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At least 775 records · Page 43Linked to original sources
PubMed2000

Use of orbicularis oculi muscle flap for undercorrected blepharoptosis with previous frontalis suspension.

The frontalis muscle and its fascia are connected with the orbicularis oculi muscle at the level of the eyebrow. Therefore, the superiorly based orbicularis oculi muscle flap, when advanced and attached to the tarsal plate, can dynamically elevate the upper lid and correct blepharoptosis with previous frontalis sling. Six patients with undercorrected blepharoptosis after frontalis sling suspension were included in this study. The superiorly based orbicularis oculi muscle flap was advanced to the tarsal plate in these patients and the redundant portion of the distal flap was resected. Postoperative results were satisfactory after 1-year follow-up.

Adolescent↗
PubMed2002

Incomplete excision of basal cell carcinoma: a prospective multicentre audit.

The audit of incomplete excision of basal cell carcinoma can be used as a parameter for clinical governance in plastic surgery units. However, there are no national standards, and all the previous reports from the UK have been retrospective and from regional units only. This 1 year prospective audit was undertaken simultaneously in the plastic surgery units of three different categories of hospital: a regional plastic surgery unit (University Hospital of South Manchester), a supraregional cancer hospital (Christie Hospital) and a district general hospital (Royal Bolton Hospital). A total of 757 lesions were excised from 600 patients, with 34 lesions (4.5%) being incompletely excised. The incidences of incomplete excision were similar in the regional unit (3.2%) and the district general hospital (3.1%), but higher in the supraregional cancer hospital (7.5%). The commonest site for incomplete excision was the eyebrow, followed by the postauricular area, the nose and the temple. There were no statistically significant differences in the distributions of the age and sex of the patients, the site and size of the lesions or the methods of repair between the three hospitals. However, there were significant differences in the distribution of syndromal, multiple and recurrent lesions, the grade of surgeon, and the clinical and histological subtypes. When the various confounding factors were adjusted by logistic regression, the variables most likely to have affected the incidence of incomplete excision were found to be grade of surgeon, minimal excision margin and histological subtype.

Adolescent↗
PubMed2001

Microsurgical and endoscopic approaches to the basilar bifurcation: quantitative comparison of combined pterional/anterior temporal and orbitozygomatic extended approaches.

To determine the most effective route to the upper third of the basilar artery, 10 cadaver dissections were performed comparing the exposure gained using the combined pterional/anterior temporal approach and the orbitozygomatic extended approach. Endoscopic evaluation through an eyebrow incision in each dissection helped determine whether any advantage was conferred by the cranial base approach. This also served to assess the benefit of using the endoscope as an adjunct to open procedures in evaluating the opticocarotid and retrocarotid routes to the basilar artery. The results of cadaveric dissections suggest that compared with the exposure afforded by the combined pterional/anterior temporal approach, the orbitozygomatic extended approach yields an increase of 8 cm in the anteroposterior axis and 10 cm in the superoinferior axis. Furthermore, as expected, the increases in visibility were directed anteriorly and posteriorly. When employed through the craniotomy site during aneurysm clipping, endoscopy was found to be potentially useful in assessing the contralateral elements of the upper basilar complex.

Journal Article↗
PubMed2003

[Human cowpox/catpox infection. A potentially unrecognized disease].

HISTORY AND ADMISSION FINDINGS: A 36-year-old woman initially noticed a red spot, about pea-sized, with a central pimple over the right eyebrow and a swollen submandibular lymph node. A pressure-sensitive, 4 cm large, node developed out of this small spot, with a central, black, tightly-adhering crust bearing several varioliform vesicles around its edge. In addition to swelling of the right half of the face, the patient had a fever up to 39.5 degrees C, general malaise, nausea and vomiting. Various antibiotics were ineffective. The woman was hospitalized with a diagnosis of facial erysipelas. She owned a cat which had developed a purulent nodule on a forepaw a few days before onset of the patient's disease. LABORATORY TEST: ESR and CRP were moderately elevated, no leukocytosis and blood cultures were sterile. Wound smears showed colonization with Klebsiella pneumoniae and Enterobacter cloacae. DIAGNOSIS, TREATMENT AND COURSE: The patient's general condition improved under initially calculated antibiotic dosages, which was later adapted to the measured resistance. The black-crusted nodes became larger, however, and incision was performed on the 8 th day after hospitalization, under the suspicion of fluctuation. However, no pus was removed, but there was massive inflammatory infiltration of the soft tissue. Examination of samples of skin and part of the crust revealed orthopox virus (cowpox virus). Spontaneous healing followed within 3 weeks, leaving only a small scar. CONCLUSIONS: This was a cowpox virus in the sense of a zoonosis transmitted by the cat. In Germany, now that smallpox has been eradicated, the clinical presentation of infections with the orthopox virus, which are closely related to variola virus, are too little recognized. Atopic and immunocompromised patients are at risk of a cutaneous dissemination with a more severe course of the infectious illness; even a lethal outcome has been reported in Germany.

Adult↗
PubMedDate not supplied

[Griscelli syndrome: a case report].

BACKGROUND: Griscelli syndrome is a rare disorder with poor prognosis. It is characterized by silver-grey hair or strands of silver-grey hair in childhood, and variable cellular immunodeficiency. The course of the untreated disease is fatal. Recurrent episodes of fever and lymphohistocytic infiltration of organs lead to hepatosplenomegaly, lymphadenopathy, pancytopenia, and progressive neurological impairment. Prognosis on morbidity and lethality depends on an early diagnosis. PATIENT: The girl we report on suffers from Griscelli syndrome. She developed normally and only her grey strands of hair, grey eyebrows, and eyelids were conspicuous. With the age of 4 years, she presented with a first episode of illness. RESULTS: Cytostatic treatment seemed to ameliorate the course of the disease although further accelerated phases could not be prevented. The only therapeutic option is a bone marrow transplantation, which we conferred upon our patient. CONCLUSION: The finding of grey hairs in childhood should alert clinicians to consider Griscelli syndrome since an early diagnosis is life and health saving.

Administration, Oral↗
PubMed2004

Congenital lipoblastoma of the scalp.

Lipoblastoma is a unique tumor of infancy and early childhood that can occur congenitally. It commonly occurs in trunk and extremities, but also rarely in head and neck. We have not encountered any report of congenital lipoblastoma of scalp in published literature. Here we describe the case of an infant who presented with a rapidly growing large scalp mass that measured 15 x 15 x 10 cm. At birth, the mass was located on the bregma but progressed to extend into the left upper eyelid and eyebrow. The mass was resected in two stages: the first stage consisted of resecting the scalp mass and the second stage consisted of excising the eyelid extension of the lesion. The histology of both resection specimens was similar and showed lobular adipose tissue separated by fibrous septae, which was consistent with a lipoblastoma. The child is free of recurrence at follow-up 3 years after the resection.

Biopsy, Fine-Needle↗
PubMed2005

Ultrasonographic findings of facial dysmorphism in Wolf-Hirschhorn syndrome.

Wolf-Hirschhorn syndrome has characteristic craniofacial dysmorphism with severe fetal growth restriction. We present a case that revealed facial dysmorphism characteristic of Wolf-Hirschhorn syndrome with two- and three-dimensional ultrasonography. The facial dysmorphic features in the present case were dolichocephaly; high forehead; large rectangular nose continuing to the eyebrows; hypertelorism; short philtrum; carp-shaped mouth; microretrognathia; and large, simply modeled, low-set ears. Chromosome analysis of amniotic fluid cells was 46,XX,del(4)(p15.2), confirming the ultrasonographic result. Examination with two- and three-dimensional ultrasonography is useful to observe the face of fetuses with severe intrauterine growth restriction to diagnose multiple congenital anomaly syndromes.

Abnormalities, Multiple↗
PubMed2005

[Wooden spike orbital injury].

A 71-year-old female patient fell in her garden, inducing a skin wound on the temporal left eyebrow. Skin disinfection and wound closure were performed elsewhere, an X-ray image did not reveal a foreign body. She was referred to our service three days later with a progressive left periorbital swelling. Clinical inspection demonstrated a painfully, fluctuant swelling around the wound with an inflammatory pseudoptosis of the left eye. Vision was reduced on the left eye; anterior and posterior segments of both eyes were unharmed. After opening the wound sutures a purulent liquid was drained and a wooden fragment was found, measuring 22 x 0.5 mm. Because of restriction of abduction of the left eye, magnetic resonance imaging (MRI) was performed, detecting another organic intraorbital foreign body and a fracture of the left medial orbital wall. Anterior orbitotomy was performed and a wooden fragment was removed, measuring 47 x 0.6 mm. Under administration of intravenous antibiotics vision and ocular motility recovered uneventfully. This case emphasizes the value of MRI in the diagnostics of retained wooden foreign bodies as well as the importance of a soigneuse inspection of skin wounds with a high risk for remaining foreign bodies.

Aged↗
PubMed2006

[Chromosome 1q syndrome and hearing loss: an unusual case].

INTRODUCTION: The interstitial deletion of chromosome 1q is a disease of rare incidence, which might be hereditary or caused by spontaneous changes within the chromosome respectively. The phenotype in most cases is based on the loss of macrochromosomal material within the long arm of chromosome 1. The characteristics of this syndrome include pre- and postnatal growth retardation, severe psychomotor retardation, microbrachycephaly, sparse fine scalp hair and eyebrows, deformity of skull with cleft of lips and palate, scoliosis, small hands and feet hernias, genital defects, clinodactyly of the fifth fingers and campylodactyly. Other morphological characteristics that have been reported are mainly kidney and cardiac abnormalities. The number of symptoms are related to the loss of genetic material. To our knowledge this is the first description of a patient with interstitial deletion of chromosome 1 (q23-q31). PATIENT: We report an eleven year old boy with interstitial deletion of chromosome 1(q23-q31). In addition to the known skeletal, orofacial disorders, hypothrophia and retardation we discovered a unilateral high-graded and contralateral middle-graded hearing loss. CONCLUSION: In infants with chromosome 1q syndrome adequate diagnostic procedures have to be employed to unveil sensineural hearing losses that might be overseen because of mental retardation. In particular a brainstem electric response audiometry should be considered for early diagnosis and treatment of a possible hearing-loss.

Abnormalities, Multiple↗
PubMed2005

Laser techniques associated with facial aesthetic and reparative surgery.

Chronological aging is a natural biological event that is seen particularly in the face. Attempts to correct the results of this facial loss of structural form are sometimes successful. The skin itself is usually neglected, and surgery sometimes fails to achieve the goals expected by the patient. The surgical laser offers an extremely elegant and powerful solution to this problem to complement or enhance the results of selected surgical facial aesthetic procedures as follows: (1) ablative full-face CO2 laser resurfacing in combination with facelifting; (2) laser surgical technique for upper eyelid ptosis; (3) lower eyelid blepharoplasty with the aid of the CO2 laser; (4) full-face resurfacing following minilifting of the lower part of the face; (5) endoscopic eyebrow lifting combined with laser resurfacing; (6) perioral CO2 laser resurfacing in combination with facelifting; and (7) several miscellaneous procedures (e.g., treatment of upper and lower xanthelasma with laser upper blepharoplasty, laser resurfacing in combination with fillers, and laser resurfacing of periocular wrinkles after surgical blepharoplasty). In the hands of the authors, the combination of laser and standard surgical procedures presented herein has consistently produced good results and high patient satisfaction. The complication rate is low and the recovery rate is excellent. Laser treatment enhances the natural look obtained by conventional surgeries.

Blepharoplasty↗
PubMed2005

A complex brain malformation syndrome with rhombencephalosynapsis, preaxial hexadactyly plus facial and skull anomalies.

We report on a 15-year-old boy with epilepsy and mental retardation who had been repeatedly shunted since birth for hydrocephalus. This child showed at imaging an unusual, severe and complex brain malformation consisting of distorted gyral patterns with deeply infolded mantle in the parietal-lateral and posterior-temporal lobes, normal versus dysplastic cortex, unseparated thalami, thin white matter, collapsed ventricles, partial frontal corpus callosum agenesis, closely apposed superior and middle cerebral peduncles with narrow fourth ventricle, continuity of posterior cerebellum hemispheric foliar patterns across the midline, closely apposed cerebellar peduncles, asymmetrical hypogenesis of the vermis and herniation of the cerebellar hemispheric pattern up through the tentorial incisure. In addition, this boy had congenital skeletal and skin anomalies including pre-axial hexadactyly with thumb duplication, wide bone occipital lacunae (catlin mark) with partial occipital suture synostosis, cutis vertex rigirata and a tuft of hair in the outer region of the right eyebrow. Several of these cerebral and cerebellar abnormalities were suggestive of rhombencephalosynapsis. Nonetheless, many of these brain abnormalities are also recorded in Chiari type 2 malformation after operative shunting. To the best of our knowledge, however, this complex constellation of nervous system, skeletal and skin abnormalities has not been previously reported.

Adolescent↗
PubMed2005

The supraorbital approach: an alternative to traditional exposure for the surgical management of anterior fossa and parasellar pathology.

OBJECT: The use of a supraorbital craniotomy as a minimally invasive neurosurgical technique to treat pathology located in the anterior cranial fossa and parasellar region is reported. MATERIALS AND METHODS: 25 patients were operated upon using the supraorbital keyhole technique to expose various lesions located in the anterior skull base. Included were benign and malignant tumors, AVM, tuberculoma and trauma. DISCUSSION AND CONCLUSION: Utilizing small eyebrow incisions, a small supraorbital ("keyhole") craniotomy, and microneurosurgical and/or endoscopically assisted access, allowed us to gain excellent optimal and safe exposure to a number of different pathologies of the anterior base and parasellar regions. The lesions were resected under complete control and with full preservation of surrounding neurovascular structures.

Adolescent↗
PubMed1996

[Effect of various electrode configurations and voluntary, reproducible artifacts in computer-assisted analysis of nystagmus].

BACKGROUND: There is no detailed information in the current literature about the best position for the electrodes with regard to electronystagmography. The computer nystagmograph registers potential changes resulting from electrodes on the forearm as nystagmus (pseudonystagmus). This phenomenon led us to investigate more closely the effect of various electrode arrangements and artifacts on the result of computer nystagmography. METHODS: The following four electrode arrangements were investigated on 20 human subjects: distance between the horizontal electrode and the lateral canthus (1 cm versus 2 cm), diagonal arrangement of the lateral electrodes, and changes to the lower vertical electrode. Recorded parameters included calibration potential, rotary nystagmus, post-rotary nystagmus, and optokinetic nystagmus. After determining the basic activity with closed eyes, the influence of five human artifacts on the computer nystagmography was investigated, namely blinking, contractions of the masticatory muscles, swallowing, facial expression, and squinting. RESULTS: The arrangement in which the horizontal electrodes were placed 1 cm away from the lateral canthus showed the greatest calibration potential and the smallest degree of human influence with regard to frequency and amplitude of the pseudonystagmus since a larger potential does not have to be amplified as much as a smaller one to achieve the same needle deflection. For this reason, the artifacts experience a smaller degree of amplification. CONCLUSIONS: We think the following arrangement of the electrodes guarantees the best signal reproduction: a distance between horizontal electrodes and the lateral canthus of 1 cm. The medial electrode is centered between the eyes on the bridge of the nose. The upper vertical electrode is placed above the left eyebrow in the line with the middle of the pupil. The lower vertical electrode is also in line with the middle of the pupil, 1 cm below the lower eyelid. The result is a clear recording of a physiological nystagmus, e.g. on rotation. In the absence of nystagmus, the analysis program is too unreliable and produces a multiplicity of pseudonystagmi. To avoid this we have to improve the recognition of nystagmus in the analysis program.

Adult↗
PubMed1989

[Optic nerve damage following craniocerebral trauma. A critical analysis of trans-ethmoid decompression of the optic nerve].

Over a period of 10 years 39 patients who suffered an optic nerve compression after a craniocerebral trauma underwent transethmoidal decompression surgery. The operation was performed bilaterally on 5 patients. Fifty per cent of the patients involved suffered a blunt head or brain injury, the others a brain concussion or space-occupying haemorrhage. At the side of optic nerve compression we found specific signs and symptoms, such as negative or sluggish direct light reaction of the pupil, a wound on the lateral side of the eyebrow, bleeding from the nose, eyelid haematoma, maximum of skull fractures and intracranial haematomas. Since the coincidence of radiological and intraoperative findings was only 67%, the ophthalmological findings such as lack of direct pupil reaction with preserved consensual light reaction or progressive loss of vision after a corresponding traumatic incident are our guideline for performing transethmoidal decompression of the optic nerve. In comparison with the results of conservative therapy as published in the literature, we achieved restitution of the visual function in about 10% more of the cases.

Adolescent↗
PubMedDate not supplied

[Niikawa-Kuroki syndrome (the so-called Kabuki make up syndrome)].

The first case of Niikawa-Kuroki-syndrome (so called Kabuki-make up-syndrome) in Europe and the second one out of Japan has been reported. It concerns a male child with retardation of growth, mental and motoric development. The syndrome can be diagnosed through the typical dysmorphia of the face, epicanthus, arched eyebrows, broad and depressed nasal tip, large malformed ears and stubby fingers. Anomalies of the dermatoglyphic patterns of the fingers observed in the Japanese patients could not be confirmed in our case. There was a normal chromosomal pattern. No further cases in the family could be found. The etiology of this new syndrome is not yet elucidated.

Abnormalities, Multiple↗
PubMed1986

[Use of botulinum toxin in ophthalmology].

Botulin toxin A was introduced as a treatment in ophthalmology by Dr. Scott of San Francisco. One important application is in cases of blepharospasm, where the toxin is injected into the lateral parts of the lower and upper lid and, if necessary, over the eyebrows in a single dose of 1-2 nanograms, preferably using a needle under electromyographic control. The effect on the blepharospasm is visible after a few days and lasts for several months. The procedure can be repeated several times. The second application is in cases of strabismus. In paralytic strabismus, contracture of the antagonist of the paralyzed muscle can be weakened by local injection of botulin toxin with a coaxial electrode under electromyographic control. Good results were observed in cases of eye muscle disorders in endocrine ophthalmopathy. In concomitant strabismus (exotropia or esotropia) administration of botulin toxin is also possible although a certain paresis of the injected muscle has to be taken into account. The doses for strabismus vary between 1/2 and 2 nanograms of the toxin. The administration of botulin toxin either in blepharospasm or strabismus has no systemic side effects and is a safe procedure if performed under careful electromyographic control. First personal experiences in the treatment both of blepharospasmus as well paralytic strabismus and concomitant strabismus are reported.

Blepharospasm↗
PubMed1997

Glabellar approach: simplified midline anterior skull base approach.

As a simplified microsurgical technique for lesions at the midline anterior skull base, a glabellar approach through a small incision (5 cm) between the eyebrows crossing the nasion was developed in four cadaver dissections. To determine the ideal positioning of the patient, the angle of the surgical trajectory was measured in the sagittal plane. In an effort to make an operation simple and accurate through this limited exposure, measurements were made in distance from the midline nasion to various intradural structures. Average distance from the midline point of the nasion (MPNa) to the midline of the tuberculum sella was 6.37 +/- 0.29 cm, 6.98 +/- 0.26 cm to the midline of the optic chiasm, and 8.00 +/- 0.11 to the lamina terminalis. In addition, measurements to other various anatomical landmarks were made. The angle of the line drawn from the MPNa to the midline of the tuberculum sella was 5.2 +/- 1 degrees against a line drawn between the lateral canthus and the tragus (LC-T) in the sagittal plane. Based upon this study, the positioning of the patient's head would be better if the LC-T line is positioned at 25 degree extension when the operating microscope is set at 20 degree inclination. Within 6 to 8 cm in depth from the MPNa, important landmarks are exposed without brain retraction. If surgical instruments are marked with ruler calibration, the depth of the surgical instruments will suggest the anatomical location. This glabellar approach has been used in three patients successfully. A brain retractor was not necessary and not used during the operations. This technique provides key exposures to the midline anterior skull base.

Adult↗
PubMed1994

Superolateral approach to orbital tumors.

The conventional lateral approach to the orbit (Krönlein) does not allow a satisfactory view of the superior part of the orbit and the operative field is rather narrow. Therefore, large tumors which have developed not only laterally but also superiorly are usually approached transcranially. The craniotomy and exposure of the dura may be avoided when the tumor does not extend too far posteriorly and medially, by turning a larger orbital bone flap than the Krönlein's one. This technique was described by Nakamura as "type I orbitotomy" and can be referred to as a superolateral approach. After a bicoronal skin incision, a free orbital bone flap is cut. It includes the lateral orbital rim, a large external part of the superior orbital rim, and the lateral orbital wall. From 1985 to 1990 this approach was performed on 23 patients presenting with lacrimal gland tumors in 14 cases (11 pleomorphic adenomas, 2 adenoid cystic carcinomas, 1 adenocarcinoma), schwannomas in 2 cases, dermoid cyst in 1 case, hydatic cyst in 1 case, cavernous hemangiomas in 2 cases, inflammatory pseudotumor in 1 case, and mucoceles in 2 cases. This superolateral approach provides a wider exposure to the superolateral orbit than the classical Krönlein's approach and avoids the drawbacks of a craniotomy. A direct incision through the eyebrow can be used for bald people or for patients in poor condition.

Follow-Up Studies↗