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PubMedDate not supplied

Tissue glue aided lid repositioning in temporary management of involutional entropion.

PURPOSE: To evaluate the efficacy of the use of tissue glue in temporary management of involutional entropion. METHODS: Ten consecutive patients aged 68-74 years presenting senile entropion were included in the study. Lid repositioning as to achieve a slight ectropion was done by application of cyanoacrylate glue in the lower lid crease using a 20-G cannula. Patients were followed at 1 day, 7 days and finally at 14 days. Assessment of correction and, if absent, duration of correction was recorded. Any other ocular or dermatological complications of the application were also recorded. RESULTS: All the patients had successful correction at day 1. In two patients adhesions broke at day 6, in one patient at day 7, in 3 at day 9 and 2 at day 11. Two patients maintained correction at 2 weeks. No ocular or dermatological reactions were noted. CONCLUSIONS: Tissue glue aided lid repositioning is an effective method for temporary management of involutional entropion.

Aged↗

PubMed2001

[Repair of facial soft tissue defect using temporal flap pedicled with orbicularis oculi muscle].

OBJECTIVE: To probe into the methods and effects of small soft tissue defect of facial area, nose and eyelid repaired by temporal island flap pedicled with orbicularis oculi muscle. METHODS: From 1994 to 1999, 12 cases with cicatricial ectropion of eyelid, scar in nose and facial area or facial mole were repaired by temporal flap pedicled with orbicularis oculi muscle. The maximal area of skin flap was 3 cm x 5 cm. RESULTS: All the skin flaps were survived after operation. Six cases were followed up from 6 months to 4 years, the results were satisfied. There were no secondary deformity or scar formation in the donor site. CONCLUSION: The blood supply of orbicularis oculi muscle is plentiful. It is a reliable method to repair of small facial tissue defect using temporal island flap pedicled with orbicularis oculi muscle. But in bigger facial soft tissue defect, it should be cautious.

Adolescent↗

PubMed2001

[Use of autogenous cranial bone grafts for orbital floor reconstruction].

OBJECTIVE: To evaluate the effects of autogenous calvarial bone grafts on treatment of the patients with defect of orbital floor from facial trauma. METHODS: During a 5-year period from April 1994 to April 1999, 34 patients ranging in age from 16 to 68 years (twenty males and fourteen females), who presented with orbital floor defects associated with other facial fractures were reconstructed by autogenous calvarial bone grafts. The surgical approach to the orbital floor involved a transconjunctival incision in 31 patients and a subciliary incision in 3 patients. After the orbital floor exploration, the bone graft was harvested through the coronal incision in 29 patients and the parietotemporal region incision in 5 patients. The bone graft was then fashioned to the appropriate size and configuration and fixed to the stable bone of the orbital floor with microplates or screws. RESULTS: The surgical incisions healed well with a minimal scar. There were no infection, extrusion or other complications associated with autogenous calvarial bone graft. There were no cases of optic neuropathy, diplopia and enophthalmos. There was no morbidity in donor sites. One patient had slight ectropion, which lasted three months and became inconspicuous in six months. 8 cases with hypoesthesia of the infraorbital region returned the sensory function within 6 months. 6 patients with enophthalmos were partly corrected. The follow-up period ranged from 6 months to 5 years. CONCLUSION: The orbital floor defects should be managed by early exploration to avoid later complications. The sequel, such as enophthalmos and dystopia or diplopia are much more difficult to correct after bony union. A vast array of autogenous and alloplastic materials have been used to reconstruct the defect of orbital floor. Autogenous bone graft reduces the risk of infection and extrusion. Cranial bone graft produces less donor site morbidity compared with other sites, non-visible scar as the incision is placed within the hair-bearing skin and the conjunctiva. The membranous bone from the skull has been shown to undergo less resorption and greater graft volume survival as compared to endochondral bone of the iliac crest or rib. Skull bone is an ideal source of bone graft in orbital reconstruction.

Adolescent↗

PubMed2001

[A clinical observation of preserved donor tarsal plate transplantation for repair of tarsus defect].

OBJECTIVE: To investigate the effect of preserved donor tarsal plate transplantation on the repair of the tarsus defect at the time of eye lid tumor removal. METHODS: Donor tarsal plates preserved in pure glycerin were used for the repair of tarsus defects of 58 cases after the complete removal of the eye lid tumors. The grafts were covered with rotated or slid myocutaneous and conjunctival flaps. The associations of the effect with the blood supply, with the size and the preserved time of the donor tarsal plates, as well as with the follow-up time were analyzed by chi(2) test. RESULTS: Of the 43 cases whose plates were fully covered with conjunctival flaps, new blood vessels began growing into the donor tarsal plates one week after the operation. The grafts were vascularized one month later. The donor tarsal plates of 15 cases were only partly covered with conjunctival flaps. As a result, the grafts were vascularized in 2 -- 3 months, and there was dissolution to varying degrees at the surface of the exposed parts of the plates. The effects of the 43 cases with good blood supply were significantly better than the effects of 15 cases with poor blood supply (chi(2) = 5.81, P < 0.05). The sizes of the donor tarsal plates ranged from 5 x 10 mm(2) to 8 x 29 mm(2). Eleven cases were equal or shorter than half of the original sizes of donor tarsal plates, 34 cases were subtotal and 13 cases were total plates. The differences of the sizes led to different results (chi(2) = 6.28, P < 0.05). The preserved times of donor tarsal plates were from 1 week to 2.5 years. However, the results were similar in all cases (chi(2) = 0.99, P > 0.05). All the patients were followed up for 6 months to 10 and half years (mean, 1.8 years). The effects had no statistical significance (chi(2) = 0.85, P > 0.05). The cilia of the donor tarsal plates were preserved in 3 cases, but all of them were totally lost during post-operative one month. After operation slight entropion occurred in 8 cases, slight ectropion in 3 cases, lagophthalmos for 2 -- 3 mm in 7 cases, notch of the palpebral margin in 5 cases and thinness of the donor tarsal plates in 4 cases, but the functional and aesthetic results were normal. Thirty-one cases were cured, 11 cases acquired tangible results and 12 cases were improved. The total effective rate was 93.1%. CONCLUSIONS: The more blood supplies of the donor tarsal plates, the better the effects. So we must make all our efforts to improve the blood supplies of the donor tarsal plates. The effects were associated with the sizes of the plates, but not associated with the preserved times of the grafts and the follow-up times. Preserved donor tarsal plate transplantation for the repair of tarsus defect is a relatively simple operation, the rejection is slight and the result satisfactory, thus it is an ideal plastic material.

Adult↗

PubMedDate not supplied

Sustained remission of Sézary syndrome.

Sézary syndrome, an aggressive form of cutaneous T-cell lymphoma, is a devastating, highly symptomatic form of non-Hodgkin lymphoma. Malignant clones of mature helper CD4 T cells containing large, convoluted nuclei known as Sézary cells circulate in the blood and infiltrate the skin. Clinical features include exfoliative erythroderma, generalized lymphadenopathy, alopecia, onychodystrophy, palmoplantar hyperkeratosis, and ectropion. Patients often have severe pruritus, burning sensations, pain, bleeding from excoriations, and disfigurement. Extracorporeal photopheresis, an immunomodulatory therapy, has become a primary therapy for these patients. This pheresis-based therapy uses psoralen and ultraviolet A radiation-mediated photochemotherapy to induce immune responses. The effects of extracorporeal photopheresis vary considerably. We report sustained remission (2 years) in a patient with Sézary syndrome. Previously he had received extracorporeal photopheresis and interferon alfa-2b injections. He is the only one of 55 patients with Sézary syndrome treated at Mayo Clinic (Rochester, Minnesota, USA) to achieve sustained remission on extracorporeal photopheresis alone.

Aged↗

PubMed2002

Genital tuberculosis in a menopausal woman. A case report.

We have analysed the role played by genital tuberculosis (TBC) in Italy today, and in particular in L'Aquila, in the light of a worrying recrudescence. We report the case of a 64-year-old patient, in menopause for the past 11 years or so, referred to the Gynecology and Obstetrics Clinic of the University of L'Aquila, with an anamnesis of menometrorrhagia since the age of 55. The patient was studied from a gynecological and internist profile including the following procedures: gynecological examination and pap-test, colposcopy, transvaginal scan, chest X-ray, abdominal and pelvic CAT, laboratory tests and Mantoux reaction. The uterus was found to be fibromatous during the gynecological examination and scan, whereas colposcopy revealed a small ectropion and the presence of very adherent yellowish mucus. The Mantoux test was positive. CAT showed cicatricial sequelae in the pulmonary parenchyma. It was decided to perform curettage, but this was prevented by the presence of pyometra. The patient was treated with specific chemotherapy and then underwent total laparohysterectomy with bilateral adnexectomy. The histological findings confirmed genital TBC. Genital TBC is now undergoing a worrying recrudescence. We need to have a full knowledge of the pathology, the diagnostic means with which to discover it and the correct therapeutic instruments to overcome it.

Age Factors↗

PubMed2003

[Treatment of benign eyelid conditions with Argon laser].

Eyelid surgery is not always uneventful. Complications (punctal ectropion, retractile scars) can sometimes occur. Argon laser treatment is an interesting alternative technique, particularly in cases with cosmetic indications. The advantages of the procedure, compared to surgery are numerous: magnified view of tissue removal, enhancing complete excision; good hemostasis, avoiding wound sutures and bandage; fast and painless technique; outpatient office procedure with little post-operative care; good acceptance of the technique by most of the patients. The technique and the main indications are described in this paper.

Anesthesia, Local↗

PubMedDate not supplied

Frequency of ocular complications of leprosy in institutionalized patients in NWFP Pakistan.

BACKGROUND: There is no systemic disease, which so frequently gives rise to disorders of the eye as leprosy does. The study was conducted to determine the prevalence and gravity of ocular complications in institutionalized leprosy patients in NWFP. It is important to provide necessary information to leprosy health workers and general physicians in order to sensitize them to early detection and treatment or referral to appropriate centre. METHODS: A prospective study of ocular complications of leprosy patients was conducted at the leprosy centre of Lady Reading Hospital Peshawar and the Leprosy Hospital Balakot, district Mansehra. The study included a record of the name, age, sex, type, duration of disease and completion of multi-drug therapy (MDT). Classification of the patients was done according to Ridley and Jopling 5-group system. Visual acuity was tested by Snellen chart and those patients having a vision of less than 3/60 were labelled as blind. Ocular adnexa were examined by naked eye and lacrimal sac regurgitation test was done. Slit lamp biomicroscopy was done for anterior segment examination and direct ophthalmoscope was used for fundoscopy. RESULTS: The authors studied 143 patients in the above mentioned leprosy centres. Out of these, 59 had lepromatous leprosy, 39 borderline tuberculoid leprosy, 9 tuberculoid leprosy, 33 borderline lepromatous leprosy, and 33 borderline leprosy. The majority of patients came from the northern districts of NWFP, including Malakand division and district Mansehra. The male to female ratio was 4:1. The age of the patients ranged from 14 to 80 years and the duration of the disease ranged from 1 year to 48 years. Ocular complications were found in 73% of the patients. These complications included loss of eyebrows in 57 patients, loss of eyelashes in 37, corneal changes (including opacity, ulceration, and/or anaesthesia) in 44, iridocyclitis in 31, lagophthalmos in 36, ectropion in 13, and chronic dacryocystitis in 3. Of the total of 15 (11%) patients who went blind from ocular complications, 16 eyes did so due to corneal opacities, 6 eyes due to cataract, 5 eyes due to chronic anterior uveitis and one eye due to corneal ulcer, panophthalmitis and phthisis bulbi each. CONCLUSIONS: A significant number of leprosy patients (73%) have ocular complications. The frequency of ocular complications increases with the increasing age and duration of disease of the patients.

Adolescent↗

PubMed2003

Ocular complications in incident relapsed borderline lepromatous and lepromatous leprosy patients in south India.

PURPOSE: To determine the magnitude of ocular complications that present in incident cases of relapsed borderline lepromatous (BL) and lepromatous leprosy (LL) patients. METHOD: From 1991 to 1997, all new BL and LL patients who had relapsed from an earlier disease, detected by active case finding in the geographically defined area of Gudiyattam taluk, were invited for ocular examination after their leprosy status was confirmed clinically and histopathologically. RESULTS: Sixty relapsed lepromatous patients, 45 male and 15 females, were examined. Fifty-two patients had relapsed after receiving only dapsone mono-therapy, 4 after receiving paucibacillary multi-drug therapy (PB-MDT) preceded by dapsone mono-therapy and 4 after only PB-MDT. Three (5%) patients had lagophthalmos, 1 (1.6%) patients each had ectropion and trichiasis, 32 (53%) patients had impaired corneal sensation in both eyes, 2 (3.3%) patients each had corneal opacity (associated with reduced vision), corneal nerve beading, punctate keratitis, keratic precipitates, and iris atrophy, 4 (6.6%) patients had cataract associated with decreased vision, 1 (1.6%) patient had blocked naso-lacrimal duct and 13 (21.7%) patients had pterygium. Seven (12%) patients had a visual acuity of 6/18 or less, 4 (6.7%) patients had 6/60 or less and one patients had vision below 3/60. General ocular complications rather than leprosy-related ocular complications were responsible for reduced vision. Lagophthalmos was associated with increased duration of the disease (P = 0.009), Grade II deformity (P = 0.001), punctate keratitis (P < 0.001) and cataract (P < 0.001). Beaded corneal nerves were associated with lepromatous leprosy (P < 0.001) and high mycobacterial infection (P = 0.05). Patients whose initial disease was categorised as BL and LL had greater impairment of vision (P = 0.037), more iris atrophy (P = 0.013), increased keratic precipitates (P = 0.013) and more corneal nerve beading (P = 0.013), when compared with the group comprising Tuberculoid-tuberculoid (TT), Borderline-tuberculoid (BT) and Intermediate (IND). CONCLUSION: This first report on ocular complications in relapsed lepromatous patients demonstrates that general and leprosy-related ocular complications occur in these patients. However, they are not in excess of those reported in other leprosy groups. Borderline and lepromatous leprosy patients tend to have had more ocular complications than patients with tuberculoid leprosy.

Adult↗

PubMed1992

[Tarsoconjunctival transposition. Causes, prevention and possibilities for correction of postoperative complications].

The Hughes' tarsoconjunctival flap technique has proved to be a reliable operative procedure for the treatment of large lower-lid defects for more than 55 years. The Hughes' procedure has maintained its importance despite the development of numerous other operations, two reasons for this being that there have now been several modifications to this technique and that the lids do not have to be closed as long. To help the surgeon avoid and eliminate problems and errors in the operative technique we provide details and some useful tricks we have learned over the years while treating over 50 patients. The causes, prophylaxis, and correction of postoperative complications are described for the following: lowering the lid margin; thinning of the lid in the area of the tarsal transposition; lymph edema of the transplant; lid margin defects, and dehiscence of the wound; corneal epithelial defects; trichiasis caused by lanugo hair; keratinization of the lid margin; ectropion of the conjunctiva; retraction of the upper lid, and entropion of the upper lid. If these details are taken into consideration, the Hughes' procedure is a simple operative technique that is free of serious complications and gives good results in the reconstruction of the lower lid.

Entropion↗

PubMed2003

Management of the ichthyoses.

The ichthyoses are a heterogeneous group of inherited scaling skin disorders that can also affect other organs. Management should be directed at both the skin and other sites. Skin therapy is not specific at this time, although new products may offer more directed therapy in the future. Moisturizers and keratolytics are the mainstay of topical therapy. Calcipotriene, retinoids, and for select types, anti-inflammatories such as topical steroids and calcineurin inhibitors have also been used. Systemic therapy is limited to the retinoids. Superinfection of the skin should be anticipated and treated. Pruritus can be disabling. Failure to sweat normally may result in heat intolerance. Eye care should seek to prevent corneal changes resulting from ectropion and more specific changes associated with specific disorders. Haring can be impaired by the accumulation of material in the external auditory canal. Severely affected children may require caloric supplementation to avoid growth retardation. Affected individuals and their family should be counseled about the long term outlook and the genetic nature of their disorder, and informed of FIRST, the Foundation for Ichthyosis and Related Skin Types, the lay foundation that offers support and information.

Dermatologic Agents↗

PubMed1992

The wedge punctoplasty for treatment of punctal stenosis.

We describe a new instrument, the Reiss punctal punch, which is specifically designed to performa "wedge" punctoplasty. The Reiss punctal punch was used alone to treat three eyelids of three patients, and in conjunction with horizontal tightening of the eyelid to treat 35 eyelids of 18 patients with symptomatic epiphora related to punctal ectropion with secondary punctal stenosis. After a mean follow up of 12 months, 36/38 (95%) of the eyelids demonstrated a patent punctum, and symptomatic relief was achieved in 35/38 (92%) of the eyes.

Dacryocystorhinostomy↗

PubMed2003

[Risk factors and reproductive sequelae associated with Chlamydia trachomatis infection in infertile women].

OBJECTIVE: To assess the clinical and sexual lifestyle characteristics associated with Chlamydia trachomatis infection among women diagnosed with infertility. MATERIAL AND METHODS: Study subjects were women with an infertility diagnosis attending the infertility clinic at the National Institute of Perinatology. Endocervical specimens from 309 women were examined for Chlamydia trachomatis using the direct immunofluorescence method. Vaginal culture samples were taken before initiating treatment. The presence of other sexually-transmitted infections was also assessed. Demographic, sexual behavioral, historical, and clinical data were collected for each subject. RESULTS: Seventy-seven women (24.9%) were infected with C trachomatis. Of these women, 70 (90.9%) had only one sexual partner, 58 (75.3%) were married, and 19 (24.7%) were single or had a common-law sex partner. Intrauterine device (IUD) was the main contraceptive method used in 15 women (19.5%). A coinfection with other sexually-transmitted microorganisms was detected in 41 of these patients (53.2%). Nineteen (24.7%) women had undergone tubal ligation. Among women with C trachomatis infection, reproductive sequelae were found: 24 (31.2%) women had had abortions and 50 (64.9%) had had a miscarriage. In 26 women cervical abnormalities were detected (33.8%); 50 (64.9%) had purulent vaginal discharge and 14 (18.1%) had pelvic pain. Bivariate analysis revealed that the risk factors for C trachomatis infection in women with infertility were: having a sex partner (OR = 2.96, 95% CI 1.22-7.5, p = 0.008), common-law union (OR = 3.68, p = 0.03), and IUD use (OR = 2.42, p = 0.01). CONCLUSIONS: A consistent relationship between C trachomatis infection and infertility was found. Infection with C trachomatis in women with infertility was associated with having one single sexual partner, marital status, and IUD use. The presence of ectropion and friability of the cervix may signal C trachomatis infection. Identification and presumptive therapy should be evaluated as measures to prevent and control C trachomatis infection in patients at risk. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Adolescent↗

PubMed2004

Elevated free tear lactoferrin levels in leprosy are associated with Type 2 reactions.

PURPOSE: To determine the association of demographics, leprosy and ocular characteristics with altered levels of lactoferrin in the tears of normal subjects and leprosy patients, and to detect the presence of antibodies to lactoferrin in these tear samples. METHOD: We collected light-stimulated tears from 298 leprosy patients and an equal number of normal subjects using the glass capillary method. Free lactoferrin levels were estimated using ELISA and the presence of antibodies to lactoferrin was detected using the immuno-blotting method. Significant associations were looked for between tear lactoferrin levels and demographic characteristics, leprosy characteristics such as type of disease, duration of disease, reactions, deformity and bacterial load, and ocular complications, using chi-square and regression analysis. RESULTS: Tear lactoferrin levels with a mean (SD) of 2.55 (2.83)mg/ml in the control group were significantly different (P<0.000) from leprosy patients with a smean (SD) of 5.66 (7.21)mg/ml. Age showed an inverse correlation with tear lactoferrin levels in controls. Increased bacterial load, grade 2 leg deformity and Type 2 reactions were significantly associated (P<0.05) with increased tear lactoferrin levels. Type 2 reactions remained significantly associated (P=0.01) on multiple regression analysis. Tear lactoferrin levels were not associated with gender, serum lactoferrin levels, Type 1 reactions, face patches, treatment status, orbicularis oculi weakness, lagophthalmos, ectropion, entropion, corneal opacity, cataract and iridocyclitis. CONCLUSION: Age is inversely related to tear lactoferrin levels in normal subjects. Free lactoferrin levels in tears are significantly higher in leprosy patients compared with normal controls. Type 2 reactions in leprosy are significantly associated with elevated tear lactoferrin levels.

Adolescent↗

PubMed1992

Ten-year follow up comparing anterior and posterior chamber intraocular lens implants.

Results achieved in eyes following a single surgeon's first 200 procedures consisting of intracapsular cataract extraction and implantation of a Choyce-Tennant anterior chamber lens (AC-IOL) (1977 to 1980) are compared with those achieved following the same surgeon's first 200 procedures consisting of extracapsular cataract extraction and implantation of a posterior chamber intraocular lens (PC-IOL) (1980 to 1982). For the AC-IOL eyes, follow up ranged from 11.1 to 14.2 years (mean, 12.0 years); for the PC-IOL eyes, from 9.5 to 10.8 years (mean, 10.0 years). The AC-IOL eyes had many early problems: pupillary block (7%), iritis (15%), and secondary glaucoma (8%). Four percent developed corneal edema, 1.5% vitritis, and 2% localized iris holes under the lens. Ectropion uveae appeared in 8.5%, indicating some ongoing inflammation. One and one-half percent of these lenses were removed or exchanged. Seventy-nine and one-half percent of these eyes had 20/40 or better vision at 10 years; 4% had visual loss along with corneal edema or vitritis, apparently related to the AC-IOLs. The PC-IOL eyes had comparatively few lens-related complications: 1% corneal edema, 1.5% iritis, 1% vitritis, and 2% secondary glaucoma. Some localized trapping of the pupil occurred in 8%. One percent of the PC-IOLs were removed, and 1% decentered, requiring McCannell sutures. Final visual acuity at 10 years was 20/40 or better in 77.5%. None of the PC-IOL eyes had decreased vision related to the lens implant.

Adult↗

PubMedDate not supplied

Aesthetic outcome of sliding island flap for reconstruction of cheek after tumour ablation.

BACKGROUND: Skin cancer is the most common malignancy in humans and the incidence continues to rise. Facial reconstruction after cutaneous tumour ablation is a challenging job and needs thorough knowledge of the anatomy and physiology of face skin, biomechanics of skin and muscles, design of local flaps and their blood supply. The objective of this study was to report the aesthetic results of sliding island flap on the cheek. METHODS: This study was carried in the department of Plastic and Reconstructive Surgery Postgraduate Medical Institute Hayatabad Medical Complex Peshawar from March 2001 to February 2004. Forty patients with age 50-70 years having Basal Cell Carcinoma on infraorbital and malar area of the cheek were taken for the study. Tumors were excised with safe margins and defects restored with sliding island flap. This flap is based on subcutaneous vertical pedicle that vascularizes the skin island through sub dermal plexus. Patients were regularly followed up with preoperative and postoperative photography. Final aesthetic results were analyzed after six months. RESULTS: Good symmetry of cheek was achieved. There was no noticeable scarring. Flap necrosis was not seen in any patient. Only one patient had mild ectropion of the lower eyelid (2.5%) that did not need any revisional surgery. CONCLUSIONS: Relatively bigger defects of the cheek can be easily covered with this flap with preservation of cosmesis and without any distortion in the symmetry of the face.

Aged↗

PubMed2006

[Clinical management of deep facial burn].

OBJECTIVE: To explore the better clinical methods for the management of deep facial burn with optimal quality. Methods Fifty-four patients with deep facial burns were enrolled in the study and were divided into delayed skin grafting group (n=48) and early escharectomy group (n=6). In delayed grafting group, after the erosion of new born granulation tissue to the basal layer with blade holder or with peel or eschar shaving method at 3 postburn weeks (PBW) according to the eschar separation and granulation growth status, the whole face of the patients were divided into 10 regions and were then covered by split thickness auto skin. The same treatment was performed on the patients in early escharectomy group at 1 PBW. Physical therapy and plastic surgery were applied after skin grafting, and the patients were followed up from 3 month to 11 years. The first operation time, postburn facial operation time, operation times to repair the whole face, blood content of Hb, the amount of blood transfusion and hemorrhage and the prognosis were compared between the two groups. RESULTS: There was no difference between the two groups in regards to the first operation time, the total operation times,blood concentration of Hb before and after operation,and the amount of blood transfusion during the operation (P > 0.05). The operation time in delayed grafting group (21.9 +/- 3.2) d was obviously later than that in early escharectomy group (12.6 +/- 1.3) d, (P < 0.05). And there was evidently less amount of hemorrhage during operation(98 +/- 52) ml/100 cm2 than that in early escharectomy group (331 +/- 121) ml/100 cm2 (P < 0.01). The facial appearance of the patients in delayed grafting group was plump with more elasticity and richer expression compared with those in early grafting group. There exhibited different degrees of microstomia and both eyebrow defect in both groups during and after 1 postoperative year. In addition, mild to moderate ectropion and hypertrophic scar on the conjunction of grafted skin could appear in 80% of these patients. These deformities might be corrected by several times of plastic surgery. CONCLUSION: Based on the principle of arranging skin grafts according to the cosmetic and functional area units, split thickness skin grafting can provide satisfactory results for the repair of deep burn injury involving whole face when the wounds were treated with eschar peeling, tangential excision, escharectomy, granulation tissue scaling, or early escharectomy. In comparison with early escharectomy, eschar peeling, tangential excision, escharectomy, or granulation tissue scaling can get better results with less bleeding, full and round facial appearance, more elasticity of grafted skin and richer facial expression appearance after the operation. Meanwhile, effective physical therapy and scheduled plastic surgery after skin grafting can also be very important in achieving cosmetic results in the repair and reconstruction of whole facial deep burn.

Adolescent↗

PubMed2006

[Maxillary swing approach in the management of tumors in the central and lateral cranial base].

OBJECTIVE: A retrospective review of seventeen patients who were operated through the maxillary swing approach was carried out to assess the efficacy of this approach in the management of tumors of the central and lateral cranial base. METHODS: From May 2000 to January 2005, 17 patients with primary or recurrent neoplasms involving the central cranial or lateral base underwent surgical resection via maxillary swing approach. Ten patients were male, and other seven patients were female, and age range was 7 to 58 years, with a mean age of 42. 6 years. Eight patients had tumors originally involving lateral cranial base, and nine patients had tumors originated from central cranial base. The pathology spectrum was very wide. Among them, five suffered from chordoma, two had rhabdomyosarcoma, two had squamous cell carcinoma, one had malignant fibrous histiocytoma, one had malignant melanoma, one had esthesioneuroblastoma, one had invaded hypophysoma, two had schwannoma, one had pleomorphic adenoma, and one had angiofibroma. Three patients had received previous surgery, two patients had previous radiation therapy and nine patients received postoperative radiotherapy. RESULTS: Sixteen of all seventeen patients had oncologically complete resection, one had near-total resection. This group patients was followed up from 10 to 60 months, with a median follow-up time of 28 months. Two patients died 14 and 26 months after surgery respectively, as a result of local recurrence and metastasis. One patient defaulted follow-up at 12 months after operation, and the other 14 patients were alive at the time of analysis. Of the 12 malignant tumors, the 1-and 2-year survival rate were 91.67% and 72.92%, respectively. The facial wounds of all patients healed primarily, and there were no necrosis of the maxilla, damage of the temporal branch of the facial nerve, lower-lid ectropion, and facial deformity. Epiphora and facial hypoesthesia were detected in all patients. Four patients (23.5%) developed palatal fistula, ten patients developed serous otitis media (58.8%), and four patients developed a certain degree of trismus (23.5%). Cerebrospinal fluid leak occurred in two patients. They subsequently healed with conservative management. CONCLUSIONS: The maxillary swing approach is a proven method for access to the central and lateral skull base with good exposure and acceptable morbidity. Complications and sequelae associated with this approach include facial scarring, transaction of the infraorbital nerve, impaired lacrimal drainage, eustachian tube dysfunction and serous otitis, palatal fistula, trismus etc. Some procedures should be performed for reducing the incidence and severity of complications in the maxillary swing approach.

Adolescent↗