A Complication of Stellate Ganglion Block?

Abstract: Stellate ganglion block is commonly used to treat the sympathetically maintained pain which may occur in one‐third of patients with complex regional pain syndrome type 1. A complication that followed a single block and presented a diagnostic dilemma for the ophthalmologist is reported.     

The “Biplanar” forehead lift

A new technique of forehead rhytidectomy is presented that combines the best features of the coronal incision with those of the anterior hairline incision. The plane of dissection is formed by an anterior subcutaneous plane dissecting a lateral subgaleal plane. This approach is particularly valuable in patients with high foreheads, severe static wrinkling, and asymmetrical eyebrows.Presented in part at the Annual Meeting of the American Society of Aesthetic Plastic Surgeons, Boston, MA, 1984     

上睑下垂78例手术分析

用额肌悬吊术或提上睑肌缩短术治疗７８例上睑下垂病例，治愈７眼，基本治愈１２眼，矫正不足３眼，矫正过度２眼，笔者认为，术前分析病因；注意提上睑肌肌力的测定；采用适当的手术方法，是手术成功的关键。     

Horner syndrome

Horner syndrome is an uncommon but important clinical entity, representing interruption of the sympathetic pathway to the eye and face. Horner syndrome is almost always diagnosed clinically, though pharmacological testing can be used to confirm the diagnosis. Imaging modalities such as PET, CT and MRI are important components of work‐up for patients presenting with acquired Horner syndrome. Our patient’s presentation with Horner syndrome unmasked the causative superior sulcus squamous cell carcinoma and a coincidental lower lobe adenocarcinoma. Successful radical treatment of these cancers resulted in complete resolution of the syndrome and disease‐free survival at 18 months. We review the anatomy and pathophysiology underlying this and other causes of Horner syndrome.     

改良限制性切口额颞部除皱术

目的　为提高额颞部除皱术的效果 ,延长有效时间 ,从理论与实际观察探讨额颞部老年化改变形成的原因 ,并采用相应的手术术式进行矫正。方法　肿胀麻醉下 ,通过颞部发际缘切口入路 ,在颞深筋膜浅面剥离 ,内达颞肌前缘及眶外缘 ,下达颧弓上缘 ,后达耳屏前线。额部切口入路在帽状腱膜下剥离 ,下达眶上缘外至颞线后至枕外隆突。口腔内上颊龈沟入路在颧骨及颧弓骨膜下剥离。上述各剥离区域相互贯通 ,最后将颞区皮瓣上提 ,并将颞浅筋膜与颞深筋膜缝合固定。结果　本组共 32例 ,术后眉外侧平均上提 8mm ,鼻唇沟变浅 ,获随访的 7例为术后 3～2 4个月 ,除皱效果满意。结论　本术式旨在通过广泛剥离解除了额颞部皮肤筋膜上提的羁绊 ,同时减少上面部降肌的作用 ,相对增强提肌的作用 ,再辅以筋膜及皮肤上提固定达到除皱的目的 ,效果确实、可靠、安全、持久。     

外侧眉下垂的解剖力学研究

目的:探讨外侧眉下垂与该区肌肉力学的关系,为眶周年轻化手术提供更加详实的解剖依据。方法:对10%福尔马林固定的成人尸头33侧进行大体和显微解剖观察。结果:下垂眉形组的额肌宽度在内眦间连线头侧3.0cm水平为(53.04±3.85)mm,5.0cm水平为(59.71±3.82)mm,明显窄于非下垂眉形组相应水平的(56.14±4.29)mm和(63.23±5.40)m(mP<0.05)。下垂眉形组眼轮匝肌外侧束出现率为87.5%,明显大于非下垂组的52.9%(P<0.01)。结论:外侧眉缺少额肌的支持及眼轮匝肌外侧束的出现是外侧眉下垂的重要原因之一。     

EMG myokymia as a cause of ptosis in hypothyroidism

Ptosis is known to be associated with thyroid disorders. We describe two biochemically corrected hypothyroid patients presenting with isolated bilateral ptosis. EMG of the orbicularis oculi showed continuous grouped motor unit potentials. In the absence of obvious aetiology, it is hypothesised that focal demyelination of terminal branches to the orbicularis oculi may play a role in the generation of the discharges.     

Phenotype delineation of ZNF462 related syndrome

Zinc finger protein 462 (ZNF462) is a relatively newly discovered vertebrate specific protein with known critical roles in embryonic development in animal models. Two case reports and a case series study have described the phenotype of 10 individuals with ZNF462 loss of function variants. Herein, we present 14 new individuals with loss of function variants to the previous studies to delineate the syndrome of loss of function in ZNF462. Collectively, these 24 individuals present with recurring phenotypes that define a multiple congenital anomaly syndrome. Most have some form of developmental delay (79%) and a minority has autism spectrum disorder (33%). Characteristic facial features include ptosis (83%), down slanting palpebral fissures (58%), exaggerated Cupid's bow/wide philtrum (54%), and arched eyebrows (50%). Metopic ridging or craniosynostosis was found in a third of study participants and feeding problems in half. Other phenotype characteristics include dysgenesis of the corpus callosum in 25% of individuals, hypotonia in half, and structural heart defects in 21%. Using facial analysis technology, a computer algorithm applying deep learning was able to accurately differentiate individuals with ZNF462 loss of function variants from individuals with Noonan syndrome and healthy controls. In summary, we describe a multiple congenital anomaly syndrome associated with haploinsufficiency of ZNF462 that has distinct clinical characteristics and facial features.     

上睑下垂美容手术的解剖学设计和效果分析

目的探讨不对称性上睑下垂美容手术的设计要点以及术后美容效果。方法通过对33例不对称性上睑下垂患者术前双眼各自不同特点的分析,提出设计要点,同时对术后的美容效果进行评价。结果本组病例中美容效果优者占87.9%,良以上者占94.0%。结论双眼对称是眼部美容手术成功的关键,只有按照患者各自的解剖学特点设计手术,才能取得良好的美容效果。     

Saethre‐Chotzen syndrome: Notable intrafamilial phenotypic variability in a large family with Q28X TWIST mutation

Saethre‐Chotzen syndrome is an autosomal dominant disease characterized by craniosynostosis, ptosis, and limb and external ear abnormalities. Variable expressivity is a well‐known phenomenon in this disorder. A large Indian family has been recently identified as carrying a nonsense TWIST mutation (Q28 X) in 17 members, of whom 16 were examined in detail. Only 4 (25%) of the patients showed patent craniostenosis, namely, oxycephaly. The penetrance of craniosynostosis in this family is lower than previously reported in the literature. Fifteen patients (93%) had moderate to severe ptosis. Minor limb and external ear abnormalities were present in most patients. Eyelid features were the hallmark of the disease for 12 members of the family, suggesting that mutations in TWIST may lead to a phenotype with mainly palpebral features and no craniostenosis. The clinical analysis of this large family clearly illustrates the significant variable expressivity, probably related to haploinsufficiency because of the TWIST mutation. This phenotypic variability remains unclear but could be the result of modifier genes and/or genetic background effect, as noticed previously in the transgenic twist‐null heterozygous mice. © 2002 Wiley‐Liss, Inc.