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Biomedical subjects

M R Levine

Publications and source records attributed to M R Levine.

At least 19 recordsLinked to original sources
PubMed1995

Metastatic basal cell carcinoma of the eyelid. Report of a case.

A patient had metastatic basal cell carcinoma of the right upper eyelid and periorbital area. Initially treated with radiation, there were multiple, extensive local recurrences requiring wide surgical excision. Ten years after the first lesion appeared, a metastasis was found in the preauricular soft tissue. A literature search found 204 previously reported cases of metastatic basal cell carcinoma, but none in the Western or European ophthalmic literature. The pathogenesis and unique features of basal cell carcinoma behavior are discussed.

Aged↗
PubMed1995

Free graft enhancement using orbicularis muscle mobilization.

PURPOSE: The purpose of this article is to demonstrate how mobilization of the orbicularis oculi muscle can improve viability, appearance, and function of free skin grafts in the periocular region. By enhancing blood supply with this technique, healing often can be achieved in difficult reconstructive cases. METHODS: Seven patients underwent orbicularis muscle mobilization before placement of free skin grafts. Two patients underwent resection of basal cell carcinomas of the lateral eyelids and canthal region requiring complex reconstructive techniques such as lateral canthal tendon reconstruction with auricular cartilage. One patient underwent upper eyelid reconstruction after total resection for sebaceous cell carcinoma with pagetoid spread. Two patients had difficult wound dehiscences that were difficult to repair primarily. In addition, the lower eyelid with recurrent basal cell carcinomas of two patients who initially had undergone reconstruction with a Hughes procedure was reconstructed using tarsal strip grafts and orbicularis muscle mobilization combined with a free skin graft. RESULTS: All seven patients have viable free grafts to date, and no further problems occurred in the two patients with wound dehiscences. Follow-up ranges from 1 to 8 years. CONCLUSION: Orbicularis oculi muscle mobilization can be combined with a variety of techniques in eyelid and periorbital surgery, including difficult wound repair, reconstruction of the lateral canthal tendon with periosteal flaps or auricular cartilage, tarsal transposition flaps, mucosal grafts, and skin grafts. The addition of this technique can enhance the blood supply to the reconstructed area and allow healing which might not be obtained otherwise.

Adult↗
PubMed1995

Orbital lymphangioma with intracranial extension.

We report a case of biopsy-proven orbital lymphangioma with contiguous spread intracranially in a 14-year-old boy. The patient had a history of congenital orbital lymphangioma and hydrocephalus. Multiple functional and cosmetic periorbital surgeries were done over the years. Severe unresponsive amblyopia developed along with disfiguring anterior orbital and brow invasion of tumor. Since the age of 4 years, the patient had had 12 episodes of periorbital and orbital cellulitis, often after upper respiratory infections. CT and MRI scans have shown progression of the tumor posteriorly beyond the orbital confines. The tumor, now present in the superior and inferior orbital fissure and the paranasal sinuses, extends extradurally into the middle cranial fossa. This case is unique, with documentation of the benign tumor's progressive posterior extension intracranially, along with repeated episodes of severe periorbital cellulitis.

Adolescent↗
PubMed1995

Maxillary sinus orbital fistula secondary to repair of an orbital floor fracture.

Orbital emphysema can occur after a blow-out fracture of the orbit, usually involving the medial wall. Repair of orbital floor fractures often involves the reduction of the herniated orbital contents and implantation of a sturdy, inelastic material to prevent the orbital contents from prolapsing into the maxillary sinus. We report a case of a maxillary sinus orbital fistula that occurred after the repair of a blow-out fracture of the right orbit, resulting in orbital emphysema. This was corrected with an autogenous fascia lata graft.

Adult↗
PubMed1994

Systematized epidermal nevi: case report and review of clinical manifestations.

A 19-year-old woman developed papillary and pigmentary changes of the skin over her entire body with extensive eyelid involvement causing trichiasis. A four-lid blepharoplasty with rotation of the anterior lid lamella led to resolution of the ocular symptoms and secondary cosmetic improvement. Histologic examination of the tissue demonstrated epidermal nevi which are congenital abnormalities of surface or adnexal epithelium. This patient was diagnosed with systematized epidermal nevus as described by Lever's classification. There is a high association of epidermal nevi with other systemic abnormalities; that association is known as "epidermal nevus syndrome" (ENS).

Adult↗
PubMed1994

The conjunctival wart: report of a case and review of treatment options.

Human papillomavirus, a papovavirus, is the causative agent of all warts. There are at least 63 subtypes of this virus, certain ones of which are more likely to cause warts in particular locations or to be associated with malignancies. Over the last 6 years, HPV-6, HPV-11, and HPV-16 have been detected in both benign and malignant lesions of the conjunctiva. We report a patient with a large viral papilloma of the palpebral conjunctiva of the right lower eyelid. This case demonstrates that even very large viral papillomas can be treated successfully.

Adult↗
PubMed1992

Spastic entropion after cataract surgery.

Spastic entropion is an acute eyelid condition seen in patients with acute inflammatory ocular conditions. It has been reported after cataract surgery. We describe three cases of spastic entropion after cataract surgery that did not resolve after the ocular irritation subsided. All were associated with eyelid and/or cul-de-sac injection of antibiotics and corticosteroids or anesthetic solution. All had dehiscence of the capsulopalpebral fascia. Spastic entropion is an evolving stage toward permanent entropion.

Aged↗
PubMed1991

Brown tumor and secondary hyperparathyroidism.

Brown tumor is a focal, bony lesion of hyperparathyroidism that results from parathyroid hormone on bone increasing osteoclastic activity with bone resorption and trabecular fibrosis. This leads to microfractures and hemorrhage and the appearance of brown tumors, which are seen most commonly in primary hyperparathyroidism and less frequently in secondary hyperparathyroidism. Rarely do these tumors involve the orbit. We report the sixth case, to our knowledge, of orbital involvement, in a patient with chronic renal failure (secondary hyperparathyroidism) and review the literature.

Adult↗
PubMed1991

Surgical treatment of thyroid-related lid retraction: a new variation.

We describe a cutaneous approach for retraction of the upper eyelid which incorporates a levator aponeurotic/Mueller's muscle recession with maintenance of the normal orbital septum levator aponeurosis anatomy. With success defined as asymmetry between the two eyelids of 1 mm or less, with a marginal reflex distance as close to 4 mm as possible, this technique was successful in 87% of 15 consecutive patients. All patients reported improved comfort. This approach is quick and easy, bleeding is minimal, height and contour are predictable, the upper eyelid crease is preserved, and spacers are avoided, with less postoperative eyelid thickening and reaction.

Eyelid Diseases↗
PubMed1991

Adrenal suppression and growth retardation after injection of periocular capillary hemangioma with corticosteroids.

Adrenal suppression and/or growth retardation were noted in two patients after injection of periocular capillary hemangiomas with corticosteroids. Parents should be warned of these two potential complications of intralesional corticosteroid therapy. Baseline and posttreatment adrenal function should be monitored. If iatrogenic adrenal suppression occurs, supplemental systemic corticosteroids may be necessary in situations involving systemic stress such as infection or surgery.

Adrenal Cortex Hormones↗
PubMed1990

Diagnosis and treatment of complications of enucleation and orbital implant surgery.

Careful surgical technique is important in enucleation surgery. Gentle and careful handling of tissues leads to superior cosmetic results and fewer complications. Extrusion of orbital implants may occur early or late. Small extrusions may be treated with a scleral patch, and larger extrusions with an acrylic sphere wrapped in fascia lata or donor sclera. Dermis fat grafts are also satisfactory secondary implants.

Eye Enucleation↗
PubMed1990

Sclerosing syringoma.

Syringoma, a benign sweat gland tumor which may occur in the eyelid, commonly presents as multiple lesions in young women. We had an unusual case of a sclerosing syringoma found as a single lesion in the lower eyelid of a man.

Adenoma↗
PubMed1989

Metastatic melanoma within and to the conjunctiva.

Two patients with epibulbar juxtalimbal primary conjunctival melanomas experienced local intralymphatic metastases to the inferior cul-de-sac, and a hematogenous metastasis to the conjunctiva developed in five other patients with cutaneous melanomas. Whether reflective of a local or distant metastasis, all of the lesions histopathologically were located in the substantia propria, and were separated from the overlying epithelium by a thin mantle of collagen. There was no evidence of atypical intraepithelial melanocytic proliferation, as would be expected in association with a primary conjunctival melanoma. Two of the cutaneous metastases exhibited a binodular or multinodular appearance that correlated histopathologically with variably confluent micronodules suggestive of the origin of the clinical lesion from a shower of tumor cell emboli. Patients with local intralymphatic spread from a primary conjunctival melanoma may experience additional lesions in the conjunctival sac or eyelid skin and are at risk for regional or distant metastases. They should be examined closely several times a year. The patients with the distant metastases all had their previously diagnosed primary cutaneous tumors on the truncal skin (a similar tendency emerges from a review of previous ocular cases), typically had myriad other cutaneous lesions, and two of them had a neoplastic iridocyclitis and vitreitis. These patients tended to die of the disseminated tumors within 1 year after conjunctival metastases developed.

Adult↗
PubMed1989

Primary intraosseous hemangioma of the orbit. Report of a case and review of literature.

Orbital intraosseous hemangiomas are rare entities, with only 15 previously reported. We review these and present our own. They are benign, vascular tumors, typically found in the frontal, ethmoid, or zygomatic bones. They tend to present in the 4th or 5th decades as a mildly painful orbital rim mass. Ocular findings may be absent or severe, including blindness. These tumors have characteristic, although not always present, roentgenologic features that differentiate them. Our case is unusual in that it is the oldest patient reported, demonstrates bilateral lesions, and did not exhibit classic x-ray findings. We report imaging these lesions with magnetic resonance imaging with nonspecific results. The pathology of orbital hemangiomas is presented, with the most common being the cavernous type. Because these tumors may bleed when entered, block excision with normal margins is the treatment of choice. Radiation therapy has specific indications for nonresectable lesions. Prognosis is uniformly good, if treated.

Aged↗
PubMed1989

Gunshot wounds of the eye and orbit.

Gunshot wounds to the globe and orbit require careful evaluation and management. This article highlights five cases of penetrating gunshot injuries, each demonstrating different points to consider when managing the severely traumatized patient. Immediate and late complications are described. Missile velocities of different weapons are detailed, and the mechanism of injury is discussed. Careful preoperative evaluation is stressed as a means of avoiding complications.

Adult↗
PubMed1988

Delayed primary wound closure. Use to prevent implant extrusion following evisceration for endophthalmitis.

We used delayed primary wound closure in three cases of bacterial endophthalmitis to minimize the risk of implant extrusion following evisceration. In a fourth case, the wound was closed primarily, but wound dehiscence and implant extrusion occurred six weeks postoperatively, and reoperation was required. The advantages of delayed primary wound closure following evisceration of the globe for endophthalmitis include rapid removal of the intraocular abscess, continued drainage and mechanical débridement of the infected scleral pouch, and the development of granulation tissue resistant to bacterial growth at the wound margins prior to wound closure. These factors are important in reducing the risk of implant extrusion following evisceration of the globe for endophthalmitis.

Adult↗
PubMed1988

Frontal sinus mucopyocele in cystic fibrosis.

This report summarizes the treatment of two patients with cystic fibrosis and frontal sinus mucopyocele. The first patient, an 18-year-old boy, had a 1-year history of a proptosis of the left eye. The second patient, a 28-year-old woman, had a 3-month history of intermittent diplopia. In both cases, the frontal sinus mucocele was diagnosed by computed tomographic scans; both were successfully treated with an osteoplastic flap and fat obliteration of the frontal sinus. When a patient with cystic fibrosis presents with a history of unilateral proptosis, diplopia, or frontal headaches, a paranasal sinus mucocele should be suspected.

Adolescent↗