Postoperative Pain Control by Intercostal Nerve Block After Augmentation Mammoplasty.

BACKGROUND: In breast augmentation with implant, there is severe pain due to damage from expansion of breast tissue and the pectoralis major. Therefore, the authors conducted this study to analyze the effectiveness of postoperative intercostal nerve block (ICNB) in reducing postoperative pain after breast augmentation with implant. METHOD: Forty-four female patients were enrolled in the study. Just before awaking from general anesthesia, 34 cases were injected with 0.2% ropivacaine to both third, fourth, fifth, and sixth intercostal spaces. We compared them (ICNB group) with the control group for VAS scores at the time of arrival in the recovery room, after 30, 60, and 120 min. RESULT: The average VAS scores per time of the control group and ICNB group were 7.1 ± 0.74 and 3.50 ± 1.81 at arrival time in the recovery room, 7.00 ± 0.67 and 3.03 ± 1.47 after 30 min, 5.50 ± 0.71 and 2.68 ± 1.49 after 60 min, and 4.60 ± 0.84 and 2.00 ± 1.35 after 120 min. VAS scores of two groups were significantly different at each time and decreased overall. Also, time and group effect of the two groups were significantly different, especially between 30 and 60 min. CONCLUSION: ICNB just before awaking from general anesthesia showed a statistically significant reduction in VAS score, and this means postoperative pain was reduced effectively and time to discharge could be shortened. Therefore, it can be a good way to reduce postoperative pain after augmentation mammoplasty with implant. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of the jaw-winking syndrome.

BACKGROUND: Marcus Gunn described for the first time a syndrome consisting of unilateral, congenital ptosis, and rapid exaggerated elevation of the ptotic eyelid during movement of the mandible to the contralateral side. METHODS: Here, clinical findings from the management of 20 patients with jaw-winking syndrome have been reviewed. Preoperative measurement of the ptotic degree and the levator function by Berke's method, and marginal limbal distance were all evaluated. Moreover, the amount of winking found in the upper eyelid on primary gaze was graded on a scale from I to III. The operation was performed on 20 patients under local anesthesia: 10 by unilateral levator resection and the other 10 by the frontalis muscle falp or orbicularis oculi muscle flap. RESULTS: The correction of blepharoptosis was possible without encountering severe complications. However, a moderated degree of jaw-winking, slight undercorrection, and transient lagophthalmos were all inevitable. CONCLUSIONS: The management of patients with jaw-winking syndrome is a challenging endeavor. Therefore, a comprehensive medical and ophthalmologic evaluation and a detailed history are mandatory before undertaking the successful treatment of patients with this syndrome.

Anthropometry of asian eyelids by age.

BACKGROUND: The normal morphologic and functional values of eyelids and orbits vary according to race, sex, and age. Unfortunately, there is a paucity of information related to these values in Asians, leading Asian surgeons to use statistical data from Caucasians. METHODS: The authors quantified and statistically analyzed nine morphologic and functional values in 234 Asian male and 264 Asian female subjects. RESULTS: Among adults, the mean value for the palpebral fissure was 27.0 +/- 1.8 mm in males and 26.8 +/- 1.7 mm in females in the horizontal dimension and 8.0 +/- 1.0 mm in males and 8.2 +/- 1.1 mm in females in the vertical dimension. The average slant of the palpebral fissure was 7.9 +/- 2.4 degrees in males and 8.8 +/- 2.3 degrees in females, and the average height of the opened upper eyelid was 12.4 +/- 2.4 mm in males and 12.0 +/- 1.9 mm in females. The average height of the double fold in the closed eye was 6.6 mm in males and 6.5 mm in females, and the average intercanthal distance was 38.4 +/- 3.0 mm in males and 38.2 +/- 2.8 mm in females. The average interpupillary distance was 64.6 +/- 2.9 mm in males and 63.6 +/- 2.9 mm in females. CONCLUSIONS: The peak level of growth in the vertical dimension of the palpebral fissure was reached between ages 10 and 13 years, that of the intercanthal distance between ages 14 and 16 years, and that of the horizontal dimension of the palpebral fissure between ages 17 and 19 years.

Comparison of levator resection and frontalis muscle transfer in the treatment of severe blepharoptosis.

BACKGROUND: The optimal surgical approach for blepharoptosis is dependent upon many factors, the most important being levator function. However, the preferred approach in severe blepharoptosis remains a matter of contention. METHODS: We investigated 130 patients with levator function between 2 and 4 mm who underwent corrective surgery for blepharoptosis between January 1990 and December 2004. There were 65 eyelids of levator resection performed in 50 patients and 105 eyelids of frontalis transfer performed in 80 patients. Postoperative results were evaluated, with an average follow-up period of 27 months. RESULTS: The average preoperative degree of ptosis was approximately 2.7 mm in cases treated with levator resection and 4.0 mm in cases treated with frontalis muscle transfer. The average postoperative level of ptosis was approximately 1.7 mm in levator resection and 2.1 mm in frontalis muscle transfer. The average degree of postoperative ptosis improvement was approximately 1.0 mm in levator resection and approximately 1.86 mm in frontalis muscle transfer. The most frequent complication of levator resection was undercorrection. Eyelid deformity due to excessive traction was more frequent in the frontalis muscle flap technique. CONCLUSION: Levator resection and frontalis transfer can effectively treat blepharoptosis patients with poor levator function. Frontalis muscle transfer should be performed more carefully in operation to avoid complications which too excessive contraction could cause for blepharoptosis patients with 2 approximately 4 mm of levator function. Also, some accessorial methods were regarded as necessary to prevent undercorrection in performing levator resection.