Orbital teratomas are rare embryonic tumors composed of a wide diversity of tissues derived from the three germinal layers. The presenting features include, a healthy newborn with extreme unilateral proptosis; marked stretching of the eyelids over a tense, fluctuating mass, with elongation of the palpebral fissure; enlargement of the bony orbit (two to three times normal size) with subsequent nasal and malar deformities; and transillumination of all or part of the orbital mass. Commonly the eye is normally developed but often vision is not preserved either due to exposure or secondary optic atrophy. The objective in the management of orbital teratoma is to save the eye to encourage orbitofacial development, maintain cosmesis and retain some vision. We report a case of massive congenital orbital teratoma successfully removed by an eyelid-sparing exenteration technique.

Alpha 1D, alpha-2C, and beta-2 receptors are documented within human Müller muscle. Human eyelid elevation response to phenylephrine is inversely related to the amount of alpha-2C receptor staining in Müller muscle. Fasanella and Putterman procedures have equal outcomes, independent of adrenergic receptors.

Digital ocular photography combined with computerized image analysis is a fast, easy to use, and reliable method of measuring ocular surface dimensions. In addition to ptosis surgery, this method can be used in other ocular surface studies.

trum of the impact of the incision from disfiguring (1) to imperceptible (10). The reviewers felt that the incision obtained 94% imperceptibility.Comment. Conchal cartilage is widely accepted for use during revision and reconstructive rhinoplasty, orbital wall reconstruction, and eyelid repair. The anterior approach to conchal cartilage harvest has become the most popular technique. After observing successful changes in the ear for anterior conchal cartilage harvest, some authors 10,11 have even developed new techniques for anterior approach otoplasty. Modest complication rates have been reported for both the anterior and posterior approaches, and complications including hypertrophic scarring, delayed wound healing, and asymmetry. Our patients underwent anterior approach only by a standardized method. Feared complications of any cosmetic surgery include hypertrophic scarring, postoperative hematomas or seromas, and infections. Fortunately, in our series of patients, there were no complications in the ears in which conchal cartilage was harvested, regardless of comorbidities, including tobacco and alcohol use, cardiovascular conditions, or diabetes mellitus. Use of perioperative antibiotics for cosmetic procedures is widely accepted and should be used in patients that are undergoing conchal cartilage harvest.Most of the patients underwent conchal cartilage harvest for Mohs micrographic surgical repair of facial malignancies. The morbidities of rhinoplasty, locoregional flaps, and tissue advancements, as well as staged procedures for repair of the nasal defects, would tend to distract the patient's attention from the less morbid conchal harvest. This, combined with the average duration of follow-up from surgery to telephone questionnaire, may have allowed some recall bias. Regardless, the rate of patient satisfaction with conchal cartilage harvest was very high. The only concerns reported were those of mild pain in the immediate postoperative period. There were no complaints of irritating dental roll bolsters, hearing changes, or problems that affected sleep positions.Most of the responses by the blinded reviewers who felt that they could make a distinction between the operated and nonoperated ear were incorrect. This may reflect the relative lack of knowledge by nonmedical personnel regarding the complex 3-dimensional auricular anatomies. After the reviewers were educated about basic auricular anatomy and conchal cartilage harvest, they felt that the incision was 94% imperceptible.Septal cartilage has proved to be the type most commonly used for autologous cartilage harvest and will likely remain that way owing to the robust nature of that type of cartilage and the indication for septoplasty associated with rhinoplasty. When septal cartilage is not available, however, conchal cartilage is a safe and cosmetically acceptable alternative for autologous cartilage harvest. Patients are very satisfied with conchal cartilage harvest.

This article focuses on the administration of anesthesia for periocular aesthetic procedures. Special emphasis is given to office-based procedures, most often without any systemic sedation, highlighting the importance of open communication with patients. Finally, attention is given to potential pitfalls including anesthetic systemic toxicity, ocular injuries, and orbicularis myotoxicity.

A 74-year-old man was diagnosed with thymic carcinoid metastatic to the mediastinum. Two years later, he developed left and then right facial palsy. Four additional episodes of facial palsy developed within 2 years, followed by an occurrence of nonarteritic ischemic optic neuropathy. While recurrent facial palsy is uncommon, it may occur in the presence of various systemic conditions such as carcinoid, diabetes, infection, and neoplasm. The presence of recurrent facial palsy logically warrants an evaluation for systemic disease.