A. Jan Berlin

Levator aponeurosis surgery. A retrospective review.

A review of all cases of aponeurotic repair done since 1980 by the author identified 140 patients and 174 eyelids. An acceptable result at 6 weeks was defined as a lid level within 1 mm of the desired level achieved in 74% of lids with acquired ptosis. The amount of ptosis present preoperatively was the major factor in our study; levator function and type of anesthesia did not affect the success rate. The most significant finding was a lower long-term success rate due to a drop in lid level clustered at the 2- to 4-month period postoperatively. The authors speculate on the cause for this finding.

Fasciocutaneous Flap, Secondary Axial Pattern Flap, and Microvascular Free Flap in Socket Reconstruction

Three techniques are described to rebuild a missing or recurrently contracted socket, the selection of which is based on the anatomy of the periorbital tissue and vascular supply. When the superficial temporal vessels are present, the ipsilateral fasciocutaneous postauricular flap is used. When the vessels are present but the postauricular flap has been used, a secondary axial pattern flap is used. When the superficial temporal vessels are absent or not suitable, the dorsalis pedis vascularized free flap is used.

Benign Osteoblastoma of the Orbit

Benign osteoblastoma is a rare, solitary, vascular, osteoid-producing tumor that is rich in osteoblasts. This is the first report of a case of osteoblastoma of the orbit not contiguous with a sinus cavity.

The use of Digital Subtraction Angiography in The Evaluation of Carotid Cavernous Sinus Fistulas

Intravenous digital subtraction angiography (IV-DSA) is a safe, rapid procedure that can be performed on an outpatient basis and provide diagnostic information comparable to conventional angiography. This paper reviews the initial experience with intravenous digital subtraction angiography in the evaluation of five cases of carotid cavernous sinus fistula, digital subtraction angiography.

Metastatic melanoma following repeated cryotherapy of recurrent pigmentation of the conjunctiva and adjacent eyelid

The authors report a patient who had repeated cryotherapy treatments for clinically flat conjunctival and adjacent eyelid pigmentation after an initial biopsy revealed only intraepitheli-al disease: primary acquired melanosis in the conjunctiva and lentigo maligna in the adjacent eyelid skin. There was no evidence of melanoma in either location. After repeated treatments, the pigmentation totally regressed. The patient never clinically developed a tumor nodule although a small zone of pigment in the palpebral conjunctiva appeared minimally thickened. The patient died of metastatic melanoma five years after initiation of cryotherapy. The terminal diagnosis was confirmed at autopsy and no second primary melanocytic neoplasm was discovered. This case illustrates three features: (1) the difficulty in clinically distinguishing between benign primary acquired melanosis (PAM) and malignant melanoma in the palpebral conjunctiva, (2) the rare tendency of thin melanomas to metastasize, and (3) the failure of cryoth...