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Biomedical subjects

C R Leone

Publications and source records attributed to C R Leone.

At least 37 records · Page 2Linked to original sources
PubMed1989

Medial and lateral wall decompression for thyroid ophthalmopathy.

A two-wall decompression of the orbit, consisting of removal of the medial and lateral walls, was successful in eight patients with thyroid ophthalmopathy. The lateral wall was by removed by using the standard orbitotomy technique in addition to enlarging the space with a pneumatic burr, and the medial wall was removed through a direct medial canthal incision. Two patients had optic neuropathy, one had intermittent subluxation of the globe, and five had symptoms of exposure or increased pressure in the orbital area. In our eight patients, the two with optic neuropathy improved, the patient with subluxation of the globe became asymptomatic, and the other five had less exposure and were more comfortable. The amount of decompression ranged between 4 and 7 mm. The lacrimal sac was injured in one patient; temporary silicone intubation avoided any permanent sequela.

Aged↗
PubMed1989

Lower lid reconstruction using tarsoconjunctival grafts and bipedicle skin-muscle flap.

We describe a method of subtotal lower eyelid reconstruction employing either a free tarsoconjunctival graft or a transpositional tarsoconjunctival flap from the upper lid together with a bipedicle skin-muscle advancement flap from the lower lid. A full-thickness skin graft is placed into the defect created by the movement of the bipedicle flap. This technique obviates the need to use a lid-sharing procedure that occludes the fissure and would be indicated for the monocular patient or one who would be at a serious disadvantage with the eye covered for several weeks.

Conjunctiva↗
PubMed1989

Bipolaris hawaiiensis-caused phaeohyphomycotic orbitopathy. A devastating fungal sinusitis in an apparently immunocompetent host.

The authors present a case report of a devastating bilateral optic neuropathy and orbitopathy initiated by a contiguous fungal sinusitis, in an apparently immunocompetent young man. The causative organism, Bipolaris hawaiiensis, and other species classified in the genus Bipolaris, are being recognized with increased frequency as causes of several ophthalmic and systemic disorders in both immunocompromised and normal hosts. A literature review demonstrates the variety of clinical presentations with emphasis on those cases which may present to the ophthalmologist.

Adult↗
PubMed1989

The management of pediatric lacrimal problems.

The most common cause of tearing in the pediatric age group is blockage of the distal end of the nasolacrimal duct at the valve of Hasner. Evaluation with fluorescein using the dye disappearance test and the primary dye test, although not always as accurate as in adults, is possible. Conservative treatment is attempted initially followed by probing and, if necessary, silicone intubation. Less common causes of tearing are punctal atresia and congenital lacrimal sac fistula, which are usually diagnosed later, requiring opening of the atretic membrane and excision of the fistula tract, respectively. Amniotoceles are usually seen within a week of birth and are treated aggressively with medication and/or probing to prevent acute dacryocystitis.

Humans↗
PubMed1989

Optic nerve pseudomeningioma secondary to localized amyloidosis.

A 55-year-old woman presented with a mass of the optic nerve sheath suggestive of a meningioma. On excision, this proved to be amyloid. No systemic involvement could be found. Although amyloid may arise as a solitary lesion of the orbit or extraocular muscle, this "pseudomeningiomatous" pattern has not been previously noted. A magnetic resonance scan was helpful because the amyloid imaged at a density similar to vitreous and cerebral white matter, unlike meningiomas, which appear more like bone. The diagnosis of localized amyloidosis, however, still remains dependent on histopathology and cannot be made on a clinical basis.

Amyloidosis↗
PubMed1989

Primary mucinous sweat gland carcinoma of the eyelid.

A 76-year-old woman had a slowly enlarging lesion of the right lower eyelid. After obtaining incisional biopsy results consistent with adenocarcinoma, we removed the tumor and made a final diagnosis of primary mucinous adenocarcinoma of the sweat gland. The defect was repaired using ipsilateral upper lid transpositional tarso-conjunctival and skin-muscle flaps. No evidence of recurrence or metastasis was noted 42 months postoperatively. Consideration of such tumors is clinically important, since they have full metastatic potential. We therefore suggest consideration of sweat gland primary mucinous adenocarcinoma in the differential diagnosis of red or violaceous eyelid masses.

Adenocarcinoma, Mucinous↗
PubMed1988

Benign osteoblastoma of the orbit.

Benign osteoblastoma is a rare lesion of the orbit--only five cases have been described previously. The usual location is in the vertebral column and to a lesser extent in the skull. Although it is an invasive lesion, recurrences have not been reported after en bloc excision. The authors report a 10-year-old boy who presented with upper lid swelling, proptosis, and hypophthalmia. A computed tomography (CT) scan showed a calcified mass in the superior orbit which had eroded through the roof, and magnetic resonance imaging (MRI) showed a well-circumscribed mass between the periorbita and dura. A transcranial approach was used to remove the tumor, and the roof reformed with polypropolene. He has been followed for 18 months without recurrence.

Child↗
PubMed1988

Surgical approaches to diseases of the orbital apex.

The authors report their experience with transcranial approaches to the orbit in situations where adequate exposure would not have been obtained with the usual orbital techniques. In addition to the standard frontal craniotomy, a supraorbital transcranial approach is described that involves removal of the superior rim and roof of the orbit, allowing exposure of all but the floor of the orbit. The main indication for this technique is a mass deep in the orbital apex that would be difficult or impossible to expose with a conventional orbitotomy. Seven representative cases are presented that illustrate conditions falling in that category.

Adult↗
PubMed1988

Management of the blepharoplasty patient with ptosis.

Patients who request correction of both dermatochalasis and acquired blepharoptosis require separate evaluation of each condition. The blepharoplasty is done in the standard way, depending on the amount of skin redundancy and fat herniation. The method of ptosis repair is dependent on whether Müller's muscle or levator aponeurosis is weak, the degree of ptosis and levator function, and the position of the upper eyelid crease. A tarsal Müller's muscle resection is employed in cases where the ptosis is minimal, the upper eyelid crease is normal, or the phenylephrine test is positive. A levator advancement is done if the ptosis is due to a levator aponeurosis dehiscence or attenuation with a higher than normal upper eyelid crease and thinning of the eyelid. Both procedures are easily combined with an upper eyelid blepharoplasty.

Aged↗
PubMed1987

Chronic hematic cyst of the orbit.

A chronic hematic cyst of the orbit caused unilateral globe displacement in four patients, two of whom had a past history of orbital trauma. The onset of a painless vertical displacement of the globe ranged from 3 weeks to 4 years. Computed tomographic (CT) findings demonstrated a homogeneous, nonenhancing, subperiosteal mass in the superior orbit in three patients and the inferior orbit in one. At surgery, all patients had masses surrounded by a pseudocapsule without epithelial or endothelial lining. The history, age distribution, and CT findings help to differentiate this entity from other causes of unilateral exophthalmos.

Adolescent↗
PubMed1987

Lateral canthal reconstruction.

After the lateral aspect of both the upper and lower eyelids were excised in six patients, a method of reconstruction was used employing a combination of periosteal flaps from the lateral orbital rim and a transpositional skin flap based in the temporal area. The periosteal flaps were crossed to form a sharp canthal angle and were joined to the tarsal edges creating the posterior lamella. The transpositional skin flap was divided at the distal end to form the anterior lamella of the upper and lower lids. The results have been satisfactory from a functional and cosmetic standpoint.

Aged↗
PubMed1987

Enophthalmos and upper eyelid retraction following osteoplastic frontal sinusotomy.

A 38-year-old man presented with hyperophthalmia, enophthalmos, and upper eyelid retraction 18 months following an osteoplastic flap and frontal sinus obliteration for mucocele. Computerized tomography confirmed the presence of frontal bone absorption in the roof of the orbit with traction and elevation of the orbital contents into the obliterated frontal sinus. A fracture of the orbital roof with penetration of periorbita at the time of original surgery was the suspected precipitating cause of the complication. Surgical management included lysis of the cicatrix between the orbit and frontal sinus and interposition of a silicone sheet between the orbit and sinus, which restored the appropriate anatomic relationships and prevented recurrence.

Adult↗
PubMed1986

Congenital orbital teratomas.

Teratomas of the orbit, rare congenital tumors consisting of normal tissues derived from all three germ cell layers, are probably choristomas rather than true neoplasms, and must be considered in the differential diagnosis of neonatal orbital masses. They typically grow rapidly after birth, causing destructive proptosis and exposure keratopathy; however, they may take a slowly progressive course, expanding slightly over several years. We studied two cases of histopathologically proven orbital teratomas. In one patient, a 2-month-old girl, the tumor was solid and enlarged rapidly after birth. In the other patient, a 15-year-old girl, the mass was cystic and grew at a very slow rate. In the latter case, vision was preserved, presumably because of the ease with which the tumor could be bluntly dissected from the ocular tissue. We believe that, when possible, early and complete extirpation is the procedure of choice, to ensure the greatest likelihood of visual preservation and symmetric orbital growth.

Adolescent↗
PubMed1986

Dermis-fat graft for orbital reconstruction after subtotal exenteration.

A surgical technique for reconstruction after subtotal orbital exenteration uses an autogenous dermis-fat graft. A musculocutaneous flap is advanced over the graft to provide the anterior vascular supply for the free dermis-fat graft. The periorbita and remaining orbital tissue provide the vascular supply posteriorly. This technique eliminates extensive skin grafting and delayed spontaneous healing. Wound healing is rapid and surgical morbidity is minimized. We have used this procedure in three patients with sebaceous gland adenocarcinoma, two patients with severe posttraumatic contracted sockets, and as a palliative procedure in one patient with a fungating choroidal melanoma and widespread metastasis.

Adipose Tissue↗
PubMed1986

Correction of a deep superior sulcus with dermis-fat implantation.

We describe five patients with deep superior sulcus deformities who had dermis-fat grafts implanted into the preaponeurotic space. Three patients had anophthalmic sockets, and two had normal seeing eyes. The grafts were taken from the left lower abdominal quadrant above the iliac crest and the donor site was closed primarily. At the time of surgery, an effort was made to overcorrect the deformity. All five patients were improved, although one of the anophthalmic patients developed a slight postoperative ptosis. A follow-up of at least one year has shown no sign of fat absorption.

Adipose Tissue↗
PubMed1986

Proptosis with mastication: an unusual presentation of an orbital dermoid cyst.

A 25-year-old woman presented in 1973 with the complaint of proptosis of the left eye with mastication. A firm retrobulbar orbital mass was detected, and diagnosis of possible dermoid cyst was made. She was subsequently lost to follow-up. Computed tomographic (CT) scanning and surgical excision done in 1984 confirmed the presence of an orbital dermoid cyst communicating with the temporal fossa through a bony defect in the lateral orbital wall. We suspect that pressure by the temporalis muscle on the dumbbell-shaped cyst caused the proptosis with mastication.

Adult↗