RESUMEN
A retrospective study and review of the literature was performed on the use of demineralized bone implants for the correction of orbital and craniofacial defects. Demineralized bone implants heal by endochondral osteogenesis, inducing a transformation of local cells, as well as by osteoconduction, similar to autogenous grafts. They induce the chemotaxis and transformation of mesenchymal cells into chondroblasts, followed by ossification. They also act as a scaffold, with bone resorption taking place simultaneous with bone formation. This study reviewed 21 patients and 31 orbits, in which demineralized bone was used for orbitocranial reconstruction for congenital deformities (nine patients), after surgery for orbital fractures (seven patients: four floor, three roof), and orbital tumors (five patients). The surgical technique is described, and the results are discussed. The follow-up period averaged 15 months (6 months to 33 months). The overall resorption rate of the demineralized bone implants was estimated based on follow-up radiologic studies (facial films, computed tomography scans, and magnetic resonance imaging scans), as well as clinical examinations. All patients had a satisfactory to excellent result. The demineralized bone and Grafton (Osteotech, Shrewsbury, NJ, U.S.A.) was obtained from the Musculoskeletal Transplant Foundation of Holmdel, New Jersey, and it was all processed and reconstituted in a standard manner with Alloprep System. Surgical complications were cerebrospinal fluid leaks (one patient) with infection, transient chemosis, enophthalmos, and hypophthalmos. There were no complications related to demineralized bone alone. Properly prepared demineralized bone is a safe material for orbital reconstruction that eliminates the need for a second operative site to harvest a bone graft.
Asunto(s)
Matriz Ósea/trasplante , Trasplante Óseo , Huesos Faciales/cirugía , Órbita/cirugía , Cráneo/cirugía , Adulto , Técnica de Desmineralización de Huesos , Preescolar , Huesos Faciales/anomalías , Huesos Faciales/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Órbita/anomalías , Órbita/diagnóstico por imagen , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/cirugía , Oseointegración , Estudios Retrospectivos , Cráneo/anomalías , Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Trasplante HomólogoRESUMEN
A 20-year-old woman with myelomeningocele presented with acute right-ear pain and right hemiplegia which improved, but then progressively deteriorated. Surgery, after MRI, revealed a large arteriovenous malformation (AVM) involving the right side of the upper cervical cord and brainstem. The woman also had two epidermal nevi at the same site as the spinal cord AVMs. There has been no previous report of an association of myelomeningocele, spinal cord AVMs and epidermal nevi syndrome. The same location of the nevus and spinal cord AVMs, with a proposed common pathogenesis, raise the possibility that the association may be more than chance occurrence. Spinal cord AVMs should be considered in patients with myelomeningocele and similar clinical features.
Asunto(s)
Anomalías Múltiples/diagnóstico , Malformaciones Arteriovenosas/diagnóstico , Meningomielocele/diagnóstico , Nevo Pigmentado/diagnóstico , Médula Espinal/irrigación sanguínea , Adulto , Malformación de Arnold-Chiari/diagnóstico , Encefalopatías/complicaciones , Encefalopatías/fisiopatología , Tronco Encefálico/irrigación sanguínea , Angiografía Cerebral , Diagnóstico Diferencial , Femenino , Lateralidad Funcional , Humanos , Imagen por Resonancia MagnéticaRESUMEN
A patient with a gunshot wound to the spinal cord with an incomplete neurologic deficit is presented. The neurologic examination revealed a combination of a central cord injury and the Brown-Séquard Syndrome. The authors suggest that the Brown-Séquard portion of the syndrome was caused by compression of tracts within the spinal cord caused by the mass of the bullet and the central cord injury was produced by the kinetic energy of the bullet during penetration into the spinal canal. They conclude that with incomplete neurologic lesions following gunshot wounds the bullet be removed.