Ophthalmic Plastic and Reconstructive Surgery最新文献

Purpose: This study aimed to describe uncommon cases of ostiomeatal complex (OMC) occlusion and maxillary atelectasis secondary to orbital pathology.

Methods: A retrospective chart review of cases of ostiomeatal occlusion and maxillary atelectasis at a single institution was performed. Patients with an identifiable orbital cause were included, whereas patients with idiopathic occlusion (silent sinus syndrome) were excluded. Data collected included patient age, sex, clinical presentation, and measurements including exophthalmolmetry, radiographic features, interventions, and outcomes.

Results: Eight patients were identified with mechanical causes of ostiomeatal occlusion arising from the orbit. Five cases had malpositioned orbital floor implants in the setting of remote orbital reconstruction, including after trauma. Two cases had previous orbital decompression for thyroid eye disease with subsequent orbital mucocele and fat prolapse into the OMC. One case had distensible venous malformation of the inferior orbit resulting in occlusion of the OMC. The majority of patients required both endoscopic sinus surgery and treatment of the orbital pathology causing the OMC occlusion.

Conclusions: While rare, orbital pathology may cause OMC occlusion, which may lead to maxillary sinus atelectasis. Orbital surgeons should be aware of these associations and have a high index of suspicion when subclinical maxillary atelectasis is seen in conjunction with orbital pathology. Treatment may require addressing the underlying cause as well as multidisciplinary management of both sinus surgery to restore maxillary sinus ventilation and possible orbital reconstruction.

Purpose: Corticosteroid use is commonly associated with an increase in intraocular pressure (IOP). Our retrospective study aims to evaluate the effect of short-term periocular topical triamcinolone acetonide (TA) use on IOP.

Methods: A retrospective review was conducted of patients treated with periocular 0.025% triamcinolone cream between 2023 and 2024 at a single specialty practice. Patients with baseline and follow-up IOP assessments at their visits were included. Factors such as age, dosage, procedure type, application site, and concomitant TA and 5-fluorouracil (5-FU) subcutaneous injections or neomycin-polymyxin B-dexamethasone drops were analyzed.

Results: A total of 62 patients involving 120 eyes met the inclusion criteria. The overall mean change in IOP (14.35 to 14.32 mm Hg) was not statistically significant ( t = 0.085, p = 0.93). IOP did not significantly increase with age ( r = 0.16, p = 0.21), once daily ( B = -3.3, p = 0.13), or twice daily dosing ( B = -3.5, p = 0.26), nor with concomitant TA and 5-FU injection ( B = -1.5, p = 0.40) or topical steroid drops ( B = -1.5, p = 0.26). Procedure type was not associated with significant IOP changes, specifically upper eyelid blepharoplasty ( B = 0.76, p = 0.39), CO 2 laser resurfacing ( B = 1.2, p = 0.39), and lower eyelid blepharoplasty ( B = 1.9, p = 0.14). Application of TA to the bilateral upper eyelids caused a significant increase in IOP of 1.7 mm Hg ( t = 3.7, p = 0.003), but the maximum IOP was within the normal range (16 mm Hg).

Conclusions: Periocular application of TA cream is not associated with clinically significant changes in IOP when used for limited periods of time.

A 58-year-old woman presented with progressive proptosis and intermittent eye pain. Imaging showed an orbital mass with a central thrombus, initially suspected as a thrombosed venous malformation. However, rapid symptom worsening with visual loss necessitated further evaluation. Transfemoral cerebral angiography demonstrated a vascular mass supplied by the ophthalmic artery with venous drainage to the cavernous sinus, suggesting an arteriovenous malformation. The patient underwent transvenous embolization followed by surgical excision. Histopathological examination confirmed angioleiomyoma with thrombus formation. This case highlights a rare presentation of orbital angioleiomyoma with acute exacerbation due to hemodynamic changes. The combined approach of embolization and surgical resection proved effective in managing the orbital tumor, reducing complications, and achieving complete resolution of symptoms.

Purpose: The pericranium, a component often overlooked in oculoplastic surgery, is a rich source of reconstructive potential. While it is frequently used in craniofacial surgery, pericranial flaps and grafts are generally underutilized in oculoplastics, with limited published research. This review aims to highlight its anatomy, surgical dissection techniques, and versatile benefits to inspire and motivate the oculoplastic community to widen its application in reconstructive surgery.

Methods: A literature review of all cases published in oculoplastic surgery using pericranial flaps.

Results: The anatomy, operative dissection methods, and all published applications of pericranial flaps and free grafts in oculoplastic surgery are described. Vascularized flaps have been used to reconstruct eyelid and orbital defects, frontal-orbital mucoceles, and orbital-sinus fistulas. Free pericranial grafts are less frequently reported in oculoplastic literature, as they are primarily used in conjunction with a vascularized cutaneous flap for eyelid defects, but may also be used alone in the repair of forniceal contraction or cases of implant exposure.

Conclusions: This review underscores the significant potential of pericranial tissue for oculoplastic reconstruction. Its advantages over existing autologous reconstructive tissues, including maintaining the integrity of overlying skin and soft tissue, rich vascularity, and convenient proximity to periocular and facial defects, make it a promising option for eyelid reconstruction. While isolating the flap may be technically challenging, pericranial flaps and grafts can significantly improve functional and cosmetic outcomes in oculoplastic reconstruction.

Purpose: To examine risk factors for the development of eyelid, face, and body basal cell carcinoma (BCC) within the National Institutes of Health All of Us database.

Methods: Around 7342 patients with BCC and 29,728 age-matched controls were included. Patients with genetic syndromes predisposing to BCC, and patients with a history of solid organ transplants were excluded. Outcomes examined included tumor location, ethnicity, age, smoking, alcohol intake, income, and access to care. Univariate and multivariate regression analyses were performed to examine the association between BCC on different areas of the body and race as well as the effect of modifiable risk factors.

Results: Almost 48.7% (3623) of patients had BCC on the body (nonface), 47.2% had BCC on the face (3505), and 4.1% (304) had BCC of the eyelid. White race (OR, 11.79; CI, 5.99-27.73; p < 0.001) and male sex (OR, 1.23; CI, 1.14-1.33; p < 0.001) were nonmodifiable risk factors for BCC and overall, patients with facial BCC were significantly older ( p < 0.001) than those with body BCC. Nonwhite patients with BCC were younger, and significantly more likely to have nonfacial BCC ( p < 0.001). On multivariate analysis, alcohol intake also showed a dose-dependent increased risk for BCC (OR, 1.54; CI, 1.14-2.13; p < 0.001) of the face.

Conclusions: Nonwhite patients were significantly younger and more likely to be diagnosed with nonfacial BCC. Thus, we hypothesize that BCC pathogenesis may not be as closely related to cumulative sun exposure as for white patients. Alcohol intake is an important modifiable risk factor.