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1.
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
2.
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
3.
Rev. Odontol. Araçatuba (Impr.) ; 42(2): 52-55, maio-ago. 2021. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1283891

ABSTRACT

Pacientes com históricos de defeitos ósseos provocados por infecções, malformação congênita, neoplasias, deformação por iatrogenia, radioterapia e trauma buscam contornos faciais mais harmônicos através da reabilitação cirúrgica. Para facilitar a reconstrução maxilofacial dois grupos de materiais podem ser utilizados, os enxertos ósseos e os materiais aloplásticos. O objetivo é relatar um caso incomum de infecção e exposição de material utilizado para enxertia a base de polimetilmetacrilato, bem como a sua posterior reabordagem cirúrgica. Embora o Polimetilmetacrilato aparente ser seguro, ele exibe complicações diversas em função da imunologia do hospedeiro, que poderá reagir de diferentes formas. Desse modo, faz-se necessário ressaltar a importância da prevenção e proservação de cada caso de forma individualizada(AU)


Patients with a history of bone defects caused by infections, congenital malformation, neoplasms, iatrogenic deformation, radiotherapy and trauma seek more harmonious facial contours through surgical rehabilitation. To facilitate maxillofacial reconstruction, two groups of materials can be used, bone grafts and alloplastic materials. The objective is to report an unusual case of infection and exposure of material used for grafting with polymethylmethacrylate, as well as its subsequent surgical approach. Although Polymethylmethacrylate appears to be safe, it exhibits different complications depending on the host's immunology, which may react in different ways. Thus, it is necessary to emphasize the importance of preventing and preserving each case individually(AU)


Subject(s)
Humans , Female , Middle Aged , Bone Transplantation , Polymethyl Methacrylate , Maxillofacial Injuries , Orbit , Surgery, Oral , Zygoma , Biocompatible Materials , Iatrogenic Disease , Maxilla
4.
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
5.
Rev. bras. oftalmol ; 80(2): 127-132, Mar.-Apr. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1280102

ABSTRACT

RESUMO Objetivo: Conheça as características demográficas e clínicas da Órbita Associada da Tiroide (OAT), bem como a taxa de exigência da cirurgia orbital em pacientes do Centro Médico Nacional do Oeste. Métodos. Estudo observacional, transversal, descritivo e retrospetivo realizado analisando os registos de pacientes diagnosticados com OAT tratados num centro de cuidados de terceiro nível de janeiro de 2005 a julho de 2016. Os resultados. Um total de 236 órbitas de 118 pacientes foram avaliados, com uma idade média de 47,3 (13,2 anos, 74,6% eram do sexo feminino e 25,4% masculinos. 4,2% dos doentes foram tratados com hipotiroidismo, 94,1% com hipertireoidismo e 1,7% com goiter tóxico difuso. 44,9% dos doentes estudados com restrição de movimento ocular,10,2% com queratopatia de exposição e 51,7% com hipertensão intraocular. 34,7% dos doentes avaliados no serviço necessitaram de descompressão orbital, 16,1% de cirurgia palpebral e 8,5% de correção do hatrabisma. Na gestão conservadora destes doentes, 48,3% exigiam o uso de lubrificantes tópicos dos olhos, enquanto 52,5% dos pacientes necessitavam do uso de hipotensivos oculares em número variável. As conclusões. A OAT foi associada principalmente ao hipertiroidismo, sendo mais comum em pacientes do sexo feminino entre os 40 e os 59 anos; mais de 50% dos pacientes necessitaram do uso de hipotensivos oculares. Da mesma forma, a gestão cirúrgica foi realizada em mais de 50% dos pacientes, sendo a descompressão orbital a intervenção mais frequente.


ABSTRACT Objective. To know the demographic and clinical characteristics of Thyroid Associated Orbitopathy (TAO), as well as the requirement rate of orbital surgery in patients of the Orbit Service in the National Medical Center of the West, IMSS. Methods. Observational, cross-cutting, descriptive and retrospective study carried out analyzing the records of patients diagnosed with TAO and treated at a third-level care center from January 2005 to July 2016. Results. A total of 236 orbits of 118 patients were valued, with an average age of 47.3 ± 13.2 years, 74.6% were female and 25.4% male. 4.2% of patients were treated with hypothyroidism, 94.1% with hyperthyroidism and 1.7% with diffuse toxic goiter. 44.9% of patients studied had eye movement restriction,10.2% exposure keratopathy and 51.7% intraocular hypertension. 34.7% of patients valued in the service required orbital decompression, 16.1% palpebral surgery and 8.5% strabism correction. In the conservative management of these patients 48.3% required the use of topical eye lubricants, while 52.5% required the use of eye hypotensives in variable numbers. Conclusions. TAO was mainly associated with hyperthyroidism, being more common in female patients between the age of 40 and 59; more than 50% of patients required the use of eye hypotensives. Likewise, surgical management was performed in more than 50% of patients, with orbital decompression being the most frequent intervention.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Orbital Diseases/surgery , Orbital Diseases/etiology , Ophthalmologic Surgical Procedures/statistics & numerical data , Thyroid Diseases/complications , Exophthalmos/surgery , Exophthalmos/etiology , Orbit/surgery , Exophthalmos/diagnosis , Graves Disease/complications , Cross-Sectional Studies , Retrospective Studies , Decompression, Surgical/methods , Intraocular Pressure
6.
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
7.
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
8.
Int. j. morphol ; 38(4): 914-918, Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1124876

ABSTRACT

The anatomical localization of foramen infraorbitale (FOI) and its relationship with ambient structures are of great importance for clinicians and surgeons. This study was performed on seventy five skulls, and the distance between FOI to important anatomical formations, angular position of the zygomatic bone and the relationship between these parameters were investigated on both sides. The distance of FOI to margo infraorbitalis (MI), apertura piriformis (AP) and spina nasalis anterior (SNA), upper face height (UH) and upper face width (UW) were measured. Zygomatic bone triangle angles (SA, PA, IA) and porion-nasion-spina nasalis anterior angle (PNS) were measured from lateral view of the skull. While there was no significant difference between right and left measurement except for PA (p=0.03), the distance from FOI to MI is showed a very high degree positive correlation between the right and left sides, the distance from the FOI to AP was weak correlated only right side.


La localización anatómica del foramen infraorbitario (FIO) y su relación con las estructuras adyacentes son de gran importancia para los médicos y cirujanos. Este estudio se realizó en setenta y cinco cráneos, y se investigó la distancia entre FIO a formaciones anatómicas importantes, la posición angular del hueso cigomático y la relación entre estos parámetros en ambos lados. Se midió la distancia de FIO al margen infraorbitario (MI), apertura piriforme (AP) y espina nasal anterior (ENA), altura superior de la cara (AC) y ancho superior de la cara (AC). Los ángulos del triángulo óseo cigomático y el ángulo anterior porion-nasion-epina nasal se midieron desde la vista lateral del cráneo. Si bien no hubo una diferencia significativa entre la medición derecha e izquierda, a excepción AP (p = 0,03), la distancia de FIP a MI mostró una correlación positiva de alto grado entre los lados derecho e izquierdo, la distancia de FIO a AP fue débil correlacionado solo en el lado derecho.


Subject(s)
Humans , Adult , Orbit/anatomy & histology , Cephalometry , Skull/anatomy & histology , Zygoma/anatomy & histology
10.
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
11.
Rev. cir. traumatol. buco-maxilo-fac ; 20(1): 27-29, jan.-mar. 2020. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1253536

ABSTRACT

Introdução: Todo tipo de trauma facial requer uma avaliação detalhada, a fim de compreender o histórico da lesão e possíveis sequelas. O trauma óculo-orbital não está entre as lesões mais frequentes na epidemiologia do trauma facial, embora esteja associado a altos índices de morbidade e sequelas graves, sendo necessário um acompanhamento multidisciplinar. O objetivo do presente estudo foi relatar um caso clínico de trauma óculo-orbitário severo ocasionado por arma de fogo. Relato do caso: Paciente de 19 anos foi atendido em um serviço de cirurgia bucomaxilofacial, vítima de trauma por arma de fogo, com a presença de um objeto metálico incomum na órbita esquerda e região temporal. Exame clínico e tomografia computadorizada foram realizados, confirmando uma trajetória extracraniana do objeto. O paciente foi submetido à cirurgia sob anestesia geral, e o objeto foi removido pelo orifício de entrada na região orbitária esquerda. Após avaliação oftalmológica, as funções do olho esquerdo não puderam ser recuperadas. Considerações Finais: O diagnóstico correto e o tratamento rápido são imperativos para restaurar a função e a estética agradável na região traumatizada... (AU)


Introduction: Any type of facial trauma requires a detailed evaluation in order to understand lesion history and possible sequelae. Oculoorbital trauma is not between the most frequent injuries within facial trauma epidemiology, although, it is associated to high morbidity rates and severe sequelae, so that a multidisciplinary follow-up is necessary. To report a clinic case of severe oculo-orbital trauma caused by firearm. Case Report: Patient, 19 years-old, attended the oral and maxillofacial surgery service victim of trauma by gunshot with the presence of an unusual metallic object in the left orbit and temporal region. Clinical exam and computed tomography scan were performed, confirming an extra-cranial trajectory of the object. Patient was submitted to surgery under general anesthesia and the object was removed through the entrance orifice in the left orbital region. After ophthalmologic evaluation, functions of the left eye could not be recovered. Final considerations: Correct diagnosis and rapid treatment are imperative to restore function and pleasant esthetics in the traumatized region... (AU)


Subject(s)
Humans , Male , Adult , Orbit , Temporal Lobe , Wounds and Injuries , Wounds, Gunshot , Eye Injuries , Lifting , Facial Injuries , Foreign Bodies , Tomography
12.
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
13.
Arq. bras. oftalmol ; 83(1): 62-64, Jan.-Feb. 2020. graf
Article in English | LILACS | ID: biblio-1088956

ABSTRACT

ABSTRACT We present a patient who underwent evisceration surgery after spontaneous rupture of the ocular globe due to long-data uncontrolled glaucoma, with posterior placement of an orbital implant made of a bone cement compound based on polymethylmethacrylate as alternative materials were not available. Such a compound is characterized by excellent biocompatibility and low cost, which makes it an interesting alternative for treatment. The anophthalmic socket was successfully filled, providing proper esthetic results and favorable conditions for the posterior scleral prosthesis implantation. No complications were observed during 10 months of follow-up. We believe that, in the absence of alternative materials, low-cost materials may be used in emergency settings to repair anophthalmic cavities and provide satisfactory functional and esthetic outcomes.


RESUMO Apresentamos um paciente que foi submetido à cirurgia de evisceração após ruptura espontânea do globo ocular devido a glaucoma não controlado de longa data, com posterior colocação de implante orbital feito de cimento ósseo, composto à base de polimetilmetacrilato, diante da indisponibilidade de materiais alternativos. Tal composto se caracteriza pela excelente biocompatibilidade e baixo custo, o que o torna uma alternativa interessante para o tratamento. A cavidade anoftálmica foi preenchida com sucesso, fornecendo resultados estéticos adequados e condições favoráveis para o implante posterior de prótese escleral. Nenhuma complicação foi observada durante os 10 meses de seguimento. Acredi­tamos que, na ausência de materiais alternativos, materiais de baixo custo podem ser usados em situações emergenciais para preencher cavidades anoftálmicas e prover resultados funcionais e estéticos satisfatórios.


Subject(s)
Humans , Male , Aged , Orbit/surgery , Bone Cements , Orbital Implants , Rupture, Spontaneous/surgery , Rupture, Spontaneous/etiology , Biocompatible Materials , Glaucoma/complications , Eye Evisceration , Reconstructive Surgical Procedures
14.
Arq. bras. oftalmol ; 83(1): 33-38, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088945

ABSTRACT

ABSTRACT Purposes: To identify problems caused by prosthesis-socket volume imbalances in anophthalmic sockets; and to evaluate rehabilitation with dermofat graft as a solution. Methods: We retrospectively reviewed medical records of patients operated in our clinic (between May 2011 and June 2016) with dermofat grafts to treat anophthalmic socket-related problems. During the preoperative examinations, ophthalmologists recorded the presence of eyelid problems due to the socket volume deficit, upper and lower fornix deficiency, deepening in the upper eyelid sulcus, epiphora and secretion, lower eyelid laxity, ptosis, entropion, and ectropion. Following the surgical repair, new prosthesis suitable for the resulting socket area were implemented for all the patients. The mean follow-up period was 27.42±16 months (ranging from 10-62 months). On the last control examinations, ophthalmologists recorded solved and unsolved socket problems that were present preoperatively. Results: We included 16 men and 5 women in this study. The mean age was 38.3 ± 18.4 years (range, 5-75 years). The mean duration of preoperative prosthesis use was 9.4 ± 6.8 years (range, 1-30 years). Preoperatively, 7 patients had only orbital volume deficits, and 14 had socket volume displacements in addition to the volume deficits. After the dermofat graft implantations, the remaining deficits were corrected during another surgical session: 6 patients underwent ptosis corrections, 5 lateral canthal suspensions, 5 lower fornix with mucosal graft formations, and 2 upper fornix formations with mucosal grafts. All patients were able to use prosthesis postoperatively. Conclusion: The use of dermofat grafts to correct anophthalmic socket problems caused by orbital volume deficits or volume displacements is an effective, reliable, and reproducible surgical method.


RESUMO Objetivos: Identificar os problemas causados pelo desequilíbrio do volume da cavidade da prótese em cavidades anoftálmicas, e avaliar a reabilitação com enxerto de dermofato como solução. Métodos: Revisamos retrospectivamente os prontuários de pacientes operados em nossa clínica (entre maio de 2011 e junho de 2016) com enxertos de dermofato para tratar problemas relacionados a cavidades anoftálmicas. Durante os exames pré-operatórios, os oftalmologistas registraram a presença de problemas palpebrais devido ao déficit de volume, deficiência de fórnice superior e inferior, aprofundamento no sulco palpebral superior, a epífora e secreção, flacidez palpebral inferior, ptose, entrópio e ectrópio. Após a cirurgia, novas próteses adequadas para a área de encaixe foram implementadas em todos os pacientes. O tempo médio de acompanhamento foi de 27,42 ± 16 meses (variando de 10 a 62 meses). Nos últimos exames de controle, os oftalmologistas registraram problemas corrigidos e não corrigidos da cavidade que estavam presentes no pré-operatório. Resultados: Foram incluídos 16 homens e 5 mulheres neste estudo. A média de idade foi de 38,3 ± 18,4 anos (variação de 5-75 anos). A duração média do uso de prótese pré-operatória foi de 9,4 ± 6,8 anos (variação de 1 a 30 anos). No pré-operatório, 7 pacientes apresentavam apenas déficit orbitais e 14 tinham desvios de volume, além dos déficits de volume. Após os implantes de enxerto de dermoadipação, os déficits remanescentes foram corrigidos durante outra sessão cirúrgica: 6 pacientes foram submetidos a correção de ptose, 5 suspensões de cantal lateral, 5 fórnix inferior com enxerto de mucosa e 2 formações de fórnice superior com enxerto de mucosa. Todos os pacientes foram capazes de usar prótese no pós-operatório. Conclusão: A utilização de enxertos de dermofato para corrigir problemas de anoftalmia causados por déficits de volume orbital ou deslocamento de volume é um método cirúrgico eficaz, confiável e reprodutível.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Orbit/surgery , Ophthalmologic Surgical Procedures/adverse effects , Anophthalmos/surgery , Reconstructive Surgical Procedures/adverse effects , Orbital Implants/adverse effects , Ophthalmologic Surgical Procedures/methods , Retrospective Studies , Reconstructive Surgical Procedures/methods , Eyelids/surgery
15.
Article in Korean | WPRIM | ID: wpr-811332

ABSTRACT

PURPOSE: To report the clinical manifestations and computed tomography (CT) findings of patients with a trapdoor type medial orbital wall blowout fracture.METHODS: From March 2009 to October 2016, the clinical records and computed tomography findings of patients who underwent surgical treatment for a trapdoor type medial orbital wall blowout fracture were retrospectively analyzed.RESULTS: A total of eight patients (six males and two females) were enrolled with a combined mean age of 14.4 years. Clinical manifestations were eyeball movement limitation (abduction and adduction) and ocular motility pain (eight patients, 100%), diplopia (seven patients, 87.5%), and nausea and vomiting (four patients, 50%). On CT, the distance from the orbital apex to the fracture site was an average of 22.0 mm and occurred in the middle position of the entire wall. Two patients had missed rectus completely dislocated into the ethmoid sinus through the fracture gap and six patients had definite involvement in the fracture gap and edema of the medial rectus muscle. The medial rectus muscle cross-sectional area was 47.7 mm² which was edematous compared to the contralateral eye (40.1 mm²). Orbital wall reconstruction was performed an average of 4.1 days after the injury. In all patients with oculocardiac reflex-like nausea and vomiting immediately improved after surgery. Six out of eight patients who had eyeball movement limitations (abduction and adduction) preoperatively showed adduction limitation after surgery. The eyeball movement limitation and diplopia disappeared 11.7 days and 46.7 days after surgery, respectively.CONCLUSIONS: Patients with trapdoor type medial wall blowout fracture showed characteristic computed tomographic findings and clinical manifestations such as eyeball movement limitation, ocular motility pain, diplopia, and oculocardiac reflex. An understanding of clinical findings and quick surgical treatment are therefore required. The type of eyeball movement limitation was abduction and adduction limitation preoperatively and adduction limitation postoperatively.


Subject(s)
Diplopia , Edema , Ethmoid Sinus , Humans , Male , Nausea , Orbit , Reflex, Oculocardiac , Retrospective Studies , Vomiting
16.
Annals of Dermatology ; : 155-158, 2020.
Article in English | WPRIM | ID: wpr-811081

ABSTRACT

Solitary fibrous tumors (SFT) are uncommon mesenchymal tumors. SFT have several synonyms including localized fibrous tumor, benign mesothelioma, localized fibrous mesothelioma, and submesothelial fibroma. SFT usually occur in the pleura or other serosal surfaces, but SFT can also develop in extrapleural areas including the nasal cavity, orbit, retroperitoneum, and pelvis. Cutaneous SFT is extremely rare, and more likely to occur in the head and neck region. Histologically, this tumor can mimic a variety of benign and malignant tumors such as dermatofibroma, dermatofibrosarcoma protuberans, spindle cell lipoma or other mesenchymal tumors. Most cases of SFT show non-aggressive clinical courses, with low recurrence rates. Herein, we describe a case of primary cutaneous SFT which presented with huge mass on the back.


Subject(s)
Dermatofibrosarcoma , Head , Histiocytoma, Benign Fibrous , Lipoma , Mesothelioma , Nasal Cavity , Neck , Orbit , Pelvis , Pleura , Recurrence , Skin , Solitary Fibrous Tumor, Pleural , Solitary Fibrous Tumors
17.
Article in English | WPRIM | ID: wpr-810980

ABSTRACT

OBJECTIVE: We aimed to investigate the ability of readout-segmented echo-planar imaging (rs-EPI)-based diffusion tensor imaging (DTI) in assessing the microstructural change of extraocular muscles (EOMs) and optic nerves in patients with thyroid-associated orbitopathy (TAO) as well as in evaluating disease activity.MATERIALS AND METHODS: We enrolled 35 TAO patients and 22 healthy controls (HCs) who underwent pre-treatment rs-EPI-based DTI. Mean, axial, and radial diffusivity (MD, AD, and RD) and fractional anisotropy (FA) of the medial and lateral EOMs and optic nerve for each orbit were calculated and compared between TAO and HC groups and between active and inactive TAO groups. Factors such as age, sex, disease duration, mediation, and smoking history between groups were also compared. Logistic regression analysis was used to evaluate the predictive value of significant variables for disease activity.RESULTS: Disease duration was significantly shorter in active TAOs than in inactive ones (p < 0.001). TAO patients showed significantly lower FA and higher MD, AD, and RD than HCs for both medial and lateral EOMs (p < 0.001), but not the AD value of lateral EOMs (p = 0.619). Active patients had significantly higher FA, MD, and AD than inactive patients for medial EOMs (p < 0.005), whereas only FA differed significantly in the lateral EOMs (p = 0.018). The MD, AD, and RD of optic nerves were significantly lower in TAO patients than HCs (p < 0.05), except for FA (p = 0.129). Multivariate analysis showed that the MD of medial EOMs and disease duration were significant predictors for disease activity. The combination of these two parameters showed optimal diagnostic efficiency for disease activity (area under the curve, 0.855; sensitivity, 68.4%; specificity, 96.9%).CONCLUSION: rs-EPI-based DTI is promising in assessing microstructural changes of EOMs and optic nerves and can help to indicate the disease activity of TAO, especially through the MD of medial EOMs.


Subject(s)
Anisotropy , Diffusion Tensor Imaging , Diffusion , Echo-Planar Imaging , Humans , Logistic Models , Multivariate Analysis , Muscles , Negotiating , Optic Nerve , Orbit , Sensitivity and Specificity , Smoke , Smoking , Troleandomycin
18.
Article in English | WPRIM | ID: wpr-810956

ABSTRACT

BACKGROUND: The big data provided by Health Insurance Review and Assessment (HIRA) contains data from nearly all Korean populations enrolled in the National Health Insurance Service. We aimed to identify the incidence of facial fractures and its trends in Korea using this big data from HIRA.METHODS: We used the Korean Standard Classification of Disease and Cause of Death 6, 7 for diagnosis codes. A total of 582,318 patients were included in the final analysis. All statistical analyses were performed using SAS software and SPSS software.RESULTS: The incidence of facial fractures consistently declined, from 107,695 cases in 2011 to 87,306 cases in 2016. The incidence of facial fractures was the highest in June 2011 (n = 26,423) and lowest in January 2014 (n = 10,282). Nasal bone fractures were the most common, followed by orbit and frontal sinus fractures. The percentage of nasal bone fractures declined, whereas those of orbital fractures increased from 2011 to 2016 (P < 0.001). Among orbital fractures, inferior wall fractures were the most common, followed by medial wall fractures. Among mandibular fractures, angle fractures were the most common, followed by condylar process and symphysis fractures. Although it was difficult to predict the most common type of zygomatic and maxilla fractures, their incidence consistently declined since 2011.CONCLUSION: We observed trends in facial fractures in Korea using big data including information for nearly all nations in Korea. Therefore, it is possible to predict the incidence of facial fractures. This study is meaningful in that it is the first study that investigated the incidence of facial fractures by specific type.


Subject(s)
Cause of Death , Classification , Diagnosis , Facial Bones , Fractures, Bone , Frontal Sinus , Humans , Incidence , Insurance, Health , Korea , Mandibular Fractures , Maxilla , Nasal Bone , National Health Programs , Orbit , Orbital Fractures
19.
Article in Korean | WPRIM | ID: wpr-785347

ABSTRACT

Immunoglobulin (Ig) G4-related disease (IgG4-RD) is newly recognized immune-mediated and fibroinflammatory conditions with various organ involvements. Any organs can be involved, but the pancreas, salivary gland, lymph nodes, and orbit are known to be commonly involved organs. A 54-year-old man presented with complaint of psoriasis like skin rash developed 4 years prior to admission. Although he had been treated for skin rash, the extent of skin lesions increased as well as hypereosinophilia, and multiple lymphadenopathies were newly developed. The patient was diagnosed with IgG4-RD by serum IgG4 levels and histologic examination of the inguinal lymph node. One month after treatment with steroid and azathioprine, his skin rash and lymphadenopathies resolved with improvement and eosinophil count was within the normal range. We herein report a case of a IgG4-RD patient associated with psoriasis-like skin rash and hypereosinophilic syndrome.


Subject(s)
Azathioprine , Eosinophils , Exanthema , Humans , Hypereosinophilic Syndrome , Immunoglobulin G , Immunoglobulins , Lymph Nodes , Middle Aged , Orbit , Pancreas , Psoriasis , Reference Values , Salivary Glands , Skin
20.
Rev. bras. cir. plást ; 34(4): 552-556, oct.-dec. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1047925

ABSTRACT

A neurofibromatose tipo 1 é uma doença autossômica dominante rara, com manifestações clínicas diversas. Sua apresentação mais marcante é a presença de neurofibromas (tumores da bainha neural) cutâneos ou internos, que também podem ocorrer de forma esporádica, associados a outras manifestações sistêmicas, como manchas café com leite e lesões oculares. Por serem tumores da bainha de mielina, os neurofibromas podem acometer diversos nervos periféricos, incluindo nervos da face. Apresentamos o caso de um paciente de 1 ano, portador de neurofibromatose tipo 1, com neurofibroma em nervo infraorbital direito, com o acesso proposto para tratamento cirúrgico que fornecesse ampla visualização e acesso a lesão, sem comprometimento estético importante, permitindo preservação de partes moles e adequado crescimento facial.


Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disease with multiple clinical manifestations. Its most significant presentation is cutaneous or subcutaneous neurofibromas (myelin sheath tumors), which may be associated with other systemic manifestations such as caféau- lait spots and eye involvement. Neurofibromas can affect several peripheral nerves, including the facial nerves. This report presents a case of a 1-year-old patient with NF1 with right infraorbital nerve neurofibroma in which the proposed access for surgical treatment allowed adequate visualization of the tumor with good aesthetic results, preservation of the soft tissues, and normal facial growth.


Subject(s)
Humans , Male , Infant , History, 21st Century , Orbit , Surgical Procedures, Operative , Orbital Pseudotumor , Neurofibromatoses , Nerve Sheath Neoplasms , Face , Neurofibroma , Orbit/abnormalities , Orbit/surgery , Surgical Procedures, Operative/methods , Orbital Pseudotumor/surgery , Orbital Pseudotumor/immunology , Orbital Pseudotumor/therapy , Neurofibromatoses/surgery , Neurofibromatoses/diagnosis , Nerve Sheath Neoplasms/surgery , Nerve Sheath Neoplasms/therapy , Face/surgery , Neurofibroma/surgery , Neurofibroma/therapy
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