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 OrbitalesRESUMEN
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.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades Orbitales/cirugía , Enfermedades Orbitales/etiología , Procedimientos Quirúrgicos Oftalmológicos/estadística & datos numéricos , Enfermedades de la Tiroides/complicaciones , Exoftalmia/cirugía , Exoftalmia/etiología , Órbita/cirugía , Exoftalmia/diagnóstico , Enfermedad de Graves/complicaciones , Estudios Transversales , Estudios Retrospectivos , Descompresión Quirúrgica/métodos , Presión IntraocularRESUMEN
The ideal implant for anophthalmic socket reconstruction has yet to be developed. Biosilicate, a highly bioactive glass-ceramic, has been used in the composition of conical implants, which were initially tested in rabbit orbits with excellent results. However, the use of this material and the conical shape of the implants require further study in the human anophthalmic socket. Thus, we propose the use of a new conical implant composed of Biosilicate for orbital volume augmentation in anophthalmic sockets. This prospective, randomized study included 45 patients receiving conical implants composed of either Biosilicate or polymethylmethacrylate (control). Patients were evaluated clinically before and 7, 30, 60, 120, and 180 days after implantation. Systemic evaluations, laboratory tests, and computed tomography of the orbits were performed preoperatively and 180 days postoperatively. Both groups had good outcomes with no significant infectious or inflammatory processes. Only 1 patient, in the Biosilicate group, had early implant extrusion. Laboratory tests were normal in both groups. Computed tomography scans showed that the implants in both groups were well positioned. The new conical implant composed of Biosilicate was successfully used for anophthalmic socket reconstruction. This implant may provide a good alternative to the only conical implant currently available on the market, which is composed of porous polyethylene.
Asunto(s)
Anoftalmos/cirugía , Vidrio , Enfermedades Orbitales/cirugía , Implantes Orbitales , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Implantación de Prótesis/métodos , Adulto JovenRESUMEN
BACKGROUND: The most common aetiological agents of mucormycosis are Rhizopus, Mucor, Apophysomyces and Lichtheimia. Apophysomyces is comparatively rare, as it has been reported in less than 3% of mucormycosis cases. The genus Apophysomyces includes six species, and only A. elegans, A. mexicanus, A. variabilis and A. ossiformis have been reported to cause infections in both immunocompetent and immunocompromised patients. CASE PRESENTATION: We present a case of a 46-year-old male patient with bilateral blepharoedema, corneal opacity in the left eye and poorly controlled diabetes mellitus. The patient was subjected to total maxillectomy, exenteration of the left orbit and treatment with liposomal amphotericin B. Direct mycological analysis with KOH 10% revealed hyaline, coenocytic, long and wide hyphae. Apophysomyces ossiformis was identified from maxillary biopsy using 18S-ITS1-5.8S-ITS2-28S rRNA gene amplification and sequencing. The patient requested to be transferred to another hospital to continue treatment, where he died on the ninth day after admittance. CONCLUSION: To the best of our knowledge, this is the first case of rhino-orbital mucormycosis due to A. ossiformis with a fatal outcome. This case reveals the need to identify the fungus causing mucormycosis with molecular methods to identify adequate treatment therapies for patients with this infection.
Asunto(s)
Complicaciones de la Diabetes/microbiología , Mucorales/genética , Mucormicosis/complicaciones , Enfermedades Orbitales/complicaciones , Rinitis/complicaciones , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Biopsia , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/cirugía , Resultado Fatal , Humanos , Huésped Inmunocomprometido , Masculino , Maxilar/microbiología , Maxilar/patología , Maxilar/cirugía , Persona de Mediana Edad , Mucormicosis/tratamiento farmacológico , Mucormicosis/microbiología , Mucormicosis/cirugía , Enfermedades Orbitales/tratamiento farmacológico , Enfermedades Orbitales/microbiología , Enfermedades Orbitales/cirugía , ARN Ribosómico 28S/genética , Rinitis/tratamiento farmacológico , Rinitis/microbiología , Rinitis/cirugíaRESUMEN
Gossypiboma and textiloma are terms used to describe tumor-like masses caused by retained gauze or surgical sponges after any operation. It is a rare surgical complication, usually difficult to diagnose due to its variable clinical presentation and nonstandard radiological appearance. We describe here a rare case of orbital gossypiboma in a child after surgical correction of an orbital blowout fracture.
Asunto(s)
Cuerpos Extraños en el Ojo/etiología , Reacción a Cuerpo Extraño/etiología , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Enfermedades Orbitales/etiología , Fracturas Orbitales/cirugía , Tapones Quirúrgicos de Gaza/efectos adversos , Niño , Diplopía/etiología , Exoftalmia/etiología , Cuerpos Extraños en el Ojo/diagnóstico por imagen , Cuerpos Extraños en el Ojo/cirugía , Reacción a Cuerpo Extraño/diagnóstico por imagen , Reacción a Cuerpo Extraño/cirugía , Células Gigantes de Cuerpo Extraño/patología , Humanos , Masculino , Enfermedades Orbitales/diagnóstico por imagen , Enfermedades Orbitales/cirugía , Tomografía Computarizada por Rayos XAsunto(s)
Dípteros/fisiología , Enfermedades Orbitales/diagnóstico por imagen , Enfermedades Orbitales/parasitología , Enfermedades de la Piel/diagnóstico por imagen , Enfermedades de la Piel/parasitología , Enfermedad Relacionada con los Viajes , Animales , Femenino , Alemania , Humanos , Larva , Persona de Mediana Edad , Enfermedades Orbitales/cirugía , Perú , Enfermedades de la Piel/cirugía , UltrasonografíaRESUMEN
Primary orbital cystic tumors caused by Echinococcus granulosus are rare. As this parasite is endemic in Peru, we report the case of a 10-year-old girl from a rural area of Huancavelica, who presented with progressive and irreducible axial proptosis of the right eye and loss of vision. Orbital tomographic images demonstrated a tumor mass with a cystic appearance. Serologic tests were negative. The patient underwent surgical resection, and histopathologic analysis revealed anhistic membranes, corresponding to hydatid cysts. During one year of follow-up, no evidence of local or systemic recurrence was observed. In conclusion, orbital hydatidosis should be considered in the differential diagnosis of a cystic orbital tumor in pediatric patients, especially if the patient is from an endemic area.
Los tumores quísticos primarios de la órbita, causados por infestaciones parasitarias como el Equinococcus granulosus son raros. Al ser el Perú zona endémica para este parásito, presentamos el caso de una niña de 10 años de edad, proveniente de una zona rural de Huancavelica, con proptosis axial irreductible del globo ocular derecho, de curso progresivo, con pérdida de la agudeza visual e imágenes tomográficas de la órbita en relación a masa tumoral de apariencia quística. Los exámenes serológicos fueron negativos, la paciente fue sometida a resección quirúrgica con resultado histopatológico de membranas anhistas correspondientes a quiste hidatídico. Al año de seguimiento no se evidencia recurrencia local ni sistémica. En conclusión, ante una tumoración orbitaria quística en pacientes pediátricos, se debe de considerar como diagnóstico diferencial la hidatidosis orbitaria, sobre todo si proceden de zonas endémicas.
Asunto(s)
Equinococosis , Enfermedades Orbitales/parasitología , Niño , Equinococosis/diagnóstico , Equinococosis/cirugía , Femenino , Humanos , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/cirugíaRESUMEN
RESUMEN Los tumores quísticos primarios de la órbita, causados por infestaciones parasitarias como el Equinococcus granulosus son raros. Al ser el Perú zona endémica para este parásito, presentamos el caso de una niña de 10 años de edad, proveniente de una zona rural de Huancavelica, con proptosis axial irreductible del globo ocular derecho, de curso progresivo, con pérdida de la agudeza visual e imágenes tomográficas de la órbita en relación a masa tumoral de apariencia quística. Los exámenes serológicos fueron negativos, la paciente fue sometida a resección quirúrgica con resultado histopatológico de membranas anhistas correspondientes a quiste hidatídico. Al año de seguimiento no se evidencia recurrencia local ni sistémica. En conclusión, ante una tumoración orbitaria quística en pacientes pediátricos, se debe de considerar como diagnóstico diferencial la hidatidosis orbitaria, sobre todo si proceden de zonas endémicas.
ABSTRACT Primary orbital cystic tumors caused by Echinococcus granulosus are rare. As this parasite is endemic in Peru, we report the case of a 10-year-old girl from a rural area of Huancavelica, who presented with progressive and irreducible axial proptosis of the right eye and loss of vision. Orbital tomographic images demonstrated a tumor mass with a cystic appearance. Serologic tests were negative. The patient underwent surgical resection, and histopathologic analysis revealed anhistic membranes, corresponding to hydatid cysts. During one year of follow-up, no evidence of local or systemic recurrence was observed. In conclusion, orbital hydatidosis should be considered in the differential diagnosis of a cystic orbital tumor in pediatric patients, especially if the patient is from an endemic area.
Asunto(s)
Niño , Femenino , Humanos , Enfermedades Orbitales/parasitología , Equinococosis , Enfermedades Orbitales/cirugía , Enfermedades Orbitales/diagnóstico , Equinococosis/cirugía , Equinococosis/diagnósticoRESUMEN
Rhinocerebral zygomycosis is a rare condition characterized by infection initially in the nose and paranasal sinuses with atypical symptoms consistent with sinusitis. Once established in the nasal sinuses, the infection can easily spread to the orbital region and brain. In the localized form of the infection, the mortality rate is approximately 10%, which increases in the occurrence of orbital involvement and survival in patients of cerebral dissemination is extremely rare. The present paper reports a patient of nasal zygomycosis with orbital and cerebral dissemination in an otherwise healthy patient who survived after 14 months of hospitalization with no neurological impairment. A review of the literature addressing aspects related to diagnosis, treatment, and complications of this fungal infection is also presented.
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Infecciones Fúngicas del Ojo/diagnóstico , Enfermedades Orbitales/diagnóstico , Rinitis/diagnóstico , Cigomicosis/diagnóstico , Adulto , Diagnóstico Diferencial , Enucleación del Ojo , Infecciones Fúngicas del Ojo/microbiología , Infecciones Fúngicas del Ojo/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedades Orbitales/microbiología , Enfermedades Orbitales/cirugía , Rinitis/microbiología , Tomografía Computarizada por Rayos X , Cigomicosis/microbiologíaRESUMEN
RESUMO A rinossinusite aguda é uma das afecções mais prevalentes das vias aéreas superiores. Fatores anatômicos presentes em crianças e jovens propiciam o aparecimento de complicações orbitárias. Embora mais raras, as complicações intracranianas das rinossinusites perfazem um grau alto de letalidade, são mais comuns em pacientes acima de sete anos, e devem ser tratadas por uma equipe multidisciplinar.
ABSTRACT Acute rhinosinusitis is one of the most prevalent diseases of the upper airways. Anatomical factors present in children and young people allow for the onset of orbital complications. Although rare, intracranial complications of sinusitis account for a high degree of lethality, are more common in patients over the age of seven, and should be treated by a multidisciplinary team.
Asunto(s)
Humanos , Femenino , Niño , Enfermedades Orbitales/etiología , Enfermedades Orbitales/diagnóstico por imagen , Sinusitis/complicaciones , Absceso Epidural/etiología , Absceso Epidural/diagnóstico por imagen , Enfermedades Orbitales/cirugía , Periostio/patología , Sinusitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Drenaje/métodos , Enfermedad Aguda , Absceso Epidural/cirugía , Absceso/cirugía , Absceso/etiología , Absceso/diagnóstico por imagenRESUMEN
Osteolytic lesions are highly suggestive of metastatic disease or in rare instances may result from primary extradural meningiomas. Herein, we describe a rare case of a patient who presented with a large area of osteolysis on the right orbital roof. An excisional biopsy revealed that the lesion was associated with the presence of hyperplastic intra-osseous meningothelial tissue. To our best knowledge, this is the first evidence that ectopic nonneoplastic meningothelial cells may induce osteolysis on the orbital walls.
Asunto(s)
Coristoma/diagnóstico , Hueso Frontal/patología , Neoplasias Meníngeas/diagnóstico , Meninges/patología , Meningioma/diagnóstico , Enfermedades Orbitales/diagnóstico , Osteólisis , Adulto , Biopsia , Carcinoma de Células Escamosas/patología , Coristoma/cirugía , Neoplasias de la Conjuntiva/patología , Diagnóstico Diferencial , Femenino , Humanos , Hiperplasia , Imagen por Resonancia Magnética , Enfermedades Orbitales/cirugíaRESUMEN
PURPOSE: To quantify the risk of new diplopia in inferomedial orbital decompression performed for cosmetic reasons. METHODS: Retrospective analysis of 114 patients with Graves orbitopathy who underwent an inferomedial orbital decompression. No patient had diplopia in any of the gaze positions or optic neuropathy. A single coronal slice 9 mm posterior to the lateral orbital rim was employed to quantify the muscular index of the extraocular recti and of the superior complex. A control group of 56 patients imaged for other reasons were also measured. After surgery the oculomotor status of all patients who complained of diplopia and of 51 patients free of diplopia was measured with the prism and cover test in the primary and secondary gaze positions. RESULTS: The rate of new-onset diplopia was 14.0% (16 patients). Eye deviations were confirmed in 14 patients. Of these, 10 had significant strabismus that warranted surgical or prism treatment. Most patients had esotropia associated with small vertical deviations. The size of the medial and inferior recti was significantly associated with the development of diplopia. The estimated odds for the appearance of diplopia in patients with muscle enlargement was 12.76 (medial rectus) and 5.21 (inferior rectus). Small-angle deviations were also detected in 27.4% of patients who did not experience diplopia. CONCLUSIONS: Medial and inferior recti enlargement is a strong predictor of new-onset diplopia. A large number of patients who do not report diplopia also present with small-angle deviations.
Asunto(s)
Descompresión Quirúrgica/efectos adversos , Diplopía/etiología , Oftalmopatía de Graves/cirugía , Músculos Oculomotores/patología , Enfermedades Orbitales/cirugía , Adolescente , Adulto , Anciano , Técnicas Cosméticas , Diplopía/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculos Oculomotores/diagnóstico por imagen , Estudios Retrospectivos , Medición de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
Treatment of facial trauma sequelae is a complex and challenging process. There is still controversy over suitable materials for orbital wall reconstruction. This study evaluated calcium phosphate cement (CPC) implants manufactured by rapid prototyping in the repair of orbital wall defects secondary to trauma. Computed tomographic scans of 5 patients were used for surgery planning and production of CPC implants. Implants were used to restore orbital wall anatomy, ocular alignment, and facial contour. Benefits resulting from the use of implants, such as a reduced operating time, patient response to biomaterial implantation, biomaterial integrity and stability, and patient satisfaction with treatment, were analyzed qualitatively. Our results suggest that CPC is an effective and safe material for orbital reconstruction because of its biocompatibility and easy production and placement.
Asunto(s)
Materiales Biocompatibles/uso terapéutico , Sustitutos de Huesos/uso terapéutico , Fosfatos de Calcio/uso terapéutico , Órbita/cirugía , Fracturas Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Prótesis e Implantes , Adulto , Materiales Biocompatibles/química , Sustitutos de Huesos/química , Fosfatos de Calcio/química , Sulfato de Calcio/química , Diseño Asistido por Computadora , Diplopía/cirugía , Enoftalmia/cirugía , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Trastornos de la Motilidad Ocular/cirugía , Enfermedades Orbitales/cirugía , Planificación de Atención al Paciente , Seguridad del Paciente , Satisfacción del Paciente , Fosfatos/química , Estudios Prospectivos , Diseño de Prótesis , Factores de Tiempo , Tomografía Computarizada Espiral , Resultado del TratamientoRESUMEN
La rinosinusitis aguda, puede presentar una serie de complicaciones conocidas, un grupo de ellas son las complicaciones orbitarias. Se presenta la historia de un paciente que consultó por proptosis ocular, siendo diagnosticado un absceso subperióstico retroorbitario secundario a una rinosinusitis aguda. Se trató con técnica endoscópica, evoluciona con un hematoma retroorbitario que tuvo que ser drenado con un abordaje mixto, endoscópico y abierto, con buena evolución. Actualmente las complicaciones orbitarias de la rinosinusitis aguda tienen una baja prevalencia, y así, las complicaciones del drenaje endoscópico son aún menos frecuentes. Se destaca la importancia del conocimiento del manejo tanto endoscópico como abierto.
Among acute rhinosinusitis complications, the ones with orbital involvement are relevant. We present a case report of a patient who presented proptosis and was initially diagnosed with a retro ocular abscess as a complication to an acute rhinosinusitis. The abscess was drained with an endoscopic sinus surgery. On the fourth post-surgery day a retro ocular hematoma was diagnosed. The hematoma was treated with a combined open and endoscopic approach with a favorable outcome. In conclusion, even though orbital complications of rhinosinusitis nowadays have low prevalence, and orbital complications of their endoscopic management are even rarer, it is important for the otorhinolaryngologist to be familiar with their open, endoscopic, or combined surgical treatment.
Asunto(s)
Humanos , Masculino , Adolescente , Absceso/cirugía , Drenaje , Endoscopía/métodos , Enfermedades Orbitales/cirugía , Rinitis/complicaciones , Sinusitis/complicaciones , Absceso/etiología , Enfermedad Aguda , Enfermedades Orbitales/etiología , Exoftalmia/etiología , Hematoma/etiología , Periostio/cirugía , Senos Paranasales , Tomografía Computarizada por Rayos XRESUMEN
Prolapsed orbital fat has rarely been described and is often confused with other conjunctival tumours, such as dermolipoma. We describe the clinical features and treatment of 15 patients with prolapsed orbital fat. We report here our experience in 15 consecutive patients who presented to the Vision Institute of Federal University of São Paulo, Brazil, between July 2004 and December 2007. Age, sex, presenting complaint, physical findings, associated local and systemic diseases, type of treatment, and complications were recorded. Ten patients were men, and ages ranged from 44-86 (mean 68). Eleven patients presented with unilateral disease. Thirteen had superotemporal prolapse, and two atypical superonasal prolapse. Two gave a history of trauma. All patients had the prolapsed fat excised for cosmetic reasons. There were no complications. Orbital fat prolapse is usually superotemporal, mainly in men, and is easily differentiated from other lesions, such as prolapsed lacrimal gland. Excision is always indicated, usually for cosmetic reasons.
Asunto(s)
Tejido Adiposo/patología , Enfermedades Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Tejido Adiposo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios de Cohortes , Enfermedades de la Conjuntiva/patología , Enfermedades de la Conjuntiva/cirugía , Estética , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/patología , Prolapso , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We present a case in which a patient with intraorbital Langerhans' cell granuloma, with anatomical and functional skills compromised by intraorbital hypertension, which was treated with urgency orbitotomy by cranial approach. Male, two years-old, presented conjuntival proptosis, red eye, complete ophthalmoplegy, exophthalmos, with non-fotoreactive mydriasis and blepharoptosis of the right eye. Fundoscopy presented venous enlargement with optic disc edema. A cranial approach with orbitotomy was carried out, removed the lesion with total remission of clinical presentation and anatomic appearance as well. The handling of Langerhans' cell granuloma can vary from primary surgical approach as corticotherapy to chemotherapy and radiotherapy. In this case, the surgery was the first option due to the imminent risk of loss of visual function.
Asunto(s)
Granuloma Eosinófilo/cirugía , Enfermedades Orbitales/cirugía , Preescolar , Granuloma Eosinófilo/patología , Histiocitosis de Células de Langerhans/patología , Histiocitosis de Células de Langerhans/cirugía , Humanos , Masculino , Procedimientos Quirúrgicos Oftalmológicos/métodos , Enfermedades Orbitales/patología , Agudeza Visual/fisiologíaRESUMEN
Apresentamos um caso no qual foi realizada orbitotomia de urgência em paciente com granuloma de células de Langerhans intraorbitário o qual apresentava comprometimento anatômico e funcional da função visual devido à hipertensão intraorbitária. Paciente masculino, 2 anos, apresentou exoftalmia, proptose conjuntival, olho vermelho, oftalmoplegia completa com midríase não fotorreativa e ptose palpebral direita. À fundoscopia apresentava engurgitamento venoso com edema de papila à direita. Foi realizada abordagem cirúrgica com orbitotomia via intracraniana sendo removida a lesão com remissão total da clínica tanto anatômica quanto funcionalmente. O manejo do granuloma de células de Langerhans pode variar desde a abordagem cirúrgica primária, passando pela terapia com esteróides até quimioterapia e radioterapia. No caso, a cirurgia foi a primeira opção devido ao e iminente risco de perda da função visual.
We present a case in which a patient with intraorbital Langerhans' cell granuloma, with anatomical and functional skills compromised by intraorbital hypertension, which was treated with urgency orbitotomy by cranial approach. Male, two years-old, presented conjuntival proptosis, red eye, complete ophthalmoplegy, exophthalmos, with non-fotoreactive mydriasis and blepharoptosis of the right eye. Fundoscopy presented venous enlargement with optic disc edema. A cranial approach with orbitotomy was carried out, removed the lesion with total remission of clinical presentation and anatomic appearance as well. The handling of Langerhans' cell granuloma can vary from primary surgical approach as corticotherapy to chemotherapy and radiotherapy. In this case, the surgery was the first option due to the imminent risk of loss of visual function.
Asunto(s)
Preescolar , Humanos , Masculino , Granuloma Eosinófilo/cirugía , Enfermedades Orbitales/cirugía , Granuloma Eosinófilo/patología , Histiocitosis de Células de Langerhans/patología , Histiocitosis de Células de Langerhans/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos , Enfermedades Orbitales/patología , Agudeza Visual/fisiologíaRESUMEN
This paper reports a rare case of acute severe orbital abscess manifested 2 days after a facial trauma without bone fracture in a 20-year-old Afro-American female. The symptoms worsened within the 24 h prior to hospital admission resulting in visual disturbances such as diplopia and photophobia. The clinical findings at the first consultation included fever, periorbital swelling and redness, ptosis, proptosis and limitation of ocular movements upwards, downwards, to the right and to the left. Computed tomography scan showed proptosis with considerable soft tissue swelling on the left side and no fracture was evidenced in the facial skeleton, including the zygomatic-orbital complex. After hospital admission and antibiotic therapy intravenously the patient was conducted to the operation room and submitted to incision and drainage under general anesthesia. The orbit was approached thorough both eyelids and the maxillary sinus was reached only through the Caldwell-Luc approach. The postoperative period was uneventful and the rapid improvement of symptoms was remarkable. Visual acuity and ocular motility returned to the normal ranges within 2 days after the surgical intervention. After 12 postoperative days, the patient presented with significative improvement in the ptosis and proptosis, and acceptable scars.
Asunto(s)
Absceso/etiología , Traumatismos Faciales/complicaciones , Enfermedades Orbitales/etiología , Absceso/tratamiento farmacológico , Absceso/cirugía , Enfermedad Aguda , Antibacterianos/uso terapéutico , Drenaje , Tratamiento de Urgencia , Femenino , Humanos , Sinusitis Maxilar/complicaciones , Sinusitis Maxilar/tratamiento farmacológico , Enfermedades Orbitales/tratamiento farmacológico , Enfermedades Orbitales/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
This paper reports a rare case of acute severe orbital abscess manifested 2 days after a facial trauma without bone fracture in a 20-year-old Afro-American female. The symptoms worsened within the 24 h prior to hospital admission resulting in visual disturbances such as diplopia and photophobia. The clinical findings at the first consultation included fever, periorbital swelling and redness, ptosis, proptosis and limitation of ocular movements upwards, downwards, to the right and to the left. Computed tomography scan showed proptosis with considerable soft tissue swelling on the left side and no fracture was evidenced in the facial skeleton, including the zygomatic-orbital complex. After hospital admission and antibiotic therapy intravenously the patient was conducted to the operation room and submitted to incision and drainage under general anesthesia. The orbit was approached thorough both eyelids and the maxillary sinus was reached only through the Caldwell-Luc approach. The postoperative period was uneventful and the rapid improvement of symptoms was remarkable. Visual acuity and ocular motility returned to the normal ranges within 2 days after the surgical intervention. After 12 postoperative days, the patient presented with significative improvement in the ptosis and proptosis, and acceptable scars.
Este artigo apresenta um caso de abscesso agudo em cavidade orbitária, após 2 dias de trauma facial, sem a presença de fratura óssea, ocorrido em uma mulher da raça negra com 20 anos de idade. Os sintomas se intensificaram nas últimas 24 h com o desenvolvimento de distúrbios visuais do tipo diplopia e fotofobia. Durante exame clínico foi constatado a presença de febre, edema e eritema periorbitário, ptose, proptose e limitação de movimentação ocular para cima, baixo, lado direto e esquerdo. A tomografia computadorizada evidenciava proptose associada a edema considerável, dos tecidos moles no lado esquerdo da face, sem fratura do complexo zigomático-orbitário. A internação hospitalar e o início da antibioticoterapia endovenosa foram realizados, e o tratamento cirúrgico de incisão e drenagem do abscesso sob anestesia geral foi conduzido, sendo realizado por meio de incisão na pálpebra superior e inferior para acesso a cavidade orbitária e por acesso de Caldwell-Luc para o seio maxilar. No pós-operatório imediato foi observada rápida melhora dos sintomas inicialmente relatados pela paciente. Após 2 dias da intervenção cirúrgica foi observado melhora na movimentação ocular e na acuidade visual, retornando ao normal. No décimo segundo dia pós-operatório, a paciente apresentou melhora significativa com relação à ptose palpebral e a proptose, com adequado processo de cicatrização.