Infecção orbitária: experiência no manejo de seis casos / Orbital infeccion: experience on the management of six cases

Infecções orbitárias são enfermidades, que requerem atenção e cuidados especiais. Os principais fatores etiológicos associados são sinusites paranasais e o trauma local. Essas infecções classificam-se em pré-septal e pós-septal e distinguem-se clinicamente, de acordo com a manutenção da acuidade visual e motilidade do globo ocular. O curso da infecção pode agravar com disfunção da motilidade ocular extrínseca, perda de visão e trombose do seio cavernoso. A tomografia computadorizada (TC) é o principal exame imaginológico para a classificação do abscesso, investigação etiológica, determinação da gravidade e a relação do processo com o sistema nervoso central. Este trabalho apresenta e discute o manejo de seis pacientes admitidos com infecção orbitária pelo serviço de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Geral Roberto Santos e em Salvador, Bahia. A TC mostrou não haver disseminação do processo inflamatório para o sistema nervoso central em nenhum dos casos tendo esse achado sido fundamental para determinar que a conduta estivesse restrita à drenagem, sem necessidade de craniotomia. As intervenções cirúrgicas e a antibioticoterapia estavam indicadas devido à importante congestão tecidual e intensa sintomatologia dolorosa. Todos os pacientes apresentaram remissão da infecção e acuidade visual preservada... (AU)

Orbital infections are diseases that require special attention and care. The main risk factors are associated with paranasal sinusitis and local trauma. These infections are classified into pre-septal and post-septal and distinguished clinically according to the maintenance of visual acuity and eye motility. The course of the infection may worsen with extrinsic ocular motility dysfunction, loss of vision and cavernous sinus thrombosis. Computed tomography (CT) is the primary imaging examination for the classification of the abscess, etiologic investigation, determining the severity of the process and the relationship with the central nervous system. This paper presents and discusses the management of six patients admitted with orbital infection by service Oral and Maxillofacial Surgery General Hospital Roberto Santos in Salvador, Bahia. A CT scan showed no spread of the inflammatory process in the central nervous system and in any case this finding was important to determine that the drainage duct was confined without requiring craniotomy. Surgical interventions and antibiotics were given because of the important tissue congestion and intense painful symptoms. All patients had remission of infection and preserved visual acuity... (AU)

A Case of Odontogenic Orbital Cellulitis Causing Blindness by Severe Tension Orbit

We report a very rare case of odontogenic orbital cellulitis causing blindness by severe tension orbit. A 41-yr old male patient had visited the hospital due to severe periorbital swelling and nasal stuffiness while he was treated for a periodontal abscess. He was diagnosed with odontogenic sinusitis and orbital cellulitis, and treated with antibiotics. The symptoms were aggravated and emergency sinus drainage was performed. On the next day, a sudden decrease in vision occurred with findings of ischemic optic neuropathy and central retinal artery occlusion. Deformation of the eyeball posterior pole into a cone shape was found from the orbital CT. A high-dose steroid was administered immediately resulting in improvements of periorbital swelling, but the patient's vision had not recovered. Odontogenic orbital cellulitis is relatively rare, but can cause blindness via rapidly progressing tension orbit. Therefore even the simplest of dental problems requires careful attention.

Complicação orbital e intracraniana devido à rinossinusite aguda: relato de caso / Orbital and intracranial complication resulting from acute rhinosinusitis: case report

Introdução: Dentre as complicações da rinossinusite, as orbitárias são as mais frequentes, e estas, ocorrem na maioria dos casos entre jovens e crianças. Complicações simultâneas envolvendo a órbita e o espaço intracraniano são extremamente raras, mas devem ser tratadas agressivamente pois oferecem alta taxa de morbidade e mortalidade. Relato do Caso: Neste trabalho, os autores relatam um caso de um paciente que se apresentou com celulite pré-septal e abscesso epidural, como complicações simultâneas de uma rinossinusite aguda. No paciente deste estudo, optou-se pelo tratamento clínico associado à cirurgia endoscópica nasossinusal e drenagem neurocirúrgica do abscesso intracraniano. A TC foi suficiente no caso apresentado para a realização do diagnóstico. Comentários Finais: Recomenda-se entretanto, que nos casos de pacientes com complicações da rinossinusite, a investigação da extensão intracraniana seja aprofundada, mesmo quando esta, a princípio não seja tão evidente. Dada a natureza polimicrobiana dessas infecções, uma antibioticoterapia agressiva guiada por cultura e um acompanhamento por equipe multidisciplinar, aumentam consideravelmente as chances de sucesso.

Introduction: Among the rhinosinusitis complications, the orbital are the most frequent ones, occurring mostly in the youngsters and children. Simultaneous complications involving the intracranial orbit and space are extremely rare, but they must be severely treated for they have a high rate of morbidity and mortality. Case report: In this work, the authors report a case of a patient who appeared to have preseptal cellulites and epidural abscess, in the form of simultaneous complications of an acute rhinosinusitis. In the patient of this case, choice was made for a clinic treatment associated with a nasosinusal endoscopic surgery and neurosurgical drainage of the intracranial abscess. CT was enough to achieve the diagnosis of this case. Final commentaries: However, it is recommended that, in cases where patients have rhinosinusitis complications, an extensive intracranial investigation needs to be deepened even when this is not so evident in the beginning. Given the polymicrobial nature of these infections, an aggressive culture-guided antibiotic therapy and a multidisciplinary follow-up significantly increase the likelihood of success.

Ontogeny of scleral ossicles of giant amazon river turtles Podocnemis expansa Schweigger, 1812(Testudines, Podocnemididae)

Scleral ossicles are bony plates in the eye sockets of many vertebrates, whose morphology, development and position differ in distinct groups of vertebrates. To investigate the development, number, shape and arrangementof the scleral ossicles of Podocnemis expansa, 15 embryos were collected, starting from the 18th day of natural incubation and 16 adult specimens belonging to the LAPAS collection, whose eye sockets were removed. The embryos and eye sockets were subjected to bone diaphanization and staining techniques. The scleral ossicles in this species of Testudines were found to be quadrangular, varying in number from 10 to 13, with 11.25 ± 0.93 in the right eye and 11.43 ± 0.81 in the left eye, occupying a position close to the anterior edge of the sclera. The ossicles develop intramembranously and begin to present ossification centers at stage 21, with ten ossification centers in the right eye and eight in the left eye. In stage 23, all the ossicles of the sclerotic ring increase in length and approach the adjacent ossicles, forming a ring. In stage 26, the scleral ossiclesare already arranged in their definitive form.

Quiste meníngeo intraorbitario asociado a tejido cerebeloso heterotópico / Cystic meningeal intraorbitary association tissue cerebrose heterotopy

Presentamos el caso de una niña de 14 meses con colomboma coroideo bilateral y proptosis paraaxial progresiva del ojo izquierdo, en la que se halló un quiste meníngeo en la órbita izquierda con tejido cerebeloso ectópico. La lesión se resolvió hallar otros dos casos similares en la literatura, describiendo tejido cerebeloso ectópico en la órbita

Patologia dos anexos oculares / Ocular adnexal pathology

Os principais temas da patologia dos anexos oculares foram revistos, com ênfase nas patologias que pertencem ao campo de atuaçäo da oculoplástica.

Localization of intraocular and intraorbital foreign bodies using computed tomography

Accurate localization of foreign bodies in the region of the orbit is vital for correct management. Computed tomography is recommended as the investigation of choice following a plain radiograph in cases of suspected ocular injury by a metallic foreign body

Orbital manifestations of paranasal sinus diseases

Sixty patients, 42 males and 18 females with a male -female ratio of 2.3: l and age ranging from 1 year to 65 years with a mean of 34.37 years had orbital manifestations which were observed mostly in 2nd decade of life. Majority of them were from middle class. There were 14 inflammatory lesions, 28 malignant tumors, 8 benign tumors and 10 miscellaneous conditions. Among 14 inflammatory pathologies ethmoidal abscess and acute ethmoiditis were noted in 8 patients in younger age group, 20 cases of maxillary antral carcinoma were encountered among 28 malignant lesions, elderly males were the main victims, 8 cases of benign tumors were found in this series, 6 of them were osteomas, 4 arising from the frontal and the other 2 from the ethmoid. Miscellaneous lesions e.g., mucoceles, cysts etc, were found in 10 cases. Orbital manifestations from sinus diseases were multiple in most of the cases. Proptosis was found in 52 cases arising from all groups of sinus diseases. Orbital cellulitis was encountered in 6 cases. Blindness in 4 cases. Antibiotic, has reduced inflammatory diseases significantly but neoplastic infiltration has remained static. Early diagnosis and management reduce the fatal outcome of these diseases

Padecimientos congénitos y enfermedades hereditarias: teratoma congénito de la órbita

En el presente trabajo, se estudiaron dos pacientes con baja visual progresiva, proptosis dinámica y deformidad orbitaria por masas tumorales retrooculares. El estudio oftalmológico condujo al diagnóstico de teratomas congénitos de la órbita en los dos casos clínicos. Se realizó evaluación y tratamiento en cada uno de ellos, con el subsecuente estudio de la historia natural de la enfermedad.

Mucormicose (zigomicose) rino cerebral: apresentaçäo de dois casos com sobrevida / Mucomycosis (zygomycosis) rhinocerebral: report of two cases with prognosis

Säo relatados dois casos de mucormicose rinocerebral em jovens diabéticos. Num paciente, a micose teve curso arrastado e apesar do envolvimento sino-órbito-cerebral, a sintomatologia refletiu apenas o comprometimento órbito-ocular. No outro paciente, a doença teve curso agudo nasal e palatina, seios paranasais, tecidos periorbitários, olho e nervos cranianos, porém sem acometimento cerebral. Houve sobrevida de ambos os pacientes, porém, em apenas um deles o diagnóstico foi completo pelo isolamento do agente