BACKGROUND: Subbrow blepharoplasty (SBB) has advantages over traditional blepharoplasty in that it results in more natural-looking creases and contours and is more effective for lateral periorbital rejuvenation. However, in older patients with sunken upper eyelid, this procedure might make the superior eyelid sulcus appear worse because the thicker upper eyelid tissue in the subbrow area is replaced by thinner tissue. To overcome this limitation, we developed a de-epithelialized musculocutaneous flap for SBB. METHODS: From August 2016 to January 2018, 13 patients with sunken upper eyelid deformity underwent SBB. For each of these patients, a typical SBB incision was made, but the tissue usually removed in SBB was dissected as a flap based on the branch of the ophthalmic vessel. After elevation, the flap was transposed or folded to correct the sunken deformity. The results were assessed by the patients themselves and by three plastic surgeons at 6 months postoperatively. RESULTS: The mean age of the patients was 63 years (range, 47–81 years). There were no postoperative complications related to wound dehiscence, hypertrophic scarring, or sensory changes. All patients and plastic surgeons provided scores indicating good to excellent results and were satisfied with the cosmetic outcomes. All patients reported improved functional visual acuity after surgery. CONCLUSIONS: Our technique is simple and effectively addresses both sunken upper eyelid deformity and dermatochalasis. Unlike fat or dermofat grafting, our new technique does not require an additional donor site, and it is more reliable in terms of vascularity.
Blepharoplasty ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Eyelids ; Humans ; Myocutaneous Flap ; Plastics ; Postoperative Complications ; Rejuvenation ; Surgeons ; Tissue Donors ; Transplants ; Visual Acuity ; Wounds and Injuries

Craniofacial cleft is a rare disease, and has multiple variations with a wide spectrum of severity. Among several classification systems of craniofacial clefts, the Tessier classification is the most widely used because of its simplicity and treatment-oriented approach. We report the case of a Tessier number 3 cleft with wide soft tissue and skeletal defect that resulted in direct communication among the orbital, maxillary sinus, nasal, and oral cavities. We performed soft tissue reconstruction using the straight-line advanced release technique that was devised for unilateral cleft lip repair. The extension of the lateral mucosal and medial mucosal flaps, the turn over flap from the outward turning lower eyelid, and wide dissection around the orbicularis oris muscle enabled successful soft tissue reconstruction without complications. Through this case, we have proved that the straight-line advanced release technique can be applied to severe craniofacial cleft repair as well as unilateral cleft lip repair.
Classification ; Cleft Lip ; Cleft Palate ; Congenital Abnormalities ; Craniofacial Abnormalities ; Eyelids ; Maxillary Sinus ; Orbit ; Rare Diseases ; Reconstructive Surgical Procedures

Animals ; Brain ; growth & development ; Child ; Eyelids ; abnormalities ; Female ; Humans ; Intellectual Disability ; genetics ; Limb Deformities, Congenital ; genetics ; Mice ; Microcephaly ; genetics ; Mutation, Missense ; N-Myc Proto-Oncogene Protein ; genetics ; Tracheoesophageal Fistula ; genetics

PURPOSE: To present a rare case of tear drainage since birth from a lacrimal ductule fistula, which is the first report in the Republic of Korea. CASE SUMMARY: 3-month-old female who presented with discharge of clear fluid from a small skin opening lateral to the right upper eyelid since birth visited the outpatient clinic. The patient was healthy and was receiving no medication. She was born on gestation age 35 weeks and 3 days. No other specific history or other ophthalmic abnormality was found. On examination, a small skin orifice approximately 2 mm diameter and no sign of infection or discoloration was observed. To relieve this symptom, the patient underwent a fistulectomy under general anesthesia. Histopathological examination of the surgical specimen was performed. The patient's symptom subsided postoperatively without recurrence. CONCLUSIONS: This is the first report in the Republic of Korea of tears draining from a lacrimal ductule fistula since birth and the subsequent clinical treatment procedures.
Ambulatory Care Facilities ; Anesthesia, General ; Congenital Abnormalities ; Drainage ; Eyelids ; Female ; Fistula ; Humans ; Infant ; Lacrimal Apparatus ; Parturition ; Pregnancy ; Recurrence ; Republic of Korea ; Skin ; Tears

Clarification is needed regarding the definitions and classification of groove and hollowness of the infraorbital region depending on the cause, anatomical characteristics, and appearance. Grooves in the infraorbital region can be classified as nasojugal grooves (or folds), tear trough deformities, and palpebromalar grooves; these can be differentiated based on anatomical characteristics. They are caused by the herniation of intraorbital fat, atrophy of the skin and subcutaneous fat, contraction of the orbital part of the orbicularis oculi muscle or squinting, and malar bone resorption. Safe and successful treatment requires an optimal choice of filler and treatment method. The choice between a cannula and needle depends on various factors; a needle is better for injections into a subdermal area in a relatively safe plane, while a cannula is recommended for avoiding vascular compromise when injecting filler into a deep fat layer and releasing fibrotic ligamentous structures. The injection of a soft-tissue filler into the subcutaneous fat tissue is recommended for treating mild indentations around the orbital rim and nasojugal region. Reducing the tethering effect of ligamentous structures by undermining using a cannula prior to the filler injection is recommended for treating relatively deep and fine indentations. The treatment of mild prolapse of the intraorbital septal fat or broad flattening of the infraorbital region can be improved by restoring the volume deficiency using a relatively firm filler.
Atrophy ; Catheters ; Classification ; Congenital Abnormalities ; Dermal Fillers ; Eyelids ; Ligaments ; Methods ; Needles ; Orbit ; Prolapse ; Skin ; Skin Aging ; Strabismus ; Subcutaneous Fat ; Subcutaneous Tissue ; Tears ; Zygoma

PURPOSE: To evaluate the long-term effectiveness of inferior retractor tightening combined with lateral tarsal strip surgery and anterior lamellar resection for simultaneously correcting the 3 main causes of involutional entropion. METHODS: In this retrospective study we reviewed 80 patients diagnosed with involutional entropion between April 2004 and February 2014 at the Korea University Guro Hospital and Cheonan Chungmu Hospital. The patients were evaluated for the 3 major causes of involutional entropion and were confirmed to have all components. Lateral canthal tendon laxity test and anterior lamellar redundancy test were performed to grade the involutional entropion patients. The patients received inferior retractor tightening, lateral tarsal strip operation and anterior lamellar resection procedure simultaneously. RESULTS: Eighty involutional entropion patients were included in the present study. The patients consisted of 35 males and 45 females with an average age of 71.1 ± 9.3 years. In the lateral canthal tendon laxity test, 52 (61.2%) eyes were grade II, 33 (38.8%) eyes were grade III. In the anterior lamellar redundancy test, 17 (20%) eyes were grade I, 57 (67.1%) eyes were grade II and; 11 (12.9%) eyes were grade III. Among the 80 patients, 85 eyelids received combined surgery, 84 had successful outcomes and 1 case recurred at 5 months following the primary surgery with an average follow up of 26.5 ± 4.6 months. Lateral canthal deformity was observed in 2 eyelids which were corrected successfully. CONCLUSIONS: Simultaneous correction of the 3 main causes of involutional entropion through inferior retractor tightening, lateral tarsal strip surgery and anterior lamellar resection procedure is effective in correcting involutional entropion and safe in avoiding overcorrection.
Chungcheongnam-do ; Congenital Abnormalities ; Entropion* ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Korea ; Male ; Retrospective Studies ; Tendons

Chromosome 11q13 deletion syndrome has been previously reported as either otodental syndrome or oculo-oto-dental syndrome. The otodental syndrome is characterized by dental abnormalities and high-frequency sensorineural hearing loss, and by ocular coloboma in some cases. The underlying genetic defect causing otodental syndrome is a hemizygous microdeletion involving the FGF3 gene on chromosome 11q13.3. Recently, a new form of severe deafness, microtia (small ear) and small teeth, without the appearance of eye abnormalities, was also reported. In this report, we describe a 1-year-old girl presenting with ptosis of the left upper eyelid, right auricular deformity, high-arched palate, delayed dentition, simian line on the right hand, microcephaly, and developmental delay. In this patient, we identified a deletion in the chromosome 11q13.2-q13.3 (2.75 Mb) region by using an array-comparative genomic hybridization analysis. The deletion in chromosome 11q13 results in a syndrome characterized by variable clinical manifestations. Some of these manifestations involve craniofacial dysmorphology and require a functional workup for hearing, ophthalmic examinations, and long-term dental care.
Coloboma ; Congenital Abnormalities ; Congenital Microtia ; Deafness ; Dental Care ; Dentition ; Eye Abnormalities ; Eyelids ; Female ; Hand ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Microcephaly ; Nucleic Acid Hybridization ; Palate ; Tooth ; Tooth Abnormalities

OBJECTIVETo discuss the operation method and characteristic of correcting upper eyelid depression by transposition of orbital septum fat.

METHODSDuring the double eyelid surgery, we set.the lateral orbital septum fat completely free, while the bottom is still connected with the middle orbital septum fat. We separate a tunnel from the middle to the inner side in orbital septum, and the separated orbital septum fat is transposed to the inner side of orbital septum by the tunnel with suturing fixation.

RESULTSFrom March 2008 to October 2013, 51 cases with upper eyelid depression were treated successfully. Patients were followed up for 3 months to 3 years (average, 7. 5 months) with sustained aesthetic results.

CONCLUSIONSOrbital septum fat transposition can successfully correct the upper eyelid depression. It should become a regular procedure in blepharoplasty.

Adipose Tissue ; transplantation ; Blepharoplasty ; methods ; Esthetics ; Eyelids ; abnormalities ; surgery ; Humans ; Orbit

OBJECTIVE: To report a case series of Tessier 3, 4, 7 and combined 4,7 craniofacial clefts, their clinical presentations, surgical approaches and outcomes in light of the current literature.
METHODS:
Design: Case series
Setting: Tertiary Government Hospital
Subjects: Five patients
RESULTS: Five  patients aged 3 to 14-years-old with Tessier 3, 4 (2  cases), 7  and combined 4,7 were included in this study: Tessier 3 - medial orbitomaxillary cleft extending through the bony skeleton traversing obliquely across the lacrimal groove, Tessier 4 - median orbitomaxillary cleft traversing  vertically  through  the  inferior  eyelid,  infraorbital rim and  orbital  floor extending  to the lip between the philtral crest and the oral commissure  (2 cases), Tessier 7 - macrostomia and cleft oral commissure and combined Tessier 4 and 7, combining features described above. Four underwent 2- or 3-stage surgeries while one declined.
CONCLUSION: Five  craniofacial  clefts  were  presented.  Because  of  the  varying  patterns of craniofacial  deformities,  a  series of surgical  procedures,  tailor-made  for  each  individual  were performed  on  four. Otolaryngologists who perform maxillofacial and cosmetic surgery  should have good background knowledge about craniofacial defects and be familiar with the  surgical approaches at their disposal to yield favorable results that are appropriate to their local contexts.

Human ; Male ; Adolescent ; Child ; Child Preschool ; General Surgery ; Macrostomia ; Surgery, Plastic ; Lip ; Otolaryngologists ; Craniofacial Abnormalities ; Eyelids ; Orbit

PURPOSE: Single umbilical artery (SUA) is the most common malformation of the umbilical cord. However, there have been no studies on the ocular findings in SUA, except for one case report. This study aimed to investigate the ocular findings in children with SUA. METHODS: Fourteen children (eight boys and six girls) with SUA were evaluated retrospectively. All children underwent a complete ophthalmologic examination. RESULTS: The prevalence of abnormal ocular findings in children was up to 42.9%. Refractive errors are detected in four eyes (14.3%): myopia > or =-1.50 diopters (D) in one eye (3.6%) and hyperopia > or =+2.00 D in three eyes (10.7%). Epiblepharon was found in three children (21.4%), and strabismus was detected in one child (7.1%). CONCLUSIONS: Approximately half of the children with SUA showed abnormal ocular findings, therefore, our case series highlight the need for a comprehensive ocular examination and larger prospective research studies in young patients with SUA.
Child, Preschool ; Eyelid Diseases/*congenital/epidemiology ; Eyelids/*abnormalities ; Female ; Humans ; Hyperopia/diagnosis/*epidemiology ; Infant ; Male ; Myopia/diagnosis/*epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Single Umbilical Artery/*epidemiology ; Strabismus/*epidemiology ; Umbilical Arteries/*abnormalities