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1.
Rev. Odontol. Araçatuba (Impr.) ; 41(2): 22-27, maio-ago.2020. ilus
Article in Portuguese | LILACS (Americas), BBO | ID: biblio-1102666

ABSTRACT

As fraturas panfaciais acometem concomitantemente os terços superior, médio e inferior da face, decorrentes de acidentes automobilísticos, arma de fogo, atropelamento, agressão física, entre outros. Essas fraturas geralmente envolvem osso frontal, zigomático, maxila, mandíbula e ossos nasais, necessitando assim, fixação interna rígida através do uso de miniplacas e parafusos com o propósito de estabilizar as estruturas fraturadas, dar suporte aos tecidos moles e evitar deformidades estéticas da face. O objetivo deste trabalho é relatar o manejo cirúrgico de um caso clinico atendido em um hospital público de Salvador/BA, no qual a vítima apresenta ampla laceração na face e fratura exposta do terço médio da face. O tratamento executado sob anestesia geral foi redução dos cotos ósseos fraturados, fixação com miniplacas e parafusos, reconstrução imediata dos tecidos moles acometidos(AU)


Panfacial fractures affect concomitantly the upper, middle, lower third of the face, resulting from automobile accidents, firearms, hit-and-run, physical aggression, among others. These fractures usually involve frontal bone, zygomatic, maxilla, jaw and nasal bones, thus requiring rigid internal fixation through the use of miniplates and screws in order to stabilize fractured structures, support soft tissues avoiding aesthetic face deformities. The objective of this work is to report the surgical management of a clinical case attended in a public hospital in Salvador/BA, in which the victim has wide laceration of the face and exposed fracture of the middle third of the face. Treatment performed under general anesthesia was reduction of fractured bone stumps, fixation with miniplates and screws, immediate reconstruction of the affected soft tissues(AU)


Subject(s)
Humans , Male , Facial Bones/injuries , Facial Injuries , Reconstructive Surgical Procedures , Face/surgery
3.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 107-111, Jan.-Mar. 2020. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1090552

ABSTRACT

Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively (p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, produc- ing favorable results with good applicability in otolaryngology clinical practice.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pharynx/surgery , Otorhinolaryngologic Surgical Procedures/methods , Reconstructive Surgical Procedures/methods , Sleep Apnea, Obstructive/surgery , Pharyngeal Muscles/surgery , Medical Records , Retrospective Studies , Longitudinal Studies , Treatment Outcome
4.
Rev. inf. cient ; 99(1): 63-70, ene.-feb. 2020. graf
Article in Spanish | LILACS (Americas) | ID: biblio-1093931

ABSTRACT

RESUMEN Se presentó el caso de un paciente masculino de 58 años, con antecedentes de salud aparente, que refiere haber recibido tratamiento quirúrgico por fractura compleja de tercio medio facial (fracturas tipo Lefort II y malar III derecha), el mismo refiere inconformidad estética por la deformidad facial postraumática que presenta. Se decidió su ingreso en el Servicio de Cirugía Maxilofacial del Hospital Universitario "General Calixto García" para su tratamiento. Se diagnosticó deformidad postraumática secundaria a una fractura facial compleja y su consiguiente daño estético. Los resultados alcanzados con la utilización de la lipotransferencia de tejido graso abdominal para el tratamiento de la deformidad facial fueron satisfactorios con permanencia y estabilidad en un año, a la vez que cumplió con las expectativas del paciente. La lipotransferencia resulta una alternativa viable en el tratamiento de las deformidades faciales adquiridas.


ABSTRACT The case of a 58-year-old male patient was presented, with a history of apparent health, who reported having received surgical treatment for a complex fracture of the middle facial third (fractures Lefort II and right malar III), the same refers to aesthetic disagreement for the deformity posttraumatic facial presenting. It was decided to enter the Maxillofacial Surgery Service of the University Hospital "General Calixto García" for treatment. Posttraumatic deformity was diagnosed secondary to a complex facial fracture and its consequent aesthetic damage. The results achieved with the use of abdominal fatty tissue lipotransfer for the treatment of facial deformity were satisfactory with permanence and stability in one year, while meeting the patient's expectations. Lipotransfer is a viable alternative in the treatment of acquired facial deformities.


RESUMO Foi apresentado o caso de um paciente do sexo masculino, 58 anos, com histórico aparente de saúde, que relatou ter recebido tratamento cirúrgico para uma fratura complexa do terço facial médio (fraturas de Lefort II e malar III direita), o mesmo se refere a discordância estética quanto à deformidade apresentação facial pós-traumática. Foi decidido entrar no Serviço de Cirurgia Maxilofacial do Hospital Universitário "General Calixto García" para tratamento. A deformidade pós-traumática foi diagnosticada secundária a uma fratura facial complexa e seu conseqüente dano estético. Os resultados obtidos com o uso da lipotransferência de tecido adiposo abdominal para o tratamento da deformidade facial foram satisfatórios com permanência e estabilidade em um ano, atendendo às expectativas do paciente. A lipotransferência é uma alternativa viável no tratamento de deformidades faciais adquiridas.


Subject(s)
Humans , Middle Aged , Adipose Tissue , Reconstructive Surgical Procedures/methods , Facial Injuries/surgery
5.
Artrosc. (B. Aires) ; 27(2): 78-87, 2020.
Article in Spanish | LILACS (Americas) | ID: biblio-1118222

ABSTRACT

La cirugía de revisión del ligamento cruzado anterior (LCA) plantea una serie de dificultades específicas. Estas incluyen la falta de masa ósea para permitir la fijación efectiva de la reconstrucción, morbilidad de la zona del donante cuando se utiliza autoinjerto óseo para llenar los túneles, etc. Para abordar algunos de estos problemas, describimos una técnica de revisión de 2 etapas que utiliza aloinjerto óseo para el llenado del túnel y el autoinjerto de tendón rotuliano (HTH) para la reconstrucción del LCA. Además, la intervención incluye una fase extraarticular en la que el ligamento anterolateral se refuerza con una tenodesis para aumentar la estabilidad rotacional de la rodilla, mejorando así las posibilidades de éxito. Tipo de Trabajo: Técnica Quirúrgica. Nivel Evidencia: V


Anterior cruciate ligament (ACL) revision surgery poses a number of specific difficulties. These include the lack of bone mass to enable effective fixation of the reconstruction, morbidity of the donor area when bone autograft is used to fill the tunnels .To address all these problems, we describe a 2-stage revision technique that uses bone allograft for tunnel filling and patellar tendon autograft (BTB) for ligament reconstruction. In addition, the intervention includes an extra-articular phase in which the anterolateral ligament is reinforced to increase the rotational stability of the knee, thus improving the prognosis of operation. Type of Study: Surgical Technique. Level of Evidence: V


Subject(s)
Adult , Reoperation , Anterior Cruciate Ligament/surgery , Reconstructive Surgical Procedures/methods , Anterior Cruciate Ligament Reconstruction/methods , Allografts , Knee Injuries/surgery
6.
Acta otorrinolaringol. cir. cabeza cuello ; 48(e-Boletín): 97-101, 2020. ilus, tab
Article in Spanish | LILACS (Americas) | ID: biblio-1095918

ABSTRACT

Una de las especialidades más afectadas con la pandemia del coronavirus SARSCov- 2/ COVID-19 es la otorrinolaringología y la cirugía plástica facial. El contacto estrecho que tienen los cirujanos plásticos faciales con la mucosa nasal, cavidad oral y nasofaringe durante el examen médico, los procedimientos de consultorio y las cirugías funcionales, estéticas y reconstructivas, ha elevado las posibilidades de contagio de esta especialidad por la alta carga viral encontrada en estos sitios anatómicos. Actualmente se están definiendo los parámetros nacionales e internacionales para definir los criterios de bioseguridad y de elementos de protección personal (EPP) para poder reiniciar la consulta externa, los procedimientos mínimamente invasivos y los procedimientos quirúrgicos del área de cirugía plástica facial. Se presentará un esquema para la realización de actividades de consulta externa, procedimientos mínimamente invasivos y procedimientos quirúrgicos electivos, estableciendo normas de seguridad para el paciente y los trabajadores de la salud. Cuando se inicien estas actividades va a depender en gran parte de la evolución de la pandemia y de la disponibilidad de servicios médicos y quirúrgicos en los diferentes ámbitos profesionales. Sin embargo, es importante hacer las adecuaciones necesarias para poder prestar los servicios de salud de la mejor manera posible y con los más altos estándares de calidad y seguridad para los pacientes y todo el personal administrativo y de salud.


Otolaryngology and facial plastic surgery are specialties have been affected directly by the pandemia of the coronavirus SARS Covid 2/Covid 19. Facial plastic surgeons have close contact with nasal mucosa, oral cavity and nasopharynx during the physical examination, the performance of office procedures and during functional and cosmetic surgery, elevating the risk of exposure and infection due to the high concentrations of Covid 19 virus found in these anatomic sites. Currently, national and international parameters are being established to try and define which are the best biosafety parameters and protective personal equipment (PPE) to be able to reopen outpatient clinics, perform minimally invasive procedures and eventually elective surgical procedures in the area of facial plastic surgery. A plan will be presented implementing guidelines trying to guarantee the highest security standards for the patient and the health workers. The timing to re-open facilities will depend mainly on the evolution of the pandemic and the availability of medical and surgical facilities in the different areas of the country. Despite this, it becomes important to start establishing the necessary changes to be able to offer health services with the highest standards of quality and security for patients, administrative and health personnel.


Subject(s)
Humans , Otolaryngology , Surgery, Plastic , Coronavirus Infections , Reconstructive Surgical Procedures , Personal Protective Equipment , Betacoronavirus
7.
Article in Spanish | LILACS (Americas), COLNAL | ID: biblio-1102964

ABSTRACT

Introducción: las perforaciones septales y su corrección quirúrgica constituyen un reto para los otorrinolaringólogos. En la literatura se describen diferentes técnicas para el cierre de las perforaciones septales; sin embargo, sus resultados en términos de efectividad son muy variables y con pocos pacientes. Desde hace 8 años se viene realizando la técnica de cierre de perforación septal con injertos de cartílago en el servicio de otorrinolaringología del Hospital de San José, y se ha observado una respuesta clínica exitosa. El objetivo del presente estudio fue describir los resultados posoperatorios de los pacientes manejados con la técnica de cierre quirúrgico de perforación septal con injertos de cartílago, en términos de aparición de complicaciones y frecuencia de perforación septal residual. Materiales y métodos: mediante un estudio de cohorte descriptiva se presentan los pacientes manejados con la técnica de cierre quirúrgico de perforación septal con injertos de cartílago de banco o cartílago autólogo. Se incluyen pacientes a partir enero de 2014 a junio 2018. De la historia clínica se extrajeron los datos demográficos, clínicos, complicaciones y presentación de perforación septal residual. Resultados: la tasa de éxito de cierre de perforación septal fue de 78,3 %; siendo las etiologías más frecuentes antecedente de cirugía e idiopática. La complicación más común fue epistaxis en el 26 % de los pacientes, seguida de dolor en el 21,7 % en el posoperatorio mediato, el cual mejoró en los controles posteriores. Conclusión: los resultados con la técnica de cierre de perforación septal con injerto de banco fueron satisfactorios en esta población.


Introduction: septal perforations and surgical correction are a challenge for ENT specialists. Several techniques for closing septal perforations are described in the literature; however, its results in terms of effectiveness are variable and with small sample sizes. The technique of closure of septal perforation with cartilage grafts has been performed for 8 years in the ENT department of Hospital de San José with a successful clinical response. Aims: to describe the postoperative results of patients managed with the technique of surgical closure of septal perforation with cartilage grafts, in terms of complications and frequency of residual septal perforation. Design: descriptive cohort study. Methods: a cohort of patients managed with the surgical closure technique of septal perforation with grafts of bank cartilage or autologous cartilage are described. Patients were included from January 2014 to June 2018. Demographic, clinical data, complications and presentation of residual septal perforation were extracted from the clinical history. Results: The success rate of septal perforation closure was 78.3 %; being the most frequent etiologies antecedent of surgery and idiopathic. The most common complication was epistaxis in 26 % of patients, followed by pain in 21.7 % in the postoperative period, which improved in subsequent controls. Conclusion: the results with the technique of closure of septal perforation with bank grafting were satisfactory in this population.


Subject(s)
Humans , Nasal Septal Perforation , Cartilage , Nose Deformities, Acquired , Reconstructive Surgical Procedures
8.
Rev. bras. cir. plást ; 34(4): 557-560, oct.-dec. 2019. ilus
Article in English, Portuguese | LILACS (Americas) | ID: biblio-1047927

ABSTRACT

O xantogranuloma juvenil (XGJ) é um tumor benigno e o mais comum do grupo das doenças histiocitárias proliferativas nãoLangerhans. Lesões; 2cm são consideradas XGJ gigantes, com relatos de lesões de até 18cm. Lesões oculopalpebrais podem necessitar de tratamento cirúrgico para controle de sintomas. Esse trabalho relata o caso de um menino de 8 anos que teve as 4 pálpebras acometidas por XGJ gigantes, além do terço médio. Ele foi submetido a 3 ressecções, sendo uma bastante profunda, necessitando enxerto de pele de espessura total diretamente sobre o músculo levantador da pálpebra superior. Posteriormente, 3 procedimentos de lipoenxertia foram realizados, atingindo resultado funcional e estético adequado, sem recorrência lesional.


Juvenile xanthogranuloma (JXG) is the most common benign tumor of the group of non-Langerhans histiocytic proliferative diseases. Lesions >2 cm are considered giant JXG, with reports of lesions of up to 18 cm. Oculopalpebral lesions may require surgical treatment to control symptoms. This study reports a case of an 8-year-old boy who had four eyelids and the middle third of the face affected by giant JXG. He underwent three resections, one of which was of great depth that required a full-thickness skin graft directly on the levator palpebrae superioris muscle. Subsequently, four fat-grafting procedures were performed and adequate functional and


Subject(s)
Humans , Male , Child , History, 21st Century , Eye Injuries , Skin Transplantation , Xanthogranuloma, Juvenile , Reconstructive Surgical Procedures , Eye , Eyelid Neoplasms , Myocutaneous Flap , Eye Injuries/surgery , Skin Transplantation/methods , Xanthogranuloma, Juvenile/surgery , Xanthogranuloma, Juvenile/therapy , Reconstructive Surgical Procedures/methods , Eye/anatomy & histology , Eyelid Neoplasms/surgery , Eyelid Neoplasms/therapy , Myocutaneous Flap/surgery , Myocutaneous Flap/transplantation
9.
Rev. bras. cir. plást ; 34(4): 561-566, oct.-dec. 2019. ilus
Article in English, Portuguese | LILACS (Americas) | ID: biblio-1047928

ABSTRACT

Introdução: O couro cabeludo é uma área de difícil reconstrução devido à sua pouca elasticidade e por sobrepor-se a uma estrutura rígida e convexa. Existem diferentes técnicas cirúrgicas para reparação dos defeitos, que podem ser produto de diversas etiologias, como: traumas, deformidades e consequência de doenças, principalmente oncológicas, como é o caso do paciente apresentada neste trabalho. O angiossarcoma cutâneo é um tumor vascular maligno raro e extremamente agressivo, que afeta principalmente idosos. É caracterizado clinicamente pelo aparecimento de placas eritêmato-violáceas e de rápida evolução. O tratamento depende da extensão da doença. A maioria dos casos são tratados com ampla ressecção cirúrgica e reconstrução. O objetivo é relatar um caso de reconstrução de grande defeito do couro cabeludo depois de uma dissecção oncológica, realizado no Hospital Central do Exército (HCE) - RJ. Métodos: O caso foi tratado com enxerto autólogo e uso de matriz dérmica, em 2 tempos cirúrgicos, até a total cobertura da área lesionada. Resultados: Obteve-se resultado satisfatório após as cirurgias de enxertia de pele na área ressecada. Conclusão: O enxerto autólogo, juntamente a matriz dérmica mostrou-se uma opção viável na reconstrução do couro cabeludo.


Introduction: It is difficult to reconstruct the scalp due to its poor elasticity and presence of layers over a rigid convex structure. Different surgical techniques are used to repair defects that may develop due to several etiologies, such as trauma, deformities, and disease sequelae, especially cancer, as noted in the present case. Cutaneous angiosarcoma, a rare and extremely aggressive malignant vascular tumor that mainly develops in elderly individuals, is clinically characterized by the onset of rapidly evolving erythematous purple plaques. The treatment depends on disease extent. Most patients are treated with wide surgical resection and reconstruction. The objective is to report a case of reconstruction of a major scalp defect after an oncologic dissection performed at the Hospital Central do Exército in Rio de Janeiro. Methods: An autologous graft and dermal matrices were applied during two surgical periods till the damaged area was fully covered. Results: Satisfactory results were obtained after performing skin grafting surgery in the resected area. Conclusion: The autologous graft and dermal matrix proved to be a viable option for scalp reconstruction.


Subject(s)
Humans , Male , Aged , History, 21st Century , Rehabilitation , Scalp , Skin Neoplasms , Reconstructive Surgical Procedures , Hemangiosarcoma , Neoplasms, Vascular Tissue , Rehabilitation/methods , Rehabilitation/psychology , Scalp/surgery , Skin Neoplasms/surgery , Skin Neoplasms/therapy , Reconstructive Surgical Procedures/methods , Hemangiosarcoma/surgery , Hemangiosarcoma/therapy , Neoplasms, Vascular Tissue/surgery , Neoplasms, Vascular Tissue/therapy
10.
Rev. bras. cir. plást ; 34(4): 571-575, oct.-dec. 2019. ilus
Article in English, Portuguese | LILACS (Americas) | ID: biblio-1047934

ABSTRACT

O presente estudo objetiva relatar a técnica do retalho toracoabdominal pós-mastectomia por tumor localmente avançado em paciente com mutação de BRCA1. Foi realizada a mastectomia com ressecção de quase todo o músculo peitoral maior à esquerda, com linfonodectomia axilar homolateral e reconstrução do grande defeito da parede torácica com retalho toracoabdominal fasciocutâneo, baseado nas artérias intercostais posteriores.


This case report describes the application of the thoracoabdominal flap technique after locally advanced tumor mastectomy in a patient with breast cancer 1 (BRCA1) mutation. The mastectomy included resection of nearly the entire left pectoralis major muscle, with homolateral axillary lymphadenectomy and reconstruction of the large chest wall defect with a fasciocutaneous thoracoabdominal flap based on the posterior intercostal arteries.


Subject(s)
Humans , Female , Adult , History, 21st Century , Patients , Surgical Flaps , Breast , Breast Neoplasms , Reconstructive Surgical Procedures , Surgical Oncology , Mutation , Surgical Flaps/transplantation , Breast/surgery , Breast Neoplasms/surgery , Breast Neoplasms/complications , Breast Neoplasms/therapy , Reconstructive Surgical Procedures/methods , Surgical Oncology/methods , Mutation/ethics
11.
Autops. Case Rep ; 9(4): e2019116, Oct.-Dec. 2019. ilus
Article in English | LILACS (Americas) | ID: biblio-1024253

ABSTRACT

Basal cell carcinoma (BCC) is the most common skin cancer. It generally has an indolent course with low rates of metastasis and mortality. However, BCC is locally invasive and can cause significant morbidity due to destructive local spread. We report our experience with a patient who was referred to our skin cancer unit due to a previously neglected lesion on the parietal region of the scalp, which had developed for 7 years. The patient was prescribed vismodegib on the basis that surgery could cause excessive functional and aesthetic damage. The patient had an objective partial response after 20 months of treatment. He was then submitted to radical skin excision, leaving a large defect that was reconstructed using a free latissimus dorsi muscle flap. The patient recovered well, and at the 1-year follow-up there were no signs of local recurrence. Our case demonstrates the value of vismodegib treatment prior to surgery in a locally advanced, high-risk scalp BCC and highlights the importance of an individualized and specialized approach with these patients, within a multidisciplinary team.


Subject(s)
Humans , Male , Middle Aged , Carcinoma, Basal Cell/drug therapy , Head and Neck Neoplasms/pathology , Patient Care Team , Reconstructive Surgical Procedures , Neoadjuvant Therapy , Antineoplastic Agents/therapeutic use
12.
Rev. bras. cir. plást ; 34(4): 445-451, oct.-dec. 2019. ilus
Article in English, Portuguese | LILACS (Americas) | ID: biblio-1047898

ABSTRACT

Introdução: O aumento da projeção da ponta nasal às vezes se torna necessário para a obtenção de uma boa proporção entre ela e o dorso. Inúmeras técnicas e táticas são descritas com essa finalidade utilizando enxertos cartilaginosos obtidos do septo nasal, concha auricular e cartilagem costal. Quando esse aumento deve ser discreto é proposto o uso dos excedentes de cartilagens alares laterais em forma de "pseudo-retalhos". Métodos: Em rinoplastias abertas primárias os excedentes das cartilagens alares, geralmente removidas, são utilizados como "pseudo-retalhos", dobrados sobre si mesmos, em forma de "suspensório de soldado francês", sobre o domus das cartilagens alares, tendo como acolchoamento de apoio os tecidos moles delas próprias, e o tecido mole interdomal, geralmente desprezado, que é liberado, e elevado para sobre os domus. Ele é mantido, descolado e deslocado para a ponta nasal, e fica contido pelos "pseudo-retalhos" das cartilagens alares ali suturados ou cobrindo o extremo do enxerto estrutural da columela. Foram operados com essa tática 36 pacientes. Resultados: 35 com bons resultados e um apresentou um abcesso de ponta nasal, provocado pela exposição endonasal de um fio de sutura não absorvível, que foi removido. Houve necessidade de uma segunda intervenção, utilizando novo enxerto auricular, ainda com resultado insatisfatório. O método é relativamente simples para quem opera narizes. Conclusão: A ponta nasal pode ser discretamente mais projetada utilizando os excessos de cartilagens alares, "pediculadas" no domus.


Introduction: An increased nasal tip projection is sometimes necessary to achieve an appropriate proportion between nasal tip and dorsum. Numerous techniques and tactics have been described for this purpose using cartilaginous grafts obtained from the nasal septum, auricular concha, and costal cartilage. When this increased projection must be discrete, the use of excess lateral alar cartilage in the form of "pseudo-flaps" is proposed. Methods: In primary open rhinoplasty, excess alar cartilage, which is generally removed, was used to produce "pseudo-flaps". The cartilages were folded over themselves in the form of a "French soldier's suspender" over the domes of the alar cartilage and supported by interdomal soft tissue padding raised over the domus. It was kept detached, and relocated to the nasal tip and was contained by "pseudoflaps" of the alar cartilages sutured there or covering the columella's structural graft. Thirty-six patients underwent surgery using this technique. Results: Thirty-five had good results and one had a nasal tip abscess, caused by endonasal exposure to a non-absorbable suture, which was removed. A second intervention was then performed using a new auricular graft, but the result was still unsatisfactory. The "pseudoflaps" method is relatively simple for those performing nasal surgery. Conclusion: The nasal tip can be projected discretely using the excess of alar cartilage "pedicled" in the domus.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , History, 21st Century , Rhinoplasty , Nose , Retrospective Studies , Reconstructive Surgical Procedures , Esthetics , Nasal Cartilages , Nasal Mucosa , Rhinoplasty/methods , Nose/surgery , Reconstructive Surgical Procedures/methods , Nasal Cartilages/abnormalities , Nasal Cartilages/surgery , Nasal Mucosa/surgery
13.
Rev. bras. cir. plást ; 34(4): 477-484, oct.-dec. 2019. ilus, tab
Article in English, Portuguese | LILACS (Americas) | ID: biblio-1047906

ABSTRACT

Introdução: Sabe-se que o câncer de mama é hoje a segunda neoplasia mais frequente entre as mulheres, as quais são submetidas desde a tratamentos clínicos até cirúrgicos mutilantes da mama. Ter mamas bonitas e harmoniosas é um direito legítimo, sendo assim o conceito de reconstrução mamária e do complexo areolo papilar se torna importante na reinserção social feminina. Este estudo visa apresentar uma técnica eficaz de reconstrução areolar, utilizando enxerto cutâneo livre palpebral bilateral, demonstrando sua eficácia através de resultados fotográficos, comparação com outras técnicas já descritas e questionários de satisfação dos pacientes. Resultados: Foram avaliados, retrospectivamente, 50 pacientes operados de reconstrução areolar com enxerto de pele palpebral e outras técnicas já descritas, operados por um único cirurgião sênior. O grupo de pacientes operados com pele palpebral não obtiveram diferenças significativas dentro da análise de resultados, comparados com outras técnicas de reconstrução. Houve boa satisfação por parte dos pacientes, quanto ao resultado das cirurgias das aréolas. Conclusão: O estudo obteve baixos índices de complicações, apresentando-se como boa opção terapêutica, dentro do arsenal cirúrgico de reconstrução areolar.


Introduction: Breast cancer is currently the second most common neoplasm among women who undergo clinical treatments and breast-mutilating surgeries. Having beautiful and harmonious breasts is a legitimate right, so the concept of reconstructing the breast and nipple-areolar complex becomes important in female social reinsertion. This study aimed to present an effective technique of areolar reconstruction using free bilateral eyelid skin grafts and demonstrate its effectiveness through photographic results, comparison with previously described techniques, and patient satisfaction questionnaires. Results: The authors retrospectively evaluated 50 patients who underwent areolar reconstruction with eyelid skin grafts and other techniques performed by a single senior surgeon. Patients who underwent eyelid skin graft surgery did not achieve significantly different results from those who underwent other reconstruction techniques. Patients who underwent areola surgeries reported good satisfaction. Conclusion: The study revealed low complication rates and demonstrated that the use of eyelid skin is a good therapeutic option for areolar reconstruction.


Subject(s)
Humans , Female , History, 21st Century , Patients , Skin , Transplantation , Breast , Patient Satisfaction , Reconstructive Surgical Procedures , Esthetics , Eyelids , Nipples , Transplantation/methods , Transplantation/statistics & numerical data , Breast/surgery , Patient Satisfaction/statistics & numerical data , Reconstructive Surgical Procedures/methods , Eyelids/surgery , Nipples/surgery
14.
Rev. cuba. oftalmol ; 32(4): e766, oct.-dic. 2019. graf
Article in Spanish | LILACS (Americas), CUMED | ID: biblio-1099104

ABSTRACT

RESUMEN La ubicación anatómica de los párpados los predispone a ser dañados frecuentemente por causas traumáticas. Se informa la evolución de un paciente masculino, de 22 años de edad, remitido a la Consulta de Urgencia del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" por presentar trauma palpebral grave en su ojo izquierdo producido por un alambre. Al examen oftalmológico se constató colgajo extenso del párpado superior, que colgaba fijado de la porción temporal. Se comprobó herida horizontal de la aponeurosis del elevador del párpado superior, de bordes anfractuosos, que se extendía a todo el párpado, así como sección del canalículo superior. Se confirmó el diagnóstico de herida avulsiva grave, con afectación del borde libre palpebral y sección del canalículo superior. Se decidió la conducta quirúrgica: reconstrucción palpebral, que incluyó aponeurosis del músculo elevador del párpado superior, canalículo superior con sonda bicanalicular y borde libre palpebral. Durante el seguimiento se constataron buenos resultados estéticos y funcionales. El conocimiento de la anatomía palpebral y una reconstrucción minuciosa de los tejidos palpebrales permiten resultados posquirúrgicos excelentes en un trauma palpebral grave(AU)


ABSTRACT The anatomical location of the eyelids predisposes them to be frequently damaged by traumatic causes. The evolution of a patient aged 22 years is reported, who was referred at Ramón Pando Ferrer Cuban Institute of Ophthalmology for presenting severe eyelid trauma in his left eye caused by a wire. The ophthalmological examination showed a large flap of the upper eyelid, which hung fixed from the temporal portion. Horizontal wound of the aponeurosis of the upper eyelid elevator, with an abnormal fracture, which extended to the entire eyelid, as well as section of the upper canaliculus, was found. The diagnosis of severe avulsive wound was confirmed, with involvement of the palpebral free edge and section of the upper canaliculus. Surgical behavior was decided: eyelid reconstruction, which included aponeurosis of the upper eyelid lift muscle, upper canaliculus with bicanalicular probe and palpebral free edge. During the follow-up, good aesthetic and functional results were observed. The knowledge of the eyelid anatomy and a thorough reconstruction of the eyelid tissues allow excellent post-surgical results in severe eyelid trauma(AU)


Subject(s)
Humans , Male , Young Adult , Reconstructive Surgical Procedures/methods , Eyelids/injuries , Aponeurosis/injuries , Oculomotor Muscles/injuries
15.
Rev. Ateneo Argent. Odontol ; 61(2): 8-12, nov. 2019. ilus
Article in Spanish | LILACS (Americas) | ID: biblio-1095111

ABSTRACT

El ameloblastoma es un tumor benigno derivado del epitelio odontogénico, clasificado actualmente de acuerdo al CIE 10-EO/SNOMED en el capítulo de tumores (neoplasia) benigna como D16.5/M-93100. Presenta un patrón de crecimiento lento, localmente agresivo, pudiendo causar, o no, grandes deformaciones faciales, en mandíbula o maxilar superior. De localización preferencial mandibular, el 75%, en el área molar y rama ascendente; mientras que, en maxilar superior, se concentran en el área molar con posible compromiso de seno maxilar y suelo de fosas nasales. La edad de presentación más frecuente es entre 20-40 años, siendo rara en pacientes pediátricos. En el tratamiento del mismo se valora tipo clínico, localización y tamaño del tumor, y la edad del paciente. El presente caso clínico destaca la importancia del oportuno diagnóstico clínico-patológico, su clasificación y el uso de nuevas técnicas complementarias (AU)


Ameloblastoma is a benign tumor derived from the Odontogenic epithelium, currently classified according to ICD 10-EO / SNOMED in the Chapter of Benign Tumors (Neoplasia) as D16.5 / M-93100. It has a slow growth pattern, locally aggressive, may or may not cause large facial deformations, in the jaw or upper jaw. Preferential mandibular location, 75% in the molar area and ascending limb; while in the upper jaw they are concentrated in the molar area with possible involvement of the maxillary sinus and the floor of the nostrils. The most frequent age of presentation is between 20-40 years, being rare in pediatric patients. In the treatment of the same, clinical type, location and size of the tumor, as the age of the patient, is assessed. The present clinical case highlights the importance of the appropriate clinical-pathological diagnosis, its classification and the use of new complementary techniques (AU)


Subject(s)
Humans , Male , Adolescent , Ameloblastoma/surgery , Ameloblastoma/diagnostic imaging , Odontogenic Tumors , Oral Surgical Procedures , World Health Organization , Radiography, Panoramic , International Classification of Diseases , Histological Techniques , Reconstructive Surgical Procedures , Dental Service, Hospital
16.
Biosci. j. (Online) ; 35(5): 1539-1543, sept./oct. 2019. ilus
Article in English | LILACS (Americas) | ID: biblio-1049049

ABSTRACT

Excessive facial skin folds is observed in several breeds of dogs and the weight exerted on the eyelids accents or promotes entropion, trichiasis and ptosis. Thus, this study reported a case of the 8-months-old male Shar-pei weighting 21.5kg was presented with an obstructed visual axis, eye discharge, fetid odor in facial folds around the jaw and the neck. It was indicated the surgical resection of the folds and correction of the upper and lower entropion. In this case, the association of Hotz-Celsus technique with rhytidectomy shaped in semiarchs, using the anchoring points with the modified walking suture, was effective in correcting the entropion and unblocking the visual axis with minimal scarring and preservation of the breed standard in 12 months follow up after surgery.


O excesso de pregas faciais é observado em várias raças de cães e o peso exercido sobre as pálpebras acentua ou promove entrópio, triquíase e ptose. Assim, este estudo relata o caso de Shar-pei, macho de 8 meses de idade, pesando 21,5 kg que apresentava o eixo visual obstruído, secreção ocular e odor fétido nas dobras faciais em torno da mandíbula e do pescoço. Foi indicada a ressecção cirúrgica das pregas e a correção do entrópio superior e inferior. Neste caso, a associação da técnica de Hotz-Celsus com a ritidectomia em forma de semiarcos, utilizando pontos de ancoragem com a técnica "walking suture" modificada, foi efetiva na correção do entrópio e na liberação do eixo visual, com mínima cicatriz e preservação do padrão da raça 12 meses após a cirurgia.


Subject(s)
Rhytidoplasty , Reconstructive Surgical Procedures , Dogs , Entropion
17.
Autops. Case Rep ; 9(3): e2018086, July-Sept. 2019. ilus
Article in English | LILACS (Americas) | ID: biblio-1021057

ABSTRACT

Fibrous dysplasia (FD) is part of a rare group of bone dysplasia. It exhibits benign behavior and can lead to osteolytic lesions, deformities, and fractures. The treatment is challenging, and accurate removal of the lesion is necessary to restore function and esthetics. Here we present two cases of FD where virtual planning with presurgical computed tomography (CT) was used for the production of a surgical guide for bone contouring. First, CT image reconstruction was performed to mirror the patient's original anatomy. Then, three surgical guides that determined the area and depth of bone wear were prepared and used in the relevant sequence during the actual surgeries, which were successfully performed in both patients. This technique is termed the template guide holes (TGH) technique. The findings from this report suggest that presurgical virtual planning and guide preparation allows direct and objective measurement of the level of bone wear and improves the functional and esthetic outcomes of surgery for FD. In particular, the TGH technique is safe and allows adequate preoperative surgical simulation, reduces the surgical duration, and increases the predictability of the final result.


Subject(s)
Humans , Male , Female , Child , Adult , Oral Surgical Procedures/methods , Reconstructive Surgical Procedures/methods , /surgery , Four-Dimensional Computed Tomography
18.
Rev. cuba. oftalmol ; 32(3): e781, jul.-set. 2019.
Article in Spanish | LILACS (Americas), CUMED | ID: biblio-1099087

ABSTRACT

RESUMEN La cirugía con incisiones de pequeño tamaño comienza a ser una norma en la medicina actual, la cual ha ganado popularidad en muchos campos, entre ellos el de la Oftalmología. Una muestra de esto son las pequeñas incisiones para la facoemulsificación, la vitrectomía sin sutura 25 G y los pequeños dispositivos de drenaje de glaucoma. Algo similar ocurre con la cirugía de estrabismo mínimamente invasiva (minimally invasive strabismus surgery) al permitir alcanzar iguales resultados motores y sensoriales que con la técnica de abordaje de los músculos extraoculares a nivel del limbo. Esta revisión bibliográfica ofrece nuevos conocimientos teóricos sobre una técnica mínimamente invasiva para el abordaje del estrabismo, que originará mejores resultados estéticos y la satisfacción de los pacientes con esta afección, así como su rápida reincorporación a las distintas ocupaciones laborales, a las escuelas y a las tareas habituales(AU)


ABSTRACT Surgery based on small size incisions is gradually becoming standard practice in health care, gaining popularity in many specialties, among them ophthalmology. Evidence of this are the small incisions made for phacoemulsification, sutureless 25-G vitrectomy, and the small glaucoma drainage devices. Something similar occurs in minimally invasive strabismus surgery, where the same motor and sensory results are achieved as with limbal approach of the extraocular muscles. The present bibliographic review provides new theoretical information about a minimally invasive strabismus surgery technique leading to better esthetic results and greater satisfaction by patients suffering from this disorder, as well as their quick reincorporation to their work, school and regular daily activities(AU)


Subject(s)
Humans , Strabismus/surgery , Minimally Invasive Surgical Procedures/methods , Reconstructive Surgical Procedures/methods , Review Literature as Topic
19.
Rev. cuba. oftalmol ; 32(3): e789, jul.-set. 2019. tab, graf
Article in Spanish | LILACS (Americas), CUMED | ID: biblio-1099082

ABSTRACT

RESUMEN Objetivos: Describir algunas características clínicas de la exotropía de gran ángulo y determinar su resultado quirúrgico. Métodos: Se realizó un estudio descriptivo retrospectivo de 35 pacientes atendidos en el Hospital Oftalmológico "Amistad Cuba-Argelia", en la Wilaya de Ouargla, Argelia, en el período enero 2014 - diciembre 2017. Se analizó el comportamiento de algunas variables relacionadas con la exotropía, como fueron la edad del paciente, el sexo, el color de la piel, las alteraciones oftalmológicas asociadas, el grado de ambliopía, el defecto refractivo asociado, el ángulo de desviación preoperatorio y posoperatorio y el tipo de cirugía realizada. Resultados: Predominó el grupo etario entre 24 y 29 años de edad con el 25,7 por ciento; el 51,4 por ciento representó al sexo femenino; el color de la piel negra fue el más frecuente con 48,6 por ciento; la ptosis palpebral correspondió al 11,4 por ciento de las alteraciones oftalmológicas asociadas y al 68,6 por ciento sin alteraciones; la ambliopía moderada se registró en el 42,9 por ciento de los casos; el defecto refractivo más observado fue el astigmatismo miópico con el 37,1 por ciento; el ángulo de desviación preoperatorio más significativo se encontró en el grupo de 71-80 dioptrías con 37,2 por ciento. A los tres meses de la cirugía el 91,4 por ciento de los pacientes se encontró en ortoforia (± 8 dioptrías) y al año de la cirugía el 94,3 por ciento se mantenía en ortoforia. El retroceso de ambos músculos rectos laterales (10,0 mm) más la resección de un músculo recto medio (7 mm) se realizó en el 37,2 por ciento de los pacientes. Conclusiones: La casi totalidad de los pacientes con exotropía de gran ángulo logran el alineamiento ocular y consiguen una mejoría en la calidad visual(AU)


ABSTRACT Objectives: Describe some clinical characteristics of large-angle exotropia and determine its surgical outcome. Methods: A retrospective descriptive study was conducted of 35 patients attending Cuba-Algeria Friendship Ophthalmological Hospital in the wilayah of Ouargla, Algeria, from January 2014 to December 2017. Analysis was carried out of variables related to exotropia, such as the patients' age, sex, skin color, associated ophthalmological alterations, degree of amblyopia, associated refractive defect, pre- and post-operative angle of deviation, and type of surgery performed. Results: The 24-29 year age group prevailed with 25.7 percent; 51.4 percent of the patients were female; black skin color was the most common with 48.6 percent; eyelid ptosis represented 11.4 percent of the associated ophthalmological alterations and 68.6 percent without alteration; moderate amblyopia was present in 42.9 percent of the cases; the most frequent refractive defect was myopic astigmatism with 37.1 percent; the most significant preoperative angle of deviation was found in the 71-80 diopter group with 37.2 percent. Three months after surgery, 91.4 percent of the patients were orthophoria (± 8 diopters) and at one year 94.3 percent remained orthophoria. Bilateral lateral rectus muscle recession (10.0 mm) plus resection of a medial rectus muscle (7 mm) was achieved in 37.2 percent of the patients. Conclusions: Practically all patients achieved ocular alignment and improved their visual quality(AU)


Subject(s)
Humans , Female , Adult , Blepharoptosis/therapy , Amblyopia/prevention & control , Exotropia/surgery , Reconstructive Surgical Procedures/methods , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies
20.
Rev. bras. cir. plást ; 34(3): 410-413, jul.-sep. 2019. ilus
Article in English, Portuguese | LILACS (Americas) | ID: biblio-1047167

ABSTRACT

Criptotia é uma deformidade auricular congênita comum em orientais e rara em ocidentais, sendo a grande maioria dos estudos de técnicas cirúrgicas orientais e aplicados em crianças. Nesta patologia, a cartilagem do polo superior da orelha encontra-se alojada embaixo da pele na região temporal, o que impossibilita o uso de óculos, devido à falta de apoio e torna o polo superior sem definição estética. O presente estudo tem por objetivo relatar o caso de um paciente adulto com criptotia, submetido ao tratamento cirúrgico com retalho de pedículo subcutâneo mastóideo, revisando as principais técnicas descritas para o tratamento deste acometimento. O retalho de pedículo subcutâneo descrito por Yoshimura, mostrou-se adequado para a correção da criptotia em paciente ocidental e adulto.


Cryptotia is a congenital ear deformity common in Easterners and rare in Westerners, with most studies addressing Eastern surgical techniques applied to children. In this pathology, the cartilage of the upper pole of the ear is lodged subcutaneously in the temporal region, which prevents individuals from using glasses due to lack of support and prevents esthetic definition of the upper pole. The present study aimed to report the case of an adult patient with cryptotia undergoing surgical treatment using a mastoid subcutaneous pedicle flap and review the main techniques described for the treatment of this involvement. The subcutaneous pedicle flap described by Yoshimura proved to be adequate for correcting cryptotia in a Western adult patient.


Subject(s)
Congenital Abnormalities , Adult , Reconstructive Surgical Procedures , Ear Cartilage , Ear Deformities, Acquired , Ear, External , Esthetics , Aesthetic Equipment , Congenital Abnormalities/surgery , Reconstructive Surgical Procedures/methods , Reconstructive Surgical Procedures/rehabilitation , Ear Cartilage/abnormalities , Ear Cartilage/surgery , Ear Deformities, Acquired/surgery , Ear Deformities, Acquired/genetics , Ear, External/abnormalities , Ear, External/surgery
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