Morphological Analysis of Nose in Patients of Tessier No. 0 Cleft With a Bifid Nose in China

Objective: Facial cleft involves complex malformations. No study assessed the facial deformity of Tessier No. 0 cleft with a bifid nose. Thus, we used anthropometric measurements to access the nose in patients.Methods: A total of 24 bifid nose deformities underwent surgery at our institution between 2010 and 2019. Standardized photographs were taken preoperatively and postoperatively. Landmarks were identified on these images; measurements for nasal analysis were performed and compared with the established Chinese norms. Surgical method differences were also analyzed.Results: The median follow-up time was 2.51 years. Postoperatively, there is a significant difference in comparison with preoperative in the nasal index, medial canthus and nose width index, nasolabial angle, nasofacial angle, ala length and nasal bridge length index, nasal tip protrusion and nasal width index, and nasal width and ala length index. Furthermore, the medial canthus and nose width index, and nasal width and ala length index were significantly larger in ordinary people, while ala length and nasal bridge length index and nasal tip protrusion and nasal width index were smaller. After surgery, most angles and index were standard except the nasolabial angle in the females, and ala length and nasal bridge length index in the males. Moreover, as for the group of costal cartilage transplantation, most index and angles have improved after surgery including nasolabial angle, nasofacial angle, ala length and nasal bridge length index, nasal tip protrusion and nasal width index, and nasal width and ala length index. However, only nasal tip protrusion and nasal width index, columella length and nasal tip protrusion index, and nasal width and ala length index in the silicone prosthesis group implantation has significance. Costal cartilage transplantation can also better improve ala length and nasal bridge length index than the silicone prosthesis implantation.Conclusion: Most defects can be repaired with surgery, but the outcome has a lack of evaluation. Thus, anthropometric assessment can serve as a material for nasal and reconstructive surgery.

The Facial Vein on Computed Tomographic Angiography: Implications for Plastic Surgery and Filler Injection

Background The knowledge of the anatomy of the facial vein (FV) is essential for plastic surgery and filler injection. Objectives The purpose of this study was to investigate the variation and three-dimensional course of FV using computed tomographic angiography (CTA). Methods The CTA images of 300 FVs from 150 Asian patients were included in this study. The distance between each anatomical landmark and FV was measured to position the course. The depth of FV beneath the skin and the height of FV above the periosteum were measured at five anatomical planes. Results The facial vein showed a relatively constant course with a frequency of 7.0% variation. The average diameter of FVs was 2.42 ± 0.58 mm. The vertical distance between medial canthus, the midpoint of inferior orbital rim or external canthus and the facial vein was 10.28 ± 2.17 mm, 6.86 ± 2.02 mm, or 48.82 ± 7.26 mm, respectively. The horizontal distance between medial canthus, nasal alar or oral commissure and the facial vein was 6.04 ± 1.44 mm, 22.34 ± 3.79 mm, or 32.21 ± 4.84 mm, respectively. The distance between mandibular angle or oral commissure and the facial vein at the inferior of mandible was 24.99 ± 6.23 mm, or 53.04 ± 6.56 mm. The mean depth of FV beneath the skin at the plane of medial canthus, infraorbital, nasal ala, oral commissure, and mandible was 1.16 ± 0.99 mm, 5.83 ± 1.64 mm, 16.07 ± 4.56 mm, 14.92 ± 2.49 mm, and 9.67 ± 2.88 mm, respectively. The mean height of FV above the periosteum at the plane of medial canthus, infraorbital, nasal ala, and mandible was 1.17 ± 1.32 mm, 3.59 ± 1.48 mm, 3.92 ± 1.95 mm, and 3.50 ± 2.03 mm, respectively. Conclusions This study revealed the three-dimensional course of the facial vein with reference to the anatomical landmarks. The detailed findings of the facial vein will provide a valuable reference for plastic surgery and filler injection.

A Novel Surgical Method of Reconstruction for Proboscis Lateralis: A Case Report and Review of the Literature

Proboscis lateralis (PL) is a rare congenital craniofacial anomaly and it is represented by rudimentary, tube-like nasal structure measuring 2–3 centimetre (cm) length and generally attaches to medial canthal region. A 22-month-old male patient was referred to our clinic with a PL hanging from the right medial canthus and a coloboma on the medial third of the right lower eyelid. Physical examination revealed that the PL was 4 cm long and 1.5 cm in diameter. There was a blind cavity with dimple at its distal segment. The right side of the nose and the nasal airway was aplastic. Before surgical correction, neuroradiological evaluation should be performed to obtain the characteristics and relationship of the lesion with adjacent structures and associated anomalies Many reconstructive options have been described in the literature, however, these options are insufficient to obtain natural contour and define alar crease, especially. We described the laterally-based skin flap from the medial wall of the left heminose and adapted to the lateral edge of the de-epithelialized skin of PL for defining supra-alar crease.

Bovine bilateral mesenchymal hamartomas on the upper eyelid: A case report

A 2-day-old calf was presented with a bilateral mass in the medial canthus of the upper eyelid. The masses were removed surgically. The morphological diagnosis was a bilateral hamartoma characterised by an abnormal mixture of tissue indigenous to that area including blood vessels, striated muscle bundles, adipose tissue, isolated cartilage and nerve bundles. No recurrence developed in the 6 months following the surgical removal. Overall, although this congenital defect is relatively rare, it should be differentiated from eyelid tumours such as haemangiomas, squamous cell carcinomas, Meibomian gland tumours, dermoid cysts and teratomas in cattle.

Validation of Eye Temperature Assessed Using Infrared Thermography as an Indicator of Welfare in Horses

This study aimed to validate eye temperature (ET) assessed using infrared thermography (IRT) as an indicator of welfare in horses. Moreover, this study aimed to determine the most accurate position for ET measured using IRT and to validate this approach as a gold-standard measurement method. As the quantitative data obtained by IRT have strongly influenced the ET results depending on the specific location of the measurement area, an accurate definition of the regions of interest (ROI) was established. A total of 176 horses (Thoroughbred, Warmblood, and Halla horses) were used at the racing course of the Korea Racing Authority and public horse-riding clubs in South Korea. The present study also compared temperatures among three ROIs of the eye—lacrimal sac, medial canthus, and lateral canthus—at rest. Correlations between ET, rectal temperature (RT), heart rate (HR), and respiratory rate (RR) were assessed. There were no significant correlations between HR, RR or RT; however, among the three ROIs, the temperature of the medial canthus was positively correlated with RT (p < 0.05). Furthermore, the size of ROI was negatively correlated with accuracy of temperature measurement. These results indicate that the most suitable area for ET measurement using IRT in horses is the medial canthus, and it is recommended to use the average temperature of the smallest ROIs (2 × 2 pixels) for temperature analysis. Therefore, this study offers a validated protocol in which ET measured using IRT in the horses is useful as an indicator of welfare.

57 The Use of a Hemi Glabella Flap for Reconstruction of Medial Canthus Defects

Background Medial canthal reconstruction is a challenging task due to the complex anatomy. The glabellar flap is a common viable technique; however, this results in narrowing of the eyebrows, bulky nasal dorsum and horizontal scarring which is aesthetically displeasing. The senior author in this paper has developed an intuitive modification to the technique. Method A rotational advancement flap involving the upper lateral nasal wall with the hemi glabella was formed and transferred to the medial canthal defect. The donor site was closed in a V-Y manner. Complete closure of defect was achieved in all patients. Results Reconstruction using the Hemi-Glabellar technique was performed on 12 patients following resection of BCC in or near the medial canthus area. Superficial cellulitis was noted in 2 patients, they were managed oral antibiotics. There was bruising in 7 patient which resolve spontaneously in 4-7 days. All patients had a good outcome at 2 months and 6 months follow up. There was no flap loss and all patients were satisfied with the aesthetic outcome. Conclusions The technique highlighted can be performed easily and is applicable to reconstruction to defects of the medial canthus with excellent aesthetic outcomes with an inconspicuous scar and supple skin with matching colour

Comparative study between medial canthus episcleral block versus peribulbar block in intracapsular cataract surgery

Background Ophthalmic regional anesthesia is now the most common anesthetic technique used for eye surgeries. There are various modes of needle-based ophthalmic anesthesia which are retrobulbar, peribulbar, and episcleral. The sub-Tenon episcleral anesthesia technique became a potential alternative to the retrobulbar and peribulbar anesthesia in most of the anterior and posterior segment eye surgeries; this is due to its better safety profile and tolerability than the other blocks. The aim of this study was to compare between medial episcleral block and peribulbar block in intracapsular cataract surgery as regards anesthesia and akinesia of the eye, the need of supplementation of local anesthetic, and finally the safety profile of each block. This was a prospective, comparative, randomized, double-blinded clinical study. It was carried out on 60 patients that were scheduled for intracapsular cataract surgery in ophthalmic surgery unit. The patients were randomly allocated into two equal groups; group A received medial canthus episcleral block technique and group B received peribulbar block technique. Results Results of this prospective, comparative, randomized, double-blinded study showed no statistical difference between the two groups as regards demographic and vital data. As regards Akinesia score, the ESA group had better akinesia score at 1, 5, and 10 min and at the end of surgery than PBA group (P value, 0.001). No patient in the ESA group received supplemental injection via inferotemporal peribulbar block technique, while 66.7% of PBA group was in need of supplementation. Regarding time to onset of acceptable akinesia score; ESA group had a faster onset with high statistical significance (P value, 0.001). Numeric pain scale was better in ESA group than PBA group with high statistical significance. There were chemosis after injection in two of the ESA group (6.6%). On the other hand, slight pricking pain at the end pf surgery developed in two cases in the PBA group. Conclusion Medial canthal episcleral technique proved to be superior in motor akinesia score, time to onset of acceptable akinesia score, and numeric pain scale in comparison to peribulbar anesthesia with high statistical significance between the two groups. Both techniques proved to be safe with no incidence of major complications.