摘要:

Several authors have reported significant exposure rates using the hydroxyapatite orbital implant in the treatment of the anophthalmic socket. Histologic studies by ourselves and others have suggested that lack of fibrovascular ingrowth into the implants may contribute to conjunctival breakdown and exposure. Recently, much attention has been given to angiogenic factors, such as rTGF-β2 and those found in plasma, in accelerating wound healing and fibrovascular ingrowth. This pilot study compares the rate of vascularization of hydroxyapatite orbital implants pretreated with plasma, rTGF-β2, and a saline/gentamicin solution with that in untreated controls in a population of New Zealand albino rabbits.Hydroxyapatite orbital spheres were implanted subcutaneously and in enucleated orbits. Untreated implants were used as a control. Implants pretreated with plasma, rTGF-β2, and a saline/gentamicin solution were removed and examined histologically at weekly intervals for the first 3 weeks after implantation.Histologic studies demonstrated that the rate of vascularization significantly increased between 2 and 3 weeks postoperatively in all study groups. Pretreating the implants with rTGF-β2 in phosphate buffered solution (PBS) or autogenous plasma did not significantly increase the rate of vascularization in comparison with controls at weeks 1 and 2. However, pretreating the implants with a saline/gentamicin solution or PBS alone was associated with an increased rate of vascularization at weeks 2 and 3. No statistically significant difference in vascularization was noted between the subcutaneous and orbital implants at any week.Hydroxyapatite implants pretreated with saline/gentamicin or phosphate buffered solutions underwent more rapid vascularization at weeks 2 and 3 in comparison with controls. Additionally, all groups were noted to have a more rapid rate of ingrowth between weeks 2 and 3 than between weeks 1 and 2. Plasma and rTGF-β2 (at the dose used) did not significantly alter the rate of vascularization of hydroxyapatite implants during the first 2 to 3 weeks. The significance of these findings is discussed.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The purpose of this study was to evaluate the role of the dermisfat graft (DFG) as an orbital implant in the pediatric age group. A retrospective study was made of a series of 16 patients who had undergone unilateral orbital implantation of a DFG. The ages of the patients at the time of surgery ranged from 2 months to 17 years, with followup ranging from 2 to 15 years. Growth of the graft was clinically apparent in the younger children. Increasing proptosis required surgical debulking of the graft in six of eight children who were 4 years old or younger at the time of DFG implantation. None of the eight children who were 9 years or older at the time of DFG implantation required surgical debulking. Indeed, five of the older patients demonstrated some degree of graft atrophy. Dermis-fat grafts placed in the orbits of young children appear to grow after implantation. This growth of the implant may help stimulate orbital growth, potentially leading to more symmetry between the involved and uninvolved sides.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The use of the malar implant to augment the malar-zygomatic eminence is rapidly becoming a popular aesthetic procedure; however, this surgery can lead to paralysis or paresis of the facial nerve. Paralytic ectropion may result from orbicularis oculi dysfunction. We report two cases of paralytic ectropion as a result of malar implant placement. Conservative management for mild orbicularis oculi dysfunction consisted of topical lubricants and observation, whereas persistent ectropion required surgical repair. Paralytic ectropion and secondary exposure keratopathy are possible complications of malar implant surgery.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The ophthalmic complications associated with facial nerve palsy present a challenging problem to the treating ophthalmologist. Over the last hundred years, a wide variety of techniques have been used to rehabilitate patients with facial nerve palsy. Each of these techniques is associated with unique complications. We describe a significantly modified surgical technique for the rehabilitation of patients with facial nerve palsy that has not, to our knowledge, previously appeared in the literature.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The results of frontalis suspension (double rhomboid technique with preserved homologous cadaver fascia) were compared in two surgical groups: 1) patients in whom the fascia was sutured to the tarsus and 2) patients in whom the fascia was not sutured to the tarsus. The study was performed to determine the optimum surgical technique and to determine whether preserved cadaver fascia is a suitable suspensory material. All data retrospectively reviewed included 1) predisposing cause of severe blepharoptosis, 2) results in the two groups of patients, suture fixation and nonsuture fixation, and 3) surgical complications. Of the 27 patients (36 eyelids), the fascia was sutured to the tarsus in 15 patients (20 eyelids) and not sutured to the tarsus in 12 patients (16 eyelids). In the suture fixation group, no undercorrections occurred, but four of 20 eyelids had lower than expected eyelid creases and six had residual dermatochalasis. Six patients had lagophthalmos with corneal exposure that required intense corneal lubrication, and three such patients required temporary tarsorrhaphy for 3 weeks. In the group without suture fixation, two patients had undercorrection (one with ocular cicatricial pemphigoid and the other with myotonic dystrophy). The mean followup period was 44 months. We conclude that preserved fascia provides excellent results with or without fixation of the fascia to the tarsus. In patients with suture fixation, the eyelid crease may form just above the point at which the fascia is sutured to tarsus and result in a low eyelid crease. Excision of excess skin should be considered at the time of frontalis suspension in selected patients in whom the fascia is fixated to the tarsus or who have preexisting dermatochalasis. Patients with suture fixation may have significant temporary postoperative lagophthalmos.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A patient with bilateral but asymmetrical brow ptosis is presented in whom the frontalis action on the relative position of the eyebrows could be demonstrated to obey Hering's law of equal innervation. The neurological basis for this finding is discussed, along with the implications for the surgical management of brow ptosis.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Endoscopic techniques are being successfully applied to address eyebrow and forehead ptosis. The methods rely on extensive subperiosteal and subgaleal release of the forehead and scalp flap, allowing the elevation of soft tissues. Ablation of the depressor supercilli and procerus can be performed to address skin folding in the glabellar region. The mobilized frontotemporal flap is then elevated to the desired level and fixated with microscrews to the outer table of the skull. Laterally, the flap is fixed to the deep temporalis fascia. The technique relies upon a solid knowledge of the regional anatomy and the use of specialized instruments now available for dissecting under the flap. The endoscopic forehead lift can achieve results comparable to those obtained by the open coronal forehead lift while minimizing the incidence and extent of postoperative cutaneous anesthesia and telegenic hair loss, which frequently follows open coronal forehead surgery. In addition, the endoscopic technique is able to address eyebrow ptosis in the balding male without causing disfiguring scarring.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Orbital inflammation is common, but the mechanisms underlying leukocytic infiltration of orbital tissue are poorly understood. We studied resident human orbital fibroblasts (OF) interleukin-8 (IL-8), and monocyte chemotactic protein-1 (MCP-1) mRNA expression and protein secretion in response to lipopolysaccharide (LPS) or recombinant human cytokines that are present during inflammation.Third-passaged cultured human OF were left unstimulated or incubated with varying concentrations of LPS, recombinant interleukin-1-beta (rIL-1β), recombinant tumor necrosis factor-alpha (rTNF-α), or recombinant interferon-gamma (rIFN±γ) for 2, 4, 8, or 24 h. Northern blot analysis and ELISA were performed to determine OFIL-8 and MCP-1 mRNA expression and protein secretion, respectively. Experiments were performed in triplicate and repeated four times on different cell lines.rTNF-α>LPS), measured after 4 h of exposure (p < 0.01). This increased in the media over the next 20 h. rIFN-γ was a potent stimulant of OF MCP-1, significant by 2 h (p< 0.05), but only a weak stimulant of IL-8 at 24 h.OF secreted IL-8 and MCP-1 in response to LPS and proinflammatory cytokines, indicating that these resident cells within the orbit have the capacity to actively participate in the initiation and propagation of orbital inflammation. Strategies aimed at modulating local mediators may be helpful in the management of orbital inflammatory disease.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Periorbital masses are often referred to oculoplastic surgeons. We report a 20-year-old patient presenting with a tender supertemporal mass that on gadolinium-enhanced magnetic resonance imaging (MRI) demonstrated a prominent dural enhancement adjacent to the mass, the so-called “dural tail sign.” This sign has been reported to be highly specific for a meningioma; however, recent literature challenges this view. In this case as well, the “dural tail sign” was not produced by a meningioma.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We report the case of a 43-year-old man who presented with painless proptosis of the right eye of 6 weeks' duration. Examination demonstrated a tense right orbit and decreased vision and extraocular motility bilaterally. Diagnostic evaluation included computed tomographic imaging of the head and orbits, a therapeutic trial of high-dose systemic corticosteroids, and orbital biopsy, which revealed the presence of metastatic adenocarcinoma. The primary tumor was found to be an estrogen-receptor-positive, infiltrating ductal adenocarcinoma of the right breast. Therapy included lumpectomy of the breast mass, orbital irradiation, and hormonal therapy. Metastatic carcinoma of the breast should be considered in the differential diagnosis of orbital neoplastic disease in the male patient.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID