inferior lacrimal gland removal from rabbit model: a surgical procedure to remove the larger inferior tear gland from rabbit eye orbit

Inferior Lacrimal Gland Removal From Rabbit Model: A Surgical Procedure to Remove the Larger Inferior Tear Gland From Rabbit Eye Orbit

To resect the larger inferior lacrimal gland or ILG, use the Colorado microdissection needle to incise and separate the skin, the depressor muscle of the inferior palpebra, the zygomaticolabial part of the zygomatic muscle, and the orbicularis muscle. Maintain hemostasis with the monopolar cautery.
As the incision is carried deeper through the skin marking, look for the sheen of a fascial plane over the zygomatic bone or superficial part of the masseter muscle. At this point, maintain the tissue plane and carry it superiorly toward the orbital rim.
Identify and incise the capsule surrounding the ILG, then, identify the tan tissue of the ILG. Only the anterior portion of the ILG head will be visible, but it can be followed medially as it passes beneath the zygomatic arch and transitions into the tail.
Use tenotomy scissors to cut the orbital septum along the inferior rim, exposing the more posterior portion of the ILG tail. Once the tissue plane is identified, extend the dissection posteriorly along the entire incision line. Use extreme care to not damage the blood supply, which the ILG receives from branches of the carotid artery.
Once the entire ILG has been exposed, remove it. If the tail terminates under the posterior canthus, see the manuscript for excision directions. Due to its large size, it can be preferable to cut the gland in half, and remove the head separately from the tail.
After the gland has been removed, close the deep connective tissue plane with multiple interrupted 5-0 ethylene terephthalate sutures. Then, close the superficial muscles and skin with a running 6-0 polyglactin 910 suture, using 0.3 tissue forceps and a needle driver.

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1. Resect the ILG
<ol>
	<li>Allow at least 5 min for the local anesthetic to take effect in the rabbit.</li>
	<li>Incise the skin, the depressor muscle of the inferior palpebra, the zygomaticolabial part of the zygomatic muscle, and orbicularis muscle with the Colorado microdissection needle and make the skin incisions along the surgical markings. Settings can vary based on clinical response and typically are between 10 to 15 units for both cut and coagulation.</li>
	<li>Maintain hemostasis with the monopolar cautery.</li>
	<li>As the incision is carried deeper through the skin marking, look for the sheen of a fascial plane over the zygomatic bone or superficial part of the masseter muscle. At this point, maintain the tissue plane and carry it superiorly toward the orbital rim using the Colorado needle for cutting (Figure 1A). 
	NOTE: For the purpose of identifying the ILG, it is easiest to perform this part of the dissection over the head of the ILG which is typically inferior to the anterior limbus of the eye.</li>
	<li>After identifying and incising the capsule surrounding the ILG, identify the tan tissue of the ILG. Only the anterior portion of the ILG head will be visible (Figure 1B). However, the head can be followed medially as it passes beneath the zygomatic arch and transitions into the tail (Figure 1C).</li>
	<li>Use tenotomy scissors to cut the orbital septum along the inferior rim exposing the more posterior portion of the ILG tail. Once the tissue plane is identified, extend the dissection posteriorly along the entire incision line (Figure 1D). 
	NOTE: The duct of the ILG passes through the lower fibrous connective tissues to enter the inferior conjunctival space in the temporal aspect of the lid. At the posterior rim, the tail of the ILG can have varying anatomic configurations. Sometimes it terminates inferior to the posterior (lateral) canthus, while in other dissections it extends more superiorly around the temporal orbit.</li>
	<li>Use extreme care to prevent inadvertent damage to the blood supply, which the ILG receives from branches of the carotid artery. The blood supply can be seen during this part of the dissection (Figure 1E).</li>
	<li>In cases where the tail terminates under the posterior (lateral) canthus, it may be necessary to bisect the temporal portion of the frontoscutular muscle to expose the tail of the ILG, which lies along the zygomatic bone.</li>
	<li>After the entire ILG has been isolated and exposed, remove it. Due to its large size, it is often preferable to cut the gland in half with scissors and remove the head separately from the tail.</li>
	<li>Proceed very cautiously when removing the head of the ILG as it lies immediately adjacent to a large venous sinus in the orbit. Although bleeding from this structure during surgical resections has not occurred, have ample hemostatic aids present to mitigate this risk.</li>
	<li>After removal of all gland tissue, close the deep connective tissue plane with multiple interrupted 5-0 ethylene terephthalate sutures. Close the superficial muscles and skin with a running 6-0 polyglactin 910 suture (Figure 1F) using 0.3 tissue forceps and a needle driver.</li>
</ol>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Acepromazine, Aceproinj</td>
			<td>Henry Schein Animal Health, Dublin, OH</td>
			<td>NDC11695-0079-8</td>
			<td>0.1ml/kg subcutaneously injection for rabbit sedation</td>
		</tr>
		<tr>
			<td>Anesthesia vaporizer</td>
			<td>VetEquip, Pleasanton, CA</td>
			<td>Item # 911103</td>
			<td></td>
		</tr>
		<tr>
			<td>Animal restraining bag</td>
			<td>Henry Schein Animal Health, Dublin, OH</td>
			<td>Jorvet J0170</td>
			<td>Use appropriately sized bag</td>
		</tr>
		<tr>
			<td>Cautery unit, high-temperature, battery-powered</td>
			<td>Medline Industries Inc, Northfield, IL</td>
			<td>REF ESCT001</td>
			<td>Keep on hand in case of bleeding</td>
		</tr>
		<tr>
			<td>Clipper, Wahl Mini Arco</td>
			<td>Henry Schein Animal Health, Dublin, OH</td>
			<td>No. 022573</td>
			<td>Cordless shears for fur removal</td>
		</tr>
		<tr>
			<td>Colorado needle</td>
			<td>Stryker Craniomaxillofacial, Kalamazoo, MI</td>
			<td>N103A</td>
			<td>Use with electrosurgical unit to make incisions</td>
		</tr>
		<tr>
			<td>Electrosurgical unit with monopolar cautery plate</td>
			<td>Valleylab, Boulder, CO</td>
			<td>Force FXc</td>
			<td>Use with electrosurgical unit to make incisions</td>
		</tr>
		<tr>
			<td>Forceps, curved dressing</td>
			<td>Bausch and Lomb (Storz), Bridgewater, NJ</td>
			<td>Storz E1406</td>
			<td>delicate serrated dressing forceps</td>
		</tr>
		<tr>
			<td>Forceps, 0.3</td>
			<td>Bausch and Lomb (Storz), Bridgewater, NJ</td>
			<td>ET6319</td>
			<td>For removal of nictating membrane</td>
		</tr>
		<tr>
			<td>Forceps, Bishop Harmon</td>
			<td>Bausch and Lomb (Storz), Bridgewater, NJ</td>
			<td>E1500-C</td>
			<td>Use toothed forceps for dacryoadenectomy</td>
		</tr>
		<tr>
			<td>Hair remover lotion, Nair</td>
			<td>Widely available</td>
			<td>Softening Baby oil</td>
			<td>Dipilitory cream for sensitive skin</td>
		</tr>
		<tr>
			<td>Isoflurane</td>
			<td>Henry Schein Animal Health, Dublin, OH</td>
			<td>29405</td>
			<td>Possible alternative sedation</td>
		</tr>
		<tr>
			<td>Laryngeal mask airway</td>
			<td>Docsinnovent Ltd, London, UK</td>
			<td>Vgel R3</td>
			<td></td>
		</tr>
		<tr>
			<td>Lid speculum, wire</td>
			<td>Bausch and Lomb (Storz), Bridgewater, NJ</td>
			<td>Barraquer SUH01</td>
			<td>For removal of nictating membrane</td>
		</tr>
		<tr>
			<td>Scissors, Vannas</td>
			<td>McKesson Medical-Surgical, San Francisco, CA</td>
			<td>Miltex 2-130</td>
			<td>Capsulotomy scissors for dacryoadenectomy</td>
		</tr>
		<tr>
			<td>Sedation gas mask</td>
			<td>DRE Veterinary, Louisville, KY</td>
			<td>#1381</td>
			<td>Possible alternative sedation</td>
		</tr>
		<tr>
			<td>Surgical marking pen</td>
			<td>Medical Action Industries, Arden, ND</td>
			<td>REF 115</td>
			<td></td>
		</tr>
		<tr>
			<td>Sutures, 5-0 Mersilene</td>
			<td>Ethicon US, LLC</td>
			<td></td>
			<td>Ethylene terephthalate sutures, used for deep connective tissue closure</td>
		</tr>
		<tr>
			<td>Rabbit, New Zealand White</td>
			<td>Charles River Labs, Waltham, MA (NZW)</td>
			<td>2-3 kg</td>
			<td>Research animals</td>
		</tr>
		<tr>
			<td>Sutures, Vicryl 6-0</td>
			<td>Ethicon US, LLC</td>
			<td></td>
			<td>Polyglactin 910 sutures, used for superficial muscle and skin closure</td>
		</tr>
		<tr>
			<td>Syringe, 1 cc</td>
			<td>BD, Franklin Lakes, NJ</td>
			<td>Ref 309659</td>
			<td>For injection of lidocaine/ epinephrine</td>
		</tr>
		<tr>
			<td>Tissue forceps, 0.8mm Graefe</td>
			<td>Roboz Surgical Store, Gaithersburg, MD</td>
			<td>RS-5150</td>
			<td>Curved Weck forceps</td>
		</tr>
	</tbody>
</table>

Source: Honkanen, R. A., et al. <a href="https://www.jove.com/v/60126">Establishment of a Severe Dry Eye Model Using Complete Dacryoadenectomy in Rabbits.</a> J. Vis. Exp. (2020).
In this video, we describe a surgical procedure to remove the large inferior lacrimal gland from a rabbit model to study the effect on tear production in the animal.&#160;

<img alt="Figure 1" src="/files/ftp_upload/20847/20847_Figure1.jpg" /> 
Figure 1: Removal of the ILG. (A) The skin and superficial muscle are incised until the fascial plane overlying the zygomatic bone or superficial part of the masseter muscle is reached. The head of the ILG usually is clearly evident as a small bulge located under the anterior limbus. (B) The fibrous capsule of the ILG is incised with scissors exposing the ILG. On...

Source: Honkanen, R. A., et al. Establishment of a Severe Dry Eye Model Using Complete Dacryoadenectomy in Rabbits. J. Vis. Exp. (2020).
In this video, we ...

In rabbits, the lacrimal glands - endocrine glands within the eyelid and the eye orbit that secrete tears - consist of two types: a larger inferior lacrimal gland, ILG, and a smaller superior lacrimal gland, SLG.
The ILG extends along the inferior and posterior regions of the orbital rim or the margin of the eye socket. To extract the ILG, prep an anesthetized rabbit, removing the fur from its face to visualize the anatomical landmarks.
Using an electro micro-dissection needle, make a precise curvilinear incision through the skin and underlying superficial muscles at the posterior and anterior eye orbits, minimizing the blood loss via tissue coagulation. Identify the fascia or the connective tissue surrounding the cheekbone.&#160;
The bulbous anterior ILG portion, known as the head of ILG partially lies on the external surface of the cheekbone, transitioning into the posterior tail of ILG. Make a small incision over the capsule surrounding the ILG head. Cut the orbital septum or the membranous boundary along the inferior orbital rim to expose the posterior ILG tail portion.&#160;
Extend the dissection posteriorly along the tissue plane to expose and remove the entire ILG, without disrupting the blood supply. Close the surgical incision. The prepared rabbit model could be studied for the effect of ILG removal on tear production.&#160;

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Inferior Lacrimal Gland Removal From Rabbit Model: A Surgical Procedure to Remove the Larger Inferior Tear Gland From Rabbit Eye Orbit

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