No abstract available
No abstract available
No abstract available
No abstract available
Pneumosinus dilatans (PD) is a rare disorder of unknown etiology which consists of an abnormal dilatation of one or more paranasal air sinuses without radiological evidence of localized mucous membrane alterations, hyperostosis, or bony erosion. Sinus walls are therefore of normal thickness. The enlargement of the bone may be generalized or focal, and apart from the aesthetic problem it carries, it is important to bear in mind the possible functional consequences it may imply. Although PD is usually a benign asymptomatic condition, some patients may develop progressive neurological signs and symptoms caused by the expanded sinuses. We herein present the case of a 12-year-old boy who had been referred to the Ophthalmology Department, complaining of a progressive and painless exophthalmos of his left eye, developed during 1 year. The cause was unknown and there were no functional problems. Computed tomography and magnetic resonance showed a large pneumatized ethmoidal sinus and confirmed the resulting proptosis. We asked the Ear Nose and Throat (ENT) department for a further examination, and finally, the patient was taken to the operating room, where the left ethmoidal sinus was exposed to an endoscopic endonasal technique; in particular, a maxillary and frontal endoscopic antrostomy ethmoidectomy was performed. Excellent results were obtained and the patient had no complaints. Currently, he remains well after a 16-month postoperative period.
A 45-year-old man presented with a progressively enlarging left lower lateral eyelid lesion. The initial biopsy was inconclusive; however, a repeat biopsy 5 years later revealed infiltrative morpheaform basal cell carcinoma with sclerosis. Two years later, the patient presented with ophthalmoplegia of the left eye. Computed tomography illustrated a heterogeneous enhancing soft tissue mass in the inferolateral orbit with erosion into the globe. Despite treatment with vismodegib for 1 year, the lesion progressed to involve the entire left lower eyelid and corneal-scleral junction with adjacent maxillary sinus invasion. The patient tested positive for human immunodeficiency virus and underwent a left orbital exenteration followed by adjuvant radiotherapy. The patient remained stable with no evidence of recurrent disease or distant metastasis 2 years after exenteration. This rare case highlights a neglected basal cell carcinoma in those immunocompromised with histopathological correlation of the aggressive disease on to the globe.
Williams-Beuren syndrome is a rare multi-system disorder affecting 1:10000 to 1:20000 live-births. The cause is de novo contiguous gene deletion on the long arm of chromosome 7 (7q11.23). It typically manifests with dysmorphic facies and predominantly involves the connective tissues, cardiovascular and nervous systems. The published literature reveals that lacrimal drainage anomalies are exceptionally rare and not much is known of those reported. The present case describes multiple lacrimal drainage anomalies in a child with Williams-Beuren syndrome.
Periorbital hemorrhage is a potentially sight threatening surgical complication. The effect of new oral anticoagulants (NOACs) on hemorrhagic events after periorbital surgery has not been investigated. We describe four cases of severe delayed postoperative hemorrhage associated with NOACs, in addition to three cases in patients on traditional antithrombotic agents. Time of delayed hemorrhage ranged from postoperative day 2 to 6. Six patients required surgical intervention to achieve control of bleeding, and two patients required transfusion of blood products. Risk factors and management of this rare complication are discussed.
Purpose: We describe a novel surgical approach for bilateral orbital roof decompression using a frontal osteoplastic flap without frontal sinus obliteration. This technique utilizes a combined external and endonasal endoscopic approach for wide exposure to the orbital roof bilaterally. We demonstrate this technique for the resection of a massive frontal fibrous dysplasia lesion in a healthy male with bilateral orbital roof involvement. The endonasal endoscopic portion of the technique includes a Draf III frontal sinusotomy (endoscopic modified Lothrop procedure) which precludes the need for frontal sinus obliteration, restores normal frontal sinus function, and allows for postoperative endoscopic surveillance.
Methods: Report of novel surgical technique with video demonstration.
Results: This technique for orbital roof decompression allows for removal of a frontal lesion, wide decompression of the bilateral orbital roof, and post-operative endonasal endoscopic surveillance of the cavity. The patient in whom we demonstrate this technique had complete resolution of his orbital symptoms and minimal residual fibrous dysplasia postoperatively.
Conclusion: Bilateral orbital roof decompression for frontal lesions can be performed safely and effectively with a frontal osteoplastic flap without frontal sinus obliteration, restoring normal orbital and sinus function.
Purpose: To report the clinical outcomes of porcine acellular dermal matrix implants sandwiched between skin and conjunctival flaps for lower eyelid reconstruction following Mohs surgery.
Methods: A retrospective review was performed on patients with lower eyelid defects following Mohs surgery treated using a porcine acellular dermal matrix sandwich graft from 2013 to 2018. Patient demographics, defect size and characteristics, and collagen matrix implant dimensions were evaluated. Postoperative course and complications were also reviewed.
Results: The dermal matrix sandwich graft was performed in 13 cases (12 patients). Average horizontal marginal defect width was 11.7 mm (range: 6–16 mm). Mean width of the implanted dermal matrix was 7.7 mm (range: 5–9 mm). There were no instances of infection or graft failure. The reconstructed lid had an excellent marginal contour in 11 cases (84.6%), while 2 had minimal irregularities. All patients had an excellent thickness of the reconstructed margin. One patient (7.7%) required cauterization of overgrown marginal conjunctiva after surgery. Two patients (15.4%) experienced symptomatic trichiasis, requiring electrolysis (n = 1) and epilation (n = 1).
Conclusions: The dermal matrix sandwich graft is an effective method for marginal defect repair when the remaining conjunctiva and skin are sufficient to develop the necessary flaps. While the resolution of edema and erythema may take several months, an excellent final result is achieved in the majority of cases. Complications are mild, relatively uncommon, and similar to those encountered in other reconstructive procedures. This single-stage, tissue-sparing technique preserves the capability of performing future tarsoconjunctival flaps or lateral canthal procedures, should the need arise.
Purpose: To assess the accuracy of radiographic interpretation between the clinician and radiologist when compared to histopathology of orbital lesions.
Methods: A retrospective chart review of patients at the University of California Davis Eye Center who underwent orbitotomy from 1/1/2000 to 5/22/2019 was performed. Charts with a preoperative imaging report, preoperative clinical assessment including the clinician’s interpretation of imaging, and histopathologic diagnosis were included. The specific diagnoses were grouped into related classes of pathology for the analysis. The clinical and radiologic assessments were compared against the final histopathologic diagnosis for concordance. A concordance analysis was performed.
Results: 242 patients (mean age 49 years, 53.5% female) were reviewed. Of these records 185 documented the clinician’s clinical impression, the radiology report, as well as the histopathology report. The clinician’s preoperative assessment had substantial agreement [kappa = 0.72 (0.65,0.79)] with the final histopathologic result and was correct in 75.7% (140/185) of cases whereas the radiology report was correct in 52.4% (97/185) with a moderate level of agreement [kappa = 0.47 (0.39, 0.55)]. In 49.2% (91/185) of cases the final histopathology correlated with both the clinical impression and radiology report [kappa = 0.58 (0.55, 0.61)].
Conclusions: The accurate interpretation of orbital imaging is a challenge and histopathologic examination remains the gold standard for diagnosis. While orbital imaging is a valuable diagnostic tool the interpretation of these studies is most accurate when conducted in the context of the patient’s medical history, clinical exam, and with the physician most familiar with various orbital lesions.