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Objective This study aims to evaluate the combination of genioglossus (GG) activity and anatomical characteristics in predicting outcomes of velopharyngeal surgery in patients with obstructive sleep apnea (OSA). Study Design Case series with planned data collection. Setting Sleep medical center. Subjects and Methods Forty patients with OSA underwent overnight polysomnography with synchronous genioglossus electromyography (GGEMG) using intraoral electrodes. The upper airway anatomy was evaluated by 3-dimensional computed tomography in patients with OSA. All patients received the same type of velopharyngeal surgery, consisting of revised uvulopalatopharyngoplasty with uvula preservation and concurrent transpalatal advancement pharyngoplasty. We followed up all patients using polysomnography for at least 3 months postoperatively. Results Twenty-five patients (62.50%) were responders, and 15 patients (37.50%) were nonresponders. The decreased apnea-hypopnea index was significantly positively correlated to the sleep onset GGEMG ( P = .006) but was negatively correlated to the change in GGEMG ( P = .013) and tonic GGEMG ( P = .018). Multiple regression analysis revealed that the minimal cross-sectional airway area at the velopharynx (VmCSA) (odds ratio [OR], 1.760; P = .019) and the sleep onset GGEMG (OR, 0.322; P = .043) were significant predictors for surgical outcomes. Combined the two predictors, the area under the ROC curve was 0.901 (OR, 0.789; P = .001) for surgical success, was more valuable than any one predictor. The area under the ROC curve with GGEMG was 0.843, VmCSA was 0.848. Conclusions The combination of sleep onset GGEMG and VmCSA can predict the outcome of velopharyngeal surgery in patients with OSA.

Background: Assessment of the growth of bony orbit in children with blind microphthalmia is essential to its management. In this study, variables were measured to evaluate the development of the bony microphthalmic orbits after treatment with self-inflating hydrogel expanders., Methods: This is a retrospective study with an interventional case series. Thirteen pediatric patients with congenital unilateral blind microphthalmia who had undergone tissue expansion with hydrogel expanders and computed tomography (CT) scanning before and after operation were included in the study. The orbital volume, depth, width, and height and retardation of the orbital rims before and after treatment were measured and analyzed using the iPlan Cranial Software., Results: The mean age at the time of first implantation was 44 months (range, 3-113 months). Of the 13 patients, eleven received orbital expansion, while two received socket expansion. In the orbital expansion group, the mean microphthalmic/contralateral ratio (MCR) of orbital volume was 79.3% before surgery, which increased to 89.8% 3 years post operation (P < 0.001). The mean MCR of orbital width also increased from 88.8% to 91.8% (P = 0.003). The development of inferior and lateral rims showed the greatest retardation before treatment; the retardation of these two rims decreased significantly at the final measurement (P = 0.004). It is also noted that the development of the microphthalmic orbits was limited in the two patients who only underwent socket expansion., Conclusions: The affected orbit enlarged in children with congenital blind microphthalmia following treatment with hydrogel expanders; this suggested that microphthalmia-associated orbital asymmetry can be treated with self-inflating hydrogel expanders., (Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: Brown syndrome is characterized by limitation of elevation in adduction, with complex mechanisms involving muscle, tendon, and trochlea. Here, we investigated mechanisms of Brown syndrome by magnetic resonance (MR) imaging., Methods: It was a retrospective case series study. Fourteen patients with unilateral Brown syndrome between 3 and 54 years of age (10 cases of congenital and 4 cases with acquired disease) were included in the study. All patients underwent complete ophthalmic and orthoptic evaluation. Imaging of the ocular motor nerves at the brainstem was performed on 3D-FIESTA sequence, the orbits were imaged with FSE T1, T2WI using surface coils., Results: Nine of 10 with congenital Brown syndrome demonstrated hypoplasia of the superior oblique (SO) of the affected side. Abnormal low signal intensity in the trochlea area was found in one patient. Three of 4 acquired patients had a history of trauma and were demonstrated fracture of the trochlea, extensive scarring, and superior orbital fracture. One acquired case was demonstrated scarring of anterior part of the SO and hypoplasia of the posterior part., Conclusion: Brown syndrome consists of a series of diseases. Their clinical features are quite similar while their anatomical mechanism varies in numerous ways. Therefore, based on patient's individual pathophysiology, the management in Brown syndrome should be personalized.

Objective: To explore the distribution and magnetic resonance imaging or computed tomography (MRI/CT) of lymphoma in orbit., Methods: Retrospective analyses were conducted for 73 cases with ocular complaints at Beijing Tong'ren Hospital from June 2006 to September 2012. They were confirmed pathologically as lymphoma with complete MRI/CT records., Results: Ocular adnexal lymphoma occurred predominantly in adults. There were 47 males and 26 females with a median age of (60 ± 12.0) years. The lesions were bilateral (n = 24), right side (n = 23) and left side (n = 26) respectively. The pathological types included mucosa-associated lymphoid tissue (MALT) lymphoma (n = 59), diffuse large B-cell lymphoma (DLBCL, n = 7), mantle cell lymphoma (MCL, n = 3), lymphoplasmacytic lymphoma (LPL, n = 2) and follicular lymphoma and natural killer/T-cell lymphoma (FL and NKT, n = 1) respectively. They had well-defined margins in 64 sides, less well-defined margins in 17 sides and ill-defined margins in 16 sides. And 29 sides of lesions presented as a regional mass within conjunctiva in 16/97 sides (16.5%), lacrimal gland in 5/97 sides (5.2%), eyelids in 3/97 sides (3.1%), ocular muscle in 2/97 sides (2.1%) and lacrimal sac in 3/97 sides (3.1%). Moreover, 68 sides of lesion were diffusely distributed. The invaded sites included preseptal region in 38/97 sides (39.2%), extraconal compartment in 69/97 sides (71.1%), intraconal compartment in 54/97 sides (55.7%), eyeball region in 45/97 sides (46.4%), subperiosteum in 14/97 sides (14.4%), cone compartment in 73/97 sides (75.3%), lacrimal gland in 38/97 sides (39.2%) and sheath of optic nerve in 33/97 sides (34.0%). And, on MRI scan, 70 cases (94 sides) had isointensity in 88/94 sides, hypointensity in 6/94 sides on T1WI and isointensity in 52/94 sides, mild hypointensity in 40/94 sides or mixed signal in 2/94 sides on T2WI. In addition, the signals were homogeneous in 67/94 sides and heterogeneous in 27/94 sides. After contrasting, these lesions showed mild contrast-enhancement (CE) in 27/94 sides, moderate CE in 67/94 sides with homogeneous CE in 52/94 sides and heterogeneous CE in 42/94 sides. On CT scan, 21 cases (24 sides) had isodensity in 18/24 sides and mild hyperdensity in 6/24 sides with homogeneous in 7/24 sides and heterogeneous in 17/24 sides. Moreover, most adjacent bone show no change (16/24 sides). Only 16/24 sides and 2/24 sides showed reformation or destruction respectively. At the same time, the lesions also involved other para-orbit structures, such as orbital apex (27/97 sides, 27.8%), fissure orbitalis inferior (14/97 sides, 14.4%), fossa pterygopalatina (10/97 sides, 10.3%), supraorbital nerve (8/97 sides, 8.2%), cavernous sinus (8/97 sides, 8.2%) and facial soft tissue (6/97 sides, 6.2%), et al., Conclusion: Ocular adnexal lymphoma occurs predominantly in male adults. And multiple strictures and sites are often involved. There is iso-/mild hyperintensity with mild-to-moderate homo-/heterogeneous CE and little change of adjacent bone on T1WI and T2WI.

Purpose: To analyze the altered amplitude of low-frequency fluctuation (ALFF) of the brain using resting-state functional magnetic resonance imaging (fMRI) in patients with primary open-angle glaucoma (POAG)., Methods: Resting-state fMRI was conducted in 21 POAG patients and 22 age-matched healthy control subjects. After the ALFF and fractional amplitude of low-frequency fluctuation (fALFF) for slow 4 and slow 5 bands were calculated, the results between POAG patients and healthy controls were compared. Then the correlations between ALFF/fALFF values and the disease stage of POAG were analyzed., Results: Compared with controls, POAG patients showed significantly decreased ALFF/fALFF values in the visual cortices, posterior regions of the default-mode network (DMN), and motor and sensory cortices. Meanwhile, ALFF/fALFF values in the prefrontal cortex, left superior temporal gyrus (STG), right middle cingulate cortex (MCC), and left inferior parietal lobule (IPL) significantly increased in POAG patients. Hodapp-Anderson-Parrish (HAP) score for POAG was positively correlated with ALFF values of the right superior frontal gyrus (SFG) and negatively correlated with that of the left cuneus. For the slow 5 band, the fALFF values of the bilateral middle temporal gyri (MTG) of POAG patients were negatively correlated with HAP score., Conclusions: Primary open-angle glaucoma is a neurodegenerative disease involving multiple brain regions, including the visual cortices, DMN, limbic system, and motor and sensory networks. Moreover, the alterations in some of these networks are correlated with the progression of POAG; for the abnormal spontaneous neural activities in the left cuneus, bilateral MTG and right prefrontal cortex are correlated with glaucoma severity., (Copyright 2015 The Association for Research in Vision and Ophthalmology, Inc.)

Objective: To evaluate the computed tomograph (CT) findings of IgG4-related disease (RD) involving soft tissue adjacent to thoracic vertebrae., Methods: The chest and abdomen CT findings of 22 cases of IgG4-RD proved by orbital pathology and/or laboratory examination were retrospectively reviewed. The CT findings of paravertebral soft tissue in posterior mediastinum and the corresponding follow-up after therapy were primarily observed., Results: Among them, there were 8 males and 2 females with an average age of 57.6 (42-70) years. CT showed diffuse thickening of soft tissue in thoracic paravertebral space forming a crescent-shaped mass encasing bilateral thoracic vertebrae without abnormal bone change. There was consistent inhomogeneous density of paravertebral adipose tissue adjacent to paravertebral mass lesion with multiple dilated vessels joining azygos vein or vena hemiazygos finally. Other abnormalities were as follows: multiple lymphadenopathy of neck, mediastinum and/or retroperitoneal space (n = 10), interstitial pneumonitis (n = 4), diffuse pancreatic thickening (n = 2) and slightly hypodense soft tissue shadow with a hazy border of retroperitoneal space (n = 8). On follow-up CTs, there was marked relief after regular therapy in 4 cases., Conclusion: The thoracic paravertebrae space is commonly involved by IgG4-RD. And it occurs frequently in senile males. The characteristic CT feature is diffuse thickening of soft tissue with multiple prominent bands in adjacent thoracic paravertebral space.

Objective: To evaluate the CT the characteristics of dehiscent sigmoid plate accompanied with pulsatile tinnitus (PT)., Methods: Dual phase contrast enhancement CT data of 15 PT patients were analyzed retrospectively., Results: Dehiscent sigmoid plate was located on the same side of PT in all patients. Thirteen defects had been showed in both CT images and surgery. Among of them, eight defects located on the descending segment, 3 on the superior curve, and the other 2 defects involved the superior curve and descending segment of sigmoid sinus simultaneously. The maximum anteroposterior and vertical diameters of defect measured in CT images were significant larger than that measured during surgery. There were still 5 defects showed in CT images, which did not been found during surgery. Among 9 patients with unilateral dominant brain venous systems, all the dehiscent sigmoid plates were seen on the dominant side. The other 2 patients showed co-dominant brain venous systems, whose the dehiscent sigmoid plates were on the left side. In addition, extensive pneumatized temporal bone filled with air was found in all patients., Conclusion: Dehiscent sigmoid plate commonly located on the anterior, lateral, or anterolateral wall of the superior curve or descending segment of the sigmoid plate, which usually coexist with the strong unilateral dominant brain venous system and extensive temporal bone pneumatization.

Objective: To describe the HRCT appearances of congenital inner ear malformations with cerebrospinal fluid leakage., Method: Conducted a retrospective case review. The subjects comprised 11 patients who were decisively confirmed by HRCT and exploratory tympanotomy. The result of temporal bone computed tomography scans (HRCT) were analyzed., Result: Inner ear malformations were classified into 4 types according to HRCT findings. There were 4 patients with cochlear aplasia, 2 patients with common cavity anomaly, 2 patients with IP-I anomaly, and 3 patients with IP- II anomaly. Eight patients had defects in the lamina cribrosa of the internal auditory canal. The development and aeration in the mastoid of involved ears was normal. Soft tissues were seen near the oval window in all involved ears., Conclusion: HRCT image has an important value in the diagnosis and treatment of inner ear malformations with cerebrospinal fluid leakage.