摘要:

We retrospectively reviewed the smoking habits of 124 patients with Graves' ophthalmopathy. We divided these patients into those without restrictive myopathy (type I) and those with restrictive myopathy (type II). Sixty-three percent of type I and 83% of type II patients were smokers at the time of diagnosis. The incidence of smoking in an age- and gender-matched randomly selected control population in the same geographic area was 30% for controls matched to our type I group and 26.6% for controls matched to our type II group. We believe smoking is an important factor in the development of both clinical subtypes of Graves' ophthalmopathy.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In involutional blepharoptosis, an abnormally low lid position in primaiy gaze is accompanied by increased lid excursion in downgaze. Described here are four patients with little or no ptosis in primary position but significant and symptomatic obstruction of the visual axis in downgaze only. All responded well to minimal aponeurotic advancement with sufficient elevation of the lids in downgaze to allow reading but with little or no discernible change of the lids in primary position. This “downgaze ptosis,” not previously described, may be an early stage of typical involutional ptosis.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The most popular technique of placement of an anophthalmic spherical implant was first described by Frost and Lange in 1886, and has remained essentially unchanged since that time. That technique incorporates imbrication of recti muscles over an 18 mm spherical implant, and purse stringing of conjunctiva and Tenon's fascia in a single layered closure. The Frost-Lange technique has led to previously reported extrusion rates as high as 11.3%. The technique is also associated with superotemporal implant migration and poor prosthetic motility. Our technique modification includes suturing recti muscles independently to a 20 mm spherical implant reinforced with autogenous fascia or preserved sciera. We then close Tenon's fascia and conjunctiva independently as separate layers. The extrusion rate for our patients during a 10 year study period was 0.84% (1 of 119). We found no implant migration, no painful socket, and prosthetic motility was good. We recommend our technique modification to replace the traditional Frost-Lange technique.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We retrospectively reviewed enucleations and secondary anophthalmic socket sphere implantations for a 3 year period. We compared the incidence of exposure of hydroxyapatite implants to the incidence of exposure of silicone implants. We found that the incidence of hydroxyapatite exposure following enucleation was 3 of 27 (11.1%), and following secondary anophthalmic socket implantation was 3 of 32 (9.4%). The incidence of silicone sphere exposure following enucleation was 0 of 48 (0%), and following secondary implantation was 1 of 30 (3.3%). The difference in exposure rate between hydroxyapatite and silicone reached statistical significance in the enucleation group (p = 0.043) and in the combined enucleation and secondary implantation group (p= 0.033), but not in the secondary implantation group when considered separately. Osteoinduction and fibrovascular infiltration were found in all hydroxyapatite specimens examined histopathologically. In the exposed implants, liquefaction necrosis of the implant occurred. In the nonexposed implant, complete fibrovascular ingrowth was noted at 7 months. We believe that the hydroxyapatite anophthalmic sphere is associated with a higher incidence of exposure and postoperative inflammation when compared to silicone anophthalmic spheres. Patient selection and technique modification may reduce the incidence of hydroxyapatite implant exposure.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The gross and histopathologic effects of external beam radiation on host response to subperiosteal implantation of dense hydroxyapatite (HA) blocks along the superior orbital rim was investigated, using the rabbit as an experimental model. Three study groups were employed: those with no radiation, those receiving 500 cGy, and those receiving 1,500 cGy. The hydroxyapatite blocks were surgically implanted 2 weeks after administration of the radiation. The pathologic specimens, including the HA block and the neighboring bone segment, were harvested and examined at either the fourth or 12th postsurgical week. There was essentially no inflammatory reaction stimulated by the implanted HA blocks, nor was there any evidence of abnormal bone remodeling in the underlying orbital rim segments. The most secure bonding between the HA block and bone was found in the specimens having received either 500 cGy or 1,500 cGy and harvested at 12 weeks. We conclude that HA serves as an acceptable bone graft substitute in areas previously treated with radiation. The various properties of HA are also reviewed.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Implanted allogeneic demineralized bone particles (DBP) may be transformed into endochondral bone by inductive or conductive new bone formation. Using a rabbit model, enucleation or evisceration was performed, and DBP was implanted into the socket. Histology confirmed endochondral bone formation in both groups. A morphologic difference existed between enucleation and evisceration: compact bone was produced following evisceration, and cancellous bony spheres were formed following enucleation. Serial quantitative computed tomography (qCT) was performed to monitor mineral density and proved to be an ideal technique to monitor bone mineralization noninvasively in the postoperative orbit. Bone mineral density (BMD, mg/ml) increased −300% in DBP implanted orbits when compared to controls at 6 weeks. The ideal mass/volume ratio of DBP to socket volume was 400 mg/ml. The rapidly formed bone is well vascularized and creates a stable integrated orbital implant, following enucleation and evisceration surgery. DBP implantation into the central orbit results in inductive bone formation with interesting potential in socket and orbit reconstruction.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The anatomy of the hard palate is reviewed with respect to the clinical considerations of harvesting intraoral hard palate grafts for various reconstructive eyelid procedures. Recommendations for harvesting grafts based on these anatomic principles are given.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A female infant was born with a reddish-purple mass situated on the dorsum of the nose and extending onto the left medial canthal region. A presumptive diagnosis of capillary hemangioma was made, and the patient was treated with multiple intralacrimal steroids and cryotherapy without success. A diagnostic incisional biopsy was confirmatory, but erroneous, due to the lack of depth. At 9 months of age, without signs of involution, the mass was removed and a diagnosis of nasal glioma was made.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This study prospectively looked at the effect of intentionally buttonholing the Hughes' flap in a series of eyelid reconstruction patients. This simple maneuver increases the versatility of the procedure, with no clinically apparent damage to the flaps or reconstructed eyelids.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The transcoronal surgical approach for the treatment of orbital disease has become increasingly popular since it affords excellent surgical exposure through a cosmetically acceptable incision. Exposure of the inferior orbit, however, can be difficult due to limited flap mobility in the frontal plane. Increased inferior exposure may be obtained by extending the incision inferiorly in preauricular skin. In children and young adults without excess preauricular skin folds or wrinkling, however, the wound may be quite apparent, compromising cosmesis. To overcome this drawback, we demonstrate a modified transcoronal incision that redirects the inferior limbs into the postauricular sulcus. This incision not only results in superior cosmesis, but avoids important preauricular neurovascular structures and enhances orbital exposure.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID