ABSTRACT
The transconjunctival approach, first described by Bourqet in 1923, has become a routine procedure for the management of fractures of the orbital floor, medial and lateral walls, and infraorbital rim. It is also used in aesthetic surgery and access surgery. Different approaches of transconjunctival surgery, however, can be complicated by the complex lower lid anatomy. In this publication we revisit the anatomy of the transconjunctival approach, and discuss the surgical steps for preseptal and postseptal dissection. We introduce the concept of interseptal space (potential space), its anatomy first described in 1991.
Subject(s)
Conjunctiva , Orbital Fractures , Humans , Conjunctiva/anatomy & histology , Conjunctiva/surgery , Orbital Fractures/surgery , Eyelids/anatomy & histology , Eyelids/surgery , Orbit/anatomy & histology , Orbit/surgery , Dissection/methodsABSTRACT
The concept of neck dissection was introduced by Crile more than a century ago. Since then, multiple modifications have been adopted to ensure the preservation of vital structures. With the new era of minimal access surgery, the incorporation of laparoscopic, endoscopic, and robotic surgery is becoming the new normal. Over the years we have carried out neck dissections using minimal access incisions. Although there is no definitive answer about the average nodal yield required in selective or modified neck dissections, it has been reported that the average nodal yield of more than 18 is associated with better survival rate. In this publication we share the results of our three-year retrospective study of 56 patients who underwent minimal access neck dissection. We look at the nodal yield, assess operating duration, complications, outcome with a three-year follow up from a single unit. Our results demonstrate that minimal access neck dissection should be considered in head and neck lymphadenectomies.
Subject(s)
Minimally Invasive Surgical Procedures , Neck Dissection , Humans , Retrospective Studies , Neck Dissection/methods , Male , Female , Middle Aged , Aged , Adult , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/pathology , Lymphatic Metastasis , Operative Time , Aged, 80 and over , Treatment Outcome , Follow-Up Studies , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/pathology , Postoperative ComplicationsABSTRACT
Keratoacanthoma is an epithelial tumour derived from hair follicles. Clinical and histopathological features of keratoacanthoma can resemble that of squamous cell carcinoma. Different treatment alternatives have been described over the years including intralesional methotrexate injection. We present an interesting case of treatment of solitary keratoacanthoma lesion on the nose with intralesional methotrexate as non-surgical therapy.
Subject(s)
Keratoacanthoma , Nose Diseases , Humans , Injections, Intralesional , Keratoacanthoma/drug therapy , Keratoacanthoma/pathology , Methotrexate , Nose Diseases/drug therapyABSTRACT
Signet-ring cell (histocytoid) carcinoma is a rare and aggressive skin neoplasm that most commonly affects elderly men. It typically originates from the upper or lower eyelid, with bilateral involvement only in rare cases, and results in a diffuse and infiltrative appearance clinically, radiologically, and histologically (the "monocle" sign). It is essential to carry out a full investigation to rule out metastasis from an internal origin.
Subject(s)
Carcinoma, Signet Ring Cell , Skin Neoplasms , Aged , Humans , MaleABSTRACT
Traditional open operations for lateral neck dissection in patients with papillary thyroid carcinoma leave an unsightly scar. We report complete lateral neck dissection and thyroidectomy for papillary thyroid carcinoma using an endoscopically-assisted approach through a small incision, and evaluate its feasibility and safety. Between March 2010 and January 2013, 6 patients with no definite metastases to the lymph nodes at levels II-IV, and 20 with definite metastases to the lymph nodes at levels II-V were selected. Thyroidectomy, dissection of the central compartment (level VI), and ipsilateral level II-IV and II-V neck dissections were done through a small incision in the neck. The steps of endoscopic lateral neck dissection were similar to those of conventional operations. The mean operating time for the whole procedure was 3.57 hours (range 2.5 - 5.0). It was successful in all patients and there were no serious complications or serious blood loss. A total of 21 patients had lymph node metastases in the central and lateral zones. The mean yield of lymph nodes was 38.6 (range 16-61). There was no evidence of residual or recurrent disease at follow-up, and the cosmetic result was excellent. Minimally invasive, video-assisted comprehensive neck dissection for metastatic papillary thyroid carcinoma is feasible and safe, and has excellent cosmetic results. Further studies with a larger number of patients and long-term follow-up are needed to verify its oncological validity.
Subject(s)
Carcinoma/secondary , Lymphatic Metastasis/pathology , Neck Dissection/methods , Thyroid Neoplasms/secondary , Video-Assisted Surgery/methods , Adult , Carcinoma/surgery , Carcinoma, Papillary , Dissection/methods , Esthetics , Feasibility Studies , Female , Follow-Up Studies , Humans , Lymph Nodes/pathology , Male , Middle Aged , Minimally Invasive Surgical Procedures , Neck Muscles/innervation , Neck Muscles/surgery , Neoplasm Staging , Operative Time , Safety , Thyroid Cancer, Papillary , Thyroid Neoplasms/surgery , Thyroidectomy/methods , Treatment OutcomeABSTRACT
Complications after Le Fort I osteotomy are rare. We report, to our knowledge, the first case of bilateral Adie's pupil after Le Fort I osteotomy.
Subject(s)
Maxilla/surgery , Osteotomy, Le Fort/adverse effects , Postoperative Complications , Tonic Pupil/etiology , Adult , Biocompatible Materials/chemistry , Bone Plates , Female , Humans , Maxilla/abnormalities , Osteotomy, Le Fort/instrumentation , Sphenoid Bone/surgery , Titanium/chemistry , Visual Acuity/physiologyABSTRACT
Paralysis of the hypoglossal nerve, the twelfth (XII) cranial nerve, leads to atrophy, deviation of the tongue to the affected side, and varying degrees of fasciculation. The injury to the nerve can occur from its origin to the tongue itself. The causes of hypoglossal nerve palsy are well documented, but idiopathic, isolated nerve palsy that does not recover, is rare. To our knowledge we describe the first case that failed to resolve, and discuss the importance of meticulous investigation to make a diagnosis and rule out sinister disease.