Stable correction of antimongoloid deformity of the external canthus

The antimongoloid deformity comprises inferior dystopia of the lateral canthus. It causes a sad looking appearance, inferior scleral show and laxity of the lower eyelid. Many different procedures have been described to correct this deformity. We believe that a stable and lasting correction can be achieved using a coronal-approach subperiosteal mask-lift, combined with DMAS (Deep Musculo-Aponeurotic System) suspension of a temporo-masseteric anchor-flap (instead of a simple canthoplasty). If bony augmentation of the cheek bones is required, we use an autograft of cartilage of the concha of the ear. While this 'orthomorphic' procedure is primarily applied in esthetic cosmetic surgery, it can also be used to correct deformities in reconstructive surgery.     

松解外眦韧带修复先天性眼睑缺损观察

目的 采用松解外眦韧带行眼睑再造术,对先天性眼睑缺损进行修复,评价其在功能修复与外观美容等方面的作用.方法 对2例先天性眼睑缺损患者,采用外眦韧带松解再造术,外眦角水平切开,松解外眦韧带上支,眼睑缺损处予以修复,关闭外眦切口,术后随访时间为3～6月,观察其修复形态和闭合程度.结果 2例患者术后缺损部位均得到满意修复,睑裂闭合良好,眼睑瞬目功能正常,角膜透明.结论 该手术可有效满足先天性眼睑缺损的修复,做到一期手术一期愈合,简化了操作程序,达到功能与外观的完满结合,值得推广.     

先天性外眦肿物合并眼睑畸形2例

临床上儿童外眦部肿物合并眼睑畸形及结膜肿物少见,需在切除眼睑、结膜肿物的同时,灵活处置眼睑整复.本文回顾2例就诊于北京儿童医院的先天性外眦肿物合并眼睑缺损的病例.术后病理示皮赘伴结膜皮样脂肪瘤.患儿眼睑肿物切除彻底,眼睑整复后外观满意.     

自体阔筋膜移植联合钛板钛钉内固定矫正难治性内眦畸形

目的评价自体阔筋膜移植联合钛板钛钉钢丝内固定矫正难治性内眦畸形的手术效果。设计回顾性病例系列。研究对象8例难治性内眦畸形患者,车祸伤6例,砂轮击伤1例,泪囊肿物摘除术后1例。其中2例为内眦畸形矫正术后再次复发者。方法采用自体大腿阔筋膜,将其一端缝合固定于内眦角深部组织即相当于内眦韧带残端处,另一端在泪前嵴保存完好的患者中,通过钢丝、钛钉固定于泪前嵴上,在泪前嵴和鼻骨破坏明显的患者中,通过钢丝、钛板、钛钉固定于深部稳定性较强的骨质上。主要指标双眼内眦与鼻中线间距,外观是否对称。结果8例患者术后内眦畸形明显矫正,外观显著改善,随诊6～12个月效果持续稳定。结论自体阔筋膜移植联合钛板钛钉钢丝内固定矫正难治性内眦畸形效果良好,可以有效预防复发。     

Hereditary congenital external ophthalmoplegia

Several members of a large pedigree suffering from hereditary congenital external ophthalmoplegia, an autosomal hereditary disorder of ocular movements, were examined and surgically treated. From nystagmographic findings it was concluded that the main cause of this disorder is of supranuclear origin. Specimen of the inferior oblique muscle revealed no abnormalities or showed decrease of type I muscle fibers.     

先天性小眼球及隐眼的眼窝畸形矫治

目的探讨先天性小眼球及隐眼眼窝畸形的最佳矫治时机与矫治方法。方法回顾性分析我院收治的14例（14眼）先天性小眼球（其中2例为隐眼）病例的临床表现、就诊时间、矫治方法及治疗效果。结果14例中的12例行小眼球摘除联合义眼座植入术,9例因小睑裂、小眼眶,同时行内、外眦延长成形术,并选用了最小号（直径18mm）的义眼座;其中3例外侧眶缘截骨术,2例术中将义眼台进行了磨削,实际直径为16～17mm。12例术后均眶腔饱满,眼睑可自然睁开和闭合,配戴义眼片后,术眼活动与健眼同步,外观逼真,达到了满意的美学效果。随访6月～6年,平均23．5个月,无感染、眼座暴露或上眶区凹陷等并发症。其余2例结膜瓣遮盖后,配戴义眼片,因眼眶发育较好,美容效果也较理想。结论由于眼眶发育与眼眶的张力即眼球的直径直接相关,且有年龄阶段性。我们认为对眼球最大直径小于10mm的小眼球宜尽早选用相对稍大的羟基磷灰石义眼座矫治眼窝畸形;对最大直径大于10mm的小眼球患者,可先配戴义眼片并不断更换较大的义眼片,到8岁以后再酌情为他们施行义眼座植入手术;对小眼球角膜直径大于7mm,眼眶、结膜囊发育接近健眼,可保留眼球,仅以定制义眼片矫治眼窝凹陷。     

Reconstruction of the temporal canthus.

In the course of tumour excision the entire lateral canthus including the lateral palpebral ligament may have to be removed along with an upper or lower lid. In such cases it is difficult to conceal the defect and restore the function of the eyelids by plastic surgery. A combined advancement rotation flap has proved to be a technically simple method of reconstruction and successful functionally as well as cosmetically. A temporal flap is prepared and advanced medially. By making incision(s) into this flap it is possible to reconstruct both the canthus and the sulcus suprapalpebralis. The lateral tarsal margins are fixed to the periosteum by chromic catgut loops, and with a skin flap there is sufficient support to ensure normal function. An inner lining is provided by mobilising conjunctiva. The advantages and results of this method are discussed.     

Giant apocrine hydrocystoma of the internal canthus

Hydrocystoma is a benign tumor whose development involves the sudoriferous eccrine or apocrine glands. We report the case of a giant apocrine hydrocystoma in a 70-year-old female diabetic patient. The tumor's natural progression over 10 years and its volume caused significant functional and aesthetic damage. This article discusses the radiological, clinical, anatomopathological, and therapeutic aspects of this tumor. The case is original in the tumor's location, size, and its double visual and lachrymal functional involvement as well as its aesthetic damage.     

Osseous choristoma of the lateral canthus.

Ocular osseous choristoma, a rare idiopathic benign deposit of bone, is typically a static epibulbar lesion that occurs sporadically in the supertemporal quadrant of an otherwise normal eye. The subject of this report is a unique U-shaped subcutaneous osseous choristoma that did not involve the eye itself but rather conformed to the right lateral canthus in an otherwise normal 2-year-old boy.     

Tendon sheath fibroma of the medial canthus

Isolated fibromas of the ocular adnexa are rare. Fibromas of the tendon sheath (FTS) are benign, collagenous, spindle cell neoplasms that typically present as an acquired, painless mass in the adult extremities. They infrequently involve the head and neck. We report a case of FTS presenting as a medial canthal mass. Like most FTS, the lesion in our patient was successfully treated by complete surgical excision. While the differential diagnosis contains a variety of mesenchymal tumors, the clinical and radiographic characteristics should lead to the correct diagnosis. To our knowledge, this is the first case of FTS reported to arise at this site.     

Unusual complex choristoma of the lateral canthus

This report details the gross and histopathologic findings of an unusual complex choristoma at the lateral canthus. Although this lesion displays elements of hair follicle nevus, bulbar dermoid, epibulbar osseous choristoma, and accessory tragus, it does not fit neatly in any of these categories. We propose that this lesion is the result of faulty migration of pluripotential cells during embryogenesis.