Opções a capsulotomia e capsulectomia no tratamento da contratura capsular: existem alternativas medicamentosas ao tratamento cirúrgico? Revisão de literatura / Options for capsulotomy and capsulectomy in the treatment of capsular contracture: are there clinical treatment alternatives to surgery? A literature review

INTRODUÇÃO: A contratura capsular é uma das principais complicações em cirurgias envolvendo implantes mamários. A classificação mais usada para avaliar o grau de contratura é a de Baker, que a divide em graus I, II, III e IV, sendo as de grau III e IV consideradas significativas. Apesar de existirem diversas teorias, a etiologia da contratura capsular permanece incerta. O tratamento convencional para os casos de contratura é a abordagem cirúrgica com realização de capsulotomia ou capsulectomia. Estes procedimentos, no entanto, não estão isentos de morbidades, com complicações como deiscências, hematomas, seromas, pneumotórax, assimetrias e recidiva da contratura. Este estudo faz uma revisão sobre as alternativas ao tratamento cirúrgico convencional, descritas na literatura. MÉTODOS: Foi realizada pesquisa nas bibliotecas da Pubmed e da Cochrane, utilizando-se os termos: 'capsular contracture', 'capsular contracture treatment' e 'capsular contracture breast treatment'. Foram identificados 991 artigos e selecionados os que discutiam opções medicamentosas para o tratamento de contratura, diferentes de capsulectomia e capsulotomia. RESULTADOS: Foram encontrados vårios estudos utilizando drogas com o fim de reduzir a contratura capsular, das quais o Zafirlucaste é apresentado em maior número de trabalhos. CONCLUSÃO: Dentre as várias drogas utilizadas, o Zafirlucaste apresentou boa eficácia, com baixos índices de complicação; a Triancinolona parece ser também uma boa opção, no entanto precisa de profissional habilitado para realizar as infiltrações. As demais drogas necessitam de maiores estudos.

INTRODUCTION: Capsular contracture is among the main complications of surgeries involving breast implants. The most commonly used classification to assess the degree of contracture is the Baker grading system, which divides contractures into grades I, II, III, and IV. Of these, grade III and IV contractures are considered significant. Although several causes have been postulated, the etiology of capsular contracture remains uncertain. Conventional treatment for contracture is based on a surgical approach, specifically capsulotomy or capsulectomy. These procedures, however, are not exempt from morbidity, and patients may develop complications such as dehiscence, hematoma, seroma, pneumothorax, asymmetry, and contracture recurrence. This study provides a review of alternatives to conventional surgery described in the literature. METHODS: We researched the PubMed and Cochrane Library databases using the following keywords: "capsular contracture", "capsular contracture treatment", and "capsular contracture breast treatment". We identified 991 articles from which we selected those discussing medication options for contracture treatment other than capsulectomy and capsulotomy. RESULTS: We identified several studies in which drugs, most commonly zafirlukast, were used to reduce capsular contracture. CONCLUSION: Among the various reported drugs, zafirlukast exhibited good efficacy and a low rate of complication. Triamcinolone also appears to be a good option, although professional assistance would be needed for drug administration via infiltration. The other drugs described would require further investigation.

O que ocorre com o ângulo columelar após cirurgia de correção da fissura labial? / What happens to columellar angle after cleft lip surgery?

Objetivo avaliar a mudança do ângulo columelar que ocorre após cirurgia de correção para fissura labial. Métodos o estudo foi observacional de caráter descritivo e de corte transversal. Foram avaliadas crianças no primeiro e segundo ano de vida, portadoras de fissura labial unilateral de ambos os sexos, que foram submetidas a cirurgia para correção da fissura. A pesquisa teve um total de 11 crianças participantes. Foi examinada a região nasal e lábio superior da criança e identificados os pontos antropométricos pronasal, subnasal e glabela. Em seguida, foi realizada fotografia para análise fotogramétrica. Foram realizadas fotos no preoperatório e cerca de 4 meses após a cirurgia. As imagens obtidas por fotogrametria foram avaliadas com o programa gráfico Image J,por meio de ferramentas de estudo angular. Resultados a média da medida dos ângulos no pré-operatório foi de 55,41 graus; a média no pós foi de 78,80 graus, percebendo-se uma aproximação ao plano vertical (p<0,0001). Pacientes com fissura lábio-palatina apresentaram variação de 32 graus quando comparadas as medidas pré e pós-operatórias, enquanto que nos pacientes com fissura pré-foramen incompleta e pré-foramen completa foram menores (0,75 e 25 graus respectivamente). Conclusão ocorre verticalização do ângulo columelar após cirurgia de correção da fissura labial. Os pacientes que apresentam maior modificação do ângulo são, justamente, aquelas que apresentam diagnóstico relacionado a deformidades mais complexas. .

Purpose to evaluate post operative columelar angle changes after cleft lip repair. Methods observational, descriptive and cross-sectional study. Were evaluated 11 childrens in first and second year old, with unilateral cleft lip, of both genres, who underwent surgery to correct the lip defect. Were examined child’s nasal area and upper lip and identified anthropometric points pronasale, subnasale and glabella, then photographic documentation was performed for photogrammetric analysis. Photos were taken preoperatively and 4 months after surgery. Images obtained by photogrammetry were evaluated with graphics program Image J, through angular study tools. Results the mean of angles measured preoperatively was 55.41 degrees, and at the postoperative was 78.80 degrees, realizing an approximation to the vertical plane (p<0.0001). Cleft lip and palate patients had a variation of 32 degrees when compared pre and post-operative measurements, while in patients with only cleft lip or cleft lip and alveolus the changes where minors (0.75 and 25 degrees respectively). Conclusion occurs a columellar angle verticalization after cleft lip surgery. Patients that had greater increase to the angle were those who had more complex deformities. .

Nostril Morphometry Evaluation before and after Cleft Lip Surgical Correction: Clinical Evidence

Introduction: The purpose to this work is to review systematically the morphological changes of the nostrils of patients undergoing surgery for correction of cleft lip and identify in the literature the issues involved in the evaluation of surgical results in this population. Review of Literature A review was conducted, searching for clinical evidence from MEDLINE. The search occurred in January 2012. Selection criteria included original articles and research articles on individual subjects with cleft lip or cleft palate with unilateral nostril anthropometric measurements before and after surgical correction of cleft lip and measurements of soft tissues. There were 1,343 articles from the search descriptors and free terms. Of these, five articles were selected. Discussion: Most studies in this review evaluated children in Eastern countries, using different measurement techniques but with the aid of computers, and showed improved nostril asymmetry postoperatively compared with preoperatively. Conclusion: There is a reduction of the total nasal width postoperatively compared with preoperative measurements in patients with cleft lip...