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PubMedDate not supplied

Management of posttraumatic enophthalmos.

Posttraumatic enophthalmos is one of the common sequelae that appears after facial injury and remains a challenge to treat for craniomaxillofacial surgeons. Several theories have been advocated regarding enophthalmos; however, the most well accepted concept is the enlargement of the orbital cavity after displacement due to orbital fractures. Generally, a 1 cm3 increase in orbital volume causes 0.8 mm of enophthalmos. Thorough knowledge of the orbital anatomy is fundamental and critical for the successful surgical correction of enophthalmos because most treatment failures are due to inadequate orbital dissection from fear of injuring the optic nerve and globe. A complete preoperative plan should be built on a comprehensive clinical examination of the periorbital soft tissue and bony components, detailed ophthalmic examination, and high resolution computed tomography scans in the axial, coronal and reformatted sagittal planes. Based on the anatomic deformities, there are two major fracture types including orbital blow out fractures and zygomatico-orbital fractures, resulting in posttraumatic enophthalmos. Treatment modalities and methods of approach are adapted according to the severity of the orbital deformities. Minor complications include ectropion, entropion, dystopia, diplopia, and residual enophthalmos. Rare but severe complications such as intraconal misplacement of the bone graft or retrobulbar hemorrhage with subsequent blindness may be encountered. The success of the procedures depend on adequate dissection and mobilization of the displaced soft tissue, correct repositioning of the dislocated or malunited bony orbit, and proper intra-orbital grafting.

Enophthalmos↗
PubMed1990

[Blepharoplasty: various technics in surgery of eyelid aging].

The authors reviewing their own experience of blepharoplasty (92 cases) over the last ten years, discuss the principal approaches used depending on the age of the patient, the amount of adipose tissue, the lower lid tarsal and muscular laxity and the quality of the skin excess. In the lower eyelid they emphasize the value of the transconjunctival approach in young and or coloured people and the use of a cutaneo-muscular flap in the classical technique. In the upper eyelid, they combine the skin excision with an orbicularis muscle strip and in old people with suspension of the lateral canthus. A wise selection of these various approaches avoids the rare complications (ectropion and scleral show) because blepharoplasty must be considered to be a "variable geometry" operation.

Adult↗
PubMed2006

Ichthyosis in two Chianina calves.

The occurrence of ichthyosis in two Italian Chianina calves is described for the first time. Both animals, affected by ichthyosis fetalis and ichthyosis congenita, respectively, showed diffuse cutaneous thickening which had been present since birth. The first patient was a three-month-old female calf; inelastic leather cuirass-like skin associated with generalized hypotrichosis and local alopecia, delay of the physiologic change of coat colour, stiff movement and growth retardation were the most prominent clinical characteristics. The patient was kept under observation for almost one year. The second case occurred in a 18-day-old female calf which was referred to our clinic after it had already died; the presence of irregular hyperkeratotic plates separated by deep fissures over the entire cutaneous surface and the slight eversion of the mucocutaneous junction (eclabium and ectropion) were the most characteristic alterations. In both cases, the major histopathological feature was a diffuse lamellar orthokeratotic hyperkeratosis. An underlying genetic defect was strongly suspected on the basis of a common ancestor for the two sires of the affected calves and of the current scientific knowledge.

Animals↗
PubMed1990

[Orbicular myorraphy for correction of bags and wrinkles of the lower eyelids].

The lower eyelid consists of four planes. The deepest plane is the orbital fat, followed by the septum, orbicularis muscle and the skin. Pouches are classically treated by resection of the fat, i.e. reduction of the orbital contents De La Plazza proposed a new method by tightening the septum which retains the orbital fat posteriorly. This idea of preservation of the orbital fat led me to consider the third plane: the orbicularis muscle. By comparing orbicularis myorraphy with median myorraphy of abdominal plasties. I propose reinforcement of the orbicularis muscle to retain the orbital fat and to reduce the pouches without resection of the fat. The fourth plane, the skin, is classically draped over the muscular layer, but as the height of the muscle plane is reduced by this myorraphy, this skin will be less involved in smiling, which improves the wrinkles. As the skin is traditionally detached from the muscle, autoplication of the orbicularis muscle is performed, taking care not to modify the position of the free edge in order not to create muscular ectropion. This suture is composed of inverted 6/0 Dexon sutures. The advantages are preservation of the orbicularis fat which prevents loss of this fat and the risk of senile enophthalmia in the long-term. The indications are of three orders: a) pouches when they are not excessive; b) static wrinkles; c) dynamic wrinkles of smiling. A muscular roll must be avoided by a very careful suture technique. Orbicularis myorraphy appears to be a new contribution to the various therapeutic procedures proposed for aesthetic blepharoplasty and may improve some of the results.

Eyelids↗
PubMed2006

Intradural lysis and peripheral nerve implantation for traumatic obsolete incomplete paralysis.

Twenty-eight patients who suffered traumatic obsolete incomplete paralysis were treated with intradural lysis and peripheral nerve implantation by a microsurgery technique. The endorachis was opened and the fibrous bands adhering to the spinal cord from the arachnoid, pia mater spinalis, ligamenta denticulatum, and the initial part of the nerve root were completely relieved. The abnormal spinal cord was then opened by three to six incisions, which were each 0.1 mm to 0.2 mm deep and longer than the abnormal portion. A cyst found in the back or side of the spinal cord was opened and the liquid in it was drained. After that, the denuded spineurium and perineurium of the autogenous sural nerve were grafted, which makes the character and aspect of the nerve like the cauda equine. The nerve was longitudinally implanted into the incised spinal cord, and the cyst was waded with grafted nerve and at least one of them is ectropion sutured with the pia mater with 9-0 scatheless wire as a drain. Finally, the endorachis was covered by sacrospinal muscle flap. These patients were followed for 2 years to 8 years (average 3.5 years), and the sensibility and motion of each increased at least one grade. The strength of the main muscle was increased two grades and reached four grades in 11 patients, and the capability to walk was recovered. Relieving of the adhesion in the endorhachis, carving the cicatricial spinal cord, and implanting the autogenous peripheral nerve yields good results by initial clinical observation for traumatic obsolete and incomplete paralysis.

Adolescent↗
PubMed2005

The versatile naso-labial flaps in facial reconstruction.

BACKGROUND: Surgical excision of tumors from the face may create a defect that is difficult to restore. Skin grafts can only cover superficial defects and has a natural tendency to contract and may not take properly. Also, because of the colour mismatch, it is not cosmetically identical to the face. The use of regional flaps such as the median forehead flaps are usually bulky, can not cover a wide range of facial reconstruction and usually require the donor area to be grafted. The naso-labial flaps are very useful and versatile local flaps, with robust vascularity that can be readily elevated without a delay. The flap can be superiorly based to reconstruct defects on the cheek, side wall or the dorsum of the nose, alae, collumula and the lower eye lid. Inferiorly based flaps can be used to reconstruct defects in the upper lip, anterior floor of the mouth and the lower lip. The flap can be turned over and used as a lining of the nose and the lip. AIM OF THE STUDY: In the current study we present our experience with utilization of the nasolabial flaps in facial reconstruction. We evaluated the indications, flap designs, technique, and complications. We will also assess the final functional and aesthetic results. MATERIAL AND METHODS: The study included 20 patients (12 males and 8 females) presented at the surgical department, National Cancer Institute (NCI) Cairo University with skin cancer at different areas of the face. Preoperative assessment includes. Assessment of the stage of the disease, the flap design and patient general condition. RESULTS: The mean age of the patients was 56.3 +/-6 years (range 16-62 years). Fifteen patients presented with basal cell carcinoma, 2 squamous cell carcinoma, one malignant melanoma, one keratoacanthoma, and one xeroderma pigmentosa. Nasal defects constituted 75% of cases, the rest were lower eye lid (2), one upper lip and one oral commisure beside a case of cheek reconstruction. There was no major complication; only one patient suffered a reactionary hemorrhage that required re-exploration to secure the bleeder. A single procedure was adequate in most of the patients (80%), only 4 patients required revision of the scar at the donor site. The overall aesthetic results were very satisfactory in the majority of patients (16), and satisfactory in 2 cases. Only 2 patients were not satisfied by the final aesthetic results, one suffered from ectropion and the other had a donor site wound healing problem. CONCLUSION: The nasolabial flap is a versatile, simple, easy to harvest local flap that can cover a variety of defects in the face. It is ideally suitable for covering small and moderate sized defects in the eye lid, cheek, nose, the anterior floor of the mouth and the lip.

Adolescent↗
PubMed1991

[Plastic surgery of the eyelids after tumoral excision. Apropos of 299 cases].

Plastic surgery of the peri-orbital area after tumor resection is a special and interesting field of reconstructive surgery. Our experience concerns the surgical treatment of 299 malignant tumors of the skin of the peri-orbital area in 291 patients. Basal cell carcinomas were the most common but we also had 8 squamous cell and 4 mixed carcinomas and 1 malignant melanoma. Among these tumors, 277 were primary and 22 were recurrences: 5 after X-Ray therapy, 9 after surgery elsewhere, 4 after electrocautery and 4 after combined treatments. The lower eyelids and the inner canthus areas were the most frequently involved in our series with relative infrequency in the outer canthus and upper eyelids. We used direct closure and local flaps in the repair of most of our patients, but we also used some full thickness skin grafts by preference for the upper eyelid. Complications consisted of 8 cases of ectropion and 2 flap necroses for which a revision was performed in some cases. Concerning our carcinological results among the 123 patients with one year minimum follow up we noticed 4 recurrences which represents a percentage of 3.2%.

Aged↗
PubMed2006

Lateral canthoplasty--10-year experience.

Lateral canthoplasty is a useful method to restore eyelid function and to protect the ocular surfaces. The success of the procedure depends on the proper analysis of periorbital anatomy as it relates to the specific indication for lateral canthoplasty. We report the experience with 129 lateral canthoplasties with emphasis on the evaluation of newer techniques that better address anatomic and functional requirements. Between 1994 and 2004, 129 lateral canthoplasties were performed in 105 patients, only for reconstructive purpose. A variety of surgical techniques have been described for lateral canthoplasty, and the evolution of the operative technique for lateral canthoplasty has been toward an operation that corresponds with the anatomy of the individual. Indications for the procedure include senile ectropion, tumors, cicatritial retraction, trauma, entropion, and congenital cleft. The evaluation of the newer procedures of lateral canthoplasty as unique reconstructive tools will be discussed.

Blepharoplasty↗
PubMed1991

Ocular findings in cutaneous T-cell lymphoma.

Seventeen patients with cutaneous T-cell lymphoma undergoing an investigative treatment regimen using extracorporeal photochemotherapy underwent ophthalmologic examinations to investigate the ocular findings in this disease. The most frequent finding was seborrheic blepharoconjunctivitis, which was noted in 13 of 17 patients. Other common lid findings included cicatricial ectropion, meibomianitis, chalazia, and madarosis. Corneal and conjunctival disease was also increased in this group of patients. The syndrome of cutaneous T-cell lymphoma has recently been redefined, and a discussion of the revised concept of this disease is included. Previous studies used the old definition of this disease and were limited to the subgroups of mycosis fungoides and Sezary syndrome, which comprise only one third of the cutaneous T-cell lymphoma population.

Adult↗
PubMed1991

[The aging eyelid].

Eyelid involution affects all the tissues of the lid, including the tarsotendinous band and the levator muscle. Dermatochalasis can be complicated by ptosis, entropion or ectropion, which must be taken into account during assessment and treatment.

Aging↗
PubMed1991

[Genetic eye defects in the dog].

Genetically determined disturbances of the normal function of the eye are distributed in high frequencies in several breeds of dogs. Two groups of these disturbances are discussed; disturbances resulting from the aims of breeding and defects caused by mutant genes. Disturbances such as ectropion, entropion and trichiasis may be regarded as the results of aims of breeding. They have a polygenic background and can be reduced by selection against the undesired traits and by modification of the breed standards. The frequencies of defects caused by mutant genes such as PRA, cataract and PHTVL/PHPV can be effectively reduced by veterinary practitioners. They are expected to be able to explain the consequences of breeding with animals carrying these genes to their clients when patients with these defects are presented.

Animals↗
PubMed1991

Orbital volume augmentation with adjustable prefabricated methylmethacrylate subperiosteal implants.

Prefabricated right and left subperiosteal implants were used in nine anophthalmic sockets to correct superior sulcus deformities. The advantages of these implants include increased stability, easy insertion under direct visualization and the possibility of easy retrieval if necessary, and custom modification for volume and shape intraoperatively, with the addition of methylmethacrylate. There were no extrusions, implant migrations, or infections. Complications included mild undercorrection, upper eyelid blepharoptosis, and transient ectropion.

Eye Enucleation↗
PubMed1991

Early excision and skin grafting of selected burns of the face and neck.

Since 1979, 16 patients with facial and neck burns have been treated with excision and skin grafting within the first 4 days of injury. The injuries were tangentially excised and immediately covered with split-thickness skin grafts. Detailed consecutive results are presented. The patients can be divided into three groups. Group 1 consisted of small subdermal or circumscribed deep dermal burns of the face (n = 8). Healing was quick. Some patients developed signs of overgrafting. As a late result, unevenness and discoloration were seen. Group 2 consisted of mixed deep dermal and subdermal burns of the face and neck (n = 5). Usually, minor areas had to be regrafted. Some patients developed hypertrophic scars at border areas. In the completely excised and grafted area, the skin was smooth, pliable, and discolored. Group 3 consisted mostly of subdermal burns of the face and neck (n = 3). The surgical trauma was significant. Small areas had to be regrafted. Ectropion and microstomia developed. It is concluded that in selected cases of deep dermal and subdermal burns, early excision and skin grafting will result in faster healing and less scarring than expectant treatment.

Adolescent↗
PubMed1991

[Use of phytostimolin vaginal cream and lavage in cervical dystrophy after DTC of the cervix].

The study evaluated the efficacy and tolerance of the active components of "phytostimolin" cream and vaginal lavage, Triticum Vulgare and Ether glycoethylen-mono-phenolic, in 40 patients suffering from dystrophic cervico-vaginal pathologies (group 1), and in 20 patients following DTC of the portio due to ectropion (group 2). The study was double blind. An overall efficacy of 70% was observed in group 1 and 90% in group 2. The results obtained, the absence of side effects, and the good level of tolerance confirm the value of the above components in the pathology in question.

Double-Blind Method↗
PubMed1990

[Ear cartilage as tarsus replacement (with long-term results)].

The authors report on 52 lid operations in combination with the transplantation of ear cartilage to serve as tarsus. The preoperative diagnoses were: ectropion (22); entropion (5); tumors (18); lid reconstruction following trauma (7). The long-term results were determined in 24 patients with 29 lids, with an average follow-up time of 26 months. The lid margin fit and the cartilage was palpable in nearly 90% of the long-term results; 83% of the patients were content with the cosmetic outcome.

Cartilage↗
PubMed1990

Anthrax of the eyelid.

Anthrax is a rare infection that is transmitted to humans from animals or animal products. In its cutaneous form it may produce lesions of the eyelids which can lead to cicatricization and ectropion. Exophthalmos, optic atrophy and panophthalmitis have also been reported. A case of anthrax affecting the eyelid of a patient seen by the author in Kabul, Afghanistan, is presented.

Adult↗
PubMed1990

Ophthalmic surgical management of facial paralysis.

Combinations of these procedures have been performed on more than 50 patients to date, with the longest follow-up being greater than 8 years. All of these patients presented with complaints of ocular irritation, tearing, photophobia, and impaired vision. Several had severe epithelial keratopathy. Some patients have also been treated following neurosurgical procedures which caused paralysis of the fifth and seventh cranial nerves, resulting in both corneal anesthesia and facial paralysis. Patients have done very well after these procedures and have achieved ocular comfort, reduced tearing, and corneal protection without the need for disfiguring and visually occluding tarsorrhaphies or other procedures. In some instances, they may still require artificial tears during the day or a lubricating protective ointment for the eye at bedtime. There have been no significant complications in this series; no cases of gold weight extrusion, recurrent ectropion, or persistent corneal epithelial keratopathy. Some patients have complained of continued excessive tearing which is most likely due to paralysis of the lacrimal pump, resulting in ineffective tear drainage to the nasal lacrimal duct. However, these patients have still noted markedly reduced tearing compared to their preoperative condition. One patient underwent secondary release of her medial canthoplasty following return of facial nerve function.(ABSTRACT TRUNCATED AT 250 WORDS)

Eyelid Diseases↗
PubMedDate not supplied

Harlequin fetus: a case report.

The authors report a case of "harlequin fetus" which was brought to their attention. The report was justified not only by the rarity of the disease, but above all because, after having examined the literature on the topic, this appears to be the third case treated with etretinate. The case in question was a female affected by congenital ichthyosis in its total form and by initial necrosis of the extremities. Etretinate treatment gave good results in terms of cutaneous modifications: reduction of hyperkeratosis, disappearance of ectropion and eclabium. Therefore, although the patient died when 16 days old due to sudden renal insufficiency, the case confirms the two previous reports on the value of this therapy.

Etretinate↗