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2.
Proc (Bayl Univ Med Cent) ; 36(2): 243-245, 2023.
Article in English | MEDLINE | ID: mdl-36876279

ABSTRACT

Cutaneous vascular lesions in the pediatric population are rare and may represent a variety of localized and systemic diagnoses with diverse treatment protocols. We present a unique case of an infant with multiple cutaneous vascular lesions, initially diagnosed as congenital disseminated pyogenic granuloma based on histopathologic findings and later diagnosed as multifocal infantile hemangioma with extracutaneous hepatic involvement. The largest vascular lesion in our patient was on the left upper eyelid, which failed medical treatment and ultimately required surgical excision to prevent amblyopia progression.

3.
Orbit ; 42(2): 170-173, 2023 Apr.
Article in English | MEDLINE | ID: mdl-35576365

ABSTRACT

PURPOSE: To study the feasibility of osseous medial canthal fixation for severe medial ectropion. METHODS: Retrospective analysis over a period of 3 years identified 10 patients who had undergone the modified medial canthoplasty. Outcome measures were based on the presence of complications and cosmetic/functional results. RESULTS: Post-operative evaluations of all patients were significant for excellent functionality and cosmetic results in the medial canthal area following the novel osseous fixation technique. No complications were reported intra-operatively or post-operatively. CONCLUSIONS: For repair of severe medial ectropion, especially cicatricial and paralytic ectropion, the modified medial "puncture hole" canthoplasty is an effective alternative to traditional repair techniques and does not necessitate the use of anchoring systems such as wiring or microplates.

4.
Orbit ; 42(3): 269-272, 2023 Jun.
Article in English | MEDLINE | ID: mdl-35766103

ABSTRACT

PURPOSE: We aimed to perform a review of facial and periorbital squamous cell carcinoma (SCC) cases to assess the relative incidence of eyelid margin involvement. METHODS: This is a retrospective review of all patients with biopsy-proven SCC who were evaluated at a single oculoplastic surgery practice from 2007 to 2019. The charts were reviewed for the anatomical location of the malignancy, and those involving the eyelid were further divided into marginal and non-marginal lesions. Statistical analysis was performed using a one proportion z-test. RESULTS: A total of 76 patients with a diagnosis of biopsy-proven periorbital and facial SCC were identified, 67 involved the ocular adnexa. Thirty-nine (58.2%) patients had lesions located on the eyelid. Of these, 33 (84.6% p < 0.0001, 95% CI 69.45-94.13) had lesions located at the margin, six of the 39 lesions were non-marginal. The remaining lesions were present within the brow (n = 10, 14.9%), medial canthus (n = 10, 14.9%), palpebral conjunctiva (n = 1, 1.5%), or orbit (n = 1, 1.5%). In six patients (8.9%) lesions involved multiple anatomic subunits. CONCLUSION: We present our investigation of the incidence of SCC of the marginal vs. non-marginal eyelid, revealing a statistically significant increased involvement of the eyelid margin. Future investigations are necessary to further elucidate the vulnerability of the eyelid margin to the development of SCC in particular in regards to the role of the unique genetic expression profile of eyelash follicular stem cells.


Subject(s)
Carcinoma, Squamous Cell , Eyelid Neoplasms , Humans , Eyelid Neoplasms/epidemiology , Eyelid Neoplasms/surgery , Eyelid Neoplasms/diagnosis , Incidence , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/diagnosis , Conjunctiva/pathology , Retrospective Studies
5.
Dermatol Surg ; 48(10): 1089-1091, 2022 10 01.
Article in English | MEDLINE | ID: mdl-35947796

ABSTRACT

BACKGROUND: The aged face results from a culmination of skin changes, gravitational descent, and volume loss. Surgical interventions in the periorbital region are beneficial for addressing these 3 factors. Despite this, studies describing CO2 laser safety settings are lacking. OBJECTIVE: There is no present consensus on ideal periorbital CO2 laser; therefore, this study evaluates the safety of periorbital laser resurfacing as an adjunct to lower blepharoplasty using robust settings. MATERIALS AND METHODS: A retrospective review was performed of all patients who underwent bilateral lower blepharoplasty with adjunctive periorbital (upper and lower eyelid) fractionated CO2 laser resurfacing from 2013 to 2018 performed by a single oculoplastic surgeon. RESULTS: Fifty-nine patients were included. Six patients experienced side effects including postinflammatory hyperpigmentation, (3/59, 5.1%), prolonged superficial excoriations (1/59, 1.7%), prolonged hyperemia (1/59, 1.7%), and lower eyelid retraction requiring lower eyelid recession (1/59, 1.7%). None of the patients developed postoperative infection. All patient expressed satisfaction at their final postoperative visit. CONCLUSION: CO2 laser resurfacing, even with robust settings, is a safe and effective adjunct to lower blepharoplasty.


Subject(s)
Blepharoplasty , Laser Therapy , Lasers, Gas , Skin Aging , Aged , Blepharoplasty/adverse effects , Blepharoplasty/methods , Eyelids/surgery , Humans , Laser Therapy/adverse effects , Laser Therapy/methods , Lasers, Gas/therapeutic use
6.
Ophthalmic Plast Reconstr Surg ; 38(6): 596-601, 2022.
Article in English | MEDLINE | ID: mdl-35604385

ABSTRACT

PURPOSE: The purpose of this study is to assess the dose-dependent immunohistopathological effects of intradermal microneedle-delivered 5-fluorouracil (5-FU) for postincisional wound healing in a murine model. METHODS: A prospective experimental study was performed. Twelve hairless mice were randomized into 4 treatment groups for postincisional wound treatment: microneedling with topical saline, or microneeding with topically-applied 5-FU at concentrations of 25 mg/ml, 50 mg/ml, or 100 mg/ml. Two surgical wounds were created on each animal. Combination wound treatments were performed on postoperative days 14 and 28, and cutaneous biopsies were obtained on day 56. Specimens were analyzed by a dermatopathologist, blinded to the treatment group, for collagen thickness, lymphocytic infiltration, histiocytic response, sub-epidermal basement membrane zone thickness, and myofibroblast density. RESULTS: Histopathologic evaluation showed increased collagen thickness, lymphocyte infiltration, and granuloma density in the groups undergoing microneedling treatment with 5-FU, compared to saline. Immunohistochemical analysis revealed a trend toward thicker basement membranes with higher concentrations of 5-FU used, reaching statistical significance between controls and those treated with 100 mg/ml 5-FU ( p = 0.0493). A trend toward decreasing myofibroblast density with increasing doses of 5-FU was noted. No postincisional or treatment complications were observed. CONCLUSIONS: Our results demonstrate that microneedling is an effective topical subepithelial drug delivery system, and further suggest a beneficial dose-dependent immunomodulatory effect of 5-FU on intermediate wound healing when used in combination with microneedling. We recommend a 5-FU dose at the mid-range 50 mg/ml concentration to simultaneously maximize efficacy and minimize complication risk.


Subject(s)
Fluorouracil , Wound Healing , Mice , Animals , Fluorouracil/therapeutic use , Prospective Studies , Collagen , Mice, Hairless
7.
Orbit ; 41(1): 79-83, 2022 Feb.
Article in English | MEDLINE | ID: mdl-33121312

ABSTRACT

PURPOSE: In March 2020, the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) advised the suspension of all non-emergent oculofacial patient care, imparting unprecedented interruptions in fellowship training. METHODS: ASOPRS fellows and program directors were asked to complete an anonymous survey regarding their perceived impact of the COVID-19 crisis. RESULTS: Forty ASOPRS fellows (70.2%) participated, including 20 first-year and 20 second-year trainees, from all country regions. During the social distancing restrictions, 100% of fellows continued to participate in surgical procedures, including orbital biopsy (77.5%), abscess drainage (55.0%), fracture repair (45.6%), eyelid lesion excision (70.0%) and temporal artery biopsy (57.5%). ASOPRS fellows evaluated patients, including in emergency room (84.6%) and inpatient hospital (76.9%) settings, wearing surgical (85.0%) or N-95 (40.0%) masks, gloves (80.0%) and eye protection (62.5%).Most ASOPRS fellows (87.5%) participated in virtual interinstitutional education sessions and indicated a desire to continue this curriculum. Fellows also used available time for research (85.0%), independent study (77.5%), personal health (70.0%) and social interaction (60.0%).ASOPRS fellows reported COVID-19 restrictions to have a mild (72.5%) to moderate (27.5%) impact on their overall training, and most (75.0%) felt their surgical confidence to decline. Fellowship program directors also asserted a mild (72.2%), moderate (19.4%) or significant (5.6%) impact on subspecialty training, and 94.4% predict adverse effects on graduation case logs. CONCLUSIONS: During the COVID-19 restrictions most ASOPRS fellows participated in emergent clinical activities and novel telemedicine curriculum. Most fellows and program directors expressed concern regarding a negative impact on overall subspecialty education and surgical confidence.


Subject(s)
COVID-19 , Curriculum , Education, Medical, Graduate , Fellowships and Scholarships , Humans , SARS-CoV-2 , Surveys and Questionnaires , United States
8.
Proc (Bayl Univ Med Cent) ; 34(4): 489-491, 2021 Mar 05.
Article in English | MEDLINE | ID: mdl-34219933

ABSTRACT

Bacillus cereus panophthalmitis secondary to intravenous drug use typically leads to an explosive ocular and/or orbital infection. Though several cases of B. cereus panophthalmitis secondary to intravenous drug use have been reported, no clear consensus exists regarding preferred surgical technique and orbital reconstruction. Additionally, no cases describe delayed dermis fat graft placement following enucleation for such cases. Herein, a case of B. cereus panophthalmitis secondary to intravenous methamphetamine use is presented, where delayed dermis fat graft placement following enucleation and orbital washout provided an excellent functional and cosmetic outcome.

9.
Ophthalmic Plast Reconstr Surg ; 37(5): e173-e176, 2021.
Article in English | MEDLINE | ID: mdl-33795607

ABSTRACT

Coccidioidomycosis osteomyelitis involving the orbital bones is exceedingly rare and is often misdiagnosed initially as other inflammatory or infectious conditions. No clear guidelines currently exist regarding appropriate management. The authors present an atypical presentation of disseminated coccidioidomycosis in an immunocompetent child with frontal bone superotemporal orbital rim osteomyelitis and associated periorbital abscess, successfully managed with surgical debridement through an upper eyelid crease incision.


Subject(s)
Coccidioidomycosis , Osteomyelitis , Abscess/diagnosis , Child , Coccidioidomycosis/diagnosis , Eyelids , Humans , Osteomyelitis/diagnosis
10.
Facial Plast Surg Aesthet Med ; 23(2): 98-102, 2021.
Article in English | MEDLINE | ID: mdl-32654507

ABSTRACT

Purpose: Preliminary studies have suggested an improvement in nasal aesthetics after endoscopic forehead lifting. We aimed to assess subjective and objective changes in nasal contour after minimally invasive forehead rejuvenation. Methods: We performed a retrospective review of patients who underwent endoscopic forehead lifting by four surgeons at a single surgery center from 2004 to 2018. All patients had subperiosteal blunt release of soft tissues overlying the radix. Changes in nasal contour were assessed on pre- and postoperative patient photos by four independent judges using the Global Aesthetic Improvement Scale. Objective changes in nasal length and length-to-base ratio were measured on patient photographs using ImageJ software. Measurements were further compared by demographic variables of age and gender. Results: In total, 326 patients met inclusion criteria. Summative judging results revealed 79.4% of patients with clinical improvement in nasal contour (11.1% very much improved, 25.6% much improved, and 42.6% improved), 20.1% with no change and 0.6% with worsening. There was a statistically significant increase in average nasal length (2.17 mm, p < 0.0001) and length-to-base ratio (0.03, p < 0.0001) postoperatively. Stratification of patients by age and gender did not reveal a significant difference in degree of nasal proportion change. Conclusions: There is a noteworthy subjective and quantitative improvement in nasal contour and length after endoscopic forehead lifting. This change restores ideal facial proportions and may serve as a useful counseling point when offering this surgery to patients.


Subject(s)
Endoscopy , Forehead/surgery , Nose/anatomy & histology , Rejuvenation , Rhytidoplasty/methods , Adult , Aged , Esthetics , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Photography , Retrospective Studies
11.
Am J Ophthalmol Case Rep ; 20: 100897, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32875164

ABSTRACT

PURPOSE: We report an unusual case of a thirty-three-year-old woman who presented with acute unilateral vision loss following pregnancy and was ultimately discovered to have a pilocytic astrocytoma of the optic nerve. OBSERVATIONS: A thirty-three-year-old previously healthy female presented one month following Caesarean section with unilateral vision loss. She was found to have significantly decreased visual acuity, an afferent pupil deficit, proptosis, optic nerve edema and choroidal folds. Imaging revealed a large lesion of the optic nerve. Biopsy was performed and pathologic analysis revealed a pilocytic astrocytoma, WHO grade 1. The patient opted for close observation without further management and demonstrated mild improvement in visual function. CONCLUSIONS/IMPORTANCE: Optic pathway gliomas (OPG) most commonly present in the pediatric patient population with painless proptosis, slowly progressive vision loss, and clinical findings of chronic optic neuropathy.( Farazdaghi et al., 2019 Sep) 1 Acute presentations of this disease in adulthood are rare. This case demonstrates a rare case of acute optic nerve glioma presentation during the post-partum period.

14.
Facial Plast Surg Aesthet Med ; 22(1): 61-63, 2020.
Article in English | MEDLINE | ID: mdl-32053422

ABSTRACT

Pedicled buccal fat flaps have demonstrated great utility for oral reconstructions. We present a retrospective case description detailing the utility of the buccal fat pad (BFP) as an anterior maxillary flap for midfacial and lower eyelid volumization and reconstruction. A 64-year-old healthy female had undergone bilateral lower blepharoplasty with silicone tear tough implantation, complicated by infection of the right tear trough implant. Delayed implant removal resulted in chronic infection and inflammation producing significant right lower eyelid retraction, and full-thickness scarring to the orbital rim. Reconstruction was performed, featuring the creation of a midfacial subperiosteal pocket and to access the BFP, which was mobilized and secured to the inferior orbital rim. Long-term follow-up confirms ongoing viability of the surgical intervention. Herein, the BFP is shown to be a source of vascularized volume in reconstructive periorbital surgery.


Subject(s)
Adipose Tissue/transplantation , Cheek/surgery , Orbit/surgery , Plastic Surgery Procedures/methods , Prostheses and Implants/adverse effects , Prosthesis-Related Infections/surgery , Surgical Flaps/blood supply , Blepharoplasty , Female , Humans , Middle Aged
15.
Retin Cases Brief Rep ; 14(3): 268-270, 2020.
Article in English | MEDLINE | ID: mdl-29227350

ABSTRACT

PURPOSE: To evaluate the clinical significance and rarity of tamoxifen retinopathy after a long-term tamoxifen treatment for an inoperable desmoid tumor. METHODS: Case report. RESULTS: Tamoxifen retinopathy is a condition rarely observed in clinical practice. Although tamoxifen is typically a treatment for breast cancer patients, we present a 68-year-old woman taking tamoxifen for an inoperable desmoid tumor, an equally rare condition. She presented with bilaterally deteriorating vision over the course of a year. Fundoscopic examination revealed parafoveal deposits bilaterally. Spectral domain optical coherence tomography exhibited hyperreflective deposits in all layers of the retina. She had a cumulative treatment dose of 292 g of tamoxifen, and the medication was subsequently stopped. Her vision remained stable 3 months after the cessation of tamoxifen. CONCLUSION: The development of tamoxifen retinopathy in the treatment of a desmoid tumor makes this case a rare entity, and this is the first reported case of these two concomitant conditions to our knowledge. With the use of long-term tamoxifen as a primary treatment, we recommend screening at regular intervals by an ophthalmologist as an integral part of treatment.


Subject(s)
Breast Neoplasms/drug therapy , Fibromatosis, Aggressive/drug therapy , Neoplasm Staging , Retina/pathology , Retinal Diseases/chemically induced , Tamoxifen/adverse effects , Visual Acuity , Aged , Antineoplastic Agents, Hormonal/adverse effects , Antineoplastic Agents, Hormonal/therapeutic use , Breast Neoplasms/diagnosis , Female , Fibromatosis, Aggressive/diagnosis , Fluorescein Angiography , Fundus Oculi , Humans , Retina/drug effects , Retinal Diseases/diagnosis , Tamoxifen/therapeutic use , Tomography, Optical Coherence/methods
16.
Article in English | MEDLINE | ID: mdl-31743289

ABSTRACT

PURPOSE: Recent research has suggested a possible role for proprioception in ipsilateral frontalis activation in the setting of ptosis; however, there has not been any robust histologic or anatomic evidence to support this theory. To further elucidate proprioceptive structures in the eyelid, this investigation uses validated histologic techniques to explore the presence of proprioceptive structures or afferent neural networks in the Levator Palpebrae Superioris (LPS) and Müller muscle. METHODS: Müller muscle and LPS samples were evaluated by a laboratory with extensive experience with the histology of extraocular muscle proprioception. Immunofluorescence and confocal laser scanning microscopy were used to analyze the tissue samples. RESULTS: Thirty-four Müller muscle samples and 10 LPS samples were analyzed. Golgi tendon bodies and muscle spindles were not identified in the Müller muscle and LPS samples. This result is expected in the Müller muscle given that these structures are not typically present in smooth muscle, but noteworthy in the skeletal muscle of the LPS. Previously undescribed synaptophysin-positive free nerve terminals within the intermuscular connective tissue of the Müller muscle were identified. CONCLUSIONS: The nerve terminals identified are anatomically consistent with free nerve endings present in the extraocular muscles that have been implicated in proprioception. These findings advance our current knowledge of the ultrastructure of Müller muscle and the LPS and suggest a possible mechanism for proprioception in the upper eyelid that may have a role in ipsilateral brow elevation in the setting of ptosis.The authors describe proprioception in the upper eyelid: A histologic analysis.


Subject(s)
Blepharoptosis , Eyelids , Humans , Muscle, Skeletal , Oculomotor Muscles , Proprioception
18.
Ophthalmic Plast Reconstr Surg ; 35(5): 509-512, 2019.
Article in English | MEDLINE | ID: mdl-31116145

ABSTRACT

PURPOSE: Volume restoration is an important component of aesthetic facial rejuvenation, particularly in the brow and upper eyelid regions. In this study, the authors describe transposition of the central, preaponeurotic fat pad in the sub-brow preperiosteal plane with full release of the brow during upper blepharoplasty. METHODS: A retrospective review including all patients who underwent transposition of the upper eyelid central, preaponeurotic fat pad at the time of upper blepharoplasty. Patients with simultaneous brow lifting surgeries were excluded. The surgical technique involved placement of the preaponeurotic fat pad pedicle in the sub-brow space after full brow release for augmentation of sub-brow volume after performing upper blepharoplasty. RESULTS: Nineteen patients (n = 36 eyelids) were identified who underwent this transposition upper blepharoplasty technique. No complications or adverse events related to this procedure were observed. All patients were satisfied with their outcome. CONCLUSIONS: Transposition upper blepharoplasty with complete brow release is a safe, effective adjunct to blepharoplasty for upper eyelid and periorbital rejuvenation.


Subject(s)
Blepharoplasty/methods , Blepharoptosis/surgery , Eyelids/surgery , Ligaments/surgery , Adipose Tissue/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies
19.
Ophthalmic Plast Reconstr Surg ; 34(6): e204-e206, 2018.
Article in English | MEDLINE | ID: mdl-30365480

ABSTRACT

Primary mucinous adenocarcinoma of the skin is an uncommon malignancy in clinical practice, but multicentric presentation of the malignancy is considered even more rare. In this case report, the authors present a 70-year-old woman with multicentric primary mucinous adenocarcinoma of the skin manifesting with 2 separate lesions located on the right eyelid and cheek. Lesion removal and immunohistochemical staining ruled out mucinous adenocarcinoma of the skin secondary to lung or thyroid carcinoma, however, was inconclusive for breast carcinoma. A negative breast examination and mammography determined the lesions were primary mucinous adenocarcinoma of the skin. Lesion removal resulted in a large defect, which was repaired using a tarsoconjunctival flap and right cheek rotational/advancement flap. Six months postoperatively, the patient's vision returned to baseline with excellent eyelid position and no evidence of local recurrence. Oral consent for the report and photographs was obtained from the patient and filed.


Subject(s)
Adenocarcinoma, Mucinous/diagnosis , Eyelid Neoplasms/diagnosis , Eyelids/pathology , Adenocarcinoma, Mucinous/surgery , Aged , Biopsy , Eyelid Neoplasms/surgery , Female , Humans , Ophthalmologic Surgical Procedures
20.
Proc (Bayl Univ Med Cent) ; 31(3): 372-374, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29904317

ABSTRACT

We present a case of a 36-year-old man who developed rapid onset of proptosis and orbital compartment syndrome resulting in no light perception vision. He was treated with surgery and subsequent rituximab therapy with some recovery of vision and motility. Though the range of presentations of idiopathic orbital inflammation is broad, such rapid evolution of proptosis with complete vision loss is very uncommon.

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