RESUMO
In recent years, orbital disease has received considerable attention and developed rapidly. It is both an opportunity and a challenge to carry out the construction of orbital disease subspecialty scientifically and efficiently. This article focuses on the necessity of establishing a subspecialty department, the particularity and complexity of orbital disease, and how to effectively perform clinical work. The large quantity of potential patients and the urgent requirement of comprehensive academic progress give rise to the necessity of developing the orbital disease subspecialty. The difficulty of diagnosis and the high risk of operation in orbital disease place emphases on specialist allocation and personnel training. The equipment support and specialist training should go hand in hand, requiring professionals to have strong pressure resistance ability and solid theoretical knowledge, so as to ensure stable, efficient and sustainable development of the orbital disease subspecialty. (Chin J Ophthalmol, 2021, 57: 805-808).
Assuntos
Doenças Orbitárias , Humanos , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/cirurgia , Gestão de RiscosRESUMO
BACKGROUND: Orbital and intracranial complications of pediatric acute rhinosinusitis (ARS) are uncommon. With a risk of significant morbidity, hospital utilization and the financial burden of these entities are often high. We sought to assess utilization trends for complicated ARS and elucidate which factors influence cost. METHODOLOGY: Analysis of Kids' Inpatient Database (2006, 2009 and 2012). Children were selected based on diagnosis codes for ARS and grouped as: uncomplicated ARS, orbital complications (OC), or intracranial complications (IC). Patients with IC were subdivided into abscess (ICa), meningitis, or sinus thrombosis. Length of stay (LOS), cost and management information were analysed. Data presented as median [IQR]. RESULTS: A weighted total of 20,775 children were included. OC and IC were observed in 10.9% and 2.7% of these patients. LOS was longer for IC compared to OC (9 [8] v 4 [3]days, pâ¯<â¯0.001). Daily cost for IC was greater than OC ($2861 [4044] v $1683 [1187], pâ¯<â¯0.001), likely due to differences in need for surgery (IC 66.3% v OC 37.1%, pâ¯<â¯0.001). Within the ICa group, patients who received both otolaryngologic (ENT) and neurosurgery, compared to neurosurgery alone, had higher total cost ($41,474 [41,976] v $32,299 [18,235], pâ¯<â¯0.001) but similar LOS (12 [10] v 11 [9] days, pâ¯=â¯0.783). CONCLUSIONS: Children with IC required more surgery than their OC counterparts, resulting in a longer LOS and increased cost. Within the ICa group, the addition of ENT surgery to neurosurgery resulted in higher costs, but with a similar LOS. Considering the increased costs, the additional benefit of ENT surgery to those with children with IC should be investigated further.
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Doenças do Sistema Nervoso Central/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Doenças Orbitárias/economia , Rinite/complicações , Sinusite/complicações , Doença Aguda , Adolescente , Abscesso Encefálico/economia , Abscesso Encefálico/etiologia , Abscesso Encefálico/cirurgia , Doenças do Sistema Nervoso Central/etiologia , Doenças do Sistema Nervoso Central/cirurgia , Criança , Bases de Dados Factuais , Feminino , Humanos , Masculino , Meningite/economia , Meningite/etiologia , Meningite/cirurgia , Procedimentos Neurocirúrgicos/economia , Doenças Orbitárias/etiologia , Doenças Orbitárias/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/economia , Trombose dos Seios Intracranianos/economia , Trombose dos Seios Intracranianos/etiologia , Trombose dos Seios Intracranianos/cirurgiaRESUMO
Purpose: Endoscopic surgeries, such as dacryocystorhinostomy (DCR), are increasingly performed for orbital and lacrimal conditions. This study describes and compares recent trends in endoscopic DCR with open, or external, DCR in the United States (US). Methods: Medicare-Part-B National Summary data files were analyzed from 2000 to 2015 for temporal and geographic trends in endoscopic and external DCR. Medicare Physician and Other Supplier public use files detailing provider information were collected and analyzed from 2012 to 2015. Results: Between 2000 and 2015, the number of external DCRs remained relatively unchanged (8008 to 7086, -0.7% average annual growth), while the number of endoscopic DCRs steadily increased (881 to 1674, 4.6% average annual growth). The greatest number of endoscopic DCRs were performed in the South Atlantic region, whereas the Mountain region had the greatest number per capita. From 2000 to 2015, the average payment per procedure for external DCR was $526.63, compared with $512.45 for endoscopic DCR. Of endoscopic DCRs performed from 2012 to 2015, 831 (79%) were performed by Ophthalmology, 184 (18%) were performed by Otolaryngology, and the remainder by other subspecialties. Conclusions: The number of endoscopic DCR surgeries increased over the last 15 years while the number of external DCR surgeries remained stable and continued to surpass endoscopic procedures. While ophthalmologists perform the overwhelming majority of endoscopic DCR, otolaryngologists are performing a growing number.
Assuntos
Dacriocistorinostomia/tendências , Endoscopia/tendências , Medicare Part B/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Dacriocistorinostomia/economia , Endoscopia/economia , Feminino , Humanos , Doenças do Aparelho Lacrimal/cirurgia , Masculino , Oftalmologia/estatística & dados numéricos , Doenças Orbitárias/cirurgia , Estados UnidosRESUMO
PURPOSE: To compare the motility and complication rates of porous and nonporous implants after enucleation surgery. METHODS: Literature searches of the PubMed and Cochrane Library databases were last performed in February 2017 to identify studies published between 2003 and 2017 on outcomes after enucleation surgeries in which a variety implants were used. The searches were limited to the English language with abstracts and yielded 43 articles, which the Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel reviewed for relevancy. Twenty-five articles were considered to have met the search strategy, and the panel methodologist assigned ratings to them according to the level of evidence. RESULTS: Only 2 of the 25 articles identified met the criteria for level I evidence. Eighteen of the studies did not assess motility after enucleation surgery, and the 7 that did evaluate this metric involved porous implants. The studies that analyzed this outcome reported favorable results, but the results were not uniformly based on objective analysis. Both porous and nonporous implants were well tolerated, and complication rates were generally low for both types. CONCLUSIONS: In keeping with increasing surgeon preference for porous implants, most studies identified in this literature search involved the use of this type of implant. These implants resulted in excellent motility after enucleation surgery, although many studies did not assess this outcome. Regardless of implant type, major complications were rare, and infection was exceptionally uncommon after enucleation. Given the paucity of data on motility and the absence of direct, objective comparisons of porous and nonporous implants, definitive conclusions about the impact of implant material on motility cannot be made. Since few studies evaluated nonporous implants, direct comparisons cannot be made definitively between implant types, and future investigations are needed to enable a critical assessment.
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Academias e Institutos , Enucleação Ocular , Oftalmologia , Órbita/cirurgia , Doenças Orbitárias/cirurgia , Implantes Orbitários , HumanosRESUMO
INTRODUCTION: Surrounded by a variety of structures including the facial sinuses and the brain, the human orbit displays unique anatomical features. It is known that orbital volume correlates with age and sex. The aim of this study was to evaluate sexual dimorphism of orbital volume relative to the size of the skull, and to establish criteria for gender determination. METHODS: Orbital volume was measured from 3D models of the orbits. The volumes were expressed in relation to the centroid size of the skull, to ensure that any sexual dimorphism in orbital volume was not simply due to a difference in skull size. Thirty-three male and 42 female subjects were included in the study. RESULTS: The volume of both orbits were significantly higher in men than in women (P=0.0001). The right, left and total orbital volumes relative to the centroid skull size were also significantly higher in men than women (P<0.05). The method was repeatable and reproducible. A test of gender determination was developed, with a precision of 77.3%. DISCUSSION: This is the first study showing a sexual dimorphism in orbital volume relative to skull size. This difference in volume could explain the greater predisposition to myopia in women and their more frequent need for orbital decompression in thyroid orbitopathies.
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Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Órbita/diagnóstico por imagem , Órbita/patologia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/patologia , Caracteres Sexuais , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cefalometria , Face/diagnóstico por imagem , Face/patologia , Face/cirurgia , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/normas , Imageamento Tridimensional/métodos , Imageamento Tridimensional/normas , Masculino , Pessoa de Meia-Idade , Órbita/cirurgia , Doenças Orbitárias/cirurgia , Tamanho do Órgão , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/patologia , Seios Paranasais/cirurgia , Reprodutibilidade dos Testes , Crânio/diagnóstico por imagem , Crânio/patologia , Crânio/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto JovemRESUMO
PURPOSE: The orbital compartment syndrome (OCS) constitutes a severe emergency, requiring immediate clinical diagnosis and surgical decompression. The key symptom is progressive visual impairment caused by an increase in intraorbital pressure, impairing the perfusion of relevant neurovascular and neurosensory structures. Intraorbital bleeding due to trauma and surgical intervention is known to be the main etiological factor. MATERIAL AND METHODS: A retrospective analysis of all patients affected by an OCS between January 1, 2012, and May 31, 2015, was performed. Patients' records were reviewed with regard to etiology, initial ophthalmologic status, fracture pattern, concomitant medication, surgical management, and postoperative outcome. The incidence of OCS was calculated based on the total number of craniomaxillofacial (CMF) emergencies. RESULTS: Within 3.5 years, a total of 18,093 CMF emergencies were registered. In 16 patients, an OCS was documented, corresponding to an incidence of 0.088%. The mean patient age was 67.31 ± 23.86 years, ranging from 22 to 102 years. The etiology varied, but trauma with subsequent intraorbital bleeding was the main cause. The use of anticoagulative medication was documented in 50% of the cases. In 14 patients, immediate surgical orbital decompression was performed: in 10 patients, vision could be preserved; in three patients, blindness resulted; and one patient was lost to follow-up. Two patients were managed without surgery. CONCLUSION: With regard to the total number of CMF emergencies, OCS is a rare condition. Early clinical diagnosis and surgical decompression are required to prevent permanent vision impairment. Anticoagulative medication must be considered as a predisposing factor for an orbital compartment syndrome in patients affected by periorbital trauma.
Assuntos
Síndromes Compartimentais , Doenças Orbitárias , Adulto , Idoso de 80 Anos ou mais , Berlim/epidemiologia , Síndromes Compartimentais/epidemiologia , Síndromes Compartimentais/cirurgia , Descompressão Cirúrgica , Traumatismos Faciais/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/epidemiologia , Doenças Orbitárias/cirurgia , Estudos Retrospectivos , Adulto JovemAssuntos
Doenças do Aparelho Lacrimal/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Doenças Orbitárias/cirurgia , Idoso , Canadá , Atenção à Saúde/tendências , Humanos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Procedimentos Cirúrgicos Oftalmológicos/tendências , Oftalmologia/organização & administração , Listas de EsperaRESUMO
We retrospectively analyzed a series of 17 tumors suggestive of dermoid cysts operated on from January 1, 1991, through November 30, 1997. Mean patient age was 3.68 years. The periorbital localization predominated. Two cases of intraorbital localizations required lateral and medial orbitotomy. Surgical treatment was given in all other cases. We observed no complication nor recurrence.
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Cisto Dermoide/cirurgia , Doenças Orbitárias/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Cisto Dermoide/patologia , Cisto Dermoide/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Órbita/patologia , Órbita/cirurgia , Doenças Orbitárias/patologia , Doenças Orbitárias/fisiopatologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
In this paper we describe the application of three-dimensional (3D) imaging and computer-generated models in the management of orbital deformity. The technique was found to be particularly useful in posttraumatic deformity and fibrous dysplasia involving the orbit. Further application was found in cases of radiation hypoplasia, high facial cleft, and facial atrophy. Funding restrictions necessitate appropriate selection of cases when using new and expensive 3D imaging rather than traditional and less expensive methods. To remain within a realistic budget only those patients who will clearly benefit from the third dimension compared with traditional methods of assessment and management should be selected. These include patients requiring precise reduction or secondary reconstruction in which there is a matched normal anatomical component for comparison. This application is also only beneficial where the planned reconstruction is dimensionally stable.
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Simulação por Computador , Desenho Assistido por Computador , Modelos Anatômicos , Órbita/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo/métodos , Orçamentos , Simulação por Computador/economia , Desenho Assistido por Computador/economia , Bases de Dados como Assunto , Feminino , Displasia Fibrosa Óssea/cirurgia , Humanos , Processamento de Imagem Assistida por Computador/economia , Masculino , Órbita/anormalidades , Órbita/diagnóstico por imagem , Órbita/lesões , Doenças Orbitárias/cirurgia , Fraturas Orbitárias/cirurgia , Osteotomia/métodos , Planejamento de Assistência ao Paciente , Seleção de Pacientes , Lesões por Radiação/cirurgia , Procedimentos de Cirurgia Plástica , Tomografia Computadorizada por Raios X , Fraturas Zigomáticas/cirurgiaRESUMO
Contrary to several recent statements craniofacial operations should not be the monopoly of large specialised centres but may be handled successfully by well trained surgeons working in a good medical environment. The experience of the Geneva University Hospital is reviewed in this paper; there has been no death or major complication and the cosmetic results compare favourably with other series.