Spectrum approach to congenital ectropion / Abordagem espectral do ectrópio congênito

ABSTRACT In the literature, there is a confusing classification among congenital floppy eyelid, eyelid eversion and ectropion. They are described as eyelid malposition with laxity and out-turning of the eyelids in newborns, usually associated with conjunctival prolapse and chemosis. Although the underlying pathophysiology of these rare conditions is obscure, they share anatomic characteristics. Thus, instead of a plethora of denominations, a spectrum approach should join these entities. In this paper, the authors present a case series of four patients that illustrates distinctive presentations of this condition and advocate that it should be considered as variants of a spectrum of congenital ectropion. Mild cases, when promptly treated, can benefit from clinical treatment. On the other hand, severe and delayed cases will need surgical correction as in the case of acquired ectropion.

RESUMO Na literatura, existe uma classificação confusa entre floppy eyelid congênita, eversão palpebral e ectrópio congênito. Essas afecções são similarmente descritas como pálpebras frouxas e evertidas em recém-nascidos e geralmente associadas a prolapso de conjuntiva e quemose. Embora a fisiopatologia dessas raras afecções seja incerta, elas apresentam íntimas características anatômicas em comum. Assim, ao invés dessa nomenclatura variada, seria interessante incluí-las em um espectro de uma só doença. Neste artigo. apresenta-se uma série de quatro casos que ilustram diferentes apresentações dessa afecção e propõe-se que todas devam ser consideradas variações do espectro de ectrópio congênito. Casos leves são beneficiados quando tratados precocemente. Por outro lado, casos mais graves ou que são tratados tardiamente necessitarão de procedimento cirúrgico semelhante ao ectrópio adquirido.

Manejo oftalmológico en parálisis facial refractaria mediante tira tarsal y suspensión del pliegue nasolabial / Ophthalmological management of refractory facial palsy using tarsal strip and suspension of the nasolabial fold

INTRODUCCIÓN. La parálisis facial refractaria produce ectropión paralítico secundario, que predispone a la queratopatía por exposición y otras complicaciones oculares, que deben ser manejadas con cirugía. OBJETIVO. Describir el manejo quirúrgico oftalmoló-gico en parálisis facial refractaria mediante tira tarsal y suspensión del pliegue nasolabial. MATERIALES Y MÉTODOS. Estudio observacional, retrospectivo. Población y muestra conocida de 8 Historias Clínicas, en el Hospital de Especialidades Carlos Andrade Marín, período enero 2016 a diciembre 2018. Criterios de inclusión: registros de parálisis facial y ectropión paralítico. Los datos fueron tomados del sistema AS400, y se analizaron en el programa estadístico International Business Machines Statistical Package for the Social Sciences, Versión 25.0. RESULTADOS. La etiología tumoral fue 62,5% (5; 8), A los 6 me-ses postquirúrgicos se observó resolución de: lagoftalmos, lagrimeo, ardor ocular y quera-titis en el 87,5% (7; 8); el ectropión se resolvió en todos los casos y se obtuvo una mejoría en la ptosis. La agudeza visual mejoró en el 75,0% (6; 8). DISCUSIÓN: La literatura evi-denció que las técnicas quirúrgicas si bien no abordan el aspecto oftalmológico y estético a la vez, aún es incierto su manejo de manera conjunta dado que ha sido poco descrita pero ha adquirido importancia por los resultados en la Unidad de Oftalmología del hospital.CONCLUSIÓN. La descripción del manejo quirúrgico oftalmológico en parálisis facial re-fractaria mediante la técnica de tira tarsal y suspensión del pliegue nasolabial fue asertiva como experiencia local.

INTRODUCTION. Refractory facial paralysis produces secondary paralytic ectropion, which predisposes to exposure keratopathy and other ocular complications, which must be managed with surgery. OBJECTIVE. Describe the ophthalmic surgical management of refractory facial paralysis using tarsal strip and suspension of the nasolabial fold. MATE-RIALS AND METHODS. Observational, retrospective study. Population and known sam-ple of 8 Clinical Histories, at the Carlos Andrade Marín Specialty Hospital, period from january 2016 to december 2018. Inclusion criteria: records of facial paralysis and paralytic ectropion. The data were taken from the AS400 system, and analyzed in the statistical pro-gram International Business Machines Statistical Package for the Social Sciences, Version 25.0. RESULTS. The tumor aetiology was 62,5% (5; 8). At 6 months after surgery, resolu-tion of: lagophthalmos, lacrimation, ocular burning and keratitis was observed in 87,5% (7; 8); ectropion resolved in all cases and ptosis improved. Visual acuity improved in 75,0% (6; 8). DISCUSSION: The literature showed that the surgical techniques, although they do not address the ophthalmological and aesthetic aspects at the same time, their joint mana-gement is still uncertain since it has been little described but has acquired importance due to the results in the Ophthalmology Unit of the hospital. CONCLUSION. The description of ophthalmic surgical management in refractory facial paralysis using the tarsal strip techni-que and suspension of the nasolabial fold was assertive as a local experience.

Abordagem conservadora do ectrópio palpebral congênito / Conservative management of congenital eversion of the eyelids

Resumo Ectrópio palpebral congênito é o termo utilizado para descrever a ocorrência da eversão das pálpebras, seja ela superior ou inferior, presente ao nascimento. Trata-se de uma afecção rara com reduzido número de casos publicados no meio científico desde 1896, ano em que o primeiro relato foi documentado. O objetivo desse trabalho é descrever um caso de abordagem conservadora do Ectrópio Palpebral Congênito, evidenciando as suas principais características, importância do diagnóstico precoce e conduta adequada para o seu tratamento. Este é um estudo transversal, retrospectivo e documental baseado na metodologia de relato de caso que envolve um recém-nascido do sexo feminino que apresentou eversão palpebral unilateral e foi tratada de maneira conservadora, obtendo melhora do quadro com satisfatório resultado estético e funcional.

Abstract Congenital eyelid ectropion is the term used to describe the eversion of the eyelids, be it in the upper or lower lid, present at birth. It is a rare condition with a reduced number of cases published in scientific world since 1896, the year it was first reported. The objective of this work is to describe a case of Congenital Ectropion treated conservatively, emphasizing its main characteristics, importance of early diagnosis and appropriate treatment. This is a cross-sectional, retrospective and documentary study based on the methodology of case report involving a female newborn who presented unilateral palpebral eversion at birth and was treated conservatively, showing a satisfactory and functional improvement of the condition.

Impact of the type of anterior lamellar reconstruction on the success of modified Hughes procedure / Impacto do tipo de reconstrução lamelar anterior no sucesso do procedimento de Hughes modificado

ABSTRACT Purpose: To determine the long-term functional and cosmetic outcomes in patients who underwent modified Hughes procedure with different types of anterior lamellar reconstruction for lower eyelid defects. Methods: This study included 58 patients who had undergone a modified Hughes flap for reconstruction of lower eyelids after tumor excision within a 10-year period. Data regarding patient demographics, size of eyelid defect, tumor pathology, surgical techniques, functional and cosmetic outcomes, and complications were recorded. Postoperative complications were evaluated according to the type of anterior lamella reconstruction (i.e., advancement flap or free skin graft). Multivariate logistic regression analysis was performed to identify risk factors affecting the success of the procedure. Results: The average size of the lower eyelid defect was 22 ± 6.3 mm (range: 11-30 mm). The anterior lamella was reconstructed with advancement flaps and full-thickness skin grafts in 36 (58.6%) and 24 (41.4%) patients, respectively. Mean follow-up time was 23.6 ± 11.9 months. Postoperative complications included trichiasis (three patients; 5.2%), ectropion (two patients; 3.0%), flap necrosis (one patient; 1.7%), flap dehiscence (one patient; 1.7%), infection (one patient; 1.7%), and eyelid margin erythema (one patient; 1.7%). The rates of complication and secondary surgery were similar among the different types of anterior lamellar reconstruction (p=768 and p=0.139, respectively). Success of the modified Hughes procedure was not significantly affected by any of the identified risk factors (p>0.05). Functional and cosmetic outcomes were 96.6% and 94.8%, respectively. Conclusion: Modified Hughes procedure is a safe and effective option for the reconstruction of small and large defects of the lower eyelid, regardless of the type of anterior lamella reconstruction (i.e., advancement flap or skin graft).

RESUMO Objetivo: Determinar os resultados funcionais e cosméticos a longo prazo de pacientes submetidos ao procedimento de Hughes modificado com diferentes tipos de reconstrução lamelar anterior para defeitos palpebrais inferiores. Métodos: Este estudo incluiu 58 pacientes que foram submetidos a um retalho de Hughes modificado para reconstrução das pálpebras inferiores após excisão do tumor durante um intervalo de 10 anos. Dados referentes à demografia dos pacientes, tamanho do defeito palpebral, patologia tumoral, técnicas cirúrgicas, resultados funcionais e cosméticos e complicações foram registrados. As complicações pós-operatórias foram avaliadas de acordo com o tipo de reconstrução da lamela anterior (ou seja, retalho de avanço ou enxerto de pele livre). A análise de regressão logística multivariada foi realizada para identificar os fatores de risco que afetam o sucesso do procedimento. Resultados: O tamanho médio do defeito da pálpebra inferior foi de 22 ± 6,3 mm (11-30 mm). A lamela anterior foi reconstruída com retalhos de avanço e enxertos de pele de espessura total em 36 (58,6%) e 24 (41,4%) pacientes, respectivamente. O tempo médio de acompanhamento foi de 23,6 ± 11,9 meses. Complicações pós-operatórias incluíram triquíase (três pacientes: 5,2%), ectrópio (dois pacientes: 3%), necrose de retalho (um paciente: 1,7%), deiscência de retalho (um paciente: 1,7%), infecção (um paciente: 1,7%) e eritema na margem palpebral (um paciente: 1,7%). As taxas de complicação e de cirurgia secundária foram semelhantes entre os diferentes tipos de reconstrução lamelar anterior (p=768 e p=0,139, respetivamente). O sucesso do procedimento de Hughes modificado não foi significativamente afetado por nenhum dos fatores de risco identificados (p>0,05). Resultados funcionais e cosméticos foram de 96,6% e 94,8%, respetivamente. Conclusão: O procedimento de Hughes modificado é uma opção segura e eficaz para a reconstrução de pequenos e grandes defeitos da pálpebra inferior, independentemente do tipo de reconstrução da lamela anterior (ou seja, retalho de avanço ou enxerto de pele).

Malposiciones palpebrales y su influencia en la topografía corneal previa y posterior a su corrección quirúrgica / Palpebral malpositions and their influence on corneal topography before and after surgical correction

Introducción: las malposiciones palpebrales (ptosis, dermatochalasis superior y ectropión) son de los principales motivos de consulta en el área de cirugía plástica ocular. Aún no hay información concluyente en la literatura sobre los cambios corneales topográficos que se generan con las malposiciones palpebrales y si hay cambios en la topografía corneal posterior a la corrección quirúrgica de estas. Objetivo: determinar los cambios corneales topográficos de los pacientes con malposiciones palpebrales sometidos a corrección quirúrgica. Diseño del estudio: estudio observacional prospectivo longitudinal. Método: pacientes seleccionados por conveniencia a quienes se les realizó corrección quirúrgica de afecciones palpebrales (ptosis, ectropión y dermatochalasis superior) en el Hospital Militar Central de Bogotá entre abril y septiembre de 2019. Se describieron los datos de la topografía corneal previa a la corrección y al mes y tres meses después de esta y la agudeza visual mejor corregida preoperatoria y en la última evaluación postoperatoria realizada. Resultados: se realizó corrección quirúrgica de malposiciones palpebrales a 106 ojos de 54 pacientes. El cilindro medio tuvo un cambio de 0,13 D y el desplazamiento de su eje de 1, 49º. El cambio global en la queratometría media fue de 0,01 D y el grosor corneal central disminuyó 1,5 mcs. En cuanto la agudeza visual mejor corregida hubo un aumento de 0,0415 por escala LogMAR. Conclusión: la cirugía de las malposiciones palpebrales genera cambios topográficos corneales, donde la corrección de ptosis es la que más cambios ocasiona, con persistencia de los cambios a los 3 meses postoperatorio.

Background: palpebral malpositions (ptosis, upper dermatochalasis and ectropion) are the main reasons for consultation in the area of eye plastic surgery. There is still no conclusive information in the literature on the topographic corneal changes that are generated with palpebral malpositions and if there are changes in the corneal topography after surgical correction. Objective: to determine the topographic corneal changes of patients with palpebral malpositions submitted to surgical correction. Study design: longitudinal prospective observational study. Method: patients selected for convenience who underwent surgical correction of palpebral conditions (ptosis, ectropion and upper dermatochalasis) at the Central Militar Hospital of Bogotá between April and September 2019. Corneal topography data prior to correction were described and one month and three months after this and the visual acuity better corrected preoperatively and in the last postoperative evaluation performed. Results: surgical correction of palpebral malpositions was performed in 106 eyes of 54 patients. The middle cylinder had a change of 0,13 D and the displacement of the cylinder axis of 1,49 °. The average global change in mean keratometry was 0,01 D and the central corneal thickness decreased 1,5 mcs. With the best corrected visual acuity there was an increase of 0,0415 per LogMAR scale. Conclusion: palpebral malpositions surgery generates corneal topographic changes, where the correction of ptosis is the one that causes the most changes, with persistence of the changes at 3 months postoperatively.

Diseases, conditions, and drugs associated with cicatricial ectropion / Doenças, condições e drogas associadas ao ectrópio cicatricial

ABSTRACT Cicatricial ectropion may be a consequence of certain systemic diseases as well as the result of drug use. Our goal here was to research the different causes of this condition as reported in the literature, including more recently suspected etiologies. A detailed PubMed literature search indicated many different etiologies were associated with cicatricial ectropion development, from severe cases of systemic diseases, such as ichthyosis and lupus erythematosus, to reversible scenarios secondary to anti-glaucomatous drug use. More recently reported connections include periorbital necrotizing fasciitis, frontal osteomyelitis, and antineoplastic agents. Indeed, cicatricial ectropion may be highly symptomatic; being able to determine its real etiology is imperative to managing patients properly. In this investigation, we felt that an explicitly multidisciplinary approach was essential, especially for cases associated with systemic conditions.

RESUMO O ectrópio cicatricial pode ser uma consequência de certas doenças sistêmicas, bem como o resultado do uso de drogas. Nosso objetivo aqui foi pesquisar as diferentes causas desta condição, conforme relatado na literatura, incluindo mais recentemente suspeitas de etiologias. Uma pesquisa bibliográfica detalhada do PubMed indicou que muitas etiologias diferentes estavam associadas ao desenvolvimento do ectrópio cicatricial, desde casos graves de doenças sistêmicas, como ictiose e lúpus eritematoso, até cenários reversíveis secundários ao uso de drogas antiglaucomatosas. Conexões relatadas mais recentemente incluem fasceíte necrosante periorbitária, osteomielite frontal e agentes antineoplásicos. De fato, o ectrópio cicatricial pode ser altamente sintomático; ser capaz de determinar sua etiologia real é imperativo para o manejo adequado dos pacientes. Nesta investigação, sentimos que uma abordagem explicitamente multidisciplinar era essencial, especialmente para casos associados a doenças sistêmicas.

The Banner-type Transposition Flap with an Auricular Cartilage Graft for Lower Eyelid Reconstruction / 대한피부과학회지

No abstract available.

Reparo da pálpebra inferior por fechamento direto com cantopexia lateral e elevação da fáscia suborbicular dos olhos: uma técnica simples para evitar o ectrópio pós-operatório / Repair of the lower eyelid with primary closure with lateral canthopexy and elevation of the suborbicularis oculi fascia: a simple technique to avoid post-operatory ectropion

Os defeitos cutâneos da pálpebra inferior frequentemente requerem reconstruções com enxertos ou retalhos para evitar-se o ectrópio. A retirada de um carcinoma basocelular da pálpebra inferior de uma paciente de 39 anos resultou em um defeito exclusivamente cutâneo, com diâmetros transversal e vertical de 32 e 13mm, respectivamente. Apesar da grande dimensão do defeito, a elevação da fáscia suborbicular dos olhos para o periósteo da borda orbital lateral permitiu o fechamento primário. A posição da pálpebra inferior também foi reforçada com uma cantopexia lateral, com excelentes resultados estético e funcional.

Cutaneous defects of the lower eyelid frequently require reconstructions with grafts or flaps to avoid ectropion. Removal of a basal cell carcinoma from the lower eyelid of a 39-year-old patient resulted in an exclusively cutaneous defect, with transversal and vertical diameters of 32 and 13mm, respectively. Despite the large size of the defect, the elevation of the suborbicularis oculi fascia to the periosteum of the lateral orbital border made primary closure possible. The position of the lower was also reinforced with a lateral canthopexy, with excellent aesthetic and functional results.

Avaliação neurológica simplificada: auxílio no diagnóstico de Hanseníase / Simplified neurological assessment: aid in the diagnosis of leprosy

Apresenta dados da Hanseníase no Brasil no Mundo. Apresenta avaliação das Lesões dos nervos periféricos, na região nasal, olhos, Nervo Facial, Nervo Trigêmeo, Teste de Acuidade Visual, Nervo Auricular, Nervo Ulnar, Nervo Mediano, Nervo Radial e Radial Cutâneo, Técnica do Estesiômetro, Nervo Fibular Profundo e Superficial, Nervo Tibial Posterior, Estesiometria nos pés.

It presents data on Hansen's disease in Brazil worldwide. Presents evaluation of peripheral nerve injuries, in the nasal region, eyes, facial nerve, trigeminal nerve, visual acuity test, auricular nerve, ulnar nerve, median nerve, radial and radial cutaneous nerve, esthesiometer technique, deep and superficial fibular nerve, Posterior Tibial Nerve, Stoichiometry in the feet.

Presenta datos sobre la enfermedad de Hansen en Brasil en todo el mundo. Presenta evaluación de lesiones de nervios periféricos, en la región nasal, ojos, nervio facial, nervio trigémino, prueba de agudeza visual, nervio auricular, nervio cubital, nervio mediano, nervio cutáneo radial y radial, técnica de estesiómetro, nervio peroneo profundo y superficial, Nervio Tibial Posterior, Estequiometria en los pies.

Il présente des données sur la maladie de Hansen au Brésil dans le monde entier. Présente l'évaluation des lésions nerveuses périphériques, dans la région nasale, les yeux, le nerf facial, le nerf trijumeau, le test d'acuité visuelle, le nerf auriculaire, le nerf ulnaire, le nerf médian, le nerf cutané radial et radial, la technique de l'esthésiomètre, le nerf fibulaire profond et superficiel, Nerf tibial postérieur, stoechiométrie dans les pieds.

Correction of Cicatricial Upper Eyelid Ectropion Using a Dermofat Graft and an Anti-Adhesive Agent

Ectropion is characterized by eversion of the eyelid margin and exposure of the cornea and conjunctiva. This leaves the inner eyelid surface exposed and prone to irritation, and in severe cases, poor eye closure. Ectropion can occur for several reasons including congenital malformations, trauma, burns, anti-cancer medications, allergies, and inappropriate eyelid surgery. Surgical treatments usually include local flaps or skin grafts, depending on the severity of the defect. We present a case of successful cicatricial upper eyelid ectropion correction using a dermofat graft and an anti-adhesive agent (Guardix-Sol) after the wide release of tethering scar tissue.

Algorithm for the management of ectropion through medial and lateral canthopexy

BACKGROUND: Patients with ectropion experience devastating symptoms. Therefore, the preventionand management of this condition are of utmost importance. To treat ectropion, it is important to perform medial and lateral canthopexy in an effective way. In this study, we propose a comprehensive algorithm for the prevention and management of ectropion based on a new classification of ectropion according to its signs and causes. METHODS: Canthopexy was performed in 68 cases according to the proposed algorithm, which starts with a categorization of the types of ectropion and ends with the recommended operative technique. To assess the results, we reviewed clinical preoperative and postoperative photographs. To evaluate improvements in patients’ symptoms, we conducted a survey with responses scored on a Likert scale. RESULTS: None of the patients had scleral show postoperatively. The average patient satisfaction score was satisfied or higher for all symptoms, and the most improved symptom was aesthetic appearance. No major complications were reported. CONCLUSIONS: For the comprehensive management of ectropion, it is crucial to consider both treatment and prevention. Through the simple surgical algorithm proposed in this study, both medically acceptable results and high levels of patient satisfaction were achieved without significant postoperative complications. We recommend using this algorithm for the comprehensive management of ectropion.

Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction

BACKGROUND: Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. METHODS: A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctivalincision and an elevator through the intraoral incision. RESULTS: The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. CONCLUSIONS: The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

The vertical orbicularis oculi muscle turn-over procedure for the correction of paralytic ectropion of the lower eyelid

BACKGROUND: Static reconstruction surgery that tightens the tension of the inferior tarsus, thereby raising the lax lower eyelid, is a common treatment for paralytic ectropion of the lower eyelid. We present one such operative procedure, in which an orbicularis oculi muscle flap was used. METHODS: The surgical technique involves partial resection of the tarsus and the skin, as well as a superior-based orbicularis oculi muscle flap that is sutured to the firm tissue present on the Whitnall tubercle. The muscle flap is approximately 7 mm in width and 15 mm in length, with a superior pedicle that is attached to the tarsus at the medial point of the resected tarsus. The procedure results in contact between the ocular surface and the lower eyelid. RESULTS: The procedure was performed in 11 patients with lower eyelid ectropion due to facial paralysis. Ten cases showed a favorable outcome following surgery, with stable results seen over an average follow-up period of 4.5 years. In one case, recurrence of ectropion was observed 2 months after surgery due to an insufficient correction, and the patient required repeat surgery. CONCLUSIONS: The orbicularis oculi muscle flap was an effective means of suspension and was able to maintain long-term traction tension. This procedure can therefore be considered a favorable treatment option for lower eyelid ectropion due to facial paralysis.

Modified Abbé flap for reconstruction of Cupid’s bow and vermilion tubercle in secondary cleft lip deformity

BACKGROUND: Abbé flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional Abbé flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid's bow and central vermilion tubercle with minimal sequalae. METHODS: From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid's bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation. RESULTS: Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid's bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional Abbé flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile. CONCLUSION: A new modified Abbé flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid's bow.

Chromomycosis, an unusual cause of cicatricial ectropion: a case report / Cromomicose como causa rara de ectrópio cicatricial: relato do caso

ABSTRACT Chromomycosis is a fungal infection that affects the epidermis, dermis, and subcutaneous tissue and is caused by dematiaceous fungal species that turn black on staining. We report the case of a 50-year-old male patient who was a rural worker and had been treated without success for three decades. Facial lesions progressed and caused severe cicatricial retraction. As the infection evolved, the left upper eyelid developed cicatricial ectropion. The surgical treatment was performed using skin obtained from the patient's own abdomen. Patient has developed a good postoperative appearance

RESUMO A cromomicose é uma infecção fúngica que afeta a epiderme, derme e tecido subcutâneo. A infecção é causada por espécies de fungo dematiáceos que se coram em preto. Nós relatamos o caso de um homen de 50 anos de idade, trabalhador da zona rural, que tinha sido tratado por três décadas sem êxito conclusivo. As lesões faciais progrediram causando retração cicatricial severa. Com a evolução do quadro, houve também retração também da pálpebra superior do olho esquerdo. O tratamento cirúrgico foi realizado utilizando pele abdominal do próprio paciente. O paciente apresentou uma boa aparência pós-operatória.

The Lateral Tarsal Strip for Paralytic Ectropion in Patients with Leprosy

BACKGROUND: In patients with leprosy, paralysis of the facial nerve results in the lower eyelid ectropion and lagophthalmos as a sequela even when the leprosy is cured. Paralytic ectropion causes many functional and cosmetic eye problems, leading to blindness if left untreated. OBJECTIVE: The purpose of this retrospective study is to evaluate the efficacy of surgical correction of paralytic ectropion, the lateral tarsal strip, in patients with leprosy. METHODS: Between 2010 and 2015, 40 Korean patients (44 eyelids) with paralytic ectropion who had visited Korean Hansen Welfare Association Hospital were treated with the lateral tarsal strip. Four-point patients' global assessment scale, local complications, and recurrence were assessed at the end of follow-up period. The average follow-up period was 12 months. RESULTS: In the 44 eyelids, recurrence was observed in 5 cases (5/44, 11.4%). There were no serious postoperative complications except mild size discrepancy of both eyes. Most patients were satisfied with the results and mean satisfaction scale was 2.6/3. CONCLUSION: The lateral tarsal strip is a simple, safe, and effective treatment method for the dermatologic surgeon to correct paralytic ectropion of mild to moderate degree in patients with leprosy.

The Reliability of the Transconjunctival Approach for Orbital Exposure: Measurement of Positional Changes in the Lower Eyelid

BACKGROUND: Lower eyelid incisions are widely used for the orbital approach in periorbital trauma and aesthetic surgery. In general, the subciliary approach is known to cause disposition of the lower eyelid by scarring the anterior lamella in some cases. On the other hand, many surgeons believe that a transconjunctival approach usually does not result in such complications and is a reliable method. We measured positional changes in the lower eyelid in blowout fracture repair since entropion is one of the most serious complications of the transconjunctival orbital approach. METHODS: To measure the positional changes in the lower eyelids, we analyzed preoperative and postoperative photographs over various time intervals. In the analysis of the photographs, marginal reflex distance 2 (MRD2) and eyelash angle were used as an index of eyelid position. Statistical analyses were performed to identify the significance in the positional changes. All patients underwent orbital reconstruction through a transconjunctival incision by a single plastic surgeon. RESULTS: In 42 blowout fracture patients, there was no statistical significant difference in the MRD2 and eyelash angle. Furthermore, there were no clinical complications, such as infection, hematoma, bleeding, or implant protrusion, during the follow-up periods. CONCLUSION: The advantages of the transconjunctival approach for orbital access include minimal scarring and a lower risk of eyelid displacement compared with other approaches. Based on these results, we recommend the transconjunctival approach for orbital exposure as a safe and reliable method.

Reconstrucción de defectos oncológicos palpebrales con colgajos regionales sin aporte condromucoso / Reconstruction of oncologic eyelid defects with local flaps with no condromucuos

Objetivo: caracterizar la reconstrucción palpebral de los defectos oncológicos de espesor total con colgajos regionales sin aporte condromucoso. Métodos: se realizó un estudio descriptivo, prospectivo y longitudinal con 30 pacientes, en los Servicios de Oftalmología y Cirugía Reconstructiva del Instituto Cubano de Oncología y Radiobiología, en el período 2009-2012. Se utilizaron las siguientes variables: edad (30-90 años), sexo, color de la piel, párpado afectado, histología del tumor (carcinoma basocelular o epidermoide), tamaño del defecto (desde 25 por ciento hasta 100 por ciento), tipo de reconstrucción, complicaciones, resultados funcionales que fueron buenos si el párpado tuvo posición y apertura normal y resultados estéticos que fueron buenos si tuvieron adecuada simetría con el otro párpado, buena función y poca cicatriz. Resultados: en la muestra predominó el sexo masculino; la edad media fue de 67 años y el tumor más frecuente fue el carcinoma basocelular. El colgajo más utilizado fue el de la región frontoglabelar. En cuanto a la funcionabilidad y estética de la reconstrucción, se obtuvieron buenos resultados en el 86,7 y 76,7 por ciento respectivamente. Las principales complicaciones estuvieron relacionadas con la técnica empleada y fueron el simbléfaron y el ectropión, con el 13,3 por ciento del total de la muestra. Conclusiones: la reconstrucción palpebral sin aporte condromucoso ofrece buenos resultados estéticos y funcionales, así como altas probabilidades de satisfacción de los pacientes, con un mínimo de complicaciones quirúrgicas(AU)

Objective: to characterize the reconstruction of full-thickness oncologic eyelid defects by using local flaps with no condromucous addition. Methods: prospective, descriptive and longitudinal study was carried out with 30 patients in the ophthalmology and reconstructive surgery services of the Cuban Institute of Oncology and Radiobiology from 2009 to 2012. The following variables were used: age (30-90 years), sex, race, affected eyelid, tumor histology (basal cell or epidermoid carcinoma), defect size (25-100 percent), reconstruction type, complications, functional results that were rated as good if the lid had normal position and opening, and aesthetic results that were considered good if they show adequate symmetry with the other eye lid, good function and small scar. Results: males predominated in the sample; the mean age was 67 years and the most common tumor was basal cell carcinoma. The flap in the frontal and glabelar region was the most used. As for functionality and aesthetics of the reconstruction, good results were achieved in 86.7 percent and 76.7 percent of cases, respectively. The main complications were related with the surgical techniques, namely simblepharon and ectoprion accounting for 13.3 percent of the sample. Conclusions: eyelid reconstruction with no condromucosous addition offers good aesthetic and functional results, as well as great possibilities for attaining higher levels of patient's satisfaction, with minimal surgical complications(AU)

Morfeia generalizada em uma criança com ictiose arlequim, uma associação rara / Generalized morphea in a child with harlequin ichthyosis: a rare association

Resumo Introdução Ictiose arlequim é uma doença cutânea congênita grave, autossômica e rara, caracterizada por ressecamento excessivo da pele e hiperqueratose. A associação de ictiose com esclerose sistêmica foi descrita em apenas três crianças. Ainda não foi descrito nenhum paciente com morfeia generalizada (MG) associada à ictiose arlequim. Relato de caso: Menina de quatro anos e seis meses de idade com diagnóstico de ictiose arlequim baseado em espessamento cutâneo difuso, com fissuras, descamação, eritema e sangramento da lesão desde as primeiras horas de vida. A paciente foi tratada com acitretina (1,0 mg/kg/dia) e creme emoliente. Aos três anos e nove meses, desenvolveu contraturas musculares com dor à movimentação e limitação nos cotovelos e joelhos e placas esclerodérmicas difusas no abdômen, nas costas, na região suprapúbica e nas extremidades inferiores. A biópsia de pele mostrou epiderme retificada e hiperqueratose leve, derme reticular com linfócitos, infiltrado mononuclear perivascular e perianexial e esclerose da derme reticular e glândula sudorípara rodeada por um tecido colágeno denso, compatível com esclerodermia. A paciente preencheu os critérios para o subtipo MG. Metotrexato e prednisona foram introduzidos. Aos quatro anos e três meses, apresentou novas lesões esclerodérmicas, associando-se azatioprina à terapêutica anterior, sem resposta após dois meses. Discussão: Um caso de ictiose arlequim associada à MG foi descrito. O tratamento dessas duas condições é um desafio e requer uma equipe multidisciplinar.

Abstract Introduction: Harlequin ichthyosis (HI) is a severe and rare hereditary congenital skin disorder characterized by excessive dryness, ectropion and eclabion. The association of ichthyosis with systemic sclerosis has been described in only three children. No patient with generalized morphea (GM) associated with harlequin ichthyosis was described. Case report: A 4-years and 6-months girl, diagnosed with harlequin ichthyosis based on diffuse cutaneous thickening, scaling, erythema, ectropion and eclabium since the first hours of birth was described. She was treated with acitretin (1.0 mg/kg/day) and emollient cream. At 3 years and 9 months, she developed muscle contractures with pain on motion and limitation in elbows and knees, and diffuse sclerodermic plaques on the abdomen, back, suprapubic area and lower limbs. Skin biopsy showed rectified epidermis and mild hyperorthokeratosis, reticular dermis with perivascular and periadnexal infiltrates of lymphocytes and mononuclear cells, and reticular dermis and sweat gland sclerosis surrounded by a dense collagen tissue, compatible with scleroderma. The patient fulfilled the GM subtype criteria. Methotrexate and prednisone were introduced. At 4 years and 3 months, new scleroderma lesions occurred and azathioprine was associated with previous therapy, with no apparent changes after two months. Discussion: A case of harlequin ichthyosis associated with a GM was reported. The treatment of these two conditions is a challenge and requires a multidisciplinary team.