Lateral Orbital Rim Research Articles

Comparative Three-dimensional Analysis of Facial Lifting Effects across Five Aesthetic Units following Continuous Radiation 115-Watt 6.78-MHz Monopolar Radiofrequency Therapy.

Modern aesthetic trends favor noninvasive facelift procedures, shifting away from traditional surgery. This study explores the three-dimensional evaluation of facial lifting across aesthetic units using the VolNewMer (VNM) device after continuous 115-W 6.78-MHz monopolar radiofrequency (RF) therapy. A cohort of 30 Korean women underwent VNM treatment with a detailed protocol, including energy levels, cooling techniques, and stem cell media application. Lifting amount was analyzed using a three-dimensional scanner with computer program in five specific areas, including the forehead, lateral orbital rim, mid-face, low-face, and neck areas. The changes in Global Aesthetic Improvement Scale for skin texture, tightening, and lifting were surveyed. Immediate and sustained improvement was observed in the mid-cheeks and lower face area. The lifting amount of facial mid-cheek areas was 1.88 ± 0.76 mm, whereas the lifting amount of lower face areas was 1.79 ± 0.91, lateral orbital rim areas was 1.62 ± 0.99, forehead areas was 1.46 ± 1.26, and neck areas was 2.66 ± 1.40 mm immediately after the procedure. The lifting amount of mid-cheek areas was 1.93 ± 0.90 mm, whereas lower face areas was 1.67 ± 1.04, lateral orbital rim areas was 1.58 ± .072, forehead areas was 1.31 ± 0.73, and neck areas was 2.80 ± 0.78 mm 1 month after the procedure. RF treatment is emerging as a recommended noninvasive procedure for facial lifting. VNM-RF treatment showed a significant lifting effect immediately after the procedure, and the lifting effect continued 1 month later (P < 0.05). Global Aesthetic Improvement Scale skin texture was more satisfying 1 month later than immediately after, suggesting a potential correlation with collagen regeneration, indicating a lasting effect over time.

The Endoscopic Transorbital Approach for Vascular Surgery: An Anterior Circulation Anatomic Study, 2-Dimensional Operative Video.

Minimally invasive endoscopic approaches in cranial base surgery have been developing in the past decades. The transorbital (TO) route is one promising alternative, yet its adequacy for intracranial vascular lesions remains unclear. The present anatomic work aimed to test the feasibility and to provide a qualitative description of the endoscopic TO approach for the anterior circulation, namely the internal carotid artery and the middle cerebral artery. Seven embalmed adult cadaveric specimens (12 sides) were used in the study. Each side was approached in 3 successive steps: (1) Superior-eyelid TO approach, with great and lesser sphenoid wing removal. (2) Removal of anterior clinoid process (ACP). (3) Removal of the lateral orbital rim. All the procedures were performed under endoscopic view. The TO approach without removing the ACP allowed to dissect the sphenoidal and lateral segments of the Sylvian fissure with an adequate identification of the middle cerebral artery bifurcation in all specimens. The removal of the ACP allowed further dissection toward the opticocarotid cistern, with the identification of the ophthalmic, posterior communicating, and the anterior choroidal arteries. The internal carotid artery bifurcation and A1 segment were also readily identified. Finally, removal of the lateral orbital rim provided a wider and more comfortable access to the above-mentioned vascular structures. According to our anatomic data, the TO approach can be used to reach the main vascular components of the anterior circulation. This opens the field for exploring its application in the treatment of vascular pathology, particularly aneurysms.

Transorbital approach to the cavernous sinus: an anatomical study of the related cranial nerves.

The cavernous sinus (CS) is a demanding surgical territory, given its deep location and the involvement of multiple neurovascular structures. Subjected to recurrent discussion on the optimal surgical access, the endoscopic transorbital approach has been recently proposed as a feasible route for selected lesions in the lateral CS. Still, for this technique to safely evolve and consolidate, a comprehensive anatomical description of involved cranial nerves, dural ligaments, and arterial relations is needed. Detailed anatomical description of the CS, the course of III, IV, VI, and V cranial nerves, and C3-C7 segments of the carotid artery, all described from the ventrolateral endoscopic transorbital perspective. Five embalmed human cadaveric heads (10 sides) were dissected. An endoscopic transorbital approach with lateral orbital rim removal, anterior clinoidectomy, and petrosectomy was performed. The course of the upper cranial nerves was followed from their apparent origin in the brainstem, through the middle fossa or cavernous sinus, and up to their entrance to the orbit. Neuronavigation was used to follow the course of the nerves and to measure their length of surgical exposure. The transorbital approach allowed us to visualize the lateral wall of the CS, with cranial nerves III, IV, V1-3, and VI. Anterior clinoidectomy and opening of the frontal dura and the oculomotor triangle revealed the complete course of the III nerve, an average of 37 (±2) mm in length. Opening the trigeminal pore and cutting the tentorium permitted to follow the IV nerve from its course around the cerebral peduncle up to the orbit, an average of 54 (±4) mm. Opening the infratrochlear triangle revealed the VI nerve intracavernously and under Gruber's ligament, and the extended petrosectomy allowed us to see its cisternal portion (27 ± 6 mm). The trigeminal root was completely visible and so were its three branches (46 ± 2, 34 ± 3, and 31 ± 1 mm, respectively). Comprehensive anatomic knowledge and extensive surgical expertise are required when addressing the CS. The transorbital corridor exposes most of the cisternal and the complete cavernous course of involved cranial nerves. This anatomical article helps understanding relations of neural, vascular, and dural structures involved in the CS approach, essential to culminating the learning process of transorbital surgery.

Alterations in Sphenoid Anatomy in Craniosynostosis: Implications for Fronto-Orbital Advancement.

Fronto-orbital advancement involves removal of the fronto-orbital bandeau. Visualization of the saw blade is lost as it passes through the fronto-orbital-sphenoid junction (FOSJ), placing the temporal lobe at risk of injury. We aim to provide a 3D analysis of the space surrounding this osteotomy to differentiate various types of craniosynostoses. Retrospective cohort. Institutional. Thirty patients with isolated unicoronal synostosis, nonsyndromic bicoronal synostosis, metopic synostosis, Apert syndrome, Crouzon syndrome, and Muenke syndrome. CT scans conducted between 2 months to 2 years of age were 3D reconstructed to compare craniometrics against normal controls. Craniometrics. The mean bone thickness of the FOSJ at the level of the supraorbital rim was significantly small for the Apert, unicoronal and bicoronal groups. The mean vertical height of the middle cranial fossa from the lesser sphenoid wing was significantly greater in the unicoronal group. The mean vertical height of the tip of the temporal lobe from the lateral sphenoid ridge was greater in the unicoronal, isolated bicoronal, and Apert groups. The mean corneal protrusion beyond the lateral orbital rim was significantly greater in the Apert and unicoronal groups. The mean horizontal depth of the orbit was smallest in the Apert group. The mean vertical distance between the dacryon and the foramen cecum, and the mean volume of temporal lobe beneath the sphenoid shelf were the largest in the Apert group. Patients with Apert syndrome have the most unfavorable morphology of the anterior and middle cranial fossae.

360° around the orbit: key surgical anatomy of the microsurgical and endoscopic cranio-orbital and orbitocranial approaches.

Several pathologies either invade or arise within the orbit. These include meningiomas, schwannomas, and cavernous hemangiomas among others. Although several studies describing various approaches to the orbit are available, no study describes all cranio-orbital and orbitocranial approaches with clear, surgically oriented anatomical descriptions. As such, this study aimed to provide a comprehensive guide to the microsurgical and endoscopic approaches to and through the orbit. Six formalin-fixed, latex-injected cadaveric head specimens were dissected in the surgical anatomy laboratory at the authors' institution. In each specimen, the following approaches were modularly performed: endoscopic transorbital approaches (ETOAs), including a lateral transorbital approach and a superior eyelid crease approach; endoscopic endonasal approaches (EEAs), including those to the medial orbit and optic canal; and transcranial approaches, including a supraorbital approach, a fronto-orbital approach, and a 3-piece orbito-zygomatic approach. Each pertinent step was 3D photograph-documented with macroscopic and endoscopic techniques as previously described. Endoscopic endonasal approaches to the orbit afforded excellent access to the medial orbit and medial optic canal. Regarding ETOAs, the lateral transorbital approach afforded excellent access to the floor of the middle fossa and, once the lateral orbital rim was removed, the cavernous sinus could be dissected and the petrous apex drilled. The superior eyelid approach provides excellent access to the anterior cranial fossa just superior to the orbit, as well as the dura of the lesser wing of the sphenoid. Craniotomy-based approaches provided excellent access to the anterior and middle cranial fossa and the cavernous sinus, except the supraorbital approach had limited access to the middle fossa. This study outlines the essential surgical steps for major cranio-orbital and orbitocranial approaches. Endoscopic endonasal approaches offer direct medial access, potentially providing bilateral exposure to optic canals. ETOAs serve as both orbital access and as a corridor to surrounding regions. Cranio-orbital approaches follow a lateral-to-medial, superior-to-inferior trajectory, progressively allowing removal of protective bony structures for proportional orbit access.

Consideration of the diameter of superficial temporal arteries related to filler injections in the temporal region.

The concavity of the temple due to adipose tissue atrophy from aging accentuates the zygomatic arch and lateral orbital rim, leading to an aged appearance. The use of hyaluronic acid filler in the temporal region has gained popularity due to its procedural simplicity and consistent outcomes. To evaluate the safety of administering hyaluronic acid filler in the temporal region concerning the frontal branch of the superficial temporal artery, which is at risk of injury. Empirical observations were conducted on the internal diameter of the frontal branch of the superficial temporal artery, a critical anatomical site for potential injury. A significant proportion of the artery segments exhibited an internal diameter below 1 mm. Given that the outer diameter of an 18-gauge cannula is 1.27 mm, this method can be considered a relatively secure approach for enhancing the temporal region. The use of an 18-gauge cannula for hyaluronic acid filler administration in the temporal region appears to be a safe and effective method, with the potential risk to the frontal branch of the superficial temporal artery being minimal.

Optimizing the Endoscopic Transorbital Approach: MacCarty Keyhole for Enhanced Surgical Exposure in the Opticocarotid Region

Background and ObjectiveIn recent years, the endoscopic transorbital approach has gained increasing interest for the treatment of middle cranial fossa lesions. We propose a technical refinement to the conventional superior-eyelid transorbital approach, which improves the surgical exposure and augments the working angles when targeting the opticocarotid region. MethodsFour embalmed adult cadaveric specimens (eight sides) were dissected at the Laboratory of Surgical Neuroanatomy of our institution. A transorbital approach was performed, with removal of the anterior clinoid process (ACP) and the lateral orbital rim. Subsequently, the MacCarty's keyhole was drilled in the superolateral orbital wall. Given that the lesser sphenoid wing was already drilled in the conventional transorbital craniectomy, the opening of the keyhole was essentially a lateral extension of the craniectomy. ResultsThe procedure was successfully conducted in all four orbits. Clinoidectomy was performed either before or after extending the craniectomy to the MacCarty´s point. Extending the craniectomy made anterior clinoidectomy easier, by increasing the surgical exposure, and allowing a more lateral entrance for the endoscope. The extension also facilitated frontal lobe retraction, and it facilitated the optic nerve and carotid artery manipulation. Postoperative CT scans showed a minimal 10 mm craniectomy extension, which remained covered by the temporal muscle after reconstruction. ConclusionThe modified endoscopic transorbital approach with the extension of the craniectomy to MacCarty´s point improves surgical access and visualization of the opticocarotid region. This facilitates anterior clinoidectomy and optic nerve decompression. Although it implies judicious instrument manipulation and a larger incision size, further studies can define its potential benefits.

Interpositional bone graft with cortical and cancellous calvarial bone for addressing the bone gap after reduction malarplasty: a case report

Asians typically exhibit prominent zygomas; therefore, several attempts have been made to reduce these structures to achieve a softer appearance. The intraoral approach is preferred because of its shorter surgical duration and lower invasiveness; however, it is associated with serious complications, such as nonunion. In revisional surgery, the intraoral approach poses limitations in accessing the upper part of the zygoma and the lateral orbital rim area due to its restricted operative field. Therefore, we developed an intraoral interpositional bone graft technique that enabled almost complete reconstruction. A 40-year-old woman presented with persistent depression in the left infraorbital and cheek regions after two revision operations after reduction malarplasty. Based on computed tomography (CT) scan findings, reconstruction using bone grafts was planned. Calvarial bone was harvested and divided into cortical and cancellous parts. The cortical bone was sculpted into an L-shape and inserted into the gap between the maxilla and the lower zygoma body. The hard-to-reach lateral orbital rim area was filled with cancellous bone without fixation. Follow-up CT scans showed that the cortical bone grafts were well-maintained and stabilized with titanium plates, while the cancellous bone had undergone significant resorption and was replaced by new bone, indicative of successful natural healing.

Endoscopic Transorbital Surgery for Trigeminal Schwannoma: Introduction of a Novel Approach: 2-Dimensional Operative Video.

The major indications of endoscopic transorbital approach include spheno-orbital meningiomas, cavernous sinus lesions, and Meckel cave lesion such as trigeminal schwannomas. It can avoid excessive brain retraction and allows for a fast recovery to the normal daily living activity. To access the cavernous sinus, the sagittal crest and meningo-orbital band should be identified and cut. 1. Skin incision along the superior eyelid is performed. 2. Careful dissection of the soft tissue under the orbicularis is required not to injure the orbital septum. 3. After the lateral orbital rim is exposed, the periosteum and periorbita are elevated from the lateral orbital wall. 4. Drilling of the zygomatic bone within the orbit exposes the temporalis muscle first followed by the exposure of the temporal dura. It is essential to obtain adequate working room when the base of the greater sphenoidal wing is drilled. The sagittal crest should be removed, and the meningo-orbital band should be cut to expose the lateral cavernous sinus wall. For successful access through the orbit, endoscopic transorbital approach needs to minimize the retraction of the orbit. To achieve this goal, retraction of the orbit should be limited to a maximum of 10 minutes. This approach can be combined with lateral orbitotomy. It provides a wider working room and makes surgery easier to access the lateral temporal lobe.The patient consented to the procedure, and the participants and any identifiable individuals consented to publication of his/her image. Images at 1:29 reproduced from Corrivetti F, de Notaris M, Di Somma A, et al, "Sagittal crest": definition, stepwise dissection, and clinical implications from a transorbital perspective, Operative Neurosurgery, 22(5), p e206-e212, ©2022, by permission from the Congress of Neurological Surgeons. Video screen capture from The Neurosurgical Atlas at 1:06 used with permission from Aaron Cohen-Gadol; ©The Neurosurgical Atlas, all rights reserved.

Surgical Anatomy of the Microscopic and Endoscopic Transorbital Approach to the Middle Fossa and Cavernous Sinus: Anatomo-Radiological Study with Clinical Applications.

The transorbital approaches (TOAs) have acquired growing notoriety, thanks to their ability to offer alternative corridors to the skull base. However, the limited access and the unfamiliarity with this surgical perspective make recognition of key landmarks difficult, especially for less experienced surgeons. The study wants to offer a detailed description of the anatomy to comprehend the potential and limitations of TOAs. Measurements of the orbit region and the surrounding areas were performed on two hundred high-resolution CT scans and thirty-nine dry skulls. Five specimens were dissected to illustrate the TOA, and one was used to perform the extradural clinoidectomy. Three clinical cases highlighted the surgical applications. A step-by-step description of the key steps of the TOA was proposed and a comparison with the transcranial anterior clinoidectomy was discussed. The mean work distance was 6.1 ± 0.4 cm, and the lateral working angle increased 20 ± 5.4° after removing the lateral orbital rim. TOAs are indicated in selected cases when tumor involves the lateral portion of the cavernous sinus or the middle skull base, obtaining a direct decompression of the optic nerve and avoiding excessive manipulation of the neurovascular structures. Comprehension of surgical anatomy of the orbit and its surrounding structures is essential to safely perform these approaches.

Rare Intraosseous Cavernous Hemangioma of the Orbit

A healthy 52-year-old man presented with a painless, enlarging, right lateral orbital nodule of 1-year duration (A, arrow). Clinical examination revealed a 2.3-cm firm immobile lateral orbital rim mass. Computed tomography displayed an expansile and osteolytic neoplasm of the zygoma with orbital and extraorbital extension (B). Lateral orbitotomy exposed a porous neoplasm of the anterior zygomatic face (C). The exophytic component was resected, and histopathological examination demonstrated multiple, dilated, blood-filled cavities between bony trabeculae, consistent with a benign intraosseous cavernous hemangioma (D). Orbital intraosseous cavernous hemangiomas are rare, and malignancy should be ruled out in the setting of a progressive osteolytic neoplasm (Magnified version of Figure A-D is available online at www.aaojournal.org/).

Management of the Bone Deformity Caused by Congenital Cyst of the Periorbital Area: Analysis of the Surgical Technique and a Short-term Outcome

The congenital periorbital cysts like dermoids/epidermoids, in rare cases, can require not only its’ excision but also correction/camouflage of the caused bone deformity. This management can require virtual surgical planning, osteotomy, and placement of the custom-made patient implant. In this report, the ultrasonography (USG) was proved as a highly effective imaging for the presurgical verification of the mass’s structure and establishment of the clinical diagnosis. The multi-slice computed tomography (MSCT), even on a two-slice MSCT machine, provided high-quality three-dimensional reconstruction of the area of bone deformation caused by the cyst and allowed for accurate surgical planning. A 20-year-old male patient with a congenital periorbital epidermoid cyst that led to the deformation of the lateral orbital rim was treated using the soft tissue volume-increasing technique for the correction of bone deformation following cyst removal. Analysis of the terminological diversity related with dermoid/epidermoid cysts is presented. Early diagnostics and management of congenital periorbital cysts can decrease the visual, orbital, and esthetic complications, as well as the need to perform bone reconstructive surgeries or other corrective surgical procedures.

Morphometry of the Bony Orbit and Periorbital Structures: Personal Perspectives From Decades of Related Research.

The author introduces his personal perspectives on the bony orbit, nerves, arteries, and ligaments relating to orbital re- construction surgery. A supraorbital fissure was 40.0 ± 2.5 mm from the supraorbital notch. Posterior ethmoidal foramen was 31.7 ± 3.0 mm from the anterior lacrimal crest. The infraorbital fissure, where the infraorbital groove started, was 26.4 ± 2.6 mm from the infraorbital foramen. The supraorbital fissure was 34.3 ± 2.7 mm from the frontozygomatic suture. The medial palpebral ligament consisted of 2 layers. The superficial layer of the palpebral ligament (SMPL) was from the anterior lacrimal crest to the upper and lower tarsal plates. The deep layer of the palpebral ligament (DMPL) lay from the anterior lacrimal crest to the posterior lacrimal crest, covering the lacrimal sac. Horner muscle was at the posterior lacrimal crest just lateral to the attachment of the DLPL and ran laterally to the tarsal plate deep to the SLPL. Three components of the lateral canthal area are: (1) lateral palpebral raphe, (2) superficial lateral palpebral ligament (SLPL), and (3) deep lateral palpebral ligament (DLPL). The lateral ends of superior and inferior orbicularis oculi muscles interlaced at the lateral commissure and formed the lateral palpebral raphe. The superficial lateral palpebral ligament extended from the lateral ends of the tarsal plate to the periosteum of the lateral orbital rim. The lateral palpebral ligament extended from the lateral ends of the tarsal plate deep to the origin of SLPL to the Whitnall tu- bercle on the zygomatic bone. The palpebral branch of the in- fraorbital artery emerged from the infraorbital foramen and ran superior and lateral to the orbital septum. After passing through the orbital septum, distributed to the orbital fat.

Comparison of Internal and External Distraction in Frontofacial Monobloc Advancement: A Three-Dimensional Quantification.

Crouzon syndrome is characterized by complex craniosynostosis and midfacial hypoplasia. Where frontofacial monobloc advancement (FFMBA) is indicated, the method of distraction used to achieve advancement holds an element of equipoise. This two-center retrospective cohort study quantifies the movements produced by internal or external distraction methods used for FFMBA. Using shape analysis, this study evaluates whether the different distraction forces cause plastic deformity of the frontofacial segment, producing distinct morphologic outcomes. Patients with Crouzon syndrome who underwent FFMBA with internal distraction [Hôpital Necker-Enfants Malades (Paris, France)] or external distraction [Great Ormond Street Hospital for Children (London, United Kingdom)] were compared. Digital Imaging and Communications in Medicine files of preoperative and postoperative computed tomographic scans were converted to three-dimensional bone meshes and skeletal movements were assessed using nonrigid iterative closest point registration. Displacements were visualized using color maps and statistical analysis of the vectors was undertaken. Fifty-one patients met the strict inclusion criteria. Twenty-five underwent FFMBA with external distraction and 26 with internal distraction. External distraction provides a preferential midfacial advancement, whereas internal distractors produce a more positive movement at the lateral orbital rim. This confers good orbital protection but does not advance the central midface to the same extent. Vector analysis confirmed this to be statistically significant ( P < 0.01). Morphologic changes resulting from monobloc surgery differ depending on the distraction technique used. Although the relative merits of internal and external distraction still stand, it may be that external distraction is more suited to addressing the midfacial biconcavity seen in syndromic craniosynostosis. Therapeutic, III.

Transconjunctival Lower Eyelid Blepharoplasty with Volume Augmentation for Correction of the Lower Eyelid and Cheek Junction.

Aesthetic surgical management of the inferior periorbital region should include an approach to volume augmentation of the midface and infraorbital hollow, reduction of fat pseudoherniation in the lower eyelids, and treatment of the overlying skin. A combined approach using volume augmentation with fat grafting, a transconjunctival approach to the lower eyelid fat pads, and conservative management of the lower eyelid skin can produce optimal aesthetic results while minimizing complications. Fat harvest from the thigh and abdominal region allows for ample grafting material to the lateral cheek, midface, and orbital rim. The treatment paradigm is to restore volume optimally while minimizing fat resection in the lower eyelids. Volume augmentation is used to restore youthful contours, as well as to counter deflation and laxity in the periorbital and midfacial regions.

Validating the Reliability and Clinical Relevance of an Infraorbital Hollow Photonumeric Scale.

Infraorbital hollowing is a facial aesthetic issue for which a broad age range of patients seek treatment. Expanding treatment options for this region warrants the development of validated tools to objectively assess infraorbital hollow (IOH) severity before and after treatment. To validate a 4-point rating scale to assess depression of IOH, depression relative to the mid-pupillary line, and visibility of the lateral orbital rim. The IOH scale described herein was developed and subjected to live validation with a total of 73 patients representing the full range of IOH severities. Scale validation was performed by board-certified plastic surgeons and dermatologists (3 raters) over 2 rounds, 2 weeks apart. Intrarater and interrater reliabilities were used to demonstrate test-retest reliability as quantitated with percentage of agreement, weighted kappa statistic with 95% confidence interval (CI), and intraclass correlation coefficient with 95% CI. The clinical relevance of a 1-grade difference was evaluated by comparing rater assessments of 77 photo pairs with their previously determined designation as "clinically different" or "not clinically different." The IOH scale demonstrated substantial to near-perfect intrarater and interrater reliabilities when utilized by trained raters to assess a diverse group of live patients. Furthermore, clinically relevant differences between grades were established, and detection of a 1-point difference could be achieved by trained evaluators using the IOH scale. This highly reliable, clinically relevant, and validated IOH scale provides a user-friendly, standardized grading system to objectively evaluate and track changes in infraorbital hollowing in clinical practice and research.

Silicone orbital prosthesis retained by a solitary dental implant placed in the inferior lateral orbital rim with a unique magnetic attachment framework

ABSTRACT Maxillofacial trauma is an excruciatingly painful condition for the patient both physically and psychologically. In clinical scenarios, wherein reconstructive surgeries fail to rehabilitate the patient, maxillofacial prosthesis comes to the rescue. Presented here is a clinical report of prosthetic rehabilitation of an orbital deformity for a patient who had an accident. A solitary intraoral dental implant was placed in the inferior lateral orbital rim. The patient was rehabilitated using a silicone orbital prosthesis retained by a unique metal framework housed with Dyna magnetic keepers and magnets embedded in a prosthesis. The framework was cemented on the implant abutment.

One-year sustainability of brow-lifting procedures

Unlike blepharoplasty or facelifting procedures, there is little evidence of the sustainability of brow-lifting techniques. This study aimed to investigate the one-year sustainability of three brow-lifting techniques performed at our department. Thirty-six patients received an upper blepharoplasty and simultaneously one of three brow-lifting procedures: the direct (excisional) browpexy, the transpalpebral brow lift, and the EndotineⓇ forehead fixation. analogue and digital measurements of 3 vertical distances, from fixed anatomical points at pupil, lateral canthal, and lateral orbital rim level, were performed preoperatively and 12 months postoperatively. Patients' and surgeons' satisfaction considering functional and aesthetic outcomes were investigated by carrying out paper-pencil surveys. Direct browpexy was performed in 8, transpalpebral eyebrow lift in 10, and the EndotineⓇ fixation in 18 of the cases. In the first year, direct browpexy showed a general descent of 1.2mm at the pupil level, 2.1mm at the lateral canthal, and 0.6mm at the orbital rim level. In the transpalpebral eyebrow lift group, a descent of 0.7mm at the pupil level and 0.3mm at the lateral canthal level was found; the orbital rim level showed a slight but nonsignificant ascent of 0.7mm. In the EndotineⓇ group, a descent of 1.1mm at the pupil level, 1.2mm at the lateral canthal level, and 0.7mm at the orbital rim level was shown. Subjective surgeon opinions and overall patient satisfaction underline an aesthetic improvement despite objective results falsifying the hypothesis of a raised eyebrow position after one year. Patients showed minor eyebrow decrement after 12 months postoperatively; therefore, sustainability is questioned and must be reevaluated. The extent of dissection, the downward pull of upper blepharoplasty resection, and the decrease in frontalis muscle activity are discussed as the possible causes.

Alterations in Sphenoid Anatomy in Craniosynostosis: Implications for Fronto-orbital Advancement

OBJECTIVE: Fronto orbital advancement (FOA) requires the removal of the fronto-orbital bandeau via an anatomically challenging osteotomy that passes from the anterior cranial fossa to the middle fossa. During the intracranial portion of the osteotomy, visualization of the saw blade is lost as it passes through the fronto-orbito-sphenoid junction, prior to entering the middle cranial fossa. This places the temporal lobe dura and parenchyma at risk of injury. The aim of this study is to provide a 3-dimensional analysis of the space surrounding this osteotomy, and determine differences amongst different types of craniosynostosis. METHOD: 18 head CT scans of patients from ages 2 to 24 months with craniosynostosis (6 Metopic, 6 nonsyndromic Bicoronal, and 6 Unicoronal) were reconstructed to 3D skulls using Mimics 24.0 (Materialise NV, Lueven, Belgium). Unicoronal skulls were mirrored as necessary to be right sided. These skulls were landmarked with 47 cephalometric points. Measurents and volumetric analysis was performed to determine differences in sphenoid anatomy between the 3 craniosynostoses. RESULTS: For the 3 craniosynostosis groups, metopic, bicoronal and unicoronal, the average distance from the lateral orbital rim to temporal lobe tip was significantly different (17.37mm, 10.15mm, 14.76mm, respectively (p<0.05)). The mean depth of the temporal lobe tip from the edge of the sphenoid was also significantly different (16.23mm, 27.5mm, 22.8 mm respectively, p<0.05). The thickness of the fronto-orbito-sphenoid junction at the level of the supraorbital rim was significantly different between the three groups as well (7.75mm, 3.60mm, 8.04mm; p=0.01). Distances from the cornea to the lateral orbital rim, anteroposterior depth of the lateral orbit, and overhang of the lesser sphenoid wing over the middle cranial fossa were not significant between groups. CONCLUSION: Sphenoid shape and the zone of the fronto-orbital-sphenoid junction differs between types of craniosynostosis. Bicoronal craniosynostosis has the most unfavorable anatomy in this area, with minimal distance between the orbit and the anterior portion of the temporal lobe, a vertically deep middle cranial fossa, and thin bone at the fronto-orbital sphenoid junction, all of which make retraction and protection of the temporal lobe more challenging. Careful understanding of the patient’s specific anatomy is necessary to perform this osteotomy safely.

Effect of Rim-Off Deep Lateral Orbital Decompression on Interpalpebral Fissure Shape.

The purpose of this study is to compare the palpebral fissure shape after rim-off deep lateral decompression with and without restoration of the lateral orbital rim. Retrospective cross-sectional quantitative analysis of the palpebral fissure images of 17 patients (25 eyes) who underwent rim-off deep lateral orbital decompression without repositioning of the rim (G1) and of 20 patients (34 eyes) operated with rim restoration. Quantification of palpebral fissure images included MRD 1 and MRD 2 , two lateral mid-pupil lid margin (MPD) distances, the width of the palpebral fissure, and the height and shape of the lateral canthus. Proptosis reduction did not differ significantly between G1 and G2. In both groups, decompression reduced the mean values of the MRD 1 and MRD 2 , the lateral height of the upper eyelid, and the height and angle of the lateral canthus. The palpebral fissure width and lateral height of the lateral lower eyelid were not affected. There was no significant difference between the mean changes of G1 and G2. Multivariate analysis showed that the lateral canthus decrease was correlated with changes in MRD 1 and MRD 2 . Small changes in palpebral fissure shape after deep lateral decompression are not dependent on the presence or absence of the lateral rim.