Growth of periocular basal cell carcinomas.

BACKGROUND: Basal cell carcinomas (BCCs) are generally regarded as slow-growing tumours. There is a paucity of data on the rate of BCC growth and the impact of delayed excision. OBJECTIVES: To measure the growth rate and assess the impact of delayed excision on the growth of periocular BCC (pBCC). METHODS: Patients referred to an oculoplastic service for excision of pBCC were recruited. The tumour dimensions and patient demographic data were recorded at the first specialist appointment (FSA). Measurement of the pBCC was repeated when the patient attended for tumour excision by Mohs micrographic surgery (MMS). Correlation analyses were performed to determine whether the histological subtype and patient factors affected the pBCC growth rates. RESULTS: The study included 112 patients and 115 pBCCs. The primary ethnicity was European with Fitzpatrick type I and II skin. The mean size of the pBCC at FSA was 8 × 6 mm (range 6-12 × 4-8 mm) with a mean area of 68·5 mm(2). The average waiting time for MMS was 157 ± 87 days. The pBCCs grew at a mean rate of 11·2 mm(2) every 30 days. From the FSA to the MMS, a mean increase of 41·9 mm(2) was observed. Recurrent tumours, larger tumours at presentation and male sex were associated with a faster growth rate. CONCLUSIONS: Periocular basal cell carcinomas can grow rapidly, and many have aggressive histological subtypes. Rapid growth is more likely in recurrent tumours, larger tumours and in men.

Prolene frontalis suspension in paediatric ptosis.

AIM: The aim of this study was to assess the efficacy of frontalis suspension using 4-0 prolene sutures for paediatric ptosis with poor levator function. PATIENTS AND METHODS: A retrospective chart review was performed on children who underwent 4-0 prolene frontalis suspension from 2000 to 2008 with a minimum of 6 months' follow-up. Functional success was defined when three criteria were met: (a) satisfactory lid height (defined as margin-to-reflex distance ≥3 mm with minimal frontalis muscle tone); (b) satisfactory lid symmetry (≤2 mm asymmetry in margin-to-reflex distance); and (c) satisfactory cosmesis. Recurrence was defined by a drop in lid height of ≥3 mm from the initial post-operative level. RESULTS: A total of 23 patients (30 eyelids) were included. The mean follow-up duration was 28.7 months (range 6.3 to 100 months). The functional success rate was 74% (17/23 patients). Ptosis recurred in 22% (5/23) of patients. Only one patient (4%) developed a complication: a case of minor wound infection. CONCLUSIONS: In paediatric ptosis with poor levator function, prolene frontalis suspension has good efficacy and an excellent safety profile. The results of prolene frontalis suspension are comparable to those of other non-autogenous materials.

Medpor porous polyethylene implants in orbital blowout fracture repair.

PURPOSE: Various materials are used in orbital blowout fracture repair. We describe a series of patients with orbital blowout fractures that were repaired using porous polyethylene (Medpor) sheets. METHODS: A non-comparative interventional case series is described of 30 blowout fractures of 30 patients aged 7-60 years (median 29 years) who underwent orbital blowout fracture repair with Medpor sheets. The mean follow-up was 19.1 months (minimum 5 months). The indication for surgery in 6 cases was non-resolving diplopia. The remaining 24 cases had surgery for enophthalmos. Ten cases underwent primary or secondary hydroxyapatite orbital implantation at the same time as orbital floor blowout fracture repair. Data were collected on postoperative motility and diplopia, enophthalmos, cosmesis, complications and re-operations. RESULTS: In no case was diplopia worsened by blowout fracture repair. Where surgery was performed for the correction of enophthalmos, late surgery did not compromise the surgical results. There were no intraoperative complications. The one major complication was a case of recurrent implant infections leading to implant removal. There were 3 minor postoperative complications: 2 cases of postoperative infraorbital anaesthesia and one case of a palpable titanium screw. Re-operations were performed for pre-existent diplopia, lid laxity, socket abnormalities and mid-facial deformities. None of these arose from the blowout fracture repair. CONCLUSIONS: The study suggests that in orbital blowout fracture repair Medpor implants are safe and effective with few complications. Late surgery for enophthalmos is technically more difficult but is not associated with poorer functional or cosmetic results.

Necrotising orbital cellulitis.

PURPOSE: To report 2 cases of severe necrotising orbital cellulitis which illustrate the need for aggressive surgical management to prevent blindness. METHODS: The case records of 2 patients with necrotising orbital cellulitis were reviewed. RESULTS: Both patients had orbital cellulitis associated with sinusitis. Each case was characterised by the rapid development of severe systemic toxicity, extensive soft tissue necrosis and abscess formation. One patient developed panophthalmitis and the eye had to be eviscerated. The other patient underwent repeated surgical drainage of multiple orbital abscesses. This led to resolution of the infection and preservation of vision. CONCLUSIONS: Atypical rapidly progressive necrotising orbital cellulitis may occasionally be encountered. In such cases, aggressive surgical drainage of orbital abscesses is crucial to prevent blindness and death.

The rhomboid flap in medial canthal reconstruction.

AIM: To describe a series of patients who have undergone a medial canthal reconstruction with a rhomboid flap. METHODS: A non-comparative interventional case series of 27 patients with medial canthal defects after Mohs excision of medial canthal basal cell carcinomas who underwent reconstruction using a rhomboid-shaped transpositional flap of adjoining skin and subcutaneous tissue. 25 cases were performed under local anaesthesia. The remaining two cases were combined with major lid reconstruction and performed under general anaesthesia. The outcome measures were closure of the defect, the cosmetic result, complications, and re-operations. RESULTS: Primary closure of the defect was achieved in all cases. The cosmetic result was highly satisfactory in all cases. There were no major complications or re-operations. Two cases had minor webbing of the medial upper lid. CONCLUSIONS: The rhomboid flap is an effective, quick, and simple technique for medial canthal reconstruction. It provides excellent cosmesis and is associated with minimal complications. It can be modified according to the nature of the periorbital skin and the location, size, and depth of the defect.