Periorbital purpura can be the only initial symptom of primary light chain amyloidosis:A case report

BACKGROUND Primary light chain amyloidosis is a rare and complex disease with complex clinical features and is highly susceptible to misdiagnosis and underdiagnosis in the early stages.CASE SUMMARY We report a case of a 47-year-old female patient whose only initial symptom was periorbital purpura,which was not taken seriously enough.As the disease progressed,pleural effusion gradually appeared,and after systematic diagnosis and treatment,she was diagnosed with“primary light chain amyloidosis”.She achieved rapid hematological remission after treatment with a daratumumab+bortezomib+cyclophosphamide+dexamethasone regimen.CONCLUSION Periorbital purpura can be the only initial symptom of primary light chain amyloidosis;we should pay attention to the cases where the initial clinical symptoms are only periorbital purpura.

A technique for periorbital syringomas: intralesional radiofrequency ablation

AIM: To evaluate the efficacy of intralesional radiofrequency ablation in the treatment of periorbital syringomas. METHODS: We tried the intralesional radiofrequency ablation for 64 patients with periorbital syringomas from 2007 to 2011. The operation was performed under 2.5 loupe magnifications. The handpiece was assembled with a needle electrode and connected to the radiofrequency ablation apparatus. The electrode was then inserted into the target lesions in dermis and delivering injury to the base of these tumors. Results were assessed clinically by comparing pre- and post-treatment photographs and patient satisfaction rates. RESULTS: Clinical improvement increased with each subsequent treatment session. The percent of patients whose clinic improvement grade were >= 3 after each session was respectively 71.9% (Session1), 83.3% (Session2), and 100% (Session3). The statistical results indicated the concordance of the clinical assessment and the satisfaction level of patients (kappa=0.78 of the session1; kappa=0.82 of the session2). The majority of patients had good or excellent cosmetic results. Postoperatively, there were no permanent side effects or recurrences. CONCLUSION: As a new technique of minimally invasion, the intralesional radiofrequency ablation was found to be an effective, inexpensive, highly precise and safe way of treating periorbital syringomas.

Primary sino-orbital peripheral T-cell lymphoma presenting as unilateral periorbital swelling: a case report

Dear Editor,My name is Ahmad Al Omari and I am currently working as an otorhinolaryngology assistant professor at Jordan University of Science and Technology. I am writing this letter to present a case of a primary sino-orbital peripheral T-cell

Periorbital Necrotizing Fasciitis Caused by Streptococcus Viridians

Necrotizing fasciitis (NF) is a life threatening soft tissue infection characterized by necrosis of fascia and subcutaneous tissue. If this disease is misdiagnosed and mistreated, because of the fast spreading, it can lead to death. Prompt treatment with antibiotics and surgical debridement is necessary and lifesaving in this disease. In uncomplicated cases and early stages of the disease it can be treated only with intravenous antibiotics. This study presents a 70-year-old female, farmer who approached in our clinic with edema of periorbital region and a minor trauma in her lower eyelid. First skin anthrax of eyelids was considered in differential diagnosis, because the patient was in contact with animals. Culture taken from the wound resulted positive for Streptococcus viridians α hemolytic Streptococcus: the viridians group. Treatment with Ceftriaxone + Penicillin was initiated immediately. Patient responded to intravenous antibiotics and after 2 days the edema began to regress. After 2 weeks patient was discharged from the hospital and the clinical outcome was satisfactory. Based on this case early diagnosed necrotizing fasciitis may be treated only with antibiotics.

The Efficacy and Safety of Succinylated Atelocollagen and Adenosine for the Treatment of Periorbital Wrinkles

The degradation of structural collagen contributes to the characteristic appearance of wrinkles. The anti-wrinkle effects of a variety of substances have been studied, but the potential anti-wrinkle effects of topical applications of collagen for periorbital wrinkles have not been investigated. To evaluate the effects of topical application of succinylated atelocollagen on periorbital wrinkles and to compare the results of treatment with adenosine, a clinical study on Korean participants was carried out. Each participant’s right or left periorbital area was treated with either a solution containing succinylated atelocollagen and adenosine or a solution containing only succinylated atelocollagen for two months. A placebo solution was applied to the opposite periorbital area of each patient’s face for two months. Based on objective and subjective measurements of clinical improvement, the assessment scores for treated sites were statistically significantly higher than scores for placebo sites after two months of treatment. Analysis of silicone casts of periorbital wrinkles demonstrated partial effects of succinylated atelocollagen on periorbital wrinkles. However, we did not observe any effects of adenosine on periorbital wrinkles. Succinylated atelocollagen may be an effective treatment option for periorbital wrinkles, but further studies including a longer treatment period and larger subject group are needed to verify these results.

Three-dimensional anthropometry in periorbital region

Anthropometry can analyze the size,weight,and proportion of the human body objectively and quantitatively to supplement the visual assessment.Various non-invasive three-dimensional(3D)anthropometric techniques have been applied to assess soft tissues’3D morphology in the clinical practice.Among them,non-invasive stereophotogrammetry and laser scanning techniques are becoming increasingly popular in craniofacial surgery and plastic surgery.They have been applied for craniofacial growth estimation and morphometric investigation,genetic and acquired malformation diagnosis,as well as orthodontic or surgical treatment arrangement and outcome evaluation.However,few studies have been published for assessing the 3D morphology of soft tissues in the periorbital region.This paper reviews the studies involving the application and evaluation of the increasingly popular 3D photogrammetry in the periorbital region.These studies proposed detailed and standardized protocols for three-dimensionally assessing linear,curvilinear,angular,as well as volumetric measurements,and verified its high reliability in the periorbital region(even higher than caliper-derived direct measurements).In the future,reliable and accurate 3D imaging techniques,as well as standardized analyzing protocols,may find applications in following up morphological growth,preoperatively diagnosing and assessing patient periorbital conditions,planning surgical procedures,postoperatively evaluating treatment outcomes of a specific procedure,and comparing the differences in surgical results between various procedures,studies,as well as populations.

Unilateral Periorbital Oedema with Hypothyroidism and Multinodular Goiter

Thyroid associated ophthalmopathy is an autoimmune disorder which involves orbital and periorbital tissue. The immune-mediated inflammation of the orbital tissues can involve extraocular muscles, orbital connective tissue or orbital fat and periocular soft tissues. Bilateral involvement of thyroid associated orbitopathy is usually asymmetric, but unilateral thyroid associated orbitopathy has been less reported. Periorbital oedema as the only sign with hypothyroidism is uncommon and if present, it is more frequent bilaterally present and no cases are evidenced as unilateral. Pitting oedema in hypothyroidism is rare and can be due to increased capillary permeability, decreased adrenergic tone and increase in serotonin metabolism. Unilateral periorbital and eyelid oedema can associate with various clinical entities, multidisciplinary team is necessary to exclude the concomitant disease, so the patient can immediately be treated with proper therapy. We represent the case of unusually unilateral recurrent periorbital oedema in the period of time for 3 years with stabilized primary hypothyroidism and multinodular goitre.

Dexamethasone’s Effect on Post-Rhinoplasty Periorbital Edema

Introduction: The efficacy of dexamethasone in reducing periorbital edema and ecchymosis following rhinoplasty was investigated in a double-blind, randomized trial. Materials & Methods: The study comprised fifty-four rhinoplasty patients who underwent open rhinoplasty surgery with tip modification, hump excision, and bilateral osteotomy and were divided into three groups: Group one: 18 patients: a single dosage of 8 mg dexamethasone given at the start of the procedure. Group two: 18 patients: three 8 mg dexamethasone doses given at the start of the procedure, then 24 and 48 hours afterwards. Group 3: a control group of 18 patients who were not given any medication. Result: In comparison to control group 3, there was a significant reduction in periorbital edema and ecchymosis in groups l and 2. Group 2 had less periorbital edema and ecchymosis at the end of the first postoperative week than group 1. Conclusion: Edema and ecchymosis were significantly reduced with dexamethasone administration in rhinoplasty with osteotomy. Use of three doses of dexamethasone can reduce edema and ecchymosis after rhinoplasty more than the single dose treatment during the first postoperative week.

Peri-Orbital Non-Invasive and Painless Skin Tightening-Safe and Highly Effective Use of Multisource Radio-Frequency Treatment Platform

The periorbital area is the third highest-ranking area for cosmetic surgery. However, surgery in this area presents a number of difficulties and safety concerns. First generation Monopolar RF treatments in this area were usually associated with considerable pain and long downtime. In the present clinical study, we used the iFine handpiece of the EndyMed PRO, multi-source phase-controlled radiofrequency (RF) for Non-invasive, pain free, skin rejuvenation of the periorbital area. The study included eleven (11) subjects, treated for periorbital signs of aging (iFine handpiece, EndyMed PRO platform, EndyMed Medical, Caesarea, Israel). The degree of clinical improvement was assessed by the global aesthetic improvement scale (GAIS) and subjects satisfaction by post treatment questionnaires. 91% of patients showed good to excellent improvement as a result of the treatment. Subjects satisfaction showed that 55% of patients reported that they were very satisfied, 45% were satisfied while none were dissatisfied. There were no incidences of infections, scarring, hypopigmentation, or any other serious complications.

Clinical features and prognosis of multiple myeloma and orbital extramedullary disease:Seven cases report and review of literature

BACKGROUND Multiple myeloma(MM)complicated with extramedullary disease(EMD)has a poor prognosis and is a limiting factor in the treatment of MM,and no standard treatment is recommended in international guidelines.Few studies have reported MM with periorbital EMD.CASE SUMMARY In this paper,the clinical characteristics and survival of seven patients with multiple myeloma and orbital are described and analyzed.The common ocular symptoms were blurred vision,proptosis and/or eye movement disorders,IgG type MM may be a risk factor for orbital involvement.Of them,six patients were treated with bortezomib-based regimens.The median overall survival(OS)and progression free survival for the entire cohort were 48 and 33 mo,respectively,which was much worse than the OS reported for MM patients without orbital EMD.CONCLUSION Orbital MM may have significantly shortened survival for the entire cohort,so multidisciplinary collaboration is emphasized and recommended in the diagnosis and treatment of these difficult cases.

Imaging characteristics of orbital peripheral nerve sheath tumors:Analysis of 34 cases

BACKGROUND Peripheral nerve sheath tumors(PNSTs),a rare group of neoplasms in the orbit,comprise only 4%of all orbital tumors.At present,there are very few studies detailing the features of these tumors identified using imaging technology.AIM To compare the differences in location,morphology,magnetic resonance imaging(MRI)signal intensity/computed tomography(CT)value,and enhancement degree of tumors of different pathological PNSTs types.METHODS Clinical,pathological,CT,and MRI data were analyzed retrospectively in 34 patients with periorbital sheath tumors diagnosed using histopathology from January 2013 to August 2021.RESULTS Among 34 cases of orbital peripheral nerve sheath tumors,21 were schwannomas,12 were neurofibromas,and 1 was a plexiform neurofibroma.Common clinical symptoms presented by patients with these types of tumors include eyelid swelling,exophthalmos,and limited eye movement.Schwannomas mostly occur in the intramuscular space with small tumor volume and rare bone involvement.Neurofibromas develop in the extrapyramidal space with larger tumor volume and more bone involvement.Radiologically,schwannomas and neurofibromas are characterized by regular morphology and uneven density and signal.One case of plexiform neurofibroma showed tortuous and diffuse growth along the nerve,with a worm-like appearance on imaging.CONCLUSION Different pathological types of orbital peripheral nerve sheath tumors have unique imaging characteristics.Comprehensive consideration of the patient's clinical and imaging manifestations is of great value in the diagnosis of orbital peripheral nerve sheath tumors.

Perioperative Dexamethasone and Post-Rhinoplasty Edema: A Prospective Observational Study

Purpose: The timing, schedule, and doses of dexamethasone administration to control edema are a topic of debate. This prospective observational study was performed to evaluate the effects of perioperative and intraoperative administration of dexamethasone on the occurrence of edema in patients who underwent rhinoplasty. Methods: This study was conducted at Najran University Hospital, Najran University, Saudi Arabia, from June 2019 to August 2020. Seventy-five patients who underwent open rhinoplasty were assigned using a consecutive non-random sampling method into three groups, with 25 patients in each group. Group A patients received three doses of intravenous 8 mg dexamethasone perioperatively, and group B patients received a single dose of intravenous 8 mg dexamethasone intraoperatively. Group C patients received intravenous 2 mL of 0.9% normal saline solution intraoperatively and were considered as a control group. Digital photographs of patients were obtained and assessed on the 1st, 7th, and 14th days post-operatively. Results: The mean duration of operation was comparable between the studied groups (p = 0.368). On comparing the studied groups, significant differences in the edema scores were observed on the 1st and 7th day post-operatively (p < 0.001 for both), but not on the 14th day (p = 0.079). When comparing each group against the postoperative day of evaluation, statistically significant differences were detected between the 1st vs. 7th day and 1st vs. 14th day in Group A, whereas, in the other groups, no significant difference was detected (all p > 0.05). No Dexamethasone-related complications were observed. Conclusion: Dexamethasone significantly reduced periorbital swelling and edema after rhinoplasty compared to the control group. A short course of triple dose perioperative administration of dexamethasone is more potent in reducing edema from 1st to 7th day postoperative than a single dose intraoperatively.

Evaluation and management of acquired ptosis

Periorbital rejuvenation is a common aesthetic goal sought by patients presenting to the plastic or oculoplastic surgeon.For this reason,it is critical that the surgeon understand the functional considerations,such as preexisting blepharoptosis,which will contribute to the ultimate aesthetic outcome.This article will review the anatomy of the normal and ptotic lid and will discuss the approach to diagnosing and characterizing the type and degree of lid ptosis.High-yield surgical techniques for ptosis correction will then be described,including the indications for and steps of each procedure.Finally,the diagnosis and management of common complications that follow ptosis surgery will be discussed.Our main objective is to arm the surgeon with the preoperative and operative planning tools to successfully manage comorbid ptosis and thereby improve blepharoplasty outcomes.