Cirurgia das fraturas do seio frontal: estudo epidemiológico e análise de técnicas

O trauma do seio frontal não é raro, correspondendo a 8% das fraturas faciais. Pode afetar a lâmina anterior e/ou posterior, com ou sem envolvimento do ducto nasofrontal. Tem alto potencial para complicações e seu manejo ainda é controvertido em algumas situações. OBJETIVO: Apresentar a epidemiologia, o diagnóstico e tratamento clínico e cirúrgico de 24 pacientes com fratura do seio frontal. MATERIAL E MÉTODOS: Estudo retrospectivo, não randomizado, de 24 pacientes com fratura de seio frontal operados no Hospital das Clínicas da Faculdade de Medicina de Botucatu, São Paulo, Brasil. RESULTADOS: Dos 24 pacientes, 16 tinham fraturas da lâmina externa e 8, da lâmina interna e externa. em 2 casos havia lesão do ducto nasofrontal. Vinte (83,4%) pacientes tiveram fraturas faciais associadas e em 13 (54,2%) foram observadas complicações intracranianas. A incisão em asa de borboleta, abaixo da sobrancelha, foi empregada na maioria dos casos cirúrgicos com bom resultado estético. Fixação dos fragmentos ósseos com diferentes materiais (fio de aço, mononylon, miniplacas de titânio) e, se necessário, reconstrução da tábua anterior com material aloplástico ou osso parietal. CONCLUSÃO: A causa principal das fraturas do seio frontal é acidente com veículos. O tratamento depende de sua complexidade, pois comumente há lesões cranioencefálicas associadas. As técnicas cirúrgicas utilizadas são as incisões, retalho bicoronal ou na sobrancelha, infra-orbital (em asa de borboleta), associadas à cirurgia endoscópica em casos de infecção fístula liquórica e complicações orbitárias.

Management of pure medial orbital wall fracture with autogenous bone graft

The orbit is an irregular conical cavity formed from 7 bones including the frontal, sphenoid, zygomatic, maxillary, ethmoid, lacrimal, and palatine bones. Fractures of the internal orbit can cause a number of problems, including diplopia, ocular muscle entrapment, and enophthalmos. Although muscle entrapment is relatively rare, diplopia and enophthalmos are relatively common sequelae of internal orbital fractures. Medial orbital wall fracture is relatively uncommon and represents a challenge for its anatomical reconstruction. In this context, autogenous bone graft has been the criterion standard to provide framework for facial skeleton and orbital walls. Therefore, it is possible to harvest grafts of varying size and contour, and the operation is performed through the bicoronal incision, which is the usual approach to major orbital reconstruction. Thus, this article aimed to describe a patient with a pure medial orbital wall fracture, and it was causing diplopia and enophthalmos. The orbital fracture was treated using autogenous bone graft from calvarial bone. The authors show a follow-up of 12 months, with facial symmetry and without diplopia and enophthalmos. In addition, a computed tomography scan shows excellent bone healing at the anterior and posterior parts of the medial orbital wall reconstruction. Copyright © 2013 by Mutaz B. Habal, MD.

Fratura do seio frontal: relato de caso

The frontal sinus fractures are derived from accidents of great intensity. Are usually associated with fractures of the midface, including the naso-orbital fractures and zygomatic ethmoid. Several treatment modalities have been proposed. In this case it was used to access bicoronal reconstruction of the anterior frontal sinus, and restore contour fronto-naso-orbital-ethmoid with satisfactory results.

Orbital Abscess during Endodontic Treatment: A Case Report

Introduction: Orbital infections may result in permanent morbidity because of the severity of infection. Furthermore, delayed diagnosis or treatment of orbital infections can lead to intracranial complications and even death. The majority of orbital infections develop from paranasal sinus infections, cutaneous infections, and periorbital trauma. Dacryocystitis and odontogenic infection are also accounted as potential etiologies but are scarcely reported in scientific literature. Methods: The patient revealed a history of having endodontic treatment on left maxillary second molar performed 2 weeks previously. Moreover, she exhibited signs of facial pain accompanied by sinusitis symptoms, fever, and nasal obstruction the week after this endodontic procedure. The patient presented proptosis, impairment of ocular motility to the right side, facial tenderness, palpebral erythema, and referred decreased visual acuity. Intraoral exam revealed root fragments of left maxillary first molar and an extensive carious lesion on left maxillary second molar. Computed tomography enabled the observation of frontal sinus, left-sided maxillary, opacity of sphenoidal and ethmoidal sinuses, and apical lesion of left maxillary first and second molars, all suggesting the presence of their apex in the maxillary sinus. In addition, images revealed ocular proptosis and presence of high-density areas suggestive of pus in the medial orbital wall region. Results: The patient was submitted to surgical drainage under general anesthesia approximately 8 hours after the clinical evaluation. Conclusions: Early detection of orbital infection, proper diagnostic tests, and treatment may provide successful outcomes of this rarely occurring disease. (J Endod 2012;38:1541-1543)

Orbital involvement in Pott's puffy tumor: a systematic review of published cases

Pott's puffy tumor (PPT) is a frontal subperiosteal abscess associated with underlying frontal bone osteomyelitis. It represents a well-known source of sinogenic intracranial infection, but the orbital complications related to this entity are rarely reported. The goal of this study was to characterize the orbital involvement in PPT.

Tab. 1: Rates of advance of the frontal push-moraines of 19 lobes in front of an approx. 4.5 km long margin of the Kötlujökull

In the last years masses of ice, about 5 km long, have been protruding from the lowest part of an advancing glacier margin of the Kötlujökull in Southern Iceland. In the summer of 1983, they appeared as sediment-covered lobes, 10-60 m long, bordering the glacier rnargin like agarland. 1 to 3 push-rnoraines without ice core, rnostly sickle-shaped, occured first in the frontal parts of the lobes: behind thern came several ice-cored moraines with heights of up to several metres. The active ice in front of the precipice of the glacier is called the "glacier-foot" in this paper. The digging out of 9 lobes and the measuring of the advance of 19 lobes showed that in most cases this glacierfoot had split up at its distal end into several plate- or stem-shaped pieces of ice which were situated one upon the other, separated by moraine deposits and proceeding irregularly into the foreland at the rate of several mm/h, The sometimes different rate of advance in the same lobe and different rates of advanee in adjoining lobes (some being entirely inactive) point to a type of rnovement which is independent of the general advance of the glacier. Research in the winter of 1983/84 showed less activity in 3 examined lobes, but the activity had not ceased. The advancement of the lower parts of the glacier-foot into and across the sands of the foreland implies the following genesis of pushmoraines: Shoving off a plate of sand, folding it and pushing it over the foreland at average rates of up to 7,2 mm/h, according to the investigations in thc summer of 1983. At a certain stage of the folding process, new folds begin to develop in front of the old, and the old folds are shifted onto the backslope of thc folds in front of them until they are completely unired. In this way, "püe-moraines" arise, which become higher and higher. They include two or more folds declining towards the glacier. Systems of small moraines presumably of the same genesis occur on old moraine areas in front of the Kötlujökull. The possible cause of formation of a glacier-foot is discussed, and the moraines of the Kötlujökull are compared with certain pleistocene push-moraines.

Propriedades Psicométricas da Bateria de Avaliação Frontal numa Amostra de Adultos da População Portuguesa

The Frontal Assessment Batery / A Bateria de Avaliação Frontal (FAB) é um teste neuropsicológico, constituído por seis subtestes, cujo objetivo é avaliar a disfunção executiva global, nomeadamente as funções relacionadas com o lobo frontal, tais como a concetualização, flexibilidade mental, programação motora, sensibilidade à interferência, controlo inibitório e autonomia ambiental frontal. De forma a contribuir para o avanço dos estudos normativos em Portugal, esta dissertação tem como objetivo avaliar as propriedades psicométricas da FAB, numa amostra de adultos da população portuguesa. O protocolo abrangeu a seguinte bateria de testes neuropsicológicos: Bateria de Avaliação Frontal, Figura Complexa de Rey, Matrizes Progressivas de Raven e Teste do Desenho do Relógio. A amostra deste estudo incluiu 376 indivíduos, 155 do sexo masculino e 221 do sexo feminino. Os resultados desta investigação sugerem que a pontuação da FAB é influenciada por algumas variáveis sociodemográficas, designadamente a idade, escolaridade, profissões e região. A análise correlacional mostrou que há apenas uma correlação positiva moderada entre a FAB e as Matrizes Progressivas de Raven. Apesar da consistência interna da FAB ser baixa, existe uma estabilidade temporal moderada. Ao finalizar, consideramos que a FAB reúne os requisitos para se apresentar como uma bateria útil e eficaz, demonstrando um grau razoável de estabilidade temporal, mas fraca consistência interna, sugerindo que a FAB não é indicada para amostra não clínica. / The Frontal Assessment Baterry (FAB) is a neuropsychological test, composed of six subtests, whose aim is to assess the overall executive dysfunction, namely functions related to the frontal lobe, such as conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control and environmental autonomy. In order to contribute to the advancement of normative studies in Portugal, this dissertation aim to evaluate the psychometric properties of the FAB, in an adult sample of the portuguese population. The protocol included the following battery of neuropsychological tests: Frontal Assessment Battery, Complex Figure of Rey, Raven's Progressive Matrices and Clock Drawing Test. The sample this study included 376 individuals, 155 male and 221 female. The results of this investigation suggest that FAB is influenced by some sociodemographic variables, namely age, education, profession and region. The correlational analysis showed that there is only a moderate positive correlation between the FAB and the Raven Progressive Matrices. However, also they found low positive correlations between the FAB and the Complex Figure of Rey, and Clock Drawing Test. Although the FAB has a low internal consistency, there is a moderate temporal stability. Finally, we consider that the FAB gathers the requirements to present itself as a useful and effective battery, demonstrating a reasonable degree of temporal stability, but weaker internal consistency, suggesting that the FAB is not indicate for non-clinical sample.

Comparison Of Postoperative Stability Of Three Rigid Internal Fixation Techniques After Sagittal Split Ramus Osteotomy For Mandibular Advancement.

The aim of this investigation was to compare the skeletal stability of three different rigid fixation methods after mandibular advancement. Fifty-five class II malocclusion patients treated with the use of bilateral sagittal split ramus osteotomy and mandibular advancement were selected for this retrospective study. Group 1 (n = 17) had miniplates with monocortical screws, Group 2 (n = 16) had bicortical screws and Group 3 (n = 22) had the osteotomy fixed by means of the hybrid technique. Cephalograms were taken preoperatively, 1 week within the postoperative care period, and 6 months after the orthognathic surgery. Linear and angular changes of the cephalometric landmarks of the chin region were measured at each period, and the changes at each cephalometric landmark were determined for the time gaps. Postoperative changes in the mandibular shape were analyzed to determine the stability of fixation methods. There was minimum difference in the relapse of the mandibular advancement among the three groups. Statistical analysis showed no significant difference in postoperative stability. However, a positive correlation between the amount of advancement and the amount of postoperative relapse was demonstrated by the linear multiple regression test (p < 0.05). It can be concluded that all techniques can be used to obtain stable postoperative results in mandibular advancement after 6 months.

Extensive Frontoparietal Abscess: Complication Of Frontal Sinusitis (pott's Puffy Tumor).

First described in 1768, the Pott's puffy tumor is a subperiosteal abscess associated with frontal bone osteomyelitis, resulting from trauma or frontal sinusitis. The classic clinical presentation consists of purulent rhinorrhea, fever, headache, and frontal swelling. The diagnosis is confirmed by CT scan and treatment requires intravenous antibiotics, analgesia, and surgical intervention. Early diagnosis and aggressive medical and surgical approach are essential for a good outcome. It rare and the early diagnosis is important; we describe the case of a 14-year-old adolescent with Pott's puffy tumor who was initially treated inadequately, evolving with extensive frontoparietal abscess. The patient underwent surgical treatment with endoscopic endonasal and external approaches combined. Intravenous antibiotics were prescribed for a prolonged time, with good outcome and remission of the complaints.

Site Specific Spin Dynamics In Bafe2as2: Tuning The Ground State By Orbital Differentiation.

The role of orbital differentiation on the emergence of superconductivity in the Fe-based superconductors remains an open question to the scientific community. In this investigation, we employ a suitable microscopic spin probe technique, namely Electron Spin Resonance (ESR), to investigate this issue on selected chemically substituted BaFe2As2 single crystals. As the spin-density wave (SDW) phase is suppressed, we observe a clear increase of the Fe 3d bands anisotropy along with their localization at the FeAs plane. Such an increase of the planar orbital content is interestingly independent of the chemical substitution responsible for suppressing the SDW phase. As a consequence, the magnetic fluctuations in combination with this particular symmetry of the Fe 3d bands are propitious ingredients for the emergence of superconductivity in this class of materials.

Orbital apex syndrome due to aspergillosis: case report

We report the case of a 73-year-old female who presented facial numbness and pain in the first division of the trigeminal nerve, ptosis, diplopia and visual loss on the right side for the previous four months. The neurological, radiological and histological examination demonstrated a rare case of invasive fungal aspergillosis of the central nervous system, causing orbital apex syndrome, later transformed in temporal brain abscess. She died ten months later due to respiratory and renal failure in spite of specific antimycotic therapy.

Astrocitoma frontal com metastase medular: registro de um caso e revisão da literatura

A case of a right frontal astrocytoma with spinal metastatic lesion in the region of the third dorsal vertebra is reported. The metastatic nodule was removed six months after the craniotomy. In the literature concerning to the dissemination of tumors cells is suggested that there is not a causal relationship between CSF seeding and operative intervention. Acess to the ventricular system or basal cisterns is of primary importance in the production of metastases.

Orbital abscess after facial trauma

This paper reports a rare case of acute severe orbital abscess manifested 2 days after a facial trauma without bone fracture in a 20-year-old Afro-American female. The symptoms worsened within the 24 h prior to hospital admission resulting in visual disturbances such as diplopia and photophobia. The clinical findings at the first consultation included fever, periorbital swelling and redness, ptosis, proptosis and limitation of ocular movements upwards, downwards, to the right and to the left. Computed tomography scan showed proptosis with considerable soft tissue swelling on the left side and no fracture was evidenced in the facial skeleton, including the zygomatic-orbital complex. After hospital admission and antibiotic therapy intravenously the patient was conducted to the operation room and submitted to incision and drainage under general anesthesia. The orbit was approached thorough both eyelids and the maxillary sinus was reached only through the Caldwell-Luc approach. The postoperative period was uneventful and the rapid improvement of symptoms was remarkable. Visual acuity and ocular motility returned to the normal ranges within 2 days after the surgical intervention. After 12 postoperative days, the patient presented with significative improvement in the ptosis and proptosis, and acceptable scars.

Orbital multicriticality in spin-gapped quasi-one-dimensional antiferromagnets

Motivated by the quasi-one-dimensional antiferromagnet CaV(2)O(4), we explore spin-orbital systems in which the spin modes are gapped but orbitals are near a macroscopically degenerate classical transition. Within a simplified model we show that gapless orbital liquid phases possessing power-law correlations may occur without the strict condition of a continuous orbital symmetry. For the model proposed for CaV(2)O(4), we find that an orbital phase with coexisting order parameters emerges from a multicritical point. The effective orbital model consists of zigzag-coupled transverse field Ising chains. The corresponding global phase diagram is constructed using field theory methods and analyzed near the multicritical point with the aid of an exact solution of a zigzag XXZ model.