conjunctival sutures followed by full thickness skin grafting, and a combination of skin grafting and local flaps. [1][2][3][4][5][6][7][8][9][10] When a combination of local flaps and skin grafting is performed, typically local flaps are used for the lower eyelid and skin grafting for the upper eyelid.Most of these patients will require multiple reconstructive surgeries. There are few reported cases discussing secondary reconstructive options for continued exposure related pathology. These options include: zygomatic reconstruction with temporalis flaps and subsequent full thickness skin grafting. 1,9 In our case autologous rib cartilage graft was used to reconstruct the lower eyelid middle lamellar structures for vertical support, along with autologous fat grafting for additional eyelid support and cosmetic improvement of her facial lipodystrophy. She has received one procedure of fat grafting, to date, but future stages of free fat grafting may be required to achieve adequate support due to expected partial fat resorption.Ablepharon macrostomia syndrome is a rare disease with devastating ocular manifestations which can result in severe complications, including blindness. Treatment should be timely with topical ocular lubricants and surgical intervention. Unfortunately, given the rarity of this disease there is a paucity of initial treatment options presented in the literature and even fewer long-term outcomes reported. These patients often require several corrective surgeries in regards to their ocular manifestations. This is the first reported case using rib cartilage graft for lower eyelid middle lamellar reconstruction and malar-zygomatic autologous fat grafting for lower eyelid support and aesthetic facial improvement. This provides a treatment option for secondary reconstruction in patients with persistent exposure keratopathy.
Background:
The aim of the study was to measure the distance of the tympanic nerve to the oval window and round window niche in adult cadavers for evaluating its usability as an anatomical landmark during middle ear-related surgeries, including stapedotomy and cochleostomy, and for preventing its iatrogenic damage during surgical practices such as otosclerosis surgery and cochlear implantation.
Methods:
The middle ears of 10 adult cadavers aged 74.70 ± 14.56 years were bilaterally dissected with the help of an endoscope and microscope to measure the distance of tympanic nerve to round window niche and oval window.
Results:
Tympanic nerve was found as 1.60 ± 0.86 mm (range, 0-3.11 mm) and 1.55 ± 0.38 mm (range, 1.04-2.20 mm) away from round window niche and oval window, respectively. In relation to the quantitative values of these 2 distances, neither right–left nor male–female significant differences were determined (
P
> .05). Tympanic nerve was observed in all temporal bones. In terms of the shape and twigs of tympanic nerve, extreme variations among cadaveric temporal bones were determined. Tympanic nerve-round window niche distance between 0-1 mm was defined as type 1 (20%), between 1 and 2 mm as type 2 (45%), between 2 and 3 mm as type 3 (30%), and between 3 and 4 mm as type 4 (5%).
Conclusion:
Tympanic nerve may be vulnerable at round window niche- or oval window-related surgeries (e.g., cochleostomy).
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