RESUMO
OBJECTIVE: To evaluate in a prospective trial two surgical technique routinely used for orbital decompression in Graves' disease ophthalmopathy. PATIENTS AND METHODS: Patients with Graves' disease exophthalmus (greater than 22 mm) that was euthyroid for at least six months after treatment were admitted to the study and randomly assigned to two groups, twenty six orbits in 17 patients were surgically decompressed with the Walsh and Ogura technique (group I) and 18 orbits in 18 patients were decompressed with Kennedy's surgical approach (group II). RESULTS: Both surgical techniques were equally effective in reducing the exophthalmus (p < 0.05). Morbility was significantly greater in terms of diplopia and infraorbital nerve lesion with Walsh and Ogura surgical approach. CONCLUSIONS: Due to reduced morbility, orbital surgical decompression with Kennedy's technique is recommended in patients with Graves' disease exofthalmus.
Assuntos
Descompressão Cirúrgica , Exoftalmia/etiologia , Exoftalmia/cirurgia , Doença de Graves/complicações , Órbita/cirurgia , Adulto , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
The male patient is in his fifth decade with a history of four months with right nasal obstruction, hematopurulent rhinorrea and scabs in the nose. The initial physical examination showed necrotic tissue and scabs in both the nasal foci. Three months later he presented a septal perforation and eroded necrotic injury in the hard palate. The two initial biopsies that were carried out showed chronic unspecified inflammation, and the third reported a polymorphic reticulosis. The histopathological analysis of the material of the third biopsy showed the existence of a non-angiocentric intermediate centrofacial lymphoma. The patient was submitted to treatment with simultaneous radiotherapy and chemotherapy with the end result of a totally successful remission of the lymphoma. These abnormalities usually appear as ulcers and erosions of the cartilage and bones of the nose, the paranasal sinuses and the palate. They are polymorphic, and there exists evidence of its association with the Ebstein Barr virus. The patient has been observed during the last five years and has shown no evidence of recurrence of any related of the disease. As a consequence of the sickness, the patient had difficulties to talk and eat, but with rehabilitation he now has adequate phonation and eating capacity. The immunohistochemistry and molecular genetic science branches of medicine have almost solved the diagnostic and therapeutic problems related to this sickness. The individual's prognosis depends mainly on the extension of the affection and seriousness of the disease from which the patient suffers.