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At least 703 records · Page 39Linked to original sources
PubMed2001

Nasolabial V-Y advancement for closure of the midface defects.

BACKGROUND: V-Y subcutaneous advancement flaps receive an excellent blood supply from subcutaneous tissue and are ideal for use on the face. Also it is advantageous cosmetically compared to other local flaps. OBJECTIVE: Nasolabial V-Y advancement flaps are very useful in closing defects of the midface region after tumor resection. METHODS: Our experience with nasolabial V-Y flaps in 22 patients is reported. The average defect size was 2.4 cm x 3.2 cm. RESULTS: Minor flap necrosis occurred in one patient and simple lower eyelid ectropion in another. CONCLUSION: Nasolabial V-Y advancement flap is a simple and satisfactory alternative for closing relatively large defects in the midface when compared with other methods such as skin graft and rotation or transposition flaps. It is easy to design, reliable, and offers good cosmetic results.

Aged↗
PubMed2003

Suspension sutures in facial reconstruction.

BACKGROUND: Suspension, pexing, or tacking sutures were used in facial cosmetic surgery and have recently been used in facial reconstruction. OBJECTIVE: Suspension sutures are used to fix the closure line at the junction of cosmetic units, to prevent distortion of free margins secondary to wound contraction (e.g., ectropion or eclabium), to reform a fold that would be obliterated by the motion of tissue, and to prevent tenting across concavities. Although suspension sutures may help to reduce the spreading of scars in wounds closed under tension, they do not prevent some spreading. METHOD: The suturing technique requires a stable structure for attachment of the suspension sutures and lax tissue to advance into the wound. On the face, a stable base exists under junctions of cosmetic units along the orbital rim, zygomatic arch, nasal vestibule, and mental crease of the chin. When the deep roll of the needle includes superficial musculoaponeurotic system with the first segment or the pulling arm of the suspension suture, tissue advancement is obtained. The second or anchoring segment is placed with the needle encompassing a very tight arc traveling in a U-shaped pass into the fascia extending to the periosteum. CONCLUSION: Suspension sutures enable linear closures, prevent distortion of free margins, prevent tenting across concavities, and fix the closure line at the junction of cosmetic units. By redirecting tension, suspension sutures mold surface contours to mimic the natural folds and curves of the face. Judicious use of suspension sutures permits simpler aesthetic reconstructive procedures than might be achieved without their use. Suspension sutures used in this manner help to apply the theoretical concepts of facial reconstruction using facial cosmetic units by performing segmental facial reconstruction.

Face↗
PubMedDate not supplied

Collodion baby associated with asymmetric crying facies: a case report.

Collodion baby is a distinct subset of neonatal erythroderma that can be a clinical marker for a variety of underlying abnormalities. The phenotype includes parchment-like hyperkeratosis, pseudocontractures, ectropion, eclabium, absence of eyebrows, and sparse hair. Asymmetric crying facies is caused by congenital hypoplasia or agenesis of the depressor anguli oris muscle. Associations of this facial defect with major congenital anomalies have been reported, most commonly in the cardiovascular system, less frequently involving the genitourinary, musculoskeletal, cervicofacial, and respiratory systems, and rarely the endocrine system. We report a newborn with a collodion membrane and asymmetric crying facies. To the best of our knowledge, this association has not been previously published.

Abnormalities, Multiple↗
PubMed2001

Use of the preseptal transconjunctival approach in orbit reconstruction surgery.

PURPOSE: This report evaluated the advantages of the preseptal transconjunctival approach in reconstruction of the orbit. PATIENTS AND METHODS: Ninety-nine preseptal incisions were used in 80 patients for different indications (blowout fracture, complex zygoma fracture, enophthalmos correction, midface hypoplasia, secondary incision). All operative procedures were performed without an additional lateral canthotomy. The infraorbital rim was stabilized with miniplates or microplates. RESULTS: There was no ectropion or entropion in any patients. Complications included 1 laceration of the tarsal plate and 1 temporary entropion after a primary subciliary incision. The overall complication rate was 2%. CONCLUSIONS: The preseptal transconjunctival incision without lateral canthotomy provides good exposure of the orbital floor and the caudal parts of the lateral and medial wall. This approach is preferable to a retroseptal approach in reconstructive orbital surgery because of minimal disturbance of the intraorbital connective tissue framework. The anatomic optimal dissection line also results in a lower complication rate.

Adolescent↗
PubMed2001

Techniques for surgical correction of adnexal disease.

The adnexa frequently requires the general practitioner to intervene surgically to manage underlying disease or as an ancillary aid in the management of corneal disease. Both acquired and hereditary disorders are encountered. This article reviews general anatomy and physiology of the eyelids and discusses indications for the more commonly performed surgical procedures and their execution. Procedures include tarsorrhaphy, management of eyelid lacerations, eyelid tumor resection, correction of upper and/or lower lid entropion, ectropion, a medial and lateral canthoplasty, colobomatous syndrome in the cat, management of distichiasis, trichiasis and ectopic ciliae, and reduction of a prolapse of the gland of the third eyelid. Finally a surgical pack inventory useful for adnexal surgery is described.

Animals↗
PubMed2001

Reconstruction of the orbital floor after its removal for malignancy.

Reconstruction of the orbital floor for malignant disease can be difficult. The tissue used should replace the floor itself and the orbital rim to ensure appropriate positioning of the globe and to avoid ectropion. The authors present a simple technique using temporalis muscle with attached coronoid process of the mandible that covers both these areas, and which is suitable for most defects in this area.

Adult↗
PubMed1998

Zygoma complex fractures.

The zygomaticomaxillary complex (ZMC) has integral structure and function in the bony skeleton of the face. The prominent convex shape of the ZMC makes it particularly vulnerable to injury. Facial trauma can result in fractures limited to a single buttress of the ZMC but more commonly results in a tetrapod fracture involving all four buttresses. Accurate clinical diagnosis is based on a thorough head and neck examination with ophthalmologic consultation when indicated. Computed tomography is the gold standard for confirmation of the clinical diagnosis and for surgical planning. Multiple surgical approaches to the ZMC are discussed, including the hemicoronal approach to the zygomatic arch, the transconjunctival and subciliary approaches to the orbital rim, and the sublabial approach to the zygomaticomaxillary suture line. The topics of one-, two-, or three-point fixation, as well as plate versus wire fixation, are discussed. Finally, the diagnosis and management of complications such as diplopia and ectropion are discussed.

Bone Plates↗
PubMed2003

Midfacial rejuvenation.

The midface is an important new area in facial rejuvenation. Rejuvenation of the midface is necessary to achieve harmonious rejuvenation of the face. The extent of "lift" to be achieved with midfacial elevation is very limited. Excessive elevation of midfacial tissues results in vertical shortening of the lower eyelid, round eye deformity, and ectropion. In patients with previous blepharoplasty or midfacelifts, minimal or no tissue can be resected. Instead, any midfacial advancement achieved is required to reconstruct the lower eyelid form and allow a canthoplasty or canthopexy to heal without undue downward traction on the repair. The surgeon must elevate the midface tissue in a very limited, safe fashion. Many current approaches to midfacial rejuvenation exist in a number of anatomic planes, with several fixation techniques. Some surgical approaches, such as surgery in a suborbicularis plane, may be inherently safer than others. Aesthetic micromanagement of the lower eyelid position and orbicularis muscle is possible. A useful test for assessing the amount of available midfacial tissue is provided.

Aging↗
PubMed1994

[New developments in 1991 in the field of the eyelids].

The publications of the year 1991 dealing with new developments in the field of lids have been reviewed. New methods of reconstruction of the upper and lower eye lid are presented. Chondroplast is a substitute for the tarsal plate which is preserved in a new way and is available in an unlimited amount. A four snip procedure for the correction of lower lid entropion is presented. A new technique of ectropion correction which allows great flexibility in the extent of the approximation of the lower lid to the globe is available. New simplified variations of the surgical treatment of Graves' disease provide a predictable height and contour of the eye lid as well as improved cosmetic results. Alternatively to Botulinum toxin Doxorubicin was injected as a treatment for benign essential blepharospasm and hemifacial spasm in an experimental study.

Eyelid Diseases↗
PubMed1992

[Cosmetic lower eyelid blepharoplasties].

Between April 1988 and December 1991 42 patients underwent a bilateral lower eyelid blepharoplasty. Depending on the etiology either a skin-muscle-flap or a skin-flap technique was used. When the lid was lax, it was shortened by a wedge-resection to prevent postoperative ectropion. The results were satisfactory with either technique.

Adipose Tissue↗
PubMed1986

[Technic and results of Fox bridge plasty for covering defects of the lower lid].

The present paper communicates results of reconstruction of lower lid defects following tumor excision. Surgery was performed on 25 patients using a modified Fox procedure. Functionally and cosmetically the results were good. Three patients developed an ectropion of the lower lid, one of them requiring surgical repair. In 3 cases there was some loss of cilia, though the patients did not find this disturbing. In 2 cases a minor sagging of the lower lid border was seen. A modified version of Fox's original method is proposed as a means of avoiding these complications.

Aged↗
PubMed1985

[Differential diagnosis and therapy of gigantopapillary conjunctivitis].

If wearers of contact lenses present with secretion and incompatibility of the contact lens, simple ectropionation of the upper eyelids often is sufficient to diagnose a giant papillary conjunctivitis as the cause. This form of papillary hypertrophy affecting wearers of both hard and soft contact lenses is morphologically similar to vernal conjunctivitis, which should be considered in cases of corneal ulceration resistant to therapy. The histological difference between the two forms of papillary hypertrophy is that contact lens-induced giant papillary conjunctivitis shows remarkably less eosinophilic infiltration of the papillary stroma. Both forms of papillary hypertrophy seem to be based on a complex immunologic reaction.

Adult↗
PubMed2000

Pharmacology of botulinum toxin.

BACKGROUND: Botulinum toxin has a well-defined role among dermatologists for the treatment of facial wrinkling, brow position, and palmar and axillary hyperhidrosis. OBJECTIVE: The purpose of this study is to educate dermatologists on the pharmacology of botulinum toxin. METHODS: A retrospective review of the literature on botulinum toxin from 1962 to the present was conducted. We examined the clinical applications of botulinum toxin, cholinergic neuromuscular transmission, the toxin's structure and molecular actions, drug and disease interactions at the neuromuscular junction, toxin assays, determinants of clinical response, and adverse side effects. RESULTS: Botulinum toxin blocks the release of acetylcholine from the presynaptic terminal of the neuromuscular junction. Several drugs and diseases interfere with the neuromuscular junction and the effects of botulinum toxin. The mouse bioassay, the most sensitive and specific measurement of toxin activity, is the gold standard for botulinum toxin detection and standardization. The major determinants of clinical response to treatment are the toxin preparation, individual patient's anatomy, dose and response relationships, length of toxin storage after reconstitution, and immunogenicity. To minimize potential antibody resistance, one should use the smallest effective dose, utilize treatment intervals of more than 3 months, and avoid booster injections. Uncommon adverse effects include ptosis, ectropion, diplopia, bruising, eyelid drooping, hematoma formation, and temporary headaches. CONCLUSION: Botulinum toxin is a safe and effective treatment. Knowledge of the pharmacologic basis of therapy will be useful for standardizing techniques and achieving consistent therapeutic results in the future.

Acetylcholine↗
PubMed1999

Surgical correction of entropion and excess upper eyelid skin in congenital cutis laxa: a case report.

Congenital cutis laxa is a rare generalized inherited elastosis, characterized by the appearance of premature aging and skin laxity with mild to severe systemic anomalies. Ocular manifestations include excess skin in the eyelids, ptosis and lower lid ectropion. Of the hyperelasticity syndromes - Ehlers Danlos, Pseudoxanthoma elasticum and cutis laxa - only cutis laxa has normal skin wound healing. The diagnosis must therefore be established before surgical options for treatment are considered. We report an unusual case of a 5-month-old male child with cutis laxa who presented with upper lid entropion secondary to severe redundant upper eyelid skin. An anterior lamellar repositioning procedure successfully corrected the lid margin malposition with complete relief of symptoms.

Journal Article↗
PubMed2002

Primary localized bilateral conjunctival amyloidosis and epiphora.

BACKGROUND: Conjunctival amyloidosis is a rare entity, which can present with epiphora. The management options, including the surgical treatment of this disease, are illustrated with a case study. METHODS: A combination of retrospective and prospective review of a patient's clinical findings, course and treatment outcome. RESULTS: A middle-aged patient with epiphora due to localized conjunctival amyloidosis is described. The clinical course of the epiphora during a 10-year period revealed a decrease on the initially symptomatic side and involvement of the opposite side despite bilateral progressive lacrimal drainage stenosis. The pathophysiology of this phenomenon is discussed. The progressive conjunctival deposits in this patient eventually required operative debulking through a conjunctival approach. Medial ectropion and punctal stenoses were also simultaneously corrected. The patient became symptom free one week after these operative interventions. CONCLUSIONS: Localized conjunctival amyloidosis is a chronic, slowly progressive disease, which is frequently bilateral. Associated ocular involvement does not seem to be a part of this disease, even with long-term follow-up. The treatment of associated epiphora requires an organized approach to the underlying cause(s). The epiphora may be managed by a staged correction of its pathogenic mechanisms.

Aged↗
PubMed2004

Lax eyelid syndrome or 'progeria' of eyelid tissues.

PURPOSE: The lax eyelid syndrome was described by Van den Bosch and Lemij as an uncommon disorder seen in non-obese elderly people and characterised by chronic ocular surface irritation symptoms and a "floppy upper eyelid". The authors present some new features of the lax eyelid syndrome. METHODS: The authors report five patients, belonging to a younger age group, who presented with premature laxity of all the eyelid tissues. This caused medial and lateral canthal dystopia and eyelid malposition including ptosis, entropion and ectropion. Initial surgical correction was often followed by recurrence after some time. CONCLUSIONS: The authors highlight the differences between lax eyelid syndrome, cutis laxa, floppy eyelid syndrome and the blepharochalasis syndrome and suggest that lax eyelid syndrome can be thought of as "progeria" or premature ageing of the eyelid tissues to distinguish it clearly from these other conditions.

Adult↗
PubMed2003

Autosomal recessive congenital ichthyosis in Sweden and Estonia: clinical, genetic and ultrastructural findings in eighty-three patients.

Congenital (non-bullous) ichthyosis is a rare group of keratinizing disorders which can be tentatively subclassified based on clinical criteria, analysis of transglutaminase 1 gene mutations and electron microscopy of epidermis. We studied 83 patients who were all on topical therapy and in 16 cases also on oral retinoids. Three main groups of patients were distinguished: (A) those with transglutaminase 1 gene mutations (n=44), (B) those without transglutaminase 1 gene mutations showing a coarse, generalized scaling (n=19), and (C) those without transglutaminase 1 gene mutations showing only fine or focal scaling (n=20). On clinical scoring, patients in group A were more hyperkeratotic and less erythematous than those in group B (p < 0.05). Anhidrosis was recorded in nearly all patients (> or = 80%), but ectropion and a collodion phenotype at birth were more common in group A versus other groups. Ultrastructurally, a high frequency of type I (Anton-Lamprecht's classification) was found in all three groups (37-63%), 20 cases of type II in group A and a few cases of types III and IV in groups B and C, respectively. In conclusion, transglutaminase 1 gene mutation is a major cause of congenital ichthyosis in Sweden and Estonia, and is often associated with severe scaling and ultrastructural type II in corneocytes. The transglutaminase-unrelated cases are more heterogeneous, probably reflecting a more varied aetiology.

Adolescent↗
PubMed1977

Eye disorders. Treatment of baggy eyelids.

Blepharochalasis is a redundancy of the eyelid skin. It may be associated with herniation of orbital fat, and the eyelids may have a baggy appearance. They may become heavy and reduce the visual field. Blepharoplasty, in which the excess skin and fat are removed, can not only improve appearance but can also improve ocular function. The most common serious complication of surgery is overcorrection of the lower eyelids. Skin grafting may be required to repair the resulting ectropion. Since visual compromise is a rare but possible complication, complete preoperative ophthalmologic evaluation is advisable.

Cutis Laxa↗