Comprehensive management of eyebrow and forehead ptosis.
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BACKGROUND: We report our experience with the minimally invasive supraorbital approach to aneurysms of the ipsilateral anterior cerebral circulation. METHODS: A prospective review of all patients who underwent operations to clip aneurysms in Newcastle between 1993 and 2002. RESULTS: Fifty-six aneurysms were clipped via minicraniotomy in 47 patients. Six patients presented with acute subarachnoid hemorrhage (SAH), 40 patients were admitted for elective clipping, and 1 patient presented with an SAH, had the responsible aneurysm clipped and was readmitted later for elective clipping of a further aneurysm. Bilateral supraorbital craniotomies were performed in 3 patients. In 6 patients, multiple aneurysms were clipped via a single craniotomy. All aneurysms were well visualized with the microscope. Endoscopic assistance was not found necessary. All were successfully clipped. Two aneurysms ruptured while being clipped. There was no direct mortality from surgery. One patient died later from a separate posterior circulation aneurysm. One patient had a significant long-term deficit but remained independent, and 1 had 3 seizures over the 12 months after surgery. This represents a 4% morbidity at 1 year. CONCLUSION: Selected anterior cerebral circulation aneurysms can be clipped with low morbidity, using an ipsilateral minicraniotomy preserving the orbital rim, and without using an endoscope. The types of aneurysm selection criteria and operative equipment used are described.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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The result of unilateral brow suspension in severe unilateral ptosis is said to be cosmetically and functionally not satisfactory. For the reason of symmetry, the myectomy of the levator muscle on the healthy side and the bilateral brow suspension have been recommended (Beard's law). However, we have successfully operated the affected side only in several patients without this far-reaching supplement.
Paralysis of the frontalis muscle causes ipsilateral brow ptosis and contralateral hypermotility of the non-paralytic frontalis muscle in Oriental patients. In this paper, we describe an effective way of correcting such asymmetry by using blepharoplasty with aponeurotic fixation, and three case reports were presented. This procedure makes it possible to reduce the hypermotility of the non-paralytic frontalis muscle, and symmetry of the brows can be achieved easily with minimal brow lift. All three patients had symmetrical brows six months postoperatively. Although we think that brow ptosis may recur eventually, if symmetry is obtained as a result of minimal brow lift, we think that our method can delay recurrence.
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The records of 283 consecutive patients treated for facial burns were reviewed. Eighteen percent of these patients had significant deformities of the eyelids or adnexal structures and underwent surgical correction. Our experience in managing these patients is presented and discussed.