Intraorbital Cysticercosis Treatment with Lateral Orbitotomy

A 33-year-old female from Uzbekistan visited our hospital with symptoms of right blurred vision, ocular pain which were exacerbated by ocular movement, and exophthalmosis for 2 months. Preoperative facial CT scan showed 3.2x2.4cm-sized cystic mass at the right retrobulbar area. The mass was located at temporal aspect of retrobulbar area and displaced optic nerve medially. Right eyeball was anteriorly displaced at the degree of 7mm than left one and intra-ocular pressure was raised as 32 mmHg compared with left one which estimated at 15 mmHg. Removal of cytic mass was performed using lateral orbitotomy. After incision was made through Stellard- Wright incision, dissection was done to lateral outer orbital periosteum then the periosteum each side of lateral orbit were dissected for lateral orbitotomy. Removal of lateral orbital wall, which was enough to removal cystic mass, by lateral orbitotomy, was done then lateral rectus muscle was divided without cutting. Cystic mass could be resected after lateral rectus muscle was divided and resected lateral orbital bone piece was re-located and fixed by absorbable miniplate. A satisfactory result could be obtained by this procedure. Postoperative intra-ocular pressure was lowerd as 15mm Hg and exophthalmosis was corrected at the degree of 1mm on Hertel's exophthalmometery and visual acuity improved at the degree of 1.0 on optomety compared with preoperative one which estimated 0.04. Preoperative symptoms such as ocular pain, foreign body sensation, headache were disappeared without any complication just like retrobulbar hemorrhage, infection etc.

Frontalis Muscle Flap or Levator Resection for the Correction of Recurred Blepharoptosis

The challenge of accurately predicting eyelid height without recurrence after blepharptosis surgery is a well-known problem even in competent hands. The authors had experienced 24 recurred blepharoptosis cases from March 1999 to Feburuary 2004. 17 cases were unilateral recurred cases and the remains were bilateral cases. Previous methods in recurrent cases are as follows; Levator aponeurosis plication(2 cases), Levator resection(7 cases), Frontalis sling(15 cases). The period from first operation to secondary revision are between about 6 months to 25 years and mean period is about 6 years. The authors had managed recurrent cases with frontalis muscle advancement flap technique in 13 recurrent cases which had poor levator function or in case of frontalis muscle flap was already used. Levator resection was addressed in 11 cases which reserved levator function of more than 3mm. In Frontalis muscle flap case, the authors fixed superior-based frontalis muscle flap to tarsal plate through tunnel which was made with orbicularis oculi muscle. Among Levator resection cases, 8 cases were delayed correction cases and another 3 cases were immediate revision cases within 2 weeks after correction operation. The majority of our series recorded as satisfactory results. But, three of them gained undercorrection in follow-up period. Except for lid edema, troublesome complication just like exposure keratitis, corneal erosion was not observed. It can be safely suggested from our study that frontalis muscle advancement flap and levator resection are reasonable options in the correction of moderate to severe recurrent blepharptosis cases and the choice of recurred case management method should be accordance with levator function of patient and previously used techniques.