Skin Crease Incision Research Articles

Successful mediastinal teratoma resection in a child by assisted VATS: a case report

BackgroundVideo-assisted thoracic surgery (VATS) is widely used for thoracic lesions in pediatric patients. VATS is also applied to pediatric mediastinal tumors if there is no adhesion or invasion between the tumor and adjacent neuronal and cardiovascular structures. Here, we present a pediatric case of mediastinal teratoma in which the tumor adhered to the superior vena cava, and resection was safely completed using assisted VATS, an integrated surgical approach comprising mini-thoracotomy with video assistance.Case presentationA 9 year-old girl presented with right shoulder pain. Chest radiography and computed tomography revealed a 5.4 × 5.1 × 5.8 cm mass in the right upper anterior mediastinum. She was presumed with a mature teratoma, and resection was performed by assisted VATS with muscle sparing axillar skin crease incision (MSASCI) for a mini-thoracotomy. The procedure was safely completed, with the patient discharged on postoperative day 5. At 1 year postoperatively, there was no recurrence with excellent motor and cosmetic results.ConclusionsThe combination of MSASCI and VATS would be useful not only for mediastinal teratomas but also for other mediastinal tumors and almost all other thoracic lesions in pediatric patients.

Axillary skin crease incision versus conventional posterolateral incision in open repair of patent ductus arteriosus for extremely low birth weight infants: a retrospective study

BackgroundThoracotomy with posterolateral incision (PLI) is commonly used for surgical repair of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. Some reports have described thoracotomy for PDA using an axillary skin crease incision (ASCI) in consideration of cosmetic problems such as surgical wounds and thoracic deformities, but the details remain unclear.MethodsIn this study, we performed clipping ligation by thoracotomy with ASCI for ELBW infants with PDA from 2011 to 2015 for the purpose of improving cosmetic results, and retrospectively compared the results with those for conventional PLI cases performed from 2016 to 2020.ResultsASCI was found to be associated with serious surgical complications and showed a significant difference in outcome parameters only for surgery time, suggesting a safety problem for ASCI. Considering these results, PLI allows clipping of the nearby PDA from the thoracotomy wound while looking straight ahead, whereas the PDA in ASCI is positioned deep and oblique to the thoracotomy wound, so the clipping angle is limited and accurate completion of the procedure is difficult.ConclusionsRegarding PDA repair in ELBW infants, ASCI shows a high risk of serious surgical complications. Conventional PLI remains preferable for safe and accurate results.

Muscle-sparing posterolateral thoracotomy for esophageal atresia Vogt Type 3b

Background: Posterolateral muscle cutting thoracotomy is the gold standard approach to repair esophageal atresia with distal tracheoesophageal fistula. This technique is associated with morbidities in terms of poor motor and aesthetic outcomes. We aim to share our experience with muscle-sparing skin crease incision posterolateral thoracotomy for esophageal atresia Vogt type 3b.
 Methods: It was a retrospective observational study conducted over a period of 3 years and 6 months from January 2016 to June 2019 at two tertiary care teaching institutes. All patients with esophageal atresia having distal tracheoesophageal fistula were included.
 Results: Fifty-nine neonates underwent muscle-sparing thoracotomy, with 23 males and 36 females. The 34 (58%) neonates had low birth weight. Anorectal malformation (ARM) was the most common (6) associated major malformation(18). Intraoperative findings included long gap EA (6), right aortic arch (RAA, 3), aberrant vessels (1), and long upper pouch (1). Conversion to muscle cutting approach (during early learning curve) was performed in 8 cases i.e. long gap EA (3), RAA (2), Subglottic stenosis (2), others (1). No intraoperative complication was encountered; postoperative seroma formation (related to the approach) was observed in 2 (3.4%) neonates. Most of the patients achieved satisfactory functional and aesthetic outcomes.
 Conclusions: Muscle-sparing skin crease incision posterolateral thoracotomy is a viable approach for repair of esophageal atresia with distal tracheoesophageal fistula. The technique is easy to perform with adequate exposure and provides satisfactory functional and aesthetic outcomes with relatively minimum morbidity.

Muscle-Sparing Skin Crease Incision Posterolateral Thoracotomies in Pediatric Patients: Our Experience.

ABSTRACTContext:Standard posterolateral muscle cutting thoracotomies in pediatric patients are associated with morbidities in terms of poor motor and esthetic outcomes and also more postoperative analgesia requirement, when compared with muscle-sparing technique.Aims:The aim of this study is to evaluate the outcomes of muscle-sparing skin crease incision posterolateral thoracotomies in pediatric patients in terms of abovementioned variables.Settings and Design:This prospective observational study was conducted over a period from January 2016 to July 2020 in a tertiary care teaching institute.Materials and Methods:All patients of stage 3 empyema and pulmonary hydatidosis were included in the study.Results:Thirty-nine patients fulfilled the inclusion criteria. There were 38 children with organized (Stage 3) empyema and one patient with bilateral lung hydatid. There were 24 males and 15 females; age ranging from 6 months to 15 years. Right thoracotomy was performed in 28, left in 10, and bilateral in one patient with lung hydatid. Adequate exposure was achieved in all cases. Decortication with complete excision of thickened parietal pleura with stripping of the visceral peel and release of the entrapped lung was performed in all 38 patients. In 5 children along with decortication, repair of bronchopleural fistula due to necrotizing pneumonia was performed. Bilateral thoracotomies with pericystectomies were performed with a gap of 3 weeks for lung hydatid. Lung expansion assessment at 3 months was satisfactory. Ultrasound assessment of the latissimus dorsi muscle and serratus anterior muscle at 4 weeks revealed complete integrity in all the cases. Most of the patients achieved satisfactory motor and esthetic outcomes.Conclusions:Muscle-sparing skin crease incision posterolateral thoracotomy is a viable alternative to standard posterolateral muscle cutting thoracotomy, especially in a resource-challenged setting. The technique is easy to perform with satisfactory exposure.

Intact Removal of Orbital Lobe Tumors of the Lacrimal Gland, With or Without Lateral Wall Osteotomy.

To examine the necessity for lateral osteotomy for intact removal of tumors within the orbital lobe of the lacrimal gland. Patients who, between 1992 and 2020, were scheduled for intact excision of well-defined masses within the orbital lobe of the lacrimal gland were identified from an orbital database. A retrospective review of the clinical records was performed and details of the tumor size obtained from histopathological reports. The first patients in the series had lateral osteotomy, whereas later, there was a shift toward osteotomy-free tumor excision through a skin-crease incision. The latter approach required isolation of the gland's orbital lobe on an intact sheet of periosteum, an anterior "flip" of the mass (out of the orbit, past the orbital rim) "hinged" at the isthmus between the orbital and palpebral lobes, and finally a division of the isthmus to release the intact mass. Clinical details were available for 100 patients (50 male), with 56 tumors removed using lateral osteotomy and 44 without. The mean age at surgery was 50.3 years with osteotomy (median, 51.8; range, 19-85 years) and 51.1 years without (median, 50.3; range, 11-81 years; P = 0.81). There were no postoperative complications in either group. Although the range of tumor volumes was similar in the two groups (1.6-15.0 ml with osteotomy; 0.9-15.1 ml without), the average volume was somewhat greater in those having osteotomy (mean, 6.4 ml) as compared with those without (mean, 4.6 ml; P = 0.0016). Inadvertent rupture of the tumor occurred once in each group, with tumors of similar small size. In many cases, large masses within the orbital lobe of the lacrimal gland can be safely removed intact, using the described flip technique without the need for lateral wall osteotomy.

Nuck cyst: a rare cause of inguinal swelling in infancy.

BACKGROUND Inguinal and/or inguino-scrotal swellings, such as hernia and hydrocele, are among the commonest anomalies in childhood. Hydrocele of the canal of Nuck is an uncommon diagnosis and a rare cause of swelling in women that occurs due to a patent vaginal process. METHODS From January 2001 to January 2016, 353 female patients 1-14 years of age were admitted to our university hospital division for inguinal swelling. We have performed 403 inguinal approaches, and of these, 399 (99%) had inguinal hernias, 3 (0.74%) had a cyst of the canal of Nuck, and 1 (0.24%) had a lipoma. All of the patients with Nuck cysts underwent surgical exploration of the swelling through a right inguinal skin crease incision. RESULTS The patients were between the ages of 1 and 8 years. The cyst sizes varied between 25 and 40 mm. All the patients exhibited right, tender, painless, non-reducible masses. In all patients, ultrasound confirmed the suspected diagnosis. The histological findings revealed fibrous-walled cystic formations with mild chronic inflammatory infiltrate that were covered by mesothelial epithelium. The patients' postoperative follow-ups at 1, 6 and 12 months revealed normally healed incisions with no recurrences. CONCLUSIONS The surgical findings and the histological demonstrations of serous epithelium seemed to validate the hypothesis that the patency of the inguinal canal combined with fluid secretion of the peritoneal serosa participated in the formation of the cysts. Surgery with high ligature of the vaginal process is considered the therapy of choice for this pathology.

Anterior Lamellar Repositioning in the Management of Meibomian Gland Inversion Secondary to Meibomian Gland Dysfunction.

To describe a simple alternative surgical approach to treat patients with Meibomian gland inversion (MGI; posterior migration of the Meibomian gland orifices) in the upper eyelid, secondary to cicatricial Meibomian gland dysfunction (MGD) not responding to maximal medical management. This was a retrospective, noncomparative, interventional case series of all patients with MGI not responding to conservative MGD treatment who underwent anterior lamellar repositioning through a skin crease incision with or without Blepharoplasty, between July 2017 and July 2019. Eleven eyes of 7 patients were included in the study. All patients had a diagnosis of MGD with MGI and had been treated on average for 32 months with intensive medical therapy. Treatment included lubricants, topical ciclosporin 0.1%, topical steroids, and doxycycline. Despite intensive treatment, these patients remained symptomatic with persistent superior ocular surface staining. Following surgery, on average, the patients were followed for 23 months. Ten eyes (91%) had improvement of symptoms and superior ocular surface staining. All patients (100%) demonstrated improvement in the anatomical eversion of the eyelid margin and Meibomian gland orifice. A simple upper eyelid everting surgery with anterior lamellar repositioning can be effective in managing patients with MGI giving them symptomatic relief when all medical treatment fail. To the best of the authors' knowledge, this is the first case series describing this simple surgical technique in the management of this subgroup of patients.

Evolution in thyroid surgeries: A short review

Aim: To contemplate on the evolution of thyroid surgeries and assess its outcome, feasibility and preferred surgical technique in thyroid surgeries. Thyroid surgeries have continued to evolve since many years with Kocher’s neck incision being the classical incision for all thyroid surgeries. Benign thyroid diseases have been more commonly treated surgically and approaches to such have evolved over years. Hence, they are approached in both functionally and aesthetically giving a superior outcome. These have led to many recent developments in different approaches for thyroid removal. Some of them are Kocher’s incision, lateral incision, TORS, and upper skin crease incision.Materials and Method: A short elucidation of surgical approaches on thyroid surgeries to the newer advents in thyroid surgery.Conclusion: Each of these following incisions have their respective advantages and disadvantages for the same. Most incisions are case specific and are suited perfectly for each type of thyroid gland removal. Hence no incision is superior in terms of outcome and removal of thyroid gland. But when the aesthetics are concerned TOR’s shows superior scar less surgery followed by high neck skin crease incision which hides the scar under shadow of mandible followed by other incisions respectively.

Optic nerve sheath fenestration via a supero-medial eyelid skin crease approach for the treatment of idiopathic intracranial hypertension in a UK population.

Optic nerve sheath fenestration (ONSF) is a surgical intervention in the management of idiopathic intracranial hypertension (IIH) infrequently performed in the United Kingdom. Numerous surgical approaches have been described, including medial transconjunctival, lateral and endoscopic. We describe our outcomes and complications from ONSF via a supero-medial eyelid skin crease incision in patients with IIH. We performed a retrospective review of consecutive patients undergoing ONSF for IIH between January 2011 and December 2017 by a single surgeon. Thirty patients were included in the analysis with a median follow-up of 14.5 months. Bilateral ONSFs were undertaken in 27 (90%). The data from one eye per patient were analysed. The mean kinetic perimetry score in mean radial degrees of the I4e isopter improved from 27.3° to 35.7°, p = 0.04. After removing cases with optic atrophy, the median modified Frisén grade of papilloedema improved from 2.5 to 1.0, p = 0.007. A total of 5/30 (17%) patients had complications: two (7%) had recurrence/late failure (one managed medically and one with cerebrospinal fluid [CSF] diversion surgery), one had transient cotton wool spots post-operatively, one had transient retinal haemorrhages and one patient had a transiently oval pupil. No patients had repeat ONSF, but CSF diversion surgery was subsequently carried out in 4/30 (13%) patients. ONSF via a supero-medial eyelid skin crease approach is effective at improving visual function in patients with IIH. The complication rates are low when compared with CSF diversion surgery and other surgical approaches for ONSF.

Palpebral Pleomorphic Adenomas of the Lacrimal Gland.

To report the characteristics and management for patients with palpebral pleomorphic adenoma of the lacrimal gland. The records for patients with palpebral pleomorphic adenoma seen at Moorfields Eye Hospital between 1978 and 2019 were reviewed for demographics, presentation, imaging, histopathology, management, and outcome. Forty-three patients (25 male; 58%) with palpebral pleomorphic adenoma were identified, presenting at a mean age of 46 years (median 46.4 years; range 24-81 years) with symptoms for an average of 31 months (median 18.0 months; range 1 month to 17 years). The commonest symptom was a painless upper lid lump (37 patients; 86%), although 4 patients (9%) had a localized ache, and 1 (2%) had episodic epiphora. A moderately-mobile, firm round mass (like a "chick-pea") was readily palpable in 39/43 (91%) patients, and significant ptosis and upper lid swelling was noted in 6 cases (14%). Imaging was reviewed in 35 patients, 28 (80%) having a well-defined homogeneous mass in front of the orbital rim, on the anterior pole of the lacrimal gland. With the exception of 8 tumors removed from the actual palpebral lobe using a conjunctival incision, all others were excised intact through an upper eyelid skin-crease incision. Histopathology confirmed an intact pseudocapsule in 39/43 (91%) and 10 (23%) had a mild chronic lymphocytic inflammation within the tumor and/or neighboring lacrimal gland. There were no tumor recurrences at an average follow-up of 40 months (median 9.1; range 2 weeks to 230 years). Most palpebral pleomorphic adenomas are discovered as an upper lid lump and a few first become manifest as upper lid swelling with ptosis. To avoid inadvertent incisional biopsy, they should be recognized preoperatively-especially as most are readily palpable as a hard lump superotemporally, often freely mobile in the suborbicularis plane (anterior to the tarsus and main lacrimal gland). Excision, generally easiest through a transcutaneous route, was judged intact in all cases and confirmed in 91% of histological reports, with no recurrent tumors.

Open Surgery for Femoral Hernias: a Single Approach with Double Window for All

Femoral hernias are relatively less frequent than inguinal hernias but most often strangulated, which carries significant mortality. The multiple approaches are described to deal femoral hernias including three classical approaches. Each approach describes a separate skin incision and dissection to access the femoral sac. We propose a single approach with double window for all femoral hernias. Inguinal canal is opened by inguinal skin crease incision which is taken over medial half of inguinal ligament. The sac is identified, released from femoral canal, and traced up to the defect of herniation (window-1) If bowel is gangrenous, a second window is made at McBurney’s point by giving another incision as that of gridiron incision (window-2) made by muscle splitting. The gangrenous bowel is dealt from the second window. This new single approach with double window is useful for all elective and emergency femoral hernias. It is easy to perform without any damage to muscles and nerves and obviates the need of multiple approaches.

Aortopexy for tracheomalacia via a suprasternal incision

AimTracheomalacia is flaccidity of the tracheal wall leading to tracheal collapse, particularly on expiration. When severe it can warrant surgical intervention. Aortopexy is one surgical option and has been described using a variety of approaches. We report outcomes of aortopexy performed via a suprasternal incision in a single centre by a single surgeon. MethodsAll patients undergoing aortopexy between February 2016 and May 2018 were prospectively included. Patients were managed by a multi-disciplinary team (MDT) and underwent standardized work-up, including dynamic flexible bronchoscopy (DFB) and contrast enhanced CT. Aortopexy was performed via a suprasternal skin crease incision. Surgery was guided by intra-operative flexible bronchoscopy. Data regarding pre-operative symptoms, degree of tracheomalacia, and outcomes were recorded. ResultsTwenty-two patients were included, 18 boys, median age 5 months (range 1 month–5 years). Two aortopexy sutures were used in all cases, and three patients required an additional tracheopexy suture. Median operating time was 1 h 24 min (range 47 min–2 h 35 min). Median pre-operative tracheal collapse on DFB was 85% (range 80–95%), improving to 35% (35–80%) intra-operatively. Median length of stay was 4 days (range 1–118). ConclusionsAortopexy via a suprasternal incision is a useful treatment modality for tracheomalacia with short operating times and rapid recovery. Outcomes vary with the best results in the TOF and premature groups. Careful patient selection and MDT work-up are essential to optimize outcomes. Level of EvidenceLevel 3 (Case Series).

Skin crease 'bikini' incision for the direct anterior approach in total hip arthroplasty: a two- to four-year comparative study in 964 patients.

The classical longitudinal incision used for the direct anterior approach (DAA) to the hip does not follow the tension lines of the skin and can lead to impaired wound healing and poor cosmesis. The purpose of this retrospective study was to determine the satisfaction with the scar, and functional and radiographic outcomes comparing the classic longitudinal incision with a modified skin crease 'bikini' when the DAA is used for total hip arthroplasty (THA). A total of 964 patients (51% female; 59% longitudinal, 41% 'bikini') completed a follow-up questionnaire between two and four years postoperatively, including the Oxford Hip Score (OHS), the University of North Carolina '4P' scar scale (UNC4P) and two items for assessing the aesthetic appearance of the scar and symptoms of numbness. The positioning of the components, rates of heterotopic ossification (HO) and rates of revision were assessed. The mean OHS was similar in both groups (p = 0.41). The mean UNC4P total score was slightly better (p = 0.01) and the proportion of patients who were very satisfied with the cosmetic aspects of the scar was higher in the 'bikini' group (p < 0.001). The proportion of patients reporting numbness in the scar was higher in the longitudinal group (14.5% vs 7.5%, respectively, p < 0.001). The abduction angle of the acetabular component, the position of the stem and rates of HO did not differ between the groups. There were no differences in the revision rates of both groups, being 2.3% in the longitudinal and 1.5% in the 'bikini' group (p = 0.911). We found that a short oblique 'bikini' skin crease incision is safe when used for the DAA at THA, without compromising the positioning of the components or increasing the rate of lateral femoral cutaneous nerve dysaesthesia. Although it leads to a superior scar satisfaction, as it is less extensile, it should be used after having gained experience with the classic longitudinal incision. Cite this article: Bone Joint J 2018;100-B:853-61.

The Utility of Muscle-Sparing Axillar Skin Crease Incision with Thoracoscopic Surgery in Children.

Thoracoscopic surgery for pediatric benign tumors is a common procedure. However, a large incision is needed to remove large tumors from the thoracic cavity. And, for intrapulmonary sequestration in lower lobe, it sometimes needs a large incision to ligate the aberrant vessels. A muscle-sparing axillar skin crease incision (MSASCI) has been introduced for thoracic open surgery, resulting in excellent aesthetic outcomes compared with a standard incision. We herein report the utility of this MSASCI technique in thoracoscopic surgery to remove large tumors from the thoracic cavity and to ligate the aberrant vessels in intrapulmonary sequestration in lower lobe. From 2014 April to 2016 March, we performed the MSASCI technique in thoracoscopic surgeries for 5 children. Five cases were diagnosed as mediastinal masses (mature teratoma for 1 case, ganglioneuroblastoma for 2 cases, and extrapulmonary sequestration and intrapulmonary sequestration for 1 case each). The age at surgery was 32.0 ± 25.0 months (range 5-58 months). The size of the mediastinal mass was 9 × 5 × 5 cm, 4 × 3 × 3 cm, 5 × 5 × 2.5 cm, and 3 × 2.5 × 2 cm. For 4 other cases, except for the intrapulmonary sequestration case, the mass was resected under thoracoscopic surgery using only three or four 5-mm trocars and the mass was removed from the thoracic cavity using the MSASCI technique. For the intrapulmonary sequestration case, the aberrant vessels were resected under thoracoscopic surgery using only two 5-mm and one 12-mm trocars and the left lower lobectomy was performed using the MSASCI technique. All lesions were resected completely. No cases had surgical complications, none showed recurrence, and all cases demonstrated good cosmetic outcomes. Performing thoracoscopic surgery using a MSASCI technique is associated with good cosmetic outcome.

Cosmetic effects of skin-crease camouflage incision versus longitudinal incision following carotid endarterectomy.

IntroductionDespite the increasing use of carotid angioplasty and stenting (CAS), carotid endarterectomy (CEA) nonetheless remains a more medically beneficial method of treatment for carotid artery stenosis. Therefore, one possibility for progress within this procedure may be to use minimally invasive carotid surgery, especially when the scar is in plain sight: the use of the natural wrinkles (skin crease) as a camouflage of the skin incision provides significant cosmetic improvements.AimTo compare the cosmetic effects of classic and trans-wrinkle CEA. To assess the distance between the carotid artery bifurcation (CAB) and the skin-crease incision whilst attempting CEA.Material and methodsIt was a randomized prospective study with two groups: patients undergoing classic surgery (control group; n = 100) and skin-crease trans-wrinkle camouflaged CEA (study group; n = 100). Follow-up was at 2 months and 1 year.ResultsThe medical results of the treatment were similar in both groups. The cumulative count of strokes and myocardial infarctions was 0.5% within 30 days, and after one year 3.5% (and 5.5% including cases of death). The superiority of the transverse crease being hidden compared to the conventional longitudinal technique was proven in the Patient and Observer Scar Assessment Scale (POSAS) score, respectively 11.4 ±1.0 vs. 14.1 ±3.4 (p = 0.0001) after 2 months and 13.5 ±2.8 vs. 14.1 ±3.4 (p = 0.039) after a year.ConclusionsTrans-wrinkle incision gives better cosmetic results, can be safely performed in most cases, and offers a comfortable approach during CEA.

Upper eyelid levator-recession and anterior lamella repositioning through the grey-line: Avoiding a skin-crease incision.

Purpose:This study aims to report a case series of upper eyelid cicatricial margin entropion with retraction, corrected through a grey-line approach only. We remind readers of the grey-line approach to levator recession (LR) and lamellar repositioning surgery.Methods:A retrospective review of clinic notes and photographs of patients who underwent grey-line split (GLS), LR, release of orbital septum, recession of levator, advancement of posterior lamella and anterior lamellar repositioning without a skin crease incision, from December 2015 to December 2016. Indications for surgery included mild-to-moderate cicatricial margin upper eyelid entropion, tarsal curling, and meibomian gland inversion. Patients requiring spacer interposition to lengthen the posterior lamella were excluded from the study. Parameters of the study included lid margin position, lid height, ocular surface health and symptom improvement.Results:Eleven eyelids of eight patients were included in the study, and underwent the procedure described. Lid margin position measured as the marginal reflex distance lowered (improved) in 72.7% of patients. Lid margin eversion was achieved in all eyes (100%). Corneal punctate epithelial erosions markedly improved, being present in 72.7% of patients preoperatively, and only 9.1% of patients postoperatively. Eight of eleven eyes showed symptomatic improvement, with six (54.5%) being completely asymptomatic and two achieving partial relief. An added observation was a pretarsal show asymmetry in some patients which improved in 36.4% of surgeries postoperatively.Conclusion:Upper eyelid LR with GLS and anterior lamella repositioning can all be performed through the plane of the split, avoiding a skin incision. Normal lid margin apposition was achieved in all eyes with 91% demonstrating a clear cornea and 72% having symptomatic improvement.

Lower eyelid entropion repair with retractor mobilization and insertion onto the anterior surface of the tarsal plate

ABSTRACTPurpose: To evaluate a modified surgical technique for the correction of lower eyelid involutional entropion in terms of recurrence rate and relief of symptoms.Method: A prospective series of 67 consecutive eyelids in 55 patients who underwent lower eyelid entropion repair using a modified surgical approach not previously published in the literature to the authors’ knowledge. The surgical technique, via a skin crease incision, involves disinsertion of the lower eyelid retractors from the tarsus and conjunctiva and suturing the retractors onto the anterior surface of the tarsal plate. Standard excision of redundant lower lid skin and orbicularis muscle was also performed as well as lateral canthal tendon repair. All procedures were performed by a single surgeon (B. A. O’donnell). This study adhered to the principles of the Declaration of Helsinki.Results: There were 67 eyelids with a minimum of 12 months follow-up: of these only 1 patient (1%) required revision surgery (average follow-up 24 months). Four other eyelids had persistent or recurrent irritation (6%) not suggestive of, or secondary to, recurrence. Seven eyelids (10%) had undergone previous operative repair with no further recurrence following their most recent surgery.Conclusion: Disinsertion and reattachment of the retractors to the anterior tarsal plate in lower eyelid entropion repair is an effective surgical technique to improve lower eyelid stability. Although minimum follow-up is 12 months and average follow-up 24 months, longer follow-up would further evaluate this technique.

Two different techniques for frontalis suspension using Gore-Tex to treat severe congenital ptosis

Severe congenital ptosis is commonly associated with poor levator function. This study compares the functional and cosmetic outcomes of open versus closed frontalis sling using Gore-Tex in the treatment of such conditions. Randomized interventional comparative case series of 20 eyes of 13 patients with severe congenital ptosis with levator excursion < 4mm. Patients were treated by frontalis suspension using Gore-Tex string sutures either through a skin crease incision (group 1) or supraciliary incisions (group II). Mean age was 5.10 ± 3.10years in group I and 7.30 ± 4.47years in group II. Ptosis was unilateral in six patients and bilateral in seven patients. Following surgery, there was a statistically significant improvement in the palpebral fissure width (PFW) and marginal reflex distance (MRD) in both groups (p value 0.001) with better functional outcome in group II (closed approach). The cosmetic results were better in group I (open approach). The mean operative time in group II was 18.1 ± 2.4min, which was significantly shorter than group I (30.2 ± 3.1min). No recurrence or grave complications were encountered during follow-up. Gore-Tex is a useful sling material for correction of severe congenital ptosis due to poor frontalis action. Open transcrease approach is recommended in absence of lid crease whereas closed approach is better used in cases with preserved crease due to its superior functional outcome.

Giant Hand Lipoma Revisited: Report of a Thenar Lipoma &amp; its Literature Review

Dear Sir, Lipoma is the commonest soft-tissue tumor occurring almost in any part of the body [1]. A special subtype—‘giant lipoma’ merits mention as it accentuates the presenting symptoms and offers diagnostic dilemma regarding its benign nature to the surgeon. In this paper we present a case of a giant hand lipoma. Sixty-one years old female presented with 4 × 4 cm swelling at her right thenar eminence since last 5 years (Fig. 1a). It was hindering her grasping activities so much so that she had to quit her job. Hand x-ray showed a diffuse soft-tissue shadow. Contrast-enhanced-magnetic-resonance-imaging showed 9.5 × 4.5 × 4cm homogeneous soft-tissue lump having superficial and deep components (Fig. 1b). It was masquerading further through 1st, 2nd till the 3rd web-spaces along the flexor digitorum tendons. Neuro-vascular structures were free. Hand-exploration through palmer-crease was performed to achieve its complete excision (Fig. 2a and b). She had a good postoperative recovery. Histopathology confirmed the benign nature of the lipoma. Fig. 1 a Thenar lipoma. Note its clinical extent. b MRI showing the complete extent of the giant lipoma. Note the coronal and the sagittal sections showing lipoma engulfing the tendons of flexor digitorum Fig. 2 Per-operative photograph showing initial part of lipoma projecting thru skin crease incision (a), followed by complete excision (b). c Completely resected specimen of giant lipoma. Note 9.5 × 4.5 × 4 cm ... It’s an interesting fact that hand lipomas are rare in spite of decent quantity of fat in palm region (1–3.8 %) [2]. Oster noted that the hand lipomas are peripherally positioned [2]. Their peripheral location may be due to thick mid-palmer fascia. They are unique in their presentation owing to limited palmer spaces (for their growth) surrounding important neuro-vascular structures. Mason further classified hand lipomas into superficial and deep palmar lipomas; the deeper ones are less common than the superficial ones and have complex variable morphology as noted in our patient [3]. Ones greater than 5 cm are designated as ‘giant’ lipomas and many of them have well-differentiated liposarcomatous components, which are difficult to differentiate from their benign counterparts [3, 4]. Patient usually approaches surgeon for compressive neurological symptoms, cosmesis, and fear of cancer (the 3 ‘C’s). Clinically small appearing hand lipomas may actually just be ‘a tip of ice-berg’ as found in our patient. Hence, they need a detailed imaging study by an MRI. Surgical excision remains the gold-standard for symptomatic and giant lipomas of the hand. Giant lipomas up to 8 cm have been reported in the literature [3, 4]. Our patient had 9.5 × 4.5 × 4 cm lipoma (Fig. 2c). Considering the ‘intricate anatomy’ of hand, a high quality imaging is necessary for their detailed study. A meticulous margin-free resection is the key for good results.

Vagal Nerve Schwannoma: Presentation of Two Case Reports

ABSTRACTVagal nerve schwannomas are rare neural sheath tumors. Although schwannomas are generally benign lesions, they are known to enlarge at a rate of 2.5 to 3 mm per year according to published reports. Vagal nerve schwannoma usually occurs between the 3rd and 5th decades of life, it does not show sex predilection, with both sexes being equally affected, and it most often presents as a painless, slow-growing, lateral neck mass. The treatment of choice is complete surgical excision with preservation of the neural pathway, when it is possible. These tumors, in fact, are almost always benign, and a conservative surgical approach is emphasized by most of the authors. Here, we are presenting two cases of cervical vagal schwannoma, both were middle aged females and presenting in the ear, nose, and throat (ENT) department as a painless lateral neck swelling and were operated by horizontal skin crease incision. Of the two cases, we succeeded to secure nerve functions in one case. The clinical features, diagnosis, management, and pathological findings of cervical vagal schwannoma are discussed.How to cite this articleGujrathi AB, Ambulgekar V, Chavan S. Vagal Nerve Schwannoma: Presentation of Two Case Reports. Int J Otorhinolaryngol Clin 2016;8(3):116-118.