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1.
Curr Med Sci ; 39(3): 415-418, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31209812

RESUMO

The colon is an alternative graft organ for esophageal reconstruction. The present study reviewed our experience with the colon interposition for esophageal replacement following corrosive ingestion, to evaluate the outcomes of colon interposition based on our surgical experience. The clinical data of 119 patients who underwent colon interposition for esophageal replacement from January 2005 to March 2017 were retrospectively analyzed. The routes of the colon interposition were retrosternal in 119 (100%). The median operative time was 390 min (range: 290-610 min) and the median blood loss was 615 mL (range: 270-2500 mL). Of these 119 patients, the cervical anastomosis was performed at the hypopharynx (n=20, 16.8%), the larynx (n=3, 2.5%), and the cervical esophagus (n=96, 80.7%). Five patients experienced cervical anastomotic leakage (4 cases for esophagus-colon, and one for hypopharynx-colon). One patient experienced wound infection of the abdominal wall. Three patients had injury of recurrent laryngeal nerve and hoarseness. Three patients had stress ulcer with bleeding and treated with octreotide. Two patients suffered from incomplete intestinal obstruction. The postoperative follow-up was made for 12 months in all patients and all of them were alive. In conclusion, The colon is well-suited for esophageal reconstruction. The selection of the colon graft should be flexible and be based on the inspection of blood supply and the length needed. We must therefore make every effort to reduce the number of postoperative complications, and improve the quality of life for patients.


Assuntos
Colo/cirurgia , Estenose Esofágica/cirurgia , Esôfago/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante Autólogo/métodos , Adolescente , Adulto , Idoso , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Colo/fisiologia , Traumatismos dos Nervos Cranianos/diagnóstico , Traumatismos dos Nervos Cranianos/etiologia , Traumatismos dos Nervos Cranianos/fisiopatologia , Estenose Esofágica/fisiopatologia , Esôfago/fisiopatologia , Feminino , Seguimentos , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/fisiopatologia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Nervos Laríngeos/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Resultado do Tratamento
2.
J Vasc Surg ; 65(6): 1673-1679, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28527929

RESUMO

OBJECTIVE: This study examined the relationship between two new variables, tumor distance to base of skull (DTBOS) and tumor volume, with complications of carotid body tumor (CBT) resection, including bleeding and cranial nerve injury. METHODS: Patients who underwent CBT resection between 2004 and 2014 were studied using a standardized, multi-institutional database. Demographic, perioperative, and outcomes data were collected. CBT measurements were determined from computed tomography, magnetic resonance imaging, and ultrasound examination. RESULTS: There were 356 CBTs resected in 332 patients (mean age, 51 years; 72% female); 32% were classified as Shamblin I, 43% as Shamblin II, and 23% as Shamblin III. The mean DTBOS was 3.3 cm (standard deviation [SD], 2.1; range, 0-10), and the mean tumor volume was 209.7 cm3 (SD, 266.7; range, 1.1-1642.0 cm3). The mean estimated blood loss (EBL) was 257 mL (SD, 426; range, 0-3500 mL). Twenty-four percent of patients had cranial nerve injuries. The most common cranial nerves injured were the hypoglossal (10%), vagus (11%), and superior laryngeal (5%) nerves. Both Shamblin grade and DTBOS were statistically significantly correlated with EBL of surgery and cranial nerve injuries, whereas tumor volume was statistically significantly correlated with EBL. The logistic model for predicting blood loss and cranial nerve injury with all three variables-Shamblin, DTBOS, and volume (R2 = 0.171, 0.221, respectively)-was superior to a model with Shamblin alone (R2 = 0.043, 0.091, respectively). After adjusting for Shamblin grade and volume, every 1-cm decrease in DTBOS was associated with 1.8 times increase in risk of >250 mL of blood loss (95% confidence interval, 1.25-2.55) and 1.5 times increased risk of cranial nerve injury (95% confidence interval, 1.19-1.92). CONCLUSIONS: This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury.


Assuntos
Perda Sanguínea Cirúrgica , Tumor do Corpo Carotídeo/cirurgia , Traumatismos dos Nervos Cranianos/etiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Brasil , Tumor do Corpo Carotídeo/complicações , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/patologia , Colômbia , Angiografia por Tomografia Computadorizada , Traumatismos dos Nervos Cranianos/diagnóstico , Bases de Dados Factuais , Europa (Continente) , Feminino , Hong Kong , Humanos , Modelos Logísticos , Angiografia por Ressonância Magnética , Masculino , México , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Base do Crânio/diagnóstico por imagem , Resultado do Tratamento , Carga Tumoral , Ultrassonografia , Estados Unidos , Adulto Jovem
3.
Eur J Vasc Endovasc Surg ; 53(3): 320-335, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28117240

RESUMO

OBJECTIVE/BACKGROUND: To review the incidence of post-carotid endarterectomy (CEA) cranial nerve injury (CNI), and to evaluate the risk factors associated with increased CNI risk. METHODS: The study was a meta-analysis. Pooled rates with 95% confidence intervals (CIs) were calculated for CNIs after primary CEA. Odds ratios (ORs) were calculated for potential risk factors. A fixed-effects model or a random effects model (Mantel-Haenszel method) was used for non-heterogeneous and heterogeneous data, respectively. Meta-regression analysis was performed to examine the influence of publication year upon CNI rate. RESULTS: Twenty-six articles, published between 1970 and 2015, were included in the meta-analysis, corresponding to 20,860 CEAs. Meta-analysis revealed that the vagus nerve was the most frequently injured cranial nerve (pooled injury rate 3.99%, 95% CI 2.56-5.70), followed by the hypoglossal nerve (3.79%, 95% CI 2.73-4.99). Fewer than one seventh of these injuries are permanent (vagus nerve: 0.57% [95% CI 0.19-1.10]; hypoglossal nerve: 0.15% [95% CI 0.01-0.39]). A statistically significant influence of publication year on the vagus and hypoglossal nerve injury rate was found, with the injury rate having decreased from about 8% to 2% and 1%, respectively, over the last 35 years. Urgent procedures (OR 1.59, 95% CI 1.21-2.10; p = .001), as well as return to the operating room for a neurological event or bleeding (OR 2.21, 95% CI 1.35-3.61; p = .002) were associated with an increased risk of CNI, whereas no statistically significant association was found between CNIs and the type of anaesthesia, the use of a patch, redo operation, and the use of a shunt. CONCLUSION: The vagus nerve appears to be the most frequently injured cranial nerve after CEA, followed by the hypoglossal nerve, with only a small proportion of these injuries being permanent. The CNI rate has significantly decreased over the past 35 years to a point indicating that CNIs should not be considered a major influencing factor in the decision making process between CEA and stenting.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Traumatismos dos Nervos Cranianos/epidemiologia , Endarterectomia das Carótidas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos dos Nervos Cranianos/diagnóstico , Traumatismos dos Nervos Cranianos/fisiopatologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
J Voice ; 31(1): 126.e1-126.e6, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26846541

RESUMO

OBJECTIVES: The aim was to investigate the clinical and electromyographic characteristics of patients with unilateral vocal fold paralysis (UVFP) combined with lower cranial nerve injury. STUDY DESIGN: This is a case series with chart review. METHODS: Among 368 patients with idiopathic UVFP, 31 patients (8.4%) were eventually diagnosed with lower cranial nerve palsy after examinations of the head and neck, radiology, and electromyogram (EMG). The clinical and electromyographic characteristics of these patients were analyzed. RESULTS: Of the 31 patients, 27 patients exhibited obvious abnormal lower cranial nerve injury physical signs, and 4 patients showed atypical physical signs, identified by EMG. Ultimately, 41.9% (13/31) were diagnosed with idiopathic causes, 38.7% (12/31) with intracranial or skull-base lesions on radiology, 12.9% (4/31) with lower cranial neuritis, and 6.4% (2/31) with radiation-induced lower cranial nerve palsy. Among the cranial lesions, lesions of the jugular foramen region were the most common (50%, 6/12). All 26 patients who underwent EMG tests were confirmed to have vagus nerve impairments (11 complete and 15 incomplete) and accessory nerve impairments (16 complete and 10 incomplete), whereas only 13 patients (50%) exhibited hypoglossal nerve injuries (5 complete and 8 incomplete). CONCLUSIONS: For patients with clinically "idiopathic" UVFP, physical examinations of the lower cranial nerves are essential screening procedures. For patients with abnormal or suspicious physical signs, radiology should be performed to detect possible cranial or cervical lesions. EMG tests were strongly recommended to identify suspicious lower cranial nerve injury and its severity, and may help to predict the prognosis.


Assuntos
Traumatismos dos Nervos Cranianos/diagnóstico , Eletromiografia , Paralisia das Pregas Vocais/diagnóstico , Prega Vocal/inervação , Voz , Adulto , Traumatismos dos Nervos Cranianos/complicações , Traumatismos dos Nervos Cranianos/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/fisiopatologia , Adulto Jovem
5.
J Vasc Surg ; 64(4): 985-989.e2, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27266596

RESUMO

OBJECTIVE: To determine predictors of cranial nerve injury (CNI) after carotid endarterectomy (CEA). METHODS: Consecutive CEAs performed over a 5-year period were enrolled in this study. Outcomes analyzed included 30-day major adverse event rate (composite of stroke, death, and myocardial infarction), death, stroke, disabling stroke, myocardial infarction, cervical hematoma and CNI rate, reoperation, and hospital readmission at 30 days. RESULTS: There were 1258 CEAs were included in the study, 1168 (93%) were performed using an eversion technique. Patients with symptoms comprised 27% of the cohort (n = 340). At 30 days, there were no deaths, 23 major adverse events (1.8%), 11 strokes (0.9%: nine minor, two major), 12 myocardial infarctions (0.9%), 41 cervical hematomas (3.3%), 9 reoperations (0.7%) and 10 hospital readmissions (0.8%). Median duration of stay was 1 day (interquartile range, 1-2 days). CNI rate at discharge was 2.3% (n = 29). Two patients (9%) had more than one cranial nerve affected. The marginal mandibular branch of the facial nerve was most frequently involved (n = 16; 52%), followed by the hypoglossal (n = 9; 29%), the vagus (n = 4; 13%), and the spinal accessory nerve (n = 2; 6%). Horner's syndrome, consistent with an injury to the cervical sympathetic chain, occurred in 13 patients (1%) who had a true cranial nerve affected as well. The vast majority (94%) of these CNIs and all Horner's syndrome neurapraxias were transient; only the two accessory lesions persisted at their follow-up visit (median, 32 months; range, 8-72 months). Significant predictors for CNI included diabetes (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.0-6.2; P = .048), cervical hematoma (OR, 41.7; 95% CI, 13.8-125.4; P < .001), and dual antiplatelet therapy (OR, 4.4; 95% CI, 1.7-11.4; P = .002). CONCLUSIONS: CNI is predominantly a transient complication, but is associated significantly with dual antiplatelet therapy use and the occurrence of a postoperative cervical hematoma. Scrupulous attention to hemostasis might reduce the incidence of CNI.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Traumatismos dos Nervos Cranianos/etiologia , Endarterectomia das Carótidas/efeitos adversos , Hematoma/etiologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/diagnóstico por imagem , Distribuição de Qui-Quadrado , Traumatismos dos Nervos Cranianos/diagnóstico , Quimioterapia Combinada , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Análise Multivariada , Infarto do Miocárdio/etiologia , Razão de Chances , Readmissão do Paciente , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
6.
B-ENT ; Suppl 26(1): 11-19, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29461730

RESUMO

Face and neck: airway and sensorial capacities. For the assessment and the management of face and neck trauma knowledge of the neuro-anatomy and physiology of the ear, nose, throat (ENT) and head and neck (HN) region and structures is essential, as this area is particularly vulnerable to injury. Indeed, the complex anatomy and physiology in this specific area supports important basic functions. In addition, this review elaborates on upper airway and sensorial capacities. Upper airway dimensions are influenced by bony and soft tissues. Age is of fundamental importance in the upper airway assessment, as significant differences in size and proportions apply in children and adults. The cranial nerves (CN) supply motor, sensory ad special sensory fibres to the upper airway. Injury of the CN is a frequent complication of trauma.


Assuntos
Traumatismos dos Nervos Cranianos/diagnóstico , Nervos Cranianos/anatomia & histologia , Face/anatomia & histologia , Traumatismos Faciais/diagnóstico , Lesões do Pescoço/diagnóstico , Pescoço/anatomia & histologia , Sistema Respiratório/anatomia & histologia , Adulto , Fatores Etários , Criança , Nervos Cranianos/fisiologia , Face/fisiologia , Audição , Humanos , Pescoço/fisiologia , Nociceptividade , Equilíbrio Postural , Fenômenos Fisiológicos Respiratórios , Olfato , Percepção Gustatória , Visão Ocular
7.
Facial Plast Surg ; 31(4): 351-6, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26372709

RESUMO

Fractures of the midface and internal orbit occur isolated or in combination with other injuries. Frequently, the patients are first seen in emergency rooms responsible for the coordination of initial diagnostic procedures, followed by the transfer to specialties for further treatment. It is, therefore, important for all physicians treating facial trauma patients to understand the basic principles of injuries to the midface. Thus, this article aims to describe the anatomy and the current classification systems in use, the related clinical symptoms, and the essential diagnostic measures to obtain precise information about the injury pattern.


Assuntos
Traumatismos Maxilofaciais/diagnóstico , Órbita/lesões , Fraturas Cranianas/diagnóstico , Traumatismos dos Nervos Cranianos/diagnóstico , Traumatismos Oculares/diagnóstico , Humanos , Traumatismos Maxilofaciais/classificação , Traumatismos Maxilofaciais/diagnóstico por imagem , Boca/lesões , Cavidade Nasal/lesões , Órbita/diagnóstico por imagem , Fraturas Cranianas/classificação , Fraturas Cranianas/diagnóstico por imagem , Avaliação de Sintomas , Tomografia Computadorizada por Raios X
13.
Eur Spine J ; 24(4): 663-70, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25150715

RESUMO

STUDY DESIGN: The lesion of the lower four cranial nerves, commonly called Collet-Sicard syndrome, can be caused by a blunt head and neck trauma. It may be associated to an isolated fracture of the occipital condyle or of the atlas. OBJECTIVE: The aim of this report is to assess the modality of the trauma, the type of fracture, the anatomic characteristics, the treatment and clinical results of this syndrome. We discuss 14 cases of fracture of occipital condyle and of atlas and 1 personal case. METHODS: We analyzed 14 cases collected from the literature between 1925 and 2013, reported a further personal case and performed an anatomical study of the paracondylar, atlas and styloid process region. The anatomical dissection was performed to assess the anatomic relationships in the site of transit in which the nerves IX, X, XI and XII are injured. RESULTS: A total of 14 cases of p-CSS were collected: 9 caused by a condyle fracture and 5 by an atlas fracture. The patients were 13 males and only 1 female, 10 of them had a blunt trauma due to the result of axial loading (force directed through the top of the head and through the spine) falling on the head. The nine cases with a condyle fracture were associated to the dislocation of part of it, while those with atlas fractures showed the fracture and/or disjunction of the articular mass. The anatomical evaluations reveal that the lower four cranial nerves, at their emergency, pass through a close osteo-ligamentous space in relationship to the condyle. Below they run through a little wider channel between the articular mass of C1 and the styloid process. Two cases underwent surgical procedure. All the other cases were treated conservatively with immobilization of the cervical spine. During follow-up three cases with condylar fractures were found to be clinically unchanged and six showed modest improvements while one case with atlas fracture had a complete recovery and four improved significantly. CONCLUSIONS: The p-CSS is caused by force directed through the top of the head. We suppose that the nerve injuries are due to their laceration caused by a displacement of a condyle fragment or to their compression and stretching when they pass between the lateral mass of the atlas and the styloid process. These modalities of trauma explain the better clinical results in patients affected by C1 fractures. Conservative treatment is the option of choice. Surgical option, when choosed, is not considered to fix nerve damages.


Assuntos
Atlas Cervical/lesões , Traumatismos dos Nervos Cranianos/etiologia , Fraturas Ósseas/complicações , Osso Occipital/lesões , Atlas Cervical/diagnóstico por imagem , Atlas Cervical/patologia , Vértebras Cervicais/lesões , Traumatismos dos Nervos Cranianos/diagnóstico , Fraturas Ósseas/diagnóstico , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osso Occipital/diagnóstico por imagem , Osso Occipital/patologia , Síndrome , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/complicações
15.
Rev. chil. neurocir ; 40(1): 37-41, jul. 2014. ilus
Artigo em Inglês | LILACS | ID: biblio-831381

RESUMO

La lesión de los nervios craneales es un acompañamiento común de un trauma en la cabeza. Lesiones de los nervios craneales asociados con la lesión cerrada de la cabeza ha sido encontrado para ser asociado con una mayor gravedad de la lesión. Los objetivos de este estudio son documentar la incidencia de lesiones de los nervios craneales en lesiones en la cabeza, que se correlaciona con la incidencia de los hallazgos radiológicos, para evaluar el tiempo de recuperación con respecto a los signos y síntomas en la presentación inicial. Se presenta un caso de un varón de 51 años de edad, con lesiones nerviosas del segundo, sexto, séptimo, octavo, noveno y décimo después de una lesión grave en la cabeza. Lo admitieron a la víctima con un historial de conducir una motocicleta utilizando un casco y con una caída a alta velocidad. Su Resonancia Magnética (RM) presenta contusión en el tronco cerebral y su tomografía computarizada (TC) simple mostró pequeña hemorragia a la derecha del tronco cerebral y el paciente fue tratado de forma conservadora. Por otra parte, si se detectan múltiples lesiones de los nervios craneales hay una necesidad de evaluar más a fondo la lesión del tronco cerebral por RM con el fin de evaluar mejor el tronco cerebral. La mayoría de las lesiones de los nervios craneales pueden recibir tratamento conservador, aunque algunos autores indican intervención quirúrgica temprana para el tratamiento de la parálisis facial con fractura a través del canal facial.


Injury to the cranial nerves is a common accompaniment of head trauma. Cranial nerve injuries associated with closed head trauma has been found to be associated with injuries of a higher severity. The incidence of cranial nerve injury in head trauma varies in the literature, ranging from 5 to 23 percent. The objectives of this study are: to document the incidence of cranial nerve injuries in head trauma; to correlate the incidence with radiological findings and to assess recovery time according with signs and symptoms at initial presentation. We report a case of a 51-year-old male having second, sixth, seventh, eighth, ninth and tenth nerve injuries after severe head trauma. He was admitted after an accident with a history of riding a motorcycle wearing a helmet and falling at high speed. Study by Magnetic Resonance Imaging (MRI) of this case presented stem contusion and a plain Computerized Tomography (CT) showed small hemorrhage on the right of the brain stem. The patient was managed conservatively. Multiple cranial nerve palsies after head injury may not carry a bad prognosis as previously thought, and may be reversible. Moreover, if multiple cranial nerve injuries are detected, a better evaluation of the stem brain is needed by MRI in order to evaluate possible lesions in this site. The majority of the cranial nerve injuries are treated conservatively, although some authors indicate early surgical intervention to treat facial palsy with fracture through the facial canal.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Acidentes por Quedas , Acidentes de Trânsito , Hemorragia do Tronco Encefálico Traumática , Traumatismos Cranianos Fechados/complicações , Traumatismos dos Nervos Cranianos/cirurgia , Traumatismos dos Nervos Cranianos/diagnóstico , Traumatismos dos Nervos Cranianos , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X
17.
Eur J Vasc Endovasc Surg ; 47(1): 2-7, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24157257

RESUMO

OBJECTIVES: The benefit of carotid endarterectomy (CEA) may be diminished by cranial nerve injury (CNI). Using a quality improvement registry, we aimed to identify the nerves affected, duration of symptoms (transient vs. persistent), and clinical predictors of CNI. METHODS: We identified all patients undergoing CEA in the Vascular Study Group of New England (VSGNE) between 2003 and 2011. Surgeon-observed CNI rate was determined at discharge (postoperative CNI) and at follow-up to determine persistent CNI (CNIs that persisted at routine follow-up visit). Hierarchical multivariable model controlling for surgeon and hospital was used to assess independent predictors for postoperative CNI. RESULTS: A total of 6,878 patients (33.8% symptomatic) were included for analyses. CNI rate at discharge was 5.6% (n = 382). Sixty patients (0.7%) had more than one nerve affected. The hypoglossal nerve was most frequently involved (n = 185, 2.7%), followed by the facial (n = 128, 1.9%), the vagus (n = 49, 0.7%), and the glossopharyngeal (n = 33, 0.5%) nerve. The vast majority of these CNIs were transient; only 47 patients (0.7%) had a persistent CNI at their follow-up visit (median 10.0 months, range 0.3-15.6 months). Patients with perioperative stroke (0.9%, n = 64) had significantly higher risk of CNI (n = 15, CNI risk 23.4%, p < .01). Predictors for CNI were urgent procedures (OR 1.6, 95% CI 1.2-2.1, p < .01), immediate re-exploration after closure under the same anesthetic (OR 2.0, 95% CI 1.3-3.0, p < .01), and return to the operating room for a neurologic event or bleeding (OR 2.3, 95% CI 1.4-3.8, p < .01), but not redo CEA (OR 1.0, 95% CI 0.5-1.9, p = .90) or prior cervical radiation (OR 0.9, 95% CI 0.3-2.5, p = .80). CONCLUSIONS: As patients are currently selected in the VSGNE, persistent CNI after CEA is rare. While conditions of urgency and (sub)acute reintervention carried increased risk for postoperative CNI, a history of prior ipsilateral CEA or cervical radiation was not associated with increased CNI rate.


Assuntos
Traumatismos dos Nervos Cranianos/etiologia , Endarterectomia das Carótidas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Traumatismos dos Nervos Cranianos/diagnóstico , Traumatismos dos Nervos Cranianos/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , New England , Razão de Chances , Alta do Paciente , Seleção de Pacientes , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Recuperação de Função Fisiológica , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
J Craniofac Surg ; 24(6): 2044-6, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24220401

RESUMO

Typical associated signs and symptoms of displaced zygomatic fractures include lack of zygoma projection, diplopia, and sensory disturbances of the infraorbital nerve (ION). The aim of this article was to assess eventual associations between ION sensory disturbances and zygomatic fractures patterns. This study is based on 2 databases that have continuously recorded patients hospitalized with maxillofacial fractures in 2 Departments of Maxillofacial Surgery in Amsterdam, The Netherlands, and Turin, Italy between 2001 and 2010. The following data for patients surgically treated for displaced zygomatic fractures were considered: gender, age, site and severity of facial fractures, etiology, and presenting symptoms. Statistically significant associations were found between ION sensory disturbances and assaults (P = 0.007) and sport accidents (P = 0.00003), as well as between ION sensory disturbances and isolated zygomatic fractures (P = 0.000002) and between ION sensory disturbances and diplopia (P = 0.00009).The severity of injury and the absorption of middle-energy and high-energy forces by the zygomatic complex only were associated with ION sensory disturbances. The etiology and severity of the injury as well as the presence of associated symptoms should be thoroughly investigated when a zygomatic fracture is suspected.


Assuntos
Traumatismos dos Nervos Cranianos/cirurgia , Nervo Maxilar/lesões , Fraturas Zigomáticas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos dos Nervos Cranianos/diagnóstico , Traumatismos dos Nervos Cranianos/etiologia , Feminino , Humanos , Escala de Gravidade do Ferimento , Itália , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Retrospectivos , Adulto Jovem , Fraturas Zigomáticas/diagnóstico , Fraturas Zigomáticas/etiologia
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