After studying this article, the participant should be able to: 1. Describe the differential diagnosis of xanthelasma palpebrarum. 2. Discuss the various nonsurgical and surgical treatment options and their advantages and disadvantages. 3. Describe the circumstances in which recurrence is most likely after treatment. Xanthelasma palpebrarum is the most common cutaneous xanthoma. It typically presents in middle-aged and older adults, most often around the eyelids. The diagnosis can often be made on clinical grounds alone. For the plastic surgeon, it is important to apply an algorithmic approach to the treatment of these lesions. Depending on the size and location, several different methods can be used to address this problem, ranging from simple excision, to laser treatment, to chemical peeling. This article addresses the underlying pathophysiology of xanthelasma and the currently accepted modes of treatment.
The anatomic classification of choanal atresia is commonly quoted as 90% bony and 10% membranous. This incidence is from a review by Fraser in 1910 of 115 cases, "many of which were insufficiently described." We have reviewed 47 computed tomography scans of choanal atresia from the literature and 16 from our clinical experience, and classified the anatomy as bony, mixed bony-membranous, or pure membranous. Our results reveal a combined incidence of 18 (29%) pure bony, 45 (71%) mixed bony-membranous, and no pure membranous atresia. We propose a new classification of choanal atresia to include bony, mixed, and membranous to accurately reflect the anatomic abnormalities. Our series of 11 patients undergoing transnasal microsurgical repair, a critical review of the literature, and the implications of the anatomic classification on the choice of surgical procedure are presented.
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