Pleomorphic Adenoma of the Orbital Ectopic Lacrimal Gland: An Extremely Rare Occurrence with Review of Literature.

Only three cases of pleomorphic adenomas (PAs) of ectopic lacrimal gland mass in deep orbital location have been reported in the literature. This report describes a case of PA of the ectopic lacrimal gland situated deep in the orbit leading to proptosis, which was managed successfully by supraorbital orbitotomy via eyebrow incision. A 60-year-old female presented with complaints of gradually progressive, painless proptosis of the right eye. Imaging revealed a well-defined circumscribed mass lesion in the right orbit located predominantly in the postero-superior aspect of the globe. The patient underwent complete excision through supraorbital orbitotomy approach, using eyebrow incision. There was no clinical evidence of recurrence at eight months follow up. In orbit, PAs of the ectopic lacrimal gland are extremely rare, and the success of the treatment depends on the removal of the tumor with its capsule.

Absence of Stressful Conditions Accelerates Dexterous Skill Acquisition in Surgery.

The negative impact of strong sympathetic arousal on dexterous performance during formal surgical training is well-known. This study investigates how this relationship might change if surgical training takes place as a hobby in an informal environment. Fifteen medical students volunteered in a 5-week training regimen and weekly performed two standardized microsurgical tasks: circular cutting and simple interrupted suturing. Time was taken and two independent reviewers evaluated the surgical proficiency. The State Trait Anxiety Inventory (STAI) and the NASA Task Load Index (NASA-TLX) questionnaires measured subjective anxiety and workload, respectively. A high-resolution thermal imaging camera recorded facial imagery, from which a computational algorithm extracted the perinasal perspiration signal as indicator of sympathetic arousal. Anxiety scores on STAI questionnaires were indifferent for all five sessions. The continuously measured arousal signal from the thermal facial imagery was moderate and did not correlate with surgical proficiency or speed. Progressive experience was the strongest contributor to improved skill and speed, which were attained in record time. It appears that dexterous skill acquisition is facilitated by the absence of strong arousals, which can be naturally eliminated in the context of informal education. Given the low cost and availability of surgical simulators, this result opens the way for re-thinking the current practices in surgical training and beyond.

Reconstruction of Extensive Post-Electric Burn Scalp Defects With Exposed Bones: A Study of 12 Cases.

The scalp is a unique part of the human body with respect to its shape and position. It is the part of the body that is usually exposed in its original form, with no covering by any means of clothing. In workplaces, especially in the electrical industry in the area of electrical substations and power transmission lines it is this part of the body that can easily come in contact with high tension electrical wires. Others who can be prone to suffer such injuries are pedestrians, people working on heights, ladies hanging clothes on terraces.This case series includes 12 patients who sustained high-voltage electric burn injury to the scalp. Of the reconstructive options used, 2 were free flaps, 1 was a distant flap, and 9 were local flaps. Of the 2 free flaps, there was loss of 1 free flap due to thrombosis, which was later reconstructed with extracorporeal radial forearm flap.Of the 9 local flaps, therewas partial flap necrosis in 2 cases, which required debridement and the wounrds healed secondarily. There was recurrent osteomyelitis in 1 patient who underwent sequestrectomy. In conclusion, the results obtained, in all the patients, were satisfactory without necessitating a bony reconstruction.