Ophthalmic Plastic and Reconstructive Surgery最新文献

Dermoid cysts of cutaneous origin are common orbital lesions, whereas dermoid cysts of conjunctival origin are rare. The authors present a case of a dermoid cyst of conjunctival origin that was attached to the tarsus in a pediatric patient. A 2-year-old boy presented to the clinic with an approximately 2 cm in diameter mobile nodule in the upper eyelid on the temporal side that distorted the eyelid architecture with temporal ptosis. During surgical excision, the lesion was firmly adherent to the tarsal plate. The mass was a conjunctival dermoid cyst lined by nonkeratinizing squamous epithelium with goblet cells and hair follicles on histological examination. This case represents the first report of a conjunctival dermoid cyst attached to the tarsus.

The authors report a rare case of a 58-year-old female with mild right-sided hemifacial spasms and eyelid myokymia and a concomitant high-grade glial mass. This report outlines the clinical presentation, diagnostic approach, and management of right hemifacial spasms and eyelid myokymia. The patient had a 5-month history of gradually worsening right hemifacial spams accompanied by mild right lower eyelid twitching. Given the persistence and exacerbation of these symptoms, alongside episodes of dysphagia, an MRI was performed. Imaging revealed a heterogeneous, peripherally enhancing mass with central necrosis at the lateral aspect of the left precentral gyrus and posterior aspect of the left middle and inferior frontal gyri consistent with high-grade glial mass. The patient subsequently underwent an awake craniotomy with resection of a temporal lobe tumor. These initial episodes of isolated facial spasms may be attributed to epilepsia partialis continua, often indicative of subcortical lesions that can compress the motor cortex. Eyelid myokymia and hemifacial spasms, though common, present significant diagnostic and management challenges. Due to high rate of underdiagnosis or misdiagnosis of these conditions, increased clinical awareness and knowledge are essential for effective patient management.

A woman in her early 20s underwent excision of a 6-mm diameter, tender, mobile mass in the temporal left upper eyelid associated with eyelid swelling and blurred vision. Surgery disclosed a large tarsal lesion that appeared to be a cyst but was found to be a soft-tissue chondroma featuring an island of hyaline cartilage surrounded by dense tarsal fibrous connective tissue containing smaller foci of myxoid cartilage. The woman reported that a nodule had been present at this site since childhood. The soft-tissue chondroma has not recurred after 1.5 years. This case represents one of the few known reports of a soft-tissue chondroma in the eyelid.

Purpose: To report the normative dimensions of the infraorbital nerve on fat-suppressed gadolinium-enhanced MRI and correlate with patient demographics in an Australian cohort.

Methods: A retrospective review of patients who underwent coronal fat-suppressed gadolinium T1-weighted MRI from September 2021 to December 2023. One hundred sixty-eight orbits were included. The maximum diameter of the infraorbital nerve and the optic nerve sheath was measured. Orbits were excluded if there was unilateral or bilateral pathology of the infraorbital nerve or optic nerve sheath, incomplete MRI sequences, poor image quality, or indiscernible infraorbital nerve on radiological examination.

Results: The mean age of participants was 58 ± 16 years, and 50% were females (n = 42). The mean normative measurements (mean ± standard deviation) on coronal T1-weighted imaging: optic nerve sheath, 5.08 ± 0.67 mm. On coronal fat-suppressed gadolinium T1-weighted imaging: infraorbital nerve, 0.89 ± 0.22mm. No significant differences were found between male or female participants in both the infraorbital nerve ( p = 0.757) or optic nerve sheath ( p = 0.646). There was no significant correlation between age and mean diameter of the infraorbital nerve (r = 0.077, p = 0.320) or optic nerve sheath (r = 0.075, p = 0.336). Additionally, no significant difference was identified between the mean diameter of the infraorbital nerve ( p = 0.079) and optic nerve sheath ( p = 0.120) across age groups. The mean infraorbital nerve to optic nerve sheath ratio was 0.18 ± 0.00.

Conclusion: Normative dimensions of the infraorbital nerve may be used to identify enlargement in conditions such as IgG4-related ophthalmic disease and reactive lymphoid hyperplasia.

Purpose: To study the microscopic anatomy of the orbital septum and evaluate its relationships with the adjoined structures.

Methods: Histological evaluation of 11 upper eyelids (5 right, 6 left) from 10 Japanese cadavers (age range: 36-94-year-old, average: 71.1) was performed. The specimens were fixed in 10% formalin and stained with Elastica Van Gieson. Specimens were microscopically analyzed using different magnifications (20×, 40×, and 100×).

Results: The orbital septum was the single fibrous layer in all the specimens, anteriorly separated from the retro-orbicularis fat pad capsule and posteriorly from the preaponeurotic fat pad capsule. At the junction of the orbital septum with the levator aponeurosis, the orbital septum proceeded towards the tarsal plate, and the preaponeurotic fat pad capsule reflected posteriorly.

Conclusions: The orbital septum is constituted of a single layer of fibrous tissue anteriorly separated from the retro-orbicularis fat pad capsule and posteriorly from the preaponeurotic fat pad capsule by the corresponding virtual spaces.