Cases reported "Cicatrix"

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1/52. Endoscopic supraorbital nerve neurolysis.

    Endoscopic surgery, performed through small incisions, yields therapeutic results equivalent or superior to those obtained using the conventional approach. The technique has been established in laparoscopic cholecystectomic surgery. In plastic surgery, endoscopic techniques were first developed in aesthetic procedures and have been reported to be useful in face-lift operations, breast reconstruction, muscle flap harvesting and subcutaneous surgery. Endobrow lift has become a more and more popular aesthetic procedure. The endoscope provides an excellent magnification and, through a high power light source, a very good illumination of the operative field. It explains why the endoscope is more and more used in reconstructive procedures. We report the case of a patient suffering from a posttraumatic entrapment of the right supraorbital nerve which was released by an endoscopic approach.
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2/52. Neurophysiological and ultrasound findings in sural nerve lesions following stripping of the small saphenous vein.

    We describe the neurophysiological and ultrasound (US) findings in two patients with right sural nerve lesions following stripping of the small saphenous vein for varicose vein treatment. In the first case, US showed a tear of the nerve proximal to the lateral malleolus and a hypoechoic swelling of the proximal stump, likely related to a terminal bulb neuroma. A sural conduction study performed distally and proximally to the lesion through a near-nerve needle technique showed absent responses. In the second case, US showed a deep subcutaneous extension of a postsurgical scar placed behind the lateral malleolus close to the sural nerve, but no nerve discontinuity. Sural conduction study showed absent responses distal to the scar. Sural stimulation immediately above the scar yielded a small response at the sciatic nerve. A subsequent investigation performed 15 months after the operation showed absent proximal and distal responses. The combination of US and sural conduction study, including recording at the sciatic nerve, to our knowledge has not been described previously, and may yield important complementary information in the diagnosis of sural nerve lesions.
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3/52. Central bump-like opacity as a complication of high hyperopic photorefractive keratectomy.

    PURPOSE: A new complication is reported in association with high hyperopic excimer laser photorefractive keratectomy. methods: One thousand consecutive eyes were treated with a Meditec MEL-60 excimer laser (Meditec Inc, Heroldsberg, germany) for hyperopic refractive error between 1 diopters and 7 diopters. RESULTS: Three eyes with high hyperopic corrections between 5 and 6 diopters had a central, round bump-like subepithelial scar develop 1 month after hyperopic photorefractive keratectomy, which reduced the uncorrected and spectacle-corrected visual acuity. CONCLUSION: Central bump-like opacity is a new, visually significant complication of unknown origin associated with high hyperopic photorefractive keratectomy. Possible causes of this complication include drying and edema of the cornea as a result of prolonged exposure, interruption of the peripheral superficial nerve plexus affecting the central anterior stroma, and abnormal epithelial or tear film function resulting from excessive central steeping.
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4/52. Granular cell traumatic neuroma: a lesion occurring in mastectomy scars.

    BACKGROUND: Granular cell changes can be observed in a variety of benign and malignant tumors, and are seen more commonly in granular cell tumors, which in about 5% of cases develop in the breast. Granular cells also have been observed in sites of previous trauma, such as surgery, and are found to be inflammatory reactions of histiocytic origin. methods AND RESULTS: We investigated, morphologically and immunohistochemically, 2 granular cell lesions occurring in mastectomy scars after surgery for carcinoma. Both lesions were composed of strands and nests of large granular cells, haphazardly set in a background of fibrous tissue, with sparse inflammatory infiltrates. Several tortuous hypertrophic nerve bundles were also embedded in the fibrous tissue. A few of these nerve bundles showed degenerative changes and contained granular cells. Immunohistochemically, granular cells were positive for S100 protein, neuron-specific enolase, vimentin, and CD68 antigen. CONCLUSIONS: We consider these proliferative lesions of peripheral nerves to have the features of both granular cell tumor and traumatic neuroma. These cases indicate that traumatic neuroma can undergo extensive granular cell changes and constitute a previously unrecognized entity, which we provisionally label granular cell traumatic neuroma. Granular cell traumatic neuroma has to be taken into consideration when evaluating lesions occurring at mastectomy scars and should be differentiated from malignant tumors with granular cells, such as apocrine carcinoma and alveolar soft part sarcoma.
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5/52. Muscle hypertrophy due to scarring of the S1 nerve root.

    Segmental muscle enlargement occurs in a variety of neurogenic conditions. We present a patient with calf hypertrophy, likely produced by continuous neuromuscular irritability and compensatory type 1 and type 2 muscle fiber hypertrophy. The underlying lesion of the S1 nerve root was caused by scarring, which could be demonstrated by Gadolinum enhanced, fat saturated magnetic resonance imaging. Thus, the application of this technique is recommended in otherwise etiologically unclear cases of neurogenic muscular lesions in order to detect chronic nerve root pathology.
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6/52. C-shape extended transconjunctival approach for the exposure and osteotomy of traumatic orbitozygomaticomaxillary deformities.

    In the treatment of post-traumatic deformities of the orbitozygomaticomaxillary complex resulting from trauma, the most appropriate exposure must be used. The choice of exposures includes the bicoronal approach and the periorbital incisions. When the whole orbitozygomatic complex is malpositioned, the bicoronal approach is desirable; this can be combined with buccal and eyelid incisions. However, the bicoronal approach is complicated by a longer duration of operation time, post-surgical scars that tend to show, and potential damage to the temporal branch of the facial nerve. A new approach using a C-shape extended transconjunctival approach is possible to have one field of vision to osteotomize the frontozygomatic suture, the lateral orbital wall, inferior orbital rim, lateral maxillary buttress, and zygomatic arch. It takes less operating time and the post-surgical scars are shorter than the bicoronal approach.
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keywords = nerve
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7/52. Bilateral linear scleroderma "en coup de sabre" associated with facial atrophy and neurological complications.

    BACKGROUND: Linear scleroderma "en coup de sabre" (LSCS) usually affects one side of the face and head in the frontoparietal area with band-like indurated skin lesions. The disease may be associated with facial hemiatrophy. Various ophthalmological and neurological abnormalities have been observed in patients with LSCS. We describe an unusual case of LSC. CASE PRESENTATION: A 23 year old woman presented bilateral LSCS and facial atrophy. The patient had epileptic seizures as well as oculomotor and facial nerve palsy on the left side which also had pronounced skin involvement. Clinical features of different stages of the disease are presented. CONCLUSIONS: The findings of the presented patient with bilateral LSCS and facial atrophy provide further evidence for a neurological etiology of the disease and may also indicate that classic progressive facial hemiatrophy (Parry-Romberg syndrome) and LSCS actually represent different spectra of the same disease.
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ranking = 0.2
keywords = nerve
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8/52. Ultrastructure of keloid: an unusual incident involving lepromatous leprosy.

    A patient with lepromatous leprosy developed keloids on the dorsum of both arms in response to ulcerations due to acute erythema nodosum leprosum reactions. Electron microscopic examination of the keloidal dermis showed a morphology indicative of increased production of normal collagen fibrils. The greatest cellular changes from normal were in fibroblasts which were enlarged due to increased amounts of rough endoplasmic reticulum and extensive Golgi complexes. Nuclear folds were also evident in these fibroblasts. Some cells, considered to be fibroblasts, were filled with cytoplasmic filaments and contained bizarre shaped nuclei. mast cells, blood vessels and nerve processes were also present.
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ranking = 0.2
keywords = nerve
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9/52. Innovation and surgical techniques: endoscopic resection of cervical branchiogenic cysts.

    The recent advent of endoscopic procedures has compelled both plastic and neck and head surgeons to reconsider the conventional methods by which the excision of cervical congenital cystic is classically achieved.An endoscopic approach for excision of the cervical congenital cystic is described. This procedure is anatomically safe and can be made with minimal morbidity through a small transcervical incision.Both specific instruments and solid anatomical knowledge are necessary to perform a safe and efficient cystic endoscopic excision.The essential surgical steps are as follows: 1. Minimal incision placed in natural cervical wrinkle over the dome of the cyst; 2. Intracystic or extracystic dissection; 3. Identification and protection of the sternocleidomastoid muscle, spinal nerve, hypoglossi nerve, and posterior belly of digastric muscle; 4. Careful dissection of the posterior surface of the cyst, avoiding injury on the carotid vessels and internal jugular vein.Eight patients were operated on with this technique and they were very pleased with postoperative comfort and aesthetic results. Inconspicuous scars and no complications were registered.With advanced endoscopic instruments and the development of new surgical technique and surgeon experience, the endoscopic surgery can be the method of choice in cervical excision of branchiogenic cysts.
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ranking = 0.4
keywords = nerve
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10/52. hair-bearing submental artery island flap for reconstruction of mustache and beard.

    Loss of mustache and beard in the adult male caused by severe burn, trauma, or tumor resection may cause cosmetic and psychological problems for these patients. Reconstruction of the elements of the face presents difficult and often daunting problems for plastic surgeons. The tissue that will be used for this purpose should have the same characteristics as the facial area, consisting of thin, pliable, hair-bearing tissue with a good color match. There is a very limited amount of donor area that has these characteristics. A hair-bearing submental island flap was used successfully for mustache and beard reconstruction in 11 male patients during the last 5 years. The scar was on the mentum in four cases, right cheek in two cases, right half of the upper lip in two cases, left cheek in one case, left half of the upper lip in one case, and both sides of the upper lip in one case. The submental island flap is supplied by the submental artery, a branch of the facial artery. The maximum flap size was 13 x 6 cm and the minimum size was 6 x 3 cm (average, 10 x 4 cm) in this series. Direct closure was achieved at all donor sites. patients were followed up for 6 months to 5 years. No major complication was noted other than one case of temporary palsy of the marginal mandibular branch of the facial nerve. The mean postoperative stay was 7 days. color and texture match were good. hair growth on the flap was normal, and characteristics of the hair were the same as the intact side of the face in all patients. The submental island flap is safe, rapid, and simple to raise and leaves a well-hidden donor-site scar. The authors believe that the submental artery island flap surpasses the other flaps in reconstruction of the mustache and beard in male patients. Application of the technique and results are discussed in this article.
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ranking = 0.2
keywords = nerve
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