Clinicopathological analysis of eyelid malignancies - A review of 85 cases.

BACKGROUND: Resection of eyelid malignancies leads to complex reconstructive problems due to the functional and aesthetic importance of an eyelid. Hence, a large number of such cases are referred to plastic surgery facilities. Eyelid malignancies are of varied histological types and the western and Asian data have considerable variations in case distribution and presentation. This study is an attempt to characterise these tumours in the Indian population. MATERIALS AND METHODS: The present study is a retrospective analysis of 85 consecutive cases of eyelid malignancies that reported to a tertiary health care facility in central India over a 15-year period starting from January 1996 up to December 2009. The cases were analysed for their age of presentation, sex distribution, tumour location, delay in seeking treatment, recurrence rate and variations with respect to the pathological subtype. OBSERVATIONS: Mean age of presentation for all the malignancies was 59 years. The median age of presentation was 65 years for basal call carcinoma (BCC), 58 years for sebaceous gland carcinoma (SGC), 55 years for squamous cell carcinoma (SCC) and 45 years for malignant melanoma. There was slight female preponderance as 56.28% of the patients were females. The most common location of the tumour was lower lid (58.2%) for all the malignancies. BCC was the most common malignancy (48.2%) followed by SGC (31.2%) and SCC (13.7%). Mean duration of symptoms was 9 months (range 3-21 months). The most common presenting complaint was mass with ulceration across all histological subtypes. Other associated complaints included itching, discharge from eye, pain and ptosis. The mean size of tumour at diagnosis was 2.34 ± 0.4 cm for BCC, 2.19 ± 0.6 cm for SGC and 1.99 ± 0.7 cm for SCC. The mean rate of growth of BCC was 1.39 cm/year. The corresponding values for SGC and SCC were 3.63 and 4.89 cm/year, respectively. The rate of follow-up was 89% at 3 months, 71% at 6 months, 62% at 1 year and 31% at 5 years. Recurrence rate was 1.9% for BCC and 12.7% for SGC. Surgical methods used included wedge excision and primary closure, excision and skin grafting, and tarso-conjunctival flap. CONCLUSIONS: We recommend that the surgeons treating eyelid malignancies in India should have a high index of suspicion for SGC. A wider margin of 10 mm is recommended for SGC excision as opposed to 5 mm for BCC.

The average Indian female nose.

BACKGROUND: This study aimed to delineate the anthropometric measurements of the noses of young women of an Indian population and to compare them with the published ideals and average measurements for white women. METHODS: This anthropometric survey included a volunteer sample of 100 young Indian women ages 18 to 35 years with Indian parents and no history of previous surgery or trauma to the nose. Standardized frontal, lateral, oblique, and basal photographs of the subjects' noses were taken, and 12 standard anthropometric measurements of the nose were determined. The results were compared with published standards for North American white women. In addition, nine nasal indices were calculated and compared with the standards for North American white women. RESULTS: The nose of Indian women differs significantly from the white nose. All the nasal measurements for the Indian women were found to be significantly different from those for North American white women. Seven of the nine nasal indices also differed significantly. CONCLUSIONS: Anthropometric analysis suggests differences between the Indian female nose and the North American white nose. Thus, a single aesthetic ideal is inadequate. Noses of Indian women are smaller and wider, with a less projected and rounded tip than the noses of white women. This study established the nasal anthropometric norms for nasal parameters, which will serve as a guide for cosmetic and reconstructive surgery in Indian women.

Effect of aging on the shape and position of the eyebrow in an Indian population.

BACKGROUND: The eyebrow is one of the most important structures of the face from an aesthetic point of view. As age increases, the brow changes its shape and position. This age-related change decreases the vitality, youth, and expression associated with the aesthetically ideal face. This article describes changes in eyebrow position in Indian women with aging. METHODS: This study recruited 80 female subjects for each of the required age ranges (20-30 years and 50-60 years) from the staff and outpatient settings at a tertiary care center in central India. Women who had any condition that could affect the measurements were excluded from the study. Standardized digital photographs in frontal view were captured with the forehead and eyebrows in a maximally relaxed position and with the eyes open. Eyebrow position was determined by measuring from a reference horizontal plane drawn between the medial canthi to vertical points on the upper brow margin at the medial canthus, pupil, and lateral canthus. The result was statistically analyzed. RESULTS: With aging, the least rise was seen in the lateral segment, which was not statistically significant. This difference was statistically significant at the medial and midbrow positions (p < 0.05). In the younger group, the lateral brow position was significantly higher than the midbrow (p < 0.05). In contrast, the older group showed a nonsignificant difference in the position of the midbrow and the lateral brow. The mean horizontal distance of the brow apex from the midpoint of the pupil for young women was 15.2 mm. CONCLUSION: The study results imply that the brow does not drop in women with age. It is recommended that in most instances, the lateral brow should be preferentially elevated, whereas the medial brow should undergo minimal or no elevation. Most patients require brow reshaping by restoration of the brow apex lateral to the level of the outer corneal limbus. By comparing eyebrow shape and position in both young and mature women, this study provides objective data that can be used to plan forehead-rejuvenating procedures in Indian women.

Aesthetic surgery: expanding horizons: concepts, desires, and fears of rural women in central India.

BACKGROUND: We are experiencing greater demand for aesthetic surgery from rural populations. The present study attempts to understand their concepts and beliefs. METHODS: A double-blinded survey with random sampling was done in 34 villages in central India. Sample population consisted of 1,000 unmarried rural women in the age range of 18-30 years. Subjects were interviewed in person and a questionnaire was filled out based on their response. RESULTS: The response rate was 87.2%. Of the 872 respondents, 829 (95%) were aware of aesthetic surgery. Television was the most common source of information (61%). Health-care providers were a source of information for 2.5% of respondents. Aesthetic surgery was associated with "some change in face" by 35.7% of subjects. Surprisingly, 29.1% associated aesthetic surgery with face transplantation. The need for aesthetic surgery was perceived by 85.7% respondents. The face was the most common part of the body perceived to require aesthetic surgery (40.9%). Fifty-seven percent of respondents failed to identify the procedure required for aesthetic correction. Of the 711 respondents who perceived the need for an aesthetic procedure, 83.8% were willing to undergo surgery. Improved marriage prospects were the most common reason for seeking surgery. Cost was the most important variable considered while choosing surgery (49.3%). Cost was also the most frequent response when asked about the biggest fear (63.1%). CONCLUSION: We recommend that scientific knowledge should be provided to the rural population, cost should be limited to a reasonable level, and the social needs of these patients should be fulfilled to ensure a greater reach of aesthetic procedures.

Changing patterns in demography of cleft lip-cleft palate deformities in a developing country: the Smile Train effect--what lies ahead?

BACKGROUND: The past decade has seen tremendous changes in the management of cleft deformities with the advent of the Smile Train project. The present study evaluates the effect of the Smile Train project on the demographics of cleft deformities. METHOD: Data collected over the past three decades were studied retrospectively. The number of cases, age at presentation, and relative proportion of cleft lip-cleft palate patients were analyzed. Thirty patients operated on at the authors' institute for cleft lip deformity were evaluated for their awareness of cleft deformities, and the results were compared with those of 22 patients operated on elsewhere in camp settings. RESULTS: The numbers of patients with cleft deformities treated at the authors' institute from 1980 to 1989, 1990 to 1999, and 2000 to 2009 were 1189, 1050, and 374, respectively. However, the number with cleft palate has remained nearly constant over the three decades. The mean age of reporting for treatment of cleft palate was 16 months after being operated on for cleft lip at the authors' institute and 41 months after being operated on elsewhere in camps. All patients operated on at the authors' institute expressed awareness of holistic treatment of cleft deformities. Of the 22 patients operated on at other camps, 16 were ignorant about the time scale and 19 were unaware of the consequences of nonadherence to the treatment protocol. Nineteen of the 22 patients felt that enough information was not provided to them at initial surgery. CONCLUSION: The authors recommend that cleft counseling, continued cleft care for the complete complex of deformities, and responsible behavior by the initial operating team should be the goals for the future.

Changing patterns in electrical burn injuries in a developing country: should prevention programs focus on the rural population?

In the developing world, the incidence of electrical injuries has increased in the past few years. This study attempts to identify the causative and demographic risk factors that can help in formulating a targeted prevention program. The study was conducted prospectively and retrospectively from 2004 to 2009. Eighty-four consecutive patients with electrical burn injuries were analyzed for their demographic profile, age, sex, occupation, rural-urban distribution, mode of injury, and place of injury. The patients were asked to fill out a questionnaire regarding their awareness about electrical burn injuries, and the results were tabulated. The age of presentation ranged from 3 to 61 years. The most frequently affected age group was the second decade of life (33.3%). Of 84 patients studied, 71 were male and 13 female. Fifty-nine patients were from the urban area, while 25 were from the surrounding rural area. Students including children and adolescents were the most common affected single group (22.5%). Contact with live wire or contact with an object that was in contact with a live wire (secondary contact) accounted for 43 of 84 cases (51%). Home was the most common location where injury occurred (51.2%). Twenty-one of 59 cases (35.6%) reported from the urban area and 3 of 25 cases (12%) from the rural area had specific knowledge about prevention of electrical burn injury. Forty-one patients (69.4%) from the urban area and 22 (88%) from the rural area believed that adequate information regarding electrical burn injury was not available. Thirty-six patients (61%) from the urban area and 24 (96%) from the rural area believed that they would have behaved differently if the information had been available. The authors recommend that prevention programs should be modified to cater to the specific needs of the younger age groups and the rural population.

Schwannoma of upper eyelid: A rare differential diagnosis of eyelid swellings.

Schwannoma is a relatively rare benign tumour of peripheral nerve origin. The occurrence of Schwannoma in eyelid is extremely rare. As per our knowledge, only 11 such cases have been reported in the literature so far. We present a case of a 40-year-old man who presented to us with a 2-year history of slowly enlarging, painless mass in his left upper lid with resultant progressive ptosis. Ocular examination was suggestive of a firm, non-tender nodule of size 2 × 1.5 × 1 cm on the left upper lid. The mass was non-adherent to the skin or the underlying tissue. The eyelid skin and conjunctiva were indurated and signs of inflammation were present. The lateral part of eyelid showed presence of an ulcer and the lid function was severely hampered. Provisional clinical diagnosis was that of an eyelid malignancy. With this in mind, the medial part of the lid was excised and reconstructed using a tarso-conjunctival flap from the lower eyelid in conjunction with a skin graft. The histopathology and immunohistochemistry established the diagnosis of Schwannoma. We recommend that Schwannoma be considered in the differential diagnosis of well-circumscribed eyelid swellings.

Endoscopic third ventriculostomy in infants.

BACKGROUND: Endoscopic third Ventriculostomy (ETV) is one of the surgical options for obstructive hydrocephalus. There are varying opinions about results of ETV in infants. We are therefore presenting the results of ETV in 54 infants. MATERIALS AND METHODS: A prospective study of 54 infants undergoing ETV in our institution in the last 2 years was carried out. There were 48 cases of congenital hydrocephalus with aqueductal stenosis, 6 of post tubercular meningitis hydrocephalus. Average follow up was 18 months. RESULTS: There was 83.3% (45 cases) clinical success rate in our study. Infection, persistent cerebro-spinal fluid (CSF) leak and bleeding occurred in 4 (8%) cases each while blockage of stoma was observed in 8 (14.8%) patients. Majority of ETV stoma closure (6 out of total 8) occurred following infection (4) or bleeding during surgery (2). One patient (2%) had transient diabetes insipidus. Overall failure rate in our study was 16.7% (8 stoma blocks and 1 procedure abandoned). Low birth weight pre mature infants had higher failure rate (3 out of 5 infants 60%) compared to full term infants with normal birth weight (12.3%). Age did not have any impact on the success rate (P>0.05). Success rates were not significanlty different in patients with aqueductal stenosis (85.4%) and TBM (66.6%) (Fisher's exact test, P=0.3). CONCLUSION: ETV was fairly safe and effective in full term normal birth weight infants while the results in low birth weight pre mature infants were poor.