Clinical effect of integrated prosthesis on eyebrow arch augmentation / 中华医学美学美容杂志

Objective:To explore the feasibility and advantages of integrated prosthesis of expanded polytetra-fluoroethylene (e-PTFE) in eyebrow arch augmentation.Methods:The clinical data of 45 patients with low or flat brow arch and glabellar zone from June 2019 to October 2020 in Chengdu High-tech Zone Xinyuerong Medical Aesthetic Clinic were analyzed retrospectively, in which it included 45 women, whose ages ranged from 20 to 39 years with average 29.8 years. Forty-three cases underwent primary surgery, and 2 cases underwent repair. The e-PTFE was sculpted to be personalized integrated prosthesis according to the shape of the patient's eyebrow arch and glabellar zone. The incision was designed on the medial and lateral sides of the lower margin of the bilateral eyebrow to avoid the supraorbital foramen, and the lacunae were striped under the frontal periosteum, and the two sides were connected to cover the glabellar zone and inverted triangle area between the eyebrows. The carved e-PTFE was implanted into one side and pulled out from the other side. The prosthesis was smoothed by Venn pliers of the ventral and dorsal sides.Results:The 45 patients in this group were followed up for 6-18 months. The incisions of all the patients were healed Ⅰ/A, and the scar of the incisions was concealed. Slight scalp numbness occurred in 4 patients and returned to normal 3 months later. The prosthesis in the glabellar zone appeared in 1 case 3 months after operation and returned to normal after reoperation. The symmetry, radian, fullness, convexity and tactility of bilateral eyebrow arch were all satisfactory in 45 cases. 39 cases were very satisfied, accounting for 86.7%; 6 cases (13.3%) were satisfactory. The sagittal distance of the anterior surface of the cornea to the soft tissues overlying the supraorbital rims was (2.02±1.72) mm preoperatively and (6.5±1.19) mm in the last follow-up. The difference was statistically significant ( t=14.49, P<0.01). Conclusions:This design of integral e-PTFE in eyebrow arch augmentation is safe, effective and easy to operate. It can significantly increase the bony beauty and stereoscopic sense of the eyebrow arch and glabellar zone, effectively deepen the eye socket, improve the eye protrusion, and reduce the risk of asymmetry and prosthesis displacement, and therefore it is one of the ideal methods for eyebrow arch augmentation.

Lift temporal com reposicionamento do músculo orbicular e da cauda da sobrancelha / Temporal lift with repositioning of the orbicular muscle and eyebrow tail

Introdução: O sistema musculoaponeurótico superficial (SMAS) é a melhor estrutura que temos à nossa disposição para elevar e reposicionar a face e o pescoço no face lift. No entanto, na região têmporo-orbitária, esta estrutura é frequentemente negligenciada. Na busca por uma solução de execução simples, eficiente e segura para tratar a queda têmporo-orbitária, o autor descreve uma tática de lift temporal com reposicionamento da cauda das sobrancelhas para tratamento do envelhecimento e flacidez da região têmporo-orbitária. Métodos: Foi realizado o tratamento em 358 pacientes entre 2017 e 2020, em lifts completos ou apenas temporais. Destes, apenas 30 foram incluídos no artigo por terem sido submetidos exclusivamente a lifts temporais, acompanhados ou não de blefaroplastias. Através de incisão intracapilar marginal quebrada em região temporal e com descolamento supraSMAS, foi realizado tratamento musculoaponeurótico da região órbito-temporal, além de ressecção da pele em excesso. Resultados: A tática apresentada foi eficiente na elevação e na abertura da cauda das sobrancelhas em todos os casos tratados, além do efeito de perda da função contrátil da porção lateral do músculo orbicular, com melhora significativa das rugas periorbitais e da flacidez órbito-temporal. Conclusão: A eficácia e os ótimos resultados alcançados com a tática operatória descrita, associada à escassez de opções de tratamento isolado ou específico da região órbito-temporal, tornam o lift têmporo-orbitário proposto uma excelente alternativa para o rejuvenescimento desta região.

Introduction: The superficial musculoaponeurotic system (SMAS) is the best structure that we have at our disposal to raise and reposition the face and neck in face lifts. However, in the temporal-orbital region, this structure is often overlooked. In search of a simple, efficient and safe solution to treat temporal-orbital fall, the author describes a technique of temporal lift with repositioning of the eyebrow tail to treat aging and flaccidity of the temporal-orbital region. Methods: The treatment was performed on 358 patients between 2017 and 2020, in face lifts or temporal lifts. Of these, only 30 were included in the article because they underwent temporal lifts exclusively, with or without blepharoplasty. Through a marginal, "W" type, intra-capillary incision in the temporal region and with supra-SMAS detachment, we performed muscle-aponeurotic treatment of the orbital-temporal region and excessive skin resection. Results: The technique presented was efficient in raising and opening the tail of the eyebrows in all treated cases, in addition to the effect of loss of contractile function of the lateral portion of the orbicularis muscle, with significant improvement of peri-orbital wrinkles and temporal-orbital flaccidity. Conclusion: The efficacy and the excellent results achieved with the described operative technique, associated with the scarcity of isolated or specific treatment options for the orbital-temporal region, make the proposed temporo-orbital lift an excellent alternative for the rejuvenation of this region.

Isolated hair loss on the eyebrow: five cases with trichoscopic features

Abstract Alopecia areta (AA) and trichotillomania (TTM) are common causes for hair loss on the eyebrows. Yellow dots, vellus hairs, anisotrichosis, empty follicular openings, and black dots were observed in the present study's patients with AA. Split hairs, question mark hairs, broken hairs, flame hairs, black dots, hairs with different lengths, and hemorrhagic areas were found in the patients with TTM. Trichoscopy is a very useful and helpful technic in distinguishing AA and TTM on the eyebrows.

Retalho em ilha tunelizado na reconstrução de defeito na sobrancelha / Tunneled island flap for reconstruction of eyebrow defect

Cirurgias na face configuram-se, muitas vezes, em desafios para o cirurgião em virtude da complexa anatomia, importância estética e funcional. Intervenções na subunidade cosmética que compreende as sobrancelhas podem ser particularmente difíceis. O objetivo deste trabalho é demonstrar o uso do retalho em ilha nesta região. Foi realizada exérese de nevo melanocítico, com bom resultado final e ausência de complicações pós-operatórias. Esta técnica é comumente utilizada para reconstrução facial, porém existem poucos casos descritos em que foi utilizada para reconstrução de sobrancelhas

Facial surgeries are often challenging for surgeons due to their complex anatomy, aesthetic and functional importance. Interventions in the cosmetic subunit that comprises the eyebrows can be particularly difficult. This case report aims to demonstrate the use of island flap in this region. We performed the excision of melanocytic nevus, with a good outcome and absence of postoperative complications. This technique is commonly used for facial reconstruction; however, the literature describes only a few cases using this method for eyebrow reconstruction.

Procedimentos cirúrgicos e não cirúrgicos para elevação das sobrancelhas: revisão sistemática e fluxograma de abordagem / Surgical and non-surgical procedures for eyebrow lift: systematic review and decision flowchart

Introdução: Realizar levantamento na literatura médica sobre os tratamentos cirúrgicos e não cirúrgicos da ptose de sobrancelha e apresentar um fluxograma de decisão para elevação da sobrancelha. Métodos: Revisão sistemática da literatura disponível no banco de dados da PUBMED seguindo critérios de inclusão e exclusão. Elaboração de um fluxograma para abordagem da queda de sobrancelha baseado na experiência dos autores. Resultados: Foi encontrada uma abundância de artigos descrevendo diversas táticas cirúrgicas e não cirúrgicas para correção da ptose de supercílio. As táticas cirúrgicas mais comuns foram a elevação interna do supercílio, elevação direta, elevação via temporal e ritidoplastia coronal / pré-triquial / endoscópica. Para a abordagem não cirúrgica foram encontradas o uso de toxina botulínica, preenchimento e fios de sustentação. Conclusão: Há diversas táticas cirúrgicas e não cirúrgicas descritas na literatura para elevação da sobrancelha, demonstrando que não há uma tática ideal para todos os pacientes. O uso de fluxograma pode ajudar a realizar uma abordagem sistemática e personalizada e considerando característica de cada paciente.

Introduction: To review the medical literature regarding the surgical and non-surgical treatments of eyebrow ptosis and to present a decision flowchart for eyebrow lift. Methods: A systematic review of the literature available was held in PUBMED following inclusion and exclusion criteria. A flowchart was elaborated to systematize the approach to eyebrow ptosis based on the experience of the authors. Results: Several articles were included describing a variety of surgical and non-surgical correction techniques for eyebrow ptosis. The most common surgical approaches were internal eyebrow elevation, direct elevation, temporal elevation, and coronal/pretrichial/endoscopic rhytidoplasty. The non-surgical approaches found were botulinum toxin injections, fillers, and fixation threads. Conclusion: There are several surgical and non-surgical procedures described in the literature for lifting of the eyebrow, demonstrating that there is no ideal method for all patients. The use of a flowchart can help carry out a systematic and personalized approach according to the characteristics of each patient.

Application of controllable hair density of eyebrow reconstruction with the treatment of scar baldness during the same operation stage / 中华医学美学美容杂志

Objective To explore a method of eyebrow reconstruction which can control eyebrows,and to repair scar baldness in the same operation stage.Methods Operations were performed in two stages.In the first stage,an expander was placed under the scalp at the same side of the defect eyebrow through the direction of the superficial temporal artery.Other expanders were placed around the scar baldness.After the incision healed,water was injected into the expander.During the expansion,the scalp hair density was approaching the uninjured eyebrow side.Then the second stage operation was prepared:an island flap with superficial temporal artery as axial artery was harvested and the expander was extracted.The subcutaneous tunnel was made in the temporal region of the eyebrow defect side.The expanded superficial temporal artery island scalp flap was passed through the tunnel and transferred to the defect eyebrow area to repair the eyebrow.After incising the scar baldness,the left expanded scalp flaps were transferred to cover the wound.Results 12 patients underwent this method of eyebrow reconstruction with scar baldness,all island scalp flaps survived,with no case of flap necrosis.After 6-24 months of follow-up,the hair density of the reconstructed eyebrows was very close to that of the uninjured side,without excessive thickening or excessive rarefaction.The scalp scars were small and can be shaded by the hair.All patients were satisfied with the operation.Conclusions The method of controllable hair density of eyebrow reconstruction with the treatment of scar baldness has good effects on reconstructing eyebrow defect and scar baldness.It is simple,economic and suitable for further application.

Evaluation of the donor site after the median forehead flap

BACKGROUND: Forehead flaps are useful for facial reconstruction. Studies of these flaps have mostly focused on the results of the reconstruction. However, due to the scarring and changes on the forehead caused by the median forehead flap (MFF), surgeons may be reluctant to perform this flap. Research into the donor site is needed for practical purposes. METHODS: We examined 42 patients who underwent an MFF at Pusan National University Hospital from 1996 to 2016. Based on a retrospective chart review, we examined the occurrence of complications. We also evaluated scars on the forehead using the Vancouver Scar Scale (VSS) and assessed changes in the eyebrow position of 22 patients. RESULTS: No complications occurred in the 42 patients. The mean VSS score of the 22 patients was 2.8±0.79. The ratio of the height of the eyebrow on each side to the distance between the medial canthi increased postoperatively, meaning that both the left and right brows were elevated slightly (P=0.026 and P=0.014). However, the symmetry between the left and right sides did not change (P=0.979). The ratio of the interbrow distance to the distance between the medial canthi decreased slightly, meaning that the interbrow distance narrowed mildly (P < 0.001). Moreover, there were no noticeable changes in the brow position as seen in a photo overlay. CONCLUSIONS: There were no notable complications in the forehead. Forehead scarring was acceptable. No change in brow symmetry was observed via photographic measurements and a photo overlay. Therefore, we propose that the MFF is a useful choice for minimizing scarring or deformation of the donor site.

Reduction of Closed Frontal Sinus Fractures through Suprabrow Approach

BACKGROUND: The traditional approach for reduction of frontal sinus fractures is coronal incision. Inherent complications of the coronal approach include long scar, hair loss, and long operation time. We describe a simple approach for the reduction of frontal sinus anterior wall fractures using a suprabrow incision that is commonly used for brow lift. METHODS: From March 2007 to October 2016, the authors identified patients with anterior wall frontal sinus fractures treated by open reduction through a suprabrow incision. Only cases with photographic/radiographic documentation and a minimum follow-up of 6 months were included. The incision line was designed to be at the upper margin of the eyebrow. Medical records and radiographic data were retrospectively reviewed. Surgical outcomes, cosmetic results, and complication were assessed. The patient scale of the patient and observer scar assessment scale was used to assess patient satisfaction for incisional scar at the 6-month follow-up. RESULTS: Thirty-one patients underwent fracture reduction through a suprabrow approach during the study period, with a mean follow-up of 41 months. No patients showed any recurrent displacement, eyebrow asymmetry, or infection during follow-up. Thirteen patients reported their forehead paresthesia postoperatively, and 12 of them had preoperative symptom. One patient complained of incisional scar and underwent scar revision. All patients were satisfied with their eyebrow and forehead contour. CONCLUSION: The suprabrow approach allowed for an accurate reduction of the fractures in the anterior wall frontal sinus by providing direct visualization of the fracture. This transcutaneous approach can effectively restore forehead contour with acceptable postoperative complications and patient satisfaction.

Efficacy of follicular unit extraction in the repair of scarring eyebrow loss: a clinical observation / 中华皮肤科杂志

Objective To evaluate the efficacy of follicular unit extraction (FUE) in the repair of scarring eyebrow loss.Methods A total of 30 patients with scarring eyebrow loss were treated with FUE technique in the Department of Plastic Surgery of Zhengzhou First People's Hospital,including 18 females and 12 males with 41 eyebrow defects.Fine soft hairs with a length of 5-10 mm were extracted from the back of the ear and temporal region of the patients,and then were split into individual follicular units under a microscope at 6 × magnification.The transplant density ranged from 20 to 30 FU/cm2.Results During the 3-18 months of follow-up after the surgery,eyebrows in the recipient areas grew in a natural direction and showed good appearance.The survival rate of hair grafts was up to 90％,and the patients were satisfied with the results.Conclusion FUE may be an ideal method for the treatment of scarring eyebrow loss with less injury and high survival rate of hair grafts.

Classificação clínica de ptose da cauda do supercílio / Clinical classification of brow ptosis

INTRODUÇÃO: O estudo do supercílio se emoldura como um grande desafio para a cirurgia plástica por sua complexa relação com as estruturas faciais. O objetivo é descrever uma classificação clínica de ptose da cauda do supercílio. MÉTODOS: Estudo transversal, com pacientes de ambos os sexos, com idade de 18 a 100 anos, subdivididos em três grupos segundo a faixa etária. Grupo 1: 18 a 30 anos, Grupo 2: 31 a 60 anos e Grupo 3: 61 a 100 anos. Realizaram-se três medidas de cada lado por examinadores distintos, sem que cada um soubesse o valor da aferição dos demais. RESULTADOS: Total de 90 pacientes, com idades variando entre 18 e 94 anos, sendo 39 (43,3%) do sexo masculino e 51 (56,7%)do sexo feminino. As medidas do Grupo 1, considerado como normal, com média de idade de 26,7 anos, e com média de 2,14 cm em relação a medidas da ptose da cauda do supercílio. Já no Grupo 2, média da faixa etária foi de 44,2 anos e a média foi de 1,9 cm. No Grupo 3, média de idade de 72,6 anos com média de 1,27 cm. A tabela com a Classificação da Ptose da Cauda do Supercílio, em que se atribuiu a cada intervalo um grau de ptose, variando de grau I ao grau IV. Cada grau foi correlacionado com um intervalo numérico em que: > 1,8 cm representa a normalidade; 1,7-1,5 cm o grau I de ptose; 1,4-1,2 cm o grau II de ptose;1,1-0,9 cm o grau III de ptose e < 0,8 cm o grau IV de ptose. Em referência à indicação cirúrgica, essa teve sua indicação nos graus II, III e IV. CONCLUSÃO: A medida objetiva da posição da cauda do supercílio possibilitou classificação do grau de ptose e orientação quanto à necessidade de intervenção cirúrgica.

INTRODUCTION: The study of the eyebrow is a great challenge for plastic surgery because of its complex relationship with facial structures. The present study aims to describe a clinical classification of brow ptosis. METHODS: A cross-sectional study with patients of both sexes and ages ranging from 18 to 100 years, subdivided into 3 groups according to age. Group 1: 18 to 30 years of age, Group 2: 31 to 60 years of age, and Group 3: 61 to 100 years of age. Three measurements were taken on each side by different examiners blinded to each other's results. RESULTS: A total of 90 patients, with ages ranging from 18 to 94, including 39 (43.3%) men and 51 (56.7%) women, were studied. Group 1, with a mean age of 26.7 years was considered normal, with mean brow ptosis of 2.14 cm. In Group 2, with a mean age of 44.2 years, the mean brow measurement was 1.9 cm. In Group 3, the mean age was 72.6 years and the mean brow measurement was 1.27 cm. The table outlining the brow ptosis classification assigns a degree of ptosis to each interval, ranging from I to IV. Each degree was correlated with a numerical range in which > 1.8 cm is normal, 1.7-1.5 cm corresponds to degree I ptosis, 1.4-1.2 cm to degree II ptosis, 1.1-0.9 cm to degree III ptosis, and < 0.8 cm to degree IV ptosis. Surgery was indicated for degrees II, III, and IV. CONCLUSION: The objective measurement of brow tail position enabled classification of the degree of ptosis and guides surgical decision-making.

Posttraumatic eyebrow reconstruction with hair-bearing temporoparietal fascia flap / Reconstrução de sobrancelha após trauma com retalho de fáscia temporoparietal associado à ilha de pele de couro cabeludo

The temporoparietal fascia flap has been extensively used in craniofacial reconstructions. However, its use for eyebrow reconstruction has been sporadically reported. We describe a successfully repaired hair-bearing temporoparietal fascia flap after traumatic avulsion of eyebrow. Temporoparietal fascia flap is a versatile tool and should be considered as a therapeutic option by all plastic surgeons.

O retalho de fáscia temporoparietal tem sido usado em inúmeras reconstruções craniofaciais. No entanto, sua utilização para a reconstrução de sobrancelha tem sido relatada esporadicamente. Descreve-se aqui o reparo com retalho de fáscia temporoparietal associado à ilha para a reconstrução de sobrancelha, após avulsão traumática, realizado com sucesso. O retalho de fáscia temporoparietal é uma ferramenta versátil e deveria ser considerada no arsenal terapêutico de todos os cirurgiões plásticos.

Medial Crease Formation in Unfavorable Subbrow Excision: Medial Crease in Subbrow Excision

BACKGROUND: Various surgical techniques have been developed to address senile upper eyelids. Upper blepharoplasty has limited efficacy in natural periorbital rejuvenation for severe lateral hooding of the upper eyelids, as well as often producing a 'surprised look'. Subbrow excision is a popular method in East Asia for the correction of eyelid drooping, especially on the lateral side as periorbital rejuvenation. However, medial upper eyelid skin redundancy often tends to be undercorrected. Here, we present a few cases of revisional blepharoplasty, especially for medial crease formation, to improve aesthetic results. METHODS: Five patients, for a total of 10 eyelids, who underwent revisional blepharoplasty from January 2011 to January 2015 after a previous subbrow excision, were included. Patients were dissatisfied with uncorrected excessive skin on the medial part of the upper eyelid after a previous subbrow excision; thus, they underwent revisional blepharoplasty for medial crease formation. RESULTS: During the follow-up period, patients were aesthetically satisfied with the postoperative results. No patients suffered from any complications during the follow-up period. CONCLUSIONS: After a previous unfavorable subbrow excision, medial crease formation, via a very minimally invasive technique, could be a favorable option to improve patient satisfaction without postoperative complication or discomfort.

The Change of Eyebrow Height after Blepharoptosis Correction

Blepharoptosis patients use frontalis muscle unconsciously to widen eye, and it results in several aesthetic problems-such as forehead wrinkling and elevated eyebrow. So forehead wrinkling and elevated eyebrow can be resolved with correction of blepharoptosis. We evaluated the change of eyebrow height in 30 patients who were corrected blepharoptosis through photogrammetry. The mean age of the patients was 36.8 years old and the mean follow up periods were 6 months. Horizontal line passing medial and lateral canthal corner in both eyes was drawn in Photopshop. From the horizontal line, 3 vertical lines perpendicular to this line were drawn passing medial and lateral canthal corner and the vertically oriented center of the pupil. Eyebrow height was measured through these 3 vertical lines. The average length of decreased value of the eyebrow height were 3.64 mm in H1, 3.31 mm in H2, 2.79 mm in H3. In unilateral cases, 2.42 mm in H1, 2.86 mm in H2, 2.78 mm in H3, and in bilateral cases, the decreased values were 4.25 mm in H1, 3.53 mm in H2, 2.79 mm in H3. From this study, the author would like to introduce the method to calculate the changes of eyebrow height after blepharoptosis correction and the values objectively.

A Proposal to Prevent the "Mephisto Sign" Side Effect of Botulinum Toxin Type A Injection in Chronic Migraine

Botulinum toxin type A (BoNT-A) has been reported as an effective treatment for chronic migraine. When BoNT-A is injected on the frontalis muscle for chronic migraine, an unexpected clinical side effect called the "Mephisto sign" may occur. The aim of this article is to propose a method to eliminate or prevent the Mephisto sign side effect. A 25-year-old female patient visited the hospital and was diagnosed with chronic migraine. A total of 155 U of BoNT-A was injected into 31 sites. 2-weeks later, and the patient developed the Mephisto sign. An additional 2-U dose was administered bilaterally to the lateral-most point of the frontalis muscles, and the eyebrow morphology returned to normal within 2-3 weeks. We propose that the development of the Mephisto sign may be prevented with an additional BoNT-A injection of 2-4 U bilaterally to the lateral most point of the frontalis muscles during the primary injection process.

Síndrome de Kabuki: caracterización clínica, estudios genéticos, manejo preventivo de las complicaciones y asesoría genética / Kabuki syndrome: clinical, genetic, preventive management of complications and genetic counseling

Introducción: Kabuki hace referencia al teatro tradicional japonés, y el nombre del síndrome proviene de la semejanza de los pacientes al maquillaje facial usado por dichos actores. El síndrome de Kabuki es una patología dismorfológica, caracterizada por rasgos faciales particulares, entre ellos fisuras palpebrales amplias, puente nasal deprimido, cejas arqueadas con el tercio externo disperso y orejas prominentes. Todos estos rasgos son concomitantes con retraso mental, cardiopatías, nefropatías, entre otros. Debido a la presencia en mayor o menor número de veces de algunas patologías, se han dividido en anomalías menores y anomalías mayores. Objetivo: Presentar una revisión sobre las generalidades del síndrome de Kabuki, características clínicas, complicaciones y su manejo preventivo, así como los estudios genéticos realizados hasta la fecha y la asesoría genética. Metodología: se utilizaron las bases de datos Pubmed y SciELO, para la búsqueda de información. Resultados: se encontraron estudios publicados alusivos a los primeros casos del síndrome, hasta aquellos recientemente publicados en donde se identifica el gen MLL2 como etiología para este síndrome. Conclusiones: hasta la fecha, el diagnóstico se realiza por los hallazgos clínicos, aunque se puede detectar la mutación del gen MLL2. Para el diagnóstico se tienen presente los antecedentes familiares y los hallazgos al examen físico, principalmente los rasgos faciales propios de este síndrome. Complementando el diagnóstico, se debe llevar a cabo un manejo preventivo de las complicaciones para así evitar potenciales riesgos, además de ofrecer a la familia información necesaria durante la asesoría genética.

Introduction: Kabuki refers to traditional Japanese theater, and the syndrome's name comes from the similarity of the patients' facial makeup used by these actors. Kabuki syndrome is a dismorfological pathology characterized by particular facial features including wide palpebral fissures, depressed nasal tip, arched eyebrows with the lateral one-third dispersed or sparse, and prominent ears. All these features are concomitant, with mental retardation, cardiopathies, nephropathies, among others. Due to the presence in greater or lesser number of times certain pathologies, have been divided into minor and major abnormalities. Objective: present a review of the generalities of Kabuki syndrome, dismorfologicas features, clinical characteristics, complications, and genetic studies to date. Methods: we used the databases PubMed and SciELO, to search for information. Results: the published studies alluding to the first cases of the syndrome, even those published recently where MLL2 gene is identified as a possible candidate for this syndrome. Conclusions: until now the diagnosis is made by clinical findings, although it can detect the mutation of gene MLL2. For the diagnosis is given through the family history and physical examination findings, especially the facial features, characteristic of this syndrome. Complementing the diagnosis must be carry out a preventive management of complications and to avoid potential risks, and offer the family information during genetic counseling.

Síndrome de Waardenburg tipo I: relato de caso / Waardenburg syndrome type I: case report

A síndrome de Waardenburg tipo I é uma desordem auditivo-pigmentária que inclui, entre outros, perda auditiva neurossensorial congênita não progressiva, telecanto, distúrbios pigmentares de íris, cabelo e pele. Indivíduos afetados podem ter maior risco de: defeitos no tubo neural, fendas labial e palatina, anormalidades nos membros e doença de Hirschsprung. O diagnóstico é clínico, sendo necessários dois critérios maiores ou um maior e dois menores. PAX3 é o único gene conhecido associado à síndrome, sendo, entretanto, mais usado no aconselhamento genético. Quanto ao diagnóstico diferencial, podemos citar: outras causas de perda auditiva neurossensorial congênita não progressiva, outros tipo de síndrome de Waardenburg, piebaldismo, albinismo, vitiligo e síndrome de Teitz. Neste trabalho, apresenta-se um paciente masculino de 11 anos com diagnóstico de síndrome de Waardenburg tipo I. Ressalta-se a importância do oftalmologista no auxílio do diagnóstico deste raro quadro sistêmico, uma vez que inclui algumas alterações oftalmológicas. O diagnóstico precoce da síndrome permite estimulação adequada para a perda auditiva, assim como medidas preventivas em caso de gestantes afetadas no aconselhamento genético.

Waardenburg syndrome (WS) type I is a non-progressive auditory-pigmentary disorder comprising congenital sensorineural hearing loss and pigmentary disturbances of the iris, hair, and skin, along with dystopia canthorum (lateral displacement of the inner canthi). Affected individuals may have higher risk of: neural tube defects, cleft lip and palate, limb abnormalities, and Hirschsprung disease. The diagnosis is clinical and should be considered if the individual has two major or one major plus two minor criteria. PAX3 is the only known gene associated to the syndrome. Nevertheless, its use is mostly for genetic counseling. Regarding different diagnosis, we may list: other causes of non-progressive auditory-pigmentary disorder comprising congenital sensorineural hearing loss, other types of Waardenburg syndrome, piebaldism, albinism, vitiligo and Teitz syndrome. This paper presents a case of an eleven year old boy with deafness and ophthalmologic alterations, based on his files and exams. It reinforced the importance of the ophthalmologist contributing for the diagnosis of this rare systemic disease, as it includes some ophthalmologic alterations. We remind that the early diagnosis allows adequate stimulation for the hearing loss, as well as preventive measures in case of pregnant women affected by genetic counseling.

Improvement of shape of eyes and eyebrows by mini-invasive facelift assisted with endoscope / 中华医学美学美容杂志

ObjectiveTo study the effect of mini invasive facelift assisted with endoscope on improvement of eyes and eyebrow in forehead and temple.MethodsSixty patients with mini-invasive facelift assisted with endoscope in forehead and temple were followed up from October 2008 to July 2010.The distance between eyebrow and lid fissure was compared before and after operation,and the morphological changes were observed in the eyebrow and eye.Results The distances between eyebrow and lid fissures increased (5.0± 1.2) mm,and eyebrow lifted effectively,and lower eyelid ptosis and relaxation were improved after operation.After the mini-invasive facelift operation,the skins around eyes became tighter than before,and eyebrows were corrected in shape and position with fishtail lines' removal.ConclusionsThe endoscope-assisted facelift for upper face through mini- invasive incision in forehead and temple can correct ptosis effectively,as well as asymmetry of eyebrows,with improvement of the shape of eyes and eyebrows,and rejuvenation comes true at the same time.

Elevação da sobrancelha via temporal alta e obtenção de monobloco fascial para avolumar a pálpebra / High temporal eyebrow elevation and fascial monoblock to fill the eyelid

Introdução: A ptose da cauda da sobrancelha está associada à flacidez cutâneo-ligamentar fronto-órbito-temporal e às bolsas e depressões palpebrais. As técnicas de elevação da sobrancelha devem incluir o tratamento destas regiões e, se possível, fornecer tecidos para o preenchimento palpebral. Após estudo anatômico, concluiu-se pela abordagem da cauda da sobrancelha a partirda região temporal alta, onde é realizado o descolamento fronto-órbito-temporal, a obtenção de material para preenchimento e a confecção das plicaturas. Método: Desde janeiro de 2005 até julho de 2009, 89 pacientes foram submetidos à cirurgia para elevação da sobrancelha. Nos últimos dois anos e em 19 pacientes, realizou-se o enxerto de monobloco de fáscias temporais. Esta técnica é embasada na técnica de Knise e caracteriza-se pela abordagem em dois planos dedescolamento a partir de uma incisão curta temporal alta. O primeiro plano é um descolamento lateral à linha de fusão temporal, realizado sobre a fáscia temporal superficial, onde se faz a ressecção de um monobloco de fáscias temporais e uma plicatura fascial sob tensão controlada. O segundo plano é um descolamento subperiostal sob a linha de fusão temporal, seguido de uma plicatura estabilizadora da nova posição da sobrancelha. Resultados: A melhora da posição da sobrancelha e da região órbito-temporal foi consistente. Conclusão: Esta técnica é mais rápida e menos traumática que o lifting frontal e menos complexa e onerosa que a endoscopia frontal.O enxerto do monobloco de fáscias temporais é opção na volumetria facial, sobretudo palpebral.

Introduction: The eyebrow ptosis is usually associated with orbito-temporal flaccidity, palpebral depressions and fat bags. Thus, the eyebrow elevation technique must include the treatment of these regions, and if possible, to generate tissues for palpebral filling. In this way, after an anatomic study it was decided by a technique performed in two planes of dissection through a short temporal scalp incision, followed by two plicatures and excision of a monoblock of fascias to fill the face. Method: From January of 2005 to July of 2009, 89 patients were submitted to eyebrow elevation. In the last two years palpebral filling was performed in 19 patients. This technique is based in the Knise technique, with a short incision done in the highest temporal scalp followed by two planes of dissection. The first one is done over the superficial temporal fascia lateral to the temporal fusion line, where a monoblock of fascias is excised, and ending with a temporal plicature. The second plane is subperiostal under the fusion line with releasing of fronto-orbito-temporal soft tissues and ending with a orbito-temporal plicature. Results: The improvement of the eyebrow position andthe stretching of the orbito-temporal region were noticed in all cases, resulting in a long lasting eyebrow repositioning. Conclusion: This technique is less traumatic than the forehead lift using coronal approach and less complex than the endoscopic approach and the possibility to fill the face with a monoblock of temporal fascias opens a new perspective in the facial rejuvenation.

Avaliação da posição do supercílio por medidas angulares / Evaluation of eyebrow position using angular measures

OBJETIVO: Avaliar a posição do supercílio em diferentes idades, utilizando medidas angulares. MÉTODOS: Foram avaliados indivíduos com idade de 4 a 6 anos (Grupo de crianças) e igual ou superior a 50 anos (Grupo de idosos), separados em faixas etárias, avaliando-se a posição do supercílio por meio de imagens digitais, utilizando medidas angulares. As imagens foram tomadas em posição primária do olhar, utilizando filmadora Sony Lithium, e posteriormente transferidas para computador MacIntosh G4 e processadas pelo programa NIH 1,58. Os parâmetros analisados foram: ângulo interno, externo e vertical da cauda do supercílio. As comparações foram entre sexos, faixas etárias e lateralidade. Os resultados obtidos foram submetidos à análise estatística. RESULTADOS: A comparação das medidas angulares mostrou que houve diferença significativa na posição da cauda do supercílio entre os grupos estudados quando comparados dentro do grupo com faixa etária semelhante. Porém, comparando-se crianças e adultos, houve diferença em todos os tipos de ângulos estudados. CONCLUSÕES: A posição do supercílio avaliada por medidas angulares mostrou diferenças entre crianças e idosos, revelando associação positiva com a idade.

PURPOSE: To evaluate the eyebrow position in children and elderly using angle measurements. METHODS: The eyebrow position was evaluated by digital images in 4 to 6-year-old children (children group) and in patients with 50 years or more (elderly group), separated by age range. The images were taken in the primary gaze position with a Sony Lithium camera and then transferred to a MacIntosh G4 computer and processed by the NIH 1.58 program. The eyebrow position was evaluated using angle measures. Comparisons were done according to age, sex and laterality and the data were submitted to statistical analysis. RESULTS: The comparison of the angular measures showed that there was a significant difference in the position of eyebrow position between the studied groups with the same age. But comparing children and elderly there were differences in all performed measurements. CONCLUSION: The eyebrow external angle positions showed differences between children and elderly with a positive association between eyebrow position and age.

Forehead Lift using Non-endoscopic Myotomy

The challenge of accurately predicting eyelid height after blepharoptosis surgery is well-known problem even in complete hands. From May 1988 to December 2004, authors reviewed 182 cases(240 eyes) of blepharoptosis corrected by frontalis muscle transfer or levator resection and had experienced 10 cases(15 eyelids) of early reoperation around the first week. The period from initial operation to reoperation are between six to eight days and mean period is seven days. Initial operative procedures were frontalis muscle transfer in 3 cases(4 eyelids) and levator resection in 7 cases(11 eyelids). Follow up period ranged from 6 months to 16 years. Early adjusting surgery was performed in accordance with the preoperative and postoperative degree of ptosis of patient and by previous operative technique. The results are evaluated according to the criteria of an ideal correction by Souther and Jordan. Seven patients have good or satisfactory results(less than 1 mm asymmetry, good in 5 cases and satisfactory in 2 cases). Three patients(5 eyelids) recorded as poor results(more than 2 mm asymmetry). Even if early or late reoperation can be effective in correcting unsatisfactory results after correction of blepharoptosis, early reoperation may lead to better results than late reoperation because early reoperation can offer a reduction in time to final result, the ease with which it is performed and potential cost savings. The experience of surgeon is also important factor for the treat ment of recurred blepharoptosis.