Use of ultrasonic dissection in the early surgical management of periorbital haemangiomas.
OBJECTIVE
To evaluate the efficacy and safety of the early surgical excision of periorbital haemangiomas with an ultrasonic scalpel in infants at risk of visual impairment.


METHODS
A retrospective analysis of 67 infants diagnosed to be at risk of amblyopia from periorbital haemangiomas, treated consecutively with the Dissectron between 1994 and 2005. Ophthalmic outcome parameters included the pre- and postoperative measurement of visual axis occlusion, strabismus, astigmatism, and degree of amblyopia.


RESULTS
Visual performance showed an overall improvement of 30% following treatment. Seventy-six patients were found to have abnormal ophthalmic examinations preoperatively, compared to 46 following surgery. After surgery, visual axis occlusion decreased from 73 to 6%; amblyopia decreased from 67 to 22%, strabismus decreased from 26 to 18% and astigmatism (>onedioptre) decreased from 66 to 31%. Mean astigmatism values decreased from 3.5 to 1.9 dioptres. No new cases of astigmatism, strabismus or amblyopia were diagnosed postoperatively. Three minor complications resolved with conservative treatment. All patients were satisfied with the outcome of their surgery.


CONCLUSIONS
Early surgical excision of periorbital haemangiomas using the Dissectron in infants with an established risk of visual impairment is a safe and effective alternative to pharmacological therapy. The use of the Dissectron is associated with reduced operative times and a shorter hospital stay.
Department of Plastic and Maxillofacial Surgery, Children Hospital Armand-Trousseau, Paris 6 University, INSERM U714, Paris, France. olivier_claude@hotmail.com
O
O
Claude
A
A
Picard
N
N
O'Sullivan
S
S
Baccache
M
M
Momtchilova
O
O
Enjolras
M P
MP
Vazquez
P A
PA
Diner
D000550:Amblyopia / Q000209:etiology; D001251:Astigmatism / Q000209:etiology; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000150:complications / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D009918:Orbital Neoplasms / Q000150:complications / Q000628:therapy*; D017060:Patient Satisfaction; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D013285:Strabismus / Q000209:etiology; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000379:methods*