ABSTRACT
The cavernous sinus area is the second most common location for intracranial dural fistulas. Although these spontaneous dural cavernous fistulas are self-limited, a sizeable number of patients will develop progressive vision loss, diplopia, or intractable glaucoma, which warrant interventional therapy.1,2 We present the case of a 54-year-old male with hypertension and type 2 diabetes, who presented with a red right eye associated with progressive exophthalmos, ophthalmoparesis, and deterioration of visual acuity. The angiotomography showed the exophthalmos with an ingurgitated superior ophthalmic vein, with early filling in the arterial phase. A digital angiography was made, and a diagnosis of dural cavernous fistula, Barrow type D was made.3 Considering several transvenous approaches, alternatives included inferior petrosal sinus, access through the superior ophthalmic vein, and an open approach.4 In this particular case the inferior petrosal sinus was not present, so we tried to catheterize through the facial vein and also puncture the ophthalmic vein. Both procedures were unsuccessful. We decided to perform, then, an open approach with the oculoplastic surgery team (Video 1). Through an eyelid dissection, we localized the superior ophthalmic vein and then canalized it by direct visualization.5 With this approach, we were able to perform the cavernous sinus packing with coils and achieved a complete occlusion of the fistula. We reproduced the direct approach to the superior ophthalmic vein in a cadaveric specimen and schematized it step by step with 3-dimensional photographs.6.
Subject(s)
Cavernous Sinus/surgery , Dura Mater/surgery , Endoscopy/methods , Endovascular Procedures/methods , Fistula/surgery , Neurosurgical Procedures/methods , Veins/surgery , Angiography , Cadaver , Cavernous Sinus/anatomy & histology , Central Nervous System Vascular Malformations/surgery , Diabetes Mellitus, Type 2/complications , Dura Mater/anatomy & histology , Exophthalmos/surgery , Humans , Hypertension/complications , Male , Middle Aged , Ophthalmoplegia/surgery , Treatment OutcomeSubject(s)
Abscess/complications , Airway Management/methods , Extracorporeal Membrane Oxygenation , Pharyngeal Diseases/complications , Supraglottitis/complications , Abscess/surgery , Emergency Service, Hospital , Female , Humans , Intubation, Intratracheal , Middle Aged , Patient Care Planning , Pharyngeal Diseases/surgery , TracheostomyABSTRACT
PURPOSE: To survey the management of congenital nasolacrimal duct obstruction, in particular, the timing of intervention and the use of massage, probing, nasolacrimal intubation, nasal endoscopy, and dacryocystorhinostomy. METHODS: This was an exploratory study that used an electronic questionnaire, which was sent via Internet to the members of Ojoplast, a social network composed of ophthalmologists from several Latin American countries. The responses were analyzed using adherence and the chi-square test. RESULTS: Seventy-two completed questionnaires were received. Approximately 64% of survey participants indicated that they use massage as the initial treatment for congenital nasolacrimal duct obstruction until 1 year of age and lacrimal probing (70.8%) for patients >1 year of age. Early probing used by 58.3% of the patients for a dilated lacrimal sac, and 66.7% reported that lacrimal system probing in conjunction with irrigation is effective. If the probing is not effective, 65.3% indicated that they repeat the procedure a second time. If the patient does not respond to massage or probing, 69.4% perform lacrimal system intubation. Sixty-two percent of the respondents indicated that they perform dacryocystorhinostomy for cases in which probing or intubation is not effective. CONCLUSIONS: The members of Ojoplast adopt massage as the initial treatment for congenital nasolacrimal duct obstruction for patients <1 year of age. Probing is performed on patients >1 year of age, and early probing is used only for cases of dilated lacrimal sac. When massage and probing are not effective, intubation is performed, and if intubation is unsuccessful, dacryocystorhinostomy is performed, in which the external approach to dacryocystorhinostomy is used most often.
Subject(s)
Dacryocystorhinostomy , Nasolacrimal Duct/surgery , Ophthalmologic Surgical Procedures , Ophthalmology/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Age Factors , Anti-Bacterial Agents/administration & dosage , Cross-Sectional Studies , Endoscopy , Health Care Surveys , Humans , Infant , Intubation , Lacrimal Duct Obstruction/congenital , Latin America , Massage , Nasolacrimal Duct/abnormalities , Ophthalmologic Surgical Procedures/statistics & numerical data , Societies, Medical , Surveys and Questionnaires , Time FactorsABSTRACT
Se ha utilizado una gran variedad de prótesis para la reconstrucción de las fracturas del piso orbitario. Se estudian los materiales usados, así como también sus complicaciones. Entre las prótesis utilizadas en los últimos tiempos, los mejores resultados se han obtenido con el uso de polietileno poroso y la hidroxiapatita, junto con las mallas de titanio en las fracturas importantes
Subject(s)
Humans , Adult , Orbital Fractures/surgery , Orbital Implants , Surgery, PlasticABSTRACT
Se ha utilizado una gran variedad de prótesis para la reconstrucción de las fracturas del piso orbitario. Se estudian los materiales usados, así como también sus complicaciones. Entre las prótesis utilizadas en los últimos tiempos, los mejores resultados se han obtenido con el uso de polietileno poroso y la hidroxiapatita, junto con las mallas de titanio en las fracturas importantes
Subject(s)
Humans , Adult , Orbital Fractures/surgery , Orbital Implants , Surgery, PlasticABSTRACT
El ojo seco es un trastorno en la lubricación ocular. Los factores causantes provocan una alteración anatómica y funcional determinando un cambio en la constitución y dinámica de la película lagrimal. Si existiera "ojo seco" previo a una blefaroplastía pueden aparecer en el post-operatorio trastornos oculares que irán desde una simple molestia a graves lesiones corneales. En esta presentación se analizarán las formas de diagnóstico y se aportarán pautas y recaudos quirúrgicos
Subject(s)
Humans , Blepharoplasty , Dry Eye Syndromes/surgery , Surgery, PlasticABSTRACT
El ojo seco es un trastorno en la lubricación ocular. Los factores causantes provocan una alteración anatómica y funcional determinando un cambio en la constitución y dinámica de la película lagrimal. Si existiera "ojo seco" previo a una blefaroplastía pueden aparecer en el post-operatorio trastornos oculares que irán desde una simple molestia a graves lesiones corneales. En esta presentación se analizarán las formas de diagnóstico y se aportarán pautas y recaudos quirúrgicos
Subject(s)
Humans , Dry Eye Syndromes/surgery , Blepharoplasty , Surgery, PlasticABSTRACT
Se presentam três casos de herida de bala por intento fallido de suicidio. Se enfatiza la necesidad de asistencia médico-quirúrgica muldisciplinaria de estos pacientes
Subject(s)
Humans , Adult , Middle Aged , Male , Female , Eye Injuries/etiology , Orbit/injuries , Wounds, Gunshot , Orbital Fractures/surgery , Orbital Fractures/complications , Orbital Fractures/diagnosis , Lead/blood , Wounds, Gunshot/blood , Wounds, Gunshot/surgery , Wounds, PenetratingABSTRACT
O Autor relata a sua experiência pessoal com diferentes quadros de trauma demonstrando os diferentes sinais e sintomas que caracterizam as fraturas das paredes orbitárias e o vértice. A restauraçäo da fratura do asoalho orbitário é geralmente tarefa do oftalmologista e esta secçäo é discutida amplamente