Epibulbar osseous choristomas are rare congenital collections of mature compact bone most often located in the supero-temporal fornix. Most cases are not recognized preoperatively, as the lesion is usually felt to represent a dermatolipoma or epibulbar dermoid. Although most previous reports have described a loose attachment to the surrounding orbital structures, we report two cases in which intimate scierai incorporation was present. In one case, preoperative computerized tomography and echography allowed the diagnosis and probable scierai involvement to be considered preoperatively, and surgery was deferred. The embryogenesis of these lesions is uncertain, although they seem to correlate with the scleral ossicles seen in avian anatomy, and may represent abnormal activation of embryonic pluripotential mesenchymal cells.
• The abundant blood supply normally found in the periorbital region grants the reconstructive surgeon many options for repair. When this blood supply is altered by such factors as thermal damage or scar formation, classic methods of lid reconstruction may not suffice. In such situations, treatment with hyperbaric oxygen accelerates the process of primary revascularization of full-thickness skin grafts and large composite grafts. Augmentation of capillary budding occurs because hyperbaric oxygen therapy raises the tissue oxygen tension in hypoxic areas to the level needed for extracellular deposition of collagen, which is needed for support of endothelial cells. Hyperbaric oxygen also appears to improve the survival of ischemic skin flaps of the face, although the exact mechanism of this action is unclear. Since 1982, a total of six patients needing periorbital reconstruction has been treated postoperatively with adjunct hyperbaric oxygen. Although the results have been uniformly favorable, a matched series comparing the results with and without hyperbaric oxygen therapy will be required to prove the efficacy of this treatment regimen.
In Brief Purpose To describe the clinical presentation of cutaneous benign mixed tumor of the eyelid and its management options. Methods Periocular cases of cutaneous benign mixed tumor were gathered from members of an oculoplastics specialty Internet discussion group. A total of 9 patients are described in this retrospective, interventional case series. The clinical presentation, histopathology, and management of these lesions is reviewed. Results Patients were typically asymptomatic, presenting with a slowly enlarging, nontender nodule of 2 to 8 years' duration. The lesions ranged from 4 mm to 17 mm in greatest dimension. Four of the lesions were on the eyelid margin, three in the sub-brow area of the upper eyelid, and two in the central lids. All six cases not involving the brow were fixed to the tarsus; one brow lesion was believed to be adherent to the skin. None of the lesions was associated with significant changes of the overlying epidermis, although one lesion showed overlying pigmentation. All patients underwent excisional biopsy for diagnostic or cosmetic reasons. On histopathologic examination, the tumors were biphasic, with an epithelial component exhibiting apocrine or hair follicle differentiation and a myxoid, adipocytic, chondroid, and/or fibrous stroma. The pathologic diagnoses were all consistent with cutaneous benign mixed tumor (chondroid syringoma, pleomorphic adenoma). Follow-up ranged from 2 weeks to 12 months, although several patients failed to keep scheduled follow-up appointments. No clinical recurrences were identified. Conclusions Cutaneous benign mixed tumor may occur in the eyelid, and, although uncommon, should be included in the differential diagnosis of firm, nodular eyelid tumors. The histopathologic features are similar to those seen in this tumor type arising in other areas of the body. Preoperative consideration of this diagnostic possibility may allow the surgeon to plan for complete excision, thereby reducing the possibility of recurrence or malignant transformation. The authors present the largest reported series of an uncommon eyelid neoplasm, cutaneous benign mixed tumor, with guidelines for identification, treatment, and management.
Three cases of atypical, extratarsal chalazia are presented. All three patients initially presented with a history of an inflammatory mass close to the lid margin. Inferior migration subsequently occurred, with loss of connection to the tarsus, causing confusion in the diagnosis. The basis for this migration is postulated to be the anatomical relationships of the tarsus, postorbicular fascia, and lower eyelid retractors. A good response was obtained with standard surgical therapy.
Molluscum contagiosum, caused by a double-stranded DNA virus, is found world-wide, affecting humans as well as other primates and marsupials. In humans, a biphasic incidence occurs with peak infection rates among young children and young adults. In children, infection is spread by direct contact or through fomites, with lesions predominating on the trunk, extremities, and face. In young adults, this disease is spread primarily through sexual contact. Periocular infection can cause secondary chronic follicular conjunctivitis, superficial keratitis, and punctal occlusion. Although many modes of therapy are effective in destruction of the virus, some may have significant side effects when used in the periocular area. We describe treatment by incision and curettage, which we recommend as a simple, effective method of managing this problem.
We explored the degree to which political bias in medicine and study authors could explain the stark variation in Hydroxychloroquine (HCQ)/Chloroquine (CQ) study favorability in the US compared to the rest of the world. COVID-19/SARS-CoV-2 preprint and published papers between January 1, 2020-July 26, 2020 with Hydroxychloroquine and/or Chloroquine; 267 met study criteria, 68 from the US. A control subset was selected. HCQ/CQ study result favorability (favorable, unfavorable, or neutral) was noted. First and last main authors of each US study were entered into FollowTheMoney.org Website, extracting any history of political party donation. Of all US studies (68 total), 39/68 (57.4%) were unfavorable, with only 7/68 (10.3%) of US studies yielding favorable results-compared to 199 non-US studies, 66/199 (33.2%) unfavorable, 69/199 (34.7%) favorable, and 64/199 (32.2%) neutral. Studies with at least one US main author were 20.4% (SE 0.053, P < 0.05) more likely to report unfavorable results than non-US studies. US Studies with at least one main author donating to any political party were 25.6% (SE 0.085, P < 0.01) more likely to have unfavorable results. US studies with at least one author donating to the Democratic party were 20.4% (SE 0.045, P < 0.05) more likely to have unfavorable results. US authors were more likely to publish studies with medically harmful conclusions than non-US authors. Cardiology-specific HCQ/CQ studies were 44.2% more likely to yield harmful conclusions (P < 0.01). Inaccurate propagation of HCQ/CQ cardiac adverse effects with individual scientific author political bias has contributed to unfavorable US HCQ/CQ publication patterns and political polarization of the medications.
Complex orbital fractures consist of fractures of the orbital rim and walls in two or more places and may be associated with more extensive facial fractures. Previously, delayed repair was the standard approach. Techniques of craniofacial surgery allow earlier reconstruction with more accuracy and stability. Enophthalmus, dystopia and facial contour deformities are avoided, and the final result improved. A new standard has been established. Three factors are important in attaining improved results. Three-dimensional CT scanning is used to obtain a comprehensive assessment of the injury, to plan reconstruction pre-operatively, and to assess the reconstruction post-operatively. Secondly, complete exposure of the facial skeleton is necessary and is achieved by the use of a coronal incision, frontal flap, infraorbital incision, and intraoral upper sulcus incision. Thirdly, cranial bone grafting is used to reconstruct orbital floors and severely comminuted or missing bones. Finally, the use of mini-plates and lag screws provides improved accuracy and stability of the reconstruction.
