Periosteal flap for lower eyelid reconstruction.
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Eyelids↗
Biomedical subjects
C R Leone
Publications and source records attributed to C R Leone.
Supervoltage orbital radiotherapy in 36 cases of Graves' disease.
Thirty-six patients who had clinically progressive Graves' dysthyroid orbitopathy were treated with supervoltage orbital radiotherapy. Twenty-three of the patients had discontinued the use of orally administered prednisone after developing intolerable side effects. Medical contraindications prevented seven patients from receiving systemic corticosteroid treatment. Six additional patients declined to take prednisone and chose orbital radiotherapy as their primary treatment. All patients were treated with one radiotherapy protocol wherein a 6 MV linear accelerator delivered 2,000 cGy to the midplane of both orbits in ten fractions. None of the 36 patients was treated with corticosteroids during the orbital radiotherapy treatment interval. We encountered three patients who failed to respond to orbital radiotherapy and required supplemental immunosuppression to arrest progression of Graves' disease. The remaining 33 patients experienced stabilization or clinical improvement of their condition. None of the patients experienced complications from orbital irradiation. We believe supervoltage orbital radiotherapy is an effective means of treating Graves' dysthyroid orbitopathy.
Adult↗
Seizure recurrence in infants with neonatal convulsions. A follow-up study.
Twenty three infants with neonatal seizures were followed prospectively to a mean age of 11 months. Only 2 were pre-term and birth weight ranged from 1700 to 4230 grams, with 17 male and 6 female infants. Hypoxic-ischemic encephalopathy was the most common etiology (82.6%). Focal clonic convulsions were the predominant seizure type, present in 7/16 infants in which the seizure type could be identified. All infants had a neurological examination and EEG, and 18 had a cranial ultrasonography performed at the follow-up. Anticonvulsant medication was discontinued, if follow-up EEG and neurological examination were normal. At the follow-up, seizure recurrence was observed in 7/23 (30%) infants. Abnormal EEG, neurological examination and cranial ultrasonography were statistically correlated with seizure recurrence. We conclude that infants with neonatal seizures can remain free of anticonvulsant medication provided they have normal neurological examination, EEG and cranial ultrasonography.
Echoencephalography↗
Bipedicle myocutaneous flap repair of cicatricial ectropion.
We present a new approach to the bipedicle myocutaneous upper eyelid to lower eyelid flap in the repair of cicatricial ectropion in lower eyelid reconstruction, and in the release of tension caused by a previous cheek rotational flap. By incorporating the pedicles into the flap design, we prevent the persistent lymphedema and the raw tissue placed against exposed epidermis encountered in previous bipedicle myocutaneous flaps. Although there may be disadvantages associated with this procedure, we have not encountered any to date. Advantages of this procedure include the double source of blood supply and the superior cosmetic result as well as the avoidance of a second operative procedure. We recommend the use of the bipedicle myocutaneous flap in selected cases.
Cicatrix↗
Correction of superior sulcus defects after enucleation.
Anophthalmic patients can develop a deep recess or sulcus in the upper lid, usually associated with enophthalmos. If due to an absence or loss of a socket implant, a secondary one can be implanted. In those cases with a socket implant, one method of treatment is directed at adding a silicone block to the inferior orbit to cause a forward movement of fat to fill out the upper eyelid as well as reducing the enophthalmos. Another approach, particularly if enophthalmos is minimal, is to directly implant a dermis-fat graft into the upper eyelid. The graft is taken from above the iliac crest and the amount implanted should create a slight overcorrection, allowing for some fat absorption.
Adipose Tissue↗
The success rate of silicone intubation in congenital lacrimal obstruction.
In our series of 100 patients who had unsuccessful probing for congenital nasolacrimal duct obstruction, all had silicone intubation associated with infracturing of the inferior turbinate. The age range was from 7 months to 4 years at the time of intubation. Sixty patients had tubes in for 1 year, and all but one, a 3-year-old girl, were treated successfully. Of the 40 who had tubes in place for less than 1 year, 38 were treated successfully. The two unsuccessful cases were those of a 3-year-old boy and a 4-year-old boy, whose tubes were removed at 3 and 4 months, respectively. The overall success rate in our series was 97%; all patients younger than two years old at the time of intubation were treated successfully.
Child, Preschool↗
Medial and lateral wall decompression for thyroid ophthalmopathy.
A two-wall decompression of the orbit, consisting of removal of the medial and lateral walls, was successful in eight patients with thyroid ophthalmopathy. The lateral wall was by removed by using the standard orbitotomy technique in addition to enlarging the space with a pneumatic burr, and the medial wall was removed through a direct medial canthal incision. Two patients had optic neuropathy, one had intermittent subluxation of the globe, and five had symptoms of exposure or increased pressure in the orbital area. In our eight patients, the two with optic neuropathy improved, the patient with subluxation of the globe became asymptomatic, and the other five had less exposure and were more comfortable. The amount of decompression ranged between 4 and 7 mm. The lacrimal sac was injured in one patient; temporary silicone intubation avoided any permanent sequela.
Aged↗
Lower lid reconstruction using tarsoconjunctival grafts and bipedicle skin-muscle flap.
We describe a method of subtotal lower eyelid reconstruction employing either a free tarsoconjunctival graft or a transpositional tarsoconjunctival flap from the upper lid together with a bipedicle skin-muscle advancement flap from the lower lid. A full-thickness skin graft is placed into the defect created by the movement of the bipedicle flap. This technique obviates the need to use a lid-sharing procedure that occludes the fissure and would be indicated for the monocular patient or one who would be at a serious disadvantage with the eye covered for several weeks.
Conjunctiva↗
Bipolaris hawaiiensis-caused phaeohyphomycotic orbitopathy. A devastating fungal sinusitis in an apparently immunocompetent host.
The authors present a case report of a devastating bilateral optic neuropathy and orbitopathy initiated by a contiguous fungal sinusitis, in an apparently immunocompetent young man. The causative organism, Bipolaris hawaiiensis, and other species classified in the genus Bipolaris, are being recognized with increased frequency as causes of several ophthalmic and systemic disorders in both immunocompromised and normal hosts. A literature review demonstrates the variety of clinical presentations with emphasis on those cases which may present to the ophthalmologist.
Adult↗
The management of pediatric lacrimal problems.
The most common cause of tearing in the pediatric age group is blockage of the distal end of the nasolacrimal duct at the valve of Hasner. Evaluation with fluorescein using the dye disappearance test and the primary dye test, although not always as accurate as in adults, is possible. Conservative treatment is attempted initially followed by probing and, if necessary, silicone intubation. Less common causes of tearing are punctal atresia and congenital lacrimal sac fistula, which are usually diagnosed later, requiring opening of the atretic membrane and excision of the fistula tract, respectively. Amniotoceles are usually seen within a week of birth and are treated aggressively with medication and/or probing to prevent acute dacryocystitis.
Humans↗
Optic nerve pseudomeningioma secondary to localized amyloidosis.
A 55-year-old woman presented with a mass of the optic nerve sheath suggestive of a meningioma. On excision, this proved to be amyloid. No systemic involvement could be found. Although amyloid may arise as a solitary lesion of the orbit or extraocular muscle, this "pseudomeningiomatous" pattern has not been previously noted. A magnetic resonance scan was helpful because the amyloid imaged at a density similar to vitreous and cerebral white matter, unlike meningiomas, which appear more like bone. The diagnosis of localized amyloidosis, however, still remains dependent on histopathology and cannot be made on a clinical basis.
Amyloidosis↗
Primary mucinous sweat gland carcinoma of the eyelid.
A 76-year-old woman had a slowly enlarging lesion of the right lower eyelid. After obtaining incisional biopsy results consistent with adenocarcinoma, we removed the tumor and made a final diagnosis of primary mucinous adenocarcinoma of the sweat gland. The defect was repaired using ipsilateral upper lid transpositional tarso-conjunctival and skin-muscle flaps. No evidence of recurrence or metastasis was noted 42 months postoperatively. Consideration of such tumors is clinically important, since they have full metastatic potential. We therefore suggest consideration of sweat gland primary mucinous adenocarcinoma in the differential diagnosis of red or violaceous eyelid masses.
Adenocarcinoma, Mucinous↗
Lipocauterization and thermal fixation in blepharoplasty.
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Adipose Tissue↗
Benign osteoblastoma of the orbit.
Benign osteoblastoma is a rare lesion of the orbit--only five cases have been described previously. The usual location is in the vertebral column and to a lesser extent in the skull. Although it is an invasive lesion, recurrences have not been reported after en bloc excision. The authors report a 10-year-old boy who presented with upper lid swelling, proptosis, and hypophthalmia. A computed tomography (CT) scan showed a calcified mass in the superior orbit which had eroded through the roof, and magnetic resonance imaging (MRI) showed a well-circumscribed mass between the periorbita and dura. A transcranial approach was used to remove the tumor, and the roof reformed with polypropolene. He has been followed for 18 months without recurrence.
Child↗
Surgical approaches to diseases of the orbital apex.
The authors report their experience with transcranial approaches to the orbit in situations where adequate exposure would not have been obtained with the usual orbital techniques. In addition to the standard frontal craniotomy, a supraorbital transcranial approach is described that involves removal of the superior rim and roof of the orbit, allowing exposure of all but the floor of the orbit. The main indication for this technique is a mass deep in the orbital apex that would be difficult or impossible to expose with a conventional orbitotomy. Seven representative cases are presented that illustrate conditions falling in that category.
Adult↗
Management of the blepharoplasty patient with ptosis.
Patients who request correction of both dermatochalasis and acquired blepharoptosis require separate evaluation of each condition. The blepharoplasty is done in the standard way, depending on the amount of skin redundancy and fat herniation. The method of ptosis repair is dependent on whether Müller's muscle or levator aponeurosis is weak, the degree of ptosis and levator function, and the position of the upper eyelid crease. A tarsal Müller's muscle resection is employed in cases where the ptosis is minimal, the upper eyelid crease is normal, or the phenylephrine test is positive. A levator advancement is done if the ptosis is due to a levator aponeurosis dehiscence or attenuation with a higher than normal upper eyelid crease and thinning of the eyelid. Both procedures are easily combined with an upper eyelid blepharoplasty.
Aged↗
Chronic hematic cyst of the orbit.
A chronic hematic cyst of the orbit caused unilateral globe displacement in four patients, two of whom had a past history of orbital trauma. The onset of a painless vertical displacement of the globe ranged from 3 weeks to 4 years. Computed tomographic (CT) findings demonstrated a homogeneous, nonenhancing, subperiosteal mass in the superior orbit in three patients and the inferior orbit in one. At surgery, all patients had masses surrounded by a pseudocapsule without epithelial or endothelial lining. The history, age distribution, and CT findings help to differentiate this entity from other causes of unilateral exophthalmos.
Adolescent↗
Lateral canthal reconstruction.
After the lateral aspect of both the upper and lower eyelids were excised in six patients, a method of reconstruction was used employing a combination of periosteal flaps from the lateral orbital rim and a transpositional skin flap based in the temporal area. The periosteal flaps were crossed to form a sharp canthal angle and were joined to the tarsal edges creating the posterior lamella. The transpositional skin flap was divided at the distal end to form the anterior lamella of the upper and lower lids. The results have been satisfactory from a functional and cosmetic standpoint.
Aged↗