Background:Benign essential blepharospasm(BEB),aberrant facial nerve degeneration and hemifacial spasm(HFS)are all examples dystonia which,though not life-threatening,can have a significant impact on patient quality o...Background:Benign essential blepharospasm(BEB),aberrant facial nerve degeneration and hemifacial spasm(HFS)are all examples dystonia which,though not life-threatening,can have a significant impact on patient quality of life.The need for reliable self-rating surveys to monitor functional disability is fundamental.The Blepharospasm Disability Index(BSDI)is already a widely utilised and validated selfrating score for blepharospasm whilst the functional disability score(FDS)requires further validation.The principle aim of this study is to repeat validation of the FDS against the BSDI,which has been validated by several groups since its original description but only in patients with BEB.Methods:A randomised blinded prospective cohort study was conducted at a single unit on 38 patients with BEB,aberrant facial nerve degeneration and HFS.Patients were blinded to complete the FDS followed by the BSDI or the BSDI followed by the FDS with a 30-minute interval.Results:Both the FDS and BSDI were found to be reliable with high internal consistency and test-retest reliability.Both scales were also found to be moderately correlated with the Jankovic disease severity score.Conclusions:This study is the first to use the FDS as a rating scale in patients with HFS and aberrant facial nerve degeneration.It is also the first study to formally validate the FDS as an acceptable rating scale for patients with dystonia and in particular it provides validation for its use in patients with HFS and aberrant facial nerve degeneration.展开更多
A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplas...A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects.Technique description and retrospective interventional case series.The reconstruction technique was used by an experienced oculoplastics surgeon(ASL)in 3 adults with malignant lesions involving the lateral upper eyelid margin,resulting in a post-excision 50%full-thickness defect between November 2017 and June 2020.The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap.The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle.Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases.One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants.In all patients,the final eyelid contour and symmetry were adequate,with only minimal scarring,evident already 3 to 4 months postoperative.There were no major complications or need for revisions.The technique described herein highlights the utility of the blepharoplasty flap for lateral,full-thickness upper eyelid defects.This logical variation enables the reconstruction of significant defects using only local tissue,obeying the“like with like”principle,and helps avoid the need for a bridging flap.We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour,together with a fast recovery of appropriate eyelid function.展开更多
Purpose: To report periocular linear basal cell carcinoma (BCC) as a distinct clinical entity,and to highlight its existence in the ophthalmic literature. Design: Retrospective,noncomparative,multicenter,interventiona...Purpose: To report periocular linear basal cell carcinoma (BCC) as a distinct clinical entity,and to highlight its existence in the ophthalmic literature. Design: Retrospective,noncomparative,multicenter,interventional small case series. Participants: Four patients with linear BCC in the periocular region. Intervention: All patients underwent margin-controlled excision,3 utilizing Mohs’ micrographic surgery and 1 using frozen section. Main Outcome Measures: Age,gender,location,preoperative tumor size,histological growth pattern,presence of perineural invasion,number of Mohs’ levels used to obtain histologic clearance,postoperative defect size,and recurrence. Results: In all 4 cases,the site of occurrence was in the lower eyelid and cheek. Histology revealed pigmented nodular BCC with an infiltrative component in 2 cases and nodular BCC in the remaining 2 cases. No perineural invasion was noted in any of the cases. Two Mohs’ levels were required for complete excision in 3 patients. Conclusions: Linear BCC is a distinct clinical entity. Presence of the tumor along relaxing skin tension lines,increase in subclinical extension,and aggressive tumor behavior are reported observations. Because of these observations,it is suggested that margin-controlled excision should be considered for linear BCC.展开更多
文摘Background:Benign essential blepharospasm(BEB),aberrant facial nerve degeneration and hemifacial spasm(HFS)are all examples dystonia which,though not life-threatening,can have a significant impact on patient quality of life.The need for reliable self-rating surveys to monitor functional disability is fundamental.The Blepharospasm Disability Index(BSDI)is already a widely utilised and validated selfrating score for blepharospasm whilst the functional disability score(FDS)requires further validation.The principle aim of this study is to repeat validation of the FDS against the BSDI,which has been validated by several groups since its original description but only in patients with BEB.Methods:A randomised blinded prospective cohort study was conducted at a single unit on 38 patients with BEB,aberrant facial nerve degeneration and HFS.Patients were blinded to complete the FDS followed by the BSDI or the BSDI followed by the FDS with a 30-minute interval.Results:Both the FDS and BSDI were found to be reliable with high internal consistency and test-retest reliability.Both scales were also found to be moderately correlated with the Jankovic disease severity score.Conclusions:This study is the first to use the FDS as a rating scale in patients with HFS and aberrant facial nerve degeneration.It is also the first study to formally validate the FDS as an acceptable rating scale for patients with dystonia and in particular it provides validation for its use in patients with HFS and aberrant facial nerve degeneration.
文摘A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects.Technique description and retrospective interventional case series.The reconstruction technique was used by an experienced oculoplastics surgeon(ASL)in 3 adults with malignant lesions involving the lateral upper eyelid margin,resulting in a post-excision 50%full-thickness defect between November 2017 and June 2020.The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap.The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle.Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases.One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants.In all patients,the final eyelid contour and symmetry were adequate,with only minimal scarring,evident already 3 to 4 months postoperative.There were no major complications or need for revisions.The technique described herein highlights the utility of the blepharoplasty flap for lateral,full-thickness upper eyelid defects.This logical variation enables the reconstruction of significant defects using only local tissue,obeying the“like with like”principle,and helps avoid the need for a bridging flap.We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour,together with a fast recovery of appropriate eyelid function.
文摘Purpose: To report periocular linear basal cell carcinoma (BCC) as a distinct clinical entity,and to highlight its existence in the ophthalmic literature. Design: Retrospective,noncomparative,multicenter,interventional small case series. Participants: Four patients with linear BCC in the periocular region. Intervention: All patients underwent margin-controlled excision,3 utilizing Mohs’ micrographic surgery and 1 using frozen section. Main Outcome Measures: Age,gender,location,preoperative tumor size,histological growth pattern,presence of perineural invasion,number of Mohs’ levels used to obtain histologic clearance,postoperative defect size,and recurrence. Results: In all 4 cases,the site of occurrence was in the lower eyelid and cheek. Histology revealed pigmented nodular BCC with an infiltrative component in 2 cases and nodular BCC in the remaining 2 cases. No perineural invasion was noted in any of the cases. Two Mohs’ levels were required for complete excision in 3 patients. Conclusions: Linear BCC is a distinct clinical entity. Presence of the tumor along relaxing skin tension lines,increase in subclinical extension,and aggressive tumor behavior are reported observations. Because of these observations,it is suggested that margin-controlled excision should be considered for linear BCC.
