No abstract available.
Korea*

No abstract available.
Gels* ; Lipopolysaccharides* ; Silver* ; Sodium*

To affect the complete closure of the eyelids in leprosy patients with lagophthalmos, we have used various surgical methods to avoid using the temporalis transfer method. Although widely accepted as the most effective treatment for the chronic lagophthalmos patient, the temporalis transfer method creates a simultaneous involuntary closure of the eyelids while biting or chewing. This side effect creates a social stigmata which former leprosy patients wish to avoid. As a result, we have attempted to identify the most effective treatment which will also eliminate this involuntary closure of the eyelids during biting or chewing. In the upper eyelid, we performed gold plate implantation and levator muscle severing. In the lower eyelid, lateral tarsal strip, permanent medial tarsorrhaphy, horizontal shortening, cartilage grafting and alloderm graft have all been used in the treatment of ectropion. Based on our treatment of multiple patients, we now believe medial tarsorrhaphy supplemented with the various other methods mentioned above are insufficient to achieve the desired result of complete closure of the eyelids. As a result, we are now looking to a modified temporalis transfer procedure to ensure complete closure of the eyelids without the eye closing side effect.
Cartilage ; Christianity ; Ectropion ; Eyelids ; Humans ; Leprosy ; Mastication ; Transplants

BACKGROUND: Eyelash ptosis(ELP) is a common finding in patients with long-standing leprosy. However, it has rarely been reported in the literature previously, because it has been diagnosed as trichiasis or entropion. OBJECTIVE: To determine the prevalence of ELP in Hansen's disease. METHODS: We took both frontal and lateral photographs of eyes in 20 patients and evaluated the degree of ptosis using a 4-point rating scale, in which 0 indicates no ptosis; 1, minimal; 2, moderate; and 3, severe. The evaluation was also performed in 20 normal persons as control group. RESULTS: All patients demonstrated ELP. In general, severity of ptosis in patient group is greater than that in control group. While the mean eyelash ptosis rating was 2.0+/-0.6 in the latter, it was 0.6+/-0.4 in the former, which is statistically significant (p<0.01). CONCLUSIONS: ELP is common in the patients with Hansen's disease and moderate to severe forms occurred more commonly in disease group compared with control group. ELP must be considered as a characteristic ocular finding in long-standing leprosy.
Eye ; Humans ; Leprosy ; Prevalence ; Trichiasis

Lepra bacilli invade the nasal mucosa from early stage. The infiltrated mucous membrane breaks down and ulcerates easily. Irritating crusts and ulcers occur, creating in perforation of the septum. When most of the septum and inner mucosal lining of the nose is destroyed, the nose is deprived of its support and it collapses. The nasal bones are typically intact, and the collapsed nose adheres to the facial skeleton, giving the characteristic 'sunken and short nose' deformities. We have operated on 25 patients with deformities such as short nose, sunken nose, collumela deformity and ala collapse since 1992. In short nose we operated with a paramedian forehead flap and rib cartilage graft in a cantilever pattern. In ala collapse we used a conchal cartilage graft. Lastly, in collumela deformity we used the local flap and a composite graft.
Cartilage ; Congenital Abnormalities* ; Forehead ; Humans ; Leprosy* ; Mucous Membrane ; Nasal Bone ; Nasal Mucosa ; Nose ; Ribs ; Skeleton ; Transplants ; Ulcer

BACKGROUND: Damage of the facial nerve, especially buccal and marginal mandibular branches, causes facial palsy and paralytic deformity of the lips such as lower lip ectropion, lip drooping, deviation of the mouth, inability of closing mouth, and the loss of the nasolabial folds. OBJECTIVE: To find out the best surgical method to correct paralytic deformity of the lips. METHODS: We reviewed retrospectively the various surgical treatment modalities of the paralytic deformity of the lips performed in The Institute for Leprosy Research for 13 years. RESULTS: One hundred and twenty five surgical procedures were performed in 80 patients with Hansen's disease. Of these, the static method, dermal suspension flap, was done in 15 cases, the dynamic methods were done in 64 cases, and others were done in 46 cases. All patients showed postoperatively clinical improvement above the average. Two patients received reoperation or additional procedures due to relapse of the condition. CONCLUSIONS: The dynamic method using tensor fascia lata was superior to other treatment modalities.
Congenital Abnormalities ; Ectropion ; Facial Nerve ; Facial Paralysis ; Fascia Lata ; Humans ; Leprosy ; Lip ; Mouth ; Recurrence ; Reoperation ; Retrospective Studies

Facial nerve paralysis in leprosy adversely affects facial regions from the forehead to the lip. In particular, lagophthalmos in patients with leprosy causes exposure keratitis, corneal and conjunctival dryness which can progress blindness and disfigurement. The function of the eyelids is controlled by the oculomotor nerve and the facial nerve. In leprosy patients the oculomotor nerve continues to function causing the levator muscle to lift the eyelids. However, paralysis of the facial nerve prevents the orbicularis oculi muscle from closing the eyelids, resulting in lagophthalmos. Various methods were developed to correct lagophthalmos, one of which was temporal muscle transfer(TMT) reported in 1934 by Gillies. Since we noted relatively high occurrence of ptosis as a complication in patients treated previously with the TMT, we performed other surgical procedures for laglphthalmos over 15 years, not to make the ptosis. Although most of the patients quite improved post-operatively, partial lid-gap frequently persisted. It may be related to involutional changes and paralyzed orbicularis muscle. Recently, we conducted 4 different TMT methods for last 4 years to reduce ptosis. The methods used included Brown & McDowell, McCord & Codner, modified Gillies & Anderson, and modified Gillies. Seventy-five TMT operations in 60 patients(26 males and 34 females) were done between 2011 and 2014. The age range of the patients was 54~87 years(the mean was 70.1). Fifteen patients had bilateral TMT procedures. As a result, ptosis appeared in 14(18.7%) out of 75 TMT procedures for 4 years. Four technical points should be considered for the initial assessment to prevent or reduce the incidence of ptosis. The first is the increase of the length of temporalis muscle flap to approximately 8cm with a parallel course to the lateral canthus, which will reduce the oblique pull. Second, the width of the fascia sling in the upper eyelid is narrow(3~4mm) to reduce weight on the eyelid. Third, the fascia sling in the upper lid is not tied with that of the lower lid at the medial canthal tendon to reduce tension. Lastly, the fascia sling in the upper eyelid is shallow(subdermal level) in location and as near as possible to the lid margin.
Aged ; Blindness ; Eyelids ; Facial Nerve ; Fascia ; Forehead ; Humans ; Incidence ; Keratitis ; Leprosy* ; Lip ; Male ; Oculomotor Nerve ; Paralysis ; Temporal Muscle* ; Tendons

Changes in the eye resulting from leprosy include lagophthalmos, ectropion and the eyelid retraction. In lagophthalmos, an interpalpebral gap(lid gap) of 2mm or less, which is most preferred after correction, does not have any adverse effect on the vision. However, a gap of 3mm or greater can cause or make the eye susceptible to the dryness of the cornea or other vision problems. Bell's phenomenon will adequately prevent eye damages, especially corneal damage when the lid gap is less than 3mm. Although static methods such as autogenous canthal sling, lateral tarsal strip, medial tarsorrhaphy and gold implant had a positive cosmetic effect when used in combination, the lid gap could hardly reduce to less than 3mm. Frequent recurrence of lagophthalmos and ectropion after static methods required further definite surgical treatment. We applied a dynamic method of modified Gillies to correct lagophthalmos and it was successful in reducing the lid gap to less than 2mm in most cases.
Cornea ; Cosmetics ; Ectropion ; Eye ; Eyelids ; Leprosy ; Recurrence ; Vision, Ocular

No abstract available.
HL-60 Cells* ; Humans ; Mass Screening* ; Protein Kinases*

Paralytic lagophthalmos and ectropion in the treatment of leprosy patients are serious complications of facial paralysis, which may lead to exposure keratitis and corneal ulceration, which can further lead to blindness. In 1995, 1997, 1999 and 2001, we reported in this journal on the surgical treatment of paralytic lagophthalmos and ectropion. In the 1st report, made in 1995, for lid closing, I (Ahn) performed various methods of traditional surgery such as temporal muscle transfer, medial and lateral canthoplasty, as well as gold implantation. In the 2nd report, made in 1997, we (Ahn and Park) presented a combination treatment of gold plate with minor changes of design and weight in the upper lid and medial canthoplasty with horizontal shortening in the lower lid. In the 3rd report, made in 1999, we described an additional graft of conchal cartilage in the lower lid. However, the lateral end of the cartilage would warp and create new partial ectropion several months later. Therefore, we shifted from cartilage to Alloderm(R), acellular dermal graft. In the 4th report, made in 2001, we reported that Alloderm(R) is a good substitute for the cartilage and is also an effective volume filler to the atrophic lower lid. The medial portion of the lower lid often presented with a recurrence of the ectropion, despite having tightened the bilateral plication of the medial and lateral canthal ligaments with an Alloderm(R) graft in the inferior border of the tarsus. In order to treat the recurring ectropion, a modified permanent tarsorrhaphy was performed. We have noted that a modified permanent tarsorrhaphy on the medial canthal area in Z-plasty successfully corrected the partial ectropion and resulted in decreased epiphora and increased esthetic satisfaction.
Ankle ; Blindness ; Cartilage ; Corneal Ulcer ; Ectropion* ; Facial Paralysis ; Humans ; Keratitis ; Lacrimal Apparatus Diseases ; Leprosy ; Ligaments ; Recurrence ; Temporal Muscle ; Transplants