Frontalis Transfer and Closed Silicone Rod Frontalis Suspension

BACKGROUND: Improvements in the degree of marginal reflex distance 1 (MRD1) were compared before and after use of the frontalis transfer (FT) method and closed silicone rod frontalis suspension surgery (SS) for severe blepharoptosis under general or local anesthesia with or without minimal sedation. METHODS: We reviewed the medical records and photographs of 76 patients who had visited our institute between 2006 and 2013 because of severe blepharoptosis with poor levator function and treated by the same senior doctor. RESULTS: In total, 104 eyes (63 patients) were included after applying exclusion criteria; 71 eyes (44 patients) were corrected using FT, and 33 eyes (19 patients) were corrected using the frontalis sling method with a silicone rod. Among the general FT, local FT, general SS, and local SS groups, the mean preoperative MRD1 was not significantly different. Postoperative MRD1 was highest in the local FT group. CONCLUSIONS: Both FT and SS positively increased MRD1, regardless of the anesthesia used; however, the change in MRD1 of the general SS group was the lowest (1.11+/-0.848 mm). Further, general FT, local FT, and local SS groups had an approximate 2 mm or greater increase in the differences between postoperative and preoperative MRD1. Specifically, the local FT group had a definite positive correlation with postoperative MRD1.

Postoperative Contralateral Blepharoptosis in Patients with Unilateral Blepharoptosis and Negative Hering's Law Dependence Test

BACKGROUND: Correction of unilateral blepharoptosis is unexpectedly difficult because healthy eye is often affected by Hering's law. METHODS: We measured changes of marginal reflex distance (MRD1) on the unaffected eyelids between preoperative and 3-month postoperative photographs after ptosis correction. This study analyzed 134 unilateral blepharoptosis patients with ptosis correction from February 2002 to February 2011. Fifty patients among them were negative in Hering's law dependence test. From the preoperative and postoperative photographs the MRD1 of unaffected upper eyelids were measured and adjusted with the average pupil diameter of Koreans. Mean age was 34.4 and male was 30 and female was 20. Average follow-up periods were 14 months. RESULTS: Thirteenth unaffected eyes (26%) showed decreased MRD1, and 3 patients (6%) showed decreased MRD1 value over 1.0 mm. Then 3 patients needed additional operations for correction of preoperatively unaffected but ptotic eyelids. CONCLUSION: There were no meaningful data statistically in the value of MRD1 in every unaffected eye of the patients and in the difference between preoperative and postoperative MRD1 of groups divided according to severity, causes, and types of operation.

The Accuracy Rate in Comprehension of Aspects of Nasal Bone Fracture Based on Simple X-ray and 2D CT Compared with 3D Image

PURPOSE: The nasal bone fracture is known as the most common facial fracture, with the postoperative results and the patient's satisfaction known to be lower than other facial fractures. The patient's satisfaction is firstly related to the accurate comprehension of the spatial relationship in the fractured nasal bone and secondly to the accurate reduction based on accurate comprehension. The aim of this study is to evaluate the objective usefulness of the three-dimensional (3D) imaging. METHODS: The survey was conducted on 10 randomly selected cases of nasal bone fractures among the 46 cases with 3D computed tomography (CT) during the past one year. It was requested upon 4 plastic residents and 4 plastic surgeons to draw 3D aspect of fractured nasal bone directly on the printed photos of cadaver nasal bone, based on simple X-ray and twodimensional (2D) CT. They were compared with the real fractured nasal bone aspects based on the 3D image and marked the difference in the 10-point scale of 0 to 10. RESULTS: The average score of the 4 residents was 1.62 and that of the 4 surgeons was 4.47 out of 10 by simple X-ray. The average score of the 4 residents was 5.67 and that of the 4 surgeons was 7.25 out of 10 by 2D CT. CONCLUSION: It was surmised that the precise analysis and accurate comprehension of the spatial relationship of the fractured nasal bone using the 3D image, as based on the 2D CT images, can produce more favorable satisfaction levels in the patients.