Clinical application of locational partition of the nasal endsin lacerated lacrimal canaliculi / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the positional relationship between the nasal ends of the lacerated lacrimal canaliculi, lacrimal caruncle, and medial canthal ligament, as well as its application in the lacrimal canalicular anastomosis.<p>METHODS: Sixty-five patients with traumatic lower canalicular laceration were selected. The distance from the lacrimal punctum to the temporal end was measured. The nasal ends were found under direct vision, and the positional relationship between the nasal ends, lacrimal caruncle and medial canthal ligament were quantitatively analyzed.<p>RESULTS: Totally 65 patients with canaliculus laceration, 39 patients had a distance of less than 6mm from the lacrimal punctum to the temporal end, where the nasal ends of 35 patients were located in the lacrimal caruncle area. There were 26 cases in which the distance from the lacrimal punctum to the temporal end was greater than 6mm, where the nasal ends of 24 cases were located in the medial canthal ligament area. The vertical distance between the nasal ends in the lacrimal caruncle area and the lacrimal mucosa was 2.1±0.7mm, and the vertical distance between the nasal ends in the medial canthal ligament area and the skin edge was 3.5±1.2mm.<p>CONCLUSION: The positions of nasal ends can be divided into the lacrimal caruncle area and the medial canthal ligament area, providing a basis for finding the nasal ends of the lacerated lacrimal canaliculi in the clinical practice.

Effects of nasofacial sulcus reversed fasciocutaneous flaps on medial canthal skin defects / 中华医学美学美容杂志

Objective To discuss the clinical effect of medial canthal skin defects reparation with nasofacial sulcus reversed fascio-cutaneous flaps.Methods Medial canthal skin defects in 10 patients were repaired with nasofacial sulcus reversed fascio-cutaneous flaps in the hospital.These patients included 3 cases of pigmented nevus,6 cases of skin tumors,1 case of scar.The size of defects varied from 0.8 cm× 1.0 cm to 1.8 cm×2.2 cm.Results In these 10 cases,the maximum area of fascio-cutaneous flaps was 2.0 cm×3.0 cm,and the minimum area was 1.2 cm× 1.5 cm.All the flaps survived with primary healing postoperatively.Incision line scar was inconspicuous and the color and texture of flaps were similar to those of surrounding tissues.Conclusions To maintain and restore the integrity of medial canthal by using nasofacial sulcus reversed fascio-cutaneous flaps would lead to a good aesthetic effects.

The Versatility of Cheek Rotation Flaps

BACKGROUND: The cheek rotation flap has sufficient blood flow and large flap size and it is also flexible and easy to manipulate. It has been used for reconstruction of defects on cheek, lower eyelid, or medial and lateral canthus. For the large defects on central nose, paramedian forehead flap has been used, but patients were reluctant despite the remaining same skin tone on damaged area because of remaining scars on forehead. However, the cheek flap is cosmetically superior as it uses the adjacent large flap. Thus, the study aims to demonstrate its versatility with clinical practices. METHODS: This is retrospective case study on 38 patients who removed facial masses and reconstructed by the cheek rotation flap from 2008 to 2015. It consists of defects on cheek (16), lower eyelid (12), nose (3), medial canthus (3), lateral canthus (2), and preauricle (2). Buccal mucosa was used for the reconstruction of eyelid conjunctiva, and skin graft was processed for nasal mucosa reconstruction. RESULTS: The average defect size was 6.4 cm², and the average flap size was 47.3 cm². Every flap recovered without complications such as abnormal slant, entropion or ectropion in lower eyelid, but revision surgery required in three cases of nasal side wall reconstruction due to the occurrence of dog ear on nasolabial sulcus. CONCLUSION: The cheek rotation flap can be applicable instead of paramedian forehead flap for the large nasal sidewall defect reconstruction as well as former medial and lateral canthal defect reconstruction.

Middle Meatus Osteotomy with Lacrimal Intubation for Post-traumatic Epiphora.

Nasolacrimal duct obstruction is common sequel following naso-orbito ethmoidal fractures. After 2 months of receiving conservative treatment, a 24-year-old male patient reported epiphora from the right eye following self-fall from a tree. Lacrimal sac mucocele was diagnosed and mucopurulent regurgitation noted on finger pressure and lacrimal sac syringing. Computed tomography revealed healed old fractures involving right nasal bone, maxillary nasal process adjacent to the medial orbital wall with lytic areas. Possibility of the subperiosteal abscess with osteomyelitis changes was suspected. A thick fibro-osseous (sequestrum) wall formation was noted separating nasal cavity and orbit. Lateral nasal wall adhesions were released by transnasal endoscopy. Two weeks later, the thick wall was fenestrated through external dacryocystorhinostomy approach. Lacrimal sac mucocele opened and bicanalicular silicone intubation performed. Epiphora relieved and lacrimal passage patency maintained and confirmed by lacrimal sac syringing on 3 months follow-up. To evaluate etiopathogenesis and patency, integrity of silicone intubation is the purpose of presenting this case.

A Case of Canaliculocele Treated with Punctoplasty and Marsupialization

PURPOSE: Canaliculocele is a rare cause of eyelid mass which is formed by dilation of the canaliculus. We introduce a case of canaliculocele treated with punctoplasty and marsupialization. CASE SUMMARY: A 35-year-old woman visited our clinic complaining of a right medial upper eyelid mass. It started 3 months ago and had the wax and wane feature. On slit lamp examination, cystic lesion was visible in the medial area of the right upper eyelid, and the punctum was obscure. Right upper canaliculus was not shown in dacryocystography. One-snip punctoplasty was performed for the diagnosis, and turbid contents were drained leading to collapse of the cyst. After diagnosis of canaliculocele, marsupialization was added by excision of the posterior wall of the mass. On histopathologic examination, the cystic wall was composed of nonkeratinized squamous epithelium with an attenuated superficial cell layer. The patient healed without recurrence of a cyst after 6 months of follow up.

Fibroma of the Medial Canthal Tendon: a Case Report

PURPOSE: To report a case of medial canthal tendon fibroma, a rarely observed tumor at the eye or ocular adnexa. CASE SUMMARY: A 47-year-old female visited our clinic with a two-year history of a hard mass in the medial canthal region. On examination, a 7 x 5 mm2 sized, hard and unmovable subcutaneous mass was palpated. The mass was slowly enlarging and the patient had no symptoms including tearing or pain. To confirm the diagnosis, a total excision of the mass was performed under local anesthesia. The tumor was a well-demarcated, 7 x 5 x 2 mm3 sized, white oval mass. The histopathologic examination of the specimen revealed dense collagen bundles with scattered fibroblasts. Based on these findings, the lesion was diagnosed as a fibroma. Although rare, fibromas should be included in the differential diagnosis of medial canthal tumors.

Large full thickness medial canthal reconstruction: a report of two cases and review of literature

The reconstruction of the upper eyelid with medial canthal involvement post extensive removal of malignant tumour remains a challenge. Proper eyelid reconstruction is necessary to re-establish anatomic integrity, restoration of its functions and to maintain the best cosmetic appearance. These case reports illustrate an alternative reconstructive technique for large upper eyelid full thickness defect with medial canthal involvement. Two cases of upper eyelid tumours involving medial canthal region underwent staged reconstruction by glabellar flap advancement and reconstruction of the posterior lamellar with autologous graft using buccal mucosa and ear cartilage. The posterior lamellar graft and flap survived without any complication except for mild eyelid margin notching in one of the two cases. The staged reconstruction with glabellar flap advancement provides adequate defect coverage, excellent blood supply, maintains eyebrow contour and function of the eyelid. The flap also perfectly matches the surrounding tissue with minimal donor site morbidity.

A Case of Inflammatory Myofibroblastic Tumor at the Upper Medial Canthal Region

PURPOSE: Inflammatory myofibroblastic tumor(IMT) is characterized by clonal proliferation of myofibroblastic spindle cells and accompanied by lymphoplasmacytic infiltration. IMT is an uncommon lesion reported to arise in various organs, and is believed to be a reactive inflammatory condition. IMT forms a spectrum of lesions ranging from benign, infection-related lesions to low- grade malignancies, capable of local recurrences and rarely distant metastasis. IMT occurs mostly in the lung, but rarely in the craniofacial region. METHODS: A 28-year-old male with painless swelling in the medial canthal area was referred to our department for the last 2 months. A 2cm sized mass was palpated. He was treated with complete local excision. RESULTS: In the study by computerized tomography, a 2.0x0.8x1.0cm mass was found in the subcutaneous tissue layer. Grossly, the mass was well-circumscribed, smooth-surfaced, flesh colored, and hard. The tumor was well demarcated from the other tissues. Histopathologic examinations showed bland spindle- shaped cells loosely arranged with scattered lymphoid cells. Immunohistochemical examinations demonstrated a positive reactivity for alpha-SMA and a negative reactivity for desmin and CD34. No recurrence was noted 12 months after surgery. CONCLUSION: Emphasis is given to complete resection of the tumor for both diagnostic and therapeutic purposes. Further evaluation to find other lesions in different sites should be considered. Continued follow-up is recommended.

Apocrine Sudoriferous Cyst in Medial Canthal Region Occurred after Trauma

PURPOSE: To report a case of apocrine sudoriferous cyst in the left medial canthal region occurred after trauma. CASE SUMMARY: A 75-year-old woman was referred for mass in the medial canthal region after trauma. The patient had got injured and been sutured on left medial canthal region when she was 11 years of age. The painless mass in the left canthal region has occurred after that. The orbital computed tomography showed a 20 x 12 x 19 mm-sized cystic mass. On physical examination, left telecanthus, left exotropia and left hypertropia were also observed. The cyst contained turbid grayish fluid and was removed completely through transcutaneous incision. On histopathologic examination, the cyst was confirmed to apocrine sudoriferous cyst lined by two-layered cuboidal epithelia.

Medial Canthal Reconstruction with Bilobed Flap

PURPOSE: We report 2 cases treated with bilobed flap surgery for medial canthal reconstruction. METHODS: Two patients with black and painless lid mass, 1 x 1 cm size, developed at medial canthal area were excised, and medial canthal reconstruction was performed. Biopsy was done before the surgery, showing basal cell carcinoma. We designed and rotated bilobed flap to reconstruct medial canthal defect caused by the radical excision, and sutured it at the incision margin of the skin. RESULTS: Pathologic examination was done after the surgery, confirming basal cell carcinoma. No marginal cancer cell were detected. Cancer relapse did not occur during 12 months of follow-up. We obtained satisfactory results in all patients, not only clinically but also cosmetically. CONCLUSIONS: It is considered that the bilobed flap procedure is effective for reconstruction of medial canthal defect developed after eyelid tumor excision and offer a good prognosis.

Surgical Correction of the Blepharophimosis Syndorome

During the past decade the syndorome of blepharoptosis, blepharophimosis, epicanthus inversus and telecanthus(blepharophimosis syndrome)have become recognized as a distinct tetrad based upon clinical and hereditary characteristics. Early surgery is recommended to minimize being teased at school altough the final results surgical correction may be better in older children and in adults. We treated nine patients with epicanthus by Mustarde's quadrilateral flap or Y to V flap Medial canthal tendon is shortened by tucking for telecanthus. Blepharoptosis is corrected by frontalis suspension using preserved dura or preserved fascia lata as a sling material. We experience satisfactory results in nine patients by this technique without serious postoperative complications.

A Case of Bilateral Dacryocystocele with Absence of the Lacrimal Puncta

A 33-year-old female suffered from bilateral mass in the medial area and epiphora for 20 years. The mass recurred after incomplete removal several times. Ocular examination showed that the puncta and papillae of the both lower and upper lids were completely missing. At operation, there was obstruction in the bony portion of the nasolacrimal duct. The mass was a distended lacrimal sac. The lacrimal sac and the mucosa of the nasolacrimal duct were compJetely excised in the right side. The excision of lacrimal sac and mucosa of the nasolacrimal duct and conjunctivo-rhinostomy using Jones tube were performed in the left side. Nine months after operation, the patient was happy with the results and there was no recurrence.