phenylephrine-hydrochloride and Eyelid-Neoplasms

Mohs micrographic surgery (MMS) is often the treatment of choice for skin cancer removal as it maximizes normal tissue sparing and can be paired with a reconstructive approach that optimizes function and cosmesis. Many tumors on the eyelid, nose, ear, and genitals are particularly well suited for MMS but can be challenging for the dermatologic surgeon.. To review the complex anatomy, as well as the authors' approach to executing and interpreting Mohs layers, at each of these anatomical sites.. A review of the literature on MMS of the eyelid, nose, ear, and genitals was performed using the PubMed database and relevant search terms.. These sites present potential pitfalls for tumor resection and reconstruction, but with the proper technique, the dermatologic surgeon can minimize tumor recurrence and MMS complications. Warning signs for potentially difficult tumor resection can signify when an interdisciplinary approach is warranted.

Topics: Ear Neoplasms; Ear, External; Eyelid Neoplasms; Eyelids; Female; Genital Neoplasms, Female; Genital Neoplasms, Male; Genitalia, Female; Genitalia, Male; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms

A case of Malignant Syringoma (syn. = Microcystic Adnexal Carcinoma, Sclerosing Swat Duct Carcinoma) of the nose in a 44 year old female patient is reported. The tumor had been misdiagnosed as a Rhinophyma some 20 years before and had thus been treated under cosmetic aspects. Besides the appearance, the patient did not suffer any complaints and was referred to the ENT-department of the Klinikum Hannover for cosmetic reasons. Histopathological examination after removal revealed a malignant syringoma, which, due to its extensive size and subepithelial growth pattern, made a complete ablation of the entire nose and the adjacent soft tissue of the face necessary. Pathohistologically cellular atypia, invasive growth pattern, perineural and perivascular infiltration was characteristic. Quantitative DNA anaylsis revealed a tumor with a diploid stem line and only few aneuploid cells. Malignant syringoma is a rare differential diagnosis of face skin tumors. The present case is discussed based on a review of the literature.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Skin Appendage; Diagnosis, Differential; Eyelid Neoplasms; Facial Neoplasms; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Rhinophyma; Sweat Gland Neoplasms; Syringoma; Time Factors

Many types of graft tissue have been used to reconstruct the posterior lamella of the eyelids in cases of full-thickness defect, lid retraction, and loss of lower lid stability. In this study, lower lateral cartilage of the nose was used for the reconstruction of posterior lamella of the eyelids, which mimics the tarsal plate in shape, thickness, and size.. This study included 10 patients who underwent lid reconstruction to support tarsal plate strength and repair full-thickness defects of the eyelids due to tumor excision and trauma. While anterior lamella was reconstructed with local or regional flaps, posterior lamella was repaired by using either chondromucosal or chondral graft of the lower lateral cartilage of the nose. Graft harvesting was performed on the inner surface of the alar rim by turning it inside out.. Cartilage grafts were sufficient to reconstruct the tarsal plate in all of the patients having eyelid defects of various sizes. In 3 patients, horizontal half of the eyelid was defective, in 3 patients 3/4, and in 2 patients 4/5 of the lids were missing. The inferior eyelid was totally reconstructed in 1 patient. Surgical outcomes provided good lid symmetry and esthetics, patient satisfaction, and proper lid function without any nasal deformity, incision scar, or discomfort.. Ala graft provides a thin, pliable, and curved cartilage for the eyelid reconstruction. It has a high similarity with the anatomy of the tarsal plate, making it adaptable to the convex surface of the eyeball, and making 3 dimensional repair possible.

Topics: Cartilage; Esthetics; Eyelid Diseases; Eyelid Neoplasms; Eyelids; Humans; Nose; Plastic Surgery Procedures; Surgical Flaps

Surgical excision of large malignant lower eyelid tumors may cause important full-thickness eyelid defects. The reconstruction of such defects must restore the physiologic function of the eyelid and also re-establish an acceptable aesthetic result.. We report the outcomes of full-thickness excision of tumors extending over half of the horizontal lid length, followed by reconstruction using a nasal chondromucosal graft (coming from the ipsilateral ala of the nose) and an upper eyelid myocutaneous flap. Histological analysis of the specimen identified the tumor type and surgical margins for each patient.. A total of 25 patients were operated using this reconstruction technique between March 2009 and June 2015: 17 basal cell carcinomas, 3 spindle cell carcinomas and 5 conjunctival melanomas (out of which 2 were associated with lentigo maligna). Mean duration of follow-up after surgery was respectively 36, 41 and 17 months for each of these 3 tumor types. We found a single local tumor recurrence and this was a basal cell carcinoma in a xeroderma pigmentosum patient. After surgery, none of the patients had lagophthalmos or ocular surface complications. Only 4 patients had a 1mm scleral show postoperatively; 3 other patients developed a small retraction of the eyelid after adjuvant radiotherapy and a 1mm scleral show occurred.. In malignant tumors, complete surgical excision with histological margins adapted to tumor type prevents local recurrence in most cases. Our repair strategy of nasal chondromucosal graft and skin-muscle flap for large inferior eyelid defects provides good functional and aesthetic results.

Topics: Adult; Aged; Aged, 80 and over; Blepharoplasty; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Eyelid Neoplasms; Female; Humans; Male; Melanoma; Middle Aged; Myocutaneous Flap; Nasal Cartilages; Nose; Plastic Surgery Procedures; Respiratory Mucosa; Retrospective Studies; Skin Neoplasms; Skin Transplantation; Treatment Outcome; Young Adult

Topics: Eyelid Neoplasms; Eyelids; Female; Humans; Male; Middle Aged; Nose; Skin Transplantation; Surgical Flaps; Treatment Outcome

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Eyelid Neoplasms; Eyelids; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps

Basal cell carcinomas commonly involve the medial canthal region and reconstruction of medial canthal defects is a challenging problem in reconstructive surgery. A new axial pattern flap raised from radix nasi region has been successfully used for the medial canthal defects in eight patients in figure-of-eight manner. One of the ellipses of the figure of eight is the defect, the other is the radix nasi flap. The radix nasi flap with a dimension up to 25 mm is transposed to the defect based either on ipsilateral anastomosis of the dorsal nasal artery with angular artery (AA) or with the connection of its source artery (i.e. ophthalmic artery) if the AA is damaged. All flaps survived and no tumour recurrence was observed. The donor sites were closed primarily and hidden at the radix nasi crease in all cases. The radix nasi flap in figure-of-eight fashion is good alternative for defects of the medial canthal area in terms of attaining a suitable colour and texture and minimal surgical scars.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Eyelid Neoplasms; Eyelids; Facial Muscles; Female; Forehead; Humans; Male; Middle Aged; Nose; Ophthalmic Artery; Plastic Surgery Procedures; Surgical Flaps

In considering periorbital reconstructive options, the goals of reconstruction are to obtain functional and esthetic results. At the medial canthus, reconstruction should maintain the normal concavity of the canthus without distortion of the surrounding tissues and should maintain normal eyebrow contour and symmetry. The authors represent their flap in flap technique that provides normal concavity of the canthus and does not cause any complex and undesirable scars.. A new modification of conventional glabellar flap which was named "flap in flap technique" was raised to cover medial canthal defect. We designed an inverted V-shaped advancement flap (123Delta-A flap) that contains both B (145Delta flap) and C (2345) flaps. The B flap is designed in the glabellar region, which is at medial side of the defect and is transposed to defect, and the C flap is planned in V-Y fashion to release tension over the B flap.. To date, we have used this technique successfully in 5 patients (4 women and 1 man), requiring a glabellar flap to reconstruct the medial canthus and proximal nasal dorsum. All defects were secondary to excision of basal cell carcinoma. All were satisfied with the cosmetic and functional results.. Our glabellar flap in flap technique for the reconstruction of medial canthal defects has several advantages such as maintaining concavity of the canthus without distortion of the surrounding tissues and providing normal eyebrow contour and symmetry.

Topics: Adult; Carcinoma, Basal Cell; Esthetics; Eyelid Neoplasms; Eyelids; Facial Neoplasms; Female; Follow-Up Studies; Forehead; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps

A versatile musculocutan flap from the radix nasi region, the radix nasi island flap, is described. The flap has an axial blood supply derived from the dorsal nasal branch of the ophthalmic artery which is anastomosed to the terminal branch of the facial artery. The flap includes the skin, subcutaneous tissue, and procerus muscle. Ten patients, aged 50 to 86 years, have been reconstructed with this flap for defects in the nose (in 4 cases), midface (in 4 cases) and lower eyelids (in 2 cases). The mean flap size was 17 x 23 mm (range: 15 x 20 to 20 x 27 mm). All flaps fully survived. Additional complications and morbidity were not observed. The donor sites were closed a primarily closure in all cases. Follow-up ranged from 3 to 12 months (mean: 8.2 months). The radix nasi flap is a safe flap, has minimal donor site morbidity, and is especially suited for nasal and midface reconstruction in terms of attaining a suitable color and thickness.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Cheek; Eyelid Neoplasms; Eyelids; Facial Muscles; Facial Neoplasms; Female; Follow-Up Studies; Graft Survival; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Ophthalmic Artery; Plastic Surgery Procedures; Skin Neoplasms; Skin Pigmentation; Skin Transplantation; Subcutaneous Tissue; Surgical Flaps; Tissue and Organ Harvesting; Wound Healing

Although several methods can be used to perform midface reconstruction, difficulties exist in selecting the appropriate method because of anatomic and functional complexities, donor site morbidities, and poor esthetic results. The purpose of this study was to develop an alternative reconstructive method for the midface using various flaps based on the angular artery.. We investigated the relation between the angular artery and its surrounding structures through cadaveric studies and then applied the findings clinically. As a result, we were able to perform reconstruction with a retroangular flap for defects of the lower half of the nose and the lower eyelid. In addition, defects of the upper half of the nose and the medial canthal area were reconstructed by use of island composite nasal flaps.. The angular artery was reliable as a pedicle whether it was used in an antegrade or retrograde manner. All the wounds were successfully closed, with the exception of minor complications such as partial skin necrosis and flap bulkiness. The esthetic outcomes for the donor and recipient sites were acceptable.. The angular artery has diverse relations with its surrounding structures according to its course of travel, and if the surgeon has a precise understanding of its anatomic location, we believe that retroangular flaps and island composite nasal flaps may prove useful for the treatment of midface defects.

Topics: Aged; Aged, 80 and over; Arteries; Cadaver; Carcinoma, Basal Cell; Dissection; Esthetics; Eyelid Neoplasms; Eyelids; Face; Facial Muscles; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Tissue and Organ Harvesting; Treatment Outcome

Topics: Antineoplastic Combined Chemotherapy Protocols; CD56 Antigen; Connective Tissue Diseases; Cyclophosphamide; Diagnostic Errors; Doxorubicin; Epstein-Barr Virus Infections; Eyelid Neoplasms; Fatal Outcome; Female; Herpesvirus 4, Human; Humans; Immunophenotyping; Killer Cells, Natural; Lymphoma, Non-Hodgkin; Lymphoma, T-Cell, Cutaneous; Male; Nose; Prednisolone; Skin; Skin Neoplasms; T-Lymphocyte Subsets; Vincristine; Young Adult

Topics: Aged; Conjunctiva; Eyebrows; Eyelid Neoplasms; Eyelids; Female; Frontal Sinus; Humans; Mucous Membrane; Neoplasm Recurrence, Local; Neurofibroma; Nose; Orbit; Reoperation; Surgical Flaps; Transplantation, Heterotopic

Sebaceous carcinoma of the eyelid is an uncommon tumour with unusual modes of presentation. It can remain occult at the primary site, without producing any mass, masquerading as chronic blepharoconjunctivitis, while setting up metastases in the regional lymph nodes especially in the pre-auricular group. We report here a case that not only masqueraded as chronic blepharoconjunctivitis with nodal metastases from an 'unknown primary' in the neck, but whose tumour spread in a pagetoid manner along the nasolacrimal duct producing a nasal tumour that was believed to be the 'unknown primary'. This case emphasizes the need for ophthalmologists, ENT surgeons and pathologists to keep sebaceous carcinoma in mind while evaluating patients with chronic blepharoconjunctivitis and cervical node metastases from 'unknown primary'. Histological clues for picking up a sebaceous carcinoma at a metastatic site include a tumour with comedo or ductal growth pattern and intracytoplasmic lipid.

Topics: Adenocarcinoma, Sebaceous; Aged; Blepharitis; Conjunctivitis; Diagnosis, Differential; Eyelid Neoplasms; Humans; Lymphatic Metastasis; Male; Neoplasm Invasiveness; Neoplasms, Unknown Primary; Nose; Syndrome

J. M. Converse described the scalping forehead flap in 1942 with the aim of using it in total nasal reconstruction. A rich net of arterial and venous vessels constitute the basic pattern of its blood supply through three principal pedicles: (1) temporal superficial, (2) supraorbital, and (3) supratrochlear. It was described for nasal reconstruction, but due to its characteristics, such as color of the frontal skin, texture, hairless skin, and reliable irrigation, it can be used in the reconstruction of other facial areas. According to these particularities, the Converse flap was used in the reconstruction of a total left lower lid and adjacent lateral nose and cheek areas in a patient with an extended squamous carcinoma. The tumoral resection included the removal of (1) complete lower lid, (2) lacrimal lower canaliculus, sac, and nasolacrimal duct, (3) lower ocular conjunctiva, (4) intraorbitary fat and both inferior oblique and inferior rectus muscles, and (5) adjacent skin of the nose and cheek. Postoperative controls showed an excellent aesthetic and functional result. A hypochromic frontal skin graft was the only sequela; definitive skin coloration was obtained by a dermopigmentation technique. The versatility of this forehead flap allows it to be successfully used for reconstruction not only in the nasal area but also in other facial ones.

Topics: Aged; Carcinoma, Squamous Cell; Cheek; Conjunctiva; Eyelid Neoplasms; Eyelids; Forehead; Humans; Lacrimal Apparatus; Male; Neoplasm Invasiveness; Nose; Oculomotor Muscles; Skin Pigmentation; Skin Transplantation; Surgical Flaps

A study was undertaken to investigate the treatment of superficial squamous cell carcinoma of the nasal planum, pinna and eyelid in cats by photodynamic therapy, using topical 5-aminolaevulinic acid cream, with subsequent exposure to red light of wavelength 635 nm, supplied by a light-emitting diode source. A total of 13 squamous cell carcinomas were treated, including 10 nasal planum lesions, two pinnal lesions and one eyelid lesion. After a single treatment, complete responses were seen in nine out of 10 nasal planum lesions, one out of two pinnal lesions and the eyelid lesion. The overall complete response rate for lesions managed with a single photodynamic therapy treatment was 85 per cent. Seven of the 11 lesions (63.6 per cent) showing a complete response subsequently recurred; the time to recurrence ranged from 19 to 56 weeks (median 21 weeks, mean 26.7 weeks).

Topics: Administration, Topical; Aminolevulinic Acid; Animals; Carcinoma, Squamous Cell; Cat Diseases; Cats; Ear, External; Eyelid Neoplasms; Light; Neoplasm Recurrence, Local; Nose; Photochemotherapy; Photosensitizing Agents; Skin Neoplasms; Time Factors; Treatment Outcome

Osseointegrated maxillofacial epitheses are an interesting therapeutic response for rehabilitation after loss of facial tissue when reconstructive plastic surgery cannot be proposed. We analyzed the criteria used for deciding on this type of treatment for the loss of local areas of auricular tissue, the nasal pyramid and the orbitopalpebral region, presenting individual clinical examples.

Topics: Adolescent; Adult; Aged; Amputation, Traumatic; Carcinoma, Adenoid Cystic; Carcinoma, Basal Cell; Ear Neoplasms; Ear, External; Eye Neoplasms; Eye, Artificial; Eyelid Neoplasms; Female; Humans; Lacrimal Apparatus Diseases; Male; Middle Aged; Nose; Nose Diseases; Orbital Implants; Osseointegration; Patient Care Planning; Prostheses and Implants; Prosthesis Design; Prosthesis Implantation

Specimens from the reconstructed eyelids of two out of 15 patients operated on using an island chondromucosal flap from the nose were observed under light and scanning electron microscopy (EM) to study the histological and ultrastructural features of nasal epithelium transferred as a flap to the lids, the microscopic appearance of the other tissues of the flap, and its vascularisation. Both light and scanning EM images showed that nasal epithelium, when transferred as part of a flap for reconstruction of the eyelid, maintains its differentiation for many months. The lumen of arteries and veins can be observed in sagittal sections within the flap, suggesting that their course is parallel to its long axis. The absence of fibrosis or muscle fibre degeneration together with a highly cellular cartilage are indirect indications of good vascularity. These data support the reliability of the island chondromucosal flap from the nose in reconstruction of the eyelid.

Topics: Aged; Blepharoplasty; Carcinoma, Basal Cell; Carcinoma, Merkel Cell; Cartilage; Eyelid Neoplasms; Eyelids; Female; Humans; Male; Microscopy, Electron; Muscles; Nose; Surgical Flaps

Partial or total lower lid reconstruction implies the repair of three layers: the skin, the tarsus, and the conjunctiva. The method of reconstruction must, therefore, aim at three objectives: ensuring the stability of the lid by repairing the tarsoconjunctival layer, achieving an aesthetic result with the repair of the skin, and taking into consideration the primary role of the upper lid in the ocular protective system. We recommend a musculocutaneous flap, taken from the upper lid, with a single lateral or medial pedicle combined with a chondromucosal alar graft. During the last 10 years, 41 patients were operated on with malignant skin tumors requiring marginal, partial, and total lower lid reconstruction. The results were quite satisfactory from a functional and aesthetic point of view. We noticed two cases of partial flap necrosis and two cases of ectropion needing revision. We believe that the procedure described can be a tool in the armamentarium of the plastic surgeon involved in the field of the orbitopalpebral area.

Topics: Eyelid Neoplasms; Eyelids; Humans; Nose; Reoperation; Skin Neoplasms; Surgical Flaps

Two cases of patient fires are presented. Components necessary for this complication to occur are outlined, in addition to recommendations for prevention.

Topics: Adult; Aged; Burns; Carcinoma, Basal Cell; Electrocoagulation; Eyelid Neoplasms; Facial Injuries; Fires; Humans; Lip; Male; Mouth; Nose; Nose Neoplasms; Operating Rooms; Safety; Skin

Topics: Adult; Diagnosis, Differential; Eye; Eyelid Neoplasms; Female; Humans; Nose; Varicose Veins

Both mechanical and magnetic types of fixation can be used with extra-oral implants, with the possibility of positioning maxillofacial prostheses by either mechanical, magnetic or mixed fixation, the latter by a combination of the two methods. These different modes of fixation allow precise positioning, avoid the use of adhesives, limit maintenance problems and, in addition, facilitate oncologic surveillance, providing a non-negligible complement to reconstructive surgery.

Topics: Adult; Aged; Biomechanical Phenomena; Carcinoma, Basal Cell; Ear, External; Eye, Artificial; Eyelid Neoplasms; Female; Humans; Magnetics; Male; Maxillofacial Prosthesis; Nose; Nose Neoplasms; Prostheses and Implants; Prosthesis Design

Periosteum is a well-known source of tissue used in eyelid and orbital reconstruction. The periosteum medial to the medial canthal tendon, on the lateral wall and bridge of the nose, is an excellent place from which to mobilize this tissue to use as replacement medial canthal tendon. When the medial canthal tendon is lost following cancer extirpation, reconstruction can be accomplished by elevation and rotation of a nasal periosteal flap. Representative cases are presented to demonstrate the technical aspects of the procedure.

Topics: Aged; Carcinoma, Basal Cell; Eyelid Neoplasms; Eyelids; Female; Humans; Male; Nose; Periosteum; Surgery, Plastic; Surgical Flaps; Tendon Transfer

The complexity of the medial canthal area is discussed and the importance of complete tumor removal with microscopically controlled excision emphasized.. Immediate reconstruction is recommended in most instances. Defects to be reconstructed are divided into nasal and eyelid sides of the medial canthal region and subdivided into superficial and deep defects. The reconstructive modalities used in the various defects are illustrated and the advantages and disadvantages of each explored.

Topics: Carcinoma, Basal Cell; Cicatrix; Eyelid Neoplasms; Eyelids; Humans; Methods; Nose; Nose Neoplasms; Skin Transplantation; Surgery, Plastic; Surgical Flaps

Topics: Adult; Aged; Eyelid Neoplasms; Eyelids; Humans; Male; Nose; Surgery, Plastic; Surgical Flaps

I hope to stress that with familiarity with this procedure: (A) 50% of one or both lids as well as canthal excision can be adequately reconstructed in one operation without the need for canthotomy. (B) Scarring is minimized and resultant function and cosmetic results are good. (C) For the purposes of ablative surgery or traumatic loss the eyelids may be considered comparable to other external sphincters and amenable to the same reconstructive procedures and concepts which obtain in these other structures. Although many procedures have been recommended for sizeable lid losses, I feel that this operation offers certain advantages, particularly in its simplicity. These 7 cases demonstrate sizeable resections of lid tissue with satisfactory results even when as much as 50% or more is removed from one or both lids. The cardinal principle of the use of local tissues as recommended by Von Imre is to be stressed and still holds true today.

Topics: Aged; Carcinoma, Basal Cell; Cheek; Eyelid Neoplasms; Eyelids; Female; Humans; Male; Methods; Middle Aged; Nose; Wound Healing

Topics: Adult; Carcinoma, Basal Cell; Dermatologic Surgical Procedures; Eyelid Neoplasms; Eyelids; Face; Humans; Male; Melanoma; Methods; Middle Aged; Neck; Nose; Orbit; Skin Transplantation; Surgery, Plastic; Sutures; Transplantation, Autologous

Topics: Alpha-Globulins; Biopsy; Bone Marrow; Child; Child, Preschool; Deafness; Eyelid Neoplasms; Female; Histiocytes; Humans; Hypergammaglobulinemia; Lymph Nodes; Lymphatic Diseases; Microscopy, Electron; Neoplasm Recurrence, Local; Nose; Orbit; Orbital Neoplasms; Pedigree

Topics: Cell Transformation, Neoplastic; Eyelid Neoplasms; Facial Neoplasms; Female; Humans; Lymphoma, Follicular; Lymphoma, Non-Hodgkin; Middle Aged; Neoplasm Metastasis; Nose; Orbital Neoplasms; Parotid Neoplasms

Topics: Congenital Abnormalities; Eyelid Neoplasms; Facial Neoplasms; Female; Head and Neck Neoplasms; Hemangioma; Hong Kong; Humans; Infant, Newborn; Male; Nose; Pedigree; Racial Groups

Topics: Eyelid Neoplasms; Humans; Medical Records; Neurilemmoma; Neurofibromatoses; Neurofibromatosis 1; Nose