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Randelovic K, Petric Vickovic I, Lacmanovic Loncar V, Pazanin L, Pusic Sesar A, Ivekovic R, Vatavuk Z. Masqueraded sebaceous gland carcinoma of the lower eyelid in a young pregnant patient. Wien Klin Wochenschr 2024:10.1007/s00508-024-02349-x. [PMID: 38634909 DOI: 10.1007/s00508-024-02349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/11/2024] [Indexed: 04/19/2024]
Abstract
The purpose of this case report is to present misdiagnosed sebaceous gland carcinoma of the lower eyelid with rapid growth in a young woman during pregnancy. Eyelid sebaceous gland carcinoma is a relatively rare tumor and a disease primarily of older patients. It occurs more commonly in oriental populations and with a predilection for the upper eyelid. Early diagnosis and appropriate treatment may help improve disease control and patient survival.
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Affiliation(s)
- Karla Randelovic
- Department of Ophthalmology, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia.
| | - Ivanka Petric Vickovic
- Department of Ophthalmology, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Valentina Lacmanovic Loncar
- Department of Ophthalmology, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Leo Pazanin
- Department of Pathology and Cytology "Ljudevit Jurak", University Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - Anita Pusic Sesar
- Department of Ophthalmology, University of Mostar, School of Medicine, Mostar, Bosnia and Herzegovina
| | - Renata Ivekovic
- Department of Ophthalmology, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Zoran Vatavuk
- Department of Ophthalmology, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
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Abstract
PURPOSE We present a retrospective case series on the use of Hughes flap in managing acquired cicatricial lower lid retraction. METHODS This was a multicentre, retrospective case series. Data was collected from medical records across different sites within Australia (Adelaide, Melbourne, and Sydney) and New Zealand (Hamilton). RESULTS Fourteen patients were identified. The aetiology of cicatricial lower lid retraction included previous lid lesion excision and reconstruction, eyelid trauma, orbital fracture repair, orbital radiotherapy, and lateral canthal dystopia from previous lid surgeries. 4/14 (29%) cases had undergone other surgery to correct the retraction prior to the Hughes flap. Pre-operative lagophthalmos due to lower lid retraction was noted in 11/14 (79%) cases with a median 2 mm (range: 1-5 mm). Exposure keratopathy was present in 7/14 (50%) cases. There were no peri-operative complications during Hughes flap reconstruction. One patient had post-operative upper eyelid retraction that did not require any further intervention. One patient had persistent lagophthalmos and exposure keratopathy that is being managed conservatively. One patient had wound dehiscence and further lid retraction following flap division, which required further surgery. Median length of follow-up was 15 months (range: 0.5-84 months). At final review, improvement or resolution of symptoms was seen in 13/14 (93%) cases. CONCLUSIONS A Hughes flap is an effective surgical technique for the management of cicatricial lower lid retraction.
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Affiliation(s)
- Valerie Juniat
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, Australia.,Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, Australia
| | - Tess Ryan
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, Australia
| | - Michael O'Rourke
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Sgj Ng
- Eye Department, Waikato Hospital, Hamilton, New Zealand
| | - Brett O'Donnell
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia
| | - Alan A McNab
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,Centre for Eye Research Australia Ltd, University of Melbourne, East Melbourne, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, Australia.,Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, Australia
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Yano T, Karakawa R, Shibata T, Fuse Y, Suzuki A, Kuramoto Y, Suesada N, Miyashita H, Yoshimatsu H. Ideal esthetic and functional full-thickness lower eyelid "like with like" reconstruction using a combined Hughes flap and swing skin flap technique. J Plast Reconstr Aesthet Surg 2021; 74:3015-3021. [PMID: 34023240 DOI: 10.1016/j.bjps.2021.03.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/30/2020] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A goal in ideal lower eyelid reconstruction is to achieve not only an esthetic recovery of the shape of the eyelid but also to obtain satisfactory eyelid function without damage to the corneal surface. In this report, we introduce our "Like with Like" reconstruction technique using a combined Hughes flap and swing skin flap. The Hughes flap is a tarsoconjunctival pedicled flap from the upper eyelid, and the swing skin flap is a kind of transposition flap based on the orbicularis muscle pedicle. PATIENTS AND METHODS Eight patients who had more than 25% of the lower eyelid affected by a full-thickness defect were included. There were five men and three women, and the average age was 68.4years old. All patients had undergone wide tumor excision of the lower eyelid due to a malignant tumor and had also had primary two-stage eyelid reconstruction with a combined Hughes flap and swing skin flap. RESULTS The average reconstructive time was 1:20, and no postoperative severe complications such as flap necrosis or wound dehiscence were observed. The follow-up period was an average of one year, and there were no functional problems such as ectropion, lower eyelid retraction, lid margin hypertrophy, lacrimation disorder, or corneal problems observed in any cases. Esthetically, no reconstructed eyelid bulging or asymmetry in the lid margin was observed in any of the cases. CONCLUSIONS Combining the Hughes flap and skin swing flap technique might be the best choice for a full-thickness lower eyelid defect with regard to the esthetic and functional results.
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Affiliation(s)
- Tomoyuki Yano
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan.
| | - Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Tomoyoshi Shibata
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Yuma Fuse
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan
| | | | - Yukiko Kuramoto
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Nobuko Suesada
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Hiroki Miyashita
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan
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Kaufman AR, Pham C, MacIntosh PW. Reconstruction of full width, full thickness cicatricial eyelid defect after eyelid blastomycosis using a modified tarsoconjunctival flap advancement. Orbit 2021; 41:488-492. [PMID: 33583316 DOI: 10.1080/01676830.2021.1884265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Following effective treatment with systemic antifungal therapy, eyelid lesions from blastomycosis infection may be replaced by disfiguring fibrosis and scarring, which may be surgically challenging to correct. A 68-year-old man with biopsy-proven eyelid blastomycosis was treated with 6 months of oral voriconazole, but resolution of the lesion was complicated by cicatricial changes causing complete lower eyelid defect, epicanthal web, cicatricial mechanical ptosis, and skin plaques. Although repair adhered to the fundamentals of eyelid reconstruction, cicatricial changes associated with blastomycosis infection necessitated a modified approach and attachment sites. A tarsoconjunctival flap (Hughes flap) with modified flap connections utilizing cicatrix and remaining viable tissue was employed to reconstruct the lower eyelid defect and combined with tissue advancement using a Mustardé four-flap epicanthoplasty and post-auricular full-thickness skin graft. Satisfactory cosmetic outcome was achieved at last follow-up of 3.5 months postoperatively. This case demonstrates a feasible technique for reconstruction of significant eyelid defects following robust cicatricial changes such as those after blastomycosis. This report also presents the first description of reconstruction of lower eyelid defect and of posterior lamellar loss after blastomycosis infection.
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Affiliation(s)
- Aaron R Kaufman
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Chau Pham
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Peter W MacIntosh
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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McKelvie J, Ferguson R, Ng SGJ. Eyelid reconstruction using the "Hughes" tarsoconjunctival advancement flap: Long-term outcomes in 122 consecutive cases over a 13-year period. Orbit 2017; 36:228-233. [PMID: 28437155 DOI: 10.1080/01676830.2017.1310256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This article evaluates the complications and long term functional and cosmetic outcomes of tarsoconjunctival advancement flaps for repairing a range of lower eyelid defects in a large cohort of consecutive cases. A retrospective series of 122 consecutive cases of eyelid reconstruction using tarsoconjunctival-advancement flaps was conducted at Waikato Hospital, or Hamilton Eye Clinic, New Zealand. All cases of lid reconstruction using tarsoconjunctival-advancement flaps between January 1, 2001 until April 3, 2014 were included for analysis. All patients provided written consent for surgery and the study complied with New Zealand Health and Disability Ethics Committee guidelines and the Declaration of Helsinki. Data were collected on patient demographics, lesion histology, defect size, adjuvant surgical procedures required for reconstruction, surgical and postoperative complications, cosmesis and patient satisfaction. Patients requiring lower eyelid reconstruction were predominantly male (56%) and basal cell carcinoma was the most common pathology (>80%). Male gender was associated with larger tarsoconjunctival-advancement-flap width (P-value = 0.0432), larger maximum flap width (20 vs 15 mm), and required on average more adjuvant procedures for reconstruction (1.80 vs 1.48, P-value = 0.02). Mean duration to flap division was 37 days and decreased over the duration of the study. Complicated cases were associated with shorter duration to flap division. Mean follow-up was 7 months, complications were observed in 14% with revision required in 4%. Tarsoconjunctival flap reconstruction of the lower lid is suitable for a range of defect sizes and produces excellent functional and cosmetic outcomes. Complications are relatively infrequent and may be associated in some cases with decreased duration to flap division.
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Affiliation(s)
- James McKelvie
- a Department of Ophthalmology , Waikato District Health Board , Hamilton , New Zealand.,b Department of Ophthalmology , University of Auckland , Auckland , New Zealand
| | - Reid Ferguson
- a Department of Ophthalmology , Waikato District Health Board , Hamilton , New Zealand
| | - Stephen G J Ng
- a Department of Ophthalmology , Waikato District Health Board , Hamilton , New Zealand
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Hishmi AM, Koch KR, Matthaei M, Bölke E, Cursiefen C, Heindl LM. Modified Hughes procedure for reconstruction of large full-thickness lower eyelid defects following tumor resection. Eur J Med Res 2016; 21:27. [PMID: 27364344 PMCID: PMC4929749 DOI: 10.1186/s40001-016-0221-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Tarsoconjunctival flap advancement, or the Hughes procedure, is among the techniques of choice for reconstructing full-thickness lower eyelid defects so as to restore normal anatomy and function with the best possible cosmetic outcome. The purpose of this study is to report the outcome of a series of patients treated with a modified Hughes procedure following malignant tumor removal. Methods This retrospective study included 45 consecutive cases of modified Hughes procedures performed between January 2013 and October 2015. During Hughes flap creation an incisional plane was chosen in all cases, which left Müller’s muscle attached to the superior tarsal margin, while disinserting the levator aponeurosis. All cases were grouped according to the horizontal length of the lower lid defect to be reconstructed, as well as to the type of anterior lamella reconstruction (free graft vs. inferiorly based advancement flap). Grouped data were compared for the rate of surgical success, defined as achievement of normal lid function and satisfactory cosmesis without needing further surgical interventions, and for the frequency of specific complications. Results Surgical success was achieved in 39 cases (87 %). The remaining cases required additional surgery for minor complications including lower-lid ectropion (4 %), pyogenic granuloma (4 %), or lower lid margin hypertrophy (2 %). Donor-site complications were not detected apart from one case of mild entropion with focal trichiasis. No case of premature flap rupture was seen. Neither the horizontal length of the lower lid defect (p = 0.489), nor the type of anterior lamella reconstruction (p = 0.349) significantly affected the surgical success. Particularly, there was no increased onset of lower-lid ectropion among patients receiving an advancement flap. Conclusions The modified Hughes procedure remains a well-suited technique for reconstructing lower eyelid defects involving up to 100 % of the horizontal lid length. Leaving Müller’s muscle attached to the Hughes flap might prevent premature flap dehiscence without increasing the frequency of upper lid retractions in turn. Whether using a free skin graft or a skin-muscle advancement flap for anterior lamella reconstruction, seems to be insignificant for the functional-aesthetical outcome.
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Affiliation(s)
- Ahmed M Hishmi
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Konrad R Koch
- Department of Ophthalmology, University of Cologne, Cologne, Germany.
| | - Mario Matthaei
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Edwin Bölke
- Department of Radiology and Radiooncology, University of Duesseldorf, Duesseldorf, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Cologne, Germany
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