This paper documents an interventional case series which describes a novel technique for reconstructing large medial upper eyelid skin defects following excision of xanthelasma palpebrum. All visible upper eyelid xanthelasma is excised and a superiorly hinged blepharoplasty skin flap is created with a classic skin crease and lateral blepharoplasty incision, the latter acting as an effective ‘back‐cut’ to allow medial advancement of the flap into the defect. Excess triangles of skin are excised and the flap is sutured without tension into the defect in a conventional manner. The patients selected were patients with medial upper eyelid skin defects not amenable to direct closure following surgical excision of xanthelasma. The main outcome measures were the upper eyelid aesthetic and functional outcome, postoperative complications and need for revisionary surgery. In our study seven patients with bilateral medial upper eyelid xanthelasma excised and reconstructed with this technique were identified. Good aesthetic outcome and high patient satisfaction without functional compromise was achieved in all patients at the last follow‐up visit. Patient age ranged from 30–52 years old. Follow up ranged from 8 to 18 months. In conclusion, the superiorly hinged blepharoplasty skin flap is a novel and simple technique for the reconstruction of skin defects that are not amenable to direct closure following xanthelasma excision. It avoids the complications of skin grafting and non‐surgical ablative methods, particularly in dark‐skinned patients.
Slow-Mohs with en-face sections achieves similar early cure rates to previously published margin-controlled excision techniques. Narrow margins of excision can optimize tissue preservation without compromising outcome.
Objective:To test the hypothesis that occlusion-positive (OP) patients with blepharospasm (BEB) or hemifacial spasm (HFS) will benefit from a Bangerter occlusion foil (BOF), compared to occlusion-negative (ON) patients. OP/ON was based on immediate improvement in spasm with placement of a hand in front of either eye.Design:Prospective non-randomised single-centre pilot study.Participants:Fifteen-patients (6 BEB, 9 HFS).Methods:Patients were identified as OP or ON and wore highest-density BOF tolerable over one spectacle lens for 1 month. Outcomes were assessed at 1 month.Main Outcome Measures:Validated quality-of-life questionnaire (CDQ-24), scores of blink-rate and spasm severity assessed by two observers from video-recordings.Results:OP group had mean improvement in all scores. There was no change or worsening of scores in the ON group. In both BEB and HFS, more OP patients reported subjective benefit from wearing a foil (2 of 4 BEB, and 2 of 2 HFS) compared to the ON group (0 of 2 BEB, and 1 of 7 HFS).Conclusion:OP patients with BEB and HFS are more likely to experience improvement in spasms from wearing a BOF compared to ON patients. The occlusion test should be considered on all patients with BEB or HFS.
Silicone sleeves are 1 method of stabilizing bicanalicular silicone intubation near the ostia during dacryocystorhinostomy surgery to prevent tube prolapse. Retained silicone sleeve following dacryocystorhinostomy is a rare and previously unreported complication that can occur despite endoscopic visualization during tube removal, particularly in narrow nasal passages. It is an easily reversible cause of dacryocystorhinostomy failure if identified.
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