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Doppler-assisted vascular pedicle flaps in eyelid and periorbital reconstruction
J Oral Maxillofac Surg 55:529-533, 1997
Abstracts Treatment of Retrobulbar Hemorrhage in Accident and Emergency Departments. Hislop WS, Dutton GN, Douglas PS, et al. Br J Oral Maxillohc Surg 34:289, 1996
Reprint requests to Dr Cheng: Department of Oral and Maxillofacial Surgery, York Distric Hospital, Wig&on Road, York, Y03 7HE United Kingdom.
Although rare, retrobulbar hemorrhage (RH) is a very serious complication that may occur after central mid-face and malar injuries around the eye. Often the first persons to examine these cases are emergency room staff. This study arose from the discovery of several patients who had been treated with undiagnosed RH resulting in permanent blindness. The aim of the study was to determine the level of awareness of RH and its treatment by accident and emergency staff. A multiple choice questionnaire with nine questions regarding diagnosis, treatment, and referral patterns of retrobulbar hemorrhage were examined from 55 medical staff working in emergency departments in Scotland. The results suggested that although most of the accident and emergency staff were aware of KH and the need to treat it quickly, the management of such patients is poor with 71% of the respondents being unable to manage them adequately. The senior staff and trainees could diagnose and treat rh significantly better than the senior house officers and clinical assistants but they made up only 29% of the respondents with 63% of them able to manage the condition satisfactorily. Two of the three surgeons who would operate described their technique in detail, one carrying out a lateral canthotomy and cantholysis, the other using a lateral brow approach. Despite the fact that experienced surgeons can manage RH extremely well this study confirms the suspicion that it may not be diagnosed or treated adequately in accident and emergency department leading to the catastrophic situation where the patient is left permanently blind.
Doppler-Assisted Vascular Pedicle Flaps in Eyelid and Periorbital Reconstruction. Yeatts RP, Newsome RW, Matthews BL, et al. Arch Ophthalmol 114:114Y, 1996 Forehead flaps are commonly used in reconstruction after the removal of periorbital epithelial malignancy, removal of malignant tumor in the paranasal sinus, or to correct an eyelid malposition in which a skin graft has failed. This report describes a technique used to identify the supratrochlear arteries and the frontal branch of the superficial temporal artery for the development of a thin tipped forehead flap used for reconstruction of periorbital facial defects. After identification of the vessels with a transcutaneous ultrasonic flow doppler detector and a coupling gel, a narrow based pedicle design facilitates flap rotation and donor site primary closure. Assurance of the vascular supply allowed primary thinning of the tip of the flap thereby permitting more accurate soft tissue replacement of the recipient bed. Thirteen patients were followed-up using this technique. Nine patients were repaired using the paramedian forehead flap based on the contralateral supratrochlear artery. Three patients were reconstructed using the flap based on the ipsilateral frontal branch of the superficial temporal artery. One patient received both a forehead and a temporal based reconstruction. Results reported from the authors range from fair to excellent in eight of 13 cases. Although forehead flaps will not rcplacc regional cutaneous advancement flaps in facial reconstruction, the use of doppler flow detectors allows for assurance of the axial vascular supply of these flaps. With vascularity of the donor tissue assured, flap design using a narrow pedicle and distal thinning allows for better matching of the thickness of the tissue bed.-.I. RROKLOFF
Reprint requests to Dr Hislop: Gosshouse Hospital, Kilmamock, KA2 OHE, United Kingdom. Helicobacter Pylori in Dental Plaque and Gastric Mncosa. Cheng LHH, Webberley M, Evans M, et al. Oral Surg Oral Med Oral Path01 Oral Radio1 81:421, 1996
Reprint requests to Dr Yeatts: Wake Forest University Eye Center, Medical Center Blvd, Winston Salem, NC 27157.1033. Surgical Treatment of Lagopthalmos in Facial Palsy: Ear Cartilage Graft for Elongating The Levator Palpebrae Muscle. Inigo F, Chapa P, Jimcncz Y, et al. Br J Plast Surg 491452, 1996
In an effort to simplify the diagnosis of antral gastritis secondary to Helicobacter Pylori (H. Pyluri) a gram-negative microaerophilic spiral bacterium, the authors attempted to identify the presence or absence of H. Pylori in dental plaque with the presence or absence in gastric mucosa. Samples of subgingival and supragingival plaque from 122 patients with symptoms of dyspepsia were obtained. These same patients also underwent gastroscopy and gastric brushings. All samples were then cultured for H. Pylori and those showing characteristic gram-negative rod appearance were further tested by oxidase, catalase, and urease tests. H. Pylovi was not isolated from the plaque of any dentate patient even when isolated from gastric brushings of the same patient. A positive H. Pylori culture was found in one edentulous paticnt with a positive correlation to gastric mucosa H. Pylori. Therefore, the authors concluded that dental plaque could neither be a significant reservoir for gastric reinfection nor facilitate a means for diagnosis of the presence of H. Pylori in gastric TTIUCoSa.-FRANK JIJORN~, JR
The disturbing consequences of facial paralysis with lagopthalmos are well documented. Cross-facial nerve grafts are the treatment of choice for re-establishing facial nerve stimulus recovering the function of facial muscles including orbicularis oculi. However, patients with long-standing paralysis are not candidates for this procedure because this muscle is usually atrophic. The authors present a new method for decreasing lagopthalmos and reducing the palpebral fissure through the suturing of an auricular cartilage graft between the tarsal plate and the levator palpebrae superioris aponeurosis. The graft clongatcs the lcvator muscle and decreases its strength. Twelve patients with long-standing facial paralysis were treated by this method between 199 1 and 1993. All procedures were performed under local anesthesia and the results after 9 to 30 months of follow-up are as 529
Abstracts Treatment of Retrobulbar Hemorrhage in Accident and Emergency Departments. Hislop WS, Dutton GN, Douglas PS, et al. Br J Oral Maxillohc Surg 34:289, 1996
Reprint requests to Dr Cheng: Department of Oral and Maxillofacial Surgery, York Distric Hospital, Wig&on Road, York, Y03 7HE United Kingdom.
Although rare, retrobulbar hemorrhage (RH) is a very serious complication that may occur after central mid-face and malar injuries around the eye. Often the first persons to examine these cases are emergency room staff. This study arose from the discovery of several patients who had been treated with undiagnosed RH resulting in permanent blindness. The aim of the study was to determine the level of awareness of RH and its treatment by accident and emergency staff. A multiple choice questionnaire with nine questions regarding diagnosis, treatment, and referral patterns of retrobulbar hemorrhage were examined from 55 medical staff working in emergency departments in Scotland. The results suggested that although most of the accident and emergency staff were aware of KH and the need to treat it quickly, the management of such patients is poor with 71% of the respondents being unable to manage them adequately. The senior staff and trainees could diagnose and treat rh significantly better than the senior house officers and clinical assistants but they made up only 29% of the respondents with 63% of them able to manage the condition satisfactorily. Two of the three surgeons who would operate described their technique in detail, one carrying out a lateral canthotomy and cantholysis, the other using a lateral brow approach. Despite the fact that experienced surgeons can manage RH extremely well this study confirms the suspicion that it may not be diagnosed or treated adequately in accident and emergency department leading to the catastrophic situation where the patient is left permanently blind.
Doppler-Assisted Vascular Pedicle Flaps in Eyelid and Periorbital Reconstruction. Yeatts RP, Newsome RW, Matthews BL, et al. Arch Ophthalmol 114:114Y, 1996 Forehead flaps are commonly used in reconstruction after the removal of periorbital epithelial malignancy, removal of malignant tumor in the paranasal sinus, or to correct an eyelid malposition in which a skin graft has failed. This report describes a technique used to identify the supratrochlear arteries and the frontal branch of the superficial temporal artery for the development of a thin tipped forehead flap used for reconstruction of periorbital facial defects. After identification of the vessels with a transcutaneous ultrasonic flow doppler detector and a coupling gel, a narrow based pedicle design facilitates flap rotation and donor site primary closure. Assurance of the vascular supply allowed primary thinning of the tip of the flap thereby permitting more accurate soft tissue replacement of the recipient bed. Thirteen patients were followed-up using this technique. Nine patients were repaired using the paramedian forehead flap based on the contralateral supratrochlear artery. Three patients were reconstructed using the flap based on the ipsilateral frontal branch of the superficial temporal artery. One patient received both a forehead and a temporal based reconstruction. Results reported from the authors range from fair to excellent in eight of 13 cases. Although forehead flaps will not rcplacc regional cutaneous advancement flaps in facial reconstruction, the use of doppler flow detectors allows for assurance of the axial vascular supply of these flaps. With vascularity of the donor tissue assured, flap design using a narrow pedicle and distal thinning allows for better matching of the thickness of the tissue bed.-.I. RROKLOFF
Reprint requests to Dr Hislop: Gosshouse Hospital, Kilmamock, KA2 OHE, United Kingdom. Helicobacter Pylori in Dental Plaque and Gastric Mncosa. Cheng LHH, Webberley M, Evans M, et al. Oral Surg Oral Med Oral Path01 Oral Radio1 81:421, 1996
Reprint requests to Dr Yeatts: Wake Forest University Eye Center, Medical Center Blvd, Winston Salem, NC 27157.1033. Surgical Treatment of Lagopthalmos in Facial Palsy: Ear Cartilage Graft for Elongating The Levator Palpebrae Muscle. Inigo F, Chapa P, Jimcncz Y, et al. Br J Plast Surg 491452, 1996
In an effort to simplify the diagnosis of antral gastritis secondary to Helicobacter Pylori (H. Pyluri) a gram-negative microaerophilic spiral bacterium, the authors attempted to identify the presence or absence of H. Pylori in dental plaque with the presence or absence in gastric mucosa. Samples of subgingival and supragingival plaque from 122 patients with symptoms of dyspepsia were obtained. These same patients also underwent gastroscopy and gastric brushings. All samples were then cultured for H. Pylori and those showing characteristic gram-negative rod appearance were further tested by oxidase, catalase, and urease tests. H. Pylovi was not isolated from the plaque of any dentate patient even when isolated from gastric brushings of the same patient. A positive H. Pylori culture was found in one edentulous paticnt with a positive correlation to gastric mucosa H. Pylori. Therefore, the authors concluded that dental plaque could neither be a significant reservoir for gastric reinfection nor facilitate a means for diagnosis of the presence of H. Pylori in gastric TTIUCoSa.-FRANK JIJORN~, JR
The disturbing consequences of facial paralysis with lagopthalmos are well documented. Cross-facial nerve grafts are the treatment of choice for re-establishing facial nerve stimulus recovering the function of facial muscles including orbicularis oculi. However, patients with long-standing paralysis are not candidates for this procedure because this muscle is usually atrophic. The authors present a new method for decreasing lagopthalmos and reducing the palpebral fissure through the suturing of an auricular cartilage graft between the tarsal plate and the levator palpebrae superioris aponeurosis. The graft clongatcs the lcvator muscle and decreases its strength. Twelve patients with long-standing facial paralysis were treated by this method between 199 1 and 1993. All procedures were performed under local anesthesia and the results after 9 to 30 months of follow-up are as 529