Arhinia and Bilateral Anophthalmia: Report of a Rare Case and Review of Literature

Arhinia is an extremely rare condition reported in less than 100 cases so far. We report a case of arhinia with bilateral anophthalmia. In physical examination, only alar portions of the nose were partially formed. No septal, lower, upper lateral cartilages or nasal bones were detectable. Both nostrils were atretic. The orbital area was covered with skin, and eyebrows were partially formed. Bilateral complete cleft lip and palate were evident. Surgical interventions should be considered not only for reconstruction of the external nose but for timely creation of a lacrimal passage and repair of the accompanying cleft lip and palate.

Asymptomatic COVID-19 as a Risk Factor of Diabetic Ketoacidosis and Mucormycosis: A Case Report and Review of the Literature

Mucormycosis is a lethal and life-threatening fungal infection. Several cases describing the association of COVID-19 and mucormycosis have been reported. In this article, we report a 58-year-old female with a history of diabetes mellitus type 2 who presented by diabetic ketoacidosis, rhino-orbital mucormycosis, and COVID-19. The patient was treated with liposomal amphotericin B and debridement of necrotic tissue of the rhino-orbital area and paranasal sinuses. Unfortunately, she passed away a few days after orbital surgery. We also conducted a review of the literature and reported 3 other similar cases that suffered from mucormycosis in association with COVID-19 and diabetic ketoacidosis and discussed the importance of this association.

Karakteristik Pasien Tumor Orbita Di PMN RS Mata Cicendo Bandung Periode 2017-2018

Orbital tumors are tumors that occur in the orbital area where they can affect the outside of the orbit and the inside of the orbit. At present, it is still rare to report the prevalence of orbital tumors in the world. In developing countries such as Indonesia, reports on the incidence of orbital tumors are also rarely reported. Diagnosis and appropriate therapy if we recognize the characteristics of these orbital tumors. The purpose of this study was to determine the characteristics of orbital tumor patients at PMN Cicendo Eye Hospital Bandung. This research is a descriptive observational study with cross sectional method with total sampling technique. Data were collected retrospectively based on medical records in the form of age, sex, eyes involved, tumor location, surgery, clinical diagnosis, and histopathological results. The results showed that orbital tumors with the majority of age> 45 years (43.3%), male gender (55.4%), involvement of the left ocular eye (51.18%), with the most frequent location not in the conjunctiva, palpebral and retrobulbar (36.8%), clinical diagnosis of benign tumors (68.3%) were cysts (22.4%), the most histopathological results of benign tumor lesions (71.4%) were inflammation (17%). So it can be concluded that knowing the characteristics of this orbital tumor will have an impact on the therapy given will be appropriate.

A series of acupuncture-related ocular injuries in Malaysia

Introduction: Acupuncture is a complementary medicine that has gained popularity in treating various systemic illness including the eye. However, there are few reported complications following acupuncture to the eye structures. Purpose: To create awareness regarding the potential complications following acupuncture involving the eye and orbit. Study design: Case series. Materials and methods: We report six cases of ocular complications related to acupuncture procedures in Malaysia, from August 2019 until December 2019. The cases were compiled from a group of ophthalmologists who encountered the patients. Results: The magnitude of the severity of complications ranges from non-sight-threatening complications to sight-threatening complications requiring evisceration. The complications compiled in this case series include preseptal cellulitis, subconjunctival haemorrhage, traumatic cataract, vitreous haemorrhage, macular hole, globe rupture, and panophthalmitis. Following the complications, patients who sustained sight-threatening complications required further surgical interventions. Conclusion: Acupuncture has significant ocular morbidity if performed incorrectly in the eye or orbital area, ranging from mild to total loss of the eye.

Reconstruction of anterior frontal wall and contours defects using bone substitute

Aim: The aim of this article is to report on the safety and long-term efficacy of Cerament® BoneVoid Filler bone substitute for repairing craniofacial bone defects. Post-traumatic cranioplasty is a complex and challenging procedure for all maxillo-craniofacial surgeons and neurosurgeons, especially when repairing large areas. The standard criterion for repairing small cranial defects is the use autogenous bone from the iliac crest or split calvarial grafts. Autogenous grafts may result in donor-site morbidity, increased surgical time, reabsorption, blood loss, and longer recovery time . Alloplastic materials used for bone repair, such as methyl methacrylate, hydroxyapatite, titanium, or porous polyethylene, are expected to have optimal properties, including easy adaptation, biocompatibility, ingrowth of new tissue, stability of shape, and low rate of reabsorption. A cranial implant should be easily shaped and positioned, allowing easy tissue growth. In very wide cranium defects the new technology is a custom made cranial implant constructed three-dimensionally with different types of materials. However, this procedure is very expensive with various infection rates depending on the kind of material used and on the chemicophysical composition of the implant. Methods: The authors report the case of a 50-year-old man with a severe deformity of the forehead-supra orbital area as a result of a previous complex fronto-facial trauma treated in an emergency Unit. Secondary correction and reconstruction of the residual deformities were performed by using Cerament® Bone Void Filler, an alloplastic biphasic material, composed of 40% hydroxyapatite, 60% calcium sulfate and the radio-contrast agent iohexol. The unique ratio of hydroxyapatite and calcium sulfate is designed to enable Cerament to resorb at the same rate that bone forms. Calcium sulfate acts as a resorbable carrier for hydroxyapatite which is highly osteoconductive, promoting bone ingrowth.It seems to be a promising bone graft substitute in the management of bony irregularities in the fronto-orbital area. Conclusion: The patient was first hospitalized as the result of a serious craniofacial trauma. One year after the first emergency cranio-orbital reconstructive operation, a marked deformity of the frontal region appeared with a “grid effect” due to the inadequate plate-bony fixation of the fractures applied during the first bony recomposition and because it was not as rigid as it should have been . A secondary surgery for deformity correction was performed. The hardware was totally removed and the bony deformity smoothed, reshaped, covered and filled using Cerament® Bone Void Filler, a biomaterial. The patient recovered with a satisfactory cranium-forehead shape, no complications, and complete disappearance of a frowning look of the fronto-orbital region. Recently, increased use of bone substitutes in the reconstruction of bone defects has been fuelled by donor site complications associated with autologous bone harvesting. Cerament® BoneVoid Filler is a biphasic and injectable bone substitute that has a highly compressive strength and the ability to promote cancellous bone healing

Horizontally oriented v-y flap may diminish lower lid retraction

Introduction: lower lid malposition following malignancy surgery in infra- orbital area is often challenging and any way to reduce its chance is appreciated. Case presentation: 36 years old women with confirmed Basal Cell Carcinoma (BCC) of left cheek underwent tumor excision with free margins and remained skin defect reconstructed with adipocutaneous v-y advancement flap, which designed in a horizontally orientation. Patient had no signs of ectropion with good wound repair and obscured scar. Conclusion: v-y flaps are commonly used local flaps with minimal donor site morbidity, and if designed horizontally, not only may reduce chance of lower lid malposition, but also can remain more acceptable scars.

Enhancing the Lateral Orbital “C-Angle” With Calcium Hydroxylapatite: An Anatomic and Clinical Study

Background Deliberate injection of specific facial subunits may improve aesthetic outcomes in facial rejuvenation. We contend that the lateral orbital area (LOA) is a key anatomic subunit in the perception of eye attractiveness, with a C-shaped distribution of fat contributing to the formation of a distinct angle in the lateral orbit. Objectives The aim of this study was to describe the anatomy of the LOA that constitutes the C-shaped angle and to investigate the safety and cosmetic outcomes of nonsurgical enhancement of that area with calcium hydroxylapatite (CaHA). Methods Four injected fresh-frozen cadaver heads were dissected. Twenty patients were enrolled in a prospective clinical study. Participants were seen on the day of injection, and at 2 weeks and 3 months postinjection. Two-dimensional and 3D photographs were analyzed to quantify the volumetric changes between pretreatment and postinjection time points. Secondary outcomes included Global Aesthetic Improvement Scale score and subject satisfaction at 3 months. Results Cadaver dissections revealed distinct fat compartments and a zone of adhesion forming the C-shaped area around the lateral orbit. In the clinical study, a mean of 1.88 mL of CaHA was injected into each lateral periorbital region. There was 97% and 76% volume retention at 2 weeks and 3 months, respectively, with 70% of patients being “very satisfied” at 3 months. The average Global Aesthetic Improvement Scale rating at 3 months was 3.95. There were no complications. Conclusions The LOA is a distinct facial subunit that can be enhanced safely by CaHA injection with good cosmetic outcomes. Focusing on the C-angle can improve periorbital aesthetics. Level of Evidence: 4

A Dramatic Relief from Cluster Headache by Classic Bloodletting Acupuncture Evidenced by Thermography Analysis: A Case Report

Background: Cluster headache is a severe headache, which causes severe impairment in the quality of life of the patients. Here, we report a successful experience of relieving cluster headache by puncturing the superficial engorged venules of the ipsilateral leg. Case presentation: This 72-year-old female with severe refractory cluster headache came from the United States to Taiwan to search for alternative therapy. Her headache was characterized by excruciating, stabbing pain on the left head, primarily around the orbital area with extension to temporal and occipital area, and accompanied with left nasal obstruction. Based upon the classic acupuncture method, her headache was dramatically and totally relieved by puncture upon superficial engorged venules of ipsilateral leg. Conclusion: This case reminded us that classic bloodletting acupuncture could be an alternative strategy for cases with refractory cluster headache. Besides, the connection between leg engorged venules and head suggesting the existence of some novel reflex, worthy of investigation in the future.