Congenital cystic eye: from prenatal diagnosis to therapeutic management and surgical treatment.

Only 28 cases of congenital cystic eye have been reported in the literature. The main issue in such cases is differential diagnosis between this malformation and different cystic malformations and masses of the orbital cavity and eyeball, the most common of which is microphthalmia with cyst. Both malformations arise from incomplete closure of the fetal optic vesicle in different stages of embryonic development. We present a case of congenital cystic eye, associated with coloboma and corneal dermoid of the fellow eye and with left brachiocephaly, discussing differential diagnosis with microphthalmia with cyst and illustrating the treatment we planned and performed. The patient first underwent a surgical excision of the left corneal dermoid, then a resection of the right orbital cyst. The last step was to perform a craniotomy and cranial vault remodeling. All the operations were planned and performed using a team approach. The team comprised an ophthalmologist, a plastic surgeon, and a neurosurgeon, and the result was a successful outcome.

Treatment of alveolar cleft performing a pyramidal pocket and an autologous bone grafting.

Alveolar cleft repair is a debate topic in cleft lip and palate treatment.The aim of this article is to analyze the outcomes and the advantages of the autologous bone grafting performed during the period between 1981 and 2006. In our plastic surgery unit, 468 patients with alveolar clefts have been treated. According to our protocol, the timing for the closure of the alveolar cleft ranged from 7 to 11 years (mean, 9.4 years). Autologous bone was taken from the skull in the 45% of patients, from the iliac crest in 35% of cases, and from the chin in 20% of cases. The surgical technique of creating a pyramidal pocket to secure the bone graft was central to achieving a good result. The postoperative evaluation of the results, using clinical criteria and endoral radiography, orthopantomography, and teleradiography at 3, 6, 12 months after surgery, and more recently, in the last 82 cases by a three-dimensional computed tomography, allows us to assert that we obtained optimal results in 50% of treated cases, good results in 40%, sufficient in 4%, partial failure in 5.4%, and complete failure in 0.6%.

Breast reshaping in gynecomastia by the "pull-through technique": considerations after 15 years.

Gynecomastia corresponds to abnormal and excessive development of breast tissue in male patients. It may be unilateral or bilateral and, depending on breast volume and skin redundancy, it can be classified, according to Simon, in four different groups. Standard therapy is surgery and different techniques have been described so far, including different type of incisions in the periareolar or intrareolar skin. In 1996 in this journal we described our personal technique, called "pull-through." Our technique combines liposuction that is performed on two planes, subcutaneous and subglandular, and sharp parenchymal excision, performed through the small liposuction incisions. These incisions are short (1-1.5 cm) and hidden in the inframammary fold and behind the anterior axillary pillar. Furthermore the operation can be performed under local anesthesia and with a short recovery period. Since then we have operated on 260 patients. We now present our 15 years experience and our review of literature, focused on authors who used and criticized our technique. Results, in terms of breast volume reduction, skin retraction, and minimal visibility of scars, were very good, even in cases more severe than in our first series (Simon's type IIb and female-to-male transsexuals). Patients' satisfaction rate was high as well and the incidence of complications was low. The results we observed in our series and the ones presented by different authors confirmed the validity and feasibility of the "pull-through" technique in terms of esthetic and functional results, patient satisfaction, and a low incidence of complications.