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Sirinturk S, Govsa F, Coban I, Bicer A. Measurements of oculo-palpebral landmarks and evaluation of patient's head position. Surg Radiol Anat 2024; 46:585-593. [PMID: 38429405 DOI: 10.1007/s00276-024-03324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/14/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Keeping the head in a neutral position is requisite for glasses/lenses/head-up designs, the suitability of oculo-plastic surgery and for the grading the eye shift. Anatomically incompatible glasses are one of the common problems affecting accommodation, reducing comfort and disturbing by causing symptoms such as dizziness and nausea. The oculo-palpebral measurements act as a key determinant in symmetrical facial attractiveness. This study aims to investigate the most effective oculo-palpebral landmarks, head-neutral as the ideal position, taking into account of individual anatomical differences of these patients. METHODS 100 females and 100 males aged between 18 and 20 years were photographed. Digital photogrammetric measurements were made with the ImageJ program. Interpupillary and interhelical distances, besides bilateral palpebral fissure length and height, and iris diameter were calculated on front-facing photographs. RESULTS Mean interpupillary distance was measured wider in males than in females. The mean length of palpebral fissure was 31 mm; palpebral fissure height was 10 mm. These figures were valid in both eyes and gender. The interhelical distance was calculated as the mean and was measured longer in men. Since the measurement values were the same in both sexes and on both sides, they were determined as important landmarks for controlling the head-neutral position, evaluating whether there was a deviation in the eye, and measuring the numerical value when detected. CONCLUSION It is essential to check the side-symmetry of the patient's palpebral fissure height, palpebral fissure length, diameter of iris and corneal depth during oculo-plastic invention and artificial design.
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Affiliation(s)
- Suzan Sirinturk
- Department of Anatomy, Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Figen Govsa
- Department of Anatomy, Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Istemihan Coban
- Department of Anatomy, Faculty of Medicine, Izmir Democracy University, Izmir, Turkey
| | - Ahmet Bicer
- Department Plastic and Reconstructive Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
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Vera-Duarte GR, Jimenez-Collado D, Kahuam-López N, Ramirez-Miranda A, Graue-Hernandez EO, Navas A, Rosenblatt MI. Neurotrophic keratopathy: General features and new therapies. Surv Ophthalmol 2024:S0039-6257(24)00042-0. [PMID: 38679146 DOI: 10.1016/j.survophthal.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
Neurotrophic keratopathy is an uncommon degenerative corneal disorder characterized by compromised corneal sensory innervation resulting in the formation of epithelial defects and nonhealing corneal ulcers. Various treatment modalities are available to stabilize disease progression, improve patient well-being, and prevent vision loss. For eligible patients, medical and surgical reinnervation have emerged as pioneering therapies, holding promise for better management. We present a comprehensive review of the disorder, providing an update relevant to ophthalmologists on pathogenesis, diagnosis, treatment options, and novel therapies targeting pathophysiological pathways.
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Affiliation(s)
- Guillermo Raul Vera-Duarte
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - David Jimenez-Collado
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - Nicolás Kahuam-López
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - Arturo Ramirez-Miranda
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - Enrique O Graue-Hernandez
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - Alejandro Navas
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - Mark I Rosenblatt
- Department of Ophthalmology and Visual Sciences, University of Illinois-Chicago (UIC), Chicago, IL 60612, USA.
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Woo SH, Kim YC, Oh TS. Facial palsy reconstruction. Arch Craniofac Surg 2024; 25:1-10. [PMID: 38461822 PMCID: PMC10924795 DOI: 10.7181/acfs.2023.00528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 03/12/2024] Open
Abstract
The facial nerve stimulates the muscles of facial expression and the parasympathetic nerves of the face. Consequently, facial nerve paralysis can lead to facial asymmetry, deformation, and functional impairment. Facial nerve palsy is most commonly idiopathic, as with Bell palsy, but it can also result from a tumor or trauma. In this article, we discuss traumatic facial nerve injury. To identify the cause of the injury, it is important to first determine its location. The location and extent of the damage inform the treatment method, with options including primary repair, nerve graft, cross-face nerve graft, nerve crossover, and muscle transfer. Intracranial proximal facial nerve injuries present a challenge to surgical approaches due to the complexity of the temporal bone. Surgical intervention in these cases requires a collaborative approach between neurosurgery and otolaryngology, and nerve repair or grafting is difficult. This article describes the treatment of peripheral facial nerve injury. Primary repair generally offers the best prognosis. If primary repair is not feasible within 6 months of injury, nerve grafting should be attempted, and if more than 12 months have elapsed, functional muscle transfer should be performed. If the affected nerve cannot be utilized at that time, the contralateral facial nerve, ipsilateral masseter nerve, or hypoglossal nerve can serve as the donor nerve. Other accompanying symptoms, such as lagophthalmos or midface ptosis, must also be considered for the successful treatment of facial nerve injury.
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Affiliation(s)
- Soo Hyun Woo
- Department of Plastic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Chul Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Suk Oh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim YG, Oh JW, Lee KC, Yoon SH. Clinical association between serum cholesterol level and the size of xanthelasma palpebrarum. Arch Craniofac Surg 2022; 23:71-76. [PMID: 35526842 PMCID: PMC9081426 DOI: 10.7181/acfs.2022.00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/19/2022] [Indexed: 11/11/2022] Open
Abstract
Background Xanthelasma palpebrarum (XP) is a benign periorbital lesion. The relationship between xanthelasma lesion size and serum cholesterol levels has been poorly studied. In this study, we investigated this relationship in the context of the clinical etiology of XP. Methods We retrospectively reviewed medical records and pathology reports of all patients treated for XP at our hospital between June 2014 and June 2021; the data were used to analyze lesion size, underlying disease, serum cholesterol, and disease recurrence. Results The mean values for patient age, serum cholesterol, and lesion size were 53.0 years, 235.0 mg/dL, and 69.2 mm2, respectively. XP mainly occurred in women (64.7%); furthermore, the incidence of XP and lesion size was greatest among patients in their 5th decade of life (41.2%). There was no statistically significant relationship between xanthelasma lesion size and serum cholesterol level. Conclusion This study compared lesion size with various clinical features in XP patients. In patients who underwent surgery for XP, serum cholesterol levels tended to be higher than those in the general population. However, the trend between the size of XP and serum cholesterol level was unclear. Therefore, if a patient with XP visits the hospital for surgery, it is recommended to check the lipid profile to confirm underlying dyslipidemia regardless of the size.
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Affiliation(s)
- Young Geun Kim
- Department of Plastic and Reconstructive Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Wook Oh
- Department of Plastic and Reconstructive Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Keun Cheol Lee
- Department of Plastic and Reconstructive Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Ho Yoon
- Department of Plastic and Reconstructive Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
- Correspondence: Sung Ho Yoon Department of Plastic and Reconstructive Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea E-mail:
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Comparative Blink Analysis in Patients With Established Facial Paralysis Using High-Speed Video Analysis. J Craniofac Surg 2021; 33:797-802. [PMID: 34743154 DOI: 10.1097/scs.0000000000008326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This study analyzed the blink characteristics of patients with incomplete and complete facial paralysis. The authors measured and compared the palpebral distance, eyelid movement distance, and the eye-closing ratio of blinks in 55 patients with Bell's palsy or Ramsay Hunt syndrome (Bell & Hunt group) and 14 with complete paralysis (Complete Paralysis group). In the Bell & Hunt group, the palpebral distance (7.94 mm) was smaller on the paralyzed side than on the non-paralyzed side (9.61 mm). The eye-closing ratio and the upper eyelid movement were reduced on the paralyzed side (65.3% versus 93.7%, 4.61 versus 7.97 mm) and in the Complete Paralysis group (25.3% versus 94.7%, 2.10 versus 8.49 mm). In the Bell & Hunt group, movement of the upper eyelid on the paralyzed side was weakened despite palpebral contracture. The Complete Paralysis group exhibited highly reduced movement in both the upper and lower eyelids.
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Kofler B, Ingels KJAO. [Dynamic procedures for facial nerve reconstruction]. Laryngorhinootologie 2021; 100:738-750. [PMID: 34461655 DOI: 10.1055/a-1376-2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this article the indications and surgical treatment options for patients with facial nerve palsy are discussed. A distinction is made between static and dynamic surgical procedures. Static reconstructions for example are used to restore the eyelid closure function. For smile reconstruction, which is important for the psychosocial life of the patient, dynamic procedures are used. Depending on the duration of the facial nerve paralysis, there are several possibilities to restore the smile. In this work the masseteric branch transposition to the buccal branch, the hypoglossal-facial nerve anastomosis, the Labbé procedure and the gracilis flap as a free muscle transplant are discussed. The surgical procedures are compared and the advantages and disadvantages of the intervention are presented. A spontaneous smile is aimed, this cannot always be achieved. With the masseteric branch transposition to the buccal branch and the Labbé procedure the smile is initially triggered by chewing. A spontaneous smile is possible through cortical adaptation. With the gracilis flap, however, a nerve anastomosis with the contralateral 'healthy' facial nerve is possible, either directly or via a so-called cross facial nerve grafting, whereby a spontaneous smile can be achieved.
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Kwon BS, Sun H, Kim JW. Modified temporalis tendon transfer extended with periosteum for facial paralysis patients. Arch Craniofac Surg 2020; 21:351-356. [PMID: 33663143 PMCID: PMC7933719 DOI: 10.7181/acfs.2020.00570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/20/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We have devised a novel surgical method, termed as temporalis muscle tendonperiosteum (T-P) compound surgical method, by modifying pre-existing techniques. Our method is characterized by elevation of temporalis muscle tendon and the periosteum of the mandibular ramus as a single compound. Here, we describe the concept and clinical outcomes of our method. METHODS We conducted both a cadaveric study and a clinical study. First, we used four human cadavers (two males and two females) to confirm the anatomy of the temporalis muscle tendon and availability of sufficient length extension through the elevation of the T-P compound. Moreover, we obtained measurements of the mouth angle and the philtrum angle from a total of six patients (two males and four females) and compared them between preoperatively and postoperatively. RESULTS The mean length of the periosteal portion was measured as 2.43± 0.15 cm (range, 2.2-2.6 cm). There was an improvement in the mouth angle postoperatively as compared with preoperatively (7.2°± 3.0° vs. 14.5°± 4.7°, respectively). Moreover, there was also an improvement in the philtrum angle postoperatively as compared with preoperatively (7.2°± 3.4° vs. 17.2°± 6.5°, respectively). CONCLUSION Our method is a simple, minimally-invasive modality that is effective in achieving good clinical outcomes. Its advantages include an ability to achieve a firm extension of the temporalis muscle tendon as well as a lack of requirement for a donor site that may cause complications.
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Affiliation(s)
- Byeong Soo Kwon
- Department of Plastic Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Hook Sun
- Department of Plastic Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Jin Woo Kim
- Department of Plastic Surgery, Inje University Busan Paik Hospital, Busan, Korea
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