Biomedical subjects
Publications and source records attributed to James R Patrinely.
A 62-year-old woman received injections of Restylane, cross-linked hyaluronic acid, for the cosmetic filling of facial rhytids and developed a severe dermal inflammatory reaction. Hyaluronidase administered directly in the inflammatory nodules resulted in rapid resolution of pain, palpable nodularity, and visible induration possibly due to dissolution of the hyaluronic acid.
PURPOSE: To report cold urticaria as an under-recognized cause of potential periorbital and facial edema after elective oculofacial plastic surgery. METHODS: Retrospective case series of three patients with primary acquired cold urticaria with review of the clinical aspects of each of the cases. RESULTS: Two of the patients had significant postoperative swelling attributed to primary acquired cold urticaria after the routine use of cool compresses to their surgical sites. The third patient had known primary acquired cold urticaria and required special perioperative management. All three patients ultimately had a good surgical outcome with no long-term sequelae. CONCLUSIONS: Although primary acquired cold urticaria is generally not a serious condition, it can be easily overlooked and misdiagnosed as a localized adverse reaction to injected anesthetic, topical antibiotic ointments, or early preseptal cellulitis after eyelid or facial surgery. Rarely, this condition can be fatal and should be recognized by the surgeon to ensure both optimal surgical results and general medical management. Three simple screening questions should identify most patients with this disorder.
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Explore the source record for details and available documents.
A 65-year-old woman received injections of Restylane, cross-linked hyaluronic acid, for the intended cosmetic filling of periorbital rhytids. The achieved result was undesirable, and the filler lasted more than 5 years. Hyaluronidase administered directly beneath the treated areas resulted in rapid resolution of the Restylane effect.
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OBJECTIVE: To report the technique and success of using monitored anesthesia care instead of general anesthesia for ocular enucleation and evisceration surgeries. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Twelve enucleated patients (Soparkar and Patrinely) and 146 eviscerated patients (Kulwin and Kersten). METHODS: Surgical logs of two oculoplastic practices were reviewed searching for cases of ocular enucleations and eviscerations performed under monitored anesthesia care between 1990 and 2001. Identified hospital and clinic charts were then reviewed. MAIN OUTCOME MEASURES: Monitored anesthesia care was deemed successful if (1) there were hemodynamic stability and complete analgesia intraoperatively; (2) there was absence of any chart documentation regarding patient or family psychological distress over the anesthesia method used; and (3) patients were discharged from the hospital without the need for observation or treatment > or = 23 hours. RESULTS: Between 1990 and 2001, 146 eviscerations were performed under local anesthesia with monitored anesthesia care by two surgeons (RCK, DRK) as their routine practice pattern. In 1996, Drs. Soparkar and Patrinely began performing enucleations under monitored anesthesia care in selected cases, and from 1996 to 2001, these surgeons enucleated 12 patients under monitored anesthesia care. Four of the enucleated patients requested surgery without general anesthesia. The remaining eight patients had been refused surgery by at least one other specialist because of the patient's perceived high medical risk for complications under general anesthesia. In all 158 patients, the procedures were deemed successful by the preceding criteria. CONCLUSIONS: This four-surgeon case series reports the successful use of local anesthesia with monitored care for ocular enucleation and evisceration procedures, offering several potential advantages over the traditional use of general anesthesia.
PURPOSE: To report a case of cherubism with extensive, bilateral orbital involvement occurring in a 27-year-old woman who had the diagnosis established at the age of 4 years. DESIGN: Single interventional case report. INTERVENTION: Ophthalmologic examination and computed tomography were performed. The patient underwent multiple surgical excisions using a bicoronal and transorbital approach. The excised orbital tissues were studied histopathologically. RESULTS: Computed tomography showed bilateral inferior lateral masses involving the orbital floors and producing marked superior displacement of the orbital contents. The intrinsic expansile bone lesions involved the inferior and lateral orbital walls with apical compression of the optic nerves. Histopathologic examination of the masses revealed scattered giant cells in a fibroblastic stroma containing small vascular channels. The lesion was interpreted as giant cell reparative granuloma. CONCLUSIONS: Giant cell reparative granuloma is an uncommon bone lesion that might involve the orbit. Cherubism should be included in the differential diagnosis of lesions that show the histopathologic features of giant cell reparative granuloma.
OBJECTIVE: To characterize and evaluate treatment options for medial rectus muscle (MR) injury associated with functional endoscopic sinus surgery (FESS). DESIGN: Retrospective interventional case series. PARTICIPANTS: A total of 30 cases were gathered from 10 centers. METHODS: Cases of orbital MR injury associated with FESS surgery were solicited from members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) through an e-mail discussion group. MAIN OUTCOME MEASURES: Variables assessed included patient demographics, computerized tomography and operative findings, extent of MR injury and entrapment, secondary orbital/ocular injuries, initial and final ocular alignment and ductions, and interventions. RESULTS: A spectrum of MR injury ranging from simple contusion to complete MR transection, with and without entrapment, was observed. Four general patterns of presentation and corresponding injury were categorized. CONCLUSIONS: Medial rectus muscle injury as a complication of FESS can vary markedly. Proper characterization and treatment are important, particularly with reference to the degree of direct MR injury (muscle tissue loss) and entrapment. Patients with severe MR disruption can benefit from intervention but continue to show persistent limitation of ocular motility and functional impairment. Prevention and early recognition and treatment of these injuries are emphasized.
We describe a new approach for the closure of eyelid margin defects. We conducted a prospective evaluation of patients undergoing the buried vertical mattress technique for full-thickness eyelid margin repair and found that 90 patients (follow-up, 3 to 18 months; average, 6 months) had eyelid margin defects closed with the use of a buried vertical mattress technique. There were no cases of dehiscence, and only 5 (5.5%) patients had minor notch formation. We conclude that the buried vertical mattress suture technique can be a safe and effective method to close eyelid margin defects while saving postoperative time and the cost of multiple sutures.
We describe an effective adjunctive suture technique for severe forms of both tarsal and marginal ectropion in a case series of 28 patients undergoing the rotation mattress suture technique for ectropion repair. Forty eyelids, followed for 1 to 5 years (average, 2.5 years), underwent tarsal or marginal ectropion repair, using the rotation mattress suture technique. Transient notching was noted in 31 eyelids (78%) but persisted in only 1 case (3%). Twenty-five eyelids (63%) had 0.5 to 1.0 mm of eyelid retraction. There were only 2 cases (5%) of recurrent ectropion. We found that excluding transient changes and predictable, mild lower eyelid retraction, the rotation mattress suture provides a powerful adjunctive reparative option for difficult cases of ectropion with low complication and failure rates.
PURPOSE: To review cases of spontaneous enophthalmos erroneously diagnosed as silent sinus syndrome to identify other inflammatory disorders with a similar clinical presentation. METHODS: Retrospective observational case series. Chart reviews were performed covering encounters over a 5-year period, searching for patients referred to two physicians with an incorrect diagnosis of silent sinus syndrome. Only cases of acquired enophthalmos of reported nontraumatic or nonneoplastic cause were included. Particular attention was directed toward noting clinical features of upper eyelid position and periocular atrophy. RESULTS: Nineteen cases of erroneous referral for silent sinus syndrome were identified. Fourteen of these cases were due to tumor, trauma, congenital facial asymmetry, or diffuse facial lipodystrophy. Among the remaining cases, four were diagnosed as Parry-Romberg syndrome and one as linear scleroderma. CONCLUSIONS: Parry-Romberg syndrome and linear scleroderma must be distinguished from silent sinus syndrome as causes of inflammatory-mediated, spontaneous enophthalmos.
PURPOSE: To report patients who received dog bite injuries to the periocular area and the incidence of repeat attacks by the biting dog and its disposition. To discuss the demographics of bite attacks, occult injuries, steps to avoid medicolegal problems, and the appropriate options for animal disposition. METHODS: Single-practice prospective case series of dog attacks on 18 victims. Patients were followed and questioned about any repeat attacks by the offending dog. RESULTS: Of 18 individuals who received dog bites to the perio-ocular area, only 2 were >12 years old. Of the 16 cases available for follow-up (4 months to 3 years; mean, 16 months), 7 of the dogs were euthanized and 1 was sent away from the family. Of the 8 remaining animals, 5 (63%) bit again. All the dogs bit family members or family friends. CONCLUSIONS: Although most dogs make wonderful pets, canine bites pose a significant public health concern, and some simple steps may be taken to protect against personal injury and legal fallout from repeat attacks.
Orbital-floor blowout fractures of the trapdoor variety, first described by Soll and Poley, have also appeared in the French and Japanese literature. The trapdoor fracture is described as a pure orbital-floor fracture, linear in form and hinged medially, which allows herniation of orbital contents through the fracture and then entraps these herniated contents. A review of the orbital-floor fracture literature reveals a high incidence of persistent diplopia associated with ocular-muscle entrapment, which may later necessitate corrective surgery of extraocular muscles. Recent publications in the ophthalmologic literature have stressed the importance of early surgical intervention. This article reports a retrospective series of 19 pediatric patients (age range, 5 to 16 years) who presented to two institutions. All patients had radiographic confirmation of a trapdoor fracture. Physical examination demonstrated a high association between these fractures and restricted ocular motility (17 of the 19 patients). In the cases with trapdoor fracture and restricted ocular movement, early intervention was associated with better postoperative function. It is thus recommended that the symptomatic trapdoor orbit fracture be considered an urgent indication for surgical intervention. Practitioners therefore must have a high index of suspicion for these injuries. Prompt diagnosis is critical to maximize clinical outcome.
OBJECT: Partial resection of the orbital bones is not uncommon during the excision of anterior and anterolateral skull base tumors. Controversy exists regarding the need for and extent of reconstruction after this procedure. The authors studied this factor in a series of patients. METHODS: The authors conducted a retrospective review of 56 patients in whom resection of 57 anterior or anterolateral skull base tumors and partial excision of the orbital bone were performed. Adverse ophthalmological outcomes were noted in 16 patients, in nine of whom adverse outcomes were believed to be directly related to resection of the orbital walls. Some degree of orbital reconstruction was performed during 23 of the 57 procedures. An adverse orbital outcome was strongly associated with resection of the orbital floor and resection of two thirds or more of two or more orbital walls, but not with the presence or absence of orbital reconstruction. The later finding, however, is likely a function of selection bias. CONCLUSIONS: In most patients elaborate orbital reconstruction is not necessary after partial excision of the orbital bones. Isolated medial and lateral orbital wall defects, or combined superior and lateral orbital wall defects, especially in cases in which the periorbita is intact, probably do not require primary reconstruction. In cases of orbital floor defects, whether isolated or part of a multiple-wall resection, primary reconstruction is recommended.