Dissertacao Dr. Fabio Maniglia.pdf - Universidade Federal do Paraná

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ABSTRACT INTRODUCTION: This paper show the experience of the occuloplastic service of the Paraná Federal University in the evaluation of success of intranasal and external dacriocystorrhinostomy (DCR) useing an eletronic protocol called SINPE. OBJECTIVES: Development and validation of SINPE to demonstrate the efficacy of this protocol in intranasal and external daciocystorrhinostomy. MATERIAL AND METHOD: We evaluated 191 dacriocystorrhinostomy ( 136 intranasal and 55 external) in 146 patients.The data was collected and analyzed by the SINPE protocol.The inclusion criteria was patients with lacrimal drainage obstruction ( epiphora) confirmed by positive Milder test, dacryocystography or lacrimal cintillography.Excluison criteria was patients with lacrimation insted of epiphora and those who do not accepted participation in the program. Surgery was performed under local anesthesia and sedation in adults and general anesthesia in children. Intransal DCR used a Halle agger nasi mucosal flap, lacrimal plate removal, openning the periórbita and lacrimal sac, silicone intubation for 6 months.External DCR was performed using a modified “linch”incision with zetaplasty, periosteum elevation with canthal tendon preservation after bone resection and mucosal flaps ( lateral wall of the nose nd lacrimal sac ) were developed and sutured to the periosteum. A silicone intubation was performed in all cases , followed by skin sutures. All patients were followed for a minimium of 12 months and 48 months in some cases. RESULTS: All patients were examined in the department of the occuloplastic service. We had more Female patients with average age of 46 ( beetween 5 – 88 years) with symptoms for more than 2 years. Reflux was found in 160 of 191 cases, this is a very important sign of lacrimal system obstruction. A positive Milder test was found in 144 patients and the left side was prevalent. Marked tear cyntillography and dacryocystography was used in smaller amount. Intranasal surgery was successfull in 91,9% of cases and 90.9% of the external surgeries. Complications related to this procedure were nasal synechia and lacrimal point laceration. CONCLUISION: intranasal DCR is a safe surgical procedure with high índex of success. The use and validation of the SINPE protocol was extremly helpfull. Key words: Dacryocystorhinostomy, epiphora, eletronic protocol.
LISTA DE FIGURAS FIGURA 1 – VISUALIZAÇÃO DO PROTOCOLO MESTRE................................ 26 FIGURA 2 – VISUALIZAÇÃO DO PROTOCOLO ESPECÍFICO......................... 26 FIGURA 3 – INFILTRAÇÃO ANESTÉSICA......................................................... 29 FIGURA 4 – INFILTRAÇÃO ANESTÉSICA INTRANASAL................................. 30 FIGURA 5 – „‟AGGER NASI‟‟, REGIÃO DO RETALHO INTRANASAL................. 30 FIGURA 6 – RETALHO INTRANASAL................................................................ 31 FIGURA 7 – RETALHO INTRANASAL DESCOLADO......................................... 31 FIGURA 8 – RESSECÇÃO DO OSSO LACRIMAL............................................. 32 FIGURA 9 – VISUALIZAÇÃO DA PERIÓRBITA (SACO LACRIMAL)................. 32 FIGURA 10 – DILATAÇÃO DO PONTO LACRIMAL INFERIOR......................... 33 FIGURA 11 – INTRODUÇÃO DA SONDA DE BOWMAN................................... 33 FIGURA 12 – SONDA DE BOWMAN PASSANDO PELO SACO LACRIMAL (VISÃO INTRANASAL).................................................................. 33 FIGURA 13 – SACO LACRIMAL ABERTO......................................................... 34 FIGURA 14 – SONDA DE MANIGLIA PASSANDO PELO PONTO LACRIMAL E SAINDO NA FOSSA NASAL..................................................... 34 FIGURA 15 – TUBO DE SILICONE INTRODUZIDO PELA SONDA DE MANIGLIA................................................................. 35 FIGURA 16 – TUBO DE SILICONE NOS CANÍCULOS LACRIMAIS................. 35 FIGURA 17 – TUBO DE SILICONE SAINDO PELA FOSSA NASAL.................. 36 FIGURA 18 – TUBO DE SILICONE SAINDO PELO SACO LACRIMAL (VISÃO INTRANASAL).................................................................. 36 FIGURA 19 – HASTE PLÁSTICA DENTRO DO SACO LACRIMAL.................... 37 FIGURA 20 – FIO DE ALGODÃO FIXANDO O TUBO DE SILICONE................. 37 FIGURA 21 – MARCAÇÃO DA INCISÃO............................................................ 38 FIGURA 22 – INFILTRAÇÃO ANESTÉSICA....................................................... 39 FIGURA 23 – INCISÃO NA PELE........................................................................ 39 FIGURA 24 – OSSO LACRIMAL E FOSSA LACRIMAL...................................... 40 FIGURA 25 – RESSECÇÃO DO OSSO LACRIMAL............................................ 41 FIGURA 26 – MUCOSA NASAL E SACO LACRIMAL......................................... 42
Page 1 and 2: UNIVERSIDADE FEDERAL DO PARANÁ FÁ
Page 3: M278 Maniglia, Fábio Fabrício Ava
Page 6 and 7: AGRADECIMENTOS Ao Prof. Dr. João M
Page 10 and 11: FIGURA 27 - RETALHO DO SACO LACRIMA
Page 12 and 13: SUMÁRIO 1 INTRODUÇÃO............
Page 14 and 15: informatizado armazenando dados na
Page 16 and 17: 1.2 VIAS LACRIMAIS A obstrução da
Page 18 and 19: 1.3 OBJETIVOS 1. Criar, aplicar e v
Page 20 and 21: informação biomédica, incluindo
Page 22 and 23: evolução da medicina e da tecnolo
Page 24 and 25: Kominek (2005) publicou trabalho co
Page 26 and 27: 3 MATERIAL E MÉTODOS 3.1 CRIAÇÃO
Page 28 and 29: FIGURA 1 - VISUALIZAÇÃO DO PROTOC
Page 30 and 31: Este estudo baseou-se na análise d
Page 32 and 33: FIGURA 4 - INFILTRAÇÃO ANESTÉSIC
Page 34 and 35: FIGURA 8 - RESSECÇÃO DO OSSO LACR
Page 36 and 37: É realizada a abertura da parede m
Page 38 and 39: FIGURA 17 - TUBO DE SILICONE SAINDO
Page 40 and 41: Recolocamos o retalho de mucosa nas
Page 42 and 43: Realizamos a dissecção através d
Page 44 and 45: FIGURA 26 - MUCOSA NASAL E SACO LAC
Page 46 and 47: Fixamos o tubo com algodão 2.0 e u
Page 48 and 49: FIGURA 33 - LOGIN E SENHA Após o p
Page 50 and 51: No lado direito da tela existem esp
Page 52 and 53: Após realizar o cadastro do médic
Page 54 and 55: específico. FIGURA 44 - LOCALIZAÇ
Page 56 and 57: O início da epífora variou muito,
Page 58 and 59:
Quando se apresenta obstrução lac
Page 60 and 61:
A causa principal de obstrução da
Page 62 and 63:
Foram realizadas 55 DCR’s externa
Page 64 and 65:
GRÁFICO 10 - QUANTO AS DCR’S REV
Page 66 and 67:
As complicações relatadas foram:
Page 68 and 69:
O protocolo informatizado pode ser
Page 70 and 71:
O suporte técnico em informática
Page 72 and 73:
dacriocistite sem tratamento adequa
Page 74 and 75:
Com o passar dos anos, com a evolu
Page 76 and 77:
alterações inerentes às fossas n
Page 78 and 79:
REFERÊNCIAS ALENCAR, T.G. Protocol
Page 80 and 81:
EL-GUINDY A, DORGHAM A, GHORABA M.
Page 82 and 83:
LUNARDELLI, P. ; AOKI, L ;JERVÁSIO
Page 84 and 85:
TRIPATHI,A.; LESSER, THJ; O’DONNE
Page 86 and 87:
ANEXOS 84
Page 88:
2.6. O CONTRATANTE poderá lhe forn
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