Innovative Surgical Treatment of Severe Cherubism.

BACKGROUND: Cherubism is an autosomal dominant syndrome characterized by excessive bilateral maxillomandibular bony degeneration and fibrous tissue hyperplasia. Conservative management is the preferred treatment as cherubism has a self-limiting course. Functional or emotional disturbances may, however, demand surgical intervention. We report a patient who underwent surgical intervention. METHOD/DESCRIPTION: He had significant enlargement of lower cheeks and bilateral lower lid scleral show. On computed tomography of the face, the patient had significant fibrous tissue involving bilateral maxilla and mandible. The mandibular tumor was excised. Given normal inferior border, bilateral sagittal split osteotomy was performed to infracture and inset the outer cortex. During the procedure, patient required blood transfusion intraoperatively, so the maxillary portion of the procedure was delayed until 6 months later. For the maxilla, bilateral transconjunctival approach was used to resect parts of the orbital floors that were concave, resulting in 1 × 2 cm defects bilaterally which were reconstructed using resorbable plates. Then the anterior maxillary tumor was excised. RESULTS: The patient and his parents were satisfied with his appearance after surgery. The patient was noted to have improvement in contour and decreased scleral show. He has most recently followed up 15 months after the initial surgery. There were no long-term complications. CONCLUSIONS: Severity of cherubism influences the type of surgical intervention. The present case is innovative because this is the first reported case of recontouring orbital floors with resorbable plates and infracturing of the mandible using sagittal split osteotomies for surgical treatment of cherubism.

The effect of mydriatic solutions on cognitive function.

INTRODUCTION: Anticholinergic and sympathomimetic ophthalmic solutions are used for mydriasis. These solutions have well-documented systemic side effects despite their topical administration. However, no studies have been conducted regarding the effect of mydriatic drops on cognitive function. The purpose of this study is to determine the effect, if any, of mydriatic drops on cognitive function, including memory, concentration, and orientation. METHODS: Participants were randomized into two groups using the technique of permuted block randomization, and randomization was stratified by gender, age, and education. Participants in Group 1 completed the Montreal Cognitive Assessment (MoCA) test with undilated pupils, while participants in Group 2 completed the MoCA test with dilated pupils. Administration time of the MoCA test was approximately 10 minutes, and each participant could receive a maximum of 30 points, with a score of 26 or greater being considered normal cognitive function. Dilation was achieved in both eyes with a combination of tropicamide 0.5% and phenylephrine 2.5%. RESULTS: There was no statistical difference between the MoCA scores of Group 1 and Group 2 (p = 0.65). In addition, MoCA scores were not statistically different between the glaucoma and non-glaucoma subpopulations within each group. MoCA test scores were shown to correlate with education (p = 0.004), age (p = 0.0003), and race (p = 0.03). Patients with confirmed or suspected glaucoma whom eyes dilated required 10.8 minutes to complete the MoCA test, while patients with no confirmed or suspected glaucoma whom eyes dilated required 8.5 minutes to complete the test (p = 0.02). DISCUSSION: Age, race, and education were found to be the most important factors affecting cognitive function in this study. There was no significant difference in the MoCA test scores of participants with confirmed or suspected glaucoma and participants without glaucoma. There was also no significant difference in the MoCA scores of dilated participants and non-dilated participants as a whole. However, dilation significantly increased the amount of time required to complete the MoCA test among the glaucoma and suspected-glaucoma population. The results of this study suggest that physicians should spend more time with dilated glaucoma patients while explaining medical conditions and treatment instructions in order to ensure that patients have adequate time to comprehend instructions for glaucoma management.