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At least 433 records · Page 24Linked to original sources
PubMed1991

Oblique facial cleft with anophthalmia in a mentally normal child.

An oro-ocular facial cleft with anophthalmia, classified as Tessier cleft no. 4, was satisfactorily corrected by a series of conservative procedures, including tube pedicle flap transfer, Z plasties, and bone grafting for orbital socket and zygomatic reconstruction. Beginning in 1975 when the patient was 4 months old, most of the reconstructions were performed before the routine tissue expansion and microsurgical tissue transfer techniques that are common today. The patient's development is normal and he is intellectually more advanced than most children his age. Correction of increasing asymmetry between growing and nongrowing regions of the skull in this young boy will probably be required.

Abnormalities, Multiple↗
PubMed2000

A rare craniofacial cleft: bilateral Tessier no. 5 cleft accompanied by no. 1 and no. 6 clefts.

A case of facial cleft that fits the anatomic description of the rare bilateral Tessier no. 5 cleft accompanied by unilateral no. 1 and no. 6 clefts is presented, and brings the total number of reported cases to 21. This case and a review of the literature help to define the soft-tissue and bony course of these clefts, and also emphasize the role of three-dimensional computed tomography to show the bony cleft route. The diagnosis and treatment plan of the no. 5 cleft as well as other rare clefts such as no. 1 and no. 6 clefts are discussed.

Anophthalmos↗
PubMed1996

Study and planning of the surgical procedure for the orbital district in patients affected by craniofacial malformations.

Orbital surgery is of critical importance within the framework of craniofacial surgery. The conical conformation of orbits requires analysis and surgical procedure planning methods involving all three dimensions. We present our protocol for the analysis and our three-dimensional surgical procedure plan to treat orbital malformations using teleradiography and two- and three-dimensional computed tomographic imaging. A number of clinical cases treated according to this approach are also presented.

Adolescent↗
PubMed1997

Tessier type VI-VII cleft combination associated with congenital bimaxillary fusion and anophthalmia.

Congenital intermaxillary fusion is a rare anomaly. Combination of the anomaly with any type of facial cleft is extremely rare. Death in a majority of these patients as a result of feeding and aspiration problems in early life may have caused the reports to be limited. In this article a 5-year-old patient, probably the first in the literature having Tessier type VI-VII facial cleft combination associated with bimaxillary fusion and anophthalmia on the right side, is presented. The patient has survived on fluid meal through a very small opening for 5 years. The features of the case are presented, and the time and method of the management of such a rare anomaly are discussed with a review of the literature.

Abnormalities, Multiple↗
PubMed2004

A case study of amnion rupture sequence with acalvaria, blindness, and clefting: clinical and psychological profiles.

The purpose of this article is to report the case of a 10-year-old girl born with anophthalmia, bilateral oblique facial clefts, and missing scalp and bones over the temporal and parietal areas of the cranial vault bilaterally. Early amnion rupture seems to be the most probable cause of this rare combination of anomalies. Because no similar case has been reported in the literature so far, we describe here the clinical and psychosocial history of this unusual patient, who has been able to live the intellectually and socially normal life of a blind child in spite of the major craniofacial deformities. The already completed and possible future therapeutic strategies are discussed.

Amniotic Band Syndrome↗
PubMed1987

Polytetrafluoroethylene as a graft material in ophthalmic plastic and reconstructive surgery. An experimental and clinical study.

A clinical and experimental study was performed to demonstrate the usefulness of polytetrafluoroethylene (PTFE) as a graft material in ophthalmic plastic surgery. PTFE is non-antigenic, autoclavable, inert, and incorporated into surrounding tissue through fibrous ingrowth. PTFE implanted into rabbit eyelids for periods ranging from 2 to 21 weeks was examined grossly and microscopically. PTFE left uncovered by a conjunctival flap extruded; PTFE covered by a conjunctival flap was well tolerated without inflammation or extrusion and demonstrated dense fibrous capsular development with fibrous ingrowth along suture tracts and extensive vascular ingrowth. Fibrous tissue showed minimal growth into intrafiber pore spaces. PTFE was implanted into seven anophthalmic patients (one patch graft and six PTFE-wrapped secondary implants), with a postoperative follow-up of from 6 to 13 months. The material was well tolerated without extrusion, granuloma formation, or irritation. PTFE offers advantages over other graft materials and appears to be a useful addition to ophthalmic plastic surgery.

Adult↗
PubMed1991

The domed dermis-fat graft orbital implant.

Dermis-fat grafts have been widely used in the reconstruction of the anophthalmic socket, both primarily after enucleation and secondarily after extrusion or migration of an existing implant. The dermis-fat graft is an effective means of replacing orbital volume and affording motility of the ocular prosthesis with both low morbidity and a satisfactory cosmetic result. We present a modification to the dermis-fat graft technique. Our modification creates a domed shape to the anterior surface of the graft that simulates the curvature of the eye. The dome-shaped graft creates deeper fornices than a standard flat-surfaced dermis-fat graft. It also allows better contact between the prosthesis and the dermis as the graft moves. The prosthesis can be thinner centrally and lighter than a prosthesis fabricated for a socket with a standard dermis-fat graft or spherical implant. This results in better motility of the prosthesis while also replacing orbital volume. There is no additional morbidity associated with this technique. We have used this procedure successfully in 18 patients; 10 were primary grafts and eight secondary grafts. Motility of the prosthesis was satisfactory in all cases. There was no abnormal graft shrinkage. All grafts maintained their domed shape. Follow-up ranged from 6 to 21 months.

Adipose Tissue↗
PubMed1992

Stimulation of orbital growth by the use of expandable implants in the anophthalmic cat orbit.

We evaluated the efficacy of expandable orbital implants to stimulate bone growth in the anophthalmic cat orbit. Eighteen cats unilaterally enucleated at 2 weeks of age received either expandable orbital implants (groups A1 and A2), solid silicone sphere implants of 12 mm or 8 mm (groups B1 and B2), or no implant (group C). Those cats with expandable implants (group A) had the implant size increased by 0.5 ml injections of saline at 2-week intervals starting at 8 weeks of age until a final volume of 4 cc was reached. Four of the expandable implants were found to be only partially inflated at 20 weeks and were subgrouped A2. At 20 weeks of age, the anophthalmic orbits with fully inflated expanders showed no significant difference in either orbital volume or orbital entrance area when compared with control orbits: volume (91.2%), area (95.7%) (p = 0.01). These same orbits also showed a significant increase in both orbital volume and orbital entrance area when compared with the growth obtained by any other group. These other groups showed growth, expressed as a percentage of normal growth, as follows: partially inflated implant: volume (63.0%), area (69.0%); 12-mm sphere implant: volume (57.0%), area (54.5%); 8-mm sphere implant: volume (46.5%), area (44.6%); no implant: volume (47.6%), area (43.6%) (p = 0.01). This study suggests that the use of expandable orbital implants stimulates bony growth in the immature cat orbit. Bony stimulation was proportional to volume implanted, and expandable orbital implants achieved maximum bony stimulation in the groups studied.

Animals↗
PubMed1994

Orbital volume augmentation with subperiosteal room-temperature-vulcanized silicone implants: a clinical and histopathologic study.

Enophthalmos, a clinical feature of the anophthalmic orbit, often produces a considerable cosmetic deformity. Management of this condition includes surgical volume augmentation with orbital implants. Several types of materials with different shapes have been used with variable success rates. Between 1984 and 1990, we treated 84 anophthalmic patients with room temperature vulcanized (RTV) subperiosteal silicone implants. Adequate volume augmentation and correction of the apparent enophthalmos was achieved in 75 patients. Extended patient follow-up, analysis of data and results, histopathologic assessment of implant capsules, and management of complications have provided a unique opportunity to study the efficacy of the surgery. We present our experience in the management of this condition.

Adult↗
PubMed1994

Animal model of porous polyethylene orbital implants.

Ophthalmologists continue to search for the ideal orbital implant for the anophthalmic socket. The successful long-term clinical performance of an implantable prosthesis is highly dependent on the materials from which the device is fabricated. Among the materials issues are chemistry, surface texture, and porosity. Polyethylene, a polymer comprised of simple hydrocarbon chains, is highly resistant to biological degradation and possesses mass and fabrication properties that would be favorable in an orbital implant. In this report, our early experimental experience with porous polyethylene orbital enucleation implants is reported. Our findings are sufficiently encouraging to warrant further exploration and refinement of the polyethylene device examined.

Animals↗
PubMed1996

Draining cutaneous fistula associated with infection of hydroxyapatite orbital implant.

The implantation of an orbital hydroxyapatite implant was complicated by conjunctival dehiscence, cutaneous fistula formation, and infection with Staphylococcus aureus. Pathologic examination of the sphere 2 years after its implantation revealed reduction in the size of the implant, peripheral lamellar bone formation and central necrosis. This is the first report of this constellation of complications with hydroxyapatite spheres positioned in the orbit. The 2-year interval between implantation and removal of the sphere is the longest reported in a case with histopathologic analysis.

Adult↗
PubMed1997

The effect of maturation on the ability to stimulate orbital growth using tissue expanders in the anophthalmic cat orbit.

Tissue expanders were used to stimulate orbital growth at different stages of maturity in the immature anophthalmic cat orbit. Twelve cats had the right globe enucleated at 2 weeks of age and tissue expanders implanted in the orbit. The cats were randomized into four groups (A, B, C, and D). The tissue expanders remained in the nonexpanded state for a preassigned length of time. Orbital volume was determined on each cat using computed tomography (CT) immediately prior to expansion of the implant. Expansion began at age 10 weeks for group A, 15 weeks for group B, and 25 weeks for group C and involved 0.7 cc injections of saline at 2-week intervals until a final volume of 4.5 cc was obtained. Group D remained as a nonexpansion control group. Four to 5 weeks after expansion was completed, a second orbital volume CT was obtained on each animal and compared with the pre-expansion CT. The right orbits of group A, had pre-expansion (week 10) orbital hypoplasia with a volume 26.2% smaller than the left control orbits. Postexpansion (week 25), the right orbital hypoplasia had decreased to a volume 10.3% less than the left control orbits. The right orbits of group B had pre-expansion (week 15) orbital hypoplasia with a volume 35.6% smaller than the left control orbits. Postexpansion (week 31), the right orbital hypoplasia had decreased to a volume 25.9% less than the left control orbits. The right orbits of group C had a preexpansion (week 25) orbital hypoplasia with a volume 39.8% smaller than the left control orbits. Postexpansion (week 41), the right orbital hypoplasia had decreased to a volume 29.3% less than the left control orbit. Tissue expanders, expanded in the hypoplastic immature cat orbit stimulated orbital growth and reversed orbital bony hypoplasia to varying degrees. The amount of growth stimulated was inversely proportional to the age at which expansion began. Orbital growth, stimulated by tissue expander expansion, was also demonstrated after the normal age of cat orbit maturation (weeks 28-30).

Animals↗
PubMed1998

Unilateral dermis-fat graft implantation in the pediatric orbit.

The purpose of this study was to evaluate the role of the dermis-fat graft (DFG) as an orbital implant in the pediatric age group. A retrospective study was made of a series of 16 patients who had undergone unilateral orbital implantation of a DFG. The ages of the patients at the time of surgery ranged from 2 months to 17 years, with followup ranging from 2 to 15 years. Growth of the graft was clinically apparent in the younger children. Increasing proptosis required surgical debulking of the graft in six of eight children who were 4 years old or younger at the time of DFG implantation. None of the eight children who were 9 years or older at the time of DFG implantation required surgical debulking. Indeed, five of the older patients demonstrated some degree of graft atrophy. Dermis-fat grafts placed in the orbits of young children appear to grow after implantation. This growth of the implant may help stimulate orbital growth, potentially leading to more symmetry between the involved and uninvolved sides.

Adipose Tissue↗
PubMed1999

Predicting the ideal implant size before enucleation.

PURPOSE: This study of volume replacement in anophthalmic sockets compares the volume replaced by the implant and prosthesis with the volume removed from the socket and evaluates A-scan ultrasonography as a tool to predict an ideal implant size before enucleation. METHODS: In this retrospective study of 59 anophthalmic patients, the volume replaced by the implant and the prosthesis was compared with the volume of the enucleated eye. The volume removed was estimated by calculating the volume of the fellow eye using A-scan ultrasonography. Enophthalmos and superior sulcus deformity were measured and correlated with the percent volume replacement in the anophthalmic sockets. RESULTS: Greater enophthalmos and superior sulcus deformity were found in patients with less than 100% volume replacement compared with those with 100% or more volume replacement. The axial length determined by A-scan ultrasonography of the fellow eye suggested that a larger implant size should have been placed in 76.3% of those patients with less than 100% volume replacement. Sixty-three percent of adult patients could have received an implant more than 22 mm in diameter to fill 80% of the volume removed at enucleation. CONCLUSIONS: A-scan ultrasonography of the fellow eye provides a useful tool for predicting the implant size before surgery for optimal volume replacement.

Adult↗