Carcinoma metatípico de piel en colgajo cérvico-facial previo. A propósito de un caso / Metatypical carcinoma of the skin in a previous cervicofacial flap. A case report

El carcinoma baso escamoso (CBE) o metatípico, es considerado un subtipo de carcinoma basocelular (CBC). Con frecuencia es infradiagnosticado ya que no posee características clínicas ni histológicas definidas, por lo que se suele diagnosticar erróneamente como un carcinoma basocelular o espinocelular (CEC). En este artículo se presenta el caso de un paciente masculino de 86 años con un CBE que se expresó en un colgajo cérvico-facial previo. Se ha descrito un alto riesgo de recurrencia y metástasis, lo que supone un pronóstico desfavorable para los pacientes. No existen protocolos terapéuticos estandarizados para esta entidad, sin embargo, el manejo es fundamentalmente quirúrgico. No se encontraron en la literatura reportes previos de carcinoma metatípico en injertos autólogos de piel(AU)

Metatypical or basosquamous carcinoma (BSC) is considered a subtype of basal cell carcinoma (BCC). It is often underdiagnosed due to the lack of defined clinical and histological characteristics, leading to misdiagnosis as either BCC or squamous cell carcinoma (SCC). This article presents a case of an 86-year-old male patient with metatypical carcinoma that manifested in a previous cervicofacial flap. There is a high risk of recurrence and metastasis associated with this condition, leading to an unfavorable prognosis for patients. Although there are no standardized therapeutic protocols for this entity, surgical management is the primary approach. No previous reports of metatypical carcinoma in autologous skin grafts were found in the literature(AU)

Situación actual de la enseñanza quirúrgica por simulación en Venezuela / Current status of surgical training with simulation in Venezuela

La simulación constituye un instrumento beneficioso para la adquisición de destrezas quirúrgicas. Su disponibilidad en países en vías de desarrollo representa un obstáculo importante en la educación quirúrgica contemporánea.Objetivo : Identificar centros de capacitación quirúrgica en Venezuela que utilicen la simulación para el entrenamiento de habilidades técnicas y conocer la opinión de los miembros de la Sociedad Venezolana de Cirugía (SVC) acerca de su uso para desarrollar habilidades en cirugía abierta.Métodos : Estudio transversal y descriptivo. Se enviaron encuestas por correo electrónico a todos los miembros activos de la SVC. Se utilizó estadística descriptiva para el análisis y presentación de los datos.Resultados : De 1115 encuestas enviadas, 111 fueron completadas; 67,6 % de los participantes no tienen conocimientos sobre la existencia de centros de entrenamiento basados en simulación quirúrgica; el 99,1 % están de acuerdo con implementar la simulación como método de capacitación complementario y consideran importante el entrenamiento de habilidades en cirugía abierta; 94,6 % manifestó que el entrenamiento debe estructurarse y ejecutarse en módulos que inicien con tareas básicas para luego avanzar hacia procedimientos más complejos; 75 % de los procedimientos avanzados que deben practicarse con mayor frecuencia corresponden al sistema gastrointestinal, destacando las anastomosis intestinales (74,7 %).Conclusión : la gran mayoría de los cirujanos en las Instituciones de salud de Venezuela no tienen acceso a la simulación como herramienta educativa, a pesar de estar de acuerdo con que su implementación es altamente potenciadora para el desarrollo de habilidades técnicas(AU)

Simulation represents a beneficial tool for acquiring surgical skills. Its availability in developing countries poses a significant obstacle in contemporary surgical education.Objective : To identify surgical training centers in Venezuela that use simulation for technical skills training, and to understand the opinion of members of the Venezuelan Society of Surgery (SVC) regarding its use for developing open surgical skills.Methods : A cross-sectional, descriptive study. Surveys were sent via email to all active SVC members. Descriptive statistics were used for data analysis and presentation.Results : Of the 1,115 surveys sent, 111 were completed. 67.6% of the participants were unaware of the existence of simulation-based surgical training centers. 99.1% agreed with implementing simulation as a complementary training method and considered training in open surgery skills important. 94.6% stated that training should be structured and conducted in modules starting with basic tasks and progressing to more complex procedures; 75% of the advanced procedures that should be practiced more frequently were related to the gastrointestinal system, with intestinal anastomoses (74.7%) being particularly highlighted.Conclusion : The majority of surgeons in Venezuelan healthcare institutions do not have access to simulation as an educational tool, despite agreeing that its implementation is highly beneficial for the development of technical skills(AU)

Cambio de imagen facial en base a rinoseptoplastía y cirugía ortognática: resultados preliminares / Facial makeover based in rhinoplasty and orthognathic surgery. preliminary results

RESUMEN Introducción: La cirugía ortognática y la rinoplastia son procedimientos consolidados con altas tasas de éxito. La sinergia entre ambos procedimientos ha sido presentada en diferentes investigaciones pero aún no es un procedimiento estándar para pacientes con deformidades faciales. Objetivo: Analizar una serie de casos tratados con cirugía ortognática y rinoplastia y discutir las opciones y fundamentos de la técnica combinada. Material y método: 14 pacientes operados de forma consecutiva fueron incluidos en el estudio. Se identificaron sujetos según el tipo de deformidad facial, el tipo de deformidad nasal y los tipos de cirugías realizadas. El seguimiento mínimo de cada sujeto fue de 12 meses. Resultados: El 50% de los sujetos presentaba deformidad facial de clase III, seguido de deformidades de clase II y I. Las deformidades nasales, de la punta y del puente nasal fueron más prevalentes, siendo el ancho nasal también una deformidad común. En la etapa intraoperatoria, después de realizar la cirugia ortognática, fue necesario realizar un análisis nuevo respecto de la morfologia nasal debido a los cambios que generaba el movimiento maxilar en la condición nasal. Conclusión: La cirugía combinada es sinérgica y viable de ser realizada con bajo número de complicaciones; protocolos y nuevos criterios de análisis son necesarios para obtener mayor predictibilidad en los resultados estéticos.

ABSTRACT Introduction: Orthognathic surgery and rhinoplasty are procedures with high success rate. The synergy between both surgeries has been showed in the past by researches but still they are not standardized procedures for the treatment of patients with facial deformities. Aim: To analyze a case series treated with orthognathic surgery and rinoplasty in the same surgical time, discussing surgical options and techniques in the combined procedure. Material and method: 14 patients were treated consecutively and were included in this research. Subjects were selected by facial deformity, nasal deformity and type of surgery. Minimal follow up was for 12 months to observe results. Results: 50% of subjects showed class III facial deformity, follow by class II and class I facial deformity. In nasal deformities, tip and nasal bridge were more prevalent, being the nasal width a common deformity; in the intraoperative time, after orthognathic surgery, it was necessary to make a new analysis and approach to nasal morphology because the new conditions related to movement of the maxilla. Conclusion: Orthognathic and nasal surgery are good complement and it is possible to do with few complications; surgical protocol and criteria for the analysis are necessaries to obtain more predictability in the esthetic results.

Unusual branching pattern and termination of facial artery and its clinical implications for facial operations / Padrão anômalo de ramificação e terminação da artéria facial e implicações clínicas para cirurgias da face

The facial artery is the main artery of the face and variations in its origin and its branching pattern have been documented. We report herein multiple facial artery branch variations in the face. A large posterior (premasseteric) branch originated from the left facial artery and coursed upwards behind the main trunk of the facial artery. This artery presented with a straight course and was closely related to the anterior border of the masseter. The branch then terminated by supplying the adjacent connective tissue below the parotid duct. It was also observed that the facial artery was very thick and tortuous and terminated as the superior labial artery. Knowledge of this variation is of great clinical significance in facial operations, especially for maxillofacial surgeons and plastic surgeons, because it forms the anatomical basis for the facial artery musculo-mucosal flap

A artéria facial é a principal artéria da face, e variações da sua origem e padrão de ramificação têm sido documentadas. Este artigo descreve múltiplas variações de ramificações da artéria facial. Um ramo posterior grande (pré-massetérico) teve origem na artéria facial esquerda e cursou para cima por trás do tronco principal da artéria facial. Essa artéria apresentou um curso reto e intimamente relacionado com a borda anterior do masseter. O ramo terminou suprindo o tecido conjuntivo adjacente abaixo do ducto parotídeo. Também se observou que a artéria facial tinha grande calibre, era tortuosa e terminava na artéria labial superior. Conhecer essa variação é de grande significância clínica em cirurgias da face, principalmente para cirurgiões maxilofaciais e plásticos, tendo em vista que ela forma a base anatômica para o retalho músculo-mucoso da artéria facial

Tratamiento con cirugía ortognática en paciente clase III esqueletal con latero desviación mandibular izquierda. Reporte de caso

a maloclusión clase III es una de las más complejas de tratar para el profesional de la salud, ya que presenta alteraciones en el componente esquelético y dentario de los pacientes. Caso Clínico: paciente de sexo masculino, de 17 años de edad, presentaba una maloclusión clase III esqueletal, con prognatismo del maxilar inferior, una asimetría facial, además un perfil ligeramente cóncavo, mordida cruzada anterior y posterior izquierda. Mediante cirugía ortognática, utilizando la técnica de osteotomía sagital de rama mandibular y segmentación del maxilar superior, Le Fort I, se corrige la maloclusión, acompañado de la técnica Alexander de Ortodoncia. Conclusión: la correcta aplicación de los conocimientos en el campo de la Ortodoncia y la Cirugía Maxilofacial permite al paciente convertirse en clase II esqueletal al análisis cefalométrico, su perfil cambia a ligeramente convexo y se alcanza clase I canina en ambos lados.

lass III malocclusion is one of the most complex to treat for healthcare because it presents alterations in skeletal and dental component of patients. Case Report: male patient, 17 years old, had a skeletal Class III malocclusion with mandibular prognathism, facial asymmetry, plus a slightly concave profile, crossbite and posterior left. By orthognathic surgery, using the technique of sagittal ramus osteotomy and segmentation maxillary, Le Fort I, malocclusion, accompanied by the Alexander technique Orthodontics is corrected. Conclusion: the correct application of knowledge in the field of Orthodontics and Maxillofacial Surgery allows patients to become skeletal class II to cephalometric analysis, changes to your profile slightly convex and canine class I is reached on both sides.

Tração hemostática temporária (THT) em ritidoplastias / Temporary hemostatic traction (THT) in rhytidoplasty

Introdução: Na tentativa de desacelerar o processo de envelhecimento, as cirurgias de contorno facial foram estabelecendo-se como técnicas rejuvenescedoras, sendo constantemente aprimoradas, assim como os resultados. Porém, como qualquer procedimento cirúrgico, há a possibilidade de intercorrências e a principal complicação delas é o hematoma. Descontentes com a presença desta complicação, com o uso de drenos e visando menor custo, os autores viram a necessidade de desenvolver uma nova tática cirúrgica chamada tração hemostática temporária - THT. Métodos: Foram incluídas neste estudo todas as ritidoplastias realizadas na Clínica Valle Pereira (Florianópolis, SC), no período compreendido entre maio de 2012 e janeiro de 2013, totalizando 64 pacientes. Todos foram submetidos à nova tática cirúrgica chamada tração hemostática temporária. Resultados: Apenas 2 pacientes apresentaram epidermólise com ótima evolução sob a THT, e 1 caso de edema facial generalizado. Não houve caso com hematoma, em qualquer período pós-operatório. Conclusões: esta nova tática cirúrgica evita o uso de drenos, diminui o espaço morto aumentando a adesão do retalho descolado e, consequentemente, diminui a presença de hematoma, seroma e edema pós-operatório, assim como diminui a tensão cicatricial na incisão da pele, visando aprimorar os resultados das ritidoplastias.

Introduction: To slow the aging process, facial contouring surgery was developed as a rejuvenating technique, and is constantly improving, as are the results. However, as with any surgical procedure, complications are possible, the main one being hematoma. Dissatisfied with the prospect of hematoma and the use of drains, and with a goal of lower costs, the authors felt the need to develop a new surgical procedure, temporary hemostatic traction (THT). Methods: Sixty-four rhytidoplasties, all performed at the Valle Pereira Clinic (Florianópolis, SC, Brazil) from May 2012 to January 2013, were included in this study. All patients underwent the new THT procedure. Results: Only two patients developed epidermolysis with optimal evolution following THT, and one developed generalized facial edema. There were no instances of hematoma at any of the postoperative stages. Conclusions: This new surgical technique avoids the use of drains and decreases dead space, thereby improving flap adhesion, and decreases hematoma, seroma, and postoperative edema; it also decreases tension on the incision, hence improving the results of rhytidoplasty.

Ritidoplastia mini-invasiva, um procedimento efetivo através de pequenas incisões / Mini-invasive facelift, an effective procedure through small incisions

Introdução: Os procedimentos aplicados nos problemas de envelhecimento facial devem ficar restritos aos tecidos brandos e às relações com o volume prévio do esqueleto. Eles podem ser realizados mediante diversas técnicas: dissecção ampla e aberta, endoscópica e mini-invasiva. O objetivo é apresentar nossa concepção de ritidoplastias mini-invasivas e ritidoplastias completas através de mini-incisões, após 18 anos de experiência. Métodos: A ritidoplastia mini-invasiva é realizada através de mini-incisões localizadas na linha do cabelo da região frontal, região temporal, na fossa triangular da orelha, no sulco submentoniano e nas pálpebras. Ampla dissecção é realizada para liberar a fáscia parietal do arco zigomático para elevar em continuidade com o SMAS e o platisma num único plano. Essas estruturas são seletivamente fixadas em posições mais elevadas, restaurando a posição dos tecidos brandos e o contorno da face. Resultados: Nossa experiência se apoia em 672 pacientes, operados durante 19 anos, com mínimo de complicações a serem registradas, tendo sido evitadas as incisões pré-auriculares em 89% dos pacientes. Estão registrados os detalhes e táticas de como realizar cirurgias com segurança e a qualidade dos resultados. Conclusões: Diferentes procedimentos são descritos para mostrar como realizamos as ritidoplastias com minivias de acesso, de acordo com as regiões tratadas e sem cicatrizes pré-auriculares em 89% dos casos operados.

Introduction: A restoring procedure of the ageing process of the face should consider the conditions of the soft tissues and the relationship between them and the existing skeletal volume. This could be done through different approaches: open, endoscopic or mini-invasive. To present our concept of mini-invasive facelift, a full facelift through minimal incisions, product of eighteen years of experience. Methods: The mini-invasive facelift is done through minimal incisions located on the frontal hairline, temporal area, triangular fossae of the auricle, submentalis sulcus and eyelids. A wide dissection is performed to liberate the parieto-temporal fascia from the zigomatic arch, to pull it up in continuity with the SMAS and the platysma as one continuous layer or composite flap. These structures are selectively fixed to a higher position restoring the location of the soft tissues and the contour of the face. Results: We have done this procedure to 672 patients, along 19 years, with minimal complications (described also), and avoiding the pre-auricular incisions in 89% of our patients. In this paper details and tips to perform this procedure in a safer way and to get the most natural results are presented. Conclusions: Different approaches are described to perform a face lift with specific mini access views according to the regions to be treated , without periauricular scar round 89% of the operated cases.

Influencia del índice de masa corporal en las características faciales de mujeres jóvenes: resultados preliminares / Body mass index influence in facial pattern of young women. preliminary results

La posición y volumen de tejidos blandos de la cara generan la necesidad de una planificación precisa al momento de cirugias faciales; la influencia del tejidos adiposo en estas caracteristicas puede estar presente. El objetivo de este estudio es identificar las medidas volumétricas y no volumétricas de puntos antropométricos faciales y establecer su relación con el índice de masa corporal (IMC). Se analizaron 29 sujetos del sexo femenino de entre 20 y 25 años de edad (promedio de 22,5 años). Se incluyeron sujetos con auto percepcion de normalidad facial y sin condiciones previas asociadas a trauma, cirugia facial u ortodoncia. Se realizó una secuencia de analisis facial realizando medidas con hilo sobre la cara y con pie de metro en los mismos puntos, estudiando distancias entre puntos antropometricos previamente definidos. Inicialmente se realizo el estudio de peso y talla de los sujetos mediante condiciones estandarizadas. En la tercera etapa se realizaron radiografías laterales en cada sujeto realizando mediciones sobre la radiografia para identificar el tejido blando presente en la región labio superior e inferior, punto A, punto B y pogonion. El analisis de datos se realizo con t test de muestras relacionadas, considerando un valor de p 0.05; el análisis estadístico ANOVA se utilizó para definir la influencia del IMC sobre las variables estudiadas. El peso obtenido registró un promedio de 57,6 kg (+/-8,3 kg) y la talla presento un promedio de 1,6mt; el IMC obtenido fue de 22,5, registrándose 2 sujetos considerados en peso inferior al normal, 20 con peso normal, 6 en sobrepeso y 1 con obesidad. Se observo que las variables volumetricas fueron diferentes a las variables no volumetricas de la cara y se asociaron significativamente con el IMC. El IMC no presento relación positiva con las mediciones realizadas en radiografias laterales; finalmente el IMC tambien no se asocio a la auto percepcion de estética facial (p=0.069)...

The position and volume of the face soft-tissue yield the necessity of a precise plan at the facial surgery time; the influence of the adipose tissue on these characteristics can be present. The aim of this study is to identify the volumetric and non-volumetric measures of anthropometrics facial points and his relationship with the Body Mass Index (BMI). It was been analyzed 29 female subjects between 20 and 25 years old (mean 22.5 years). It was include subjects with self-perception of facial normalcy and without conditions associated to trauma, facial surgery or orthodontic treatment. It was made a sequence of facial analysis measuring with a thread over the face and a caliper the same points, studying distances between anthropometrics points previous define. Previously, it was made a study of the weight and size of the subjects, through standards conditions. At the third stage it was made lateral radiographs to identify the soft tissue present at the superior and inferior lip region, point A, point B and Pogonion. The data analysis was made with the t test of relationship samples, considering a p value 0.05; the statistics analysis ANOVA was used to define the influence of the BMI over the variables. The weight registered a mean of 57.7 kg (+/-8,3 kg) and the size performed a mean of 1.6 m.; the BMI acquired was 22.5, registering, being 2 subjects considerate inferior to the normal weight, 6 overweight and 1 obesity. It was seem that the volumetric variables were different to volumetric variables of the face and they were associated significantly with the IMC. The IMC didn´t show positive relationship with the measures made on the laterals radiographies; finally, the BMI, as well, did not associate to the self-perception of facial aesthetic (p=0.069). It is possible to conclude that the BMI influence the measures obtained on the face and did not influence on the register made over the laterals radiographs.