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1.
Indian J Ophthalmol ; 70(1): 281-286, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34937255

RESUMO

Facial skin defect reconstruction in medial-canthal area of the lids can be a challenge even when performed by a skilled surgeon. The excision of large tumors in this area leads to significant surgical defects that cannot be repaired by merely closing the wound. The glabellar area provides a source of redundant skin with similar characteristics to that of the medial-canthal lid area. The purpose show the possibility of the glabellar flap technique surgery in patients after tumor excision in the medial canthal area with the formation of a large surgical defect and especially those with defect under the medial canthal tendon. We selected 15 well-documented retrospective cases of patients operated over 2 years and followed up for a minimum of 36 months, who underwent surgery with a glabellar flap technique. Patients were operated with V-Y glabellar rotation, advancement, or combined transposition flap techniques. According to the defect's location, we divided the patients into three groups: upper, medial, and lower surgical defects. A satisfactory functional result was obtained in all the patients. In most of them, the cosmetic results were also good. No additional surgical procedures were required in any of the patients. Our experience showed excellent results with the glabellar flap technique in all three types of lesions in the medial canthal zone-upper, medial, and especially lower which until recently was thought to be inappropriate.


Assuntos
Carcinoma Basocelular , Neoplasias Palpebrais , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Cutâneas , Carcinoma Basocelular/cirurgia , Neoplasias Palpebrais/cirurgia , Humanos , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos
2.
Photobiomodul Photomed Laser Surg ; 39(10): 661-664, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34597195

RESUMO

Objective: This study is the first time to explore the feasibility of CO2 laser treating some eyelid lacrimal puncta benign tumor. Background: Eyelid lacrimal papillae is special anatomy region. Treatment of eyelid peripunctal tumor is relatively intractable and needs reconstruction of the lacrimal passage in most of the time. We use super pulse CO2 laser to treat peripunctal benign tumor and appears to be effective. Materials and methods: It contained 12 participants treated with super pulse CO2 laser photocoagulation without lacrimal duct silicone tube placement. The areas of lesions were as follows: eight cases were located in the upper eyelid lacrimal puncta, four cases in the lower lacrimal puncta. Super pulse CO2 laser was used to treat it. The follow-up period was 4 weeks, 24 weeks, and 3 years after treatment. Histological diagnoses were obtained in all patients. Results: All patients were satisfactory after treatment with their cosmetic outcomes, and the wounds are dry, with no infections. No patient has functional damage, secondary epiphora, and lacrimal drainage system obstruction. Complete epithelialization occurs 2-4 weeks after treatment and forms normal epithelium. It showed no obvious scars or notches after treatment, and only temporarily less hyperpigmentation is in the treated area than the circumambient normal skin. During the follow-up period, there were no complications and no relapses were observed. Conclusions: Super pulse CO2 laser therapy for eyelid peripunctal benign tumors without lacrimal duct silicone tube placement sometime appears to be available, effective, and well-tolerated alternative to traditional surgery in the clinic, especially for selected disease. The IRB proved number is 2016034.


Assuntos
Neoplasias Palpebrais , Terapia a Laser , Lasers de Gás , Neoplasias Palpebrais/radioterapia , Neoplasias Palpebrais/cirurgia , Pálpebras/cirurgia , Humanos , Lasers de Gás/uso terapêutico , Estudos Retrospectivos
3.
Indian J Ophthalmol ; 69(10): 2788-2795, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34571636

RESUMO

Purpose: : To evaluate the cost, safety, surgical outcome, and efficacy of modified Cutler-Beard eyelid reconstruction utilizing a novel silicone plate as a tarsal plate replacement in the repair of 60% to 100% eyelid defects following the excision of large malignant tumors. Methods: : A prospective, noncomparative, interventional study of 30 eyes was done over 3 years. Fourteen patients were female, and 16 patients were male. In all the cases, a silicone plate, the synthetic, artificial tarsal plate, was utilized for a total or subtotal replacement of the tarsal plate. The created defect was measured in mm (length and width) and later expressed in percentage. Pre- and postoperative action of levator palpebrae superioris (LPS) was measured. Pre- and postoperative measurements of the margin-to-margin reflex distance (MRD1) were noted. Results: : Preoperative LPS action was 1.23 ± 1.35 mm, whereas postoperative LPS actions at the end of 1 week and 18 months were 11. 8 ± 0.88 mm and 13.53 ± 0. 73 mm, respectively. Preoperative MRD1 was - 3.0 ± 1.144 mm, whereas postoperative MRD1 values at the end of 1 week and 18 months were 2.18 ± 0.27 mm and 4.16 mm ± 0.35, respectively. The mean created defect after the removal of the tumor was 87.3% ±11.10. The mean length of the silicone plate implanted in this study was 27.53 ± 2.48 mm. The follow-up period for the study participants was 18 months. Conclusion: : The synthetic novel silicone plate was successful as a tarsal plate replacement. A second surgical site for ear cartilage harvesting is avoided. Cadaver transfer of Achilles tendon carries the risk of transmission of communicable diseases, for example, hepatitis B and HIV. Silicone is an inert, nonreacting, and tissue-tested material, thus eliminating the possibility of graft rejection. This material is readily available and cost-effective. The novel silicone plate is considered to be the most promising alternative material as a tarsal replacement in the future generation.


Assuntos
Neoplasias Palpebrais , Silicones , Neoplasias Palpebrais/cirurgia , Pálpebras/cirurgia , Feminino , Humanos , Masculino , Músculos Oculomotores , Estudos Prospectivos , Estudos Retrospectivos
4.
Graefes Arch Clin Exp Ophthalmol ; 259(12): 3769-3776, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34313825

RESUMO

PURPOSE: To review the results of medial canthal reconstruction with the medial (transnasal or transglabellar) semicircular flap. METHODS: Medical charts of 38 patients who underwent the described procedure were reviewed. After tumor excision, a semicircular flap created along the nasal bridge or glabella was advanced to the canthal defect; if necessary, this flap was combined with other reconstructive methods. RESULTS: The patients (19 male, 19 female; mean age, 66 years) had basal cell (n = 36) or squamous cell (n = 2) carcinomas. The mean tumor diameter was 9.2 mm (range, 3-21 mm). Tumor epicenters were in the midcanthal area in 21 patients (55%) and in the infra- or supracanthal areas in 17 patients (45%). After excision, 22 patients had only canthal defects, and 16 had an associated upper and/or lower eyelid defect. To cover the defect, the medial semicircular flap alone was used in 19 patients (50%) and in association with other flaps in 19 patients (50%). The excisional defect was primarily closed in 37 patients (97%). Flap necrosis or infection did not occur. During follow-up (range, 1-91 months; median, 19 months), 10 patients (26%) developed a total of 17 complications. Three patients (8%) required secondary surgery for eyelid reconstruction-related complications. CONCLUSIONS: Transnasal or transglabellar semicircular flap may be a good alternative for medial canthal reconstruction. For large or complex defects, the medial semicircular flap can be combined with other periocular flaps. In the latter case, postoperative complications requiring secondary surgery may develop.


Assuntos
Carcinoma Basocelular , Neoplasias Palpebrais , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Cutâneas , Idoso , Carcinoma Basocelular/cirurgia , Neoplasias Palpebrais/cirurgia , Feminino , Humanos , Masculino , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos
5.
J Craniofac Surg ; 32(8): 2830-2832, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34172674

RESUMO

PURPOSE: The aim of this study is to present the outcomes of one triangle blepharoplasty flap upper eyelid (UE) reconstruction. It is a hardly recognized technique used to repair anterior lamella pretarsal defects resulting from the removal of lesions on the UE. METHODS: Retrospective review of three excised lesions reconstructed with one triangle-blepharoplasty flap technique between 2017 and 2020 at Río Hortega University Hospital in Valladolid, Spain. It is a technique to reconstruct wide-based anterior lamella UE lesions, 25% to 50% UE length. Demographic characteristics, histology results and complications are presented. RESULTS: Medical records of three patients have been reviewed with a minimum follow-up of 6 months (mean follow up of 16 months). The patient's average age was 67 years. Histology results were three seborrheic keratosis. There were no intra or post-surgical complications and all had good functional and aesthetic upper lid results. CONCLUSIONS: The reconstruction of pretarsal lesions limited to the anterior lamella of the UE using one triangle-blepharoplasty flap is a technique with good functional and aesthetic results.


Assuntos
Blefaroplastia , Neoplasias Palpebrais , Idoso , Estética Dentária , Neoplasias Palpebrais/cirurgia , Pálpebras/cirurgia , Humanos , Estudos Retrospectivos , Retalhos Cirúrgicos
6.
Turk J Ophthalmol ; 51(2): 118-122, 2021 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-33951901

RESUMO

The goals of periorbital region reconstruction are to obtain both functional and esthetic results. Medial canthus is the second most common periorbital location for basal cell carcinoma. If left untreated, it is locally destructive but rarely metastasizes. Incompletely resected medial canthal tumors recur or penetrate along the lacrimal path and expand to wider lesions. A safety margin is necessary to ensure a complete lesion resection. Since it was introduced in 1941, Mohs surgery has been promoted as an efficient method of dealing with infiltrative periorbital skin tumors. It has been shown to have high rates of complete cancer removal during surgery, minimizing the amount of normal tissue loss and securing better functional and cosmetic outcomes. Due to its concave contour and convergence of skin units with variable thickness, texture and mobility, reconstruction of the medial canthal region (MCR) remains challenging. Reconstructive methods such as free full-thickness skin grafts and glabellar flaps have been used alone or in combination with other techniques. The concavity of the canthus must be achieved, but the maintenance of the normal contour and symmetry of the surrounding tissue is critical. The glabellar flap (GF) is a triangular advancement flap that adequately restores the volume in deeper defects, guaranteeing sufficient vascular support without complex or undesirable scars. We present two cases of basal cell carcinoma affecting the MCR that was successfully reconstructed using a GF alone in one case and together with a cheek advancement flap in the second one. In both cases, tumor excision was performed using Mohs surgery.


Assuntos
Blefaroplastia/métodos , Carcinoma Basocelular/cirurgia , Neoplasias Palpebrais/cirurgia , Pálpebras/cirurgia , Cirurgia de Mohs/efeitos adversos , Transplante de Pele/métodos , Retalhos Cirúrgicos/tendências , Idoso , Feminino , Humanos , Aparelho Lacrimal/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Reoperação
7.
J Plast Reconstr Aesthet Surg ; 74(11): 3015-3021, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34023240

RESUMO

BACKGROUND: A goal in ideal lower eyelid reconstruction is to achieve not only an esthetic recovery of the shape of the eyelid but also to obtain satisfactory eyelid function without damage to the corneal surface. In this report, we introduce our "Like with Like" reconstruction technique using a combined Hughes flap and swing skin flap. The Hughes flap is a tarsoconjunctival pedicled flap from the upper eyelid, and the swing skin flap is a kind of transposition flap based on the orbicularis muscle pedicle. PATIENTS AND METHODS: Eight patients who had more than 25% of the lower eyelid affected by a full-thickness defect were included. There were five men and three women, and the average age was 68.4years old. All patients had undergone wide tumor excision of the lower eyelid due to a malignant tumor and had also had primary two-stage eyelid reconstruction with a combined Hughes flap and swing skin flap. RESULTS: The average reconstructive time was 1:20, and no postoperative severe complications such as flap necrosis or wound dehiscence were observed. The follow-up period was an average of one year, and there were no functional problems such as ectropion, lower eyelid retraction, lid margin hypertrophy, lacrimation disorder, or corneal problems observed in any cases. Esthetically, no reconstructed eyelid bulging or asymmetry in the lid margin was observed in any of the cases. CONCLUSIONS: Combining the Hughes flap and skin swing flap technique might be the best choice for a full-thickness lower eyelid defect with regard to the esthetic and functional results.


Assuntos
Estética , Neoplasias Palpebrais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia
9.
J Craniofac Surg ; 32(7): e642-e645, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33852518

RESUMO

ABSTRACT: Eyelid malignancies are frequently seen in clinical practice. There is a lack of studies that have assessed the features of these lesions in mixed population countries. The epidemiologic profile, clinical stage at presentation, management, and outcomes of patients with eyelid malignancies were assessed, in order to better understand the features of these lesions in a multi-ethnic country. The medical records of patients who underwent eyelid tumor excision in a tertiary service in Brazil, from 2014 to 2019 were retrospectively reviewed. It was recorded for each patient: age, gender, time of onset, location, diagnosis, management, and follow-up. The medical records of 298 patients who presented with eyelid tumors were evaluated and 67 (22.4%) were malignant. The mean age of patients with malignancies was 52.93 years and 50% were male. Basal cell carcinoma was the most prevalent (61.2%), followed by squamous cell carcinoma (SCC) (29.9%) and sebaceous gland carcinoma (3%). The average time it took from appearance to surgical treatment was 3 years; the lower eyelid was the most affected for both basal cell carcinoma and SCC; 70% of SCCs were locally invasive at presentation and metastasis occurred in 15%. Basal cell carcinoma was the most common eyelid malignancy observed, however, its frequency was lower when compared to other western countries. The advanced stage at presentation may reflect the lack of education of the population to seek early care, and the lack of specialized tertiary centers in remote areas, resulting in delayed diagnosis.


Assuntos
Carcinoma Basocelular , Neoplasias Palpebrais , Neoplasias das Glândulas Sebáceas , Neoplasias Cutâneas , Carcinoma Basocelular/epidemiologia , Neoplasias Palpebrais/epidemiologia , Neoplasias Palpebrais/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Rev. argent. cir. plást ; 27(1): 08-14, jan.-mar. 2021. fig, tab
Artigo em Espanhol | LILACS | ID: biblio-1223452

RESUMO

Este estudio demuestra la utilidad del colgajo inervado de Tripier en pacientes con diferentes etiologías, ya sean lesiones oncológicas, postraumaticas o lesiones causadas por iatrogenia. León Tripier, en 1889, describió un colgajo musculocutáneo inervado basado en el músculo orbicular, en donde utiliza un exceso de piel del párpado superior y orbicular para reconstruir los defectos del párpado inferior. Las evaluaciones preoperatorias y los procedimientos fueron realizados por un solo equipo quirúrgico en 34 pacientes, con edades comprendidas entre 18 y 72 años. El estudio se realizó en un período de 3 años, desde noviembre de 2016 a noviembre de 2019. Se pudo concluir que el colgajo musculocutáneo inervado de Tripier es una excelente alternativa para el cubrimiento de defectos que se presentan en la lamela anterior del párpado inferior. Su disección es fácil y rápida, presenta un buen aporte vascular y nervioso y es segura, lo cual es un factor importante, ya que la población de mayor demanda son pacientes de avanzada edad.


This study demonstrates the utility of the Tripier's innervated flap in patients with different etiologies, be they oncological, post-traumatic lesions or injuries caused by iatrogenesis. León Tripier in 1889 described an innervated musculocutaneous flap, based on the orbicularis muscle, where he uses excess skin from the upper eyelid and orbicularis to reconstruct defects of the lower eyelid. Preoperative evaluations and procedures were carried out by a single surgical team, and for this, 34 patients were taken, aged between 18 and 72 years. The study was conducted over a 3-year period from November 2016 to November 2019. It was concluded that Tripier's innervated musculocutaneous flap is an excellent alternative for covering defects that occur in the anterior lamella of the lower eyelid. Its dissection is easy and fast, and it also has a good vascular and nervous contribution, being safe, bearing in mind that it is an important factor, since the population in greatest demand is elderly patients.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Cirurgia Plástica , Retalhos Cirúrgicos/transplante , Estudos Retrospectivos , Neoplasias Palpebrais/cirurgia , Estudos Longitudinais
12.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542009

RESUMO

Proliferating trichilemmal tumours (PTTs) are rare cutaneous adnexal tumours derived from the hair shaft outer root sheath. We are reporting the first case of PTT in a young child. In this case, a 7-year-old girl presented with trichilemmal keratinisation consistent with PTT. The patient was monitored with no signs of recurrence. PTT is a rare tumour occurring primarily in adults and we present this case so that young patients with PTT can be diagnosed and treated appropriately with a painless, mobile, rapidly growing mass on the right upper eyelid. CT imaging showed well-circumscribed, heterogenous mass measuring 1.6 cm with fluid-filled appearance and no tissue invasion. Surgical excision was performed and pathology revealed an unencapsulated, well-demarcated tumour.


Assuntos
Neoplasias Palpebrais/cirurgia , Neoplasias de Anexos e de Apêndices Cutâneos , Criança , Neoplasias Palpebrais/patologia , Feminino , Humanos , Neoplasias de Anexos e de Apêndices Cutâneos/patologia , Neoplasias de Anexos e de Apêndices Cutâneos/cirurgia , Neuroimagem
14.
Ann Otol Rhinol Laryngol ; 130(9): 1016-1023, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33514267

RESUMO

OBJECTIVES: Advanced cutaneous squamous cell carcinoma of the head and neck (CSCCHN) is associated with poor outcome despite multimodality therapy. Comprehensive risk stratification may pinpoint the most suitable adjuvant treatment. This study aimed to evaluate the outcomes of surgically treated locoregional CSCCHN and to identify prognostic indicators of treatment outcomes. METHODS: We retrospectively analyzed disease variables, pathologic characteristics, and management in association with treatment outcomes of all consecutive advanced CSCCHN patients who underwent surgical resection at Tel Aviv Sourasky Medical Center. RESULTS: From 2008 to 2018, 74 patients met the inclusion criteria. Only perineural invasion (PNI) was significantly associated with worse overall survival (OS) (P = .001). Location within the facial "mask areas" was significantly associated with pathologically negative cervical disease (P = .001). Forty-seven patients underwent adjuvant radiation therapy (RT) which significantly improved OS and disease-free survival versus surgery alone (P = .025 and P = 0.035, respectively). CONCLUSION: PNI was associated with worse OS in surgically treated advanced CSCCHN. Adjuvant RT conferred better outcomes despite high risk features.


Assuntos
Neoplasias Faciais/cirurgia , Linfonodos/patologia , Esvaziamento Cervical , Radioterapia Adjuvante , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Idoso , Idoso de 80 Anos ou mais , Bochecha/patologia , Bochecha/cirurgia , Quimiorradioterapia Adjuvante , Intervalo Livre de Doença , Neoplasias da Orelha/patologia , Neoplasias da Orelha/cirurgia , Extensão Extranodal/patologia , Neoplasias Palpebrais/patologia , Neoplasias Palpebrais/cirurgia , Neoplasias Faciais/patologia , Feminino , Testa/patologia , Testa/cirurgia , Humanos , Hospedeiro Imunocomprometido , Estimativa de Kaplan-Meier , Neoplasias Labiais/patologia , Neoplasias Labiais/cirurgia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Recidiva Local de Neoplasia , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos , Glândula Parótida , Modelos de Riscos Proporcionais , Procedimentos Cirúrgicos Reconstrutivos , Couro Cabeludo/patologia , Neoplasias Cutâneas/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Taxa de Sobrevida , Resultado do Tratamento
19.
Orbit ; 40(5): 415-418, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32731781

RESUMO

Cutaneous melanoma of the eyelid constitutes less than 2% of all eyelid malignancies. Such cases in the pediatric population are even rarer, and exceedingly so in darkly pigmented individuals. A 9-year-old African American boy presented with a left upper eyelid lesion. Biopsy was consistent with deep penetrating melanoma, and the patient underwent a wide local excision and sentinel node biopsy. One upper parotid sentinel node was positive, leading to further parotidectomy and selective neck dissection. The eyelid defect was reconstructed by primary closure after margin clearance. This is the first reported case of cutaneous eyelid melanoma in an African American child with nodal metastasis. Clinical features of melanoma in the pediatric population can be more atypical and higher index of suspicion is indicated. While rare, the diagnosis of melanoma in darkly pigmented patients is still possible and cannot be excluded without a definitive biopsy.


Assuntos
Neoplasias Palpebrais , Melanoma , Neoplasias Cutâneas , Afro-Americanos , Criança , Neoplasias Palpebrais/cirurgia , Pálpebras , Humanos , Metástase Linfática , Masculino , Melanoma/cirurgia , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/cirurgia
20.
Orbit ; 40(6): 470-480, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32990145

RESUMO

PURPOSE: The reconstruction of large (>50%) upper eyelid margin defects can be technically challenging, with multiple approaches described in the literature. We sought to review the recent literature for new techniques or modifications to existing techniques. METHODS: We conducted a Pubmed search for technique papers on the reconstruction of large upper eyelid defects published within the past ten years with a minimum of four patients. RESULTS: We identified ten articles, and divided them into techniques that use a bridging flap from the lower eyelid and those that do not. The number of upper eyelids repaired in each article ranged from 4 to 17. Most techniques could be considered either a modification of the Cutler-Beard technique or a novel anterior lamella flap laid over a graft for the posterior lamella. Postoperative complications included upper or lower eyelid cicatricial retraction, trichiasis, entropion, and lagophthalmos. CONCLUSIONS: Surgeons continue to innovate for this challenging reconstructive surgery. Overall, the trend was to use a graft, most commonly tarsoconjunctiva from the contralateral upper lid, to replace the posterior lamella, and a skin flap, from the lower eyelid or from the adjacent periorbital area, to replace the anterior lamella. Bridging techniques utilized the skin; the skin, orbicularis, and conjunctiva; or a tarsoconjunctival flap from the lower eyelid. Non-bridging techniques generally used a tarsoconjunctival or substitute graft for the posterior lamella, and a skin flap for the anterior lamella.


Assuntos
Entrópio , Doenças Palpebrais , Neoplasias Palpebrais , Procedimentos Cirúrgicos Reconstrutivos , Doenças Palpebrais/cirurgia , Neoplasias Palpebrais/cirurgia , Pálpebras/cirurgia , Humanos , Transplante de Pele , Retalhos Cirúrgicos
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