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1.
Braz. j. otorhinolaryngol. (Impr.) ; 88(2): 257-262, Mar.-Apr. 2022. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1374726

RESUMEN

Abstract Introduction: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. Objective: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome. Methods: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group. Results: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD = −4.02 [−7.93; −0.12], p -value = 0.04, I2 = 96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR = 0.78 [0.27; 2.23], p -value = 0.64,I2 = 0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group. Conclusion: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.


Resumo Introdução: O tratamento padrão da celulite orbitária inicia-se com uma combinação de antibióticos intravenosos de amplo espectro concomitante ao tratamento do seio comprometido. Objetivos: O objetivo deste estudo foi avaliar se a adição de corticosteroides poderia levar a uma resolução mais precoce da inflamação e melhorar o desfecho da doença. Método: Fizemos uma pesquisa independente em cinco bancos de dados (PubMed, SCOPUS, Embase, Web of Science e o banco de dados Cochrane) em busca de estudos publicados até dezembro de 2019. Dos estudos incluídos, revisamos a celulite orbitária e a morbidade da doença através dos períodos de internação, incidência de drenagem cirúrgica, edema periorbital, visão, níveis de proteína C-reativa e níveis séricos de leucócitos com foco na comparação do grupo tratado com esteroides e antibióticos e do grupo tratado apenas com antibióticos. Resultados: Os tempos de internação após a admissão dos diagnosticados com celulite orbitária (SMD = -4,02 [-7,93; -0,12], p-valor = 0,04, I2 = 96,9%) diminuíram no grupo tratado com esteroides e antibióticos em comparação ao grupo tratado apenas com antibióticos. A incidência de drenagem cirúrgica (OR = 0,78 [0,27; 2,23], p-valor = 0,64, I2 =0,0%) foi menor no grupo tratado com esteroides e antibióticos em comparação com o grupo tratado apenas com antibióticos. Conclusão: O uso de esteroides sistêmicos como adjuvante da antibioticoterapia sistêmica para celulite orbitária pode diminuir a inflamação orbitária com baixo risco de agravar a infecção. Com base em nossa análise, concluímos que o uso precoce de esteroides por um curto período pode ajudar a encurtar os dias de internação e prevenir a progressão da inflamação.


Asunto(s)
Humanos , Enfermedades Orbitales/complicaciones , Enfermedades Orbitales/tratamiento farmacológico , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/etiología , Celulitis Orbitaria/tratamiento farmacológico , Esteroides , Celulitis (Flemón)/complicaciones , Celulitis (Flemón)/tratamiento farmacológico , Estudios Retrospectivos , Corticoesteroides/uso terapéutico , Inflamación , Antibacterianos/uso terapéutico
2.
Int. j. morphol ; 39(6): 1683-1687, dic. 2021. ilus, tab
Artículo en Inglés | LILACS | ID: biblio-1385553

RESUMEN

SUMMARY: Late orbital reconstruction is a complex and challenge for surgeons. The aim of this article is to present complex orbital reconstruction using patient specific implant (PSI) strategy and polyetheretherketone (PEEK). A literature review and a cases series of sequelae after complex orbital trauma are presented; cases with great middle third deformities showing defect in the maxilla, nasal area, body of the zygoma and zygomatic arch were included; in both cases the sequelae was for more than 10 years. Virtual planning and PEEK implants were manufacture using a puzzle (two or three parts) by 3D print or injection. Patients were treated and their surgeries carried out without complications, using a minimal surgical approach. No infections were observed, and after 12 months follow-up they were stable showing normal function. PSI based-PEEK for orbital reconstruction are safe, efficient, effective and to obtain orbital morphology with low complications.


RESUMEN: La reconstrucción tardía de la órbita es un desafío complejo para cirujanos. El objetivo de este artículo fue presentar la reconstrucción orbitaria compleja utilizando implante paciente específico (PSI) y polietereterketona (PEEK). Son presentados una revisión de literatura y una serie de casos con secuelas posteriores a un trauma orbitario complejo; además, son presentados casos con gran deformidad del tercio medio del rostro mostrando defectos en maxila, área nasal, cuerpo del hueso cigomático y arco cigomático; ambos casos de secuela fueron por más de 10 años. Planificación virtual e implantes en PEEK fueron creados usando una estrategia de puzzle (dos o tres partes) por inyección o impresión 3D. Los pacientes fueron tratados y sus cirugías realizadas sin complicaciones usando accesos quirúrgicos reducidos. No se observaron infecciones y después de 12 meses de seguimiento permanecieron estables mostrando función normal. Los PSI para reconstrucción orbitaria son seguros, eficientes, efectivos y recuperan morfología de órbita con bajas complicaciones.


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Enfermedades Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Impresión Tridimensional , Órbita/lesiones , Enfermedades Orbitales/complicaciones , Polímeros/química , Benzofenonas/química , Materiales Biocompatibles/química , Resultado del Tratamiento , Implantes Orbitales
3.
Journal of Taibah University Medical Sciences. 2015; 10 (4): 496-500
en Inglés | IMEMR | ID: emr-175039

RESUMEN

Orbital complications in sickle cell disease are uncommon, but can be severe enough to result in significant morbidity. We report a 10-year-old boy with sickle cell disease who presented with fever, bilateral eyelid edema, proptosis, and diminished vision with left eye involvement more than the right eye. Investigations revealed anemia, thrombocytopenia, and derangement of coagulation profile consistent with disseminated intravascular coagulopathy, and salmonella species was recovered from blood culture. MRI of the orbits showed bilateral large subperiosteal hematomas. The treatment included intravenous antibiotics, pulse methylprednisolone and bilateral canthotomy with surgical drainage of the hematomas. Postoperative visual assessment revealed complete loss of vision in the left eye with normal vision in right eye. This case highlights the importance of the early evaluation and consideration of surgical intervention in sickle cell disease with this rare complication


Asunto(s)
Humanos , Masculino , Niño , Enfermedades Orbitales/complicaciones
4.
Korean Journal of Ophthalmology ; : 52-54, 2013.
Artículo en Inglés | WPRIM | ID: wpr-19706

RESUMEN

The author reports a case of orbital Sarcoidosis in a 70-year-old female that initially presented as diffuse swelling of the lower eyelid. The patient complained of painless swelling of the left lower lid without palpable mass, and a computerized tomography (CT) scan of the orbit was unremarkable. A serum angiotensin converting enzyme level was elevated, and hilar lymphadenopathy was noted on the chest CT. The patient underwent surgical debulking for histologic confirmation, which led to a final diagnosis of sarcoidosis involving the orbital fat. Unexplained chronic eyelid swelling without a mass should be considered a possible ophthalmic manifestation of orbital sarcoidosis.


Asunto(s)
Anciano , Femenino , Humanos , Biopsia , Diagnóstico Diferencial , Edema/diagnóstico , Enfermedades de los Párpados/diagnóstico , Párpados/patología , Enfermedades Orbitales/complicaciones , Sarcoidosis/complicaciones , Tomografía Computarizada por Rayos X
7.
Arq. bras. oftalmol ; 71(4): 579-580, jul.-ago. 2008. ilus
Artículo en Inglés | LILACS | ID: lil-491893

RESUMEN

Group A beta-hemolytic streptococcus is the most common agent implicated in post-infectious acute glomerulonephritis. We report a case of acute poststreptococcal glomerulonephritis associated with sinus-related orbital abscess in an 11-year-old boy treated with surgical drainage and intravenous ceftriaxone and clindamycin. Twelve days after supportive measures, renal function was normalized. We also discuss this potentially severe nonsuppurative complication of orbital cellulitis caused by group A beta-hemolytic streptococcus.


Os estreptococos beta-hemolíticos do grupo A são os agentes mais comumente envolvidos na glomerulonefrite aguda pós-infecciosa. Relatamos um caso de glomerulonefrite pós-estreptocócica aguda associada a um abscesso orbitário secundário à sinusite, em menino de 11 anos de idade, o qual foi tratado com ceftriaxona e clindamicina endovenosas e drenagem cirúrgica. Doze dias após tratamento de suporte, a função renal se normalizou. Também discutimos a importância desta grave e potencial complicação não supurativa das celulites orbitárias causadas pelos estreptococos beta-hemolíticos do grupo A.


Asunto(s)
Niño , Humanos , Masculino , Absceso/complicaciones , Glomerulonefritis/complicaciones , Enfermedades Orbitales/complicaciones , Infecciones Estreptocócicas/complicaciones , Enfermedad Aguda , /análisis , /análisis , Seno Maxilar/cirugía , Streptococcus pyogenes/aislamiento & purificación
8.
Korean Journal of Ophthalmology ; : 66-69, 2008.
Artículo en Inglés | WPRIM | ID: wpr-142608

RESUMEN

PURPOSE: To report a case of bilateral ophthalmic artery occlusion in rhino-orbito-cerebral mucormycosis. METHODS: Reviewed clinical charts, photographs, and fluorescein angiography RESULTS: An 89-year-old man with poorly controlled diabetes developed sudden bilateral ptosis, complete ophthalmoplegia of the right eye, and superior rectus palsy of the left eye. Brain and orbit magnetic resonance imaging showed midbrain infarction and mild diffuse sinusitis. On the 2nd day of hospitalization, sudden visual loss and light reflex loss developed. There were retinal whitening, absence of retinal arterial filling, and a total lack of choroidal perfusion on fluorescein angiography of the right eye. The left eye showed a cherry red spot in the retina and the absence of retinal arterial filling and partial choroidal perfusion on fluorescein angiography. On rhinologic examination, mucormyosis was noticed. Despite treatment, visual acuity and light reflex did not recover and he died 4 days after admission. CONCLUSIONS: Bilateral ophthalmic artery occlusion can occur in rhino-orbital-cerebral mucormycosis.


Asunto(s)
Anciano de 80 o más Años , Humanos , Masculino , Arteriopatías Oclusivas/diagnóstico , Encefalopatías/complicaciones , Resultado Fatal , Lateralidad Funcional , Imagen por Resonancia Magnética , Mucormicosis/complicaciones , Arteria Oftálmica/patología , Enfermedades Orbitales/complicaciones , Enfermedades de los Senos Paranasales/complicaciones
9.
Korean Journal of Ophthalmology ; : 66-69, 2008.
Artículo en Inglés | WPRIM | ID: wpr-142605

RESUMEN

PURPOSE: To report a case of bilateral ophthalmic artery occlusion in rhino-orbito-cerebral mucormycosis. METHODS: Reviewed clinical charts, photographs, and fluorescein angiography RESULTS: An 89-year-old man with poorly controlled diabetes developed sudden bilateral ptosis, complete ophthalmoplegia of the right eye, and superior rectus palsy of the left eye. Brain and orbit magnetic resonance imaging showed midbrain infarction and mild diffuse sinusitis. On the 2nd day of hospitalization, sudden visual loss and light reflex loss developed. There were retinal whitening, absence of retinal arterial filling, and a total lack of choroidal perfusion on fluorescein angiography of the right eye. The left eye showed a cherry red spot in the retina and the absence of retinal arterial filling and partial choroidal perfusion on fluorescein angiography. On rhinologic examination, mucormyosis was noticed. Despite treatment, visual acuity and light reflex did not recover and he died 4 days after admission. CONCLUSIONS: Bilateral ophthalmic artery occlusion can occur in rhino-orbital-cerebral mucormycosis.


Asunto(s)
Anciano de 80 o más Años , Humanos , Masculino , Arteriopatías Oclusivas/diagnóstico , Encefalopatías/complicaciones , Resultado Fatal , Lateralidad Funcional , Imagen por Resonancia Magnética , Mucormicosis/complicaciones , Arteria Oftálmica/patología , Enfermedades Orbitales/complicaciones , Enfermedades de los Senos Paranasales/complicaciones
10.
Arq. bras. oftalmol ; 70(6): 1029-1033, nov.-dez. 2007. ilus
Artículo en Portugués | LILACS | ID: lil-474116

RESUMEN

Inflamação orbital não-específica apresenta diversas formas clínicas. O envolvimento do segmento posterior do olho, geralmente, por contigüidade pode trazer sérios danos à função visual. A esclerite posterior, em geral, acarreta prejuízo permanente da visão e raramente evolui com glaucoma agudo. RELATO DO CASO: E.N., 24 anos, masculino, negro apresentando queixa de dor em OE há dez dias, acompanhada de diminuição da acuidade visual, mal-estar geral, náuseas e vômitos. Ao exame oftalmológico apresentava proptose, restrição da movimentação e edema na pálpebra superior de OE. AV c/c: 20/20 e CD 1,5m. À biomicroscopia, apresentava em OE hiperemia conjuntival, córnea com precipitados endoteliais, câmara anterior rasa, células e " flare" na câmara anterior 2+. Pressão intra-ocular (Po) de 14 mmHg em OD e 34 mmHg em OE. A gonioscopia em OE evidenciava ângulo fechado 360º, não se visualizando linha de Schwalbe. O mapeamento de retina revelava aumento da tortuosidade vascular e edema do pólo posterior. O tratamento para o glaucoma agudo foi instituído, ainda em ambiente hospitalar, e solicitados exames complementares. O exame de ultra-som ocular e TC de órbita revelaram espessamento difuso da parede ocular e da musculatura extrínseca ocular. Os demais exames apresentaram-se dentro da normalidade. A hipótese diagnóstica foi de inflamação orbitária anterior não-específica aguda com envolvimento do segmento posterior do globo ocular, complicado por glaucoma agudo. Instituiu-se tratamento com prednisona 60 mg/dia via oral. Após duas semanas do início da corticoterapia sistêmica, apresentava-se assintomático com nítida regressão da proptose, do quadro de esclerite e normalização da Po (11mmHg em AO). O presente caso, apesar de pouco freqüente, mostra que o glaucoma agudo pode estar presente em um quadro inflamatório orbitário e deve ser tratado com corticoterapia sistêmica, além da medicação tópica.


The nonspecific orbital inflammatory presents several clinical forms. When it evolves the posterior segment of the eye, usually by contiguity, it can lead to serious damage to vision functions. Posterior scleritis causes permanent damage to the vision and rarely progresses to acute glaucoma. CASE REPORT: E.N., a 24-year-old black man, complained of pain in the left eye (OS) for ten days, with low visual acuity, malaise, nauseas and vomiting. On ophthalmologic examination, he presented proptosis, restricted eye movements and edema on the upper left eyelid. Best-corrected visual acuity was 20/20 in OD and counting fingers at 1.5m in OS. The intraocular pressure was 14mmHg in OD and 34 mmHg in OS. The biomicroscopy presented in OS conjunctival hyperemia cornea with keratic precipitates, shallow anterior chamber with cells and flare 2+. Gonioscopy in OS showed angle-closure of 360º. The ophthalmoscopic examination revealed increased vascular tortuosity and posterior pole edema. Treatment for acute glaucoma was initiated and complementary tests were ordered. Ocular ultrasonography and orbit computerized tomography showed a diffuse thickening of the ocular wall and extrinsic muscles. Other tests were normal. The presumptive diagnosis was acute nonspecific orbital inflammation affecting the ocular bulb posterior segment together with acute glaucoma. He initiated on prednisone 60 mg/day PO. After two weeks of systemic corticotherapy, the patient was asymptomatic, with evident regression of proptosis and scleritis and normal intraocular pressure (11 mmHg in AU). Although not very frequent, acute glaucoma may be present in orbital inflammatory process and should be treated with systemic corticotherapy and topical medication.


Asunto(s)
Adulto , Humanos , Masculino , Glaucoma de Ángulo Cerrado/etiología , Enfermedades Orbitales/complicaciones , Escleritis/etiología , Edema/etiología , Exoftalmia/etiología
11.
Arq. bras. oftalmol ; 69(3): 427-429, maio-jun. 2006. ilus
Artículo en Portugués | LILACS | ID: lil-433812

RESUMEN

O prolapso de gordura orbitária é entidade benigna incomum que pode causar defeitos estéticos. Os autores apresentam uma paciente de 63 anos com prolapso de gordura orbitária temporal bilateral associado a pterígio medial bilateral, ressaltando aspectos clínicos e cirúrgicos. Discute-se a importância do diagnóstico clínico e de imagem, além da comprovação histopatológica da lesão.


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Tejido Adiposo/cirugía , Enfermedades Orbitales/complicaciones , Pterigion/complicaciones , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/cirugía , Prolapso , Pterigion/diagnóstico , Pterigion/cirugía , Resultado del Tratamiento
12.
Arq. bras. oftalmol ; 67(1): 153-156, jan.-fev. 2004. ilus
Artículo en Portugués | LILACS | ID: lil-359366

RESUMEN

Em crianças, as inflamações orbitárias idiopáticas são extremamente raras e de difícil diagnóstico. O presente trabalho tem por objetivo descrever um caso de inflamação orbitária idiopática aguda em criança de um ano e um mês de idade, que evoluiu com importante seqüela oculomotora. Além do estudo de caso, discute-se o diagnóstico diferencial entre a celulite orbitária e as inflamações orbitárias idiopáticas e faz-se uma revisão da literatura sobre a ocorrência das inflamações orbitárias idiopáticas na infância.


Asunto(s)
Humanos , Femenino , Lactante , Celulitis (Flemón) , Enfermedades Orbitales/complicaciones , Enfermedades Orbitales/diagnóstico , Inflamación/complicaciones , Estrabismo , Diagnóstico Diferencial , Órbita , Tomografía Computarizada por Rayos X
13.
Indian J Ophthalmol ; 2003 Mar; 51(1): 83-4
Artículo en Inglés | IMSEAR | ID: sea-71900

RESUMEN

Wooden intraorbital foreign body is characteristic for delayed manifestation, silent progression and unpredictable outcome. A silent wooden intraorbital foreign body is difficult to diagnose clinically. Spontaneous expulsion of entire foreign body is rare.


Asunto(s)
Adulto , Antibacterianos , Quimioterapia Combinada/uso terapéutico , Cuerpos Extraños en el Ojo/complicaciones , Lesiones Oculares Penetrantes/complicaciones , Migración de Cuerpo Extraño/etiología , Humanos , Masculino , Enfermedades Orbitales/complicaciones , Resultado del Tratamiento , Madera
14.
Artículo en Inglés | IMSEAR | ID: sea-41507

RESUMEN

A 6-month-old girl came to the hospital with swelling of the right lower eyelid, exophthalmos, chemosis and upward deviation of the eyeball--all of which had been present since birth. Iris, optic disc, and chorioretinal coloboma were also apparent. Magnetic resonance imaging revealed a small globe with a large cystic lesion in the orbit of the right eye. Pre- and post-operative photographs and magnetic resonance imaging indicated a safe, simple single orbital aspiration as an alternative treatment for mild microphthalmos with an orbital cyst.


Asunto(s)
Quistes/complicaciones , Femenino , Humanos , Lactante , Microftalmía/complicaciones , Enfermedades Orbitales/complicaciones
15.
Indian J Ophthalmol ; 2000 Sep; 48(3): 231-3
Artículo en Inglés | IMSEAR | ID: sea-71435

RESUMEN

Sarcoid is an idiopathic multisystem non-caseating granulomatous disease with protean clinical manifestations. In the eye, the common sites of involvement are the skin of eyelid, conjunctiva, uveal tract, retina, optic nerve and lacrimal gland.


Asunto(s)
Administración Oral , Biopsia con Aguja , Diagnóstico Diferencial , Diplopía/diagnóstico , Edema/diagnóstico , Enfermedades de los Párpados/diagnóstico , Párpados/patología , Glucocorticoides/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Músculos Oculomotores/diagnóstico por imagen , Órbita/patología , Enfermedades Orbitales/complicaciones , Prednisolona/administración & dosificación , Sarcoidosis/complicaciones , Tomografía Computarizada por Rayos X
16.
Radiol. bras ; 33(3): 175-8, maio-jun. 2000. ilus
Artículo en Portugués | LILACS | ID: lil-280185

RESUMEN

Os autores descrevem um caso incumum de metástase orbitária de tumor renal envolvendo a musculatura extrínseca ocular bilateralmente, apresentando-se como manifestaçäo inicial do tumor original. Säo analisados os aspectos tomográficos da lesäo, sendo ressaltada a importância desse diagnóstico como diferencial nas lesões orbitárias.


Asunto(s)
Humanos , Masculino , Femenino , Adenocarcinoma/complicaciones , Enfermedades Orbitales/complicaciones , Riñón/fisiopatología , Diagnóstico por Imagen
17.
Indian J Cancer ; 1996 Dec; 33(4): 171-2
Artículo en Inglés | IMSEAR | ID: sea-49878

RESUMEN

A patient with primary non-hodgkins lymphoma of the paranasal sinuses presenting as rhinoorbital myiasis is reported. The myiasis causing species was identified as Chrysomia bezziana Villeneuve. This case demonstrates the extreme destruction caused by myiasis and the inadequacy of therapeutic options available in such patients.


Asunto(s)
Senos Etmoidales/parasitología , Femenino , Humanos , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma no Hodgkin/complicaciones , Persona de Mediana Edad , Miasis/complicaciones , Enfermedades Orbitales/complicaciones , Neoplasias de los Senos Paranasales/complicaciones , Rinitis/complicaciones
19.
Artículo en Inglés | IMSEAR | ID: sea-43363

RESUMEN

This is the first case report of primary orbital amyloidoma in a 56-year-old Thai man who presented with proptosis for 4 days. He also complained of orbital discomfort associated with palpitation during the past 4 months. He was treated with corticosteroid for 6 months and slight left orbital pain ensued after cortisone discontinuation. Surgical removal of the orbital mass was done and proved to be "Amyloidoma" by multiple method technologies AL type. His visual acuity and proptosis were improved. Investigation for systemic amyloidosis was done by rectal biopsy and protein electrophoresis but there was no evidence of systemic amyloidosis. The authors reported the first case of orbital amyloidoma in Thailand.


Asunto(s)
Amiloidosis/complicaciones , Exoftalmia/etiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/complicaciones
20.
SJO-Saudi Journal of Ophthalmology. 1995; 9 (1): 29-37
en Inglés | IMEMR | ID: emr-39542

RESUMEN

Purpose: To present a number of cases of sinonasal disease with secondary orbital involvement and to review these disorders in the light of previously published reports. A retrospective study of patients with primary sinonasal tract disease and secondary orbital involvement who were admitted to the King Abdul Aziz University Hospital in Riyadh, Saudi Arabia from 1988 to 1993. Patients with disease causing concomitant involvement of the sinonasal tract and the orbit which did not originate in the sinuses were excluded, as were ambulatory patients. The final study group comprised 28 patients [19 males and 9 females, ranging in age from 18 months to 65 years, mean 33 years] with the following diagnoses: nine bacterial sinusitis, eight fungal sinusitis, two mucoceles, two osteomata, one fibrous dysplasia, one angiofibroma, one fibromatosis, and four carcinomas. Conclusions: Diseases of the sinonasal tract with orbital extension must be considered whenever a patient presents with signs and symptoms of orbital disease. Cooperation between the ophthalmologist and the otolaryngologist is desirable for proper management


Asunto(s)
Humanos , Enfermedades Orbitales/complicaciones , Sinusitis/patología , Neoplasias de los Senos Paranasales/etiología , Estudios Retrospectivos/métodos
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