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1.
Arq. bras. oftalmol ; 86(1): 68-70, Jan.-Feb. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1403470

ABSTRACT

ABSTRACT This case report describes the clinical characteristics and ophthalmic management of a patient who developed corneal perforation due to severe enophthalmos consistent with "silent brain syndrome." A 27-year-old man with a history of congenital hydrocephalus and ventriculoperitoneal shunt was referred with complaints of "sinking of the eyeballs" and progressively decreasing vision in the left eye. Examination revealed severe bilateral enophthalmos in addition to superonasal corneal perforation with iris prolapse in the left eye. The patient underwent therapeutic keratoplasty the next day. Orbital reconstruction with costochondral graft and shunt revision of the intracranial hypotension were performed the next month to prevent further progression.


RESUMO Este relato de caso descreve as características clínicas e o manejo cirúrgico de um paciente que teve perfuração da córnea devido à enoftalmia grave consistente com a "síndrome do cérebro silencioso". Um homem de 27 anos com história de hidrocefalia congênita e derivação ventrículo-peritoneal foi encaminhado com queixas de "afundamento dos globos oculares" e diminuição progressiva da visão no olho esquerdo. O exame revelou enoftalmo bilateral importante, além de perfuração superonasal da córnea com prolapso iriano no olho esquerdo. A paciente foi submetida à ceratoplastia terapêutica no dia seguinte. Foi realizado no mês seguinte a reconstrução da órbita com enxerto costocondral e revisão do shunt para evitar progressão e piora do caso.

2.
Rev. cir. traumatol. buco-maxilo-fac ; 22(3): 46-50, jul.-set. 2022. ilus
Article in English | LILACS, BBO | ID: biblio-1400137

ABSTRACT

Objetivo: As fraturas do complexo zigomático-maxilar (CZM) constituem as principais fraturas do terço médio da face. O diagnóstico é complexo, por envolver uma área alternente sensorial e nobre da face. Portanto o tratamento não visa apenas devolver os contornos ósseos, mas também preservar as funções oculares. No presente caso paciente apresentou severo trauma facial associado a TCE com afundamento do frontal e teto de órbita. Relato de caso: Paciente do sexo masculino, 33 anos, vítima de queda da própria altura. No exame físico notou-se FCC extenso em região frontal, se estendendo para a região supra-orbital esquerda, blefaroedema periorbital esquerdo, com oclusão palpebral e distopia ocular. Escoriações em face e afundamento em região fronto parietal esquerda e perda de consciência. O diagnóstico apontou para fratura do complexo zigomático-maxilar associada a afundamento do osso frontal. Paciente submetido à osteossíntese das fraturas com por meio da ferida e complementado com acesso subciliar e caldwel luc. Foi alcançada boa reabilitação estética e funcional. Conclusão: Portanto, a redução aberta com fixação funcional estável com placas e parafusos segue sendo o padrão ouro para o tratamento de fraturas complexas do CZM. Sendo imperativo uma adequada redução e o reestabelecimento do continente orbitário... (AU)


Objective: Fractures of the zygomatic-maxillary complex are the main fractures of the middle third of the face. The diagnosis is complex, as it involves an alternating sensory and noble area of the face. Therefore, the treatment is not only aimed at restoring bone contours but also preserving ocular functions. In the present case, the patient presented severe facial trauma associated with TBI with frontal and orbital sinking. Case Report: Male patient, 33 years old, victim of a fall from standing height. Physical examination revealed extensive CCF in the frontal region, extending to the left supraorbital region, left periorbital blepharoedema, with eyelid occlusion and ocular dystopia. Excoriations on the face and sinking in the left fronto-parietal region and loss of consciousness. The diagnosis pointed to fracture of the zygomatic-maxillary complex associated with frontal bone sinking. Patient undergoing osteosynthesis of fractures through the wound and complemented with subciliary access and caldwell luc. Good aesthetic and functional rehabilitation were achieved. Conclusion: Therefore, open reduction with stable functional fixation with plates and screws remains the gold standard for the treatment of complex ZMC fractures. An adequate reduction and reestablishment of the orbiting continent is imperative... (AU)


Objetivo: Las fracturas del complejo cigomático maxilar son las principales fracturas del tercio medio de la cara. El diagnóstico es complejo, ya que involucra una zona sensorial y noble alternada de la cara. Por lo tanto, el tratamiento no solo está dirigido a restaurar los contornos óseos sino también a preservar las funciones oculares. En el presente caso, el paciente presentó trauma facial severo asociado a TCE con hundimiento frontal y orbitario. Caso Clínico: Paciente masculino, 33 años, víctima de caída desde altura de pie. A la exploración física destacaba FCC extensa en región frontal, con extensión a región supraorbitaria izquierda, blefaroedema periorbitario izquierdo, con oclusión palpebral y distopía ocular. Excoriaciones en la cara y hundimiento en la región fronto-parietal izquierda y pérdida del conocimiento. El diagnóstico apuntó a fractura del complejo cigomático-maxilar asociada a hundimiento del hueso frontal. Paciente con osteosíntesis de fractura a través de herida y complemento acceso subciliar y calwell luc. Se logró una buena rehabilitación estética y funcional. Conclusión: Por lo tanto, la reducción abierta con fijación funcional estable con placas y tornillos sigue siendo el estándar de oro para el tratamiento de fracturas CCM complejas. Es imperativo una adecuada reducción y restablecimiento del continente en órbita... (AU)


Subject(s)
Humans , Male , Adult , Zygomatic Fractures , Open Fracture Reduction , Fracture Fixation, Internal , Mandible/surgery , Maxilla/injuries , Accidents, Home , Maxillofacial Injuries
3.
Rev. cir. traumatol. buco-maxilo-fac ; 22(1): 26-29, jan.-mar. 2022. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1391750

ABSTRACT

Objetivos: O carcinoma adenoide cístico é uma lesão rara e agressiva. O presente trabalho visa relatar o caso de uma ressecção de carcinoma adenoide cístico e manutenção do arcabouço ósseo realizado por meio de sonda de Foley insuflada com soro fisiológico. Relato do caso: Um paciente submetido a ressecação de um carcinoma adenoide cístico em maxilla com destruição de soalho de órbita foi relatado. O caso foi realizado no Hospital Josina Machel em Luanda, Angola. A região apresenta uma considerável escassez de materiais de fixação e outros mais, o que impossibilita reconstruções maxilofaciais com a excelência necessária. A realização de enxertos microvascularizados ou implantes customizados torna-se inviável devido aos custos e tecnologia dispendida para tal. Conclusão: A sonda de Foley mostra-se como uma alternativa viável nos casos de reconstrução de terço médio de face com envolvimento de seio maxilar e soalho de órbita em locais de mais difícil acesso... (AU)


Objectives: Adenoid cystic carcinoma is a rare and aggressive lesion. The present work aims to report the case of a resection of adenoid cystic carcinoma and maintenance of the bone framework performed using a Foley catheter insufflated with saline solution. Case report: A patient who underwent resection of an adenoid cystic carcinoma in the maxilla with destruction of the orbital floor was reported. The case was carried out at Hospital Josina Machel in Luanda, Angola. The region has a considerable shortage of fixation materials and others, which makes maxillofacial reconstructions with the necessary excellence impossible. The realization of microvascularized grafts or customized implants becomes unfeasible due to the costs and technology used for this purpose. Conclusion: The Foley catheter is a viable alternative in cases of reconstruction of the middle third of the face with involvement of the maxillary sinus and orbital floor in areas that are more difficult to access... (AU)


Objetivos: El carcinoma adenoide quístico es una lesión rara y agresiva. El presente trabajo tiene como objetivo reportar el caso de una resección de carcinoma quístico adenoide y mantenimiento de la estructura ósea realizada mediante sonda de Foley insuflada con suero fisiológico. Caso clínico: Se reporta un paciente que fue sometido a resección de un carcinoma adenoide quístico en el maxilar con destrucción del piso orbitario. El caso se llevó a cabo en el Hospital Josina Machel de Luanda, Angola. La región tiene una escasez considerable de materiales de fijación y otros, lo que imposibilita las reconstrucciones maxilofaciales con la excelencia necesaria. La realización de injertos microvascularizados o implantes personalizados se vuelve inviable por los costes y la tecnología utilizada para tal fin. Conclusión: La sonda de Foley es una alternativa viable en los casos de reconstrucción del tercio medio de la cara con afectación del seno maxilar y suelo orbitario en zonas de más difícil acceso... (AU)


Subject(s)
Humans , Female , Middle Aged , Orbit/surgery , Orbit/pathology , Maxillary Sinus Neoplasms , Jaw Neoplasms , Carcinoma, Adenoid Cystic , Maxillary Sinus , Wounds and Injuries
4.
Rev. bras. oftalmol ; 81: e0042, 2022. graf
Article in English | LILACS | ID: biblio-1387970

ABSTRACT

ABSTRACT Introduction: The use of tridimensional (3D) printing in healthcare has contributed to the development of instruments and implants. The 3D printing has also been used for teaching future professionals. In order to have a good 3D printed piece, it is necessary to have high quality images, such as the ones from Computerized Tomography (CT scan) exam, which shows the anatomy from different cuts and allows for a good image reconstruction. Purpose: To propose a protocol for creating digital files from computerized tomography images to be printed in 3D and used as didactic material in the ophthalmology field, using open-source software, InVesalius®, Blender® and Repetier-Host©. Methods: Two orbit CT scan exam images in the DICOM format were used to create the virtual file to be printed in 3D. To edit the images, the software InVesalius® (Version 3.1.1) was used to delimit and clean the structure of interest, and also to convert to STL format. The software Blender® (Version 2.80) was used to refine the image. The STL image was then sent to the Repetier-Host© (Version 2.1.3) software, which splits the image in layers and generates the instructions to print the piece in the 3D printer using the polymer polylactic acid (PLA). Results: The printed anatomical pieces printed reproduced most structures, both bone and soft structures, satisfactorily. However, there were some problems during printing, such as the loss of small bone structures, that are naturally surrounded by muscles due to the lack of support. Conclusion: Despite the difficulties faced during the production of the pieces, it was also possible to reproduce the anatomical structures adequately, which indicates that this protocol of 3D printing from medical images is viable.


RESUMO Introdução: O uso de impressão em 3-D na área da saúde tem contribuído para o desenvolvimento de instrumentos e próteses. A impressão 3-D tem sido usada para o ensino de futuros profissionais. Para se alcançar uma boa peça em 3-D, é necessário ter imagens de alta qualidade, como aquelas geradas pelo exame de Tomografia Computadorizada (TC), que mostra a anatomia sob diferentes cortes e permite uma boa reconstrução de imagem. Objetivo: Propor um protocolo para a criação de arquivos digitais a partir de imagens de tomografia computadorizada a serem impressas em 3-D e usadas como modelo de material didático oftalmológico usando software de código aberto, InVesalius®, Bender® e Repetier-Host©. Métodos: Foram utilizadas imagens em formato DICOM provenientes de dois exames de tomografia computadorizada de órbitas para a impressão tridimensional. Para manuseio das imagens, foram utilizados o InVesalius®, versão 3.1.1, para delimitar e limpar a estrutura de interesse e também para converter em formato STL. O Blender®, versão 2.80 foi usado para refinamento. A imagem em STL foi então enviada para o programa Repetier-Host, versão 2.1.3, que divide a imagem em camadas e gera as instruções para impressão da peça em ácido polilático na impressora tridimensional. Resultados: As peças anatômicas impressas reproduziram de forma satisfatória a maioria das estruturas ósseas e musculares. No entanto, houve dificuldade durante a impressão das estruturas ósseas menores, como perda de estrutura óssea pequena, que não possuíam sustentação, por serem envoltas pelo músculo. Conclusão: Apesar das dificuldades encontradas na produção dessas peças de estudo, foi possível reproduzir estruturas com fidelidade, indicando que o protocolo proposto viabiliza a impressão de imagens oriundas da tomografia computadorizada para impressão tridimensional.


Subject(s)
Humans , Ophthalmology/education , Orbit/anatomy & histology , Orbit/diagnostic imaging , Tomography, X-Ray Computed/methods , Imaging, Three-Dimensional/instrumentation , Printing, Three-Dimensional/instrumentation , Students, Medical , Teaching , Software , Education, Medical/methods , Anatomy/education , Models, Anatomic
5.
Autops. Case Rep ; 12: e2021345, 2022. tab, graf
Article in English | LILACS | ID: biblio-1355723

ABSTRACT

Mucormycosis is a rare, sometimes severe fungal infection that has emerged as a possible complication of COVID-19. We report a case of a non-diabetic, apparently immunocompetent patient diagnosed with rhino-orbital-cerebral mucormycosis shortly after COVID-19 treatment with dexamethasone. The patient received optimized systemic antifungal therapy and extensive surgical treatment. So far, four months after the last hospital discharge, the patient has been in good general condition. This case is a dramatic reminder that beneficial corticosteroid therapy in general inevitably carries a risk of opportunistic infection, and corticosteroid therapy for COVID-19 risks orbital-rhinocerebral mucormycosis that clinicians should watch for with vigilance.


Subject(s)
Humans , Female , Adult , Orbit/pathology , Adrenal Cortex Hormones/therapeutic use , SARS-CoV-2 , Mucormycosis/complications , Opportunistic Infections , Immunocompetence
6.
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 173-178, Dec. 2021.
Article in Spanish | LILACS | ID: biblio-1352991

ABSTRACT

El colgajo de fascia temporal superficial es muy versátil para la reconstrucción de defectos tisulares localizados en los tercios superior y medio de la cara, en la región orbito-palpebral, en la cavidad oral, en la base del cráneo y a nivel mandibular. En nuestra experiencia, constituye una opción segura para reconstrucciones complejas de cavidades. En el presente artículo los autores exponen el caso de una paciente en quien se reconstruyó un defecto de órbita con un colgajo de fascia temporal superficial prelaminado


The superficial temporal fascia flap is versatile for the reconstruction of tissue defects located in the upper and middle thirds of the face, in the orbital-palpebral region, in the oral cavity, at the base of the skull and at the mandibular level. In our experience, it is a safe option for complex cavity reconstructions. In this article the authors present the case of a patient in whom an orbit defect was reconstructed with a pre-laminated superficial temporal fascia flap


Subject(s)
Transplants , Orbit , Fascia
7.
Arq. bras. oftalmol ; 84(3): 209-213, May-June 2021. graf
Article in English | LILACS | ID: biblio-1248967

ABSTRACT

ABSTRACT Purpose: To identify the lymphatic vessels in orbital specimens from human cadavers using light microscopy and immunohistochemical analysis. Methods: A postmortem study included 10 orbital specimens from 10 human cadavers. The orbital specimens were obtained no later than 12 hours after death. The orbital specimens were dissected into lacrimal gland, optic nerve, fat tissue, and oculomotor muscles. The histologic criteria to qualify as a lymphatic vessel were thin-walled channels of endothelium without a well-developed basal membrane and with an erythrocyte-free, irregular lumen. The immunohistochemical criteria were irregularly shaped, thin-walled vessels with an erythrocyte-free, irregular lumen and immunopositivity for podoplanin D2-40. Results: The lacrimal gland, optic nerve, fat tissue, and extraocular muscle sections were positively stained with podoplanin D2-40. Conclusions: This study demonstrated lymphatic vessels in the human orbit, more precisely, in the lacrimal gland, dura mater of the optic nerve, adipose tissue, and extrinsic oculomotor muscles via light microscopy and immunohistochemistry.(AU)


RESUMO Objetivos: Identificar vasos linfáticos em espécimes orbitários de cadáveres humanos através de microscopia óptica e análise imunohistoquímica. Métodos: Um estudo postmortem incluiu dez espécimes orbitários provenientes de dez cadáveres humanos. Todos os espécimes orbitários foram obtidos até 12 horas após a morte com uma técnica cirúrgica de exenteração orbitária e dissecados em glândula lacrimal, nervo óptico, gordura órbitária e músculos extraoculares. Para classificar como um vaso linfático, os critérios histológicos incluíram vasos endoteliais de parede única sem membrana basal bem desenvolvida, irregulares e lúmen sem hemácias, e os critérios imunohistoquímicos incluíram vasos endoteliais de parede única, com formato irregular e lúmen sem hemácias e reagentes a podoplanina D2-40. Resultados: As lâminas histológicas de glândula lacrimal, nervo óptico, tecido adiposo e músculos extraoculares reagiram positivamente a podoplanina D2-40. Conclusão: Este estudo demonstrou vasos linfáticos na órbita humana, mais exatamente, na glândula lacrimal, no nervo óptico, na gordura orbitária e nos músculos extrínsecos extraoculares via microscopia óptica e imunohistoquímica.(AU)


Subject(s)
Optic Nerve/anatomy & histology , Orbit/anatomy & histology , Lymphatic Vessels/diagnostic imaging , Immunohistochemistry , Lacrimal Apparatus/anatomy & histology , Microscopy/instrumentation , Oculomotor Muscles/anatomy & histology
8.
Int. arch. otorhinolaryngol. (Impr.) ; 25(2): 267-272, Apr.-June 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1286736

ABSTRACT

Abstract Introduction Ear, nose and throat (ENT)pathologies can present with proptosis as the early manifestation. The majority of ENT pathologies present with ocular manifestations, due to close anatomical relationship. Objective To study proptosis in ENT disorders in terms of etiology, pathogenesis, and management. Methods The present article is a prospective study conducted at a tertiary care center, in Telangana, India. Patients presenting with proptosis secondary to ENT disorders were thoroughly evaluated and subjected to surgical exploration after providing a signed informed consent. Results Sixty cases of proptosis secondary to ENT disorders have been reported. The most common cause was sinonasal squamous cell carcinoma followed by juvenile nasopharyngeal angiofibroma and allergic fungal rhinosinusitis. Conclusion Many ENT disorders can present with proptosis. Proptosis needs to be evaluated completely for proper management and to limit the morbidity associated with it.

9.
Article in Chinese | WPRIM | ID: wpr-934464

ABSTRACT

Objective:To address a new classification method in term of the three-dimensional space of orbit and to present the different surgical approaches correspondingly.Methods:In a retrospect study from April of 2015 to June of 2018, 102 patients were performed lower eyelid blepharoplasty, including 20 males and 82 females, aged 21-65 years, with an average of 45.2 years. These patients were divided into five groups, which were described in term of three-dimensional structure of orbit, based on the following points: the presence and extent of herniated orbital fat, the presence of inferior orbitopalpebral sulcus, amount of excess skin, and the skin wrinkles in the lower eyelid. And then patients in different group were treated with different kinds of blepharoplasty. All patients in this study ranged in follow-up from 1 month to 12 months. With patients' permit, photographs and clinical information were taken to evaluate the preoperative and postoperative outcome.Results:In type 1, all the 32 cases healed well, no complications such as hematoma, infection and ectropion occurred. During the follow-up of more than 1 months, the overall effect was good, and the pouch-shaped appearance of lower eyelid pouch was significantly improved. In types 2, 8 cases had no complications, and the incision healed well; the patients were followed up for more than 3 months, the lower eyelid bag and lower eyelid skin relaxation were significantly improved, and the lower eyelid skin was tighter than before. In types 3, there were no complications in these 19 cases, and the incision was healed well. The patients were followed up for more than 3 months, the deformity of lower eyelid bag was improved obviously, and no obvious local bulge was found under static and dynamic expression. In type 4, there were no complications in all 34 cases, and the incision healed well; during the follow-up of more than 3 months, the lower eyelid pouch deformity and lower eyelid skin relaxation were greatly improved, except for 1 case with mild bulge (untreated). In type 5, 9 cases had no complications, and the incision healed well; during the follow-up of more than 3 months, the fold of the lower eyelid skin disappeared.Conclusions:Little information is available about classification of lower eyelid bags. And the exact surgical approach remains controversial and largely dependent upon surgeon preference and a patient's stated cosmetic desire. In this study, an objective classification based on clinical appearance combined with forming reasons of lower eye bags is little available, and the appropriate surgical approach remains controversial as well.

10.
Autops. Case Rep ; 11: e2021282, 2021. graf
Article in English | LILACS | ID: biblio-1285409

ABSTRACT

Intraconal dermoid cysts are very unusual in routine clinical practice. Clinical symptoms depend upon the site and extension of the lesion. Though rare, proptosis, diplopia, and orbital pain are the presenting symptoms encountered in patients with an intraorbital dermoid cyst. Although radiology can be diagnostic, a complete correlation with the final histopathology is always mandatory for its confirmation. Endoscopic excision of the cyst ensures a complete cure for the disease without any intraoperative/postoperative complications.


Subject(s)
Humans , Male , Adult , Orbit/pathology , Dermoid Cyst/surgery , Eye Neoplasms/surgery
11.
RGO (Porto Alegre) ; 69: e2021013, 2021. tab
Article in English | LILACS-Express | LILACS, BBO | ID: biblio-1250643

ABSTRACT

ABSTRACT Objetive To determine the percentage of correctness of the Orbital Index (OI) for estimation of sex, ancestry and age in Brazilian skulls. Methods Cross-sectional study of 183 human dry skulls from the southeastern Brazil. A total of 100 skeletons were males and 83 females; of which 36 were aged up to 39 years, 60 aged between 40 and 59 years, and 87 aged 60 years or older. As for ancestry, 103 were from white, 51 mixed race, and 29 black individuals. The OI was calculate by the formula = height/width x 100. The data were submitted to Student's t test, F (ANOVA), Tukey and Kruskal Wallis tests as well as to discriminant analysis, with a 5% significance level. Results The sample was characterized as mesoseme, with a mean age of 56.62 (±19.97) years. No significant difference was observed (p=0.511) between the OI in females (right: 86.43 ± 6.58 and left: 86.70 ± 5.93) and males (right: 85.78 ± 6.69 and left: 86.37 ± 6.20). There were no significant differences between age, ancestry and the variables analyzed (p>0.05). The right and left orbital widths were significantly dimorphic between sexes (p<0.001). The percentage of correctness of the method for estimation of sex, age and ancestry was found to be 65.6%, 43.7%, and 43.6%, respectively. Conclusions The OI is not an appropriate method for estimation of sex, ancestry and estimation of age in this Brazilian sample. The methodology should be expanded to other population groups so that it can be improved.


RESUMO Objetivo Determinar a porcentagem de correlação do Índice Orbitário (IO) na estimativa do sexo, da ancestralidade e da idade em crânios brasileiros. Métodos Estudo de corte transversal de 183 crânios secos humanos do sudeste brasileiro. No total, 100 esqueletos eram homens e 83 mulheres; dos quais 36 tinham até 39 anos, 60 tinham entre 40 e 59 anos e 87 tinham 60 anos ou mais. Quanto à ascendência, 103 eram brancos, 51 pardos e 29 negros. O IO foi calculado pela fórmula = altura / largura x 100. Os dados foram submetidos aos testes t de Student, F (ANOVA), Tukey e Kruskal Wallis, bem como à análise discriminante, com nível de significância de 5%. Resultados A amostra foi caracterizada como mesoseme, com média de idade de 56,62 (± 19,97) anos. Não houve diferença significativa (p = 0,511) entre o IO no sexo feminino (direita: 86,43 ± 6,58 e esquerda: 86,70 ± 5,93) e do sexo masculino (direita: 85,78 ± 6,69 e esquerda: 86,37 ± 6,20). Não houve diferenças significativas entre idade, ancestralidade e as variáveis analisadas (p> 0,05). As larguras orbitais direita e esquerda foram significativamente dimórficas entre os sexos (p <0,001). A porcentagem de acerto do método para estimativa de sexo, idade e ancestralidade foi de 65,6%, 43,7% e 43,6%, respectivamente. Conclusão O IO não é um método apropriado para estimativa de sexo, ancestralidade e estimativa de idade nesta amostra brasileira. A metodologia deve ser expandida para outros grupos populacionais para que possa ser aperfeiçoada.

12.
West Indian med. j ; 69(3): 168-170, 2021. graf
Article in English | LILACS | ID: biblio-1341889

ABSTRACT

ABSTRACT Rhinoscleroma (more appropriately 'scleroma') is a chronic, disfiguring inflammatory lesion that is rarely encountered in the present-day otolaryngology practice. The diagnosis often becomes difficult especially when it recurs and presents late with complications. This report illustrates the clinical and histologic features of rhinoscleroma in a defaulter patient who represents advanced-stage disease with orbital and intracranial extensions. Special emphasis has been provided on the computed tomography impressions such that the evolution of scleroma with time can be studied.


Subject(s)
Humans , Male , Middle Aged , Rhinoscleroma/pathology , Severity of Illness Index , Tomography, X-Ray Computed , Rhinoscleroma/diagnostic imaging
13.
Article in Chinese | WPRIM | ID: wpr-910794

ABSTRACT

Objective:To investigate the feasibility of maximum standardized uptake value (SUV max) of extraocular muscle during 99Tc m-diethylene triamine pentaacetic acid (DTPA) orbital SPECT/CT imaging for the clinical diagnosis and evaluation of thyroid associated ophthalmopathy (TAO). Methods:From July 2019 to April 2020, 38 patients (13 males, 25 females, age: 15-77 (48.8±13.7) years; 76 eyes) diagnosed with TAO and 11 healthy volunteers (2 males, 9 females, age: 20-87 (53.5±20.2) years; 22 eyes) were enrolled retrospectively from the Second Hospital of Dalian Medical University. According to the clinical activity score (CAS), 76 eyes were divided into active group (46 eyes) and inactive group (30 eyes). All subjects underwent 99Tc m-DTPA orbital SPECT/CT imaging, then SUV max and uptake ratio (UR) of extraocular muscles were measured and calculated by 3 nuclear medicine physicians. The corrected SUV max was obtained after correction. Kruskal-Wallis rank sum test and Bonferroni test were used to compare the differences of corrected SUV max and UR among the three groups. Spearman rank correlation analysis was used to analyze the correlation between corrected SUV max /UR and CAS. The receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of corrected SUV max and UR. Intra-class correlation coefficient (ICC) was used for reliability analysis to evaluate the consistency of corrected SUV max and UR among the 3 measurers. Results:The corrected SUV max of the extraocular muscles in the active group, inactive group and control group were 15.96(10.99, 19.63), 7.98(6.80, 9.28), 7.59(6.59, 8.20) respectively ( H=42.196, P<0.001), and UR were 2.17(1.65, 2.79), 1.22(1.03, 1.39), 1.12(0.99, 1.36) respectively ( H=40.642, P<0.001). The corrected SUV max and UR of the extraocular muscles in the active group were significantly higher than those in the inactive group ( H values: -4.971, -5.053, both P<0.001) and in the control group ( H values: -5.681, -5.436, both P<0.001), while there was no significant difference between the inactive group and the control group ( H values: -1.190, -0.796, both P>0.05). Both corrected SUV max and UR were positively correlated with CAS ( rs values: 0.653, 0.615, both P<0.001). The area under the ROC curve of corrected SUV max was 0.851, and the threshold value of corrected SUV max for distinguishing active and inactive periods was 10.125, with the sensitivity of 80.4%(37/46) and the specificity of 86.7%(26/30). The area under the ROC curve of UR was 0.845, and the threshold value for differentiating active and inactive periods was 1.565, with the sensitivity of 80.4%(37/46) and the specificity of 86.7%(26/30). The ICC of corrected SUV max and UR were 0.966(95% CI: 0.953-0.976, P<0.001) and 0.618(95% CI: 0.436-0.744, P<0.001) respectively. Conclusion:Compared with UR, SUV max may be a more promising index for estimating disease activity of orbits in patients with TAO.

14.
Int. j. morphol ; 38(6): 1810-1817, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134515

ABSTRACT

SUMMARY: The pear-shaped bony orbit connects with intracranial cavity via foramina's and fissures. The Meningo-orbital Foramen (MOF) is usually present in greater wing of sphenoid close to lateral edge of Superior orbital fissure. It provides a route for an anastomosis between the orbital branch of the middle meningeal artery (MMA) and recurrent meningeal branch of Ophthalmic Artery (OA) and hence, risk of damage during surgeries can occur. To verify occurrence and location, with morphology of MOF in dry orbits and the impending clinical hazards in surgeries pertaining to the orbit, document and analysis it to determine a standardized guideline. The presence for MOF was studied in 446 dry orbits with its location from the supra orbital margin (SOM), front zygomatic suture (FZS), the lateral tubercle of Whitnall (WT)and the lateral end of superior orbital fissure (SOF) along with its patency, laterality and number of foramina's present. Nylon probes, long divider/pins, compass and Vernier callipers was used to check the patency and various parameters. The study noted the percentage prevalence of MOF as 69 % with communication with middle cranial fossa (MCF) being 76 % of 69 % and the average distance from SOM, FZS, WT and lateral end of SOF being 35.58 mm, 24.9 mm, 26.6 mm and 0.92 mm. On comparison with various population studies, certain similarities and differences with regards to different parameters were noted. Prevalence of MOF was mostly unilateral and showed multiple foramina, that can act as channels for arteries, a variant of MMA or OA, that supply orbital structures or tumour growths. Thus, awareness of this variation is of prime importance to ophthalmologists and neurosurgeons as well as interventional radiologists, in preventing haemorrhagic condition which could further raise the difficulties in operative procedures and surgical outcomes.


RESUMEN: La órbita ósea en forma de pera se conecta con la cavidad intracraneal a través de forámenes y fisuras. El foramen meningoorbitario (MOF) suele estar presente en el ala mayor del esfenoides cerca del margen lateral de la fisura orbitaria superior. Proporciona una ruta para una anastomosis entre la rama orbitaria de la arteria meníngea media (MMA) y la rama meníngea recurrente de la arteria oftálmica (OA) y, por lo tanto, puede ocurrir riesgo de daño durante las cirugías. Para verificar la ocurrencia y ubicación, con la morfología de MOF en órbitas secas y los peligros clínicos inminentes en cirugías de la órbita, documentarlo y analizarlo para determinar una pauta estandarizada. Se estudió la presencia de MOF en 446 órbitas secas desde el margen supraorbitario (MOS), sutura cigomática frontal (FZS), el tubér- culo lateral de Whitnall (WT) y el extremo lateral de la fisura orbitaria superior (SOF) junto con su permeabilidad, lateralidad y número de forámenes presentes. Se utilizaron sondas de nailon, divisores / pasadores largos, brújula y calibradores Vernier para comprobar la permeabilidad. En el estudio se pudo observar que la prevalencia porcentual de MOF era del 69 %, siendo la comunica- ción con la fosa craneal media (MCF) del 76 % del 69 % y la distancia promedio desde SOM, FZS, WT y el extremo lateral de SOF era de 35,58 mm, 24,9 mm, 26,6 mm y 0,92 mm. En comparación con varios estudios de población, se observaron ciertas similitudes y diferencias con respecto a diferentes parámetros. La prevalencia de MOF fue mayoritariamente unilateral y mostró múltiples forámenes, que pueden actuar como canales para las arterias, una variante de MMA u OA, que irrigan estructuras orbitarias o crecimientos tumorales. Por lo tanto, la conciencia de esta variación es de primordial importancia para los oftalmólogos y neurocirujanos, así como para los radiólogos intervencionistas, en la prevención de una enfermedad hemorrágica que podría aumentar aún más las dificultades en los procedimientos y los resultados quirúrgicos.


Subject(s)
Humans , Orbit/anatomy & histology , Orbit/diagnostic imaging , Surgical Flaps , Meningeal Arteries/anatomy & histology , Meningeal Arteries/diagnostic imaging , Ophthalmic Artery/anatomy & histology , Ophthalmic Artery/diagnostic imaging , India
15.
Rev. Fac. Med. (Bogotá) ; 68(3): 399-404, July-Sept. 2020. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1143728

ABSTRACT

Abstract Introduction: Knowing eye morphology is crucial for the training of medical students; however, learning about the anatomy of the eye is limited to virtual models and illustrations that do not accurately portray the orbital cavity and its contents. In this sense, the use of dissection techniques has shown to improve the learning of the morphology of any anatomical structure. Objective: To modify the Caldwell-Luc procedure using a simultaneous superior approach that allows access to all the extrinsic structures of the eye contained in the orbital cavity, and thus facilitate its study in situ. Materials and methods: Based on a thorough literature review, dissection practices were performed first with pig eyes to gain the necessary experience, and then the dissection was carried out by planes on a human corpse: the maxillary bone was cut and a horizontal cut was made at the base of the skull. Results: By dissecting all the extrinsic muscles of the eye it was possible to visualize the nerves (cranial pairs), their branches and vascular structures from an upper and lower perspective of the orbit. Conclusion: The successful application of the modified Caldwell-Luc procedure described in this study is a better tool for teaching and learning about the anatomy of the eye, as it allows observing as many of the surrounding structures of the eye in situ as possible, and provides an opportunity to improve students' anatomical dissection skills.


Resumen Introducción. Conocer la morfología ocular es crucial para la formación de estudiantes de medicina; sin embargo, el aprendizaje de la anatomía del ojo está limitado a modelos virtuales e ilustraciones que no ofrecen una impresión real de la cavidad orbitaria y su contenido. Al respecto, se ha demostrado que el uso de técnicas de disección mejora el aprendizaje morfológico de cualquier estructura anatómica. Objetivo. Modificar la técnica Caldwell-Luc con un abordaje superior simultáneo que permita acceder a todas las estructuras extrínsecas del ojo contenidas en la cavidad orbitaria y, de esta forma, facilitar su estudio in situ. Materiales y métodos. Basándose en una revisión exhaustiva de la literatura, primero se realizaron prácticas de disección con ojos porcinos para adquirir la experiencia necesaria y luego se procedió a realizar la disección por planos en un cadáver humano: se llevó a cabo el corte del hueso maxilar y el corte horizontal en la base del cráneo. Resultados. La disección de todos los músculos extrínsecos del ojo permitió observar los nervios (pares craneales) con sus ramos desde una perspectiva inferior y superior de la cavidad orbitaria. Conclusión. La aplicación satisfactoria de la técnica modificada de Caldwell-Luc descrita en el presente estudio constituye una mejor herramienta para la enseñanza y el aprendizaje de la anatomía ocular, ya que esta permite observar la mayor cantidad de estructuras anexas del ojo in situ y ofrece una oportunidad para mejorar las habilidades en disección anatómica de los estudiantes.

16.
Arch. argent. pediatr ; 118(4): e410-e413, agosto 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1118594

ABSTRACT

El schwannoma es un tumor primario, habitualmente, benigno, procedente de las células de Schwann, productoras de la vaina de mielina que recubre los nervios periféricos. Constituye menos del 10 % de los tumores intracraneales y es infrecuente en la edad pediátrica.Se presenta a un paciente de 6 años y 11 meses de edad, previamente sano, con antecedente de cefalea holocraneana intermitente asociado a proptosis y disminución de la agudeza visual del ojo izquierdo, epífora y estrabismo, con evidencia tomográfica de una masa retroocular. Se realizó la exéresis macroscópicamente completa, con diagnóstico anatomopatológico de schwannoma orbitario


Schwannoma is a usually benign primary tumor. It develops from the Schwann cells, which produce the myelin sheath that surrounds the peripheral nerves. It represents less than 10 % of the intracranial tumors, and it is infrequent in the pediatric age.We hereby present a 6-year-and-11-month-old previously healthy patient, with a history of intermittent generalized cephalea associated with proptosis and a diminished visual acuity of the left eye, epiphora and strabismus, with radiological evidence of retro-ocular mass. A macroscopically complete exeresis was performed, with an anatomopathological diagnosis of orbital schwannoma


Subject(s)
Humans , Male , Child , Schwann Cells , Neurilemmoma/diagnostic imaging , Orbit/injuries , Exophthalmos , Neoplasms , Neurilemmoma/surgery
17.
Rev. cir. traumatol. buco-maxilo-fac ; 20(4): 40-44, out.-dez. 2020. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1252982

ABSTRACT

Introdução: Trauma contuso e penetrante na região orbital pode ter um efeito devastador, tanto funcional quanto estético para a órbita e estruturas adjacentes. Uma inspeção meticulosa das pálpebras e do globo deve ser realizada e, se houver suspeita de retenção de um corpo estranho dentro dos tecidos moles orbitais, deve ser obtida uma tomografia computadorizada (TC). O objetivo do presente estudo foi relatar um caso clínico de trauma óculo-orbitário severo ocasionado por acidente com animal. Relato de caso: paciente de 22 anos do gênero masculino apresentou-se em um hospital de referência em trauma na cidade de Campina Grande-PB, com história de acidente com cavalo e colisão em cerca de madeira. A tomografia revelou que havia a presença de um corpo estranho (CE) de madeira que apresentava uma forma pontiaguda e proximidade com estruturas como músculos, vasos e nervos da órbita, além da presença de fratura no assoalho da órbita. Considerações finais: A presença de CE de madeira deve sempre ser investigada quando há trauma direto na cavidade orbitária, pois a madeira é áspera e contém uma grande quantidade de bactérias e parasitas. Sendo assim, deve ser removido o mais precocemente possível a fim de se evitar complicações infecciosas... (AU)


Introduction: Blunt and penetrating trauma to the orbital region can have a devastating effect, both functional and aesthetic for the orbit and adjacent structures. Meticulous inspection of the eyelids and the globe should be performed and, if a foreign body is suspected to be retained within the orbital soft tissues, a computed tomography (CT) scan should be obtained. The aim of the present study was to report a clinical case of severe oculo-orbital trauma caused by an accident with an animal. Case report: a 22-year-old male patient presented at a trauma referral hospital in the city of Campina Grande-PB, with a history of accident with a horse and collision on a wooden fence. The tomography revealed that there was the presence of a wooden foreign body (EC) that had a pointed shape and proximity to structures such as muscles, vessels and nerves in the orbit, in addition to the presence of a fracture in the orbit floor. Final considerations: The presence of wood CE should always be investigated when there is direct trauma to the orbital cavity, as the wood is rough and contains a large amount of bacteria and parasites. Therefore, it should be removed as early as possible in order to avoid infectious complications... (AU)


Subject(s)
Humans , Male , Young Adult , Orbital Fractures/etiology , Eye Foreign Bodies/etiology , Accidental Injuries/complications , Wood , Tomography, X-Ray Computed , Eye Foreign Bodies/surgery , Eye Foreign Bodies/diagnostic imaging , Horses
18.
Rev. cir. traumatol. buco-maxilo-fac ; 20(2): 5-11, abr.-jun. 2020. tab
Article in Portuguese | LILACS, BBO | ID: biblio-1253401

ABSTRACT

Introdução: A reconstrução óssea de defeitos craniofaciais é um processo desafiador. Diferentes técnicas operatórias e materiais reconstrutores são utilizados para reestabelecer a forma ideal do crânio. Materiais aloplásticos vem ganhando popularidade nas reconstruções orbitárias devido à sua facilidade de uso, com grande variedade de formas e tamanhos disponíveis. O objetivo deste estudo foi avaliar as reconstruções dos defeitos ósseos orbitários após traumatismos craniofaciais. Metodologia: Trata-se de um estudo observacional, que avaliou pacientes vítimas de traumatismo crânioencefálico com envolvimento orbitário e necessidade de reconstrução por meio de material aloplástico de titânio, atendidos no período de março de 2015 a junho de 2016, no Hospital da Cidade de Passo Fundo, Rio Grande do Sul,Brasil.Resultados: 13 pacientes foram incluídos no estudo e analisados de acordo com idade, gênero, etiologia do trauma,tipos de fratura que envolveram os defeitos craniofaciais e o material utilizado na reconstrução. O exame clínico avaliou a estabilidade da reconstrução, o resultado estético e funcional e a ocorrência de infecção pós-operatória. Tomografias Fan-Beam foram tomadas no pré e pós-operatório. Conclusões:Os resultados obtidos mostram que a escolha do material aloplástico de titânio é segura, e oferece excelente taxa de sucesso estético e funcional, corroborando com a literatura existente... (AU)


Introduction: Bone reconstruction of craniofacial defects is a challenging process. Different surgical techniques and reconstructing materials are used to reestablish the ideal shape of the skull. Alloplastic materials have been gaining popularity in orbital reconstructions due to their ease of use, with a wide variety of shapes and sizes available. The aim of this study was to evaluate the reconstruction of orbital bone defects after craniofacial trauma. Methodology: This is an observational study that evaluated patients who were victims of traumatic brain injury with orbital involvement and the need for reconstruction by means of titanium alloplastic material, treated from March 2015 to June 2016, at the Hospital da Cidade de Passo Fundo, Rio Grande do Sul, Brazil. Results: 13 patients were included in the study and analyzed according to age, gender, trauma etiology, types of fracture involving craniofacial defects and the material used in reconstruction. The clinical examination evaluated the stability of the reconstruction, the aesthetic and functional result and the occurrence of postoperative infection. Fan-Beam tomography were taken before and after surgery. Conclusions: The results obtained show that the choice of titanium alloplastic material is safe and offers an excellent rate of aesthetic and functional success, corroborating the existing literature... (AU)


Subject(s)
Humans , Male , Female , Skull , Titanium , Facial Injuries , Mandibular Reconstruction , Brain Injuries, Traumatic , Wounds and Injuries , Bone and Bones , Tomography , Fractures, Bone
19.
Article in Portuguese | LILACS | ID: biblio-1358875

ABSTRACT

RESUMO: As fraturas do complexo zigomático-orbitário são bastante frequentes devido a sua localização e projeção na face, podendo gerar grandes transtornos funcionais e estéticos ao paciente. O osso zigomático é essencial na configuração da face, sendo a principal estrutura formadora do terço médio dela. Os traumas que mais frequentemente provocam fraturas do complexo zigomático-orbitário são agressões físicas, acidentes de trânsito e esportivos. O tipo de fratura, tempo decorrido, a severidade e o envolvimento de outras estruturas faciais influenciam a modalidade de tratamento a ser empregado. O presente trabalho apresenta um caso clínico de fratura do complexo zigomático-orbitário esquerdo, diagnosticada tardiamente, e tratada por meio de osteotomia, redução e fixação em três pontos com placas e parafusos do sistema 1.5, e reconstrução do assoalho orbitário com tela de titânio. (AU)


ABSTRACT: Fractures of the zygomatic-orbital complex are quite frequent due to their location and projection on the face, which can cause major functional and aesthetic disorders to the patient. The zygomatic bone is essential in the configuration of the face, being the main forming structure of the middle third of it. The traumas that most often cause fractures of the zygomatic-orbital complex are physical aggression, traffic accidents, and sports. The type of fracture, elapsed time, severity, and the involvement of other facial structures influence the type of treatment to be employed. The present work presents a clinical case of fracture of the left zygomatic-orbital complex, diagnosed late, and treated by osteotomy, reduction, and fixation in three points with 1.5 system plates and screws, and reconstruction of the orbital floor with titanium mesh. (AU)


Subject(s)
Humans , Male , Adult , Orbit/injuries , Zygoma/injuries , Accidents, Traffic , Fractures, Bone , Facial Bones/injuries , Facial Injuries/surgery
20.
Indian J Ophthalmol ; 2020 Jan; 68(1): 219-221
Article | IMSEAR | ID: sea-197769

ABSTRACT

Penetrating orbitocranial injuries can present with foreign body/bodies (FBs) lodged in eye, orbit, and/or brain. But limited literatures are available about FBs lodged partly in orbit and partly intracranially. Here, we present a rare case of orbitocranial wooden FB impacted in right palpebral aperture extending intracranially following accidental fall from height. Unexpectedly, the patient himself removed the FB in fully conscious and oriented state while waiting for neurosurgical intervention, later completely recovered under observation and antibiotic prophylaxis. Therefore, it is important to have high suspicion of intracranial extension in impacted orbital FBs and a team approach for managing such cases.

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