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PURPOSE: To measure palpebral fissure morphology in patients with severe congenital blepharoptosis. METHODS: The palpebral fissure shape of 20 patients (30 eyes) with severe congenital blepharoptosis (levator excursion < or = 4 mm) was quantified with digital image processing in a cross-sectional design. Several variables related to the morphology of the palpebral fissure were measured: (a) upper and lower eyelid curvature, (b) palpebral fissure angle, and (c) position of the upper maximum and lower minimum eyelid contour. RESULTS: Patients with severe congenital blepharoptosis often show a moderate degree of antimongoloid palpebral fissure orientation and eyelid drooping that is greater temporally than nasally. CONCLUSIONS: Contour adjustment in severe congenital blepharoptosis surgery is better when it is not centered on the midline, but rather has a slight lateral displacement.
Assuntos
Blefaroptose/congênito , Pálpebras/patologia , Processamento de Imagem Assistida por Computador , Adolescente , Adulto , Blefaroptose/cirurgia , Criança , Pré-Escolar , Pálpebras/cirurgia , HumanosRESUMO
OBJECTIVE: This study used image processing techniques to quantify the upper eyelid contour of patients with Graves upper eyelid retraction and congenital blepharoptosis. DESIGN: The study design was a cross-sectional study. PARTICIPANTS: A total of 29 patients with Graves disease, 22 patients with congenital blepharoptosis, and 50 patients with no history of eye disease participated. INTERVENTION: The images of the palpebral fissure of all participants were transferred to a personal computer and processed with NIH Image 1.55 software. MAIN OUTCOME MEASURES: The following parameters were analyzed: the curvature of the upper eyelid contour, the position of the contour peak relative to the midline, and the ratio between the temporal and nasal upper quadrant areas of the palpebral fissure. RESULTS: All upper eyelid contours could be fitted with second-degree polynomial functions. The mean temporal/nasal area ratio was 1.33 mm in patients with Graves disease, 0.92 mm in patients with blepharoptosis, and 1.04 mm in control subjects. The peak of the upper eyelid contour was found to be lateral to the midline in control subjects (1.05 mm) and in patients with Graves disease (2.09 mm). In patients with blepharoptosis, the peak was 0.69 mm medial to the midline. Overall, the distance between the midpupil and the upper eyelid margin was correlated with several factors: the degree of curvature, the position of the peak of the eyelid contour, and the temporal/nasal area ratio. CONCLUSIONS: In Graves eyelid retraction, the curvature of the upper eyelid is enhanced, the peak of the contour is displaced laterally, and the temporal upper quadrant area is increased. Conversely, in congenital blepharoptosis, the eyelid is almost flat, the peak of the contour is displaced medially, and the upper quadrant area is diminished. The lateral segment of the upper eyelid is more involved than the nasal segment in both Graves upper eyelid retraction and congenital blepharoptosis.
Assuntos
Blefaroptose/congênito , Blefaroptose/complicações , Pálpebras/patologia , Doença de Graves/complicações , Processamento de Imagem Assistida por Computador/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Processamento de Sinais Assistido por ComputadorRESUMO
Nasal obstruction is a common pediatric clinical complaint that involves a great number of pathologies (allergic rhinopathy,adenoid hypertrophy, septal deformities, infectious sinusitis, tumours, choanal atresia, nasal foreign bodies, etc.). Not only the history, and a through physical examination but also, the subsidiary exams are of great value in the etiologic diagnostic. Antro-choanal polyp (Killian's polyp) must be remembered in the differential diagnosis of nasal obstruction, when a sinus roentgenogram with unilateral maxillary opacification is seen. Clinically, the lesion often protrudes into the nasopharynx and in some cases it may even be seen extending into the oropharynx. The surgical procedure usually employed is a unilateral Caldwell-Luc antrostomy, with oropharyngeal remotion. We present 12 pediatric patients with antral-choanal polyps,and discuss history, radiology, nasal/nasopharyngeal endoscopic evaluation, considerations about the origin and surgical treatment of choice.
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Alkaline batteries as foreign bodies in the nasal cavities are dangerous because they can cause liquefaction necrosis with subsequent severe local tissue destruction. Batteries found in the nasal cavities should be removed immediately to prevent sequelae such as septal perforations or nasal meatus stenosis. Due to the common use of these batteries (e.g. watches, electronic toys and games, calculators) physicians and the general public should be more aware of this type of foreign body and the peculiarities in their management. We present five cases of button battery foreign bodies in the nasal cavities and review 12 cases described in the literature and discuss the special aspects of these foreign bodies.