Oncological and aesthetic outcome following surgical management of orbito-palpebral skin cancers: A retrospective study of 132 patients

BackgroundThe incidence of facial skin cancers continues to rise, with major studies on their impacts still lacking in the literature. This study reports on the oncological and aesthetic results following surgical management of an orbito-palpebral skin cancer.MethodsThis retrospective, monocentric study included patients treated for a non-melanoma skin cancer of the eyelid and orbit. Risk factors, location, histological type, invaded or insufficient margins, healing time, surgical management by excision and direct closure, skin graft or local flaps, self-evaluated aesthetics, and quality of life results were all compared.ResultsThe study included 132 patients operated for basal cell carcinoma (71.9%), squamous cell carcinoma (22.9%), or for another type (5.2%) between November 2011 and January 2017. Average tumor size was 9.6 ± 6.3 mm. Surgical management resulted in excision and open healing (9.1%), excision and direct closure (3.9%), skin graft (31.1%), local flap (21.9%), or another type of reconstruction (3.0%). Significant links between invaded or insufficient margins and basal cell type (OR = 3.37, p = 0.014), tumor size over 7 mm (OR = 2.7, p = 0.011), double location (OR = 8.44, p = 0.04), flap-based reconstruction (OR = 0.290, p = 0.02), and female gender (OR = 0.418, p = 0.034) were reported throughout our multivariate analysis.ConclusionsThis study brings out consequential information on factors linked with invaded or insufficient excision margins. Larger cohorts should evaluate the aesthetic outcomes in such a population.     

一种防脱出易制作义眼台的研制

目的探讨一种新型简易防脱出的义眼台的制作方法与效果。方法根据眼球摘除后的解剖特点设计义眼台大小,选择聚甲基丙烯酸甲酯和涤纶布为材料制作复合材料义眼台,并对6只家兔行眼球摘除后置入义眼台,经HE染色观察及肉眼观察术后不同时间置入物与眼周围组织的解剖关系。结果聚甲基丙烯酸甲酯部分与组织无黏连,涤纶布形成牢固黏连,周围有纤维组织长入并包绕,义眼台无脱出、移位。结论以聚甲基丙烯酸甲酯和涤纶布为材料制作复合义眼台,方法简易,效果可靠,组织相容性好,术后反应轻,值得在临床上推广使用。     

常见眼眶病变的MRI诊断与鉴别诊断

目的：探讨眼眶病变的MRI诊断与鉴别诊断价值。方法：对29例经临床病理确诊的眼眶病变的病例进行回顾性分析，重点观察该类疾病的MRI表现。结果：眼眶病变29例，包括肿瘤10例。炎症10例，血管性病变3例，眼肌病变6例。其在MRI表现各具有影像学特征，眼眶肿瘤多表现为位于眼眶内、外的局限性软组织肿块，MR T1WI呈等或稍低信号，T2WI呈高或等信号多见；炎性假瘤则表现为眶内局限性软组织肿块或弥漫性异常信号．MR T1WI呈低信号，T2WI呈高信号，常伴有眼肌肥大或眼环增厚，泪腺肿大等。结论：MRI检查能显示眼眶病变的影像学特征，对其诊断及鉴别诊断具有重要价值。     

眶骨的改变在眶部疾病HR-MRI诊断中的作用

目的:探讨眶骨的影像学所见及其在眶部疾病诊断中的作用。方法:回顾性分析诊断明确的眶部疾病80例的HR-MRI影像表现。80例中良性囊肿18例，外伤6例，炎性疾病6例，蝶骨嵴脑膜瘤9例，其他肿瘤41例。磁共振扫描采用1．5T GE Signa及Siemens Magnetom Sp63磁共振扫描机，用眶部表面线圈，SE系列常规轴位、冠状位及矢状位扫描，部分病例行脂肪抑制及增强扫描。结果：正常眶骨的HR-MRI表现为结构完整，边缘光整，皮质骨在T1WI及。T2WI上均为无信号区。15例眶骨受压迫性改变全见于良性囊肿的病例，骨质增生改变主要见于蝶骨脑膜瘤，2例骨折见于外伤病例，21例骨质破坏大多见于不同的恶性肿瘤病变中。结论：不同的眶部病变对眶骨的影响有差异，良性囊肿主要表现为眶骨受压迫性改变，蝶骨脑膜瘤多表现为骨质增生，外伤病例伴有眶骨骨折，恶性肿瘤病例常伴有眶骨的破坏。眶骨的改变对眶部疾病HR-MRI的诊断和鉴别诊断有重要作用。     

中面部牵引成骨术后眶周结构三维位置变化的评估

目的 观察中面部牵引成骨技术对眼眶周围软、硬组织结构的三维空间位置变化的影响.方法 回顾性分析2003年9月至2006年6月接受Le Fort III型截骨+中面部牵引成骨术的8例Crouzon综合征患者CT数据,平均年龄11.9岁,实施影像三维重建后,采用眶耳平面(术前)作为测量的基准平面,分别选择眶上点、眶下点、眶内缘点、眶外缘点、眼球前点、眼球后点,以及上、下、内、外四直肌与眼球的附着点作为评估标志,以双侧耳门上点连线作为颅底宽度基准,记录各个主要标志点至耳门上点连线的矢状距(y轴向)、垂直距(z轴向)以及眼球前点、眼球后点的水平间距(x轴向)变化,行配对t检验,并与健康对照组比较.结果 牵引成骨术前后眼球前点的y轴向及z轴向位置并没有显著性变化,但x轴向间距变化为-3.40 mm;眶下点移动在y轴向平均12.24 mm,z轴向平均4.25 mm;眶内缘点移动在y轴向平均10.11 mm,z轴向平均2.80 mm;眶外缘点移动在y轴向平均9.86 mm,z轴向平均2.31mm;下直肌支点移动,y轴向平均3.63mm,z轴向平均2.98mm.其余各标记点未见有临床意义的位移变化.结论 以Le Fort III型截骨为主的面中部牵引成骨技术,可以使Crouzon综合征患者的术后眼眶内、外、下侧壁均出现明显的前、下方移位,而患者的眼球没有显著性的矢状向位置变化,仅呈现轻度的内移、下降和前上方旋转.     

Meningioma of the floor of the anterior cranial fossa with bilateral intraorbital extension

We report meningioma of the floor of the anterior cranial fossa with bilateral, symmetrical intraorbital extension, describing the findings on plain films and CT.     

眼动脉眶内段的应用解剖研究

目的 :为眶内手术中寻找和处理眼动脉及其分支提供解剖学依据。方法 :手术显微镜下解剖、观察、测量4 0侧成人眶内眼动脉的分段、各段的长度、外径、重要毗邻、主要分支、各分支起点与各段分界点之间的相互位置关系。结果 :(1)眶内眼动脉依其行程分为 4段。O3 段与O4段的分界点 (O4段起点 )坐标在左眼约位于时钟 5 4分钟位置 ,在右眼约位于时钟 10分钟位置。 (2 )视网膜中央动脉的起点多集中在眼动脉角后约 7.4 0mm至角前约 3.90mm的范围内 ,视网膜中央动脉穿视神经鞘处至眼球后极的距离平均为 (8.4 6± 1.91)mm。 (3)眼动脉角至眼球后极的距离平均为 (19.32± 4 .2 2 )mm ;眼动脉弯至眼球后极距离平均为 (14 .2 0± 3.92 )mm。 (4 )眶内眼动脉各段中 ,以O2段发出的至眼球、眼外肌和泪腺的分支最多。结论 :(1)眶内眼动脉以四分段法对眶内手术更有实用意义。 (2 )眼动脉各分支的起点变化较大 ,可用眼动脉四段的分界点作为识辨眼动脉及其重要分支的标志     

Orbital epidermoids and dermoids

Summary A series of 1 epidermoid and eight dermoid tumors with primary orbital location is reported on. The term cholesteatoma is inadequate to cover epidermoids, dermoids and inflammatory cholesteatomas.The features present in our series and in 81 similar cases collected from literature show that a long standing disaxiale proptosis, without impairment of ocular motility, is indicative of the tumouts under discussion. The X-ray finding of a clearcut patch of bone rarefaction with a marginal hyperostosis is also characteristic of these lesions.Radical surgery is mandatory; a subfrontal extradural approach to orbit is favoured.

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Zusammenfassung Es wird über eine Serie von einem Epidermoid und acht Dermoiden mit primärer Lokalisation in der Orbita berichtet. Der Ausdruck Cholesteatom ist inadäquat, weil er Epidermoide, Dermoide und entzündliche Cholesteatome zusammenfaßt. Die klinischen Bilder der Fälle unserer Serie und von 81 ähnlichen Fällen aus der Literatur zeigen eine disaxiale Proptosis ohne Einschränkung der Augenbeweglichkeit und dies ist für diese Tumorgruppe charakteristisch. Die Röntgenbefunde zeigen eine scharf begrenzte Knochenusur mit Wand-Hyperostose. Radikale Chirurgie ist erforderlich. Eine subfrontale, extradurale Freilegung der Orbita wird von uns bevorzugt.

     

MRI of orbital schwannomas

The literature on MRI of orbital schwannomas is limited. The appearances in three patients with an orbital schwannoma were reviewed. A superior orbitotomy through a subfrontal craniotomy revealed a schwannoma in all cases. MRI characteristics of very low signal on T 1-weighted images and homogeneous postcontrast enhancement may be helpful for differentiating schwannomas from other intraconal masses. Received: 21 June 1999/Accepted: 20 September 1999     

Imaging spectrum in sclerotic myelomas: an experience of three cases

The classic radiographic presentation of multiple myeloma is lytic skeletal lesions. Primary sclerotic manifestations are rare and occur only in 3 % of cases. The imaging spectrum in three cases of multiple myeloma with primary osteosclerosis is described. The first patient had spiculated sclerosis of the orbit, which is an uncommon site for myeloma. The second patient with POEMS syndrome had multiple, scattered, skeletal lesions with sclerotic margins. The third patient presented with a chest wall mass and had an expansile thick spiculated sclerosis in the rib. The wide imaging spectrum possible in sclerotic myelomas and their relevant differential diagnosis is emphasized. Received: 14 March 2000; Accepted: 25 April 2000