ABSTRACT
An otherwise healthy 1-month-old female infant presented with a congenital nasal appendage in the left medial canthal region with associated left-sided nasal hypoplasia. The diagnosis of proboscis lateralis was made, and a 2-stage excision and reconstruction was performed in conjunction with probing and irrigation of the lacrimal system. The patient had markedly abnormal nasal anatomy, but a patent lower canalicular system with anomalous entry in the nose and a distally stenotic upper canalicular system on the affected side. A case report and review of proboscis lateralis is provided, as treatment of this rare congenital malformation should be multidisciplinary and necessitates an informed oculoplastic surgeon or ophthalmologist's assistance.
Subject(s)
Craniofacial Abnormalities/surgery , Eyelids/abnormalities , Facial Asymmetry/congenital , Nose/abnormalities , Ophthalmologic Surgical Procedures/methods , Plastic Surgery Procedures/methods , Craniofacial Abnormalities/diagnosis , Diagnosis, Differential , Eyelids/surgery , Facial Asymmetry/diagnosis , Facial Asymmetry/surgery , Female , Follow-Up Studies , Humans , Infant, Newborn , Lacrimal Apparatus/abnormalities , Lacrimal Apparatus/surgery , Nose/surgeryABSTRACT
OBJECTIVE: To evaluate the efficacy and safety of a combined endoscopic and transconjunctival orbital decompression in patients with thyroid-related orbitopathy with orbital apex compression. STUDY DESIGN: Retrospective review. METHODS: A sequential series of patients with thyroid-related orbitopathy presenting with orbital apex compressive myopathy with and without optic neuropathy who were undergoing combined endoscopic and transconjunctival decompression by the same surgeons from 1992 to 2001 was reviewed. Patients were regularly evaluated preoperatively and postoperatively over a 3- to 55-month period to record the effects of this approach on visual acuity, Hertel exophthalmometry, and diplopia. Complications and secondary ophthalmological procedures were reviewed. RESULTS: Between 1992 and 2001, 72 combined endoscopic and transconjunctival decompressions were performed on 41 patients with orbital apex compression. Visual acuity improved in 89.3% of the patients with compressive optic neuropathy (P <.0005) and in 34.1% of those without neuropathy. Proptosis was reduced by 3.65 mm, on average. There was one case of transient intraoperative cerebrospinal fluid extravasation at the site of the optic nerve decompression, and one patient developed epistaxis. CONCLUSIONS: The study supports the treatment of thyroid-related orbital apex compression with and without compressive optic neuropathy by a combined transconjunctival and endoscopic approach. This approach offers short hospital stays, excellent visual recovery, and minimal complications in patients with thyroid-related orbital apex compressive myopathy and related compressive optic neuropathy. The beneficial effects observed in the patients with visual loss continued to improve over time and were significant (P <.001).
