Treatment of orbicularis oculi muscle hypertrophy in lower lid blepharoplasty

Curschmann's spirals have been observed for more than 100 yr in the sputum of patients affected by lung cancer, asthma, chronic bronchitis, or in asymptomatic smokers. However, to date, their clinical significance and pathogenesis have not been completely explained. Curschmann's spirals in the sputum of two populations were studied: 164 traffic policemen of Rome and 119 subjects living in a rural district near Perugia. Of these two groups, only the first were exposed daily to urban environmental pollutions. Spirals were detected in the sputum of 29 traffic policemen and in 3 subjects from the group not exposed daily to urban environmental pollutants. Between these two groups of subjects the difference was statistically significant (P < 0.001). Therefore, daily exposure to urban atmospheric pollution may play a role in the production of Curschmann's spirals. Our two groups were also divided into smokers and nonsmokers to evaluate if cigarette smoking could influence the presence of spirals in sputum. Our study confirms the association of spirals in the sputum of smokers but also indicates their presence in individuals who never smoked but were exposed to environmental pollutants. We also noticed that exposure to pollution and cigarette smoking may have a synergistic effect on the formation of spirals in the respiratory tract.     

Sub-Tenon's anesthesia and orbicularis oculi function

BACKGROUND AND OBJECTIVE: To assess the necessary volume of local anesthetic with added hyaluronidase that must be infiltrated to the sub-Tenon's space to achieve complete eyelid akinesia. PATIENTS AND METHODS: Eighty-five consecutive patients were randomly assigned to two groups, receiving either 5 ml or 7 ml of local anesthetic to the sub-Tenon's space. Each patient was assessed clinically at 5 and 10 minutes for orbicularis oculi function. The anesthetic solution consisted of 5 ml of 2% lidocaine, 5 ml of 0.75% bupivacaine hydrochloride, and 1500 IU of hyaluronidase. A top-up of anesthetic infiltration was given in doses of 2 ml if excessive orbicularis muscle function persisted at 10 ml. Routine phacoemulsification surgery was performed, and, if necessary, a top-up of anesthetic was given on the table. RESULTS: Complete eyelid akinesia was achieved in 7.5% (3 of 40) of the patients in the 5-ml group and in 93.3% (42 of 45) of the patients in the 7-ml group (P < .005). There was no effect for 57.5% (23 of 40) of the patients in the 5-ml group and for 2.2% (1 of 45) of the patients in the 7-ml group. A top-up of anesthetic was given in the anesthetic room to 40 patients, 37 of whom were in the 5-ml group, and a Van Lint block of the facial nerves was necessary for 1 patient from the 5-ml group. An on-the-table top-up of anesthesia was necessary for 3 patients (2 from the 5-ml group, 1 from the 7-ml group). CONCLUSIONS: The addition of hyaluronidase promotes diffusion of sub-Tenon's anesthetic, resulting in effective akinesia of the orbicularis oculi. The infiltration of 7 ml of the anesthetic solution significantly improves the rate of eyelid akinesia.     

Delay of clinical recovery from paralysis induced by atracurium: comparison between orbicularis oculi and adductor pollicis

OBJECTIVE: To compare with train-of-four stimulation the delays of the beginning of the spontaneous recovery of the orbicularis oculi and of the adductor pollicis after profound neuromuscular blockade with atracurium. STUDY DESIGN: Prospective, comparative open study. PATIENTS AND METHODS: Twenty-eight physical class ASA 1 and 2 patients under general anaesthesia (propofol, N2O, fentanyl) and profound neuromuscular blockade with atracurium. Train-of-four stimulation, every 10 s, of the ulnar nerve at the wrist (for assessing by tactile means the response of the adductor pollicis) and of the temporal branch of the facial nerve (for assessing visually the response of the orbicularis oculi). On each site, measurement of the delay between the end of the maintenance of deep neuromuscular blockade (last dose of atracurium) and the beginning of the recovery (first response to train-of-four stimulation). RESULTS: In each case, the recovery of the orbicularis oculi began earlier than the recovery of the adductor pollicis (26 +/- 9 min vs 34 +/- 9 min, P < 0.001). The delays of recovery at each site were strongly correlated (r = 0.87; P < 0.001) but the time lag between the responses varied greatly: 1 to 21 min, mean: 8 +/- 5 min, coefficient of variation: 56.6%. CONCLUSION: The orbicularis oculi should not be monitored alone for assessment of recovery from profound neuromuscular blockade by atracurium, as it predicts poorly the time of the recovery of the adductor pollicis.     

Electrical study of jaw and orbicularis oculi reflexes after trigeminal nerve surgery

Trigeminal nerve ophthalmic and motor division function was assessed clinically and electrically in 32 patients who had undergone various surgical procedures for trigeminal neuralgia. Using known electrophysiological techniques, the orbicularis oculi and jaw reflexes were tested in all subjects. Abnormalities of the orbicularis oculi reflex were anticipated on the basis of ophthalmic division anaesthesia. However, jaw reflex abnormalities appeared in operated cases with no clinical or electromyographic evidence of masseter denervation. These results were unexpected, and imply that the proprioceptive fibres of the jaw reflex are mediated by a sensory and not a motor root as previously believed.     

The importance of accurate repair of the orbicularis oris muscle in the correction of unilateral cleft lip

Most of the attempts and efforts in cleft lip repair have been directed toward the skin incision. The importance of the orbicularis oris muscle repair has been emphasized in recent years. The well-designed skin incision with simple repair of the orbicularis oris muscle has produced a considerable improvement in the appearance of the upper lip; however, the repaired upper lip seems to change its shape abnormally in motion and has a tendency to be distorted with age if the orbicularis oris muscle is not repaired precisely and accurately. Following the dissection of the normal upper lip and unilateral cleft lip in cadavers, we could find two different components in the orbicularis oris muscle, a superficial and a deep component. One is a retractor and the other is a constrictor of the lip. They have antagonistic actions to each other during lip movement. We also can identify these two different components of the muscle in the cleft lip patient during operation. We thought inaccurate and mixed connection between these two different functional components could make the repaired lip distorted and unbalanced, which would get worse during growth. By identification and separate repair of the two different muscular components of the orbicularis oris muscle (i.e., repair of the superficial and deep components on the lateral side with the corresponding components on the medial side), better results in the dynamic and three-dimensional configuration of the upper lip can be achieved, and unfavorable distortion can be avoided as the patients grow.(ABSTRACT TRUNCATED AT 250 WORDS)     

Chronic orbital hematic cysts: a case for craniofacial correction

Chronic hematic cysts are rare conditions that usually present to the ophthalmic surgeons with displacement of the globe. There is usually no, or minimal, bone involvement. Two patients with unusual presentations of chronic orbital hematic cysts are reported. These cysts resulted in significant expansion and erosion of the bony orbits. The presentation, operative findings, and reconstruction are reported and discussed.     

Use of the orbicularis muscle flap for complex lower lid problems: a 6-year analysis

There are several groups of patients seeking lower lid blepharoplasty who present with the potential for unsatisfactory postoperative results, such as those presenting with atonic eyelids, patients with severe blepharochalasis alone or with large fat bags, patients with festoons, those with abnormal anatomy, and patients with deformity due to prior surgery. The orbicularis muscle flap technique provides good results in patients with potentially problematic lower eyelids. Of 600 blepharoplasties, 8.5 percent underwent the orbicularis muscle flap procedure. Follow-up time was 1.3 years, and average patient age was 54 years. Details of this technique are described together with results, including illustrative photographs. Of 51 patients, 49 had excellent or acceptable results and 2 had unacceptable results, 1 of whom required a small correction. This method produces a "minilift" of the lower eyelid and upper cheek skin that cannot be achieved with the standard lower eyelid blepharoplasty as described to date.     

Malar augmentation by osteotomy and advancement

We developed a modification of Tessier's zygoma plasty to increase anterior and lateral projection of the malar eminences in 8 patients with malar hypoplasia. The four steps of our modification are: (1) access solely through an intraoral upper sulcus incision; (2) osteotomy of the inferior orbital rim at a more medial site and of the lateral orbital rim more cephalad; (3) careful preservation of both the zygomaticomaxillary buttress and the zygomatic arch; and (4) use of a cranial bone graft alone, as a wedge, to stabilize the rotated zygoma, without the need for plate or screw fixation. Eight patients have undergone this procedure. Follow-up ranged from 4 to 15 months. There have been no complications. All 8 patients have achieved excellent accentuation of their malar eminences, with maintenance of symmetry. The increase in malar eminence projection has improved overall facial form in these patients. The modified Tessier zygoma plasty offers a stable and predictable technique for improving facial form. It provides a very natural correction for deficient malar projection, without introducing visible scars.     

Unilateral tucking and advancement of the inferior oblique muscle for treatment of A-pattern strabismus

We present two patients with moderate left ventricular dysfunction, who developed a pleural effusion after coronary artery bypass grafting (CABG). The effusion was proven to be an exsudate of tuberculous origin. This illustrates that not all pleural exsudates developing after CABG are due to a post-pericardiotomy syndrome. Therefore microbiological examination of pleural fluid and if necessary pleural biopsy should be performed in all patients with an unresolving pleural effusion following CABG.     

Myofibril size variation along the length of extraocular muscle in rabbit and rat. I: orbital layer

We have identified two members of a novel class of genes in Drosophila that encode putative transmembrane proteins with six leucine-rich repeats and a single immunoglobulin loop. These two molecules, Kek1 and Kek2, show striking conservation in their extracellular domains and have large and more divergent intracellular regions. Both genes are expressed in neurons as they differentiate in the embryonic central nervous system (CNS). kek1 is also expressed in other patterned epithelia, such as the follicle cells of the developing egg chamber, where it is found in a dorsal-ventral gradient around the oocyte. The homology of the kek genes to other known adhesion and signaling molecules, together with their expression patterns, suggests that both genes are involved in interactions at the cell surface. Genetic analysis reveals that deletion of the kek1 gene causes no obvious developmental defects. The coexpression of kek2 in the CNS leads us to suggest that Kek1 is part of a family of cell surface proteins with redundant function.     

基于编码器与NFC修正融合的带式输送机轨道式巡检机器人定位方法

轨道式巡检机器人的高精度定位技术是带式输送机智能化巡检的重要研究方向之一,而矿用带式输送机距离超长,工作环境复杂,严重影响巡检机器人的定位精度。针对目前的轨道式巡检机器人定位技术在矿用带式输送机巡检领域存在的问题,提出了基于编码器和NFC双传感器修正融合的高精度定位方法。分析带式输送机轨道式巡检机器人轨道与环境特性对编码器系数的影响,提出轨道分段原则。利用机器人搭载的编码器数据反馈特点,构建编码器递推定位方法。通过机器人运行的历史数据,对编码器系数进行分段分方向修正,并提出基于递推最小二乘的编码器系数修正方法,以提高编码器对轨道环境的适应性。在此基础上,根据机器人所在轨道分段的位置不同,在段端基于卡尔曼滤波算法实现编码器和NFC数据融合,在段内利用分段分方向修正系数与编码器信息进行递推定位,实现轨道式巡检机器人连续高精度的定位。针对所提方法搭建了实验平台并进行了实物测试,实验结果表明,相较于编码器定位、RFID定位和两者融合定位三种传统定位方式,基于编码器和NFC的修正融合定位算法能够有效提高轨道式巡检机器人定位对轨道环境的适应性,同时提高轨道式巡检机器人的定位精度。      

Nasal sill augmentation in adult incomplete cleft lip nose deformity using superiorly based turn over orbicularis oris muscle flap: an anatomic approach

Adult incomplete cleft lip nose deformity is not uncommon in India. Poverty, ignorance, and parental neglect account for its late presentation. Besides the classical features of cleft lip nose deformity, the constant findings observed in this patient population have been a widened and depressed nasal sill. This is attributable to the sparse, hypoplastic, and abnormally orientated orbicularis oris muscle in the region of the sill. Failure to restore the nasal sill symmetry by suitably augmenting the sill frequently leads to unsatisfactory and asymmetric results. However, in the literature, satisfactory restoration of the nasal sill has not been given the importance it deserves while performing cleft lip rhinoplasty. We present a method of augmenting the depressed nasal sill in cases of adult incomplete nose deformity using a superiorly based orbicularis oris muscle flap, which is harvested from the soft tissues between the apex of the cleft and the nostril sill. Following de-epithelialization of the overlying skin, the exposed muscle is raised as a superiorly based flap after dissecting it from the underlying mucosa. It is folded, turned over, and tucked into the nasal sill base and anchored to the anterior nasal spine to give the desired augmentation. Satisfactory results have been obtained in 18 cases of nasal deformity associated with incomplete cleft lip. In our opinion, this technique offers a simple and effective method of augmenting the depressed sill by utilizing locally available tissues and without the need for procuring autologous tissue from distant sites.     

Bunionette correction by metatarsal osteotomy: preliminary report

A preliminary report is presented of 17 patients who underwent 27 fifth metatarsal osteotomies. Oblique osteotomy without internal fixation was used. Union of the osteotomy without external immobilization occurred in 16 of the patients. Correction was effected in a case of delayed union in one foot because it was symptomatic. Improvement and normal function were the result in 26 of the 27 osteotomies. Delayed union did not seem to mean failure of relief. No painful scars occurred.     

依靠科技进步实现韶钢整体结构的优化

韶钢在“八五”、“九五”期间,积极依靠科技进步,用先进技术改造传统产业,通过技术改造,从产量规模、产品质量到生产成本等方面有了很大进步,提升了企业的竞争力,面对新世纪冶金前沿技术的飞速发展,韶钢坚定不移地推进钢铁主体和工艺技术升级换代,使钢铁主体形成“工艺先进、结构合理、质量优良、效益显著”的新格局,生产出具有核心竞争力的拳头产品。     

Reactivity and aggression in the rat: Induction by !a-adrenergic blocking agents injected ventral to anterior septum but not into lateral septum.

Intracranial injections were made bilaterally through permanently implanted cannulas ending in the lateral septum or in the region ventral to the anterior septum of 78 male hooded rats. Ss were first screened with injections of a local anesthetic, lidocaine, which blocks both synaptic and axonal conduction. Those Ss that showed an increase in reactivity and aggression were then injected with a synaptic transmitter blocking agent. Results show that transmitter blocking agents reproduced the effect of the local anesthetic only in the region ventral to the anterior septum and that α-adrenergic (phentolamine, tolazoline), but not β-adrenergic (propranolol, hydralazine), cholinergic (atropine, hyocine), or dopaminergic (haloperidol) blocking agents were effective. Results suggest that synapses in the forebrain system controlling reactivity and aggression are α-adrenergic and are located in the region ventral to the anterior septum just lateral to the diagonal band of Broca. The septum itself may be involved only to the extent that it is transversed by fibers of passage. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frontofacial osteotomies, advancement, and remodeling by distraction: an extended application of the technique

The purpose of this clinical report is to present the distraction technique for advancement of the frontofacial skeleton as a unit. Our 14-year-old patient was diagnosed with Carpenter's syndrome and kleblattsch?del deformity at birth. At other centers the patient underwent corrective surgeries, including repeated fronto-orbital advancement in an attempt to correct the residual deformity. This has resulted in bony malunion and recurrent deformity, and it has left the patient with no available donor sites for harvesting of bone graft. The patient had class III malocclusion, severe midfacial and frontal deficiency, and relative turricephaly. We performed frontofacial osteotomies and placement of the distraction devices. Distraction of 20 mm was accomplished, correcting the exophthalmos and midface retrusion and producing class I dental occlusion. We conclude that distraction is an optional surgical method that can be applied in selected cases for advancement of the entire frontofacial skeleton.