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1.
Plast Reconstr Surg ; 145(2): 382e-390e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985648

RESUMO

BACKGROUND: The purpose of this study was to determine what craniometric changes occur to both orbits of unicoronal craniosynostosis patients undergoing fronto-orbital advancement and remodeling, and which of these changes are associated with new onset of postoperative strabismus. METHODS: A retrospective analysis was performed of the preoperative and postoperative orbits of 24 unicoronal craniosynostosis patients and the orbits of 24 control subjects, totaling 144 orbits. Eight parameters were evaluated using multivariate logistic regression analysis. One of the parameters was modified orbital index, an indicator of severity of harlequin deformity. RESULTS: Significant differences in orbital dimensions and angles were present bilaterally in unicoronal craniosynostosis orbits when compared to controls. Fronto-orbital advancement and remodeling increased the ipsilateral unicoronal craniosynostosis orbital volume from 13,184 ± 2003 mm to 16,220 ± 2323 mm (p < 0.001). Ipsilateral horizontal cone angles were increased from 48 ± 5 degrees to 54 ± 7 degrees (p = 0.004). Ipsilateral vertical cone angles were decreased from 73 ± 8 degrees to 66 ± 10 degrees (p = 0.003). Ipsilateral modified orbital index improved from 0.83 ± 0.06 to 0.88 ± 0.06 (p = 0.003). Three of the 19 unicoronal craniosynostosis patients developed transient postoperative strabismus. Logistic regression analysis displayed a strong significant association between new-onset strabismus and a change in modified orbital index with a coefficient of 30.84 ± 14.51 (p < 0.05). CONCLUSIONS: The orbital dysmorphology in unicoronal craniosynostosis is bilateral in nature, and it is not wholly treated with conventional fronto-orbital advancement and remodeling. The severity of ipsilateral orbital dysmorphology is correlated with the incidence of postoperative strabismus following conventional fronto-orbital advancement and remodeling. Future research is needed to develop strategies to mitigate the risk of development of strabismus in this group of patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Craniossinostoses/complicações , Osso Frontal/cirurgia , Órbita/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estrabismo/etiologia , Estrabismo/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Órbita/patologia , Estudos Retrospectivos , Estrabismo/patologia
2.
Artigo em Chinês | MEDLINE | ID: mdl-31954385

RESUMO

Objective: To analyze the method and effect of reconstruction of the orbital floor defect with preserved orbital contents after advanced maxillary sinus cancer resection. Methods: Thirty-three patients of T3/T4 stage maxillary sinus cancer with orbital invasion who were treated in Shandong Provincial Hospital from January 2010 to October 2016 were retrospectively analyzed, including 20 males and 13 females, aged from 12 to 80 years old. Patients were treated with appropriate surgical methods according to their clinical manifestation, imaging finding, invasion range, preoperative and intraoperative pathology. Surgical approaches such as maxillectomy, expanded maxillectomy and superstructure maxillectomy were used for patients with Medpor orbit floor repairment. Patients were followed up regularly after surgery, and the surgical efficacy was discussed by descriptive statistical method. Results: Of those 33 cases, 19 were squamous cell carcinoma, 8 were adenoid cystic carcinoma, 5 were inverted papilloma malignant transformation, and 1 was myoepithelial carcinoma in our study. After tumor resection and orbital floor repair, the orbital contents and eyeball function of all patients remained intact. During follow-up time ranged from 3 to 8 years, a total of 6 patients relapsed at 3 years and died of ineffective treatment. The survival rate was 81.8% (27/33). Conclusion: Tumor resection and Medpor orbital floor repair in maxillary sinus cancer patients with orbital invasion can preserve the function of the eyeball well, greatly improve the quality of patient's life.


Assuntos
Neoplasias do Seio Maxilar/cirurgia , Órbita/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Neoplasias do Seio Maxilar/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
3.
J Craniofac Surg ; 31(1): e89-e92, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31881595

RESUMO

OBJECTIVE: This study aimed to investigate the efficacy and success rate of the anterolateral thigh flap (ALT) in reconstructing total maxillectomy defects. METHODS: This retrospective study involved patients with total maxillectomy defects, who underwent free ALT reconstruction from June 2005 to October 2014. RESULTS: The study included 72 patients (43 males and 29 females; age range, 7-77 years; mean age, 43 years). Four patients experienced major complications related to surgery: total flap loss in one patient, partial flap necrosis requiring reoperation in one patient, hematoma requiring operative evacuation in 1 patient, and diplopia requiring reoperation in 1 patient. Two patients experienced minor complications: partial flap loss healed by secondary intention with local wound care, and donor site suture rupture in 1 patient healed by secondary intention. Six patients died because of cancer-related death (after local recurrence or metastatic disease). The defects in 5 patients involved the facial skin for which the ALT was segmented into three parts to reconstruct the facial skin, nasal lining, and oral lining. The defects in 4 patients involved the orbital floor for which a segment of tensor fascia lata was included with the flap on the same pedicle and used to repair the orbital floor. In the remaining patients, the free ALT flap, including a segment of vastus lateralis, was used to repair the maxillary defect and fill the dead space. All but one of the surviving patients were satisfied with their final appearance postoperatively. CONCLUSION: The free ALT flap with or without fascia lata to repair the orbital floor is safe, reliable, and acceptable for reconstructing total maxillectomy defects.


Assuntos
Seios Paranasais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Coxa da Perna/cirurgia , Adolescente , Adulto , Idoso , Criança , Craniotomia , Feminino , Retalhos de Tecido Biológico , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Adulto Jovem
4.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(6): 259-267, nov.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186955

RESUMO

Antecedentes y objetivo: La órbita es una estructura de interés para diversas especialidades médicas. Los abordajes quirúrgicos de la órbita presentan una dificultad significativa para el neurocirujano general. Quien decide incursionar en cirugía orbitaria debe tener un vasto conocimiento anatómico de esta estructura. Sin embargo, gran parte de las publicaciones existentes sobre anatomía de la órbita muestran detalladamente la complejidad de esta estructura, pero no logran facilitar su entendimiento. El propósito del presente trabajo es sistematizar el estudio anatómico de la órbita desde una perspectiva quirúrgica, de modo sencillo, que permita facilitar su entendimiento. Materiales y métodos: Se realizó una revisión de la literatura mundial sobre el tema y se siguió el principio de la regla del 7 para su ordenamiento. Para ilustrar se utilizaron fotografías de preparados cadavéricos y dibujos digitales. Resultados: Las órbitas son 2cavidades ubicadas simétricamente a ambos lados de la nariz. Tienen una forma piramidal, de 4lados, con un vértice posterior, una base anterior y con su eje establecido desde el plano sagital en un ángulo de 20 grados. Una característica distintiva de la órbita es que sus elementos están organizados en grupos de a 7: 7huesos, 7músculos extraoculares intraorbitarios y 7nervios. Conclusión: Se realizó una sistematización de la anatomía orbitaria con claras ilustraciones a fin de simplificar su estudio. La comprensión de la anatomía de la órbita es clave para clasificar una lesión y proporciona una base sólida a la hora de elegir el abordaje más adecuado para su tratamiento


Background and objective: The orbit is a structure of interest for many medical specialties. Surgical approaches to the orbit present significant difficulties for the general neurosurgeon. Whoever decides to practice orbital surgery must have vast anatomical knowledge of this structure. However, although many of the existing publications about orbital anatomy show the complexity of this structure in detail, they fail to facilitate their understanding. The purpose of this study was to systematise and simplify the anatomical study of the orbit from a surgical perspective, to facilitate its understanding. Materials and methods: A review of the international literature on the subject was carried out, and the principle of the rule of 7was followed for its ordering. For illustration purposes, photographs of cadaveric preparations and digital drawings were used. Results: The orbits are 2 cavities located symmetrically on both sides of the nose. They have a pyramidal shape, with 4sides, a posterior vertex, an anterior base and their axis established from the sagittal plane at a 20-degree angle. A distinctive feature of the orbit is that its elements are organised into groups of seven: 7bones, 7intraorbital extraocular muscles and 7nerves. Conclusion: A systematisation of the orbital anatomy was performed with clear illustrations to simplify its study. The understanding of the anatomy of the orbit is vital to classify lesions and provides a solid basis when choosing the most appropriate approach for their treatment


Assuntos
Humanos , Órbita/anatomia & histologia , Órbita/cirurgia , Cadáver , Crânio/anatomia & histologia , Osso e Ossos/anatomia & histologia , Músculos/anatomia & histologia , Dissecação/métodos , Osteotomia/métodos , Microcirurgia/métodos
5.
Rev. bras. cir. plást ; 34(4): 552-556, oct.-dec. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047925

RESUMO

A neurofibromatose tipo 1 é uma doença autossômica dominante rara, com manifestações clínicas diversas. Sua apresentação mais marcante é a presença de neurofibromas (tumores da bainha neural) cutâneos ou internos, que também podem ocorrer de forma esporádica, associados a outras manifestações sistêmicas, como manchas café com leite e lesões oculares. Por serem tumores da bainha de mielina, os neurofibromas podem acometer diversos nervos periféricos, incluindo nervos da face. Apresentamos o caso de um paciente de 1 ano, portador de neurofibromatose tipo 1, com neurofibroma em nervo infraorbital direito, com o acesso proposto para tratamento cirúrgico que fornecesse ampla visualização e acesso a lesão, sem comprometimento estético importante, permitindo preservação de partes moles e adequado crescimento facial.


Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disease with multiple clinical manifestations. Its most significant presentation is cutaneous or subcutaneous neurofibromas (myelin sheath tumors), which may be associated with other systemic manifestations such as caféau- lait spots and eye involvement. Neurofibromas can affect several peripheral nerves, including the facial nerves. This report presents a case of a 1-year-old patient with NF1 with right infraorbital nerve neurofibroma in which the proposed access for surgical treatment allowed adequate visualization of the tumor with good aesthetic results, preservation of the soft tissues, and normal facial growth.


Assuntos
Humanos , Masculino , Lactente , História do Século XXI , Órbita , Procedimentos Cirúrgicos Operatórios , Pseudotumor Orbitário , Neurofibromatoses , Neoplasias da Bainha Neural , Face , Neurofibroma , Órbita/anormalidades , Órbita/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Pseudotumor Orbitário/cirurgia , Pseudotumor Orbitário/imunologia , Pseudotumor Orbitário/terapia , Neurofibromatoses/cirurgia , Neurofibromatoses/diagnóstico , Neoplasias da Bainha Neural/cirurgia , Neoplasias da Bainha Neural/terapia , Face/cirurgia , Neurofibroma/cirurgia , Neurofibroma/terapia
6.
BMC Ophthalmol ; 19(1): 256, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842802

RESUMO

BACKGROUND: Accurate measurement and reconstruction of orbital soft tissue is important to diagnosis and treatment of orbital diseases. This study applied an interactive graph cut method to orbital soft tissue precise segmentation and calculation in computerized tomography (CT) images, and to estimate its application in orbital reconstruction. METHODS: The interactive graph cut method was introduced to segment extraocular muscle and intraorbital fat in CT images. Intra- and inter-observer variability of tissue volume measured by graph cut segmentation was validated. Accuracy and reliability of the method was accessed by comparing with manual delineation and commercial medical image software. Intraorbital structure of 10 patients after enucleation surgery was reconstructed based on graph cut segmentation and soft tissue volume were compared within two different surgical techniques. RESULTS: Both muscle and fat tissue segmentation results of graph cut method showed good consistency with ground truth in phantom data. There were no significant differences in muscle calculations between observers or segmental methods (p > 0.05). Graph cut results of fat tissue had coincidental variable trend with ground truth which could identify 0.1cm3 variation. The mean performance time of graph cut segmentation was significantly shorter than manual delineation and commercial software (p < 0.001). Jaccard similarity and Dice coefficient of graph cut method were 0.767 ± 0.045 and 0.836 ± 0.032 for human normal extraocular muscle segmentation. The measurements of fat tissue were significantly better in graph cut than those in commercial software (p < 0.05). Orbital soft tissue volume was decreased in post-enucleation orbit than that in normal orbit (p < 0.05). CONCLUSION: The graph cut method was validated to have good accuracy, reliability and efficiency in orbit soft tissue segmentation. It could discern minor volume changes of soft tissue. The interactive segmenting technique would be a valuable tool for dynamic analysis and prediction of therapeutic effect and orbital reconstruction.


Assuntos
Tecido Adiposo/anatomia & histologia , Enucleação Ocular , Músculos Oculomotores/anatomia & histologia , Órbita/anatomia & histologia , Órbita/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Tecido Adiposo/diagnóstico por imagem , Algoritmos , Feminino , Humanos , Imageamento Tridimensional/métodos , Masculino , Variações Dependentes do Observador , Músculos Oculomotores/diagnóstico por imagem , Órbita/diagnóstico por imagem , Implantes Orbitários , Imagens de Fantasmas , Reprodutibilidade dos Testes , Software , Tomografia Computadorizada por Raios X
7.
J Craniofac Surg ; 30(6): 1888-1890, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31756877

RESUMO

BACKGROUND: Surgical precision in the reconstruction of the orbital floor is crucial to functional visual and aesthetic outcomes. Increasingly, computer-aided design is being utilized to aid in precise preoperative planning by using the mirror images of the unaffected side. The authors aim to use 3-dimensional (3D) quantitative analysis to establish whether the native orbital floor topography is sufficiently symmetric to support this practice. METHODS: Ten high resolution head and neck computed tomography scans of patients without periorbital pathology were obtained. These were imported into a 3D medical image processing software and segmented to isolate bilateral orbital floors. Each native orbital floor was compared to the mirror image of the contralateral side by conformance map computation. Data collection included measures of 25% and 75% quartile, median, mean, standard deviation, and root-mean-square (RMS). RESULTS: The topographic analysis demonstrated a high degree of topographic conformance with a mean RMS of 0.58 ±â€Š0.37 mm. Further volumetric analysis comparing the total orbital volume between each side also demonstrates a high degree of volumetric symmetry with a mean difference of 0.55 mL (P = 0.30). CONCLUSION: Comparison of the native orbital floor and the mirror image of the contralateral side by conformance map computation and volumetric analysis demonstrated a high degree of morphologic similarity. The native orbital floor topography provides optimal symmetry to support mirror imaging techniques used in orbital floor reconstruction.


Assuntos
Órbita/diagnóstico por imagem , Órbita/cirurgia , Desenho Assistido por Computador , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Software , Tomografia Computadorizada por Raios X/métodos
9.
Zhonghua Yan Ke Za Zhi ; 55(11): 876-880, 2019 Nov 11.
Artigo em Chinês | MEDLINE | ID: mdl-31715684

RESUMO

Orbital blowout fractures can easily lead to defects of the orbital wall. In order to restore the continuity of the bone wall and avoid a series of clinical symptoms caused by orbital contents herniation or incarceration, the site of the defect should be reconstructed. The effect of reconstruction depends on the choice of surgical plan and repair material. The typical materials for bone wall defect repair include bone sheet, high density porous polyethylene, titanium mesh, absorbable polymer, bioactive ceramics and tissue engineering bone. This paper reviews the research findings and application of material for repairing of orbital blowout fracture. (Chin J Ophthalmol, 2019, 55: 876-880).


Assuntos
Fraturas Orbitárias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Materiais Biocompatíveis , Cerâmica , Humanos , Órbita/cirurgia , Polietileno , Polímeros , Telas Cirúrgicas , Engenharia Tecidual , Titânio
10.
Ophthalmic Plast Reconstr Surg ; 35(6): e147-e148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31593040

RESUMO

A 58-year-old man presented with a 9-month history of a chronically draining surgical wound and low-grade periorbital inflammation following a right lateral orbitotomy. Imaging of the right orbit revealed a peculiar lesion in the right lateral orbit that was hypointense on both T1- and T2-weighted MRI with peripheral enhancement. Exploratory orbitotomy and biopsy established the diagnosis of a chronic foreign body inflammatory reaction to bone wax; symptoms resolved following evacuation of the retained foreign material.A 58-year-old man developed a chronic, symptomatic, inflammatory reaction to bone wax following a lateral orbitotomy; only once previously has symptomatic orbital inflammation following orbital surgery as a result of bone wax been reported.


Assuntos
Corpos Estranhos , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Doenças Orbitárias/etiologia , Palmitatos/efeitos adversos , Ceras/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/cirurgia
11.
Korean J Ophthalmol ; 33(5): 436-445, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612654

RESUMO

PURPOSE: We sought to investigate the effects of Graves' orbitopathy (GO) and orbital decompression on lamina cribrosa depth (LCD) using spectral-domain optical coherence tomography. METHODS: Forty eyes that underwent orbital decompression to relieve compressive optic neuropathy or correct disfiguring exophthalmos in the context of GO were included. Subjects were imaged with spectral-domain optical coherence tomography before surgery and at 1 and 3 months after surgery, at which the examiner measured the LCD (distance from the anterior surface of the lamina cribrosa to the Bruch membrane opening line) and peripapillary retinal nerve fiber layer thickness. Subjects were divided into two groups-a muscle-dominant group composed of patients who had extraocular muscle enlargement on preoperative orbital computed tomography scan and a fat-dominant group composed of patients who did not show extraocular muscle enlargement on preoperative orbital computed tomography scan-and subgroup analysis was performed. Preoperative and postoperative intraocular pressure, exophthalmos, LCD, and retinal nerve fiber layer thickness were evaluated. RESULTS: At baseline, LCD was remarkably shallower in the muscle-dominant group than in the fat-dominant group (95% confidence interval, p = 0.007). In the muscle-dominant group, LCD showed no definite change after surgery. However, the fat-dominant group showed temporary posterior displacement of the lamina cribrosa at 1-month postoperation that was reversed to baseline at 3 months postoperation (95% confidence interval, p < 0.01). CONCLUSIONS: The lamina cribrosa was anteriorly displaced preoperatively, and its position was nearly unchanged after the surgery, especially in association with extraocular muscle enlargement. An enlarged extraocular muscle could reduce the pressure-relieving effect of orbital decompression around the scleral canal in patients with GO.


Assuntos
Descompressão Cirúrgica/métodos , Oftalmopatia de Graves/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Órbita/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Oftalmopatia de Graves/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Disco Óptico/diagnóstico por imagem , Órbita/diagnóstico por imagem , Estudos Prospectivos , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Adulto Jovem
12.
J Craniofac Surg ; 30(7): 2277-2279, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31574787

RESUMO

OBJECTIVE: To define a reliable and consistent landmark, the superior posterior wall of the maxillary sinus, and to describe how this landmark can be used when repairing orbital floor fractures. METHODS: Retrospective chart review. Patients >18 years old diagnosed with unilateral orbital floor and/or zygomaticomaxillary complex fractures. MAIN OUTCOMES: The distance from the inferior orbital rim to the superior posterior wall of the maxillary sinus (landmark distance), and the distance from the landmark to the entrance of the optic canal were reported. RESULTS: Eighty patients were included in the study. Each had unilateral isolated orbital floor fractures (n = 46) or unilateral zygomaticomaxillary complex fractures with an orbital floor component (n = 34). The contralateral eye in all patients was uninjured, and was used as an internal control. In orbital floor fractures, the mean landmark distance was 38.8 ±â€Š1.4 mm, with a mean distance on the normal side of 38.8 ±â€Š1.6 mm (P = 0.49). Distance to the optic canal on the injured side in isolated orbital floor fracture patients was 9.0 ±â€Š0.8 mm with the same measurement on the normal side being 8.8 ±â€Š0.7 (P = 0.21). In the setting of zygomaticomaxillary complex fracture, the orbital floor length was 38.2 ±â€Š1.3 mm with a mean normal floor length of 37.8 ±â€Š1.1 mm (P = 0.18). The mean distance from the superior posterior wall to optic canal in zygomaticomaxillary complex fractured orbits was 9.2 ±â€Š1.1 mm with a normal side mean length of 9.5 ±â€Š1.0 mm (P = 0.23). No significant difference was found between the measured distances in the fractured orbit and its normal counterpart for both fracture groups. CONCLUSIONS AND RELEVANCE: The superior posterior wall of the maxillary sinus is a reliable landmark that can be used to assist in placement of an orbital floor reconstructive plate. The landmark is unchanged despite the presence of an orbital floor or zygomaticomaxillary sinus fracture.


Assuntos
Órbita/cirurgia , Placas Ósseas , Humanos , Seio Maxilar/cirurgia , Fraturas Orbitárias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
13.
J Craniofac Surg ; 30(7): 2091-2093, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31490438

RESUMO

PURPOSE: One of the most characteristic features in premature craniosynostosis is fronto-orbital retrusion. The standardized surgical technique of fronto-orbital advancement (FOA) can treat this (some) deformity, such as bilateral coronal synostosis. The purpose of the study is to investigate an available method to assess the postoperative outcome of the craniofacial surgery. METHODS: From 2010 to 2015, 6 pediatric patients were taken the FOA in the Department of Burn and Plastic Surgery in the Children's Hospital of Nanjing Medical University. All the patients were performed the computed tomography (CT) scan preoperatively and postoperatively. The CT databases were processed by DICOM files into MIMICS 16.0 software, which were automatically calculated into orbital volume and orbital roof and base surface area. T-test was used to compare measured values before and after surgery. P < 0.05 was considered statistically significant. RESULTS: The average preoperative orbital volume was 13930.70 mm, and the postoperative was 18578.67917 mm. After operation, the volume of orbital was significantly increased (P < 0.05). The mean area of the orbital roof surface was 753.989025 mm preoperatively, and the postoperative was 1122.074583 mm. The difference was statistically significant (P < 0.05). The average area of the orbital base (S2) was 334.94 ±â€Š91.76 mm. After the FOA, the orbital base was 356.99 ±â€Š114.21 mm. P(S2) = 0.6072 > 0.05, there was no significant statistical difference. CONCLUSIONS: Fronto-orbital advancement can successfully improve morphological orbital deformities in children with premature craniosynostosis, but much less for maxillary. The computer-assisted technique can present a measurement of FOA preoperatively and postoperatively, which make the evaluation intuitive.


Assuntos
Craniossinostoses/cirurgia , Criança , Pré-Escolar , Humanos , Lactente , Órbita/cirurgia , Período Pós-Operatório , Tomografia Computadorizada por Raios X
14.
Neurochirurgie ; 65(5): 252-257, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31525394

RESUMO

More and more genetic syndromes are associated with bicoronal synostosis (BCS), making non-syndromic BCS (NSBCS) a shrinking entity. However, the numerical importance and clinical impact of syndromic BCS (SBCS) versus NSBCS have not been much studied. We retrospectively reviewed our experience with BCS over the last four decades in order to compare prevalence trends in SBCS and NSBCS. 195 patients were treated for BCS during the period 1978-2017: 104 (53.3%) were syndromic, 24 (12.3%) showed clinical and/or familial features suggesting a syndrome, although without final diagnostic confirmation, and 7 (3.5%) had associated extra-cranial malformations suggesting a syndromic context without identified genetic mutation; the remaining 61 (31.3%) were purely NSBCS. Surgery was required earlier in SBCS (21.7months, 95%CI 18.4-25.1) than in NSBCS (29.5months 95%CI 26.4-32.7). Prevalence of hydrocephalus and tonsillar herniation was significantly lower in NSBCS, and mortality concerned only SBCS. Prevalence of NSBC decreased significantly over the study period, likely because of more accurate testing, and decreased slightly over the last decade, possibly because of prenatal testing and abortion. NSBCS is now much less common than SBCS, and has a less aggressive clinical course, with lower rates of hydrocephalus, tonsillar herniation and mortality. This subgroup also deserves attention because it is likely that new discoveries are still to be made.


Assuntos
Craniossinostoses/cirurgia , Osteotomia/métodos , Criança , Pré-Escolar , Craniossinostoses/complicações , Craniossinostoses/fisiopatologia , Feminino , Osso Frontal/anormalidades , Osso Frontal/cirurgia , Humanos , Hidrocefalia/etiologia , Lactente , Masculino , Órbita/anormalidades , Órbita/cirurgia , Estudos Retrospectivos , Crânio/anormalidades , Crânio/cirurgia , Síndrome , Resultado do Tratamento
15.
J Craniofac Surg ; 30(7): 2106-2110, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31513039

RESUMO

BACKGROUND: Restoring the orbital cavity integrity in orbital floor defects is a challenging issue due to the anatomical complexity of the floor's surface. This is a showcase for technical description of a novel "in house" rapid prototyping protocol aimed to customize implant for orbital floor reconstruction. METHODS: The authors present 4 cases to show our Computer-aided-design and Computer-aided-manufacturing digital workflow. The system was based on a 3D-printed press that; through a virtually designed mold, was used to conform a patient specific titanium mesh for orbital floor reconstruction. RESULTS: The merging procedure analysis by iPlan Cranial 3.0 (Brainlab, Munich, Germany) highlighted a 0.71 ±â€Š0.23 mm (P <0.05) discrepancy in a point-to-point superimposition between the digital planned reconstruction and the real in vivo result. CONCLUSIONS: The authors expect that this technique will reduce operative time and cost however further study and larger series may better define the applicability in everyday surgical practice.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Desenho Assistido por Computador , Humanos , Órbita/cirurgia , Impressão Tridimensional , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/métodos , Telas Cirúrgicas , Fatores de Tempo , Titânio
16.
Rev. bras. cir. plást ; 34(3): 362-367, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047155

RESUMO

Introdução: Os retalhos interpolados são opções cirúrgicas eficazes para reconstruções de defeitos cutâneos em várias áreas do corpo, inclusive na face. O retalho proposto dispensa cuidados pós-operatórios com o pedículo exposto e pode ser realizado em tempo único. O objetivo é avaliar a utilidade do retalho interpolado de sulco nasogeniano (RISN) em ilha, na reconstrução de segmentos nasais e do canto interno da órbita, bem como discutir refinamentos em seu design e execução. Métodos: Estudo retrospectivo de prontuários de pacientes com defeitos nasais ou de canto interno da órbita, e que foram reparados com retalho interpolado do sulco nasogeniano. Todos os retalhos foram confeccionados de maneira randômica, realizando-se túnel subcutâneo para evitar pedículo exposto e cicatriz que comunicasse a área doadora e o defeito. Resultados: cinco pacientes foram incluídos no estudo, com idade entre 30 e 92 anos. Em todos os casos foi realizada biópsia de congelação intraoperatória que revelou margens livres de doença, orientando a extensão da ressecção. O CBC foi encontrado em 4 pacientes e o CEC em um paciente. Não houve complicações como sangramento pós-operatório ou necrose. Bons resultados funcionais e estéticos foram alcançados em todos os pacientes. Discussão: Vale ressaltar a versatilidade do retalho nasogeniano interpolado, sendo capaz de auxiliar na reconstrução de defeitos extensos não apenas de asa, ponta e columela nasais, mas também de dorso e canto medial do olho. Destaca-se também o aspecto estético mais favorável do pedículo do retalho interpolado em ilha comparado ao de transposição. Conclusão: O RISN interpolado em único estágio é uma opção confiável na reconstrução de segmentos faciais. Apresenta boa vascularização, possibilidade se ser realizado em único tempo e pode ser utilizado para cobertura nos locais onde há poucas opções reconstrutivas disponíveis.


Introduction: Interpolation flaps are effective surgical options for reconstructing skin defects in various areas of the body, including the face. The proposed flap does not require postoperative care with the pedicle exposed and can be performed in a single surgery. The objective is to evaluate the usefulness of the nasolabial interpolation island flap (NIF) for reconstructing nasal segments and the inner corner of the eye, as well as discuss improvements in its design and performance. Methods: In this retrospective study, medical records of patients with nasal defects that were repaired with a nasolabial interpolation flap were reviewed. All flaps were created with a subcutaneous tunnel to avoid pedicle exposure and prevent scar connection with the donor area and the defect. Results: Five patients aged 30­92 years were included. In all cases, intraoperative frozen biopsy revealed disease-free margins, indicating the extent of the resection. Basal cell carcinoma was found in four patients and squamous cell carcinoma in one. There were no complications such as postoperative bleeding or necrosis. Good functional and aesthetic results were achieved. Discussion: The NIF can help in the reconstruction of extensive defects of the nasal ala, tip, columella, and medial dorsum as well as the corner of the eye. We also highlight the more favorable aesthetic aspect of the pedicle in the interpolation island versus transposition flap. Conclusion: The single-stage NIF flap is a reliable option for reconstructing facial segments as it has good vascularization, can be performed in a single surgery, and can be used to cover places where few other reconstructive options are available.


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso de 80 Anos ou mais , História do Século XXI , Órbita , Nariz , Registros Médicos , Estudos Retrospectivos , Procedimentos Cirúrgicos Reconstrutivos , Face , Sulco Nasogeniano , Retalho Perfurante , Neoplasias , Órbita/anormalidades , Órbita/cirurgia , Nariz/anormalidades , Nariz/cirurgia , Registros Médicos/normas , Procedimentos Cirúrgicos Reconstrutivos/métodos , Face/anormalidades , Face/cirurgia , Sulco Nasogeniano/anormalidades , Sulco Nasogeniano/cirurgia , Retalho Perfurante/cirurgia , Retalho Perfurante/efeitos adversos , Neoplasias/cirurgia
17.
Korean J Ophthalmol ; 33(4): 366-370, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389213

RESUMO

PURPOSE: Orbital exenteration is a psychologically and anatomically disfiguring procedure which indicated in some patients with malignant or progressive diseases of orbital and periorbital area. In this study, we reviewed 176 patients that underwent orbital exenteration. METHODS: This was a retrospective study of medical records from all patients who underwent orbital exenteration from March 1991 to March 2014 in oculoplastic department at an eye care center. Demographic data, diagnosis, site of primary involvement and technique of surgery were determined in patients. RESULTS: One hundred seventy-six cases of orbital exenteration were included that had documented histopathology. The age of patients ranged from 1 to 91 years (mean age ± standard deviation, 55.43 ± 27 years). Ninety-seven (55.11%) males and 79 (44.88%) females were included. Fifteen different tumors were identified. The most common indication was patients with basal cell carcinoma 49 (28%) followed by 41 (23.5%) squamous cell carcinomas, 35 (20%) retinoblastoma, and 13 (7%) adenoid cystic carcinomas. In total, adnexal malignancies were the most common tumors, secondarily involving the orbit. Eyelids 89 (50.5%) and the globe 43 (24%) were the most frequent site of involvement. Three types of exenteration were performed, based on available data of 129 operation sheets, 46 (35.7%) subtotal, 62 (48.1%) total, and 21 (16.3%) cases of extensive exenterations. In total 97 cases were evaluated pathologically for perineural involvement, of which perineural invasion was noted in 9 (7%) reports. CONCLUSIONS: Frequency of exenteration in our center has increased in past 3 years and the majority of cases were eyelid basal cell carcinoma. Patient education considering periocular lesions can help in earlier diagnosis of malignant lesions and therefore reducing the number of exenteration.


Assuntos
Neoplasias Oculares/cirurgia , Previsões , Exenteração Orbitária/tendências , Órbita/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
18.
J Craniofac Surg ; 30(7): e661-e664, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31449199

RESUMO

This study aimed to evaluate the effect of laterally-based pedicled cranial bone flap (LBPCBF) for the repair of secondary zygomaticomaxillary defects. Between December 2014 and December 2016, 6 patients with unilateral zygomaticomaxillary defects were selected; of these, 5 had trauma, and 1 was exposed to titanium mesh in the infraorbital area due to radiotherapy following total maxillectomy for right maxillary squamous cell carcinoma. Preoperatively, 3 patients suffered from an intraoral vestibular groove fistula, 2 suffered from an extraoral fistula, and 1 from local exposure of titanium mesh. Surgical treatment was implemented in all 6 patients, of which, the 5 trauma patients underwent debridement, reduction, and fixation of periorbital fracture, followed by repair of the defects in the infraorbital margin, anterior wall of maxillary sinus, and zygomatic body with LBPCBF, and then, reconstruction of the orbital floor with titanium mesh. The other patient with exposed titanium mesh underwent repair of defects in the infraorbital margin and anterior wall of the maxillary sinus with LBPCBF after titanium mesh trimming. Postoperative review at 6 months revealed disappearance of intraoral fistula, wound healing, and improvement of facial deformity in all 6 patients, of which 2 patients demonstrated postoperative ectropion. The application of LBPCBF can simultaneously repair bone defects in the infraorbital margin, anterior wall of maxillary sinus, and zygomatic body, as well as, supplement the soft tissue, thereby indicating a satisfactory treatment effect.


Assuntos
Maxila/cirurgia , Retalhos Cirúrgicos , Zigoma/cirurgia , Adulto , Carcinoma de Células Escamosas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos/cirurgia , Telas Cirúrgicas , Titânio
19.
J Craniofac Surg ; 30(6): 1782-1786, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31449214

RESUMO

: Orbital fractures can involve floor, lateral and medial wall. Surgical access depends on fracture's severity, ocular trauma and patient's age. Subciliary, subtarsal, infraorbital or transconjunctival approaches are the main access to the orbit. Surgical interventions in the eyelid may induce scar tissue formation and, consequently, the cicatricial scleral show. The authors present a study with the aim to evaluate the incidence of cicatricial scleral show in patients treated for orbital fractures with or without simultaneous Tarsal Sling Canthopexy in our Plastic Surgery Department. METHODS: The authors evaluated 50 patients divided in 2 groups: Group 1, subciliary approach and reconstruction of orbital floor without simultaneous Canthopexy Tarsal Sling; Group 2: reconstruction of orbital floor through subciliary approach with simultaneous Canthopexy Tarsal Sling. RESULTS: Patients, who underwent Canthopexy Tarsal Sling, did not have any scleral show. Instead patients, who did not undergo this prevention technique, had scleral show even if a minor entity. DISCUSSION: Although there was no muscle or skin removed, in our procedure, but only cutaneous incision, scleral show can appear as a complication. Canthal ligament and tarsus' elasticity influence the incidence of post-surgical scleral show, which is more frequent in elderly patients. Therefore, the authors suggest to prevent it routinely with Tarsal Sling Canthopexy. CONCLUSION: Canthopexy Tarsal Sling is procedure that stretch tarsal structure and it may help to prevent scleral show.


Assuntos
Fraturas Orbitárias/cirurgia , Esclera/cirurgia , Adolescente , Adulto , Idoso , Pálpebras/cirurgia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Órbita/cirurgia , Estudos Retrospectivos , Adulto Jovem
20.
World Neurosurg ; 130: 306-312, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299303

RESUMO

BACKGROUND: Certain cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) are difficult to access through transarterial or transvenous routes and may necessitate access through direct transorbital puncture of the superior ophthalmic vein (SOV) or the CS. However, to be successful, the accurate design of the puncture route and guidance are crucial. This study aimed to report our preliminary clinical experience using cone-beam computed tomography (CT) with real-time fluoroscopic overlays for image guidance during transorbital needle puncture. METHODS: Between December 2017 and July 2018, 3 patients with CS DAVFs were treated via a transorbital puncture to establish access to the CS under the guidance of XperGuide planning software either via direct CS puncture or through the SOV. The guidance trajectory was superimposed onto the real-time fluoroscopic image during needle puncture. Once access was established, the CS DAVFs were treated with a combination of liquid embolic materials and coils. RESULTS: Image guidance aided to avoid at-risk structures and treatment resulted in all cases in complete obliteration of the CS DAVFs as verified by control angiography without peri- or postprocedural complications. CONCLUSIONS: Endovascular embolization of CS DAVFs via direct transorbital puncture aided by image guidance provided an alternative option when more conventional approaches are deemed not possible.


Assuntos
Seio Cavernoso/cirurgia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Tomografia Computadorizada de Feixe Cônico , Órbita/cirurgia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Angiografia Cerebral/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Embolização Terapêutica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Punções/métodos
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