Sebaceous carcinoma with apocrine differentiation arising in a known case of basal cell carcinoma: A rare entity.

Sebaceous carcinoma is a ra malignant tumor of adnexal origin arising from sebaceous glands. It is most commonly seen arising from the eyelids and head and neck. It is predominantly seen in females with an average age of around 65 years. Apocrine differentiation in sebaceous carcinomas is rare but has been reported in the literature. Here, we present a case of sebaceous carcinoma with apocrine differentiation in a 62-year- old female who was a diagnosed case of basal cell carinoma.

Reconstruction of Medial Canthal Defects by Local/Loco-Regional Flaps.

AIM: To describe a series of medial canthal defect reconstruction by local/loco-regional flaps following excision of basal cell carcinoma. MATERIAL AND METHODS: A series of 35 medial canthal defects following excision of basal cell carcinoma was reconstructed by local/loco-regional flaps. For smaller defects, glabellar lateral advancement flap or Limberg's flap from the nasolabial area were used to resurface the defects. For larger defects extending to the upper and lower eyelid or to the nose, a combination of flaps, that is, forehead and cheek rotation flaps or glabellar and cheek rotation flaps were used. RESULT: In all the cases, the aesthetic and functional results were highly satisfactory except in one, where punctum and lower canaliculi were also excised with the tumor for clearance. This patient complained of watering from the affected eye. Two patients had developed webbing after the operation. It was corrected by Z plasty after 6 months. CONCLUSION: Medial canthal defects are best managed by local/ loco-regional flaps. For smaller defects in the upper part, the glabellar flap is the choice of the flap and in the lower part, flaps from the nasolabial region give the best result. For larger defects not amenable to single flap, a combination of flaps (glabellar/forehead flap and cheek rotation flap) can close the defects with the good aesthetic and functional results.

Versatility of Superficial Temporal Artery Pedicle for Postburn Facial Reconstruction: Our Center experience.

OBJECTIVES: Superficial temporal artery (STA) is the one of the terminal branches of external carotid artery. Superficial temporal artery divides into frontal and parietal terminal branches. Various types of locoregional flaps can be based on the STA as a pedicle to provide effective and robust cover. In this article, we shall discuss the various applications of STA and its terminal branches as a pedicle for postburn facial reconstruction in our clinical experience of more than 20 years. METHODS: This is a retrospective review of 531 cases of postburn facial reconstruction using STA and one its terminal branches as a pedicle done at Department of Plastic and Reconstructive Surgery, Lok Nayak Hospital, which is tertiary care government hospital in New Delhi for burn care from March 2000 to March 2020. We started use of this flap initially for postburn ear reconstruction cases and slowly expanded our indications over the period of time due to its high vascularity and versatile nature. There were 269 females and 262 males included in this review. RESULTS: We have used STA and one its terminal branches as a pedicle to our advantage with varied indications and excellent results. We had minor complications which were easily manageable with 7 cases of partial flap loss and zero case of total flap loss. We shall discuss all the details in our review. CONCLUSIONS: We wish to conclude that STA and one its terminal branches as a pedicle offers excellent versality and vascularity for postburn facial reconstruction with good long-standing results.

Anthropometric analysis of linear parameters of the Indian nose: A cross-sectional study and comparison with literature.

BACKGROUND: Many studies have been done to find out the accepted "ideal" appearance and proportions of the nose. However, much of this work has been limited to the facial architecture of the North American Caucasian population. Therefore, most beauty standards are driven by Western influences. AIMS AND OBJECTIVES: To measure different standard linear parameters of Indian faces and compare them with the studies found in the literature, in an endeavor to help in preoperative planning in rhinoplasty while maintaining their ethnicity. METHODS: This was a hospital-based cross-sectional study of 500 subjects. A total of 21 standard measurements were noted directly from the faces, and 11 proportional values calculated. Mean values with standard deviations were statistically used for comparisons with studies in the literature. RESULTS: There were significant differences between male and female subjects of our study in 16 variables. The proportional indices calculated also revealed significant differences statistically in 6 out of 11 measurements between male and female subjects. Significant differences were found in most of the parameters when our data were compared with Indian American, North American white population, Korean, Chinese, and African American. CONCLUSIONS: Facial measurements in the Indian population are different from those of other races, such as nasal index: (al-al × 100/n-sn), sn-prn x 100/ al-al index, and sn-prn x 100/n-Sn index, and it is important to have own set of parameters to act as standards guiding esthetic nasal surgeries while maintaining ethnicities. Our study is an attempt at the same. However, because of the huge diversity of the Indian population, it requires larger studies from different regions to achieve the final aim to create standards for cosmetic rhinoplasties.

Assessment of Treatment Outcome of Presurgical Nasoalveolar Molding in Patients With Cleft Lip and Palate and Its Postsurgical Stability.

OBJECTIVE: To analyze the effects of presurgical nasoalveolar molding (PNAM) in newborns with cleft lip and palate and evaluate its postsurgical stability at 1-year follow-up using a nasal stent. DESIGN: Prospective clinical trial. SETTING: Department of Orthodontics, Maulana Azad Institute of Dental Sciences, Delhi. PATIENTS: Patients with cleft lip and palate of 0 to 6 months. Sample size 25 recruited, 16 satisfactorily completed the procedure. INTERVENTIONS: Presurgical nasoalveolar molding done as indicated in all the patients. Postsurgical external nasal stents were given for 1 year to maintain the nasal correction. MAIN OUTCOME MEASURES: Changes in cleft defect and maxillary arch were recorded pre- and post-PNAM. Changes in nasal morphological parameters assessed pre- and post-PNAM and 1 year after surgical repair following the use of nasal stent. RESULTS: There was a significant reduction in cleft defect assessed both intraorally ( 4.16 mm) and extra orally ( 4.42 mm) at the end of PNAM therapy (average treatment time 4 months). The nasal morphology improved with an increase in columella height (1.5 mm) and reduction in columella width. Bialar width reduced (2.90 mm) with an increase in nostril height ( 2.10 mm). Better symmetry was achieved in all cases as the nostril height and width difference changed significantly pre- and post-nasoalveolar molding. The percentage increase in columella height was greater for infants less than 6 weeks. CONCLUSIONS: Presurgical nasoalveolar molding considerably reduces the cleft gap and improves arch form making surgical union easier along with improved nasal morphology which can be maintained at 1-year postsurgery by use of a postsurgical external nasal stent.

An algorithmic approach to management of whistle deformity.

BACKGROUND: Various techniques have been described for the correction of whistle deformity, but no single technique can be used for all types of whistle deformities because the cause of deformity and tissues available for its correction may be different. METHOD: Forty-seven cases of whistle deformity were divided in to 5 groups depending on its cause (deficient tissue) and the tissues available for its correction. Various techniques available for the correction of whistle deformity were analyzed. Techniques available for that particular group were short listed, and the appropriate technique was selected for correction of whistle deformity of the patient belonging to that particular group. RESULT: Of the 47 patients, 3 required reoperation. CONCLUSIONS: The proposed classification of whistle deformity and, accordingly, an algorithm for its management helps the operating surgeon to select the appropriate technique from a wide list of options available for correcting whistle deformity.

Dental impression compound as an effective splint for maintenance of ear elevation in microtia reconstruction.

Ear projection is an important goal to be achieved after stage two (ear elevation) in cases of microtia. This is a retrospective study conducted on patients with microtia who underwent staged reconstruction for the same. This study has been carried out over a period of 10 years with 211 patients. Dental impression compound was used as a splint after ear elevation and split skin grafting to maintain the projection of the ear. Projection of the ear was measured both pre- and post-procedure and at every follow-up using goniometer and photographic documentation was simultaneously done. Statistical analysis was performed using t-test. Patients were reviewed every month and splint was continued until 6 months post-surgery. The splint was very effective in maintaining the ear projection of more than 20(°) even after prolonged follow-up of upto 2 years. There were no complications associated with the splint application or prolonged use.