Background: Trauma is one of the most common causes of enophthalmos, and post-traumatic enophthalmos primarily results from an increased volume of the bony orbit. We achieved good long-term results by simultaneously using an anatomical absorbable implant and iliac bone graft to correct post-traumatic enophthalmos. Methods: From January 2012 to December 2016, we performed operations on seven patients with post-traumatic enophthalmos. In all seven cases, reduction surgery for the initial trauma was performed at our hospital. Hertel exophthalmometry, clinical photography, three-dimensional computed tomography (3D-CT), and orbital volume measurements using software to calculate the specific volume captured on 3D-CT (ITK-SNAP, Insight Toolkit-SNAP) were performed preoperatively and postoperatively. Results: Patients were evaluated based on exophthalmometry, clinical photographs, 3D-CT, and orbital volume measured by the ITK-SNAP program at 5 days and 1 year postoperatively, and all factors improved significantly compared with the preoperative baseline. Complications such as hematoma or extraocular muscle limitation were absent, and the corrected orbital volume was well maintained at the 1-year follow-up visit. Conclusion: We present a method to correct enophthalmos by reconstructing the orbital wall using an anatomical absorbable implant and a simultaneous autologous iliac bone graft. All cases showed satisfactory results for enophthalmos correction. We suggest this method as a good option for the correction of post-traumatic enophthalmos.
A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotidcavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7–8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.
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The objective of this study was to review outcomes of early one-stage surgery of acutely infected preauricular sinus compared to conventional delayed surgery after infection control. The study is a case series with chart review conducted in an academic center. From January 1, 2007 to January 31, 2012, we performed surgical treatments for 136 congenital preauricular sinuses on 103 patients aged 0-15 years. We classified the sinuses according to the state of their infection at the time of the surgery intraoperatively--Group I (asymptomatic; n = 68, 50 %), Group II (infected state; n = 26, 19 %) and Group III (infected state with abscess formation; n = 42, 31 %). The surgical outcomes of Groups I, II, and III were documented during an outpatient department observation period. The follow-up period was from 6 months to over 2 years. One patient from Group II and one patient from Group III had a recurrent infection which could be managed by local infection control. One patient from Group I and one patient from Group III had skin defects by necrosis of a skin flap margin which could be secondarily healed. All patients had no recurrence or significant chronic complications. We performed early one-stage surgical treatments on a total of 136 sinuses with an even acute infection with abscess formation and achieved good surgical outcomes, and patients were satisfied in aspects of treatment period and cost. So we present our early one-stage surgical treatment as a good option for infected preauricular sinus management.
Dermatofibroma, also known as benign fibrous histiocytoma, is a benign tumor composed of fibroblastic and histiocytic cells. Dermatofibroma most frequently occurs in the dermis, but it can also be found in subcutaneous soft tissue in rare cases, particularly on the face. Herein, we report a case of pure subcutaneous dermatofibroma of the cheek, which was confirmed histopathologically with immunohistochemical staining. This report describes a pure subcutaneous dermatofibroma with a literature review and reminds surgeons to consider the possibility that dermatofibromas may occur in the subcutaneous layer before establishing their operative plan.
It is essential to reduce and reconstruct bony defects adequately in large orbital floor fracture and defect. Among many reconstructive methods, alloplastic materials have attracted attention because of their safety and ease of use. We have used resorbable plates combined with artificial bone substitutes in large orbital floor defect reconstructions and have evaluated their long-term reliability compared with porous polyethylene plate. A total of 147 patients with traumatic orbital floor fracture were included in the study. Surgical results were evaluated by clinical evaluations, exophthalmometry, and computed tomography at least 12 months postoperatively. Both orbital floor height discrepancy and orbital volume change were calculated and compared with preoperative CT findings. The average volume discrepancy and vertical height discrepancies were not different between two groups. Also, exophthalmometric measurements were not significantly different between the two groups. No significant postoperative complication including permanent diplopia, proptosis, and enophthalmos was noted. Use of a resorbable plate with an artificial bone substitute to repair orbital floor defects larger than 2.5 cm2 in size yielded long-lasting, effective reconstruction without significant complications. We therefore propose our approach as an effective alternative method for large orbital floor reconstructions.
Background Various materials are available for the reconstruction of bone defects in cases of medial wall blowout fracture. This study was conducted to assess the efficacy of the combination of a resorbable meshed plate and cancellous bone allograft. Methods From March 2014 to March 2017, a total of 111 patients were evaluated. Sixty-three patients received reconstruction surgery with porous polyethylene plates (control group) and the other forty-eight patients underwent operation with a resorbable meshed plate plus allogenic cancellous bone (combined group). The results were assessed by exophthalmometric measurements, width, and volume discrepancies as compared with the unaffected orbit, and operation time. Results The difference in exophthalmometric measurements between the affected and unaffected orbits were 0.94 ± 0.70 mm in the control group and 1.05 ± 0.73 mm in the combined group without statistical significance (p = 0.425). In the analysis of computed tomography images, the width discrepancy was 1.55 ± 0.86 mm and 1.08 ± 0.69 mm, respectively (p = 0.003); however, the volume discrepancy demonstrated no statistically significant difference (2.58 ± 1.40 cm3 versus 2.20 ± 1.80 cm3; p = 0.209). Operation time was significantly shorter in the combined group as compared with the control group (43.0 ± 7.0 versus 38.3 ± 7.0 minutes; p = 0.001). Conclusion The combination material composed of resorbable meshed plate and cancellous bone allograft made reconstruction surgery of medial wall blowout fracture easier and quicker to perform with long-lasting results.
BackgroundAxillary osmidrosis is characterized by unpleasant odors originating from the axillary apocrine glands, resulting in psychosocial stress. The main treatment modality is apocrine gland removal. Until now, of the various surgical techniques have sometimes caused serious complications. We describe herein the favorable outcomes of a new method for ablating apocrine glands by minimal subdermal shaving using sclerotherapy with absolute ethanol.MethodsA total of 12 patients underwent the procedure. The severity of osmidrosis was evaluated before surgery. Conventional subdermal shaving was performed on one side (control group) and ablation by means of minimal subdermal shaving and absolute ethanol on the other side (study group). Postoperative outcomes were compared between the study and control groups.ResultsThe length of time to removal of the drain was 1 day shorter in the study group than in the control group. There were no serious complications, such as hematoma or seroma, in either group, but flap margin necrosis and flap desquamation occurred in the control group, and were successfully managed with conservative treatment. Six months after surgery, we and our patients were satisfied with the outcomes.ConclusionsSclerotherapy using absolute ethanol combined with minimal subdermal shaving may be useful for the treatment of axillary osmidrosis. It can reduce the incidence of seroma and hematoma and allow the skin flap to adhere to its recipient site. It can degrade and ablate the remaining apocrine glands and eliminate causative organisms. Furthermore, since this technique is relatively simple, it takes less time than the conventional method.
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