Radiofrequency in the treatment of craniofacial plexiform neurofibromatosis: a pilot study.

BACKGROUND: Neurofibromatosis type 1 manifests itself by the development of plexiform neurofibromas, with craniofacial deformities caused by bone alterations and soft-tissue infiltration. The medical treatment of this disease is disappointing, and the surgical management of these deformities calls for aggressive procedures. There is a strong risk of recurrence. METHODS: A pilot study was performed to test radiofrequency as a minimally invasive method with which to diminish the size of craniofacial neurofibromas either as an adjunct to craniofacial surgery (in cranio-orbital neurofibromas) or to avoid a visible scar in young patients (in infraorbital neurofibromas). Five patients ranging in age from 6 to 18 years were treated by three procedures 2 months apart using radiofrequency performed under local anesthesia or under sedation for the youngest patients. RESULTS: The tolerance of the treatment was excellent, with no major side effects and no pain in the postoperative course. A diminution of the size of the lesion was noted clinically in four patients and on computed tomography in two patients. A biopsy performed in one case illustrated the effect of the treatment. CONCLUSIONS: A partial diminution or stabilization of plexiform neurofibromas may be obtained using radiofrequency. This treatment is well tolerated. The best effect can be observed in the early stages of the disease. The optimal dose and frequency of the procedure require further study.

Surgical strategy in the treatment of globe protrusion depending on its mechanism (Graves' disease, nonsyndromic exorbitism, or high myopia).

BACKGROUND: Graves' ophthalmopathy affects orbital contents and eyelids. Protrusion of the globe can also be the result of myopia and/or an abnormal orbit shape, which is responsible for nonsyndromic exorbitism. It is necessary to recognize these components of protrusion to treat patients adequately. The authors present a surgical strategy for treatment of the orbit and lids. METHODS: Files of 84 patients treated from 1984 to 2003 were retrospectively reviewed. Sixty-eight patients were operated on for Graves' ophthalmopathy and 16 for nonsyndromic exorbitism with or without myopia. The surgical strategy was adapted to the degree of emergency, the age of the patient, and the shape of the orbit measured using computed tomography. The accepted standard of treatment was a coronal approach with a two-wall expansion, with or without bone grafts, especially in cases of associated nonsyndromic exorbitism, with or without complementary ablation of the external part of the orbital floor. Lid surgery was performed at a second stage. RESULTS: Nonsyndromic exorbitism patients were successfully treated in one step. No diplopia was present either preoperatively or postoperatively. In contrast, the treatment of the Graves' ophthalmopathy patients justified one to three orbital expansion procedures per patient and/or one to seven procedures for levator palpebrae lengthening or reinsertion. Forty-three percent of preexisting diplopias were improved by the surgery. The overall postoperative incidence of de novo diplopia was 19 percent. In the Graves' ophthalmopathy series, three patients (5 percent) finally underwent strabismus surgery. No major complication occurred. CONCLUSIONS: The treatment of Graves' ophthalmopathy is challenging. A graded approach is justified. Patients have to be informed that several procedures may be necessary and, in cases of nonsyndromic exorbitism or myopia, that facial modifications might occur.

[Aesthetic blepharoplasty]. / Blépharoplasties esthétiques.

Suzanne Noël, a pioneer of aesthetic surgery in Europe, first published her results with cosmetic blepharoplasty in 1926, in a book entitled: "The social role of aesthetic surgery". Paul Tessier further expanded the range and surgical possibilities of blepharoplasty by incorporating lateral canthopexies and underlying the importance of the craniofacial skeleton. Other authors in the 20th century brought their own technical refinements to this operation, such as the transconjunctival route, and various fat preserving modifications as well as lipostructure. The aim of this paper was to review the surgical approach to blepharoplasty, according to both historical and currently used protocols (including data gathered by questionnaires sent to eight French and foreign plastic surgical teams). A new perspective is proposed regarding the analysis of different morphological and ageing subtypes. The indication for individual surgical techniques stems from an accurate analysis of each patient according to anatomical categories. Pre-operative records before any orbito-palpebral surgery should include a full orthoptic and ophthalmological assessment, as well as high-quality medical photographs. An increasing emphasis has developed recently upon the use of autologous fat harvested locally (septofat advancement), or from a distant site (lipostructure).