Zhengkang Li's research while affiliated with Renji Hospital and other places

Purpose Divided nevus with verrucous hyperplasia will always recur after surgery but non-verrucous divided eyelid nevus rarely recur. This study analyzed the differential expression of Ki-67, S100, Melan A and HMB45 and identified the correlation between the clinical and histopathological features of verrucous and non-verrucous divided eyelid nevus. Methods This study included 29 patients, of whom 8 patients had verrucous divided nevus. Immunohistochemistry labeling was used to assess the expression of Ki-67, S100, Melan A and HMB45 after excision. The difference between verrucous and non-verrucous divided eyelid nevus was analyzed. Results The patients’ ages ranged from 2 to 59 years, with a mean age of 19 years. The lesion size ranged from 1.5 to 2.0 cm in diameter and invaded the eyelid margins and the posterior lamella of the eyelids. Immunohistochemistry labeling showed strong positivity for approximately 98.5% of S100 and positive staining for approximately 27.6% of Ki-67, 72.4% of Melan A and 6.8% of HMB45. However, Ki-67 was significantly upregulated in verrucous divided nevus of the eyelids compared with non-verrucous divided nevus, with approximately 38.8% upregulation in verrucous and 18.3% upregulation in non-verrucous nevus. Conclusions This study correlated the clinic-pathologic features of verrucous divided eyelid nevus by means of statistically analyzing the varied clinical features and pathological impressions. The significant over-expression of S100 may be used as an indicator of divided nevus of the eyelids, and the over-expressed Ki-67 may contribute to the recurrence of verrucous divided nevus. High expression of HMB45 and Melan A may represent malignant transformation.

Background: Few quantitative results are reported about the surgical effect of orbital reconstruction in Le Fort III fractures. The authors' team proposed an ordered surgery method which was effective for Le Fort III fractures. The aim of this study was to evaluate the effectiveness of this method with quantitative outcomes. Methods: A retrospective study was conducted of all patients who were diagnosed with Le Fort III fractures and underwent orbital and facial fractures repair from January 2015 to June 2019. Surgical reconstruction was performed with an ordered surgery method. Orbital volumes were used to evaluate the effectiveness of orbital reconstruction. Results: Fifteen patients (21 eyes) with Le Fort III fractures were included in this study. Preoperative and postoperative orbital volume changes were statistically significant (P<0.01). For unilateral fractures, orbital volumes were different in 2 eyes (P<0.01). For bilateral fractures, orbital volumes were almost the same in 2 eyes (P=0.34). For the affected eye in unilateral fractures group and eyes in bilateral fractures group, after surgery, orbital volume were almost the same (P=0.35). Conclusions: This study showed effectiveness and safety of the ordered surgery in the treatment of Le Fort III fractures, which would result in significant decrease in orbital volumes.

Purpose: To evaluate the clinical effectiveness and safety of bioresorbable implants for treating paediatric zygomaticomaxillary complex (ZMC) fractures with concomitant orbital floor defects. Methods: A retrospective review of paediatric patients who underwent ZMC repair with concomitant orbital floor fractures with bioresorbable implants in Shanghai Ninth People's Hospital from July 2015 to June 2019 was performed. The primary outcome measures included ocular motility, diplopia, enophthalmos, facial deformities, and restricted mouth opening, as well as complication rates. Pre- and post-operative computed tomography scans were obtained for clinical diagnosis and surgical effectiveness. Results: Twenty two children were included in this study. Facial deformities were corrected in all 22 cases by surgical reconstruction postoperatively, and the average relative distance of Portals point-Zygomaxillare and Anteriornasalspine-Zygomaxillare were 1.3 ± 0.6mm (P = 0.22) and 1.2 ± 0.5mm (P = 0.19). The eye movement restored to normal in 13 patients. The mean amount of relative enophthalmos was 1.0 ± 0.4 mm (P = 0.12). 12 cases had complete resolution of diplopia postoperatively at the extremes of the gaze, and 1 case presented persistent diplopia on the down gaze as before, but from level III to level I. Facial numbness was resolved completely in 6 cases, and 2 cases presented with persistent numbness but relieved significantly. The average Hounsfield units of RapidSorb plates and OrbFloor PI were 154 ± 5 and 99 ± 4 respectively on computed tomography image obtained 1 week postoperatively, which showed no obvious difference compared with 0.5 year postoperatively (P > 0.1). Hounsfield units of implants gradually declined around 1 year postoperatively. Hounsfield units of RapidSorb plates (20 ± 1) were consistent with periorbital tissue during postoperative 2-year follow-up, and Hounsfield units of OrbFloor PI (19 ± 1) were consistent with periorbital tissue during postoperative 1.5-year follow-up. No patients had severe sequelae or implant related complications postoperatively. None of bone nonunion, malunion, infection or rejection occurred during the follow-up periods. Conclusions: Open reduction and internal fixation for the treatment of ZMC fracture have achieved significant improvement in functional and cosmetic outcomes postoperatively. Bioresorbable materials have been proved to be effective and safe in the treatment of children's ZMC and orbital wall fractures.

Objective To evaluate the myocutaneous sliding flap for restructuring the eyelid of divided nevus, thus optimizing the aesthetic outcome. Design A retrospective clinical study. Participants Clinical data from patients with a small or medium-sized divided nevus of the eyelids between January 2015 and December 2018 in the Shanghai Ninth People's Hospital were reviewed. Methods The safety and efficacy of a surgical approach using a myocutaneous sliding flap were evaluated based on postoperative features and complications. Results This study included 53 patients with an average age was 21.6 years (range, 2–68 years). The lesions involved the inner canthus in 5 patients (9.43%) and the lateral canthus in 14 patients (26.42%). Three (5.66%) patients had undergone primary surgery elsewhere. Overall, the eyelid margins were in good shape postoperatively at an average follow-up of 22.7 months, and there were no obvious eyelid deformities, lagophthalmos, or other unacceptable complications postoperatively. The nevi were benign intradermal (60.38%), junctional (16.98%), and compound types (22.64%) without malignant transformation, as confirmed by pathologic examination. No malignant transformation was observed until the end of the follow-up period. Conclusion A myocutaneous sliding flap can provide an appropriately size pedicle graft and achieve satisfactory cosmetic results for divided eyelid nevus.

Purpose To investigate the clinical effects of a custom-made conformer wrapped in lower oral mucosa for the correction of severely contracted socket. Methods Clinical data and photographs of 32 patients with severely contracted socket were retrospectively analyzed. Among the 32 cases, 21 were males and 11 were females. Their ages ranged from 20 to 71 years (mean, 45 years). Each patient underwent conjunctival sac plasty using a custom-made conformer wrapped by oral mucosa, then compression bandage for 1 month. All patients received tarsorrhaphy 6 months postoperatively, and an artificial eye was worn 1 week later. Results All the grafts were fully vascularized. The conjunctival sacs had enough space to fit the desirable artificial eyes, and adequate aesthetic outcomes were reached postoperatively. The mean depth of the upper fornix was 4.28 ± 0.66 mm preoperatively and 18.84 ± 0.65 mm postoperatively ( p < 0.01), and lower fornix depth was 2.69 ± 0.42 and 8.78 ± 0.82 mm, respectively ( p < 0.01). Lower lip deformity occurred in one case. Conclusion A custom-made conformer wrapped in lower oral mucosa was a safe and effective grafting material. The grafts can be effectively used in the reconstruction of severely contracted socket and lead to good cosmetic outcomes.

Purpose To report a case with neurofibromatosis type 1 presenting as prominent enophthalmos and abnormal infraorbital artery. Case description A 19-year-old man with a family history of neurofibromatosis presented with prominent right enophthalmos. Computed tomography showed orbital dysplasia and enlarged inferior orbital fissure but no plexiform neurofibroma. Prominent intraoperative hemorrhage originated from several abnormal arteries in the infraorbital region during orbital reconstruction. A tortuous and dysplastic infraorbital artery was verified postoperatively by computed tomography angiography. The bleeding vessels were supposed to be the orbital branches of the dysplastic infraorbital artery. Conclusions The orbital malformation and enlargement of inferior orbital fissure probably resulted in an abnormal infraorbital artery. Selective artery embolization may be chosen as a preceding treatment before orbital reconstruction surgery.

Delayed orbital apex syndrome (OAS) is rare during orbital blowout fracture reconstruction. A 30-year-old woman fractured the right orbital floor in a fall and undergone repairing operation 2 weeks later. After severe sneezing on postoperative day 10, she gradually arose vision loss, ophthalmoplegia, ptosis with a dilated and fixed pupil within few hours, then consulted our department and was diagnosed as OAS. Computed tomography scan showed displaced implant and retrobulbar emphysema resulting in a constellation of compression to orbital apex. Therefore, an exploratory operation was engaged to reposition the implant and reduce the emphysema concurrent with mega-dose steroids. The patient regained vision immediately and resolved all symptoms at the 6 months follow-up.

Purpose: To describe the use of an image-guided 3-dimensional surgical navigation system for the removal of metallic foreign bodies from the human intraorbital region. Patients and methods: Between January 2016 and June 2019, 30 patients with metallic foreign bodies in the orbital area underwent image-guided 3-dimensional surgical navigational removal at the authors' center, and their data were retrospectively analyzed. Patients' age, gender, complaints, cause of initial injury, location, interval between injury, and surgery were recorded. Preoperative CT scans of the orbits were obtained and used for preoperative planning. The 3-dimensional navigation system was used for intraoperative navigation. Results: In all 30 patients, the foreign bodies were removed by minimally invasive access without any severe complications. The intraoperative average depth of foreign bodies was 19.98 ± 11.47 mm which was consistent with the depth measured in preoperative planning. The mean length, width, and height of foreign bodies determined in preoperative planning were confirmed by postoperative measurements. There was no significant difference between preoperative and postoperative mean logarithm of Mininal Angle Resolution (logMAR) best-corrected visual acuity. According to the postoperative CT scan, all 30 patients' metallic foreign bodies were successfully removed by surgeries using the surgical navigation system. Most patients who presented with diplopia, eye movement pain, and paresthesia were improved after surgery. Conclusion: This study demonstrated that computer-assisted image-guided 3-dimensional surgical navigation had the advantages of accurate real-time localization of foreign bodies, minimizing collateral damage, determining the appropriate surgical path, and increasing the successful rate of foreign body retrieval.

Purpose: We employed intraoperative tarsorrhaphy depending on the degree of edema to treat moderate conjunctival chemosis during orbital fracture repair surgery. Methods: This is a retrospective case review of 1367 patients (1384 eyes) who underwent orbital fracture repair surgery by a transconjunctival approach. All cases of moderate conjunctival chemosis during surgery were included and were divided into 2 groups. In one group, intraoperative tarsorrhaphy was performed immediately the chemosis reached a moderate degree and the conjunctiva was incarcerated by the lower eyelid margin; once severe chemosis developed, stitches were added to cover all of the prolapsed conjunctiva with a palpebral margin. In the second group, moderate chemosis was treated with bandage pressure without stitches even after appearance of severe chemosis. The time course of conjunctival edema was recorded. Results: The incidence of moderate conjunctival chemosis in orbital reconstruction surgery by the transconjunctival approach was 9.4%. The average time for resolution of moderate chemosis in the tarsorrhaphy group (3.5 ± 1.4 days) was obviously shorter than in the bandage group (6.2 ± 1.9 days). The incidence of severe chemosis in the intraoperative tarsorrhaphy group (14.1%) was significantly lower than in the bandage group (31.8%). Overall, the total duration of severe chemosis in the tarsorrhaphy group was obviously shorter than that of the bandage group. Conclusion: Intraoperative tarsorrhaphy was a highly effective method of treating moderate chemosis and preventing severe conjunctival chemosis during orbital fracture repair surgery.