Outcome of Management of Vascular Malformations of Lip.

OBJECTIVES: To describe the characteristics and outcome of management of vascular malformations of lip. PLACE AND DURATION OF STUDY: The Department of Plastic Surgery and Burn Unit, King Edward Medical University, Mayo Hospital, Lahore, from January 2009 to December 2013. METHODS: A prospective case series of 38 patients with vascular malformation of lip was performed. Demographic information and clinical features were noted. Treatment employed, complications, functional, and cosmetic outcome were recorded. Surgical debulking was performed as definitive treatment in all patients and nonsurgical techniques were added as adjuvant modalities in 18 patients. Sclerotherapy was performed for venous malformations in 10 patients. LASER was performed in 8 patients with capillary or combined malformations. Arterial malformations were managed surgically without embolization. Postexcision defects were closed primarily in 36 patients with Abbe flap in 1 and nasolabial flap in another patient for reconstruction. RESULTS: Of 38 patients included in the study 20 (53%) were males with mean (SD) age 18 (6) years. Twenty-one percent were high and 79% low-flow malformations (29% venous, 16% capillary, and 34% combined). Lower lip was involved in 70% patients with 95% having difficulty in eating and 87% abnormal speech. Referring diagnosis was incorrect in 35% patients. Postsclerotherapy and postexcision pain scores were mean (SD) 5 (1.26) and 4 (1) respectively. All patients had improvement in eating and speech with restoration of normal muscle function in mean (SD) 5.63 (1.2) weeks. Ninety-five percent patients were satisfied with their outlook. One patient had recurrence at 1 year follow-up. CONCLUSION: Surgical debulking with proper use of adjuvant procedure for vascular malformations of lip produces best functional and aesthetic results with minimal complications.

Ophthalmic injuries in orbito-zygomatic fractures.

OBJECTIVE: To assess the frequency and severity of ophthalmic injuries in patients with orbito-zygomatic fractures. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Oral and Maxillofacial Department, KEMU/Mayo Hospital Lahore, from January 2009 to December 2011. METHODOLOGY: Patients with orbito-zygomatic fractures were divided into three groups. Group-1 patients had fracture of floor/medial wall of the orbit (orbital-blow out fracture). Group-2 had comminuted orbito-zygomatic fractures. Group-3 had simple zygomatic bone fractures. Frequency and types of ocular injuries were determined on each group. RESULTS: There were 296 (260 male, 36 female) patients with mean age of 31.7 years. Group-1 (n = 20) had 28 ocular findings in 12 (60%) patients including diplopia (n = 10, 36%), enophthalmos (n = 6, 14%), and hyphema, vitreous hemorrhage, retinal hemorrhage, choroidal rupture, traumatic mydriasis, and commotio retinae in 2 cases, 7% each. In Group-2 (n = 106), 44 ocular findings were identified in 30 (28%) patients including diplopia (n = 10, 23%), enophthalmos (n = 4, 9%), commotio retinae (n = 10, 23%), reduced visual acuity (n = 6, 14%), retinal hemorrhage (n = 4, 9%) and corneal laceration, corneal abrasion, retinal detachment, traumatic mydriasis, and canthal laceration in 2 cases, 4.5%. In Group-3 (n = 170), 22 ocular findings were seen in 16 (9%) patients included diplopia (n = 10, 45%), enophthalmos (n = 4, 18%), and retinal tear, hyphema, angle recession, and traumatic mydriasis in 2 cases, (9%) each. CONCLUSION: Ophthalmic injuries are a common complication of orbitozygomatic fractures occurring in about 20% of patients in this study, most frequent in the orbital blow fractures subgroup. Ophthalmology consultation is recommended for patients presenting with midface fractures.