Use of suborbicularis oculi fat flap to cover peri-orbital bone exposure

Wide resection of recurrent basal cell carcinoma (BCC) in the peri-orbital-infraorbital-nasal area may include periosteum resection with maxillary or nasal bone exposure. The absence of vascularized periosteum makes the defect ungraftable and local flaps are often required. As an alternative to a large single flap or a combination of flaps, it is possible to turn the ungraftable portion of the defect into a graftable one. The suborbicularis oculi fat (SOOF) flap is an advancement flap that is used in aesthetic surgery for midface rejuvenation. The use of the SOOF flap along with a full-thickness skin graft, as an alternative to the use of other standardized flaps to cover defects in the peri-orbital-infraorbital-nasal area with avascularized tissue or noble structure exposure, is reported herein. As an immediate single-stage reconstruction, this procedure leaves other flap options intact in the event of re-operation for a recurrent tumour

The epidemiological analysis of maxillofacial fractures in Italy: The experience of a single tertiary center with 1720 patients

Maxillofacial fractures represent a serious public health problem. Their epidemiology is extremely variable, and its analysis is crucial to establish effective treatment and prevention of these injuries. However only two works have been published about maxillofacial fracture epidemiology in Italy

Unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy: benign exophthalmos syndrome (BES). A description of a new clinical condition.

Abstract: PURPOSE. To report the clinical and radiologic characteristics of a group of patients who experienced unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy. The clinical features of these patients are presented and a hypothesis proposed to explain this condition for which the authors introduce the term benign exophthalmos syndrome (BES). METHODS. Retrospective, noncomparative case series. Participants: Four patients experienced slow progressive unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy, with no evidence of orbital mass or extraocular muscles involvement. Intervention: Main Outcome Measures. Symptomatic outcome and measurement of the degree of relative exophthalmos. RESULTS. The onset of exophthalmos was associated with clinical and radiologic features that resemble BES. In all patients, radiologic examination demonstrated an ipsilateral mucosal turbinate hypertrophy and not the presence of orbital disease or expanding lesions of paranasal sinus. After daily intranasal spray of steroid, in three of the four cases the globe returned to within 1 mm of exophthalmometry of the contralateral eye. CONCLUSIONS. The relationship between the feature of paranasal sinus disease and the development of ipsilateral exophthalmos has been described in the literature. The four cases described herein appear peculiar for the slow progressive onset of the exophthalmos, without inflammatory and mass effect signs. This condition associated in all cases with ipsilateral hypertrophy of the nasal mucosa provides a guide to a hypothetical mechanism for BES. According to these hypothesis, the therapy should be devoted to the nasal disease more than the orbital

Evaluation of retinal nerve fiber layer with optic nerve tracking optical coherence tomography in thyroid-associated orbitopathy.

Abstract AIMS: To evaluate retinal nerve fiber layer (RNFL) thickness in eyes with Graves' orbitopathy (GO), in eyes with ocular hypertension (OHT) and in a control group of healthy eyes. METHODS: Observational, controlled cross-sectional study. We evaluated all patients with primary open-angle glaucoma (POAG) and all patients with GO and intraocular pressure >23 mm Hg in primary position examined from March 2006 to June 2007. Forty apparently healthy patients (80 eyes) were enrolled as a control group. Complete ophthalmic evaluation, visual field (VF) examination with the Humphrey Visual Field Analyzer and RNFL thickness measurement with optic nerve tracking optical coherence tomography (ONT-OCT; OCT/SLO, OTI, Toronto, Ont., Canada) were performed. RESULTS: Among 116 eyes with POAG [58 patients, 32 males, 26 females, mean age 62 (46-71) years], RNFL was reduced in 87 eyes (75%, p = 0.05) when compared with the control group, and a good correlation was found between RNFL thickness and VF abnormalities (Spearman's rho 0.822; p = 0.001). Among 60 eyes [30 patients, 12 males, 18 females, mean age 56 (50-69) years] with GO and OHT, nonglaucomatous diffuse abnormalities of the VF were detected in 44 eyes (73.3%, p = 0.03), while RNFL thinning was present in 14 eyes (9 patients, 23.3%, p = 0.03). No correlation was found between RNFL thickness and VF abnormalities (Spearman's rho 0.365; p = 0.02). No significant differences in RNFL pattern were present between the group with GO, OHT and RNFL thinning and the group with POAG. CONCLUSIONS: In patients with GO and OHT, evaluation of RNFL thickness with ONT-OCT may represent an objective diagnostic technique for detecting optic neuropathy

[A chart for low visual acuities: experience in a center for low vision and rehabilitation].

Commonly used visual test charts can be used to measure 1-m minimal visual acuities (VA) of 20/1000 (Snellen chart) and 1/40 (Early Treatment of Diabetic Retinopathy Study [ETDRS] charts)

Combination of flavonoids with Centella asiatica and Melilotus for diabetic cystoid macular edema without macular thickening.

Purpose: The purpose of this study was to evaluate the orally administered combination of flavonoids desmin and troxerutin with Centella asiatica and Melilotus for the treatment of diabetic cystoid macular edema (CME) without macular thickening. Methods: In this prospective, interventional, controlled study, 40 consecutive patients with type 2 diabetes and CME without macular thickening at optical coherence tomography were randomized into 2 groups of 20 subjects each (treatment and control groups). The treatment group received an oral combination of desmin (300 mg/day) and troxerutin (300 mg/day) with C. asiatica (30mg/die) and Melilotus (160 mg/die) for 14 months. Best collected visual acuity, central retinal thickness at optical coherence tomography, retinal sensitivity (RS), and stability of fixation at microperimetry were measured at baseline and monthly for 14 months. Results: In both groups, mean best collected visual acuity, central retinal thickness, and stability of fixation did not show differences during follow-up (P > 0.05). At month 14, the RS was greater in the treated group (P=0.01) and was significantly reduced in the control group only (P < 0.001). Five eyes in the study group showed disappearance of the intraretinal cysts after a mean time of 3.5 +/- 0.3 months, which persisted in the following months. These 5 eyes presented a greater RS at each follow-up visit when compared with the control group (P < 0.05). Anatomic improvement was never reported in the control group. Conclusions: The orally administered combination of flavonoids, C. asiatica, and Melilotus could be beneficial in preserving RS in diabetic CME without macular thickening

Long-Term Follow-Up of Oral Administration of Flavonoids, Centella asiatica and Melilotus, for Diabetic Cystoid Macular Edema Without Macular Thickening.

To evaluate long-term follow-up of the orally administered combination of flavonoids with Centella asiatica and Melilotus for treatment of diabetic cystoid macular edema (CME) without macular thickening. Methods: Seventy consecutive patients with type 2 diabetes and CME without macular thickening at optical coherence tomography (OCT) were prospectively and randomly enrolled in two groups of 35 subjects each (treatment and control groups). Patients in the treatment group were treated with an oral combination of diosmin (300 mg/day), with C. asiatica (15 mg/day) and Melilotus (160 mg/day). All patients underwent a complete ophthalmologic examination, OCT (Spectralis HRA-OCT), and central microperimetry (SD-SLO/OCT) at baseline, month 3, month 6, month 12, month 24, and month 36. Results: No differences in HbAc1 percentage, blood pressure, microalbuminuria, visual acuity, mean central retinal thickness, and stability of fixation were present between the two groups during follow up (p>0.05). Retinal sensitivity reduced in the control group only from month 6 until month 36 (p<0.001). In the treatment group, a greater retinal sensitivity was present at month 12, month 24, and month 36 (p=0.001). No side effects of treatment were observed. Conclusion: Oral administration of flavonoids, C. asiatica and Melilotus, in patients with CME without macular thickening provided preservation of retinal sensitivity during 36 months of follow up when compared with untreated patients

Retinal Micropseudocysts in Diabetic Retinopathy: Prospective Functional and Anatomic Evaluation.

Aim: To evaluate the prevalence, progression and functional predictive value of retinal micropseudocysts (MPCs) in diabetic patients. Methods: Prospective controlled observational study. From among all the type 2 diabetic patients evaluated during a period of 5 months between September 2009 and January 2010, we enrolled all patients with retinal MPCs at spectral-domain scanning laser ophthalmoscope/optical coherence tomography (SD-SLO/OCT) not previously treated for diabetic retinopathy. Forty diabetic patients without MPCs served as the control group. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), macular sensitivity and stability of fixation at SD-SLO/OCT microperimetry were measured monthly for 12 months. Results: 22/156 patients with type 2 diabetes (14.1%, 32 eyes) met the inclusion criteria. The 95% confidence interval for the prevalence estimate of MPCs was 12.3-16.6%. Mean BCVA, CRT and central retinal sensitivity at baseline were 77.53 2.2 Early Treatment Diabetic Retinopathy Study letters, 242.31 31.0 m and 15.95 0.61 dB, respectively. Fixation was stable in all cases. Compared to the control group, eyes with MPCs had similar BCVA but greater CRT (p = 0.01) and reduced macular sensitivity (p = 0.001) at baseline and at each follow-up visit. Over time, CRT remained stable in eyes with MPCs, whereas macular sensitivity progressively decreased. Conclusion: MPCs in diabetic retinopathy are associated, temporally or causally, with a progressive reduction of macular sensitivity despite a stable BCVA, CRT and fixation