OBJECTIVETo study the clinical characteristics and the treatment of periorbital injuries.

METHODS61 cases were treated, including 30 cases orbitozygomatic fracture, 6 cases of frontal-orbital fracture, 8 cases of naso-ethmoid-orbital fracture, 7 cases of blow -out fracture and 10 cases of complicated fracture. The patients were diagnosed after physical examination and other examination, like CT. Through bicoronal or local mini incision at the end of eyebrow, combined with subciliary incision and local wound approach, the fractured sites were exposed completely. Then the fractured fragments were repositioned and fixed rigidly. The orbital wall was reconstructed with titanium net and Medpor.

RESULTSThe wounds healed primarily. Good cosmetic and functional results achieved in most of the patients. 4 cases underwent second-stage ophthalmectomy. 2 patients had diplopia after operation, but improved gradually. 3 cases of blepharoptosis needed further treatment.

CONCLUSIONSEarly diagnosis and treatment is very important for periorbital injuries. Fracture reposition and orbital wall reconstruction should he performed at early period.

Adolescent ; Adult ; Aged ; Child ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Orbital Fractures ; surgery ; Skull Fractures ; surgery ; Young Adult

OBJECTIVETo study the surgical reconstruction of secondary fracture deformities of the nasal-orbital ethmoid area.

METHODSTypical bicoronal and subciliary incisions or the adjacent scar incision were employed to expose the fractured area. The flattened nasal bone was narrowed by curved osteotomy along the medial orbital rims and trimed with a bur. 2-3 pieces of cranial outer table were used to reconstruct the nasal framework, which were fixed to the frontal bone with mini-plates. After the medial orbital wall and orbital floor were exposed, the herniated orbital contents were released and reduced to the orbital cavity. The fractured orbital walls were repaired precisely with autogenous cranial outer table or Medpor. The medial canthal tendons were anchored superior-posteriorly to the lacrimal fossa with transnasal wires.

RESULTSFrom December 1996 to December 2001, 34 cases of severe nasal-orbital ethmoid fracture deformities were repaired with this technique. Of them, 12 cases had combined orbital-zygomatic fracture, 4 cases had fontal sinus fracture, 1 case had Le Fort II and 1 case had Le Fort III fracture. All the patients recovered well and their facial appearance improved greatly.

CONCLUSIONSThe key points for surgical reconstruction of the periorbital post-fracture deformities are narrowing the flattened nasal root by curved osteotomy, the nasal framework reconstruction with autogenous bone graft, the orbital wall repair to correct enophthalmos, and most importantly, the medial canthal tendon reduction and canthal plasty.

Adolescent ; Bone Transplantation ; methods ; Cicatrix ; surgery ; Enophthalmos ; surgery ; Ethmoid Bone ; injuries ; Humans ; Nasal Bone ; injuries ; Nose Deformities, Acquired ; surgery ; Orbit ; surgery ; Orbital Fractures ; surgery ; Osteotomy ; methods ; Paranasal Sinuses ; injuries ; surgery ; Polyethylenes ; Reconstructive Surgical Procedures ; Skull Fractures ; etiology ; surgery ; Tendons ; surgery

BACKGROUNDCerebral hyperperfusion syndrome is an important complication of carotid endarterectomy (CEA). An >100% increase in middle cerebral artery velocity (MCAV) after CEA is used to predict the cerebral hyperperfusion syndrome (CHS) development, but the accuracy is limited. The increase in blood pressure (BP) after surgery is a risk factor of CHS, but no study uses it to predict CHS. This study was to create a more precise parameter for prediction of CHS by combined the increase of MCAV and BP after CEA.

METHODSSystolic MCAV measured by transcranial Doppler and systematic BP were recorded preoperatively; 30 min postoperatively. The new parameter velocity BP index (VBI) was calculated from the postoperative increase ratios of MCAV and BP. The prediction powers of VBI and the increase ratio of MCAV (velocity ratio [VR]) were compared for predicting CHS occurrence.

RESULTSTotally, 6/185 cases suffered CHS. The best-fit cut-off point of 2.0 for VBI was identified, which had 83.3% sensitivity, 98.3% specificity, 62.5% positive predictive value and 99.4% negative predictive value for CHS development. This result is significantly better than VR (33.3%, 97.2%, 28.6% and 97.8%). The area under the curve (AUC) of receiver operating characteristic: AUC(VBI) = 0.981, 95% confidence interval [CI] 0.949-0.995; AUC(VR) = 0.935, 95% CI 0.890-0.966, P = 0.02.

CONCLUSIONSThe new parameter VBI can more accurately predict patients at risk of CHS after CEA. This observation needs to be validated by larger studies.

Aged ; Blood Pressure ; physiology ; Cerebrovascular Circulation ; physiology ; Cerebrovascular Disorders ; physiopathology ; Endarterectomy, Carotid ; Female ; Hemodynamics ; physiology ; Humans ; Male ; Middle Aged ; Prospective Studies

BACKGROUND AND PURPOSE: Myasthenia gravis (MG) is usually comorbid with thymoma. More accurate estimates of the incidence thymoma in MG will help inform patients and their physicians, facilitate health policy discussions, provide etiologic clues, and optimize the management of MG. METHODS: We conducted a systematic review search of relevant English-language studies published between 1960 and 2012 using MEDLINE and Embase. We identified additional studies by reviewing the bibliographies of the retrieved articles and hand searched the main neurology journals. Only incidence studies and case series of unselected MG patients in which information about thymoma were included. RESULTS: Out of 2206 potentially relevant studies, 49 met the inclusion criteria. Although there was a considerable degree of heterogeneity, the pooled estimate of the incidence of thymoma in MG was 21% (95% confidence interval, 20-22%). The pooled incidence was significantly higher for surgery-based studies than for population- and hospital-based studies. A large proportion of the reported thymomas were noninvasive. Furthermore, thymoma appears to occur significantly more frequently among male MG patients and those older than 40 years at the onset of MG. CONCLUSIONS: Thymoma is common in MG patients, but appears to be found more often in male MG patients and those older than 40 years at the onset of MG. Further research is needed to expand our understanding of these association conditions.
Cohort Studies ; Hand ; Health Policy ; Humans ; Incidence ; Male ; Myasthenia Gravis ; Neurology ; Population Characteristics ; Thymoma

Objective To investigate the correlation between the CT perfusion and microvessel density (MVD),expression of vascular endothelial growth factor(VEGF)in neoplasm of head and neck.Methods Eighty-eight lesions of head and neck were scanned by spiral CT.The largest axial surface of the mass was searched on unenhanced imaging,and at this level the dynamic contrast enhanced scan series was acquired.Time-density curves (TDC)were created from circular or oval regions of the interest drawn over the mass,target artery by Toshiba Xpress/SX spiral CT with perfusion functional software.The parameters were measured including:peak height (PH ),peak time (PT ),mean transit time (MTT), contrast enhancement ratio(RPH),and perfusion flow (PF).Histopathological slides of 35 masses were carefully prepared for the anti-CD34 and VEGF immunohistochemical staining and tumor microvessel density and calculation of VEGF expression scores.The parameters of CT perfusion were correlatively study with MVD and VEGF.Results(1)The TDC of CT perfusion imaging could be classified into 3 types.The TDC of 53/77 (68.9% )malignant tumors presented the type with rapid ascending and rapid descending after injecting contrast.The TDC of 6/9 malignant lymphomas showed low platform curve。(2)The PF median of thyroid carcinoma was 82.2(41.0,183.4)ml?min~(-1)?100 g~(-1).There was significantly difference in the parameters of CT perfusion among thyroid carcinoma and squamaous cell cancer (Median 23.8 (7.0, 108.4)ml?min~(-1)?100 g~(-1))and lymphomas (Median 24.5(13.2,78.6)ml?min~(-1)?100 g~(-1)).(3) MVD in benign tumors was (44.7?3.4),and in malignant tumors,it is (49.6?14.8 ).There was no significantly difference in MVD between benign and malignant tumors.High VEGF expression was found in 15 malignant tumors and 1 benign tumors,low VEGF expression was found in 9 malignant tumors and 10 benign tumors.(4)There were no significantly difference in VEGF expression and MVD.There was good correlation between MVD (M 40.0 )and PH (M 26.9 ),RPH (M 14.5 ),PF (M 46.8 )(r = 0.35,45.49, 0.41 ).There was correlation between VEGF(M 4.0)and MTT(M 16.7 )(r = -0.41 ).Conclusion The TDC and CT perfusion could be helpful to differentiate benign from malignant tumors. CT peffusion in neoplasm of head and neck is correlated with MVD and VEGF,and may reflect MVD and expression of VEGF.

OBJECTIVETo investigate the treatment of square face with compositive methods. METHODS A total of 71 patients with square-shape face were treated. According to the different face skeleton and desire of patient, mandible angle curved-osteotomy and mentoplasty were used as main methods and zygomatoplasty, buccal fat pad resecting and other aesthetic methods as assistant methods to recontour the whole face skeleton.

RESULTSThe face skeleton of all patients was improved with satisfaction. The following-up period was 6 months to 2 years. In this patients group, massive haemorrhage was occurred during operation in one patient, mental nerve of of one side was injured in two patients, the lip mucosa was wounded in five patients.

CONCLUSIONMandible angle curve-osteotomy and mentoplasty combined with other assistant aesthetic operations were ideal methods to recontour square face. The result was satisfactory.

Adolescent ; Adult ; Cheek ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Mandible ; surgery ; Osteotomy ; Surgery, Plastic ; Treatment Outcome

OBJECTIVETo investigate the cell viabilities of vascular smooth muscle cells and vascular endothelial cells stimulated by cigarette smoke extract(CSE) .

METHODSThe CSE was prepared by smoke-bubbled phosphate buffered saline(PBS) generation.After culturing cells with different concentrations of CSE, we used the cell counting kit-8 to determine the cell viability.The expression levels of c-jun and cyclinD1 were analyzed through Western blot.The c-jun plasmid was transfected to detect the change of cyclinD1 expression.

RESULTSThe smooth muscle cell viability increased when the CSE concentration ranged 0.625%-10%, whereas the endothelial cells viability decreased when exposed to the CSE concentration. After exposure to CSE for 48 hours, there was no difference in c-jun expression between toxin group and PBS group;however, the expression of p-c-jun in the smooth muscle cells significantly increased in the toxin groups than in the PBS group(P<0.05) and the expression of p-c-jun in the vascular endothelial cells significantly decreased(P<0.05) . The level of cyclinD1 significantly increased after exposed to CSE, and its expression level also increased in respond to the c-jun overexpression.

CONCLUSIONCSE can enhance the proliferation of vascular smooth muscle cells and decrease in the activity of endothelial cells proliferation, which may be explained by the phosphorylation of c-jun and the expression of cyclinD1.

Cell Proliferation ; drug effects ; Cell Survival ; Cells, Cultured ; Cyclin D1 ; metabolism ; Endothelial Cells ; drug effects ; metabolism ; Humans ; Myocytes, Smooth Muscle ; drug effects ; metabolism ; Proto-Oncogene Proteins c-jun ; metabolism ; Tobacco ; adverse effects

OBJECTIVETo investigate a technique for correction of severe microgenia.

METHODSThe mandibular symphysis was exposed through intraoral mucous incision. Two parallel osteotomies were performed under mental foramen. The mobilized segments were advanced like two steps and fixed rigidly with miniplate.

RESULTSFrom June, 2004 to Dec, 2005, 10 cases with severe microgenia were treated with this technique. The duration of follow-up was six months. The mean chin advancement was 1.1 cm and the mean chin vertical increase was 0.7 cm. All the patients healed very well with satisfactory aesthetic result.

CONCLUSIONSWith this two-step genioplasty, the chin can be moved to ideal position with a natural appearance. It is a reliable method for severe microgenia.

Adult ; Chin ; abnormalities ; surgery ; Female ; Humans ; Mandible ; abnormalities ; surgery ; Osteotomy ; Young Adult

OBJECTIVETo analyze the clinical results and complications of three methods for microgenia, including chin augmentation with silicone implant, bone autograft, and genioplasty.

METHODSThe advantages and disadvantages of the three methods for microgenia were assessed through 3-D CT reconstruction, X-ray and intraoperative observation during the second operation. The indications for each technique were also studied.

RESULTSThe frequently observed problems for chin augmentation with silicone implants were implant malposition, underlying bone absorption, periosteal reaction and undercorrection. Chin augmentation with bone autograft had a great long-term bone graft absorption which led to undercorrection. Genioplasty showed a satisfactory cosmetic result with no serious complication.

CONCLUSIONSChin augmentation with silicone implant is suitable for mild microgenia with a shallow mentolabial groove, but without facial vertical insufficient and facial asymmetry. Genioplasty can be used in all kinds of microgenia in any severity, especially those with deviated chin and facial asymmetry. Chin augmentation with bone autograft can't achieve good long-term result and should be applied prudently.

Adult ; Chin ; abnormalities ; surgery ; Female ; Humans ; Prostheses and Implants ; Silicone Elastomers ; Surgery, Plastic ; methods ; Young Adult

OBJECTIVETo explore a new method for mentoplasty.

METHODSThe bilateral prominent mandibular angle or outer lamina was resected through the intraoral approach. The resected bone fragments were shaped and rigid fixed to the chin with miniplates and screws.

RESULTSA total of 30 patients (28 females, 2 males) accepted chin augmentation with this method. The mandibular angle bone was used in 20 cases and the mandibular outer lamina was used in 10 cases. The operative results were satisfactory, and the patient's facial contour was improved substantially.

CONCLUSIONNo rejection reaction was found after this procedure. Chin augmentation with autogenous mandibular bone is an ideal method for genioplasty.

Adult ; Bone Transplantation ; methods ; Chin ; surgery ; Female ; Humans ; Male ; Mandible ; surgery ; Reconstructive Surgical Procedures ; methods ; Transplantation, Autologous ; Treatment Outcome