorhinostomy • Don O. Kikkawa, Kanjana Leelapatranurak and Bobby S. Korn 421
60. Bicanalicular intubation with silicone stent • Bobby S. Korn 428
61. Treatment of canaliculitis • Ramzi M. Alameddine and Bobby S. Korn 433
62. Silicone stent intubation with pigtail probe • Bobby S. Korn 437
63. Snip punctoplasty • Don O. Kikkawa and Bobby S. Korn 441

SECTION IV Orbit
64. Three wall orbital decompression • Bobby S. Korn and Don O. Kikkawa 444
65. Lateral orbitotomy with rim removal • Bobby S. Korn and Don O. Kikkawa 455
66. Inferior orbitotomy for cavernous hemangioma • Bobby S. Korn 460
67. Orbital fracture repair • Don O. Kikkawa and Bobby S. Korn 468
68. Orbital floor reconstruction in silent sinus syndrome • Bobby S. Korn 476
69. Transcaruncular approach to ethmoidal artery ligation • Don O. Kikkawa and Bobby S. Korn 487
70. Reposition of prolapsed lacrimal gland • Bobby S. Korn and Don O. Kikkawa 493
71. Optic nerve sheath fenestration • Bobby S. Korn and Don O. Kikkawa 499
72. Evisceration with orbital implant placement • Bradford W. Lee, Don O. Kikkawa and Bobby S. Korn 506
73. Enucleation and orbital implant placement • Jeremiah Tao and Bobby S. Korn 518
74. Orbital exenteration • Bobby S. Korn and Don O. Kikkawa 529
75. Orbital implant exchange with dermis fat graft • Bobby S. Korn 538
76. Multidisciplinary management of orbital varix • Jack Rootman 546

Index 551

Contents

vii
This page intentionally left blank
 Video table of contents

Eyelid and face

Chalazion incision and drainage • Chapter 2, Video 1 – Bobby S. Korn
Upper blepharoplasty • Chapter 3, Video 2 – Bobby S. Korn
Asian upper blepharoplasty • Chapter 4, Video 3 – Bobby S. Korn
Asian eyelid crease formation (double eyelid operation) by suture ligation method • Chapter 5, Video 4 – Yoon-Duck Kim
Revision of Asian upper eyelid crease • Chapter 6, Video 5 – Yoon-Duck Kim
Root Z-epicanthoplasty • Chapter 7, Video 6 – Kyung In Woo
Mustardé’s epicanthoplasty • Chapter 8, Video 7 – Dongmei Li
Transconjunctival lower blepharoplasty with fat redraping • Chapter 9, Video 8 – Bobby S. Korn
Transcutaneous lower blepharoplasty with orbitomalar suspension and fat redraping • Chapter 10, Video 9 – Bobby S. Korn
Ptosis repair by external levator advancement • Chapter 11, Video 10 – Bobby S. Korn
Ptosis repair by small incision external levator advancement • Chapter 12, Video 11 – Bobby S. Korn
Ptosis repair by conjunctival Müller’s muscle resection • Chapter 13, Video 12 – Bobby S. Korn
Congenital ptosis repair by levator resection • Chapter 14, Video 13 – Bobby S. Korn
Frontalis suspension with silicone rod • Chapter 15, Video 14 – Bobby S. Korn
Repair of conjunctival prolapse • Chapter 16, Video 15 – Bobby S. Korn
Upper eyelid retraction repair • Chapter 17, Video 16 – Bobby S. Korn
Levator extirpation and frontalis suspension • Chapter 18, Video 17 – Bobby S. Korn
Upper eyelid loading with platinum weight • Chapter 19, Video 18 – Bobby S. Korn
Direct browplasty • Chapter 20, Video 19 – Bobby S. Korn
Internal browplasty • Chapter 21, Video 20 – Bobby S. Korn
Endoscopic browplasty • Chapter 22, Video 21 – Bobby S. Korn and Don. O. Kikkawa
Pretrichial browplasty • Chapter 23, Video 22 – Bobby S. Korn
Facelift by minimal access cranial suspension (MACS) • Chapter 24, Video 23 – Bobby S. Korn
Ectropion repair by retractor reinsertion and lateral tarsal strip • Chapter 25, Video 24 – Bobby S. Korn
Ectropion repair by medial spindle • Chapter 26, Video 25 – Bobby S. Korn
Ectropion repair with full thickness skin grafting • Chapter 27, Video 26 – Bobby S. Korn

ix
Canthus sparing drill hole canthoplasty • Chapter 28, Video 27 – Bobby S. Korn
Entropion repair by transconjunctival approach • Chapter 29, Video 28 – Bobby S. Korn
Entropion repair by Wies procedure • Chapter 30, Video 29 – Don O. Kikkawa
Entropion repair by posterior tarsotomy • Chapter 31, Video 30 – Bobby S. Korn
Epiblepharon repair • Chapter 32, Video 31 – Bobby S. Korn
Limited upper eyelid protractor myectomy • Chapter 33, Video 32 – Bobby S. Korn
Lower eyelid retraction repair with porcine acellular dermal collagen matrix • Chapter 34, Video 33 – Bobby S. Korn
Lower eyelid retraction repair with dermis fat • Chapter 35, Video 34 – Bobby S. Korn
Lower eyelid retraction repair with hard palate grafting • Chapter 36, Video 35 – Bobby S. Korn
Lower eyelid wedge resection and reconstruction • Chapter 37, Video 36 – Bobby S. Korn
Lower eyelid reconstruction with periosteal flap and upper eyelid rotational flap • Chapter 38, Video 37 – Bobby S. Korn
Lower eyelid reconstruction with semicircular flap • Chapter 39, Video 38 – Don O. Kikkawa
Lower eyelid reconstruction with Hughes’ tarsoconjunctival flap • Chapter 40, Video 39 – Bobby S. Korn
Lower eyelid reconstruction with Mustardé flap • Chapter 41, Video 40 – Bobby S. Korn
Lateral canthal reconstruction with rhomboid flap • Chapter 42, Video 41 – Bobby S. Korn
Upper eyelid reconstruction with Cutler-Beard flap and free tarsal graft • Chapter 43, Video 42 – Bobby S. Korn
Temporal artery biopsy • Chapter 44, Video 43 – Bobby S. Korn
Conjunctival pillar tarsorrhaphy • Chapter 45, Video 44 – Bobby S. Korn
Lateral tarsorrhaphy • Chapter 46, Video 45 – Bobby S. Korn
Autologous fat transfer to the tear trough • Chapter 47, Video 46 – Morris Hartstein
Hyaluronic acid gel filler to the inferior periorbita • Chapter 48, Video 47 – Guy G. Massry
Botulinum toxin treatment for lateral canthal rhytids (crow’s feet) • Chapter 49, Video 48 – Michael S. McCracken and Eric M. Hink
Botulinum toxin treatment for glabellar rhytids • Chapter 50, Video 49 – Michael S. McCracken and Eric M. Hink
Botulinum toxin treatment for forehead rhytids • Chapter 51, Video 50 – Michael S. McCracken and Eric M. Hink
Thermal conjunctivoplasty • Chapter 52, Video 51 – Bobby S. Korn

Lacrimal system
Endoscopic dacryocystorhinostomy • Chapter 53, Video 52 – Bobby S. Korn
Endoscopic dacryocystorhinostomy with osteotome • Chapter 54, Video 53 – Bobby S. Korn
Endoscopic dacryocystorhinostomy with lacrimal sac biopsy • Chapter 55, Video 54 – Bobby S. Korn
Endoscopic revision of failed dacryocystorhinostomy • Chapter 56, Video 55 – Don. O Kikkawa
Endoscopic dacryocystorhinostomy with intranasal flap suturing • Chapter 57, Video 56 – Nattawut Wanumkarng
Endoscopic dacryocystorhinostomy with balloon dacryoplasty • Chapter 58, Video 57 – Don O. Kikkawa
Endoscopic conjunctivodacryocystorhinostomy • Chapter 59, Video 58 – Don O. Kikkawa
Bicanalicular intubation with silicone stent • Chapter 60, Video 59 – Bobby S. Korn
Treatment of canaliculitis • Chapter 61, Video 60 – Bobby S. Korn

Video table of contents

x
Silicone stent intubation with pigtail probe • Chapter 62, Video 61 – Bobby S. Korn
Snip punctoplasty • Chapter 63, Video 62 – Don. O. Kikkawa

Orbit
Three wall orbital decompression • Chapter 64, Video 63 – Bobby S. Korn
Lateral orbitotomy with rim removal • Chapter 65, Video 64 – Bobby S. Korn and Don O. Kikkawa
Inferior orbitotomy for cavernous hemangioma • Chapter 66, Video 65 – Bobby S. Korn
Orbital fracture repair • Chapter 67, Video 66 – Don O. Kikkawa
Orbital floor reconstruction in silent sinus syndrome • Chapter 68, Video 67 – Bobby S. Korn
Transcaruncular approach to ethmoidal artery ligation • Chapter 69, Video 68 – Bobby S. Korn
Reposition of prolapsed lacrimal gland • Chapter 70, Video 69 – Don O. Kikkawa
Optic nerve sheath fenestration • Chapter 71, Video 70 – Bobby S. Korn
Evisceration with orbital implant placement • Chapter 72, Video 71 – Don O. Kikkawa
Enucleation and orbital implant placement • Chapter 73, Video 72 – Bobby S. Korn
Orbital exenteration • Chapter 74, Video 73 – Bobby S. Korn
Orbital implant exchange with dermis fat graft • Chapter 75, Video 74 – Bobby S. Korn
Multidisciplinary management of orbital varix • Chapter 76, Video 75 – Jack Rootman

Video table of contents

xi
Foreword to the second edition
This is a first for me. I have had the honor of writing the fore- wish to share with our residents and fellows, most of them have
word for several books but never for a video atlas. As I reviewed difficulty remembering more than a few “pearls” from each case
the first edition of this work and the revisions that will be incor- – it’s simply a matter of information overload during what can
porated into the second edition, I found myself wishing that be a stressful experience. The opportunity to review the work
such a resource had been available in the 1980s when I first of masterful surgeons such as Drs. Korn and Kikkawa and their
began teaching residents and fellows. Intraoperative photo- collaborators – and to do so at leisure, without the challenges
graphs are helpful but static and inherently limiting. As I watch of communicating, often cryptically with hand signals, while the
the videos, however, I am impressed by how much more effec- patient is awake and listening acutely to every word – is a major
tive they are in demonstrating the myriad points that we wish advance.
to make when assisting trainees as they operate. A few exam- This new edition has increased its scope from 43 procedures
ples that our residents have heard me mumble more than once: to more than six dozen, including new information on eyelid
surgery in Asian patients, additional options for the reconstruc-
• Inject the anesthetic sloooooowly to minimize discomfort. tion of periocular and facial defects following tumor excision,
• Keep the skin on stretch during the incision but don’t place multiple perspectives on endoscopic dacryocystorhinostomy,
pressure on the eye. and chapters on aesthetic topics such as fat grafting, injection
• Keep the scalpel parallel to the skin…but bevel it here. of fillers, and face lifts. In addition to the step-by-step instruc-
• Incise the skin uphill, or stay ahead of the blood if going tions offered for each procedure, I like the accompanying tables
downhill. that summarize potential complications and ways to reduce the
• Don’t punish the skin; grasp the edge gently yet firmly, and risk of such, as well as the helpful listing of “consumables”
only once. needed for the operation.
• The scissors are curved for a reason; use that to your I predict that this atlas will be even more successful than its
advantage. original iteration – to the benefit of new residents, fellows on
• Cut purposefully; don’t nibble or gnaw. the steep slope of the learning curve, experienced surgeons
• Sew as closely as possible to the wound edge and space who wish to hone their skills, and, most importantly, to the
your sutures closely to avoid a ropey closure. patients we serve.
• Evert the wound edges; approximate, don’t strangulate.
• Don’t let the tissue slip off the needle. George B. Bartley, M.D.
• Don’t let the patients’ eyelids open while you’re closing the The Louis and Evelyn Krueger Professor
skin; she is having a nice nap and won’t appreciate being of Ophthalmology, Mayo Clinic
disturbed. Chair Emeritus, Department of Ophthalmology, Mayo Clinic
Chief Executive Officer Emeritus, Mayo Clinic in Florida
Although as teachers we usually want to critique each of the
dozens (? hundreds ?) of subtle but important steps that we

xii
 Foreword to the first edition
This oculofacial video atlas is a true gem. It is the next best every detail, and their unusual ability to transmit their extensive
thing to being there in the operating room with the authors. knowledge to others. Dr. Korn was an outstanding fellow under
Drs. Korn and Kikkawa are dedicated teachers who take a “belt Dr. Kikkawa, and I had the distinct privilege of having Dr.
and suspenders ” approach to teaching in this text. First, they Kikkawa as an exceptional fellow. We have given lectures and
provide exquisite, carefully edited, high-definition videos of all courses together and have collaborated on publications, so I
the surgical procedures. Then, to further clarify each proce- know well their intellectual integrity, bright minds, surgical skill,
dure, they have all of the important steps described with high- and impeccable academic credentials.
definition still frame photographs taken from the videos and This video atlas combines all of the elements of a true learn-
placed in a standard text. Important anatomic structures are ing experience for anyone performing oculofacial plastic and
emphasized with color shading overlays in many of the photo- reconstructive surgery.
graphs. Details about the fine points of each procedure are
described in the captions as well. Richard K. Dortzbach MD, FACS
This video atlas should be helpful to the beginning surgeon Professor Emeritus
as well as the more experienced surgeon. The procedures Former Peter A. Duehr Chair
covered range all the way from surgical management of a Department of Ophthalmology & Visual Sciences
chalazion to endoscopic dacryocystorhinostomy and compli- University of Wisconsin School of Medicine and Public
cated orbital operations. Both functional and cosmetic proto- Health
cols are carefully and elegantly delineated. Madison, WI
I have known Drs. Korn and Kikkawa very well for many years
and can attest to their vast surgical experience, attention to

xiii
Preface
Five years ago we embarked on a mission to bring the realm In addition, revised chapters from the first version with re-edited
of oculofacial plastic surgery directly from the operating room videos are also included.
to the practicing surgeon. We are now pleased to release the The field of oculofacial plastic surgery is still in its infancy.
Second Edition of the Video Atlas of Oculofacial Plastic and Many time-honored procedures from the past are no longer
Reconstructive Surgery. This video atlas is the product of hun- being performed today, being replaced by techniques that
dreds of hours of oculofacial surgery captured in high definition, allow for improved results and faster healing. Since inception,
edited and narrated with anatomic overlays and step-by-step oculofacial plastic surgery has been a discipline passed from
diagrams. mentor to student and from colleague to colleague. We have
We have made it our goal to include only the highest quality endeavored to maintain this close personal instructional method
videos to guide the surgeon through even the most complex in this atlas and hope that the readers enjoy this format.
of operations. Highlights of the second edition include new
chapters on fat grafting, face-lifting, orbital fracture repair and Bobby S. Korn
expanded section on Asian eyelid surgery and epicanthoplasty. Don O. Kikkawa

xiv
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 List of contributors
Ramzi M. Alameddine, MD Don O. Kikkawa, MD FACS
Senior Clinical Instructor Professor of Ophthalmology and Plastic Surgery
Department of Ophthalmology Vice Chair, Department of Ophthalmology
University of California, San Diego School of Medicine University of California, San Diego School of Medicine
Shiley Eye Institute Shiley Eye Institute
La Jolla, CA La Jolla, CA
USA USA
Christine C. Annunziata, MD Yoon-Duck Kim, MD
Attending Oculofacial Plastic Surgeon Professor of Ophthalmology
Metrolina Eye Associates Samsung Medical Center
Matthews, NC Sungkyunkwan University School of Medicine
USA Seoul
Korea
Weerawan Chokthaweesak, MD
Assistant Professor of Ophthalmology Audrey C. Ko, MD
Mahidol University Senior Clinical Instructor
Ramathibodi Hospital Department of Ophthalmology
Bangkok University of California, San Diego School of Medicine
Thailand Shiley Eye Institute
La Jolla, CA
Morris E. Hartstein, MD, FACS
USA
Director, Oculoplastic Surgery
Assaf Harofeh Medical Center Bobby S. Korn, MD PhD FACS
Department of Ophthalmology Associate Professor of Ophthalmology and Plastic Surgery
Zerifin, Israel University of California, San Diego School of Medicine
Clinical Associate Professor Shiley Eye Institute
Saint Louis University La Jolla, CA
Department of Ophthalmology USA
St. Louis, MO
Bradford W. Lee, MD, MSc
USA
Assistant Professor of Ophthalmology
Eric M. Hink, MD Bascom Palmer Eye Institute
Assistant Professor of Ophthalmology University of Miami, Miller School of Medicine
University of Colorado Miami, FL
Denver, CO USA
USA

xv
Kanjana Leelapatranurak, MD Sang-Rog Oh, MD
Attending Ophthalmologist Attending Ophthalmologist, Division of Oculofacial and
Department of Ophthalmology Reconstructive Surgery
Bumrungrad International Hospital Department of Ophthalmology
Bangkok The Permanente Medical Group
Thailand Sacramento, CA
USA
Dongmei Li, MD
Professor of Ophthalmology Midori H. Osaki, MD, MBA
Beijing TongRen Eye Center Chief, Division of Ophthalmic Plastic and Reconstructive Surgery
Capital Medical University Department of Ophthalmology and Visual Sciences
Beijing Paulista School of Medicine/Federal University of Sao Paulo
China Sao Paulo
Brazil
Lee Hooi Lim, MBBS
Senior Consultant and Director Tammy H. Osaki, MD PhD
Eye Etc. Partners Pte. Ltd. Attending Ophthalmologist, Division of Ophthalmic Plastic and
Reconstructive Surgery
Singapore
Department of Ophthalmology and Visual Sciences
Honglei Liu, MD, PhD Paulista School of Medicine/Federal University of Sao Paulo
Associate Professor of Clinical Ophthalmology Sao Paulo
Vice Chair, Department of Ophthalmology Brazil
No. 4 Hospital
Ayelet Priel, MD
Xi’an City
Goldschleger Eye Institute
China
Sheba Medical Center
Guy G. Massry, MD Ramat-Gan
Clinical Professor of Ophthalmology Israel
University of Southern California, Keck School of Medicine
Karim G. Punja, MD, FRCSC
Los Angeles, CA
Clinical Associate Professor
USA
Department of Surgery, Division of Ophthalmology
Michael S. McCracken, MD University of Calgary
Medical Director, McCracken Eye and Face Institute Calgary, Alberta
Assistant Clinical Professor Canada
University of Colorado Health Science Center
Jack Rootman FRCS
Denver, CO
Professor (Emeritus)
USA
Department of Ophthalmology and Visual Science
Masashi Mimura, MD Department of Pathology and Laboratory Science
Chief, Clinic of Lacrimal Drainage Surgery and Ophthalmic University of British Columbia
Plastic and Reconstructive Surgery
Vancouver, British Columbia
Department of Ophthalmology
Canada
Osaka Medical College
Osaka
Japan

List of contributors

xvi
Mr Richard L. Scawn, MBBS, FRCOphth Patrick T. Yang, MD
Locum Consultant University of Toronto
Adnexal Service Department of Ophthalmology and Vision Sciences
Moorfields Eye Hospital Toronto
London Canada
UK
Suk-Woo Yang, MD
Jeremiah Tao, MD, FACS Professor of Ophthalmology
Associate Professor Department of Ophthalmology and Visual Sciences
Chief, Oculofacial Plastic Surgery Division of Ophthalmic Plastic and Reconstructive Surgery
Department of Ophthalmology Seoul St. Mary’s Hospital
Gavin Herbert Eye Institute The Catholic University of Korea
University of California Seoul
Irvine, CA Korea
USA
Nattawut Wanumkarng, MD
Attending Ophthalmologist
Department of Ophthalmology
Bumrungrad International Hospital
Bangkok
Thailand
Kyung In Woo, MD
Professor of Ophthalmology
Samsung Medical Center
Sungkyunkwan University School of Medicine
Seoul
Korea

List of contributors

xvii
Acknowledgements
We are indebted to the editorial staff at Elsevier for their the highest form of art possible. Second, we thank our distin-
support of this project. In particular, we are grateful to Russell guished colleagues for their valued contributions to this book
Gabbedy (Executive Content Strategist) who has been a tire- and for their friendship. Third, we thank all of our fellows and
less supporter of this project since he commissioned the first residents for continually challenging us to find the best surgical
edition of the Atlas. We would also like to acknowledge Nani approaches in the care of our patients. Many of our fellows
Clansey (Senior Content Development Strategist) for doing have contributed to this book making it even more meaningful
her best to manage this complex project, Andrew Riley (Project to us. Fourth, we thank the members of our academic office,
Manager), Jonathan Davis (Multimedia), Alex Baker (Medical Annaleah Ariola and Denise Adame for their administrative
Illustrations). support.
This book would not be possible without the support of col- Finally, we acknowledge our families for without their unwa-
leagues and friends. First, we thank our teachers for instilling vering love, patience and support this book would not be
in us the desire to continue to learn and the passion to practice possible.

Dedication
For our parents, Tom and Tuanjai (BSK) and Robert and Alice
(DOK)

For Wanya, Justin and Bryan (BSK) and Cheryl, Jason, Claire
and Alina (DOK)

xviii
 SECTION ONE INTRODUCTION

CHAPTER 1
Foundations of oculofacial plastic surgery
Bradford W. Lee • Ramzi M. Alameddine • Don O. Kikkawa • Bobby S. Korn

(Figure 1.1) and globe position by exophthalmometry (Figure

INTRODUCTION 1.2) should be carefully documented for any orbital procedure.
Oculofacial surgery is a unique specialty that combines The Naugle exophthalmometer is useful for measuring propto-
aspects of ophthalmology, general plastic surgery, head and sis or enophthalmos when prior surgery has been performed
neck surgery, dermatology, neurological surgery, and craniofa- to remove the lateral orbital rim. Vertical and horizontal globe
cial surgery. With advances in endoscopic and small incision displacement should be noted as well. Evaluation of lacrimal
techniques, many oculofacial procedures can now be per- diseases requires functional and anatomic testing. Both dye
formed safely and effectively with minimal scarring and excel- disappearance testing and lacrimal probing and irrigation are
lent aesthetic results. useful.
Ancillary testing for oculofacial surgery may include visual
EVALUATION field testing for functional eyelid conditions, dacryoscintigraphy
Oculofacial surgery encompasses both functional and aes- for lacrimal obstructions, and imaging studies for orbital dis-
thetic goals. As such, the evaluation of the oculofacial patient eases. Computed tomography (CT) is useful for evaluation of
requires a complete history and physical examination with par- bony structures and general screening for orbital disease. Mag-
ticular attention to medical, functional, aesthetic, and psycho- netic resonance imaging (MRI) is better suited for soft-tissue
social details. lesions and optic nerve diseases. Angiography is indispensable
A complete medical history should be elicited, with particular for evaluating vascular malformations.
attention to hypertension, diabetes, liver disease, immune Photography is an essential component of the oculofacial
status, current or prior cancer, and trauma. Surgical history examination. Ideally, photographs should be taken during all
should include any previous facial surgery, ophthalmic surgery aspects of patient care from the preoperative evaluation, intra-
(such as refractive surgery), use of neurotoxins and dermal operatively when indicated, and at postoperative visits. Many
fillers, and chemical- or energy-based skin treatments. Medica- third-party insurance carriers require photographic documenta-
tions, including anticoagulants, tobacco, and alcohol, should tion prior to authorization of functional oculofacial surgeries.
be documented. A history of implanted cardiac devices should Additionally, photographs are important for the aesthetic patient
also be noted since this determines which types of cautery can to document changes after treatment and for medical legal
be safely used. The use of medications, tobacco and alcohol protection. Photographs should be taken in the frontal, side,
should be documented. and three-quarter views. For orbital diseases, eye movements
The physical examination should focus on the areas of patient in the nine positions of gaze are taken. Additionally, a worm’s
concern and the proposed surgical procedure. The entire face eye view (Figure 1.3) is used to document globe position and
should be examined and the patient can be allowed to point closure of the lids to document the presence or absence of
to areas of concern using a handheld mirror. For most eyelid, lagophthalmos (Figure 1.4).
facial, and orbital procedures, documentation of visual acuity, Modern digital single lens reflex (DSLR) cameras are ideal in
pupillary function, color vision, slit-lamp examination, intraocu- the oculofacial setting. These DSLRs allow for rapid sequence
lar pressure, eyelid position and closure, and tear film are photography with excellent resolution and dynamic range com-
minimum requirements. Dilated fundoscopic examination may pared to pocket-sized cameras with smaller imaging sensors.
be required in select cases if there is any evidence of optic Uniform lighting can be difficult and variable depending on
nerve compromise. Ocular motility in nine positions of gaze the clinical situation. In general, flash photography is used to

1
Figure 1.1 Standard version photographs showing the eyes in nine positions of gaze.

Figure 1.2 Globe position as measured using a Naugle Figure 1.3 Worm’s eye view in a patient with thyroid-related orbitopathy.
exophthalmometer.

Figure 1.4 Worm’s eye view of a patient gently closing her eyelids with
lagophthalmos on the right side.

SECTION ONE • INTRODUCTION

Chapter 1 Foundations of oculofacial plastic surgery
2
normalize lighting. A dedicated photo room with a blue back- pain perception according to the gate control theory. Dilution
drop and diffuse lighting is ideal, but for most surgeons, a of lidocaine/bupivacaine with sodium bicarbonate (in a 1 : 10
DSLR using the pop-up or external flash will suffice. The use ratio) raises the pH to minimize injection site burning. Pre-
of a 50 mm macro lens is ideally suited for full-time use. Using cooling the target area with ice packs is another adjunct, as is
the macro function, this lens allows close-up photography of use of topical lidocaine cream for the skin or 4% lidocaine on
small lesions on the face. Furthermore, with its fixed focal cotton tip applicators for mucous membranes. Finally, slow
length, facial photographs will appear square and consistent, injection, handholding and talking “talkesthesia” are all useful
avoiding the barrel distortion seen when the camera is too in fully conscious patients. Minimizing pain during injection will
close to the subject. Finally, to achieve uniform focus across go a long way towards maintaining the confidence of your
the entire photograph, a small aperture (at least greater than patients and ensuring subsequent cooperation during the
f/10) should be set to allow for a deep depth of field. procedure.

ANESTHESIA Regional block

The choice of anesthesia depends on patient age, medical Regional blocks can be useful in oculofacial procedures but are
condition, as well as physician and patient preference. Patient rarely used as a standalone means of anesthesia due to redun-
safety and comfort are an absolute priority, and intraoperative dant innervation in the facial region (Figure 1.5). It allows the
patient cooperation may be needed during certain oculofacial surgeon to minimize the volume of local infiltration needed,
procedures. A combination of various anesthetic modalities is anesthetize broad regions of the face, and minimize tissue
frequently utilized to provide an optimal surgical experience. distortion from local infiltration. Regional blocks of the face
must address one or more branches of the ophthalmic, maxil-
Topical anesthesia lary, and mandibular divisions of the trigeminal nerve.
Topical anesthetic drops such as proparacaine or tetracaine Lacrimal nerve
are useful for conjunctival procedures and also to prevent The lacrimal nerve branches off the ophthalmic division of the
ocular discomfort from prep solutions (e.g., Betadine solution). trigeminal nerve and supplies the lateral upper eyelid and lac-
Topical anesthetic gels, such as lidocaine gel, with concentra- rimal gland. It can be blocked by injecting the needle along the
tions ranging from 1% to 4%, can be used in more involved superolateral orbital rim behind the lacrimal gland. Potential
procedures because of their longer-lasting effect. Also, topical risks include injury or injection into the lacrimal artery. This block
anesthetic creams can be applied to the skin before injection is useful when performing lacrimal gland biopsies or resuspen-
procedures or minor cutaneous biopsies. sion procedures (Chapter 70).
Local infiltration
Frontal nerve
In most oculofacial procedures, local infiltration of involved The frontal nerve is a branch of the ophthalmic division of the
tissues is the preferred method of anesthesia. It entails minimal trigeminal nerve. It further divides into the supraorbital and
risks while allowing adequate patient comfort and cooperation. supratrochlear nerves and supplies the medial and central
Local anesthetic agents include short-acting lidocaine and pro- upper eyelids and the forehead. It can be fully blocked by inject-
caine, or long-acting bupivacaine. A mixture of short-acting and ing anesthetic deep in the orbit along the central orbital roof.
long-acting anesthetic agents is often used to have a rapid Alternatively, the supraorbital nerve can be selectively blocked
onset and long duration of action. The mixture of equal parts by injecting near its exit from the orbit, at the supraorbital notch
of 2% lidocaine with epinephrine at 1 : 100,000 and 0.75% or foramen, around the medial third of the superior orbital rim.
bupivacaine is an effective combination. The vasoconstrictive A supraorbital block anesthetizes the central eyelid, eyebrow,
effect of epinephrine improves hemostasis, reduces vascular and forehead. Similarly, the supratrochlear nerve can be
absorption, and increases duration of action of the anesthetic. blocked by injecting anesthetic near the trochlea at the junction
Other potential additions include hyaluronidase, which facili- of the medial and superior orbital rim. A supratrochlear block
tates anesthetic dispersion through tissues, and bicarbonate, anesthetizes the medial eyelid and eyebrow. Prior to injecting,
which buffers the pH, reducing the stinging sensation during the surgeon should withdraw the plunger on the syringe to
infiltration. The surgeon should be vigilant for possible cardiac ensure that inadvertent intravascular injection into the supraor-
or neurologic side effects, particularly with inadvertent intravas- bital or supratrochlear arteries does not occur. This block can
cular injections. By withdrawing the plunger and ensuring that be used for any upper eyelid procedure and is well suited for
there is no reflux of blood prior to injecting, the risk of intravas- limited upper eyelid protractor myectomy (Chapter 33).
cular injection can be further reduced. Local anesthetic should
be injected sparingly during external levator advancement and Nasociliary nerve
eyelid retraction repairs, since infiltrating the levator with anes- The nasociliary nerve is the third branch of the ophthalmic divi-
thetic can cause artificially reduced levator function. Other risks sion of the trigeminal nerve. It supplies the nasal mucosa and
include tissue necrosis, although this is unlikely due to the skin through the anterior and posterior ethmoidal nerves, as
abundant vascularity of the periorbital area. well as the medial canthus and lacrimal sac via the infratroch-
When local anesthesia is administered in a clinic setting lear nerve. An infratrochlear block is achieved by injecting
without oral or IV sedation, several maneuvers can be per- deeply under the trochlea above the level of the medial canthal
formed to minimize discomfort. Performing massage or vibra- tendon. A deeper injection at the same location would block
tory distraction at or near the site of injection may decrease the ethmoidal nerves, but possible injury to the corresponding

3
 Supraorbital
nerve

Supratrochlear
Supraorbital Supratrochlear nerve
Infratrochlear

Lacrimal Infratrochlear nerve

nerve
Zygomatic

Lacrimal
Zygomaticofacial
nerve
Infraorbital

Nasal

Supraorbital nerve

Frontal nerve

Supratrochlear
nerve

Infraorbital
nerve
Mental
nerve

Figure 1.5 Periocular sensory nerves.

ethmoidal arteries can cause orbital hemorrhage. Ethmoidal line drawn from the nasal ala to the lateral canthal angle. Alter-
nerve blocks can be performed prior to dacryocystorhinostomy natively, deeper orbital injection along the orbital floor can block
or medial-wall decompression (Chapters 53–59, 64). the nerve more proximally. This block is useful for nasolacrimal
intubation in the clinic setting (Chapter 60).
Infraorbital nerve
The infraorbital nerve branches off the maxillary division of the Zygomaticofacial nerve
trigeminal nerve and supplies the lower eyelid skin and con- The zygomaticofacial nerve is another branch of the maxillary
junctiva, in addition to the medial canthus, lacrimal sac, mid- division of the trigeminal nerve; it supplies the lateral canthus
face, and maxilla. It can be blocked where it exits the infraorbital and lateral lower eyelid. It can be blocked where it exits the
foramen around 7–10 mm inferior to the infraorbital rim. Either zygomatic bone through a foramen around 10 mm inferior to
the transconjunctival or sublabial routes can be used for admin- the lateral canthus. This block is useful for adjunctive anesthe-
istration. The foramen can be palpated where it intersects a sia during a zygomaticomaxillary complex fracture repair.

SECTION ONE • INTRODUCTION

Chapter 1 Foundations of oculofacial plastic surgery
4
Mental nerve block hyperthermia should be obtained, since these life-threatening
The mental nerve is a branch of the mandibular nerve. Blocking conditions are more commonly associated with musculoskel-
this nerve can be useful in administering fillers in the lower lip etal ocular conditions. All cases of surgery under general
and chin region. This block can be given through the lower anesthesia should employ the use of sequential compression
gingival sulcus just as the mental nerve exits its foramen. devices (SCDs) to minimize risk of deep venous thrombosis
(Figure 1.6).
Oral sedation
Oral sedation in conjunction with local anesthetic administration Tumescent anesthesia
is preferred for most in-office procedures. Oral benzodi- Tumescent anesthesia is a technique that provides effective
azepines such as diazepam are given at least 30–60 minutes pain control and hemostasis for larger regions of the face and
prior to the procedure. Clonidine can be used for both its body. It can be effectively used in liposuction/lipotransfer, face
anxiolytic and anti-hypertensive properties. Oversedation is and neck lifting, and endoscopic or pretrichial brow lifting
the most common risk, especially with benzodiazepines, in (Chapters 22–24, 47). Care should be taken to ensure the
which case flumazenil (a benzodiazepine antagonist) can be meticulous dilution and labeling of tumescent anesthetic solu-
administered. tions and to consider the total amount of anesthetic delivered
Monitored anesthesia care in order to prevent anesthetic or epinephrine toxicity.
Monitored anesthesia care combined with local or regional
block is preferred in more complex procedures. It is popular HEMOSTASIS
because of its ability to provide sedation, amnesia, and anxioly- Hemostasis in oculofacial surgery is of vital importance, since
sis. Intravenous propofol may be given as a bolus at the time an orbital hemorrhage can cause compartment syndrome and
of local anesthetic injection, followed by a steady-state infusion possible blindness. Even for non-orbital surgeries, postopera-
supplemented with opioids (fentanyl) or benzodiazepines. Pos- tive bleeds or hematomas can result in blood loss and patient
sible side effects include apnea, myocardial depression, and anxiety, compromise of flaps or grafts, inflammation, and
decreased vascular resistance. For this reason, close monitor- increased postoperative healing time. Prolonged epistaxis after
ing of vital signs, ECGs, and pulse oximetry is necessary. lacrimal surgery can result in significant postoperative morbidity
and discomfort.
General anesthesia
General anesthesia is reserved for more prolonged and stimu- Anticoagulants
lating procedures, when nasal bleeding is expected, or in chil- Prior to surgery, patients on anticoagulants should be advised
dren and other patients who may have difficulty following to discuss with their internist, cardiologist, or other prescribing
instructions. Local anesthesia with epinephrine is typically physician the possibility of stopping them in the perioperative
administered as an adjunct for hemostasis and postoperative period. A decision must be made balancing the risks of
pain. Risks involved include laryngospasm, malignant hyper- intra- and postoperative bleeding versus the risk of potentially
thermia, myocardial infarction, and even death. A careful family life-threatening thromboembolic events. Where appropriate,
history looking for unexplained anesthesia death or malignant coagulation studies should be ordered preoperatively.

Figure 1.6 Sequential compression device.

5
Other documents randomly have
different content
Fig. 293.—The
auditory
apparatus in the
tibia of a
grasshopper,
showing the
tympanal nerve-
endings in situ:
EBI, terminal
vesicles of
Siebold’s organ;
SN, nerve of the
organ of Siebold;
Gr, group of
vesicles of same;
SO, nerve-
endings of the
same; vT, front
tympanum; vTr,
front branch of
 the trachea; hT,
hinder
tympanum; hTr,
hinder branch of
the trachea; Sp,
space between the
tracheæ; go,
supra tympanal
ganglion; rN,
connecting nerve-
fibrils between
the ganglion cells
and the terminal
vesicles; R, upper,
n-S, lower, root of
the transparent
covering
membrane.
(Other lettering
not explained by
author.)—After
Graber.

These tracheæ, says Graber, though formed on a similar plan, present many
variations, corresponding to those of the tympana, and showing that the tympana
and the tracheæ stand in intimate connection with one another. For instance, in
those species where the tympana are equal, the tracheæ are so likewise; in
Gryllotalpa, where the front tympanum only is developed, though both tracheal
branches are present, the front one is much larger than the other; and where there
is no tympanum, the trachea remains comparatively small, and even in some cases
undivided (Lubbock, ex Graber).
The acoustic nerve, which next to the optic is the thickest in the
body, divides soon after entering the tibia into two branches, one
almost immediately forming a ganglion, the supra-tympanal
ganglion, the other passing down to the tympanum, where it expands
into an elongated flat ganglion, the organ of Siebold (Fig. 293), and
closely applied to the anterior tracheæ.
At the upper part of the ganglion is a group terminating below in a
single row of vesicles, the first few of which are approximately equal,
but which subsequently diminish regularly in size. Each of these
vesicles is connected with the nerve by a fibril (Fig. 293, vN), and
contains an auditory rod (Fig. 294). They are said by Graber to be
brightly refractive, hollow (thus differing from the retinal
rods, which are solid), and terminate in a separate end-piece
(ko). The rods were first discovered by Siebold, and, as
Lubbock remarks, may be regarded as specially characteristic
of the acoustic organs of insects.

Fig.
294.—
Audit
ory
rod of
Gryllu
s
viridis
simus:
fd,
audito
ry
rod;
ko,
termi
nal
piece.
—
After
Grabe
r,
from
Lubbo
ck.
 As will be seen in Fig. 293, at
the upper part of the tibial organ
of Ephippigera there is a group
of cells, and below them a single
Fig. 295.— row of cells gradually
Chordotonal organ in diminishing in size from above
nymph of a white ant. downwards. “One cannot but
—After Müller, from ask oneself,” says Lubbock,
Sharp. “whether the gradually
diminishing size of the cells in
the organ of Siebold may not
have reference to the perception of different notes, as is
the case with the series of diminishing arches in the organ
of Corti of our own ears.”
These organs were supposed to be restricted to the
Orthoptera, but in 1877 Lubbock discovered what seems Fig. 296.—Right half
to resemble the supra-tympanal auditory organ of of 8th body-segment
Orthoptera in the tibia of the yellow ant (Lasius flavus). of Corethra
Graber confirmed Lubbock’s account, and also discovered plumicornis: g,
these organs in the tibia of a Perlid (Isopteryx apicalis), ganglion of ventral
and Fritz Müller has detected them in the fore tibiæ of the cord; lm, longitudinal
nymph of Calotermes rugosus (Fig. 295). To these muscle; cn,
structures Graber gave the name of chordotonal organs. chordotonal nerve; cl,
He has also detected these organs in all the legs of other chordotonal ligament;
insects (Trichoptera, Pediculidæ), and auditory rods have cg, chordotonal
been discovered in the antennæ of Dyticus and of ganglion; cs, rod of
Telephorus by Hicks, Leydig, and Graber. Graber chordotonal organ;
classifies the chordotonal organs into truncal and cst, terminal cord; tb,
membral. In Coleoptera and Trichoptera they may occur tactile setæ; hn, out-
on several joints of the leg; others are more localized,— going fibres of the
thus he distinguishes femoral (Pediculidæ), tibial integumental nerves.
(Orthoptera, Perlidæ, Formicidæ), and tarsal organs —After Graber, from
(Coleoptera). Lang.
A type of chordotonal organ, observed in the body-
segments of the larvæ of several insects by Leydig, Weismann, Graber, Grobben,
and Bolles Lee, is to be seen in the transparent larva of Corethra (Fig. 296), where
the auditory organ extends to the skin. It contains at the point cs two or three
auditory rods. In the opposite direction a fine ligament (cl) passes from cg to the
skin; in this way the auditory organ is suspended in a certain state of tension, and
is favorably situated to receive even very fine vibrations. A similar apparatus has
been detected in the larva of Ptychoptera.
Antennal auditory hairs.—It is not at all improbable that the
antennæ of different insects contain auditory as well as olfactory
structures. Lubbock has suggested that the singular organs which
have only been found in the antennæ of ants and certain bees, and to
which he gives the name of “Hicks’ bottles” (Fig. 281), may act as
microscopic stethoscopes, while Leydig also regards them as
chordotonal organs.
That, however, some of the antennal hairs of the mosquito, as first
suggested by Johnson and afterwards proved experimentally by
Mayer, are auditory, seems well established. Fastening a male
mosquito down on a glass slide, Mayer then sounded a series of
tuning-forks. With an Ut4 fork of 512 vibrations per second, some of
the hairs were seen to vibrate vigorously, while others remained
comparatively at rest. The lower (Ut3) and higher (Ut5) harmonics of
Ut4 also caused more vibration than any intermediate notes. These
hairs, then, are specially tuned so as to respond to vibrations
numbering 512 per second. Other hairs vibrated to other notes,
extending through the middle and next higher octave of the piano.
Mayer then made large wooden models of these hairs, the one
corresponding to the Ut3 hair being about a metre in length, and on
counting the number of vibrations they made when they were
clamped at one end and then drawn on one side, he found that it
“coincided with the ratio existing between the numbers of vibrations
of the forks to which covibrated the fibrils,” or hairs. It should be
observed that the song of the female mosquito corresponds nearly to
this note, and would consequently set the hairs in vibration. Mayer
observed that the song of the female vibrates the hairs of one of the
antennæ more forcibly than those of the other. Those auditory hairs
are most affected which are at right angles to the direction from
which the sound comes. Hence from the position of the antennæ and
the hairs a sound will be loudest or most intense if it is directly in
front of the head. If, then, the song of the female affects one antenna
more than another, the male turns his head until the two antennæ
are equally affected, and is thus able to fly straight towards the
female. From his experiments Mayer found that the male can thus
guide himself to within 5° of the direction of the female. Hence he
concludes that “these insects must have the faculty of the perception
of the direction of sound more highly developed than in any other
class of animals.” (Also see Child’s work.)
 Special sense-organs in the wings and halteres.—Organs of a special
sense, which Hicks supposed to be those of smell, were found by him near or at the
base of the wings of Diptera, Coleoptera, and less perfect ones in Lepidoptera,
Neuroptera, and Orthoptera, with a trace of them in Hemiptera; but these were
considered by Leydig to be auditory organs, since he found the nerves to end in
club-shaped rods, like those of Orthoptera.
Hicks found, as to the halteres and their sense-organs, that the nerve in the
halter is the largest in the insect, except the optic nerve; and that at the base of the
halteres is a number of vesicles arranged in four groups, to each of which the nerve
sends a branch. Afterwards Bolles Lee discovered that the vesicles, undoubtedly
perforated, contain a minute hair, those of the upper groups being protected by
hoods of chitin. He regarded them as olfactory organs, while Lubbock seems
inclined to consider them as auditory structures. Graber also regards the vesicles of
Hicks as chordotonal organs.
In his elaborate account of the balancers, Weinland concludes that the organs of
sense of varying structure occurring at the base of these appendages allow the
perception of movements which the halteres perform and which enable the fly to
steer or direct its course. The halteres can thus cause differences in the direction of
the flight of a fly in the vertical plane. If the balancers act unequally, there is a
change in direction.

e. The sounds of insects

Insects have no true voice; but sounds of different intensity, shrill

cries, and other noises are produced mechanically by insects, either
being love-songs to attract the sexes, to give signals, to communicate
intelligence, or perhaps to express the emotions. The loud, shrill cry
of the Cicada, or chirp of the cricket, is evidently a love-call, and
results in the mating of individuals of separate broods more or less
widely scattered, thus preventing too close interbreeding.
The simplest means of making a noise is that of the death-watch
(Anobium), which strikes or taps on the wall with its head or
abdomen. Longicorn beetles make a sharp sound by the friction of
the mesoscutellum against the edge of the prothoracic cavity, the
head being alternately raised and lowered, Burying-beetles
(Necrophorus) rub the abdomen against the hinder edges of the
elytra. Weevils make a loud noise by rapidly rubbing the tips of the
abdomen on the ends of the elytra.
Landois offers the following summary of the kinds of noises produced by beetles:
 1. Tapping sounds (Bostrycinæ, Anobium).
2. Grating sounds (Elateridæ).
3. Friction without special rasping organs (Euchirus longimanus).
4. Rasping sounds produced by friction:
a. Rubbing of the pronotum on the mesonotum (Cerambycidæ except
Spondyli and Prionus).
b. Friction of the prosternum on the mesosternum (Omaloplia brunnea).
c. Elytra with a rasp at the end (Curculionidæ, Dyticidæ, Pelobius).
d. With a coxal rasp (Geotrupes, Ceratophyus). The male of Ateuchus
stridulates to encourage the female in her work, and from distress when
she is removed. (Darwin.)
e. Friction of the edge of the elytra against the femur (Chiasognathus
grantii).
f. Pygidium with two rasps in the middle (Crioceris, Lema, Copris, Oryctes,
Necrophorus, Tenebrionidæ).
g. Abdomen with a grating ridge and four grating plates (Trox).
h. Abdomen with two toothed ridges rubbing on a rasp on edge of wing-cover
(Elaphus, Blethisa, Cychrus).
i. Rubbing the elytra on a rasp on the hind wings (Pelobius hermanni).
j. Friction of the wing against the abdominal segments (Melolontha fullo).
Mutilla makes a rather sharp noise by rubbing one abdominal segment against
another. Ants (Ponera) have a stridulating apparatus, and other genera numerous
(20) ridges between the segments.
Even certain moths and butterflies emit a rasping or crackling noise. The
death’s-head moth and other sphinges cause it by rubbing the palpi against the
base of the proboscis. These and certain butterflies are provided with parallel
ridges forming a rasp on the “basal spot” of the inner side of the basal joint of each
palpus (Reuter). A South American butterfly (Ageronia feronia) can be heard for
several yards as it flies with a crackling sound. Hampson finds that the cause of the
clicking sound is due to a pair of strong chitinous hooks attached to the thorax,
against which play the spatulate ends of a pair of hooks attached to the fore wings.
An Australian moth (Hecatesia) flies with a whizzing sound; Vanessa is said to be
sonorous.
The males of Orthoptera produce their shrill cries or chirping noises, 1, by
rubbing the thighs against the sides of the body (Acrydiidæ); 2, by the friction of
the base of the fore wings on each other (Locustidæ); 3, by rubbing the base of the
upper on the base of the hinder or under pair (Gryllidæ), in the two last there being
a shrilling apparatus consisting of a file on the hind wings, which rubs on a
resonant surface on the fore wings. The females are not invariably dumb, both
sexes of the European Ephippigera being able to faintly stridulate. Corixa also
produces shrill chirping notes. (Carpenter.)
Certain insects also hum, and have what may perhaps be called a
voice. The cockchafer, besides humming with the wings, produces a
sound almost like a voice. In the large trachea, just behind each
spiracle, is a chitinous process, which is thrown into vibrations by
the air during respiration, and thus produces a humming noise.
(Lubbock.) Such is also the case with flies, the mosquito, dragon-
flies, and bees. In flies and dragon-flies the “voice” is caused by the
air issuing from the thoracic spiracles; while in the humble-bee the
abdominal spiracles are also musical. The sound made by the
spiracles bears no relation to that caused by the wings. Landois tells
us that the wing-tone of the honey-bee is A′; its voice, however, is an
octave higher, and often goes to B″ and C″.
The sounds produced by the wings are constant in each species,
except where, as in Bombus, there are individuals of different sizes;
in these the larger ones generally give a higher note. Thus the
comparatively small male of Bombus terrestris hums on A′, while
the large female hums an entire octave higher.
From the note produced the rapidity of the vibrations can be
calculated. For example, the house-fly, which produces the sound of
F, vibrates its wings 21,120 times in a minute, or 335 times in a
second; and the bee, which makes a sound of A′, as many as 26,400
times, or 440 times in a second. On the contrary, a tired bee hums on
E′, and therefore, according to theory, vibrates its wings only 330
times in a second. Marey has confirmed these numbers graphically,
and found by experiment that the fly actually makes 330 strokes in a
second. (Lubbock.)
A different kind of musical apparatus is that of the cicada, which
has been elaborately described by Graber. The shrill, piercing notes
issue from a pair of organs on the under side of the base of the
abdomen of the male, these acting somewhat as two kettle-drums,
the membrane covering the depressions being rapidly vibrated.
 LITERATURE ON THE ORGANS OF
HEARING

a. The auditory organs

Siebold, C. Th. E. von. Ueber das Stimm- und Gehörorgan der

Orthopteren. (Archiv f. Naturgesch., 1844, x, pp. 52–81.)
Johnston, Christopher. Auditory apparatus of the culex
mosquito. (Quart. Journ. Micr. Soc., 1855, iii, pp. 97–102, 1 Fig.)
Hicks, Braxton. On a new organ in insects. (Journ. Linn. Soc.
Zool., London, 1857, pp. 130–140, 1 Pl.)
—— Further remarks on the organ found on the bases of the
halteres and wings of insects. (Trans. Linn. Soc., London, 1857,
xxii, pp. 141–145, 2 Pls.)
Hensen, V. Ueber das Gehörorgan von Locusta. (Zeitschr. f.
wissens. Zool., xvi, 1866, pp. 190–207.)
Graber, V. Bemerkungen über die Gehör- und Stimmorgane der
Heuschrecken und Cicaden (Wiener Sitzungsber. Math.-natur-
wiss. Cl., lxvi, 1 Abt., 1872, pp. 205–213, 2 Figs.)
—— Die tympanalen Sinnesapparate, der Orthopteren. (Denkschr.
d. k. Akad. d. wissens. Wien, xxxvi, 1876, 2 Abt., pp. 1–140, 10
Taf.)
—— Die abdominalen Tympanalorgane der Cicaden und
Gryllodeen. (Ibid., 1870, xxxvi, pp. 273–290, 2 Taf.)
—— Ueber neue, otocystenartige Sinnesorgane der Insekten.
(Archiv f. mikroskop. Anat., 1878, pp. 35–57, 2 Taf.)
—— Die chordotonalen Sinnesorgane und das Gehör der Insekten.
(Archiv f. mikroskop. Anat., 1882, xx, pp. 506–640; 1883, xxi,
 pp. 65–145, Taf.)
Mayer, Alfred Marshall. Researches in Acoustics No. 5. 3.
Experiments on the supposed auditory apparatus of the culex
mosquito. (Amer. Jour. Sc. and Arts, Ser. 3, viii, 1874, pp. 81–
103; also Amer. Naturalist, viii, pp. 577–592.)
Schmidt, Oscar. Die Gehörorgane der Heuschrecken. (Archiv f.
mikroskop. Anat., xi, 1875, pp. 195–215, 3 Taf.)
Ranke, J. Beiträge zu der Lehre von den
Uebergangssinnesorganen, das Gehörorgan der Acridier und das
Sehorgan der Hirudineen. (Zeitschr. f. wissens. Zool., xxv, 1875,
pp. 143–164, 1 Taf.)
Lee, A. Bolles. Les balanciers des Diptères, leurs organes
sensifères et leur histologie. (Recueil Zool. Suisse, ii, 1885, pp.
363–392, 1 Pl.)
—— Bemerkungen über der feineren Bau der Chordotonalorgane.
(Archiv f. mikroskop. Anat., 1883, xxiii, pp. 133–140, 1 Taf.)
—— Les organes chordotonaux des Diptères et la méthode du
chlorure d’or. (Observations critiques.) (Recueil Zool. Suisse,
1884, ii, pp. 685–689, 1 Pl.)
Weinland, E. Ueber die Schwinger (Halteren) der Dipteren
(Zeitschr. f. wissens. Zool., 1890, li, pp. 55–166, 5 Taf.)
Adelung, N. v. Beiträge zur Kenntnis des tibialen
Gehörapparates der Locustiden. Inaug. Diss., Leipzig, 1892, 2
Taf.
Child, Ch. M. Ein bisher wenig beachtetes antennales
Sinnesorgan der Insekten, mit besonderer Berücksichtigung der
Culiciden und Chironomiden. (Zeitschr. f. wissens. Zool., lviii,
1894, pp. 475–528, 2 Taf.; also, Zool. Anzeiger, xvii Jahrg., pp.
35–38, and in Annals and Mag. Nat. Hist., 1894 (6), xiii, pp.
372–374).
Also the writings of J. Müller, Kirby and Spence, Burmeister,
Gilbert White, Westwood, Guilding, Meinert, Paasch, Leydig,
Viallanes, Minot, Forel, Mayer, Darwin (Descent of Man, i, ch.
 x.), F. Müller, Lubbock (Senses of animals), Westring, Köppen,
Bates, Vom Rath, Peckham, Jourdan, Nagel, etc.

b. The sounds made by insects

Scudder, S. H. Notes on the stridulation of grasshoppers. (Proc.

Bost. Soc. Nat. Hist., xi, 1868, pp. 306–313 and 316.)
—— The songs of the grasshoppers. (Amer. Naturalist, ii, 1868, pp.
113–120, 5 Figs.)
Riley, C. V. The song notes of the periodical Cicada. (Proc. Amer.
Assoc. Adv. Science, xxxiv, 1885, pp. 330–332; also in Kansas
City Rev., October, 1885, pp. 173–175.)
Swinton, A. H. (Ent. Month. Mag., 1877.) Sound produced in
Ageronia by a modification of the hook and bristle of the wings.
Hampson, G. F. On stridulation in certain Lepidoptera, etc.
(Proc. Zool. Soc. London, 1892, ii, pp. 188–193, Fig; also Psyche,
vi, p. 491, 1 Fig.)
With the writings of Landois, Lubbock, Graber, Kolbe, Carpenter
(Nat. Science), Bruyant, and others.
THE DIGESTIVE CANAL AND ITS
APPENDAGES
Fig. 297.—Transverse section through
an abdominal segment of larva of
Megalopyge crispata, showing the
relations of the digestive canal to the
other organs: int, hind-intestine, with
its mucous or epithelial layer (ep),
and ml its outer or muscular layer;
ng, ventral ganglion; ht, heart; mp,
urinary tubes; f, fat-body; sc,
thickened portion of the hypodermis
(hy) containing the setigenous cells;
m, muscles; m′, a pair of retractor
muscles inserted near the base of the
lateral glandular process (lgp); cut,
cuticula; l, legs. Also compare Figs.
142–144 and 234.
Fig. 298.
The alimentary or digestive canal of insects is a more or less
straight tube, which connects the mouth and anus, the latter invariably
situated in the last segment of the body, under the last
tergite or suranal plate. It lies directly over the ventral nervous
cord and under the dorsal vessel, passing through the middle of the
body (Fig. 297). It is loosely held in place by delicate retractor
muscles (retractores ventriculi, found by Lyonet in the larvæ of
Lepidoptera, and occurring in those of Diptera), but is principally
supported by exceedingly numerous branches of the main tracheæ.
Fig. 298.—Internal anatomy of Melanoplus femur-rubrum: at, antenna
and nerve leading
to it from the “brain” or supraœsophageal ganglion (sp); oc, ocelli, anterior
and vertical ones,
with ocellar nerves leading to them from the brain; œ, œsophagus; m,
mouth; lb, labium or under
lip; if, infraœsophageal ganglion, sending three pairs of nerves to the
mandibles, maxillæ, and
labium respectively (not clearly shown in the engraving); sm, sympathetic
or vagus nerve, starting
from a ganglion resting above the œsophagus, and connecting with
another ganglion (sg) near the
hinder end of the crop; sal, salivary glands (the termination of the salivary
duct not clearly
shown by the engraver); nv, nervous cord and ganglia; ov, ovary; ur, origin
of urinary tubes;
ovt, oviduct; sb, sebaceous gland; bc, bursa copulatrix; ovt, site of opening
of the oviduct (the
left oviduct cut away); 1–10, abdominal segments. The other organs
labelled in full.—Drawn from
his original dissections by Mr. Edward Burgess.
 Fig. 299.—Digestive canal of Anabrus: m, mouth: œ, œsophagus; sm, the
sympathetic nerve passing along the crop; t, tongue; fg, frontal ganglion; br,
brain, the nervous cord passing backward from it; sr, salivary reservoir; sg,
salivary gland; pv, proventriculus; ur, origin of urinary tubes; sb, sebaceous
gland; 1–10, the ten abdominal segments.—Burgess del.

It is in the higher adult insects differentiated into the mouth and

pharynx, the œsophagus or gullet, supplementary to which is the
crop (ingluvies) or “sucking stomach” of Lepidoptera, Diptera, and
Hymenoptera; the proventriculus or gizzard; the ventriculus, “chyle-
stomach,” or, more properly, mid-intestine, and the hind-intestine,
which is divided into the ileum, or short intestine, the long intestine,
often slender and coiled, with the colon and the rectum.
Morphologically, however, the digestive or enteric canal is divided
into three primary divisions, which are indicated in the embryo
insect; i.e., the fore-intestine (stomodæum of the embryo), mid-
intestine or “chyle-stomach,” and hind-intestine or proctodæum
(Fig. 300). The three primary regions, with their differentiations,
may be tabulated thus:—
Fore-intestine Mouth and pharynx.
(Stomodæum).
Pumping apparatus of Hemiptera, Lepidoptera,
and Diptera.
Œsophagus.
Crop or ingluvies, food reservoir, or “sucking
stomach.”
Proventriculus.

Mid-intestine Mid-intestine, “chylific stomach,” or ventriculus

(Mesenteron). (with cœcal glands).

Hind-intestine Ileum, or short intestine (with the urinary tubes).

(Proctodæum).
Long intestine.
Colon.
Rectum (with rectal glands).
Anus (with anal glands).
 Fig. 300.—The three primary
divisions of the alimentary
canal of an embryonic
orthopterous insect: br, brain;
sbg, subœsophageal ganglion;
ng, nervous cord; st,
stomodæum; pr, proctodæum;
mv, malphigian tubes; mesen,
mid-intestine; ht, heart; md,
mandibles; mx, mx′, 1st and 2d
maxillæ.—After Ayers, with
some changes.

The appendages of the alimentary canal are: (1) the salivary and
poison glands, which arise from the stomodæum in embryonic life;
(2) while to the chylific stomach a single pair of cœcal appendages
(Orthoptera and larval Diptera, e.g. Sciara), or many cœca may be
appended; (3) the urinary tubes, also the rectal glands and the paired
anal glands. In a Hemipter (Pyrrhocoris apterus) appendages arise
from the intestine in front of the origin of the urinary tubes. In
certain insects a single cœcal appendage (Nepa, Dyticus, Silpha,
Necrophorus, and the Lepidoptera) arises from the proctodæum.
In certain larval insects, as those of the Proctotrypidæ (first larval
stage), the higher Hymenoptera (ichneumons, ants, wasps, and bees,
Fig. 301), in the Campodea-like larvæ of the Meloidæ and Stylopidæ,
the larva of the ant-lion (Myrmecoleo), and those of Diptera
pupipara (Melophagus), the embryonic condition of the separation
of the proctodæum and mid-gut (mesenteron) persists, the stomach
ending in a blind sac; in such cases the intestine, together with the
urinary tubes, is entirely secretory.
The anus is wanting in the larva of the ant-lion, as also in the
wasps (in which there is a rudimentary colon) and in freshly hatched
 bees, though it becomes perfectly formed in
the fully grown larvæ (Newport, art. Insecta,
p. 967, and H. Müller).
In the larvæ of lamellicorn Coleoptera
(Melolontha vulgaris) the digestive tube is
nearly as simple as in bees, though there is a
large colon, which at its beginning forms an
immense cœcum, and has also one anal
aperture (Newport).
The length and shape of the digestive
canal is dependent on the nature of the food
and also on the mode of life, especially the
ease or difficulty with which the food is
digested.
Fig. 301—Larva of honey- Newport, while stating that the length of the
bee: g, brain; bm, ventral alimentary canal in larvæ is not in general indicatory
nervous cord; œ, of the habits of the species, makes this qualification
œsophagus; sd, spinning- after describing the digestive canal of Calandra as
gland; cd, mid-intestine or compared with that of Calosoma: “The length and
chyle-stomach; ed, hind- complication of the intestines, therefore, appear to
intestine, not yet have some reference to the quality of the food to be
connected with the mid- digested, since it is well known that the food of these
intestine; vm, urinary latter insects (weevils) is of difficult assimilation,
tube; an, anus; st, being as it is chiefly the hard ligneous fibres of
stigmata.—After Leuckart, vegetable matter; but they cannot be received as
from Lang. always indicatory of a carnivorous [or] vegetable
feeder, since, as above remarked, the length of the
canal is considerable in one entirely carnivorous larva, while it is much shorter in
some herbivorous, and particularly in pollenivorous larvæ, as in the Melolontha
and the apodal Hymenoptera.”
 Fig. 302.—Digestive canal of a carabid
beetle: b, œsophagus; c, crop; d,
proventriculus; f, mid-intestine, or
“chyle-stomach,” with its cœeca; g,
posterior division of the stomach; i, the
two pairs of urinary tubes; h, intestine; k,
rectum; l, anal glands.—After Dufour,
from Judeich and Nitsche.

Newport also contends that the length of the alimentary canal is not more
indicative in the perfect insect of the carnivorous or phytophagous habits of the
species than in the larva. It is nearly as long (being from two to three times the
length of the whole body), and is more complicated, in the rapacious Carabidæ
(Fig. 302) than in the honey-sipping Lepidoptera, whose food is entirely liquid.
Referring to the digestive canal of Cicindelidæ, which is scarcely longer than the
body, he claims that “we cannot admit that the length of the digestive organs, and
the existence of a gizzard and gastric vessels, are indicatory of predacity of habits
in the insect, because a similar conformation of parts exists often in strictly
vegetable feeders. The existence and length of these parts seem rather to refer to
the comparative digestibility of the food than to its animal or vegetable nature.”
Newport then refers to the digestive canal of Forficulidæ (in which the gizzard is
present, the canal, however, passing in an almost direct line through the body,
making but one slight convolution), “a farther proof that the length of the canal
must not be taken as a criterion whereby to judge of the habits of a species.” He
adds this will apply equally well to the omnivorous Gryllidæ, in which there exists a
short alimentary canal, but a gizzard of more complicated structure than that of
the Dytiscidæ.
In larval insects and others (Synaptera, Orthoptera, etc.), in which
the digestive canal is simplest, it is scarcely longer than the body, and
passes through it as a straight tube.
In the caterpillar, which is a voracious and constant feeder, the
digestive canal is a large straight tube, not clearly differentiated into
fore-stomach, stomach, and intestine; but in the imago, which only
takes a little liquid food, it is slender, delicate, and highly
differentiated. In the larva the mid-gut forms the largest part of the
canal; in the imago, the intestine becomes very long and coiled into
numerous turns; at the same time the food-reservoir (the “sucking
stomach”) develops, and the excretory tubes are longer.

a. The digestive canal

It will greatly simplify our conception

of the anatomy of the digestive canal if
we take into account its mode of origin in
the embryo, bearing in mind the fact that
during the gastrula condition the
ectoderm is invaginated at each pole to
form the primitive mouth and fore-gut
(stomodæum) and hind-gut
(proctodæum). The cells of the ectoderm
Fig. 303.—Interior view of the
bottom of the head of Danais
secrete a chitinous lining (intima), which
archippus, the top having forms the continuation of the outer
been cut away, showing, in the chitinous crust, and thus the lining of
middle, the pharyngeal sac each end of the digestive canal is cast
with its five muscles: the whenever the insect molts; while the
frontal (f.m), dorsal pair mid-intestine (mesenteron), arising
(d.m), and the lateral pair independently of the rest of the canal
(l.m); cl, clypeus; cor, cornea;
œ, œsophagus; p.m, one of the much later in embryonic life from the
large muscles which move the mesoderm, is not the result of any
labial palp.—After Burgess. invagination, being directly derived from
the mesoderm, and is not lined with
chitin.
The mouth, or oral cavity, and pharynx.—This is the
beginning of the alimentary bounded above by the clypeus, and
labrum, with the epipharynx, and below by the hypopharynx, or
tongue, as well as the labium. Into it pour the secretion of the
salivary glands, which passes out through an opening at the base of
the tongue or hypopharynx. On each side of the mouth are the
mandibles and first maxillæ.
The sucking or pharyngeal pump.—This organ has been
observed by Graber in flies and Hemiptera, but the fullest account is
that by Burgess, who was the first to discover it in Lepidoptera. In
the milk-weed butterfly (Danais archippus) the canal traversing the
proboscis opens into a pharynx enclosed in a muscular sac (Figs.
303, 304, and 310).
The pharyngeal sac, says Burgess, serves as a pumping organ to
suck the liquid food through the proboscis and to force it backwards
into the digestive canal.
Meinert (“Trophi Dipterorum”) has made
elaborate dissections of the mouth and its
armature, including the pharynx of several
types of Diptera, with its musculature. He
describes the pharynx as the principal, and
in most Diptera, as the only part of the pump
(antlia), and says: “By the muscles of the
pump (musculis antliæ) the superior lamina
of the pharynx is varied that the space
between the two laminæ may be increased,
and the liquid is thus led through the siphon
formed by the mouth-parts into the mouth”
Fig. 304.—Longitudinal
(Fig. 81). section through the head
The œsophagus.—This is a simple tube, of Danais, showing the
largest in those insects feeding on solid, interior of the left half:
usually vegetable, food, and smallest in those mx, left maxilla, whose
living on liquid food. It usually curves canal leads into the
pharynx; hph, floor of the
upwards and backwards, passing directly latter, showing some of
under the brain, and merges into the crop or the taste-papillæ; oe,
proventriculus either at the back part of the œsophagus; ep,
head or in the thorax, its length being very epipharyngeal valve; sd,
variable. Its inner walls longitudinally are salivary duct; d.m, f.m,
folded and lined with chitin. and cl, as in Fig. 302.—
After Burgess.
According to Newport, in the œsophagus
of the Gryllidæ, of the two layers of the
mucous lining the second is distinctly glandular and secretory, and in
it there are many thousands of very minute granular glandular
bodies, which probably secrete the “molasses” or repellent fluid often
ejected by these and other insects when captured.
The crop or ingluvies.—This, when present, is an enlargement
of the end of the œsophagus, and lined internally with a muscular
coat. It is very large in locusts (Fig. 298), Anabrus (Fig. 299), and
other Orthoptera (the Phasmidæ excepted), in the Dermaptera, and
most adult Coleoptera. A crop-like dilatation in front of a spherical
gizzard is also present in the Synaptera (Poduridæ and Lepismidæ),
as well as in the Mallophaga (Nirmidæ).

Fig. 306.
—Section
of the
crop (H),
gizzard
(I), and
stomach
(K) of
Athalia.-
After
Newport.

Fig. 305.—Digestive
canal of Calandra: H,
pear-shaped
œsophagus; I, crop;
K, gastric cœca L,
ilium; MN, colon; P,
urinary tubes.—After
Newport.
 Fig. 307.—Upper
side of head and
digestive canal of
Myrmeleon
larva: a, crop; b,
“stomach”; c,
free ends of two
urinary tubes; c′,
common origin
of other six
tubes; d, cœcum;
e, spinneret; ff,
muscles for
protruding its
sheath; gg,
maxillary glands.
—After Meinert,
from Sharp.

In the larvæ of weevils (Calandra sommeri) there is a crop (Fig.

305), but not in the larva of Calosoma; also, according to
Beauregard, in the pollen-eating beetles Zonitis, Sitaris, and
Malabris it is wanting, while in Meloe it is highly developed (Kolbe).
 The crop forms a lateral dilatation of the end of the œsophagus in
the larvæ of weevils and of saw-flies (Athalia centifoliæ, Fig. 306).
The “sucking stomach” or food-reservoir.—This is a thin
muscular pouch connected by a slender neck with the end of the
œsophagus or the crop, when the latter is present. There is no such
organ in Orthoptera, except in Gryllotalpa. It is wanting in the
Odonata and in the Plectoptera (Ephemeridæ); in Platyptera
(Perlidæ and Termitidæ), in Trichoptera, and in Mecoptera
(Panorpidæ). In most adult Neuroptera (Myrmeleonidæ,
Hemerobiidæ, and Sialidæ), but not in Rhaphidiidæ, the long
œsophagus is dilated posteriorly into a kind of pouch or crop, and
besides there is often a long “food-reservoir” arising on one of its
sides, that of Myrmeleon (Fig. 307) and Hemerobius being on the
right side.
 Fig. 308.—Digestive canal of Sarcophaga
carnaria: a, salivary gland; b, œsophagus;
c, food reservoir; f-g, stomach; h, intestine;
i, urinary tubes; k, rectum.—From Judeich
and Nitsche.

A true food-reservoir is present in most Diptera (Fig. 308) as well

as in the larvæ of the Muscidæ, but according to Dufour it is wanting
in some Asilidæ and in Diptera pupipara, and according to Brauer in
the Œstridæ. The food-reservoir in Diptera is always situated on the
left side of the digestive canal; there is usually a long neck or canal,
while the reservoir is either oval or more usually bilobed, and often
each lobe is itself curiously lobed.
In Lepidoptera (Figs. 309, 310) the so-called “sucking stomach” is,
as Graber has proved, simply a reservoir for the temporary reception
of food; though generally found to contain nothing but air, Newport
has observed that in flies it is filled with food after feeding. He has
found this to be the case in the flesh fly, and in Eristalis he has found
it “partially filled with yellow pollen from the flowers of the ragwort
upon which the insect was captured,” the pollen grains also occurring
in the canal leading to the bag, in the gullet, and in the stomach
itself. Graber has further proved by feeding flies with a colored sweet
fluid that this sac is only a food-receptacle. As he says: “It can be
seen filling itself fuller and fuller with the colored fluid, the sac
gradually distending until it occupies half the hind-body.”
The food-reservoir of the Hymenoptera is a lateral pouch at the
end of the long, slender œsophagus, and has been seen in the bee to
be filled with honey.
Fig. 309.—
Digestive canal of
Sphinx ligustri: h,
œsophagus; i,
rudiment of the
gizzard; k,
“stomach”; q, its
pyloric end; t,
food reservoir; p,
urinary tubes; l,
ilium; m, cœcum
 of colon; n,
rectum; v, vent.—
After Newport.

In the mole-cricket the hinder part of the crop is armed within

with hook-like bristles directed backwards so as not to prevent the
energetic pressure of the food backwards into the proventriculus,
and to obviate the possibility of a regurgitation. (Eberli.)
The fore-stomach or proventriculus.—This is especially well
developed in the Dermaptera, in the Orthopterous families
Locustidæ, Gryllidæ, and Mantidæ, while in the Thysanura
(Lepisma) there is a spherical gizzard provided with six teeth. It also
occurs in many wood-boring insects, and in most carnivorous
insects, notably the Carabidæ, Dyticidæ, Scolytidæ, in the Mecoptera
(scorpion-flies), in the fleas, and in many kinds of ants, as well as
Cynips, Leucospis, and Xyphidria. It is very muscular, lined within
with chitin, which is usually provided with numerous teeth arising
from the folds. These folds begin in the œsophagus or crop, and
suddenly end where the mesenteron (“chylific stomach”) begins. It
has been compared with the gizzard of birds, and is usually called by
German authors the chewing or masticating stomach. (Kaumagen.)
The proventriculus is best developed in the Gryllidæ (Acrida viridissima), where
the six folds at the end of the crop close together to form a valve between the crop
and proventriculus. “They are each armed with five very minute hooked teeth; and,
continued into the gizzard, develop many more in their course through that organ.
These first teeth are arranged around the entrance to the gizzard, and seem
designed to retain the insufficiently comminuted food and to pass it on to that
organ.
Fig. 310.—Anatomy of
Danais archippus after
removal of right half of
the body. Lettering of
the head: a, antenna;
ph, pharynx; pl, labial
palpi; r, proboscis; g,
brain; usg,
subœsophageal
ganglion. Lettering of
the thorax: I. II. III.
thoracic segments; b1,
b2, b3, the coxal joints
of the three pairs of
legs; bm, muscles of the
wings; ac cephalic aorta
with its swelling; œ,
œsophagus; bg,
thoracic ganglia of the
ventral cord; sd,
salivary glands of one
side, those of the other
side cut off near their
entrance into the
common salivary duct.
Lettering of the
abdomen: 1–9.
abdominal segments; h,
heart; sm, so-called
sucking-stomach (food-
reservoir); cm, chyle-
stomach; ag,
abdominal ganglia: ed,
hind intestine with
colon (c) and rectum
(r); rm, urinary vessels;
ov, ovarial tubes, those
of the right side cut off;
ove, terminal filaments
of the ovaries; bc, bursa
copulatrix; obc, its
outer aperture; od,
oviduct; vag, vagina;
wo, its outer aperture;
ad, glandular
appendages of the
vagina partly cut away;
vk, connective canal
between the vagina and
bursa copulatrix with
swelling (receptaculum
seminis); an, anus.—
After Burgess, from
Lang.