Características clínicas y evolutivas de pacientes rehabilitados con prótesis oculares / Clinical and evolutive characteristics of patients rehabilitated with ocular prosthesis

Introducción: La prótesis ocular es un medio artificial con fines funcional y estético, que posibilita la rehabilitación física, psíquica y social de pacientes con defectos en los ojos. Objetivo: Describir la evolución de los pacientes con prótesis ocular según signos de infección en las cavidades oculares rehabilitadas, factores de riesgos asociados, así como modificaciones en la forma de la cavidad y/o en la prótesis ocular. Métodos: Se realizó un estudio observacional, longitudinal y prospectivo de 74 pacientes aquejados por defectos oculares, que recibieron tratamiento protésico en el período de 2018 a 2019 en la Clínica de Rehabilitación Bucomaxilofacial de Santiago de Cuba, los cuales fueron evaluados a través de una encuesta y un examen clínico en tres momentos durante un año de evolución. Para establecer la asociación entre variables, se emplearon la prueba de la Χ2 de Pearson y la exacta de Fisher de acuerdo con el cumplimiento de supuestos. Resultados: De los 222 exámenes efectuados a las cavidades oculares rehabilitadas, 31 revelaron la presencia de secreciones en 23 pacientes, con recurrencia en 8 de ellos; dicho signo clínico se manifestó de manera similar a la hipercoloración de la conjuntiva en cuanto al momento del hallazgo y al grupo etario afectado, con mayores porcentajes al año de evolución y una incidencia superior en los pacientes de 60 y más años de edad. Asimismo, se constató una asociación estadísticamente significativa de las variables higiene diaria de la cavidad y de la prótesis con la existencia de secreciones, para un intervalo de confianza de 95 %. Conclusiones: Se demostró la ventaja del aseo semanal de la cavidad ocular y de la prótesis en sus portadores, pues con ello se disminuye la frecuencia de los signos inflamatorios e infecciosos de la mucosa, lo que debe observarse con mayor rigurosidad en los ancianos, quienes resultan ser los más afectados.

Introduction: Ocular prosthesis is an artificial means with functional and cosmetic ends that facilitates the physical, psychic and social rehabilitation of patients with eyes defects. Objective: To describe the evolution of patients with ocular prosthesis according to infection signs in the rehabilitated ocular cavities, associated risk factors, as well as modifications in the form of the cavity and/or in the ocular prosthesis Methods: An observational, longitudinal and prospective study of 74 patients suffering from eye defects that received prosthetist treatment from 2018 to 2019 in the oral maxillofacial Rehabilitation Clinic was carried out in Santiago de Cuba, who were evaluated through a survey and a clinical exam in three moments during a year of evolution. To establish the association between variables, the Pearson chi-square and Fisher exact tests were used with the fulfillment of suppositions. Results: Of the 222 exams made to the rehabilitated ocular cavities, 31 revealed the presence of secretions in 23 patients, with recurrence in 8 of them; this clinical sign became evident in a similar way to the hypercoloring of the conjunctiva as for the moment of the finding and the age group affected, with higher percentages at the year of evolution and a higher incidence in the patients of 60 years and over. Also, an association statistically significant of the daily hygiene of the cavity and prosthesis variables with the existence of secretions was verified, for a confidence interval of 95 %. Conclusions: The advantage of the ocular cavity and prosthesis weekly personal cleanliness was demonstrated, because with it the frequency of the inflammatory and infectious signs of the mucous is reduced, what should be strictly observed in elderly, who are the most affected.

Rehabilitación protésica híbrida en un defecto orofacial. Presentación de un caso / Prosthetic hybrid rehabilitation in orofacial defect. Case presentation

Los procesos tumorales que comprometen la región de cabeza y cuello, pueden afectar particularmente la identidad del ser humano. Para la eliminación de estas neoplasias existen diferentes alternativas terapéuticas, que generan secuelas de tipo funcional, afectando: la fonación, deglución y masticación, además de defectos estéticos y alteraciones psicológicas. Por consiguiente, el enfoque para el tratamiento de pacientes con cáncer se basa no solamente en el control de la enfermedad, sino también en la supervivencia, rehabilitación y su reintegración a la sociedad. A continuación se presenta el caso de un paciente con defecto orofacial, resultado del tratamiento ante un carcinoma basocelular, con radioterapia y su posterior resección quirúrgica tras recidiva tumoral. Se rehabilita mediante la elaboración de una prótesis híbrida (obturador intraoral y prótesis facial) con el objetivo de compensar parcialmente las pérdidas funcionales, estéticas, incidiendo positivamente en su estado psicosocial.

Tumor processes compromising the head and neck region can particularly affect the identity of the human being. There are different therapeutic alternatives to remove these dysplasias, which generate functional sequels affecting phonation deglutition and mastication. Therefore, approach for cancer patients is not only based on control of the disease, but additionally in patient's survival, rehabilitation and reinsertion in society. We hereby present the case of a patient with an orofacial defect resulting from treatment of basal cell carcinoma with X-ray therapy and later surgical resection after tumor recurrence. The patient was rehabilitated with manufacture of a hybrid prosthesis (intraoral obturator and facial prosthesis) which was achieved with the purpose of partially compensating functional and aesthetic losses and thus improving the patient's psychosocial circumstances.

Prosthetic rehabilitation of an orbital and periorbital defect: a case report

Losing an eye can be a fatal experience for a patient. The deformed appearance of the face resulting after an oncosurgery may results in psychological trauma as well as social embarrassment for the patient. It is a challenge to manage the defect on the face with surgery. Maxillofacial Prosthodontist can fabricate and rehabilitate defects with orbital and periorbital prosthesis. The defect can be restored with custom made orbital prosthesis consisting of orbital globe made up of heat cured acrylic resin and periorbital prosthesis made up of silicon elastomeric material, which can give real life like appearance and also improves the quality of life of the patient. The patient can feel more comfortable and accepted in the social circle. A multidisciplinary approach and team management are essential in providing more accurate and effective rehabilitation of such defects. This case report presents the fabrication of a custom made orbital and periorbital prosthesis for a patient.

Mutilação de cabeça e pescoço: vivendo as perdas e refazendo os caminhos / Head and neck Mutilation: living the losses and rebuilding the roads

Introdução: A mutilação intra-oral, após tratamento de tumores, ocasiona além de deformidades estéticas, perda de função e impacto na qualidade de vida do paciente. Proposição: Avaliar a experiência individual do paciente tratado por lesões benignas e malignas que resultaram em mutilação intra-oral e necessidade de reabilitação complexa maxilo mandibular Material e Método: Através de entrevistas semi estruturadas, à luz da metodologia de análise de conteúdo, proposta por Bardin em 1977, utilizando a pergunta norteadora O que aconteceu na sua vida antes, durante e o que acontecerá depois da lesão/doença que te trouxe aqui, foram entrevistados seis pacientes, como mutilação intra-oral em reabilitação protética maxilo facial. Resultados e Discussão: Após análise, exploração e interpretação dos resultados colhidos em entrevistas semi-estruturadas, que duraram em média 1hora e meia a duas horas cada, foram extraídas duas categorias dos discursos dos sujeitos: Vivendo a mutilação, perdendo os dentes, a comunicação e a socialização e Preservando a esperança de um novo normal, respeitando a doença com a sombra da recidiva. Conclusão: Os dados revelam que o paciente que sofreu mutilação intra-oral após tratamento de tumor, é um sujeito que vive as seqüelas da terapêutica, tem respeito extremo pela doença que o levou àquela condição, tem medo de possíveis recidivas, mas, fundamentalmente, nutre a esperança de retomar sua vida e construir um novo normal.

Introduction: Intra-oral mutilation after treatment of tumors, causes beyond cosmetic deformities, loss of function and impact on quality of life of patients. Proposition: To evaluate the experience of the individual patient treated for benign and malignant lesions that resulted in injury intra-oral and maxillofacial complex rehabilitation needs Methods: Using semi-structured interview, supported of content analysis proposed by Bardin in 1977, using the guiding question "What happened in your life before, during and what will happen after the injury / illness that brought you here," were interviewed six patients, such as mutilation intra-oral maxillo facial prosthetic rehabilitation. Results and Discussion: After analysis, exploration and interpretation of the results collected from semi-structured interviews, which lasted on average 1 hour and a half to two hours each, were extracted from two categories of the speeches: Living mutilation, losing teeth, communication and socialization and preserving the hope of a "new normal", respecting the disease in the shadow of recurrence. Conclusion: Our data show that patients who suffered mutilation after intra-oral tumor treatment, is a guy who lives the consequences of therapy, has utmost respect for the disease that led to that condition, afraid of possible relapse, but fundamentally nurtures the hope of resuming their lives and build a "new normal".