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ONC - Comunicações e Conferências

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http://hdl.handle.net/10400.10/215

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Browsing ONC - Comunicações e Conferências by Author "Coutinho, I"

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  • Dacryocystorhinostomy: drill technique
    Publication . Ramalho, M; Coutinho, I; Pedrosa, C; Pina, S; Vaz, F; Ferreira, M; Melo, A
    Introduction: Dacryocystorhinostomy or DCR is a bypass procedure with an anastomosis between the lacrimal sac and the nasal mucosa via a bony ostium. It may be performed through an external skin incision or intranasally with or without endoscopic visualization. The success rates for endoscopic and external dacryocystorhinostomy vary widely (external 70-95%; endonasal 59-99%). Video: In the “classic” Dupuy-Dutemps-Brouget technique a scalpel blade is used to perform the skin incision and a Citelli’s punch is used to perform an osteotomy. In our procedure we use an electric scalpel to perform the skin incision which is an arciform incision at the orbital rim and a high speed rotary drill to perform the osteotomy. This technique is the procedure of choice in our Hospital. In 54 consecutive procedures with at least 1 year of follow-up there were only 2 recurrences, with an overall success rate of 96.3%. Conclusion: DCR is today a surgery which is carried out with excellent results by the ophthalmologist as well as by the otorhinolaryngologist. Our procedure has some differences from the common approach which may help to raise the success rate.
    2013Conference object Open access Show more
  • Orbital lymphangioma: a surgical challenge
    Publication . Ramalho, M; Santos, C; Pina, S; Coutinho, I; Vaz, F; Ferreira, M; Melo, A
    Lymphangioma is an uncommon venolymphatic lesion with dead-end lymphatic channels, also defined as vascular hamartoma of lymphatic origin. Orbital lymphangiomas present management challenges to the ophthalmologist due to the tendency to recur locally unless it is completely excised, this is often difficult, because lymphangiomas tend to be infiltrative. The recurrence of hemorrhage and expansion can lead to vision loss and disfigurement. Case report: A 22-year-old woman who had a right orbital lesion excised when she was 18 months, with the confirmation of the clinical suspicion of lymphangioma, had also undergone surgery for another 3 times with a different surgeon. The patient presented with conjunctival chemosis, proptosis, exotropia, and no vision in the right eye, this symptoms had been present for several years. On ophthalmic examination, visual acuity was light perception in the right eye and 10/10 in the left eye. The biomicroscopy of the right eye revealed a punctate keratitis and an exuberant chemosis. The patient had proptosis and a limitation on the adduction of the right eye. Extensive orbital excision of the lymphangioma was performed with symptomatic improvement. After 13 years of follow-up the symptoms recurred progressively associated with recurrent corneal ulcers and pain, an evisceration was performed. The patient presented with adherences and fibrosis in the anophtalmic socket with the need for 2 surgerys for the excision of adherences and 1 surgery for correction of ectropion. Functional as well as aesthetic outcome was obtained. Conclusion: Orbital lymphangiomas represent unique treatment challenges. These infiltrative lesions are prone to recurrence with bleeding, disfigurement, vision loss, and diplopia and can result in disfigurement. Complete surgical excision, as in this case, is typically unattainable without
    2013Conference object Open access Show more