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Articole originale Jurnalul de Chirurgie, Iaşi, 2011, Vol. 7, Nr. 2 [ISSN 1584 – 9341] Este vital sã se suspicioneze o astfel de leziune la pacienţii cu mecanisme lezionale sugestive, urmând apoi ca un examen clinic amãnunţit coroborat cu informaţii anamnestice detaliate despre accident, rezultatele imagistice (eco FAST, LPD, CT şi/sau Rx abdominalã) sã confirme diagnosticul, favorizând o atitudine terapeuticã adecvatã. ACKNOWLEDGMENTS This paper is supported by the Sectoral Operational Programme Human Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/6/1.5/S/S17. BILBIOGRAFIE 1. Fraga GP, Silva FH, Almeida NA, Curi JC, Mantovani M. Blunt abdominal trauma with small bowel injury: are isolated lesions riskier than associated lesions Acta Cir Bras. 2008; 23(2): 192-197. 2. Menegaux F, Trésallet C, Gosgnach M, Nguyen-Thanh Q, Langeron O, Riou B. Diagnosis of bowel and mesenteric injuries in blunt abdominal trauma: a prospective study Am J Emerg Med. 2006; 24(1): 19-24. 3. Brownstein MR, Bunting T, Meyer AA, et al. Diagnosis and management of blunt small bowel injury: A survey of the membership of the American Association for the Surgery of Trauma. J Trauma 2000; 48: 402. 4. Butela ST, Federle MP, Chang PJ, Thaete FL, Peterson MS, Dorvault CJ, et al. Performance of CT in detection of bowel injury. AJR Am J Roentgenol 2001; 176(1): 129-135. 5. Fakhry SM, Brownstein M, Watts DD, et al. Relatively short diagnostic delays (
Articole originale Jurnalul de Chirurgie, Iaşi, 2011, Vol. 7, Nr. 2 [ISSN 1584 – 9341] TRATAMENTUL CHIRURGICAL AL LAGOFTALMIEI PARALITICE POSTPAROTIDECTOMIE C. C. Ciocan – Pendefunda, Carmen Vicol, Eugenia Popescu, V. V. Costan Clinica de Chirurgie Orală şi Maxilofacială. Universitatea de Medicină şi Farmacie “Gr. T. Popa” Iaşi SURGICAL TREATMENT OF PARALYTIC LAGOPHTHALMOS AFTER PAROTIDECTOMY (ABSTRACT): Introduction. Long – term facial palsy appears in patients who undergone surgical procedures with the interrupting the continuity of the facial nerve. The resulting lagophthalmos must be treated in order to prevent visual problems. The treatment is complex, consisting in conservative and surgical methods. This study describes the experience of our unit with the use of gold weight implant in the upper eyelid for lagophthalmos. Material and method. We present 5 cases operated in the Oral and Maxillofacial Surgery Department Iasi treated using the same technic. In all patients the gold plate was shaped prior to surgical procedures. The implant was inserted between the tarsus and orbicularis muscle. Results. The postparotidectomylagophthalmos was successfully treated in all situations. The scar from upper eyelid was camouflaged. The ocular symptoms disappeared in every case. Discussions. The treatment of lagophthalmos must solve the functional problems of the eye and also the esthetic issue. Nowadays, the most common technic used for the correction of lagophthalmos is the insertion of a gold weight in the upper eyelid. In some cases there are necessary surgical procedures for the ectropion consecutive to facial palsy. Conclusions. This technic with gold implant is safe, cheap and repeatable for the correction of paralytic lagophthalmos. Sometimes we have to perform interventions in the lower eyelid also. The postoperative complications are rare. KEYWORDS: PARALYTIC LAGOPHTHALMOS, GOLD WEIGHT IMPLANT, PAROTIDECTOMY. Corespondență: Dr. Cătălin Ciocan, doctorand, UMF Iași, Clinica Chirurgie OMF, Sp. Sf. Spiridon, str. Independenței, nr. 1, 700111, e-mail: catalinciocan2004@yahoo.com * Introducere Pareza facială permanentă este adesea întâlnită la pacienţii care au fost supuşi unor proceduri chirurgicale care au avut drept consecinţă sacrificarea nervului facial. Lagoftalmia apărută la aceştia trebuie întotdeauna tratată cu scopul de a preveni apariţia tulburărilor de vedere [1]. Tratamentul chirurgical al tumorilor maligne de glande parotide presupune adesea sacrificarea nervului facial, în totalitate sau doar a anumitor ramuri, în funcţie de situaţiile clinice şi aprecierea intraoperatorie a chirurgului. Paralizia de nerv facial apare şi ca o consecinţă a unor traumatisme diverse, care la rândul lor pot afecta nervul în totalitate sau doar anumite ramuri. Sunt situaţii în care infecţiile (Herpes Zooster Oticus – Ramsay Hunt Sindrom, virusul varicelei), sau afecţiunile neurologice (Sindromul Guillaine – Barre, Miastenia Gravis), amiloidoza, etc duc la instalarea lagoftalmiei paralitice [2]. Una dintre complicaţiile paraliziei de facial este lagoftalmia, cu imposibilitatea închiderii pleoapei superioare. Acest fapt determinămodificări trofice la nivelul corneei şi tulburări estetice cu impact asupra integrării socioprofesionale ale pacienţilor şi a calităţii vieţii. * received date: 07.01.2011 accepted date: 04.05.2011 250
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