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Temporoparietal fascial flap for orbital and eyelid reconstruction.

The temporoparietal fascial flap is a recognized technique for the transfer of vascularized tissue in the craniofacial region. The flap has a predictable axial vessel, provides thin vascularized tissue, and can be harvested with minimal donor-site morbidity. The temporoparietal fascial flap is well suited for orbital or eyelid reconstruction because of its proximity to the orbit. The flap is useful for reconstruction of anatomic barriers between the orbit, intracranial cavity, and paranasal sinus spaces. We present four patients in whom the temporoparietal fascial flap was used for orbital reconstruction following extirpative surgery for orbital neoplasm and two patients in whom the flap was used for lower eyelid and malar reconstruction.

Adult↗

[Orbital pathology--I].

The signs of orbital diseases depend on an ideal anatomic and physiological symmetry which ensures correct position of the eyeballs and proper coordination and synchronization of the action of the oculomotor muscles. In the initial stage of pathological lesion development, the following may occur: burning sensation in conjunctivae, feeling of dryness, excessive lacrimation, and periodically appearing stabbing pain in the eye. Orbital diseases are associated most frequently with exophthalmus, and frequently also with lateral displacement of the eyeball and disturbances of its mobility. Injuries, inflammatory states and orbital neoplasms jeopardize not only the visual system but often are life-threatening. The determination of precise localization, size, type, and aetiology of pathological lesion and undertaking as soon as possible proper therapeutic management is the foremost task of every doctor.

Humans↗

US and color Doppler imaging of ocular and orbital disease in the pediatric age group.

Ultrasonography (US) is a rapid, accurate, noninvasive method of evaluating ocular and orbital disease. A wide spectrum of pediatric ocular and orbital disorders can be demonstrated with US: ocular congenital malformations, vitreoretinal disorders, primary and metastatic ocular and orbital neoplasms, inflammatory and congestive disease (focal or systemic), cystic disease, trauma, and foreign bodies. US may be the method of choice for studying ocular congenital anomalies and vitreoretinal disorders owing to its high definition and noninvasiveness. In ocular neoplasms, US demonstrates the morphology of the lesion, its solid or liquid nature, and the presence of calcifications. Its use is limited when the tumor extends outside the globe; computed tomography (CT) or magnetic resonance (MR) imaging must then be performed. In ocular trauma, US precisely demonstrates the presence of hemorrhage, retinal and choroidal detachment, and foreign bodies. CT and MR imaging are superior in evaluation of orbital disease. Color Doppler US often allows differential diagnosis of vascular, inflammatory, and neoplastic disease.

Child↗

[Intra-orbital hydatid cyst. An uncommon site of hydatidosis. Discussion apropos of a recent case].

The authors present an observation of intraorbital hydatid cyst. They review the literature and discuss the main data of such a rare lesion. Hydatid cyst should be systematically evoked in any case of tumoral exophthalmia developed in a young patient, particularly if he comes from an endemic country. The pre-operative diagnosis relies on the confrontation between clinical and echographical data, and C.T.-scan imaging. The only treatment is surgery. A puncture performed at the beginning of the surgical procedure will confirm the diagnosis. In fact, it should be indicated for every intra-orbital neoplasm observed in a country of endemicity, mostly when the preoperative diagnosis is difficult, that is when no C.T.-scan or echography are at disposal. The infectious prognosis is excellent; but the functional one depends on the precocity of surgery and remains reserved in most cases.

Echinococcosis↗

[A broad subfrontal access to the tumors in the base of the skull].

A total of 30 patients, aged 16 to 67, with neoplasms in the brain base and in paranasal sinuses were operated on, during 1997-2002, at Burdenko's Research Institute for Neurosurgery of the Russian Academy of Medical Sciences (RAMS). A majority of patients (21) had meningiomas. Other observations included: fibrous dysplasia of the anterior cranial fossa in 3 patients, chondroma in 2 patients, angiofibroma in 2 patients, pituitary adenoma in 1 patient and adamantinoma in 1 patient. The application of diluted subfrontal approach and of its modifications is indicated for extradural tumors located in the anterior cranial fossa and extending into the latticed main sinus of the nasopharynx. No increasing neurological symptomatology was noticed in any patients. Nasal liquor was not noted either. A seizure of an essential reduction of exophthalmos was registered in cases with crania-orbital neoplasm. It restored postoperatively in all patients with malfunctions of nasal breathing. Two patients died. The death reasons are not directly related with the approach technique. The diluted subfrontal approach is effective in extensive tumors of the anterior cranial fossa involving the latticed and main sinuses. Our experience of using the diluted subfrontal approach showed its efficiency not only in extensive extradural neoplasms but also in large meningiomas of the anterior cranial fossa extending into the latticed sinus, main bone platform, tubercle of sella turcica and into both optic canals. The discussed approach ensures essentially reduced brain traction as compared with the traditional subfrontal approach. The hermetic closure of defects formed in the brain basis is an important surgery stage involving the diluted subfrontal approach. This approach is, under modern conditions, a valuable addition to the methods, which are generally accepted in neurosurgery, and it has undoubtedly an indisputable perspective.

Adenoma↗

Hemangiopericytoma.

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Hemangiopericytoma↗

Orbitofacial masses in children: an endoscopic approach.

OBJECTIVE: To describe an endoscopic approach for pediatric orbitofacial masses. DESIGN: A retrospective medical chart review. SETTING: Tertiary-care children's hospital. PARTICIPANTS: Patients (4 boys, 7 girls) ranged in age from 6 months to 11 years. All children underwent endoscopic excision of an orbitofacial mass. INTERVENTION: A single port approach was used in all but the initial case. The scalp incision was placed approximately 2.0 cm behind the frontal hairline. A subgaleal dissection was performed to minimize risk of nerve injury. Under endoscopic visualization, the mass was resected. MAIN OUTCOME MEASURES: Ability to successfully excise the mass endoscopically, and the incidence of complication. RESULTS: All lesions were successfully resected endoscopically. The surgical time varied from 30 to 105 minutes (mean, 50.5 minutes). Pathologic examination revealed 10 dermoid cysts and 1 neurofibroma. Two children had transient frontalis branch palsies that resolved spontaneously. There was 1 unilateral frontal hypoesthesia in the patient with the neurofibroma (an expected result). There were no other complications. CONCLUSIONS: An endoscopic approach to pediatric orbitofacial tumors is safe and effective. Although the risk of nerve injury may be higher, a thorough knowledge of frontotemporal anatomy and careful dissection will minimize this risk. The distinct advantage of an endoscopic approach is the absence of any facial scar in these young patients.

Child↗

Gorlin's basal cell nevus syndrome.

A case report is used to illustrate the characteristics of Gorlin's syndrome and to emphasize the need for early recognition by the physician and for thorough lifetime follow-up by the patient to prevent severe sequelae.

Adult↗

Angular dermoids.

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Dermoid Cyst↗

Issues in the local control of rhabdomyosarcoma.

BACKGROUND: Rhabdomyosarcoma (RMS) is a heterogeneous disease consisting of several different histologies arising from a variety of anatomic sites. Approximately half of the children who die of this tumor have failure at the primary site of involvement, making local control an important component of therapy. PROCEDURE: Published literature and newly analyzed data from the Intergroup Rhabdomyosarcoma Study Group (IRSG) regarding local control of RMS were reviewed. Information regarding the role of various local control modalities for different primary disease sites is presented along with new directions for clinical research. RESULTS: Local control rates for RMS average 80% for group III tumors, with large variations seen for different anatomic sites. Important gains in functional outcome for certain sites such as gynecologic system and bladder/prostate have been achieved by optimizing the use of the various treatment modalities. Local control at other sites such as the chest and extremities remains a problem. CONCLUSIONS: Advances in surgical and radiotherapy techniques coupled with multiagent chemotherapy are providing improved local control with decreasing morbidity. Optimal outcome is dependent on close collaboration between surgical, radiotherapy, and pediatric oncology specialists.

Antineoplastic Combined Chemotherapy Protocols↗

Tumor imaging in children.

Twnty-six children suspected of having malignant diseases were examined by Gallium-67 scintigraphy. The scintigrams were pathologic in the 20 children with final diagnoses of malignancy. The lesions visualized by scintigraphy were 12 primary tumors and eight cases of local recurrence or dissemination of cancer. Gallium-67 did not accumulate in a hematoma of the liver, and scintigraphy was normal in five children with no clinical evidence of tumor recurrence. Several cases are reported and the clinical value of 67Ca scintigraphy for detection and control of childhood neoplasms is emphasized.

Abdominal Neoplasms↗

Radiation therapy of malignant melanoma: experience with high individual treatment doses.

Reports of the existence of a large shoulder on the radiation survival curve of cultured mouse and human malignant melanoma cells prompted a clinical trial of radiation therapy using high individual-dose-fractionation schedules. Typically, individual doses of larger than or equal to 600 rads were delivered once or twice weekly. The most clear-cut effect was against skin metastases. Twenty-nine of 33 lesions showed partial or complete regression when treated in this manner. None of 11 lesions responded that were treated with individual treatment doses of 200 to 500 rads, although in some cases the total doses were greater than 5000 rads. Some of the possible roles for an effective radiation regimen in the overall management of this complex disease are discussed.

Aged↗