The mesh has to be tailored in accordance with

The mesh has to be tailored in accordance with the size and shape of the defect; fortunately, the malleability of the titanium material facilitates restoration of symmetric orbital socket conformation in three dimensions. It is still necessary to move the mesh plate in and out repetitively from the orbital socket before an ideal contour has been reached. Although there is only one case report in the literature, the impingement of the orbital contents or infraorbital nerve did occur if the soft tissue was not held adequately. With this technique, a silicone guide becomes the barricade of orbital soft tissue, clarifying the boundary between the fracture site and orbital contents. Another silicone shell with identical size and shape is fabricated as a guide template. The titanium mesh can be fashioned according to this template, and then it will become much easier and safer to be repetitively drawn out for fine-tuning its contour and reinserted, because at this moment the orbital content was held and retracted adequately. The treatment of enophthalmos consists of restoration of the original bony anatomy and return of orbital soft-tissue volume. The high incidence of residual enophthalmos following orbital wall reconstruction has been observed. The details of this procedure were described in our previous study.
Introduction Cystic hygroma (CH), also known as cystic lymphangioma, is a benign congenital malformation of the ginsenoside rh2 occurring as a result of the incomplete development of lymphatic vessels. CH mainly develops during childhood and accounts for 6% of all pediatric soft tissue tumors. The five main locations are the cervical, axillary, inguinal, retroperitoneal, and thoracic regions. The shoulder, breast, mediastinum, abdominal cavity, and pelvis have also been reported to harbor this kind of tumor. As is well known, CH rarely occurs in adults. Only three adult case reports discussing the axillary CH have appeared in the English literature on PubMed. This article reports such a rare case of our own, and reviews the literature to discuss the clinical presentation, diagnosis, and treatment of CH.
Case report A 36-year-old male, who had been in an apparently healthy condition, noted a palpable mass in the right axillary area for 1 month. The lesion was a soft, movable, nontender mass with smooth skin surface, located in the right axillary fossa. The mass kept growing slowly, and extended to the lateral chest wall. There were no other palpable axillary masses grossly. The patient denied any history of trauma to the affected area as well as any recent infections. The magnetic resonance imaging (MRI) showed a cystic lesion measuring 7.5 cm × 7.5 cm with mild capsular enhancement in the right axilla. No abnormal signal intensity change in the adjacent muscle intensity was found. The visible bony marrow also showed no unusual signal intensity. (Fig. 1). Tumor excision was performed under general anesthesia, and the wound was primarily closed with a residual Jackson–Pratt drain. The patient was discharged smoothly 2 days after operation. The tumor grossly appeared grayish and elastic, and the pathological diagnosis was a CH. Under microscopy, the specimen was composed of thin-walled lymphatic spaces lined by flat epithelium with a collagenous background and accompanying lymphocytic infiltrates in the surrounding fibroadiposal stroma (Fig. 2). One regional lymph node with reactive hyperplasia was also present. There was no sign of recurrence during the 6 months of regular clinic follow-up.
Discussion CH is a benign tumor of the lymphatic system. These lesions are usually found in infants prior to the age of 1 year, and about 90% of the lesions occur in children younger than 2 years. CH, which is considered a congenital lymphatic malformation, accounts for 6% of all pediatric soft tissue tumors. The most common sites of occurrence are the posterior triangle of the neck (75%), axilla (20%), and mediastinum. It is rarely found in the groin, retroperitoneal space and pelvis. The lesions usually present as solitary mass lesions with fluctuant, compressible, movable, and painless characteristics.