Craniofacial and Tomographic Changes in People Affected by Leprosy Attended in the Program of Basic Health Unit and Hospital Colônia Pedro Fontes, Cariacica (ES), Brazil
Name: RACHEL AZEVÊDO SERAFIM
Publication date: 10/04/2017
Advisor:
Name |
Role |
|---|---|
| PATRÍCIA DUARTE DEPS | Advisor * |
Examining board:
| Name |
Role |
|---|---|
| ALOÍSIO FALQUETO | Internal Examiner * |
| PATRÍCIA DUARTE DEPS | Advisor * |
Summary: Introduction: Leprosy is an infectious disease caused by Mycobacterium leprae, and, more recently, Mycobacterium lepromatosis, a slow evolution, manifested mainly by dermatoneurological signs and symptoms. In addition to affecting the skin and peripheral nerves, it can also compromise the nasal tissues, eyes, testicles and bones. Skeletal facial and extremity deformities are historical markers and part of the stigma of this disease. Objective: To study craniofacial changes in leprosy. Methods: A case series study was carried out. Fifty-five patients were evaluated, 26 ex-leprosy from the Pedro Fontes Hospital and 29 leprosy patients from the UBS of Jardim América, Cariacica/ES, from September 2015 to December 2016. They were submitted to a Questionnaire with epidemiological data, otolaryngological evaluation and tomographic examination, when necessary. We attempted to correlate some variables with nasal / facial changes clinically and radiologically such as: gender, age, delay time in the diagnosis of leprosy, classification of leprosy, group of participants, leprosy face characteristics. Results: Of the main results found, ten (18.2%) patients presented features of the leprosy face, nine (16.4%) had nasal tip projection smaller than normal, 12 (21.8%) had no nasal tip support, nine (16.4%) had no nasal dorsal support, and the columella was reduced in 14 (25.5%). Regarding the tomographic findings of the 38 patients evaluated, the nasal bones were altered in nine (23.6%), there was resorption of the anterior (partial or total) nasal spine in 21 (55.2%) and septal perforation In five (13.2%), and 16 (42.1%) had lower and middle atrophy of the turbinates. In addition, between the toothed teeth (with three or more upper incisors) only one (2.6%) presented partial resorption with root exposition of the alveolar maxilla process, about upper toothless 27 (71%) presented resorption (partial or even palatal process), and 28 (73.7%) had lost all four upper incisors. Conclusions: Changes in bone and in the anterior nasal spine and alveolar process of the maxilla were frequent. However, alterations of the nasal bones were observed only in the lepromatous leprosy. The mean time of onset of the first lesion up to the diagnosis of the disease was 28.69 months, suggesting the later diagnosis of leprosy. The analysis of esthetic aspects of the face showed changes. However, there are no studies on this subject in leprosy that allow comparisons. Nasal changes were present in 5.5% to 36.4% of patients. The tomographic alterations ranged from 9% to 70%, depending on the structure, being more prevalent in lepromatous leprosy and in patients with more than ten years of diagnosis of the disease. Clinically advanced pictures were evidenced in the imaging exam. The radiological examination contributed and confirmed the otolaryngological findings, evidencing the importance of the two exams in patients with leprosy or ex-patients with the disease.
