Disfigurement Research Articles

Skin Scarred by Structural Violence

This article examines the facial disfigurement caused by vitriolage or acid attacks, and unravels the aesthetics of the disfigured faces by exploring their visually signified materiality, which divulges alternative aesthetics, jarring the viewers into a state of abjection. It unfolds the commonalities between acid-attack survivors and disabled people, given the physical, psychological, and social consequences which led to the inclusion of women acid attack survivors into the category of disability in the RPWD Act 2016 in India. This research probes into three major critical interventions: first, it scrutinises the relation between vitriolage and structural violence; second, it studies its cause and effect through the close textual analysis of select texts, Priya’s Mirror (a graphic novel) and Chhapaak (a Bollywood movie); and third, it delves into the nuances of appearance impairment, and its isolating and disabling effects. Succinctly, this research uncovers the multiple aspects of acid violence in the Indian context by studying the select texts as a cultural archive and, through their respective visual narratives, attempts to inquire about the previously concealed or overlooked corporeality of women acid attack survivors.

Multi-Center Outcome Analysis of 16 Face Transplantations – A Retrospective OPTN Study

Facial Vascularized Composite Allotransplantation (fVCA) restores form and function for patients with severe facial disfigurements, yet multi-center outcome data remain scarce. We accessed the Organ Procurement and Transplantation Network (OPTN) database from 2008 to 2024 to identify all full- or partial-face fVCA recipients, excluding patients under 18 years and those with physiologically impossible BMIs. Of 25 identified patients, 16 (64%) met inclusion criteria (69% male; mean age 43 ± 14 years). Recipients experienced a median of 5 [IQR 0.0–10] acute rejection episodes, which correlated with inotrope use during donor procurement (p = 0.033). On average, patients were hospitalized 2.4 ± 1.8 times, with arginine vasopressin (AVP) administration linked to fewer hospitalizations (p = 0.035). Seven recipients (44%) experienced complications, and extended-criteria donor (ECD) status was associated with higher complication rates (p = 0.049). These findings underscore the promise of fVCA to address complex facial defects while identifying key risk factors—particularly inotrope use and ECD status, while AVP administration may mitigate hospital stays. Further studies with larger cohorts are warranted to refine perioperative strategies, improve outcomes, and expand the clinical utility of fVCA.

Quick identification and preservation of facial nerve using only posterior belly of digastric muscle

Parotid glands are the largest salivary glands separated into two lobes by the neurovascular plane of the facial nerve. Superficial or total parotidectomy is considered the best therapeutic option for different Parotid lesions. There are various key indicators for locating the anatomical landmarks of the facial nerve in either anterograde or retrograde manner or using nerve monitoring, microscope, gamma probe etc. The Aim here is to promptly detect and preserve the facial nerve trunk and its terminal branches during parotid surgery with using only the posterior belly of the Digastric muscle aided with microscope. This is a one-year prospective observational study of 19 cases undergoing parotidectomy. The time taken to find the facial nerve trunk and its distance from the posterior belly of the digastric muscle were documented intraoperatively followed by post-surgery cranial nerve VII’ examinations. The “facial nerve” was satisfactorily preserved in 16 out of 19 (84.21%) cases with sole usage of the “posterior belly of the digastric muscle.” The mean time to identify the FNT was calculated as: 21.78 mins. The average distance of the FNT from the anterior border of the PBDM was estimated as 6.44mm. Prompt exposure of the PBDM, followed by locating the FNT just at a distance of 6.5 mm anteromedial to PBDM, can be done within 20-22 minutes, which is found to be the quickest and easiest method to identify and preserve the facial nerve with pes anserinus using PBDM as the robust indicator, preventing facial disfigurement and mental stress to the patient.

Noma in a Pacient whitout Sistemic Involvement

Noma, also known as Cancrum oris or gangrenous stomatitis, is an infectious disease of bacterial origin, often in association with other microorganisms, affecting orofacial tissues and manifesting through a sequence of precursors. It begins as necrotizing gingivitis and progresses to necrotizing periodontitis and necrotizing stomatitis. In advanced stages, it can lead to facial mutilations, difficulty in eating, and psychological distress due to social stigma. Untreated, it can result in a mortality rate of up to 90%, mainly due to septicemia, dehydration, and malnutrition. When addressed early, the prognosis is favorable, and by treating its precursors, it is challenging to reach severe stages. The disease is often associated with children in impoverished social conditions, weakened immune systems, and malnutrition, especially in regions with low human development indices, such as sub-Saharan Africa, although some cases have been reported elsewhere. Treatment involves several phases, including debridement of necrotic areas, antibiotics, antimicrobial mouth rinses, and supportive periodontal therapy. Despite its rarity, infection can also occur in developed countries and affect adult patients, sometimes without underlying health conditions. The aim of this article is to report a clinical case of noma in a 31-year-old man, without systemic involvement, who sought treatment at the Maria Aparecida Pedrossian University Hospital in Campo Grande, Mato Grosso do Sul, Brazil, due to swelling in the submental region. After hospitalization, biofilm control and postoperative care, there was a satisfactory improvement in the clinical condition.

Impact of Face Mask-Wearing on Quality of Life in Post-Surgical Oral Cancer Patients: A Cross-Sectional Study.

Background: Treatments for oral squamous cell carcinomas (OSCCs) often result in significant aesthetic and functional issues, impacting patients' quality of life (QoL). The COVID-19 pandemic's mask mandates may have provided psychosocial benefits by concealing facial disfigurements, potentially reducing stigma. This study aimed to assess the impact of mask-wearing on the QoL of patients surgically treated for OSCC. Methods: This single-center, cross-sectional study, conducted from June 2022 to December 2023, included patients who had completed their treatment and returned home before or during the mask-wearing mandate. They answered a questionnaire using a four-point Likert scale to evaluate the mask-wearing's impact on QoL and the influence on it of physical appearance, tumor localization, radiotherapy, and treatment end date. Results: The questionnaire analysis found a high internal consistency among the questions (Cronbach's alpha = 0.931). Considering 41 patients (median age 69, 63% male), wearing a mask significantly improved QoL, with a mean score of 1.66 compared to a score of 2.00 for patients not wearing it (p < 0.001). This improvement was particularly notable for appearance concerns, fear of perception by family or others, and sociability apprehension. The QoL, with or without mask use, was not significantly modified when considering physical appearance, tumor localization, radiotherapy, or end date of the treatment, as demonstrated by two-way ANOVA tests and multiple linear regression. Conclusions: Mask-wearing positively impacted QoL in OSCC patients, providing psychological relief from disfigurement and social stigma. Masks offer a simple, accessible solution to enhance QoL while awaiting a definitive prosthetic treatment, suggesting that their continued use could be beneficial in supportive care strategies.

Management of Traumatic Undiagnosed Condyle Fracture in Children

Background: Condyle trauma is considered to be the major cause of TMJ ankylosis but it is also the most neglected and under-managed problem in children. ?TMJ ankylosis leads to be malocclusion and facial disfigurement. The aim of early treatment is to restore the mandibular mobility and to enhance further growth in order to reduce the possibility of future facial asymmetry. Patients and Methods: We report two patients with inability to open mouth few months following injury. They most probably suffered missed diagnosis condyle fracture by the previous physician. The latest physical examination and radiological finding shows the mandible was micrognathic and unilateral TMJ ankylosis was confirmed. A sequential protocol of TMJ ankylosis management based on aggressive resection of ankylotic mass was performed and followed withphysiotherapy.Result: In 2 month-follow up, both patients showed significant improvement in mouth opening and the mastication function was restored, accompanied with physical therapy to gain maximum mouth opening for at least a year.Summary: A detail history, clinical and functional examination, radiographic examination facilitating correct diagnosis followed by immediate surgical intervention, and physiotherapy can help us to restore physical, psychological, and emotional health of the child patient.

Resurgence of Noma (Cancrum Oris) in Nigeria.

Recent data from Médecins Sans Frontières and local health authorities highlight a concerning rise in noma cases across previously unaffected Nigerian states. Noma is a severe gangrenous disease affecting impoverished populations, causing severe facial disfigurement and high mortality rates, especially among children. Despite its eradication in developed regions, sub-Saharan Africa faces an escalating noma incidence. This communication highlights the urgent need for enhanced surveillance, awareness, regional treatment centers, and international support to mitigate its impact in Nigeria and avoid exacerbation of the condition across sub-Saharan Africa.

A Case Report of Mesenteric Panniculitis and Fibrous Dysplasia with Primary Metabolic Syndrome.

Mesenteric panniculitis (MP) is a rare clinically diagnosed disease resulting from fibro-inflammation in the intestinal adipose tissue. Precedent intra-abdominal inflammation or trauma is often evident. Fibrous dysplasia (FD) is a benign uncommon childhood disease of the bones, with fibrous connective tissue replacing bone tissue. FD can cause pain, disfigurement, and entrapment of critical neighbouring structures. Adult-onset craniofacial involvement is rare. Metabolic syndrome is characterized by obesity and chronic subclinical inflammation, promoting abnormal cellular fibrosis and proliferation. The concomitant incidence of MP and FD in an older female adult with metabolic syndrome is unprecedented. An aberrant metabolic contributory pathophysiology for both MP and FD could be postulated. A 60-year-old Caucasian woman with primary long-standing well-treated metabolic syndrome with obesity presented for revision bariatric surgery. She had previous intra-abdominal surgeries and occasional intermittent abdominal pain. The surgery was abandoned due to extensively inflamed intestinal mesentery. Radiological studies and intra-abdominal biopsy confirmed MP. She subsequently developed pronounced unilateral facial swelling and radiological studies confirmed FD. Treatment has been suboptimal for both MP and FD. She developed venous thromboembolism on tamoxifen treatment for MP. The patient currently reports abdominal pain and swelling from MP, and facial disfigurement, pain, and tinnitus from FD. Blood markers for inflammation have remained consistently high, and there is statin intolerance. Most recently liver steatosis and diabetes have developed. A case of MP and FD with primary metabolic syndrome is unique. An increased awareness of such rare cases could lead to further research, and critically needed treatments to optimize outcomes. Mesenteric panniculitis (MP) is a rare disease as is craniofacial fibrous dysplasia (FD) in adults. The incidence of these two rare diseases in an older adult with primary metabolic syndrome is previously unknown, making this case the first of its kind.Metabolic syndrome is common condition of the industrialized population, and an aberrant common "systemic" metabolic pathophysiology could contribute significantly to the inflammatory and fibrotic cellular changes inherent to both these two localized diseases of MP and FD.Knowledge about rare diseases, particularly if clustered with a primary systemic disease, could lead to better treatment outcomes in the future and promote novel therapeutic targets.

Limbal dermoid in right eye in an infant: a case report

Limbal dermoids are congenital, benign tumors located at the corneoscleral junction, often associated with ocular surface abnormalities and potential facial disfigurement. They can vary in size and impact visual development depending on their location and extent. This case report describes an infant presenting with a mass growth in the right eye (RE) accompanied by facial disfigurement. The infant underwent a clinical examination, which confirmed the presence of a limbal dermoid in the right eye. The physician's management plan included initiating patching therapy for the left eye (LE) for 2 hours daily to stimulate visual development in the affected eye and to prevent amblyopia. A review was scheduled for 6 months later to monitor the dermoid's growth and assess visual acuity. Conservative management with regular monitoring was deemed appropriate due to the benign nature of the limbal dermoid and the absence of significant refractive error.

The Influence of Facial Injury during the First World War on the Development of Plastic and Reconstructive Surgery in Britain and Germany.

In the First World War (WW1), different types of injuries became both political and economic factors for the main belligerent countries. This work illustrates the special role facial injuries played during and after the war and the profound impact they had on the field of Plastic Surgery in Britain and Germany.This is a historical work based on primary and secondary sources. English and German material was used to compile an overview of the development of Plastic and Reconstructive Surgery as a specialty during WW1 and up to the Second World War (WW2).Plastic and Reconstructive Surgery had the task of reconstructing male beauty and personalities, restoring the most intense, disfigured reminders of a terrible war in homes and the public. Looking at the significant role the specialty played during the war, remarkably, most of the contributors struggled to find financial support to develop designated specialized departments in the inter-war period. The specialty's connection to the emotional subject of facial disfigurement did not work in its favor at a time when people wanted to forget the horrors of the war.The developments in Britain and Germany during the WW1 were less isolated than often described and the inter-war period saw much effort for international collaboration. The different developments of WW2 further illustrate how essential the efforts of a strong group of individuals and support from authorities were for the evolution of Plastic Surgery as a specialty.

In the eye and mind of the beholder: The effects of familiarisation on the perception of atypical infant facial configurations.

Perception of infant faces plays a crucial role in adult-infant caretaking behaviour, with adults being found to demonstrate a reliable attraction towards infant faces over other stimuli. When affected by a congenital facial malformation such as cleft lip and/or palate, however, adults' visual scanning patterns and subjective appraisal of these faces have been found to be adversely affected. Little past work has explored how an observer's prior experience with this specific malformation might play a role in the perception of cleft-affected infant faces. To this end, two groups of adult female participants were recruited and presented with 48 images of infant faces (24 typical, 24 cleft-affected) with one group subjected to novel, purpose-built familiarisation training, where participants were exposed to infant cleft lip/palate related visual and informational stimuli prior to testing (n = 43). Eye gaze patterns and subjective "cuteness" ratings from this group were compared with an age matched control group which received no training (n = 41). No between group differences were found for "cuteness" ratings or eye gaze patterns to the cleft-affected mouth area in isolation, however, a significant negative relationship was found between gaze duration to the mouth region of cleft-affected images and subjective "cuteness" ratings, for control participants only. Notably, this relationship was not observed for the familiarised participants, suggesting their modified prior experience attenuated the effect that visual processing had on subjective appraisal of cleft-affected faces, when these two factors were assessed in tandem. Our findings suggest it is possible to attenuate the typically observed aversive behaviour towards cleft-affected infant faces. This may have implications for clinical practice concerned with supporting adult caretaking of malformation-affected infants and policies related to increasing positive perception of congenital facial disfigurement.

12231 PAPP-A As A Potential Target In Thyroid Eye Disease

Abstract Disclosure: C.A. Conover: None. L.K. Bale: None. D. Hamadi: None. M. Stan: ; Tourmaline, Genentech, Third Rock Ventures, ArgenX, Septerna, OrthoDi. ; Horizon, Immunovant, Lassen, Sling. Background: Proptosis in Thyroid Eye Disease (TED) can result in facial disfigurement and visual dysfunction. Studies revealed an interaction between thyroid-stimulating hormone receptor (TSHR) and insulin-like growth factor-I receptor (IGF-IR) that is essential in promoting TED pathogenesis. Treatment with Insulin-like growth factor I receptor (IGF-IR) inhibitors has been shown to be effective in reducing proptosis but with side effects. PAPP-A is metalloprotease that can increase pericellular IGF bioavailability through specific cleavage of inhibitory IGF binding proteins, in particular IGFBP-4. We propose that inhibition of IGF-IR indirectly and more selectively with PAPP-A inhibitory antibodies attenuates IGF-IR signaling in TED with fewer side effects. Methods: Informed consent was obtained from TED patients undergoing surgery in Mayo Clinic operating suites in Rochester, MN. Retro-orbital tissue was collected from 19 TED patients and 2 control subjects for fibroblast isolation and culture and was performed in a sterile tissue culture facility. TED and control fibroblasts were treated with pro-inflammatory cytokines, and flow separation of CD34- and CD34+ orbital fibroblasts was done, the latter representing infiltrating fibrocytes into the orbit in TED. Main outcome measured were PAPP-A expression and proteolytic activity, IGF-I stimulation of phosphatidylinositol 3 kinase/Akt pathway and inhibition by immuno-neutralizing antibodies against PAPP-A, CD34+ status and associated PAPP-A and IGF-IR expression. Results: Primary cultured cells showed that PAPP-A is expressed in orbital fibroblasts from TED patients but not in control subject fibroblasts and were markedly increased by pro-inflammatory cytokines stimulation. IGF-IR expression was not affected by cytokine treatment. Inhibition of PAPP-A’s proteolytic activity suppressed IGF-IR activation in orbital fibroblasts from TED patients. CD34+ orbital fibroblasts represent 80% of cells in culture from TED patients, and approximately 70% of these cells were accountable for PAPP-A and IGF-IR expression. Conclusion: These results support a role for PAPP-A in TED pathogenesis and indicate the potential for novel therapeutic targeting of the IGF axis. Presentation: 6/2/2024

Conjunctival Melanoma: A Clinical Review and Update.

Conjunctival melanoma (Co-M) is an aggressive, invasive eye and eyelid cancer. Its global incidence of ~1 in a million is increasing at a rate ratio of ~1.4, but this rises sharply in over 65-year-olds. Although rare, Co-M has a devastating impact on the lives of those who develop it. Co-M is often misdiagnosed or overlooked, leading to vision loss either from the destructive effects of the tumour or side effects of therapy, facial disfigurement from radical surgery, and death from metastases. Due to its rarity, there is limited evidence for diagnosis and management; hence, there is no standardised treatment and not all cases are referred to a specialised ocular oncology centre. Recent progress in cancer immunology and genetics have revolutionised the treatment of cutaneous melanomas, which share some similarities to Co-M. Importantly, a better understanding of Co-M and its precursor lesions is urgently needed to lead to the development of novel targeted and immunotherapies both for local tumour control and disseminated disease. This review aims to provide a comprehensive clinical overview of the current knowledge regarding Co-M, its epidemiology, pathogenesis, presentation, diagnosis and recent changes in the classification of its precursor lesions, management, and recent advances in novel biological therapies for personalised treatment of this disease.

Cleft lip and palate surgery in the Otolaryngology and Head-neck surgery department of a Medical College Hospital in Bangladesh

Background: Cleft lip and palate (CLP) are one of the most common developmental anomalies in orofacial region. CLP surgery lies in the anatomical domain of Ear Nose Throat and Head - Neck Surgery. In Bangladesh specialty of plastic surgery is still in developing stage and plastic surgeons are not easily available everywhere. ENT and Head-Neck surgeon had to take up the responsibility of some of cleft patients. This article is a retrospective analysis of a series of 200 cases of cheiloplasty and palatoplasty done in ENT and Head-Neck Surgery department of Khulna City Medical College Hospital, Bangladesh. Results were satisfactory in our, patient and parent's consideration. Objective: Our aim is to discuss the demographic profile, presentations, degree &amp; type of cleft and outcome of CLP surgery in Otolaryngology and Head-Neck Surgery department of a Medical College Hospital of Bangladesh. We will also discuss the embryology of face &amp; historical background of the cleft surgery. Materials and Methods: This is a retrospective analysis of CLP surgery for 200 cleft patients. We based on inclusion and exclusion criteria for selection of patients. Majority of cleft lip patients were operated following the Millard modified rotation advancement technique and isolated cleft palate patients were operated following Von Langenbeck bipedicle flap and Veau-Wardil-Kilner V-Y pushback technique in the ENT and Head-Neck Surgery Department of a Medical College Hospital. Patients were advised for periodic follow up. Results: Total of 200 patients of CLP were operated in our department out of which male was 92 (46%) and female was108 (54%)), male and female ratio being 1:1.08. The age range was 3 months to 40 years with a mean of 8.38 years. Pre alveolar group both male and female comprised of 134 (67%) and alveolar group 66 (33%) patients and that of isolated cleft palate 7 (10.60%) patients. Pre alveolar unilateral CLP was high. The results of surgery were satisfactory in our postoperative evaluation. Patients and parents were also satisfied with the outcome. Conclusion: Majority of CLP patients don’t suffer functional problem apart from facial disfigurement. Restoration of normal anatomy, facial appearance and function can be achieved by surgery in appropriate time and age. Few cases may be associated with feeding difficulties, dental and hearing problems. Some cases are associated with other congenital anomalies and syndromes. Those cases demand team approach of different specialty.

Post-traumatic stress disorder in maxillofacial trauma victims- A systematic review and meta-analysis

BackgroundMaxillofacial trauma often results in visible facial disfigurements and can lead to psychological complications such as post-traumatic stress disorder (PTSD). However, PTSD often remains unrecognized and un/undertreated. The goal of the current systematic review was to determine the incidence of PTSD after maxillofacial trauma, associated risk factors, assessment tools employed, and management. MethodsA literature search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library databases following PRISMA guidelines up to March 2024. Collected variables included the number of patients included, PSTD assessment tool, PTSD incidence, and risk factors and management. The meta-analysis was conducted using random effect models in STATA 16. ResultsThe review included 14 studies (1633 patients, male=1025, female=230, not mentioned=378). Assessment tools varied widely among studies. Meta-analysis revealed a pooled incidence of PTSD of 27 % (n = 14, 95 % CI, 24 %-30 %) at 1–3 months post-trauma and 10 % (n = 3, 95 % CI, 3 %-17 %) at the 6–12 months follow-up, with a statistically significant 60 % reduction between these periods. ConclusionThe overall incidence of PTSD following maxillofacial trauma was 27 % at 1–3 months and decreased to 10 % after 6 months. The emphasis should be given to the importance of early intervention strategies and awareness among the treating surgeon to prevent PTSD.

The Politics of Ear Mutilation: Cropping an Enslaved Person in the Gospel Passion Narratives

This article challenges a slaveholder perspective of the treatment of the high priest’s enslaved agent in the canonical gospels. It seeks to demonstrate how ancient traditions and practices of ear cropping and facial mutilation, especially of enslaved folks, give insight into the significance of the enslaved agent’s treatment in the gospels. Far from being a mere plot device, the enslaved person who is maimed is a site of political knowledge that has simultaneous implications for our understanding of the enslaved agent themselves, the mutilating disciple, and Jesus. While the vast majority of interpreters of the passage view the maiming of Malchus’s ear as unimportant, a close analysis of contexts where ears are mutilated, maimed, and cropped provides a useful framework for rereading the episode in each of the gospels. After analyzing the contexts of ear cropping, from ancient Southwest Asia to second-century literature, I re-read each version of the episode from a narrative-critical point of view. In light of ancient accounts of cropping and mutilation, I find that the mutilating disciple’s behavior in the gospels was not heroic, that the enslaved person retains no agency, and that Jesus is complicit in the disciple’s actions against the high-priest’s agent.

Prosthetic Rehabilitation of a Hemi-mandibulectomy Patient with Interim Mandibular Guide Flange and Maxillary Twin Occlusion: A Case Report

ABSTRACT In hemi-mandibulectomy patients, the fabrication of a successful prosthesis is a challenging task. Segmental resection of the mandible causes deviation toward the resected side resulting in facial disfigurement, difficulty in speech, mastication, swallowing, respiration, and restricted mandibular movements. Such a condition affects the daily life of the patient and might also result in a disturbed psychological state. The primary goal of treating these patients was to achieve facial aesthetics and restore function and phonetics. Such a scenario can be tackled more efficiently with good patient cooperation and a well-fabricated prosthesis.

Electrophysiological Changes in Patients with Postoperative Cross-facial Nerve Graft in a Tertiary Care Center.

Facial nerve palsy is a multifaceted pathology that causes facial disfigurement, affecting eye closure, speech articulation, oral competence, and emotional expression, with functional, aesthetic, and psychological consequences. Standardized electrophysiological tests, such as electroneurography and electromyography, allow an objective evaluation of the functional state of the nerve. Here, we aimed to compare and correlate clinical findings with electromyography in patients with facial nerve palsy, before and after facial nerve reanimation with cross-facial nerve grafts. Eight patients with traumatic or nontraumatic facial paralysis with complete clinical records who underwent surgical reanimation of facial nerve with cross nerve grafts. The median time from diagnosis to treatment was 173 days (interquartile range = 222). Outcomes were evaluated using standard clinical scales (House-Brackmann, Sunnybrook, and eFACE) and electromyography. The median time for postoperative outcome evaluation was 768 days (interquartile range = 1053). A statistically significant difference was found between pre- and postoperative outcomes according to eFACE (Δ median = 13, P = 0.003), House-Brackmann (Δ median = -2, P = 0.008), and electromyography (Δ mean = 855, P = 0.005). A positive correlation between electromyography and clinical evaluation with eFACE was observed (r = 0.751, 95% confidence interval = 0.174-0.944, P = 0.019). Our results suggest that cross nerve grafts are associated with clinical and electromyographic improvement of the paralyzed face. Electromyography and eFACE scores validate the reliability of eFACE scale for measuring postoperative outcomes. We suggest postoperative electromyography as an objective measure of postoperative evaluation in patients with a delay in improvement at 6-9 months.

Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province.

In sub-Saharan Africa, ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour and is strongly associated with HIV infection. This range of ocular malignancies can be managed early to prevent large tumours requiring invasive treatment, facial disfigurement and mortality. Primary healthcare workers (HCWs) play a critical role in the early identification of the lesion. In addition, the ocular lesion can also be the presenting sign of HIV infection in individuals who have not yet been diagnosed. The aim of the present study was to assess the management of suspicious conjunctival growths in HIV-infected patients in primary health facilities and a specialist eye clinic in South Africa. To assess the knowledge, attitude and current practice of HCWs working in HIV clinics regarding ocular surface lesions and to evaluate the management of patients with ocular surface lesions at a tertiary hospital. A cross-sectional study design was used (November 2020 - May 2021), for which 149 HCWs were invited to assessments about their knowledge, attitudes and practices regarding ocular surface lesions. In addition, files of patients with ocular surface lesions who presented between January 2018 and August 2020 to the eye clinic were reviewed using a data extraction sheet. One hundred-and-three HCWs agreed to participate in the survey (response rate 69.1%). Of these participants, 84.5% were experienced professional nurses (6 - 15 years of work experience) but had minimal experience with detection and management of eye complaints and lesions. Twenty-seven (26.2%) of the participants recognised some ocular surface lesions and 86 (83.5%) reported that they would refer patients with suspicious lesions. Sixty-two files were reviewed and 51 (82.2%) of the patients had an HIV-positive diagnosis. Fifty percent had carcinoma-in situ and squamous cell carcinoma of the conjunctiva. Thirty-one (50%) of the patients were lost to follow-up. OSSN is an important manifestation of HIV infection. It would be beneficial for patients to receive a basic ocular examination as part of the baseline clinical evaluation; this may contribute to early referral to an eye care facility. The health system would benefit from establishing an eye health support system with the nearby health facilities, thereby educating primary HCWs about the association between HIV and OSSN.

Aconite-Induced Metamorphosis From Beauty to Ugliness in a Japanese Tale.

The authors present a narrative that details the cause and process of a woman's transformation from beauty to ugliness in a Japanese tale. In " Tokaido Yotsuya Kaidan ," the metamorphosis from a beauty to an ugly woman is analyzed. After taking medication to recover from childbirth, Oiwa's face became disfigured and grotesque. Oiwa: It seems to be good for my blood, but when I drink it, it causes fraying and breakdown, causing sudden pain. I feel a numbing dullness. When she looked at herself in the mirror, she was shocked. Oiwa: What's wrong with my face? I hate this, it's such a disgusting thing. Neighbor: It was a lie that the medicine you drank was a helpful medicine that protects the appearance of people's faces. Your face is that of a wicked woman (). Oiwa: Is it really me? Why does she have the face of an evil woman? Her hair falls out in a gruesome combing scene, driving her mad. The poison Oiwa took was aconite, which grows wild in Japan. Both aconite tincture and raw aconite roots contain high concentrations of Aconitum alkaloids, which can penetrate the stratum corneum following the diffusion gradient. As her hair fell out during a horrific combing session, she abandoned her maternal role and sought revenge, having lost what she considered a symbol of her femininity. In treating female patients with facial disfigurement, it is important to be mindful of their psychological state, akin to that of Oiwa, who became disfigured through no fault of her own.