Medial Canthus Research Articles

Foreign Body Nose: An Unusual Presentation

Introduction This is a very interesting case of retained homicidal foreign body in the nose in contrast to most of the foreign bodies which are accidental. Case Report A 27 year old male presented to ENT emergency with alleged history of assault over face with sharp object following which patient developed nasal bleed. On examination vertical laceration of approximately 8 cm in length was present along left naso-orbital groove extending superiorly from medial canthus of left eye and inferiorly to nasal alar cartilage. On anterior rhinoscopy a metallic foreign body was seen in both nasal cavities, which appeared to be crossing from left to right side piercing the nasal septum. Foreign body was removed via open approach. Discussion Penetrating maxillofacial injury with foreign body impaction are less common. High index of suspicion is required in diagnosing these cases. Radiological intervention should be done to get idea of exact location and extent of foreign body. Lateral rhinotomy is a useful approach in removing these foreign bodies.

Screening of febrile cows using a small handheld infrared thermography device

As dairy herds increase in size, close monitoring of health becomes a necessity, but this is expensive and labour-intensive. Early detection of febrile diseases is essential for economical and welfare reasons and to prevent the spread of disease. The goal of this study was therefore to evaluate a mobile, non-invasive technique for measuring the body temperature of cows that precludes the need for restraint of the animals. An infrared thermographic imaging camera installed on a smart phone was used to measure the surface temperature of cows. In experiment 1, a metal block heated to defined temperatures was used to obtain infrared thermographic measurements (THM). The accuracy of THM made at different distances from the block and at 2 different ambient temperatures was determined. In experiment 2, non-febrile cows underwent infrared thermographic imaging, and the body regions with the highest correlations between thermographic and rectal temperature were identified. In experiment 3, THM were made in febrile and neighbouring non-febrile cows. In experiment 1, the thermographic and true temperatures of the block had the strongest relationships at 0.5 and 1.0 m (r = 0.98). The ambient temperature had a significant effect on the THM, which had larger variations and greater deviations from the block temperature at 14.8 °C than at 23.8 °C. In experiment 2, the maximum temperature at the eye (r = 0.37), THM at the muzzle (r = 0.28) and the medial canthus (r = 0.27) showed the strongest relationships with the rectal temperature. After correcting the THM with the mean difference between thermographic and rectal temperatures of the non-febrile cows, sensitivities of 88, 90 and 82 %, respectively, were calculated for THM at the muzzle, eye and medial canthus in febrile cows in experiment 3. The corresponding specificities were 6, 23 and 32 %. Based on the low specificities of the infrared THM, the thermographic imaging camera has limited usefulness for the mass screening of dairy cows for febrile conditions. Cattle falsely identified as febrile need to be separated, caught and re-examined, which causes unnecessary stress to the animal and increases labour input.

Xanthelasma palpebrarum removed with Atmospheric Plasma technique: 11-year follow up.

Xanthelasma palpebrarum is a subcutaneous lesion of the lid and cause a cosmetical issue. The aim of the present study was to evaluate the atmospheric plasma treatment for the treatment of xanthelasma with an 11-year follow up. Seventy-two patients with bilateral xanthelasma and 26 patients with unilateral xanthelasma by atmospheric plasma technique known also as voltaic arc dermabrasion (VAD, Europe Medical s.r.l. Montesilvano (PE), Italy). Photographs were obtained at the baseline and after the procedure and analyzed by an independent observer. The evaluation of the results was made 2 months after this single treatment with 11 years of follow up. The subjects average age was 48.5 years (range 41-63 years). All subjects were elected for a single session for the lesion removal. The erosion is epithelialized from the lesion margins and the dermal basal cells. After 2 months from the treatment, the result was scored as 4 (clearing of lesions > 75%, complete resolution) in 66 patients for a total of 104 lesions treated; scored as 3 in 24 patients for a total of 48 lesions, and as 2 in nine patients for a total of 18 lesions. No subjects scored 0 or 1. A total of 8 lesions showed mild erythema in the treated areas for 1 month. Numerous approaches were proposed for xanthelasma exeresis such as a surgical treatment especially in case of excessively large lesions or lesions involving the medial canthus that could produce a more limited skin laxity rapidly induces a risk of ectropion. In conclusion, the effectiveness of the present investigation suggest that the atmospheric plasma is a useful therapeutic option for the treatment of xanthelasma palpebrarum.

Risk factors for persistent epiphora following successful canalicular laceration repair.

To identify the risk factors of epiphora in patients with anatomical patency after surgical repair of canalicular laceration. This retrospective case series included 178 cases of canalicular laceration repair from 2005 to 2012. Demographic data collected from each patient included age, sex, type of injury, distance from the distal lacerated end of the canaliculus to the punctum, the severity score for the structural abnormity of the medial canthus, the duration of stent placement, and the timing of surgery. The risk factors for epiphora were evaluated using Logistic regression models. Among the 178 cases, 45 (25.3%) with lacrimal patency after irrigation had symptomatic epiphora at the final follow-up. Patients' sex, age, type of injury, duration of stent placement, timing of surgery, and concurrent trauma were not found to be significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus (P>0.05). A distance of more than 5 mm from the distal cut end to the punctum was closely and significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus (P<0.01). Symptomatic epiphora was significantly more frequent in patients with higher severity scores for structural abnormities of the medial canthus (P<0.01). Our results indicate that the risk factors for postoperative symptomatic epiphora include a further distance between the distal cut end and the lacrimal punctum and a higher severity score for structural abnormities of the medial canthus. These findings could be used to prognosticate postoperative symptomatic epiphora.

Anthropometric Assessment of Canthal Distances and Canthal Index of South Indian Region: A Cross-Sectional Study

Background: Orbitofacial anthropometric measurements can be used in identification of gender and ethnicityin forensic anthropology. It also plays a crucial role used in plastic surgery and for identifying geneticsyndromes. Canthus is the term employed to explain the either corner of the eyes. Inner canthus is alsocalled as medial or nasal canthus. Outer canthus, is otherwise called as lateral or temporal canthus. Normalcanthal values can function as a guide for the diagnosis of pathology and interventions for craniofacialabnormalities. Thus, it is necessary to have a knowledge about the local data of those parameters sincethis standard reflects the doubtless different pattern of craniofacial growth resulting from racial, ethnic,sexual and dietary differences. Hence this study is undertaken to find out the normative inner canthal andoutercanthal distance measurement in population of South Indian region.Aims and Objectives: The present study was done to find out the normal inner and outercanthal distanceand also canthal index of population of South Indian ethnic origin and also to analyse the sexual dimorphismin them.Materials and Method: This descriptive cross-sectional study was conducted on 200 volunteers of agegroup 18-25 years of both sexes belonging to South Indian region. Innercanthal distance(ICD) and Outercanthal distance(OCD) were measured using digital vernier caliper.Canthal index was calculated. All thedata were analysed using SPSS 16.0 version software and correlated with gender.Results: Mean innercanthal distance was found to be 2.64 ±0.51 cm in males and 2.51 ±0.46 cm in femalesrespectively in the present study. There is significant sexual dimorphism in ICD . The study also showedoutercanthal distance to be 10.35± 0.81cm in males and 10.19 ±1.02 cm in females respectively. Canthalindex was 25.71 ±4.91 in males and 24.83±7.83 in females. There is no significant sexual dimorphism inOCD and Canthal index.Conclusion: It was observed that all the values were significantly higher in males than females of southIndian ethnic origin. And there is a significant sexual dimorphism in inner intercanthal distance.

Primary Non Hodgkin’s Lymphoma of the Lacrimal Sac-A Noteworthy Watery Eye

Lacrimal sac tumours are rare tumours in ophthalmology but may have serious complications when misdiagnosed. Lacrimal sac tumours can be either epithelial or non epithelial tumours. Epithelial tumours account for 60-94% of tumours. Pseudostratified ciliated columnar epithelium lines the lacrimal sac. Squamous cell carcinoma, transitional cell carcinoma, mucoepidermoid carcinoma, oncocytic adenocarcinoma, adenoid cystic carcinoma and metastasis are the commonly occurring epithelial tumours. Inverted papilloma is a locally aggressive tumour. Non epithelial tumours (25%) are rarer than the epithelial tumours. Lymphoproliferative, melanocytic, and mesenchymal tumours are the non epithelial tumours, among which the lymphoproliferative tumours constitute 2-8%. Very rarely Non Hodgkin’s lymphoma can occur as a primary in the lacrimal sac. Melanoma can occur as a primary from the melanocytes of the lining in the lacrimal sac or as a secondary from the conjuctival melanoma. Kaposi sarcoma and rhabdomyosarcoma are the mesenchymal tumours. Here is a case of Non Hodgkin’s Lymphoma (NHL) occurring in the lacrimal sac in an 80-year-old male. The patient came with the chief complaint of swelling around the right eye since two months. On radiological examination, Computed Tomography (CT) revealed a homogenous solid mass in the right medial canthus, causing bony erosions of the orbit and extending into the nasolacrimal canal. An incisional biopsy of the mass was consistent with the diagnosis of Non Hodgkin’s lymphoma which was further confirmed by immunohistochemistry. This unusual presentation and histopathological features are described.

Eosinophilic Folliculitis in a Dog

Background: Canine eosinophilic folliculitis is a dermatological disease of acute onset with development of erosive to ulcerative papular lesions, especially on the nasal bridge, that may cause severe skin abnormalities leading to discomfort and pain to the patient. The aim of this report was to characterize a case of a canine eosinophilic folliculitis with papular, ulcerative and crusting dermatitis on the nasal bridge, papules on eyelid and pinna, with confirmed diagnosis based on aspiration cytology, history and response to immunosuppressive therapy with glucocorticoid.Case: A 1-year-old intact Daschund was attended showing an acute onset (over 4 h) of generalized urticarial reaction and nonpruriginous lesion at the muzzle with mild serosanguineous exudate, which persisted for 96 h when the dog was evaluated. It was observed a papular and ulcerative dermatitis with serosanguineous exudate and hematic crusts at nasal bridge, papules measuring 2 mm in diameter in the medial and lateral canthus of the left eyelid, ulcerative papule with hematic crust in the border of left ear pinna, multifocal papules on the skin, dyskeratosis and generalized hair loss. The patient was anesthetized for blood sampling (CBC and serum biochemistry), lesions fine-needle aspiration, scraping and imprint for cytological examination, bacterial culture and nasal turbinates radiography. Fragments for histopathological evaluation were also collected. Erythrogram and platelet evaluation were unremarkable. Leukogram revealed leukocytosis (neutrophilia, lymphocytosis, monocytosis and eosinophilia). Serum biochemistry revealed hyperalbuminemia and discrete hyperproteinemia; values of alanine aminotransferase, creatinine and globulins were within normal range. In cytological examination, intense cellularity was observed with predominance of eosinophils (60%), neutrophils (35%), macrophages performing cytophagocytosis (5%) and degenerated cells. There was no bacterial growth within 48 h after incubation of nasal bridge lesion swab. There were no abnormalities identified at radiographic evaluation of nasal turbinates. As the patient was already with antibiotic therapy and steroidal anti-inflammatory, it was opted to maintain it, since interruption between the day of examination and laboratory results could cause more prejudice than benefit, corticosteroid dose, however, was readjusted (prednisone 2 mg/kg/per os/every 24h). After 1 week of treatment the owner reported significant improvement of clinical signs without any further complaint.Discussion: Typically, type I hypersensitivity reactions such as insect bites do not exceed clinical signs of erythema, local edema and pruritus, with spontaneous remission of clinical signs within few hours after exposure to the antigen. Eosinophilic folliculitis, however, may cause more severe clinical alterations, such as pain, apathy and hyporexia. Nasal bridge is the predominant site described to be affected in cases of eosinophilic folliculitis, being auricular pinna, thorax and limbs considered atypical presentations which can delay proper diagnosis, since in endemic regions for diseases such as visceral leishmaniasis, infectious etiology may be listed first. Differential diagnosis also includes superficial pyoderma, juvenile cellulitis, pemphigus foliaceus and pharmacodermia. The case described in this report emphasize the importance of an accurate diagnosis as well as an early and adequate treatment in order to promote satisfactory response. Also, highlights inadequate use of antimicrobials as a direct consequence of lack of laboratorial investigation.Keywords: skin, eosinophilia, furunculosis, dermatitis, insects.

Diagnostic analysis of vertical orbital dystopia and canthal tilt for surgical correction.

ObjectivesWe sought to identify a clinically useful method of analyzing orbital dystopia to aid in diagnosis and treatment planning and to quantify vertical discrepancies in eye level and variations in canthal tilt in Koreans.Patients and Methods In 76 Korean patients with a mean age of 23.12 years, mean differences in the level of the pupils, lateral canthi, medial canthi, and canthal tilt were measured. The difference in pupil level was calculated from the perpendicular lines drawn from the midpupil area of each eye to the midline of the face to determine the amount of skeletal discrepancy of the eye. Soft tissue discrepancies were determined according to the vertical difference between the lines drawn from the lateral or medial canthus of each eye perpendicular to the midline of the face. The canthal tilt was determined from the inclination of a line connecting the lateral and medial canthi, then classified as class I, II, or III.ResultsMean differences in pupil level, medial canthi, and lateral canthi were 1.57±1.10 mm, 1.14±1.07 mm, and 2.03±1.64 mm, respectively. The mean degree of canthal tilt were 8.45°±3.53° for the right side and 8.42°±3.81° for the left side. No study participants presented with class III canthal tilt. The mean canthal tilt values for those with class I tilt were 3.21°±1.68° for the right side and 3.18°±1.63° for the left side, while, for those who had class II tilt, the values were 9.60°±3.66° for the right side and 9.54°±2.99° for the left side.ConclusionThe presented diagnostic method of orbital dystopia can be used to effectively establish a treatment plan that takes into consideration the patient’s skeletal and soft-tissue discrepancies.

Use of random pattern skin flaps for wound closure in two horses

SummaryA 9‐year‐old Thoroughbred broodmare presented with a mass rostral to the medial canthus of the left eye. The mass was removed under general anaesthesia and the wound bed infiltrated with carboplatin emulsion before partially closing using a Z‐plasty. The mass recurred and subsequently was resected twice. It has not recurred 68 weeks post‐treatment. The second case describes removal of a granulomatous mass from the metatarsus of a yearling Thoroughbred colt. Skin expanders and a rotational flap were used to allow tension‐free closure. This required two separate surgeries to firstly insert the skin expanders and secondly to remove the mass, the expanders and to close the defect. The wound healed with good cosmesis. There have been few reports on the use of skin flaps in equine reconstructive surgery in the last 30 years. This report details two cases of wound closure where skin flaps were used to achieve primary intention wound healing.

Investigation of retro-orbicularis oculi fat and associated orbital septum connective tissues in upper eyelid surgery.

To study the anatomical characteristics of retro-orbicularis oculi fat (ROOF) in the upper eyelid and to investigate its relevance in upper eyelid surgery. Thirty-eight Chinese hemifacial cadaver specimens were used. Several sagittal plane section planes were recorded from the medial canthus to the lateral canthus of the eyelid after P45 sheet plastination. ROOF and the associated orbital septum connective tissues in the 38 hemifaces were studied. According to the anatomic results, the lowest point of the junction of the orbital septum and the ROOF (SRJ) was raised for surgical dissection. We improved the intraoperative management of patients who underwent upper eyelid surgery in the plastic surgery department of the First Affiliated Hospital of Dalian Medical University in 2019. Patients were evaluated by observation and self-assessment. ROOF is fascia adipose tissue. In the upper portion of upper eyelid, ROOF fibers were observed to be extremely dense and continuous with the fascia on the surfaces of orbicularis oculi muscle, the periosteum of the orbital margin, and the orbital septum. In the middle portion, positional relationships were identified between the lowest point of the SRJ and the lowest point of the junction of the orbital septum and the levator palpebrae superioris (SAJ). Lifting the SRJ significantly increased the upper eyelid reflex distance in all 57 patients. ROOF is an important factor in upper eyelid surgery. Lifting the SRJ effectively improves the retraction force of the levator palpebrae superioris muscle (LPS).

Congenital Lacrimal Sac Fistula: A Case Report and Literature Review

Introduction: Congenital lacrimal sac fistula is a rare anomaly of the lacrimal system in which, an epithelium-lined lacrimal tract is connected to the skin through a fistula. In most cases, it usually presents as an asymptomatic unilateral lesion located inferolateral to the medial canthus. Several studies reported that congenital lacrimal sac fistulas may be associated with systemic anomalies like Down syndrome, renal agenesis, etc. However, in this case, we aimed to report a patient with isolated bilateral congenital lacrimal sac fistula and its surgical management. Case presentation: A previously healthy 17 years old female presented with the complaint of intermittent watery discharge from her left eye since a few months ago. Physical examination revealed a small orifice in the skin at about 4 mm from the medial canthus on the medial side in both eyes without any signs of inflammation. Probing and irrigation in the left eye disclosed communication with the puncta and nose. Surgical repair was carried out through fistulectomy which successfully controlled the patient’s lacrimation. Conclusions: Recent advances in surgical techniques have shown better rates of success in relieving the patient’s lacrimation through fistulectomy than the simple excision methods. Our experience with the case presented here demonstrates that this lacrimal system anomaly can be treated successfully by surgical intervention.

Ocular Manifestation As Earliest Presentation Of Non-Hodgkin’s Lymphoma, Mimicking Multiple Chalazia: A Rare Case Report

Primary orbital Non-Hodgkin’s lymphoma (NHL) is very rare. This 40 year old female patient presented with small multiple smooth swellings on upper and lower conjunctival fornix and in subsequent visits she develops swelling arising from both side lacrimal sac location. MRI brain and orbit suggested multiple oval shaped lesions noted at retro-bulbar , medial and lateral canthus of both eyes and periorbital area without any bony destruction. Biopsy confirmed it to be a case of primary non-Hodgkin’s lymphoma. She was given 6 cycles of chemotherapy with CHOP. The patient is now asymptomatic 2 months after the last cycle of the chemotherapy.

Predicting Resting Oral Commissure Tone Outcomes Following Masseter Nerve Transfer in Facial Reanimation.

Objective: To quantify the degree of oral commissure resting tone improvement in patients undergoing masseter to facial nerve transfer. Methods: A retrospective cohort study was completed in a tertiary academic medical practice. Consecutive cases of masseter nerve transfer patients within a patient database were evaluated from 6/2012 to 9/2017. Inclusion criteria were patients >18 years of age, with complete unilateral paralysis, receiving a masseter to facial nerve transfer, with at least 12 months of recovery, and possessing complete pre- and postoperative data. Patients were excluded if a simultaneous adjunctive procedure was performed so that tone could not be attributed to masseter transfer alone. The main outcome measure was the facial asymmetry index (FAI): the measured difference in distance between the medial canthus and oral commissure of the healthy and paralyzed sides. Results: Twenty-nine patients met inclusion and exclusion criteria and were further analyzed for this study. The oral commissure symmetry improved from 4.7 ± 2.8 mm preoperatively to 2.2 ± 2.3 mm postoperatively. In multivariate analysis, the preoperative FAI was the only significant predictive factor for improvement in commissure symmetry at rest (r = 0.589). This suggests that for each 1.0 mm of worse preoperatively oral commissure asymmetry, the improvement postoperatively was 0.6 mm. Age, gender, body mass index, side of paralysis, duration of paralysis, and recipient branch of facial nerve were not significant predictors in a multivariate analysis. Conclusion: Masseter to facial nerve transfer yields an estimated 60% correction in the oral commissure asymmetry. This estimation may be helpful in determining if adjunctive procedures should be utilized.

Modelling multiple outcomes in repeated measures studies: Comparing aesthetic eyelid surgery techniques

We propose a multivariate regression model to deal with multiple outcomes along with repeated measures in the context of longitudinal data analysis. Our model allows for flexible and interpretable modelling of the covariance structure within outcomes by using a linear combination of known matrices, while the generalized Kronecker product is employed to take into account the correlation between outcomes. We present maximum likelihood estimation along with extensions of the classical multivariate analysis of variance and multiple comparison hypothesis tests to deal with multivariate longitudinal data. The model and the associated multivariate hypothesis test are motivated by a prospective study conducted to compare three aesthetic eyelid surgery techniques, namely blepharoplasty, endoscopic forehead lift and endoscopic forehead lift associated with blepharoplasty. The effect of the techniques was assessed using measurements of a horizontal line through pupil centre and then three vertical lines, which go in direction to lateral canthus, middle pupil and medial canthus to the top of the brow. In this study, 30 female patients were randomly divided into three groups. Preoperative measurements were compared with postoperative measurements taken 30 days, 90 days and 10 years after the surgery. The presented multivariate model provided a better fit than its univariate counterpart. The results showed that the three surgery techniques tend to increase all considered outcomes in a long-term perspective, that is, from preoperative to 10 years postoperative evaluations. The only exception was for the outcome lateral eyebrow, for which the blepharoplasty had no significant effect.

Use of the medial canthal point (MCP) as a reliable anatomical landmark to the frontal sinus.

ObjectivesFrontal sinus surgery is considered one of the more challenging aspects of Functional Endoscopic Sinus Surgery, due to the complex variations in normal sinus anatomy but also increased morbidity due to the close proximity of critical structures such as the anterior cranial fossa and orbits. We aim to investigate the medial canthal point (MCP) as an anatomical landmark for safe frontal sinus access.MethodsThe MCP intranasally is identified during surgery with non‐tooth forceps, with one limb just anterior to the medial canthus and the other intranasally in the same coronal plane along the skull base. This point was identified on 100 paranasal sinus computed tomography (CT) scan reconstructions. The distance between the anterior cranial fossa and MCP was measured on imaging—medial canthal point distance (MCPD). The maximal anterior‐posterior (AP) distance was measured on all scans.ResultsThe average MCPD for males was 13.0 mm (8.7‐20.4 mm) and for females 12.0 mm (6.8‐22.8 mm). Mean AP distance for males was 12.0 mm (4.5‐20.2 mm) and for females 10.4 mm (3.8‐15.9 mm). Mean distance for all 100 patients was 12.6 mm (range 7.5‐22.8 mm). In all cases, the MCP was anterior to the cranial fossa. Mixed effects modelling analysis showed a significant correlation between the MCPD and AP distance (P = .006).ConclusionThe MCP is a consistent anatomical landmark that can serve as an adjunct to safe frontal sinus access alongside the first olfactory fiber and CT navigation systems. However, patient selection continues to be very important, with larger well pneumatized frontal sinuses being ideal to tackle earlier in a surgeon's career.Level of evidenceNA

A preliminary study on the clinical features of congenital lacrimal fistula

Objective: To summarize the clinical characteristics of congenital lacrimal fistula for reference in its clinical diagnosis and treatment. Methods: Retrospective case series study. The clinical data of 27 patients (32 eyes) with congenital lacrimal fistula admitted to the Lacrimal Center of Third Medical Center of PLA General Hospital from July 2011 to November 2017 were analyzed, including gender, age of diagnosis, left eye or right eye, family history, physical examination, ophthalmic examination, fistula opening location and appearance, symptoms, results of lacrimal duct irrigation, three-dimensional reconstruction of the lacrimal drainage system with CT, lacrimal endoscopy, treatment, outcomes and follow-up. Results: In the 27 patients, the male to female ratio was 1∶2. The age of diagnosis was 1 to 74 years old, and the median was 32 years old. The ratio of unilateral fistula to bilateral fistula was 4.4∶1 (22/5), and the ratio of left eyes to right eyes was 1.2∶1 (12/10). The disease was sporadic in 22 patients, and 5 patients had a family history. Genetic analysis showed that congenital lacrimal fistula presented autosomal dominant inheritance. Fistulas were found on the skin surface of the lacrimal sac area under the medial canthus in 30 eyes, on the lacrimal caruncle in one eye, and on the conjunctiva of the medial canthus in one eye. All the patients presented with epihora, and irrigation liquid outflowed from the fistulas with purulence in 18 eyes. Lacrimal CT of the 27 patients showed contrast agents were left in the lacrimal sac. Lacrimal duct fistula was found open in the common canaliculus with concretions in the lacrimal system in four patients. Eight patients with mild symptoms underwent observation. Three patients underwent lacrimal therapeutic irrigation and probing. Sixteen patients underwent fistulectomy and were cured without recurrence during the follow-up of 1 to 6 years. Conclusions: Congenital lacrimal fistula is usually unilateral, and the opening is mostly located on the skin surface of the lacrimal sac area under the inner canthus ligament. Most cases are sporadic, and some cases are of familial inheritance in an autosomal dominant condition. (Chin J Ophthalmol, 2020, 56: 688-692).

A multicentre review of the histology of 1012 periocular basal cell carcinomas.

To evaluate primary periocular basal cell carcinomas (BCCs) in depth including comparing histological margins with subtype, location and surgical specialty after wide local excision. A retrospective review was performed for all BCCs excised from three hospitals over 5 years, covering a population of just over 1 million. Tumours were classified according to histological subtype location. Incomplete excision rates and margins were analysed in detail and comparisons made. The most common subtype found was nodular followed by infiltrative. Lesions were most commonly located at the lower lid. Infiltrative BCCs were associated with perineural invasion and incomplete excision despite the largest peripheral margins. Superficial BCCs had the smallest mean peripheral margin but the largest mean deep margin. 2 mm histological margins gave an 83.7% complete excision rate, 6.4% incomplete excision rate and 7.1% where the clearance margin was 0.3 mm or less. Distribution of eyelid BCCs based on subtype and periocular location mirrored the general consensus. Infiltrative BCCs should be excised with wider margins or referred for Mohs surgery, especially if the medial canthus is involved. Superficial BCCs should be excised with wider but shallower surgical margins. Ophthalmologists were more likely than dermatologists or plastic surgeons to incompletely excise a periocular BCC, which is reflective of their more difficult case mix.

Magnetic Resonance Imaging Features of Medial Canthal Tendon in Centurion Syndrome

ABSTRACT Purpose To describe the magnetic resonance imaging (MRI) features of the medial canthal tendon (MCT) insertion in a series of patients of the Centurion syndrome. Methods This was a prospective study carried out over a period of 1 year. All patients clinically diagnosed with Centurion syndrome underwent MRI with surface coils. The insertion of both the limbs (anterior and posterior) of the MCT was studied radio-logically and correlated clinically. Results We recruited six patients, of whom four were males. The anterior limb of the MCT was found to insert anterior to the anterior lacrimal crest in three, normally inserted in two, and thinned out and mal-developed in one. None of the patients with normal insertion had the classical beak sign or prominent nasal bridge. Conclusion The anterior limb of the MCT may not always be inserted anteriorly in cases of Centurion syndrome; it can be normal or mal-developed. Disinsertion of the MCT, which is the most common procedure done for Centurion syndrome, might not be helpful in cases where the MCT is normally inserted or mal-developed.

Treatment of Medial Canthal Tumor by Rotation Flap

Purpose: To describe the cosmetic outcome after repairing medial canthal defects via glabellar rotation flaps in patients undergoing wide clear margin excision of medial canthal tumour.&#x0D; Study Design: Interventional case series.&#x0D; Place and Duration of Study: This study was conducted at Khalid Eye Clinic, Nazimabad, Karachi, from March 2019 to August 2019.&#x0D; Methods: Study approval was obtained from the Ethical Review Committee. Eleven patients of both genders with clinically suspected medial canthal tumor were included in the study. Patients who underwent previous treatment such as radiation, cryotherapy or surgery were excluded. All surgeries were done to remove the tumor along with surrounding wide clear margins followed by reconstruction of the defect of the medial canthusareawith the help of arotation flap. Patients were followed for a period of up to six months post operatively for any wound related problems or recurrence. All patients were informed about the study and consent was obtained from each of them.&#x0D; Results: All eleven patients of this study were satisfied at the end of the follow-up period with the final cosmetic outcome. Seven out of elevenpatients were males and the remaining four were females, which also highlighted a greater incidence of medial canthal tumors in the male gender.&#x0D; Conclusion: Glabellar rotation flap is a suitable procedurefor themedial canthal area restoration after the tumor excision and can be customizedas per the characteristics of the surrounding skin as well as thesite, dimensions, and profundity of the defect.&#x0D; Key Words: Medial canthal tumor, Glabellar rotation flap, Medial canthus.

Primary cutaneous anaplasic large-cell lymphoma involving medial canthus of the eyelid

Cutaneous anaplastic large-cell lymphoma (cALCL) is a condition within CD30 lymphoid proliferations spectrum. Involving the eyelid is unusual and all cases found in the literature are located in the upper eyelid. In this case we report an cALCL atypical presentation. A 39 year-old woman with no significant medical history, presents a fast-growing mass in the medial canthus, with inflamatory-infectious appearance. After a week with antibiotics with no response, an excisional biopsy was practiced. The hystopathology analysis with a negative systemic work up confirmed the diagnosis of a cALCL. After two-year follow up, patient is asymptomatic. cALCL involving the eyelid are rare but potentially life-threatening disorders, so more information about diagnosis, treatment and follow up is needed.