Endovascular treatment of coarctation of the aorta with a self-expanding endoprosthesis: how i do it using the braile dominus ® coarctation aorta device

Abstract The coarctation of the aorta is a relatively highly prevalent congenital heart disease and may be diagnosed as an underline cause of hypertension in adolescents and adults. The gold standard treatment for coarctation of the aorta in these patients is being replaced - from open surgery to endovascular therapy. Some prostheses have been developed to treat the coarctation with less acute and chronic complications. The Dominus® Coarctation Aorta (Braile Biomédica) is the first self-expandable prosthesis created specifically to treat coarctation of the aorta, reducing possible acute complications, like aortic rupture or aortic dissection. Here, we discuss the step-by-step method for using this prosthesis.

Impact of tooth loss due to periodontal disease on the prognosis of rehabilitation

Abstract When periodontal disease is diagnosed, it is difficult to predict the clinical response of treatment of a tooth over time because the result of treatment is affected by several factors and will depend on the maintenance and support of periodontal treatment. Rehabilitation with removable dental prostheses, fixed prostheses, and dental implants makes it possible to restore the function and esthetics of patients with tooth loss due to periodontal disease. The predictive factors of tooth loss in periodontitis patients should be assessed by dentists to inform their clinical decision-making during dental treatment planning. This will provide detailed individualized information and level of risk of patients considered suitable for dental rehabilitation. Therefore, the aim of this article was to review the subject of "Impact of tooth loss due to periodontal disease on the prognosis of rehabilitation" and the effect of fixed, removable, and implant-supported prostheses in periodontal patients.

Prosthesis-socket volume imbalance and dermofat graft rehabilitation in patients with an anophthalmic socket / Os problemas causados pelo desequilíbrio do volume da cavidade da prótese, nos casos de cavidades anoftálmicas, e a sua reabilitação com o enxerto de dermofat

ABSTRACT Purposes: To identify problems caused by prosthesis-socket volume imbalances in anophthalmic sockets; and to evaluate rehabilitation with dermofat graft as a solution. Methods: We retrospectively reviewed medical records of patients operated in our clinic (between May 2011 and June 2016) with dermofat grafts to treat anophthalmic socket-related problems. During the preoperative examinations, ophthalmologists recorded the presence of eyelid problems due to the socket volume deficit, upper and lower fornix deficiency, deepening in the upper eyelid sulcus, epiphora and secretion, lower eyelid laxity, ptosis, entropion, and ectropion. Following the surgical repair, new prosthesis suitable for the resulting socket area were implemented for all the patients. The mean follow-up period was 27.42±16 months (ranging from 10-62 months). On the last control examinations, ophthalmologists recorded solved and unsolved socket problems that were present preoperatively. Results: We included 16 men and 5 women in this study. The mean age was 38.3 ± 18.4 years (range, 5-75 years). The mean duration of preoperative prosthesis use was 9.4 ± 6.8 years (range, 1-30 years). Preoperatively, 7 patients had only orbital volume deficits, and 14 had socket volume displacements in addition to the volume deficits. After the dermofat graft implantations, the remaining deficits were corrected during another surgical session: 6 patients underwent ptosis corrections, 5 lateral canthal suspensions, 5 lower fornix with mucosal graft formations, and 2 upper fornix formations with mucosal grafts. All patients were able to use prosthesis postoperatively. Conclusion: The use of dermofat grafts to correct anophthalmic socket problems caused by orbital volume deficits or volume displacements is an effective, reliable, and reproducible surgical method.

RESUMO Objetivos: Identificar os problemas causados pelo desequilíbrio do volume da cavidade da prótese em cavidades anoftálmicas, e avaliar a reabilitação com enxerto de dermofato como solução. Métodos: Revisamos retrospectivamente os prontuários de pacientes operados em nossa clínica (entre maio de 2011 e junho de 2016) com enxertos de dermofato para tratar problemas relacionados a cavidades anoftálmicas. Durante os exames pré-operatórios, os oftalmologistas registraram a presença de problemas palpebrais devido ao déficit de volume, deficiência de fórnice superior e inferior, aprofundamento no sulco palpebral superior, a epífora e secreção, flacidez palpebral inferior, ptose, entrópio e ectrópio. Após a cirurgia, novas próteses adequadas para a área de encaixe foram implementadas em todos os pacientes. O tempo médio de acompanhamento foi de 27,42 ± 16 meses (variando de 10 a 62 meses). Nos últimos exames de controle, os oftalmologistas registraram problemas corrigidos e não corrigidos da cavidade que estavam presentes no pré-operatório. Resultados: Foram incluídos 16 homens e 5 mulheres neste estudo. A média de idade foi de 38,3 ± 18,4 anos (variação de 5-75 anos). A duração média do uso de prótese pré-operatória foi de 9,4 ± 6,8 anos (variação de 1 a 30 anos). No pré-operatório, 7 pacientes apresentavam apenas déficit orbitais e 14 tinham desvios de volume, além dos déficits de volume. Após os implantes de enxerto de dermoadipação, os déficits remanescentes foram corrigidos durante outra sessão cirúrgica: 6 pacientes foram submetidos a correção de ptose, 5 suspensões de cantal lateral, 5 fórnix inferior com enxerto de mucosa e 2 formações de fórnice superior com enxerto de mucosa. Todos os pacientes foram capazes de usar prótese no pós-operatório. Conclusão: A utilização de enxertos de dermofato para corrigir problemas de anoftalmia causados por déficits de volume orbital ou deslocamento de volume é um método cirúrgico eficaz, confiável e reprodutível.

O passo a passo da moldagem em sobredentaduras mandibulares / Mandibular Overdenture impression step by step

Este artigo descreve o passo a passo da execução do molde em sobredentaduras mandibulares, contemplando a reprodução da área basal com excelência e a transferência dos implantes com precisão.

This article describes the mandibular overdenture impression step by step, showing the optimal reproduction of the basal area and the precise implants transference.

Three Dimensional Printing Technique and Its Application to Bone Tumor Surgery / 대한정형외과학회잡지

Orthopaedics is an area where 3-dimensional (3D) printing technology is most likely to be utilized because it has been used to treat a range of diseases of the whole body. For arthritis, spinal diseases, trauma, deformities, and tumors, 3D printing can be used in the form of anatomical models, surgical guides, metal implants, bio-ceramic body reconstruction, and orthosis. In particular, in orthopaedic oncology, patients have a wide variety of tumor locations, but limited options for the limb salvage surgery have resulted in many complications. Currently, 3D printing personalized implants can be fabricated easily in a short time, and it is anticipated that all bone tumors in various surgical sites will be reconstructed properly. An improvement of 3D printing technology in the healthcare field requires close cooperation with many professionals in the design, printing, and validation processes. The government, which has determined that it can promote the development of 3D printing-related industries in other fields by leading the use of 3D printing in the medical field, is also actively supporting with an emphasis on promotion rather than regulation. In this review, the experience of using 3D printing technology for bone tumor surgery was shared, expecting orthopaedic surgeons to lead 3D printing in the medical field.

Gluteoplastia Técnica Intramuscular (XYZ) / Gluteoplasty using the Intramuscular (XYZ) Method

INTRODUÇÃO: No conceito de beleza corporal, a forma e o tamanho das nádegas são fundamentais, provocando uma crescente busca não só de mulheres, como também de homens, pela cirurgia de gluteoplastia. O objetivo deste trabalho é apresentar a experiência do autor em gluteoplastia com a técnica intramuscular (XYZ). MÉTODO: No período de 2010 a 2015 foram operados 29 pacientes com idades entre 22 e 64 anos (média 43 anos), sendo 26 mulheres (89,66%) e três homens (10,34%). Foram usados implantes redondos ou ovais, com volumes entre 240 e 420 ml (média de 330 ml), dependendo da melhor indicação para cada caso. RESULTADOS: Foram obtidos bons resultados sob o aspecto de aumento de volume e harmonia da região glútea, com alto índice de satisfação dos pacientes. CONCLUSÕES: Na casuística do estudo a técnica intramuscular (XYZ) se mostrou segura, tanto nas cirurgias primárias como nas cirurgias secundárias, para tratar casos de assimetria e/ou implantes visíveis. Com a pré- determinação dos pontos fixos XYZ, o procedimento torna-se seguro e reprodutível.

INTRODUCTION: The shape and size of the buttocks are essential to the notion of bodily beauty. This has resulted in a growing interest in gluteoplasty among both women and men. The aim of the present study was to present the author's experience with gluteoplasty using the intramuscular XYZ method. METHOD: Between 2010 and 2015, 29 patients aged 22 to 64 years (average, 43 years) underwent gluteoplasty; of these 26 were women (89.66%) and 3 were men (10.34%). Round or oval implants were used, with volumes of 240 to 420 ml (average, 330 ml), depending on the individual case. RESULTS: Good results were obtained in terms of volume increase and harmony of the gluteal region, with a high degree of patient satisfaction. CONCLUSIONS: The intramuscular XYZ method was safe, both for primary and secondary surgery, to treat cases of asymmetry and/or visible implants. Predetermining the XYZ reference points makes this procedure safe and reproducible.

Silicone Implant-Based Paranasal Augmentation for Mild Midface Concavity

BACKGROUND: Midface concavity is a relatively common facial feature in East Asian populations. Paranasal augmentation is becoming an increasingly popular procedure for patients with mild concavity and normal occlusion. In this study, we evaluate clinical outcomes following a series of paranasal augmentation. METHODS: A retrospective review was performed for patients with Class I occlusion who had undergone bilateral paranasal augmentation using custom-made silicone implants, between October 2005 and September 2013. Patient charts were reviewed for demographic information, concomitant operations, and postoperative complications. Preoperative and postoperative (1-month) photographs were used to evaluate operative outcome. RESULTS: The review identified a total of 93 patients meeting study criteria. Overall, aesthetic outcomes were satisfactory. Five-millimeter thick silicone implant was used in 81 cases, and the mean augmentation was 4.26 mm for this thickness. Among the 93 patients, 2 patients required immediate implant removal due to discomfort. An additional 3 patients experienced implant migration without any extrusion. Nine patients complained of transient paresthesia, which had resolved by 2 weeks. There were no cases of hematoma or infection. All patients reported improvement in their lateral profile and were pleased at follow-up. Complications that arose postoperatively included 9 cases of numbness in the upper lip and 3 cases of implant migration. All cases yielded satisfactory results without persisting complications. Sensations were fully restored postoperatively after 1 to 2 weeks. CONCLUSION: Paranasal augmentation with custom-made silicone implants is a simple, safe, and inexpensive method that can readily improve the lateral profile of a patient with normal occlusion. When combined with other aesthetic procedures, paranasal augmentation can synergistically improve outcome and lead to greater patient satisfaction.

Peri-implantite: visão crítica e atual sobre fatores etiológicos, diagnóstico clínico/radiográfico e prognóstico: revisão de literatura / Peri-implantitis: critical and current overview of etiological factors, clinical/radiographic diagnosis and prognosis: a literature review

A peri-implantite tem sido diagnosticada mais frequentemente, porém, a melhor forma de tratamento ainda não foi estabelecida. É necessário o conhecimento da etiologia, diagnósticos clínico e radiográfico para a prevenção, tratamento e controle das infecções peri-implantares, visando o sucesso no tratamento com implantes. Objetivo: essa revisão de literatura tem como objetivo realizar uma abordagem crítica e atual da etiologia, diagnóstico e prognóstico nos casos deperi-implantite, baseando-se em artigos nas bases de dados PubMed e Science Direct. Resultados: a peri-implantite é um processo infeccioso/inflamatório que afeta os tecidos duros e moles ao redor dos implantes, com etiologia multifatorial. Alguns métodos de diagnóstico clínico/radiográfico são essenciais para avaliar sua ocorrência e progressão. Apesar de crescentes, os trabalhos científicos são divergentes e inconclusivos quanto ao tratamento ideal e prognóstico. Conclusão: a peri-implantite é um comprometimento que deve ser diagnosticado de forma precoce, sendo necessário o acompanhamento periódico dos pacientes para o sucesso do tratamento com implantes.

Peri-implantitis has been more frequently diagnosed; however, the best treatment method has not yet been established. It is paramount to understand its etiology, as well as clinical and radiographic diagnosis to prevent, treat and control peri-implant infections and, asa result, achieve implant success. Objective: This literature review aims to address the etiology, diagnosis and prognosis of peri-implantitis in a critical and up-to-date manner. It is based on articles retrieved from PubMed and Science Direct databases. Results: Peri-implantitis is an infectious/inflammatory process affecting the peri-implant tissues around dental implants and of multifactorial etiology. Some clinical/radiographic, diagnostic methods are essential to assess the occurrence and progression of peri-implantitis. Despite existing in high numbers, scientific studies are divergent and inconclusive with regard to ideal treatment and prognosis. Conclusion: peri-implantitis is a disease that must be diagnosed at an early stage. Regular monitoring of patients is important for treatmentand implant success.

The use of soft silicone solid implant molded intraoperatively for pectus excavatum surgical repair / Utilização de silicone sólido de baixo índice de dureza moldado no período intraoperatório para a correção de pectus excavatum

Objective To describe a new surgical technique to treat pectus excavatum utilizing low hardness solid silicone block that can be carved during the intraoperative period promoting a better aesthetic result. Methods Between May 1994 and February 2013, 34 male patients presenting pectus excavatum were submitted to surgical repair with the use of low hardness solid silicone block, 10 to 30 Shore A. A block-shaped parallelepiped was used with height and base size coinciding with those of the bone defect. The block was carved intraoperatively according to the shape of the dissected space. The patients were followed for a minimum of 120 days postoperatively. The results and the complications were recorded. Results From the 34 patients operated on, 28 were primary surgeries and 6 were secondary treatment, using other surgical techniques, bone or implant procedures. Postoperative complications included two case of hematomas and eight of seromas. It was necessary to remove the implant in one patient due to pain, and review surgery was performed in another to check prothesis dimensions. Two patients were submitted to fat grafting to improve the chest wall contour. The result was considered satisfactory in 33 patients. Conclusion The procedure proved to be fast and effective. The results of carved silicone block were more effective for allowing a more refined contour as compared to custom made implants. .

Objetivo Descrever a técnica para reparação de pectus excavatum com o uso de bloco de silicone sólido de baixa dureza, que possibilita a adequação de suas dimensões no intraoperatório para melhor resultado estético. Métodos Entre maio de 1994 e fevereiro de 2013, pacientes do gênero masculino, portadores de pectus excavatum, foram submetidos à correção cirúrgica com bloco de silicone sólido de baixa dureza, de 10 a 30 Shore A, pré-fabricado em forma de paralelepípedo, com as dimensões da altura e da base coincidentes com as da falha óssea. Durante o ato cirúrgico, esse bloco foi esculpido até adequar-se ao formato do espaço dissecado. Os pacientes foram acompanhados por um mínimo de 120 dias de pós-operatório. Resultados Trinta e quatro pacientes foram operados. Destes, 28 foram de tratamento primário e 6 secundário a outras técnicas cirúrgicas, ósseas ou de uso de implantes. As complicações foram dois casos de hematoma e oito de seroma. Foi necessária a retirada do implante em um dos casos devido à dor. Em outro caso, foi a realizada revisão cirúrgica das dimensões da prótese. Dois pacientes foram submetidos a enxerto de gordura, para melhorar o contorno da parede torácica. Não ocorreu nenhum caso de infecção. O resultado foi considerado satisfatório em 33 pacientes. Conclusão O procedimento mostrou-se rápido e efetivo. Os resultados dos contornos obtidos foram considerados mais efetivos quando comparados aos obtidos com a utilização de próteses pré-moldadas. .

Implante transcateter de bioprótese valvular pulmonar: revisão sistemática da literatura / Transcatheter pulmonary valve implantation: systematic literature review

A correção cirúrgica de algumas cardiopatias congênitas complexas envolve a reconstrução da via de saída do ventrículo direito com a interposição de homoenxertos, biopróteses, enxertos de jugular bovina ou outros condutos valvulados entre o ventrículo direito e o tronco da artéria pulmonar. Apesar de essas cirurgias poderem ser realizadas com baixa mortalidade, a vida útil das válvulas ou dos condutos implantados é normalmente pequena (< 10 anos), seja por degeneração e/ou calcificação. Graus variáveis de estenose pulmonar na maioria das vezes associada a insuficiência pulmonar são consequências da degeneração dos condutos. Em 2000, Bonhoeffer et al. foram os primeiros a relatar o implante transcateter de bioprótese valvular pulmonar (ITVP) com um dispositivo que posteriormente foi denominado de válvula Melody® (Medtronic, Minneapolis, Estados Unidos). A técnica foi inicialmente desenvolvida para limitar a necessidade de múltiplos procedimentos cirúrgicos, substituindo, em última análise, uma nova troca cirúrgica valvular. Estudos subsequentes na Europa e Estados Unidos atestaram para a segurança e eficácia dessa técnica em um número maior de pacientes. Como a Agência Nacional de Vigilância Sanitária (Anvisa) concedeu a aprovação para o uso clínico da válvula biológica pulmonar transcateter Melody® em fevereiro de 2013, consideramos necessária e oportuna a avaliação judiciosa da utilização dessa nova tecnologia antes que ela fosse aplicada em larga escala em nosso país. O objetivo deste estudo foi realizar uma revisão sistemática da literatura sobre o ITVP em pacientes com disfunções de homoenxertos, condutos valvulados e biopróteses implantados cirurgicamente na via de saída do ventrículo direito.

Surgical repair of some complex congenital heart diseases involves reconstruction of the right ventricular outflow tract using homografts, bioprostheses, bovine jugular grafts or other valved conduits between the right ventricle and the main pulmonary artery. Although these surgical procedures may be performed with low mortality rates, the life span of these implanted valves or conduits is usually short (< 10 years) due to either degeneration and/or calcification. Variable degrees of pulmonary stenosis, often associated with pulmonary insufficiency, are consequences of conduit degeneration. In 2000, Bonhoeffer et al. were the first to report the transcatheter pulmonary valve implantation (TPVI) of a bioprosthetic pulmonary valve later named Melody® valve (Medtronic, Minneapolis, USA). The technique was initially developed to limit the need for multiple surgical procedures, and, ultimately, to work as a surrogate of a new surgical valve replacement. Subsequent clinical studies in Europe and the United States confirmed the safety and efficacy of this technique in a larger number of patients. Since the National Sanitary Surveillance Agency (Agência Nacional de Vigilância Sanitária - Anvisa) granted approval for clinical use of the Melody® transcatheter pulmonary biological valve in February 2103, we deemed that a judicious assessment of this new technology was timely and necessary before the widespread use in our country. The objective of this study was to perform a systematic literature review on the use of TPVI in patients with dysfunctional homografts, valved conduits and bioprostheses implanted surgically in the right ventricular outflow tract.

Development of a Rabbit Model for a Preclinical Comparison of Coronary Stent Types In-Vivo

Along with the development of innovative stent designs, preclinical trials in animal models are essential. Many animal models have been used and appear to yield comparable results to clinical trials despite substantial criticisms about their validity. Among the animal models, porcine coronary artery models have been the standard models for the preclinical evaluation of endovascular devices. However, rapid growth rate, high body weight potential, and the propensity to develop granulomatous inflammatory reactions are major limitations of the porcine coronary artery model. Compared with porcine coronary artery models, the comparative rabbit iliac artery model has the advantages of being small and easy to handle and relatively inexpensive. Furthermore, the rabbit model has been known to reliably reflect human restenosis histopathologically and have major advantages such as pairwise comparison, which makes each animal serve as its own control subject, therefore, maximizing its statistical power for comparative testing. However, despite the widespread use of this model, a systematic description of the procedure and harvest protocols has never been published. This article describes the surgical procedure, stent implantation procedure, method for tissue harvesting, and how measurements are performed. Although the results of animal models may not perfectly extrapolate to humans, the comparative rabbit iliac artery model may be a useful tool for assessing and comparing the efficacy of new coronary stents with conventional stent systems. This thorough description of the techniques required for vascular access, stent implantation, tissue preparation, and measurement, should aid investigators wishing to begin using the comparative rabbit iliac artery model.

Determinação de prognóstico: quando tratar e quando extrair / Determining the prognosis: When to treat and when to extract

Introdução: o advento dos implantes reativou a discussão de um dos grandes dilemas da clínica odontológica, que é a identificação, baseada no prognóstico, de quando um dente deve ser extraído ou quando outras opções terapêuticas podem ser consideradas. Características periodontais, endodônticas e restauradoras devem ser cautelosamente avaliadas para determinação do prognóstico e da previsibilidade terapêutica e consequente elaboração do plano de tratamento. Objetivo: diante da relevância do tema, o objetivo desse trabalho é, por meio de uma revisão de literatura, ajudar o cirurgião-dentista a avaliar situações clínicas em que seja necessária a tomada de decisão entre extrair ou manter um dente, estabelecendo para tal um correto prognóstico. Resultados: achados na literatura mostram que autores divergem entre abordagens mais conservadoras e a colocação de implantes. Fatores que podem distinguir esses casos são o conhecimento técnico-científico e a experiência do profissional, o comprometimento do paciente com sua higiene bucal, bem como suas condições sistêmicas, dentárias e financeira. Contudo, não existe na literatura um consenso a respeito da soberania de uma técnica sobre outra para o tratamento das diferentes situações clínicas. Conclusão: assim, o que irá nortear a escolha do clínico é uma análise crítica e científica da relação custo/benefício para estabelecimento de um plano de tratamento individualizado, multidisciplinar e com maior previsibilidade.

Introduction: The advent of implants revived the discussion of one of the great dilemmas of clinical dentistry,which is the identification, based on prognosis, of when a tooth must be extracted or when other treatment options can be considered. Periodontal, endodontic and restorative characteristics must be carefully evaluated to determine prognosis and treatment predictability and consequent development of the treatment plan. Objective: Due to the relevance of this topic, the objective of this work is, by means of a literature review, to assist the dentist in evaluating clinical situations requiring decision making between keeping or extracting a tooth, establishing a correct prognosis. Results: Findings in the literature show that authors disagree among more conservative approaches and implant placement. Factors that can distinguish those cases are the technical and scientific knowledge and professional experience, commitment to their patient’s oral hygiene, as well as its systemic, dental and financial conditions. However, there is a consensus in the literature regarding the sovereignty of one technique over another for the treatment of different clinical situations. Conclusion: What will guide the clinician’s choice is a critical and scientific analysis of the cost-benefit to establish an individualized, multidisciplinary and with greater predictability treatment plan.

Cranioplastia: parietal versus prótese customizada / Cranioplasty: parietal versus customized prosthesis

INTRODUÇÃO: Os defeitos ósseos da calota craniana ocorrem frequentemente pela perda tecidual relacionada ao trauma ou para tratamento de tumores, sendo a maior causa de deformidade do crânio pós-trauma a craniectomia realizada na intervenção neurocirúrgica para tratamento da injúria cranioencefálica. As principais indicações para a correção dos defeitos cranianos incluem proteção do tecido cerebral, correção estética e melhora clínica, que envolve a pulsação de tecidos moles e a sensação de insegurança relatada pelo paciente. Defeitos extensos da calvária de espessura total são de grande desafio ao cirurgião pelo seu curso complexo, que envolve cirurgias prévias, infecções locais e osteonecrose, que leva à dificuldade na escolha do melhor método reconstrutivo. MÉTODO: Análise retrospectiva dos casos operados entre Janeiro de 2008 e Abril de 2010 para reconstrução da calota craniana realizados no Centro de Cirurgia Crânio-maxilofacial - Instituto Nacional de Traumatologia e Ortopedia (MS). RESULTADOS: Foram analisados 11 pacientes com defeitos extensos de espessura total da calota craniana operados no período, destes 9 foram submetidos a correção com enxerto ósseo autólogo de tábua externa do parietal e 2 com prótese customizada. CONCLUSÃO: O protocolo do nosso centro define que a primeira opção de reconstrução para defeitos extensos da calota craniana de espessura total é o enxerto autólogo de tábua externa do osso parietal sem craniectomia. Nos casos selecionados em que esse método reconstrutivo não pode ser utilizado, a opção é pelo uso de prótese customizada.

BACKGROUND: Cranial bone deformities are most often the result of trauma or extirpation for tumors, and the principal cause of the cranial deformities after cranial trauma is related to the craniectomy realized in neurosurgical approach for the treatment of brain damage. The reconstructive goals in cranioplasty are to provide protection of the brain, restore preinjury appearance and to lead clinical improvement like soft tissue pulsation and the unsafe feeling. Large full thickness skull defects can be quite challenging for the surgeon because of its complexity course which includes previous surgery, local infection and osteonecrosis. These factors lead to the difficult choice of the best reconstructive material. METHODS: A prospective study of the patients treated, from January 2008 to April 2010, for the calvaria reconstruction at Centro de Cirurgia Crânio-maxilofacial - Instituto Nacional de Traumatologia e Ortopedia (MS). RESULTS: Eleven patients with large full thickness skull defects submitted to cranioplasty were analysed. Nine of them were treated with parietal outer table without craniectomy and two were treated with customized prosthesis. CONCLUSIONS: In large full thickness skull defects the first method of reconstruction is the parietal outer table without craniectomy. In selected cases, when this reconstructive method can not be used, the option for the cranioplasty is the customized prosthesis.

Management of Prosthesis and Implants by Infection Control Department / 中华医院感染学杂志

OBJECTIVE To investigate the management criteria for selecting and applying of prosthesis and implants.METHODS Through a standard system and appropriate measures,the strict management to the purchase and entire application of prosthesis and implants was encouraged.RESULTS The systemic management ensured the hospital to use prosthesis and implants safely on patients and prevent from improper or illegal use,thus to safeguard the interests of both the patients and the hospital,avoiding unnecessary harms to patients′ body and spirit,therefore to minimize the conflicts between hospitals and patients.During the implementation of the management,further improvement and investigation were required.CONCLUSIONS Maintaining the mutual inferests between patients and hospital,avoiding unnecessary harms to patients′can minmize the medical conflicts and persistent improvements.

Avaliação in vitro do emprego de retificadores de cilindros fundidos na adaptação de próteses implanto suportadas / In vitro evaluation of cast cylinders rectifiers in the marginal misfit of implant-supported prosthesis

Avaliou-se a interface de assentamento de cilindros fundidos em ligas não preciosas a pilares protéticos implanto-suportados, após o uso de retificadores desenvolvidos para reduzir a desadaptação marginal de fundições. A investigação foi realizada com dois grupos de componentes: Esteticone e Micro-Unit, fundidos em liga de Ni-Cr (Wiron 99,) e Co-Cr (Wirobond C), pela técnica convencional (maçarico) e por indução em alta freqüência. Cilindros usinados em ouro foram empregados como padrões de referência. As mensurações das desadaptações marginais dos cilindros fundidos foram realizadas com auxílio de microscópio óptico em dois momentos, antes e após o uso de retificadores de cilindros. Para os componentes usinados em ouro, a leitura foi efetuada em um único momento, pois não houve retifica destes componentes. Os valores de desadaptação dos cilindros fundidos foram submetidos à análise estatística utilizando-se ANOVA (3-fatores) e Teste de Tukey (a: 5%). Comparações entre cilindros fundidos retificados e cilindros usinados foram realizadas com Teste t de Student para amostras não pareadas. A redução da desadaptação marginal foi estatisticamente significante (p< 0,05) para componentes fundidos em Ni-Cr. Para os cilindros fundidos em Co-Cr, os retificadores não determinaram importantes modificações em todos os grupos testados. Os menores valores de desajuste marginal foram registrados para componentes Micro Unit fundidos convencionalmente (maçarico) em Ni-Cr após a retífica (29,08mm). A desadaptação registrada para este grupo foi estatisticamente semelhante (p> 0,05) à obtida com componentes similares usinados em ouro (22,44mm). Concluiu-se que o uso de retificadores manuais de cilindros fundidos determinou expressiva redução de desadaptação marginal em componentes fundidos, principalmente com liga metálica de Ni-Cr.

This study evaluated the fitting interface of cylinders cast in non-precious alloys to implant-supported prosthetic abutments, after utilization of rectifiers designed to reduce the marginal misfit of cast cylinders. Two groups of components were investigated, namely Esteticone (Est) and Micro-Unit (MU), cast in Ni-Cr alloy (Wiron 99) and Co-Cr (Wirobond C), by the conventional technique (torch) and by induction. Gold-machined cylinders were used as controls. Measurement of the vertical misfits of cast cylinders was performed with aid of a light microscope at two periods, before and after utilization of cylinder rectifiers. For the gold machined components, reading was performed only once, since these components were not rectified. The misfit values of the cast cylinders were submitted to statistical analysis by the three-way ANOVA and Tukey tests (5%). Comparisons between the rectified cast cylinders and machined cylinders were performed by the Student t test for non-paired samples. The reduction in misfit was considered significant (p<0.05) for the components cast in Ni-Cr. With regard to the components cast in Co-Cr, the reduction in misfit was not considered significant for all groups of components. The means of marginal misfit for the Micro Unit components cast in Ni-Cr by the conventional technique (torch) after utilization of cylinder rectifiers (29,08mm) were not statistically different (p> 0,05) from the gold machined cylinders means (22,44mm). The utilization of manual rectifiers on cast cylinders led to significant reductions in marginal misfit of components cast in Ni-Cr alloy.

Implante de peso de ouro: complicações precoces e tardias / Gold weight implantation: premature and late complications

OBJETIVOS:Avaliar as indicações, os resultados e as complicações observadas nos pacientes submetidos ao implante de peso de ouro para correção do lagoftalmo paralítico. MÉTODOS: Vinte prontuários de pacientes com lagoftalmo secundário à paralisia facial de diversas etiologias, que foram submetidos à colocação do implante de ouro na pálpebra superior do lado afetado, foram examinados retrospectivamente. RESULTADOS: A causa mais freqüente de lagoftalmo paralítico foi pós-cirurgia de neurinoma do acústico (40 por cento). Complicações precoces e tardias ocorreram em 40 por cento dos implantes colocados. Quatro pacientes (20 por cento) apresentaram reação inflamatória local nos primeiros meses de pós-operatório. Dois pacientes (10 por cento) apresentaram afinamento da pele e do músculo orbicular sobre o peso de ouro, após 4 e 7 anos do implante, respectivamente. Um paciente (5 por cento) apresentou deslocamento do peso de ouro após 3 anos de sua colocação e outro paciente (5 por cento), extrusão do peso de ouro tardiamente, após 10 anos do implante. CONCLUSÕES: Nesta série, foi alto o índice de complicações com o implante de ouro (40 por cento). As complicações foram divididas em precoces, possivelmente relacionadas à impureza do material, e complicações tardias, devido à evolução do quadro da paralisia facial que apresenta diminuição do tônus muscular.

PURPOSE: To evaluate the indications, the results and the complications seen in the patients submitted to gold weight implantation to correct paralytic lagophthalmos. METHODS: Charts of 20 patients with lagophthalmos secondary to facial nerve palsy of diverse etiologies, which were submitted to gold weight implantation in the upper eyelid of the affected side, were retrospectively examined. RESULTS: The most frequent cause of paralytic lagophthalmos was acoustic neurinoma after surgery (40 percent). Early and late complications occurred in 40 percent of the implants. Four patients (20 percent) presented a local inflammatory reaction in the first 3 months after surgery. Two patients (10 percent) presented skin and orbicular muscle thinness over the gold weight 4 and 7 years after the implant, respectively. One patient (5 percent) presented gold weight displacement after 3 years and another patient (5 percent) had late gold weight extrusion after 10 years. CONCLUSIONS: In this series, the complication rate of gold weight implantation was high (40 percent). The complications were divided into early, possibly related to the material impurity and the late, due to the evolution of the facial nerve palsy that presented a decrease in muscle tonus.

A Case of Revision Augmentation Rhinoplasty with Dermofat Graft: 2 Years Follow-up Result

Many allograft materials have been used for performing augmentation rhinoplasty. But in cases involving complications such as infection, inflammation and foreign body reaction, these should be removed and replaced with an autograft material which is more suitable for revision surgery. Frequently, the use of autograft materials, including bone and cartilage, are restricted by many limitations such as unavailability, insufficiency in volume, and resorption. By using the dermofat, however, we achieved good surgical results in revision rhinoplasty from the aspect of volume and donor site morbidity. Thus, we report this case with a review of the literature.