Osteomas fronto-etmoidais: aspectos clínicos e cirúrgicos Fronto-ethmoid osteomas: clinical and surgical aspects

Introdução: Osteomas fronto-etmoidais são os tumores benignos mais freqüentes dos seios paranasais, podendo evoluir com complicações infecciosas e destruição das estruturas adjacentes. Apesar de serem relativamente freqüentes, poucos são os casos que necessitam de tratamento cirúrgico. Objetivo: Relatar um grupo de nove pacientes com osteoma frontal ou etmoidal, e discutir a apresentação clínica e o tratamento mais adequado desta doença. Forma de estudo: Clínico prospectivo. Material e Método: Realizado estudo clínico prospectivo de nove pacientes, operados no HSPE-FMO e no Hospital São Luiz de São Paulo, no período de 1995 a 1999. O tratamento cirúrgico foi a opção terapêutica escolhida neste grupo. Foi avaliada a evolução clínica no pós-operatório. Resultados: Dos nove pacientes, cinco eram do sexo feminino e quatro do sexo masculino, com idade variando de 12 a 55 anos e com média etária de 39,55 anos. Todos os pacientes tiveram resolução do quadro inicial, sendo que apenas um evoluiu com seqüelas (hiposmia). Conclusão: Baseados na revisão bibliográfica e nos casos acompanhados, concluímos que as lesões localizadas próximas ao óstio de drenagem do seio frontal, as que ultrapassam os limites dos seios frontal e etmoidal, bem como aquelas localizadas no etmóide, devem ser tratadas cirurgicamente.<br>Introduction: Fronto-ethmoidal osteomas are the most frequent paranasal sinus benign tumor and they may envolve with either infectious complications and destruction of adjacent structures. Though they are relatively frequent, few of them are cases requiring surgery. Aim: To report on a group of nine patients with frontal or ethmoidal osteoma, as well as to discuss the clinical presentation and the most suitable treatment of this disease. Study design: Clinical prospective. Material and Method: A prospective clinical study of nine patients who were submitted to surgery at the HSPE-FMO (State Public Servants Hospital) of São Paulo, and at the São Luiz Hospital of the city of São Paulo, in the period from 1995 to 1999. The surgical treatment was the therapeutic option selected in this group. The clinical evolution was assessed during the postoperative period. Results: Of the nine patients, five were females and four a male, ages ranging from 12 to 55 years, with an average age of 39,55 years. All the patients had a resolution of the symptoms and only one of them presented sequels (hyposmia). Conclusion: Based on both the literature review and on the cases followed, the authors concluded that the lesions compromising the drainage of the frontal sinus osteos, those with destruction of the sinus limits as well as any ethmoidal tumors should be surgically treated

Cirurgia de osteoma de seio frontal Surgery of frontal sinus osteoma

Os osteomas do seio frontal correspondem a 57% dos osteomas dos seios paranasais, com incidência variando de 0,01% a 3%. A remoção cirúrgica nos osteomas frontais é indicada nos pacientes sintomáticos. Nos pacientes assintomáticos pode-se adotar a conduta conservadora ou cirúrgica em todos os pacientes independente da sua localização ou extensão. Cinco pacientes com diagnóstico de osteoma de seio frontal foram operados entre 1995 e 1999. A idade média foi 38,4 anos (extremos de 12 a 55 anos), sendo 3 homens e 2 mulheres. O período de sintomatologia variou de 6 meses a 3 anos com média de 10,5 meses. Quatro pacientes apresentaram cefaléia. Um paciente apresentou epistaxe. Os exames complementares realizados foram: radiografia simples e tomografia computadorizada de seios paranasais com cortes axiais e coronais. Em dois pacientes o diâmetro do osteoma foi maior que 3 cm, e menor que 3 cm em três. A decisão da técnica cirúrgica entre coronal e supraciliar foi estética, reservando-se a abordagem supraciliar para um paciente com calvície, apesar do tumor ser volumoso com extensão para seio etmoidal. Nenhuma dificuldade técnica intra-operatória foi atribuída à escolha da abordagem. O óstio nasofrontal não foi obstruído no intra-operatório. O seguimento pós-operatório mínimo foi de dois anos. Em todos os casos a remoção foi total sem recidiva ou resíduos tumorais. Os sintomas clínicos, achados radiológicos e abordagens cirúrgicas são discutidos. Não ocorreram complicações pós-operatórias.<br>Frontal sinus osteomas are 57% of all paranasal sinus osteomas, with an incidence of 00.1 to 3%. Surgical removal of the frontal sinus osteomas is done in symptomatic patients. Asymptomatic patients can be managed conservatively or submitted to surgery in spite of its location or extension. Five patients having the diagnosis of frontal sinus osteoma were operated on between 1995 and 1999. Medium age was 38.4 years (from 12 to 55 years), 3 male and 2 female. Symptoms occurred from 6 months to 3 years, average of 10.5 months. Four patients had previous headache and one had epistaxis. All patients had standard radiological exams and computed tomography with coronal and axial studies of paranasal sinus. In two patients the diameter of the osteoma was larger than 3 cm and in three smaller than 3 cm. The choice between coronal and supraciliar approach was made according to esthetics, supraciliar approach was made in only one bald patient even with the tumor being large and extending to ethmoidal sinus. Any intra operative difficulty was related to the choice of the approach. Naso-frontal ostium was not obstructed in intra operative course. Minimal postoperative follow up was of two years. Osteomas were radically removed in all patients with no recurrence or residual tumor. Clinical findings, radiological exams and surgical approaches are discussed. No postoperative complications occurred

Early Complex Society on the North and Central Peruvian Coast: New Archaeological Discoveries and New Insights

Archaeological data from the north and central Peruvian coast are presented here as a means to explore key themes relating to social complexity, including complex society and its origins, newly resolved chronological issues, the relationship between iconography and society, and the definition of a new culture. Focusing on an early time span, from ca. 3000 to 200 cal BC, we identify key questions about the trajectory through which early Andean complexity developed, and we discuss new ideas about the chronological placement of Cerro Sechín and Chavín de Huántar. We also use an intertextual approach to study the iconography of the complex Sechín Alto polity and as a means to demonstrate duality, social hierarchy, and the origin of symbols within the society’s iconography. Finally, we highlight a newly described polity, centered in the Nepeña Valley, that is important because its urban traits presage later cultural complexity and because the recognition of this polity demonstrates the potential for similar discoveries of comparable small polities