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Purpose The aims are to compare short- versus long-term patient satisfaction and report temporary versus permanent complications in 650 patients with endoscopic forehead lift procedure (EFL). Methods This is a retrospective study on all of the consecutive patients with EFL. Patients with previous trauma and surgery and less than 2 years follow up were excluded. Short- (6 months) and long-term (≥2 years) patient satisfaction (visual analog score [VAS], 0-100) were recorded. Patients' perspectives on temporary versus permanent complications were also documented. Results Mean age and follow up were 46.4 and 7.1 (2-13) years, respectively. Long-term satisfaction (79.9) was significantly lower than the short term (96.6). The long-term satisfaction decreased in 95.7%, increased in 2.7%, and remained the same in 1.6% of the patients. Intraoperative skin laceration occurred in 3 patients (0.5%). Mean time of forehead numbness recovery was 2.3 months. Temporary complications were itching (13.7%), headache (6.3%), unilateral facial nerve palsy (5.8%), acne (3.2%), and remained staples (1.7%). Permanent complications included undercorrection (7.1%), alopecia (4.2%), forehead irregularities (2.3%), surprised look (2.2%), incision site complications (2%), and glabellar depression (0.9%). Reoperation (1.2%) was performed for undercorrection and alopecia. While short-term satisfaction was significantly lower in patients with temporary facial nerve paresis, long-term satisfaction was lower in patients with undercorrection and reoperation. Conclusion A high satisfaction scores of 96.6 and 80 were observed in the short- and long-term follow up after the EFL. Frequency of temporary and permanent postoperative complications was 30.3% and 15.8%. Reoperation rate was 1.2%.

Purpose To describe the frequency of blepharoptosis and factors affecting it after the pars plana vitrectomy (PPV) procedure. Methods In a prospective study, patients were recruited consecutively from October 2016 to June 2018. Upper eyelid margin reflex distance 1 and 2 (MRD1 and 2), upper eyelid crease height, and levator function were measured before, 1 and at least 6 months after surgery by the same investigator. Clinical and Clinically significant ptosis were defined as ≥0.5 and ≥2 mm drop of MRD1. Result There were 60 eyes from 57 patients. The majority of surgeries were performed by the fellows (63.3%, 38/60) and under general anesthesia (95.0%, 57/60). Clinical and clinically significant ptosis following PPV were 47.2% (25/53) and 11.3% (6/53) at the last follow up (at least 6 months), respectively. MRD2 (p = 0.389) and eyelid crease height (p = 0.057) did not significantly change. Surgeons' level, time of the procedure and other variables were not significantly impacting the frequencies. Conclusion Persistent clinically significant ptosis was observed in 11% of patients undergoing PPV. No variable was significantly associated with persistent postoperative ptosis after PPV.

Objective To compare the characteristics and outcomes of rhino-orbito-cerebral mucormycosis (ROCM) in diabetic versus non-diabetic patients. Method It is a retrospective comparative case series on consecutive patients with biopsy-proven ROCM. Systemic and ophthalmic manifestations, imaging, management and final outcomes were compared between diabetic versus non-diabetic ROCMs referred the eye clinic of a university-based hospital (2008-2016). Results Forty-three diabetics (55 eyes) with mean age of 54.6 (SD:12.5) years and 20 non-diabetics (24 eyes) with mean age of 57.5 (SD:13.8) years were enrolled. Patients' survival was observed in 51% of diabetics and 70% of non-diabetics (P = .1). The mortality rate was 7.4 times (CI95%: 1.85-29.96) higher in diabetic ROCM treated with non-liposomal amphotericin (P = .01). Exenteration did not significantly change the mortality rate in either group. Globe survival was 40% and 50% in diabetics and non-diabetics (P = 1), respectively. Vision survival was observed in 20% of diabetics and 37% of non-diabetics (P = .2). Conclusion Patients', globe and vision survivals were not different between diabetic and non-diabetic patients with ROCM. They were 51%, 40% and 20% in diabetic and 70%, 50% and 37% in non-diabetic ROCM.

Purpose To demonstrate the technique and report the results of endoscopic-assisted lateral orbitotomy for 6 patients with huge intraorbital dermoid cyst causing orbital roof bone erosion and dural invasion. Methods Patients had unilateral cystic tumor with proptosis and hypoglobus for more than 6 months. There was no compressive optic neuropathy. Lateral orbitotomy procedure was performed from 2004 to 2016 by 1 surgeon. Cysts were dissected, and fluid content was aspirated to reduce the size. Solid contents were then suctioned, its cavity was repeatedly irrigated, and orbital part of epithelial lining was removed. The remained epithelial lining and keratinized content at the orbital roof (abutting the dura) were removed using the rigid endoscope lenses (4 mm, 0° and 30°) and curettage. Orbital tissue was pulled away from the roof (inferior) by an assistant surgeon to make a space for introducing the lens and curette. The surgical field was frequently irrigated. No orbital drain was used, and all the patients were discharged on the same day after 8-10 hours of observation. Skin sutures were removed 1 week later. Results They were 4 men and 2 women with age range of 19-48 years. A large superolateral orbital tumor with roof erosion and dural invasion was observed on imaging. Procedures were performed uneventfully. Dermoid was the pathological diagnosis. While one patient lost to follow up after 1 week, others had 6-18 months follow-up time with no recurrence. Conclusions Endoscopic-assisted lateral orbitotomy approach provided a good field of view, illumination, and magnification to totally remove all the content and epithelial lining of very large orbital roof dermoid cysts with dural invasion.

None of brow lift techniques are completely satisfactory because of their limited effectiveness, lack of longevity, and potential complications. The aim of this study was to provide a comprehensive review of the literature on the pros and cons of the most popular techniques in brow and forehead lift. Relevant original articles in the PubMed database (English language) were sought using the search terms “eyebrow lift”, “forehead lift”, ”periorbital rejuvenation”, ”eyebrow ptosis”, ”blepharoplasty and eyebrow change”, ”surgical eyebrow lift”, and ”non-surgical eyebrow lift”, No date limitation was considered. Titles and abstracts were scanned to include the most pertinent articles. Subsequently, full texts of included articles (111 articles) were skimmed and finally 56 references were selected for the review. A narrative synthesis of data was finally undertaken with particular attention to the indications, techniques, and common complications of the eyebrow lift procedures. Ten popular techniques including two nonsurgical methods (Botulinum toxin A and soft tissue fillers) were reviewed in this article. In general, non-surgical methods of forehead/brow lift are temporary, need less experience and correction would be easier should any complication occur. Surgical methods are divided into three categories: trans-blepharoplasty eyebrow lift, direct eyebrow lift, and trans-forehead eyebrow/forehead lift. Currently, the most popular method is the endoscopic forehead lift approach even though its longevity is limited. Direct brow-lift is particularly useful in patients with facial palsy and those who are more likely to be accepting of the scar (male gender, high forehead hair line).

Purpose of review After failed conservative management, most clinicians treat congenital nasolacrimal duct obstruction (CNLDO) in a conventional stepwise fashion: starting with probing, then repeat probing, next silicone intubation and/or balloon dilatation, and finally dacryocystorhinostomy. This approach is based on the patient's age and previously failed procedures and recruits 'one procedure for all' CNLDO. A newly introduced approach is based on the type of obstruction and recruits 'all procedures for one' CNLDO. The aim of this review is to examine the best available evidence regarding CNLDO management. Recent findings Recent articles support the concept that through intraoperative evaluation of obstruction in CNLDO, clinicians may predict probing failure and instantaneously employ more appropriate treatment modalities. This review addresses whether an age-based approach should be changed into a one-stage obstruction-based approach. Summary An age-based approach treats CNLDO as a homogeneous disease and thus treats all patients with one predetermined procedure. A one-stage obstruction-based approach, however, considers CNLDO to be a heterogeneous disease, and therefore allows recruitment of all procedures simultaneously and selects the best intraoperatively. It may allow replacement of the conventional stepwise approach to CNLDO treatment provided that randomized trials verify its efficacy, safety, and cost-effectiveness.Video abstract http://links.lww.com/COOP/A30.

Background Aneurysm formation of internal carotid arteries (ICA) in patients with mucormycosis is a scarce phenomenon. However, the prevalence of rhino-cerebral mucormycosis has been reported to increase after the coronavirus disease 2019 (COVID-19) pandemic. Methods Three patients with stroke and subarachnoid hemorrhage due to ICA aneurysm after the involvement of adjacent paranasal sinuses with mucormycosis were presented. All patients were recruited from Namazi and Khalili hospitals affiliated with Shiraz University of Medical Sciences in Iran from April 2021 to May 2021. Results They had a history of diabetes and corticosteroid use. Also, one of them was treated with imatinib. Two out of three patients were infected with SARS-CoV-2 infection before developing mucormycosis. Two patients had diagnostic angiography before endovascular intervention. One patient did not undergo any therapeutic intervention due to total artery occlusion, whereas the other patient experienced a successful parent artery occlusion by coiling, and only this patient survived. Although all patients received antifungal treatment and surgical debridement, two of them died. Conclusions In the patients with rhino-cerebral mucormycosis evolving of aneurysm should be promptly and meticulously investigated by magnetic resonance angiography (MRA) and computed tomography angiography (CTA). As this type of aneurysms was very fast-growing, as soon as the involvement of sphenoid sinus was detected, the possibility of ICA aneurysm formation should always be kept in mind. If the patient developed an aneurysm, prompt intensive antifungal therapy and therapeutic endovascular interventions such as stenting, coiling, or sacrificing should be considered as soon as possible to optimize outcomes.

Purpose/Aim of the study: To evaluate if there is any relationship or coincidence between gastroesophageal reflux disease (GERD) and primary acquired nasolacrimal duct obstruction (PANDO).We enrolled 180 patients with PANDO, confirmed by positive regurgitation on sac squeezing or by irrigation test. In the control group, any patient with lacrimal drainage obstruction was excluded. For diagnosis of gastroesophageal reflux we used a (Gerd Q) questionnaire by R. Jones.According to Gerd Q, prevalence of gastroesophageal reflux in patients with PANDO was 20% (36 out of 180 patients) and in the control group, it was 10.6% (19 out of 180 patients), which was significantly higher in the presence of PANDO (p valve = 0.013). In women, 28 patients (23.5%) in the case group versus 13 patients (10.9%) in the control group has gastroesophageal reflux (p value = 0.01), which was not significant among men (p value = 0.870). When we considered age as an independent variable, results reveled significant value only for patients over 60 years old (p value = 0.008).The prevalence of gastroesophageal reflux disease was significantly higher in patients with PANDO. This statistical relationship was greater among women and patients over 60 years old. In this study, we found an association between GERD and PANDO.

Purpose: Pterygium is a pathologic process with angiogenic and tumor cell like characteristics. Chemokine and chemokine receptors may contribute to the formation and growth of pterygia. The aim of this study was to assess the expression of stromal cell derived factor (SDF)-1, as an angiogenic chemokine, and its receptors, CXCR4 and CXCR7, gene transcripts in pterygia. Methods: RNA was extracted from tissue samples of 33 patients with primary pterygium and 35 volunteers with conjunctiva as the control group. Then the mRNA expression of SDF-1, CXCR4, and CXCR7 was assessed through quantitative Real Time PCR method using appropriate primers. Results: SDF-1 and both receptors transcripts had significantly higher expression in pterygia samples compared to the control group (P

To report four patients with forehead pressure ulcer (PU) following encircling head dressing and review the literature.Uneventful endoscopic forehead lift procedure was performed with moderate skin elevation in three patients. Left upper eyelid crease incision was made to remove the sub-brow dermoid cyst uneventfully in one patient. All procedures were performed under general anesthesia. Mixed topical antibiotic and steroid ointments were placed on the incision sites before putting the encircling forehead dressing (using gauze and elastic bandage). The dressing was then removed on the first postoperative examination.Forehead and eyebrow PUs were observed on the first follow-up visit (16-72 h) after removing the dressing. Patients were otherwise healthy. They did not have significant pain or burning postoperatively. Management included pressure release, wound debridement, daily dressing, topical antibiotic and steroid, and silicone-based anti-scar cream. None had infected ulcer and all except one ended up with atrophic scar in the last follow-up (2-14 months). External pressure and shearing forces were assumed to be the main causative factors, even though reperfusion injury could contribute in the development of PU.Encircling head dressing can cause PU and result in scar formation in healthy immunocompetent patients. If there is a low risk of postoperative hematoma, encircling dressing should be avoided. Early loosening of the dressing and frequent examination of the skin are the best preventive and diagnostic measures. Treatment includes pressure removal, daily debridement, and topical medications.

Purpose To introduce a new (Supine) test and assess the values of lateral eyelid bulging for diagnosis of lacrimal gland (LG) prolapse before upper blepharoplasty. Methods In a prospective case series (2011-2017), lateral eyelid bulging and Supine Test were recorded, preoperatively. Lacrimal gland prolapse was graded as mild ( 7 mm). A few spots of cautery on LG capsule was performed in patients with bilateral mild and suture repositioning in unilateral or bilateral moderate and severe LG prolapse. Patients with asymmetric LG prolapse were treated based on more severe grade, bilaterally. Results Included were 1,207 patients. Frequency of positive Supine Test (11.8%, 142/1,207) increased from almost 10% in patients less than 41 years of age to 15% in more than 60 years of age. Their mean age was significantly older, and 53.2% showed asymmetric LG prolapse. Septum was just opened in patients with positive Supine Test, and all had LG prolapse of ≥3 mm (mean: 5.6 mm, range: 3-14 mm). Mild LG prolapse, moderate LG prolapse, and severe LG prolapse were observed in 22.5%, 62.6%, and 14.7% of the patients, respectively. Mean follow-up time was 22 months (12-60 months). Recurrence was observed in 1 patient (bilateral) after suture repositioning. Lateral eyelid bulging had a high negative (96.2%) and low positive (30.6%) predictive value when compared with the Supine Test. Conclusions Positive Supine Test means LG prolapse of ≥3 mm (100% positive predictive value). Negative lateral eyelid bulging was highly predictive of no LG prolapse.

Introduction Salivary gland tumours (SGTs) are important parts of human neoplasms. The most common SGT is the pleomorphic adenoma (PA); and the most common malignant SGTs are mucoepidermoid carcinoma (MEC) and adenoid cystic carcinoma(ADCC). T-helper-17 cells (Th17) are characterised with the ability to secrete cytokines including IL17A, IL17F, IL9, IL21, IL22, IL23, IL26 and TNF-α. Th17 cells play important role in inflammatory disease, infections, and cancers. This study aimed to investigate the role of Th17 in sera level of patients with SGTs. Material and methods The level of IL9,TNF-α, IL17A,IL17F, and IL21 were measured in the sera of 43 patients with malignant SGTs, 28 patients with benign SGTs, and 4 patients with inflammation in comparison with 25 healthy controls by using flow cytometry assays. The data were analysed by using Kruskal-Wallis and Mann-Whitney tests. Results and discussions The findings revealed the IL17A to have increased in SGTs compared with the healthy controls (p=0.009 and p=0.002, respectively). The serum level of IL17A increased significantly in MEC, ADCC and PA tumour types compare with the control group (p=0.001, p=0.050, p=0.002, respectively). There was no significant differen with other Th17 cytokines and groups with clinicopathological parameters. Conclusion The results showed that IL17A was significantly overexpressed in malignant and benign SGTs, suggesting that IL17A might be involved in carcinogenesis. It was concluded that IL17A could be a novel biomarker for distinguishing different malignant SGTs.

Introduction Interleukin-33 (IL-33) is a member of the IL-1 family of cytokines that has a dual-function which acts both as an extracellular alarming cytokine and an intracellular nuclear factor. Previous studies have shown that IL-33 play important role in induction of type-2 immune responses. In addition, this cytokine is intrinsically expressed in epithelial barrier tissues to maintain barrier function in normal conditions, and is released as a danger signal immediately after cellular damage or stress. Moreover, IL-33 helps tumour to evade from immune responses by promoting expansion and immunosuppressive effect of myeloid-derived suppressor cells. Material and methods 42 patients with malignant salivary gland tumours including mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (ADCC), acinic cell carcinoma, squamous cell carcinoma, malignant mixed tumour and 14 patients with pleomorphic adenoma (PA) as benign salivary gland tumour cases were enrolled in this study. Also, 28 healthy subjects were matched as the control group. Serum levels of IL-33 was measured by sandwich ELISA method. Results and discussions The mean concentrations of IL-33 in malignant, benign and healthy subjects were 6.73±2.97 pg/ml, 5.47±2.52 pg/ml and 5.26±5.89 pg/ml, respectively, which were significantly different (p=0.001). The serum levels of IL-33 were significantly increased in ADCC (8.07±4.59 pg/ml) and MEC (6.93±1.60 pg/ml) malignant salivary gland types compared with PA (5.47±2.52 pg/ml), (p=0.05 and p=0.009 respectively) and the control group (5.26±5.89 pg/ml) (p=0.003 and p=0.001 respectively). There were also positive and significant correlations between stage (p=0.005) and tumour size (p=0.024) of salivary gland tumour patients with IL-33 concentration. Conclusion According to our results, IL-33 could be suggested as a novel biomarker used to distinguish different types of salivary gland tumours.

To explore if the increased percentages of Regulatory T (Treg) cells, as well as, overexpression of Cytotoxic T-Lymphocyte Antigen-4 (CTLA-4) are involved in laryngeal-squamous cell carcinoma (SCC), 45 patients with laryngeal-SCC and 27 healthy controls were enrolled. Flow cytometry was performed to investigate, in the peripheral blood, the prevalence of CD4+CD25+FoxP3+ Treg cells, as well as, surface and intracellular expression of CTLA-4 by the main lymphocyte subsets (CD4+, CD8+ and CD19+). The results indicated intracellular (In)CTLA4 with considerable higher expression in the CD8+ lymphocytes among patients with laryngeal-SCC compared with the control group (8.2 ± 8.7 versus 2.3 ± 3.5, P = 0.001). The mean percentage of InCTLA4+CD4+ and InCTLA4+CD19+ lymphocytes was also significantly higher in patients (8.7 ± 7.8 versus 4.4 ± 4.2, P = 0.018 and 0.6 ± 0.8 versus 0.2 ± 0.2, P = 0.024, respectively). With respect to surface (Sur)CTLA4, the difference between patients and controls was, however, significant only in the case of CD8+ lymphocytes (0.7 ± 0.6 versus 0.3 ± 0.3, P = 0.003, respectively). The percentage of Treg cells was observed to be significantly higher in patients (7.5 ± 6.3 and 3.2 ± 1.9, P < 0.0001). Furthermore, association analysis revealed the association of Treg cell increase with the higher tumor-size and lymphnode stage (P < 0.005). These data collectively suggest that patients with laryngeal-SCC may benefit from immunotherapy targeting CTLA4 and Treg cells.

Objective:There is currently controversy over the association between serum interleukin-4 and -10 levels and head and neck squamous cell carcinoma in patients of different ethnicity. This study aimed to investigate serum levels of these cytokines in Iranian patients with this pathology, and to analyse correlations with tumour location and tumour stage at diagnosis.Design:Serum cytokines levels were quantified using commercial enzyme-linked immunosorbent assays.Subjects:Study groups comprised 93 untreated patients and 53 healthy donors.Results:Serum interleukin-4 levels were significantly increased in patients compared with controls (p Conclusion:Serum levels of interleukin-4, but not -10, were increased in Iranian head and neck squamous cell carcinoma patients. These data do not support an association of these cytokines with tumour progression; this is consistent with previous findings.

Background: The aim of this study was to investigate the association of head and neck squamous cell carcinoma (HNSCC) with serum levels of interleukin-7 (IL-7) and IL-8, the two cytokines whose associations with HNSCC need more clarifications. Materials and Methods: Commercial enzyme-linked immunosorbent assay kits were used for the quantification of the cytokines. Sera were collected from 48 untreated patients (36 men and 12 women; mean age: 52.7 ± 9.8 years) and 34 healthy donors (26 men and 8 women; mean age: 53.1 ± 9.0 years). Results: Serum IL-8 level was neither significantly different between HNSCC patients and control individuals nor associated with smoking status, gender, age, tumor location, tumor grade, and stage of the patients (P > 0.05). Regarding IL-7, all control individuals had serum levels below the sensitivity of the kit (3 pg/ml), but nine patients had detectable levels, and that the mean serum IL-7 was significantly higher in the patients compared to the controls (P = 0.008). Conclusions: Serum IL-8 level is not significantly associated with HNSCC. With the sensitivity of the kit we employed, it seems that serum IL-7 levels are specifically elevated in HNSCC patients compared to healthy individuals. Data from other independent studies are required to clarify the possible employment of IL-7 as an HNSCC biomarker.