Rinomodelação ou rinoplastia não-cirúrgica: uma abordagem segura e reprodutível / Rhinomodelation or non-surgical rhinoplasty: a safe and reproducible approach

Introdução: A rinoplastia é uma cirurgia que muitas vezes apresenta resultados imprevisíveis, mesmo em mãos de cirurgiões experientes. Neste sentido, a rinomodelação com preenchedores é um procedimento não-cirúrgico para corrigir pequenas alterações externas nasais em casos específicos. Métodos: Os autores descrevem a técnica de aplicação de preenchedores (ácido hialurônico ou hidroxiapatita de cálcio) para modelação nasal. Foram incluídos todos os pacientes submetidos ao preenchimento nasal, entre 2009 e 2012. Foi avaliado o edema da ponta nasal, a dor e o grau de satisfação dos pacientes com o resultado. Resultados: Foram incluídos 39 pacientes no estudo. Com relação aos desfechos analisados com ácido hialurônico: 52% apresentaram edema leve; 74% tiveram dor leve; 15% se mostraram muito satisfeitos e 74% satisfeitos com o resultado. Com relação aos pacientes submetidos à rinomodelação com hidroxiapatita de cálcio: 67% apresentaram edema moderado; 50% dor moderada; 17% dor intensa e 84% se mostraram satisfeitos com o resultado. Conclusão: A rinomodelação com preenchedores reabsorvíveis é um procedimento simples, com resultados estéticos aceitáveis, sendo necessário um profundo conhecimento anatômico para diminuir o risco de complicações.

Introduction: Rhinoplasty often leads to unpredictable results, even in the hands of experienced surgeons. However, in specific cases, rhinomodelation with fillers, a non-surgical procedure to correct minor nasal external changes, can be used. Methods: This study describes the application technique of fillers (hyaluronic acid or calcium hydroxyapatite) for nasal modeling. Patients undergoing nasal filling between 2009 and 2012 were included. Edema of the nasal tip, pain, and the degree of patient satisfaction with the outcome were assessed. Results: Thirty-nine patients were included in the study. Regarding the outcomes of rhinomodelation with hyaluronic acid, 52% patients presented with mild edema, 74% had mild pain, 15% were very satisfied, and 74% were satisfied with the result. For the outcomes of rhinomodelation with calcium hydroxyapatite, 67% patients presented with moderate edema, 50% had moderate pain; 17% had severe pain, and 84% were satisfied with the result. Conclusion: Rhinomodelation with resorbable fillers is a simple procedure with acceptable esthetic results. However, a deep anatomical knowledge is necessary to decrease the risk of complications.

Feohifomicosis nasal por Curvularia spicifera en un paciente pediátrico con neutropenia y leucemia mieloide aguda / Nasal phaeohyphomycosis by Curvularia spicifera in pediatric patient with neutropenia and acute myeloid leukemia

There are very few reports of pediatric patients with infections by dematiaceous filamentous fungi. In this publication we report a case of invasive fungal infection of the nasal septum by Curvularia spicifera in a pediatric patient with acute myeloid leukemia. The patient presented with a painful scabby wound in the nasal vestibule. Culture and universal PCR were consistent with Curvularia spicifera. Early management with surgical debridement and bi-associated antifungal therapy achieved complete resolution of the lesions, with no evidence of dissemination and relapses. Clinical management of these fungal infections represents a challenge as the antifungal selection and duration of therapy is not yet well stablished.

Existen pocos reportes de infecciones por hongos dematiáceos en pediatría. Comunicamos el caso de una infección fúngica invasora del tabique nasal en un niño con una leucemia mieloide aguda, que se presentó como una lesión costrosa dolorosa en el vestíbulo nasal. Se realizó desbridamiento quirúrgico precoz y recibió tratamiento antifúngico biasociado, lográndose resolución completa de las lesiones, sin diseminación ni recaídas. El cultivo y la RPC universal fueron compatibles con Curvularia spicifera. El manejo de estas infecciones fúngicas representa un desafío, considerando que la elección del agente antifúngico y la duración de la terapia no están completamente establecidas.

Leishmaniasis mucosa nasolaringotraqueal en un adolescente / Nasolaryngotracheal mucosal leishmaniasis in an adolescent

La leishmaniasis es un problema creciente de salud pública, que produce un gran impacto social. La leishmaniasis laríngea y sin puerta de entrada evidente es rara, en especial en pacientes inmunocompetentes. Describimos un caso de leishmaniasis laríngea con extensión traqueal y estenosis secundaria en un adolescente previamente sano y sin factores de riesgo ambiental o personal.

Leishmaniasis is a growing public health problem and it produces a great social impact. Laryngeal leishmaniasis without obvious gateway is rare; especially in immunocompetent patients. We report a case of laryngeal leishmaniasis with tracheal involvement and stenosis on a previously healthy teenager without environmental or personal risk factors.

Spontaneous Cerebrospinal Fluid Rhinorrhea with Pneumocephalus: An Unusual Manifestation of Nasal Tuberculosis

An unusual case of spontaneous cerebrospinal fluid (CSF) rhinorrhea with a pneumocephalus is described in a middle-aged woman who presented with a watery nasal discharge for 1 week and headache, vomiting, and fever for 1 day. The neurological examination revealed meningeal signs and bilateral papilledema. The CSF picture suggested pyogenic meningitis, and computed tomography of the brain revealed pneumocephalus. Diagnostic nasal endoscopy showed outpouching of the dura from the left olfactory cleft with a CSF leak and granular nasal mucosa. The defect was repaired surgically, and a biopsy of that area revealed granulomatous changes suggestive of tuberculosis. The patient recovered completely with standard four-drug antitubercular therapy. To our knowledge spontaneous CSF rhinorrhea with pneumocephalus occurring secondary to nasal tuberculosis has not been previously reported.

Disquinesia ciliar primaria: su presentación en Otorrinolaringología: Experiencia con 14 pacientes / Primary ciliar dyskinesia: its presentation in otolaringology: experience with 14 patients

La disquinesia ciliar primaria (DCP) es una enfermedad subdiagnosticada que suele tener manifestaciones importantes en Otorrinolaringología. Se analizan 14 pacientes en quienes el diagnóstico de DCP se basó en la persistencia de infecciones crónicas, ya sea a nivel nasosinusal u ótico. Las patologías más frecuentemente involucradas fueron la rinosinusitis crónica y la otitis media con efusión. El diagnóstico se hizo con microscopía electrónica de transmisión de mucosa bronquial. La alteración ciliar encontrada más reiteradamente fue la ausencia del brazo interno de dineína. En 6 pacientes se debió realizar cirugía endoscópica funcional de cavidades perinasales debido a una rinosinusitis crónica y, en 8, se debió colocar tubos de ventilación, por la otitis media con efusión persistente.

Nasal granuloma gravidarum presenting with recurrent massive epistaxis.

Nasal granuloma gravidarum is a rare condition associated with pregnancy and minor trauma. This condition presents with a nasal mass with varying degree of bleeding and obstruction. We report a patient with nasal granuloma gravidarum in the third trimester of pregnancy. Surgical excision is the definite treatment for this condition in order to stop the vicious cycle of recurrent massive bleeding. Possible etiology, clinical features and management are discussed.

Trombose séptica de seios cavernosos, transverso e sigmóide e de veia jugular, associada à meningite, secundária a furúnculo nasal: relato de caso / Septic thrombosis of cavernous, transverse, sigmoid sinuses and jugular vein, associated with meningitis, secondary to nasal furuncle: case report

Os autores descrevem um caso de furúnculo nasal que evoluiu com trombose séptica de seio cavernoso, bilateral e assimétrica, e de seios transverso e sigmóide e de veia jugular interna a esquerda, associada à meningite bacteriana, em um paciente previamente hígido. Apesar da trombose séptica extensa de seios venosos, o paciente apresentou boa evoluçäo, após tratamento clínico agressivo com antibióticos, corticosteróides e anticoagulantes. Porém, manteve como seqüela: paresia de VI nervo à esquerda e lesäo parcial de nervo óptico homolateral.

Presumably entomophthoramycosis in an HIV-infected patient: the first in Thailand.

The authors reported the case of a symptomatic HIV-infected woman with a slowly progressive infiltrative lesion which invaded in and around the nasal cavity over a 6-month period. Physical examination showed erythematous to violaceous plaques at the nasal and malar areas. Swelling of the inferior turbinate was noted in the right nare. Skin biopsy of the involved area revealed multiple nonseptate, broad, thin-walled hyphae within giant cells and granulomata. Entomophthoramycosis was diagnosed based on clinical features and histopathology. She was treated with intravenous amphotericin B for two weeks, followed by oral itraconazole 400 mg daily. At six months there was complete resolution of all lesions.

Mucormicose rinocerebral: relato de um caso / Rhinocerebral mucormycosis: report of case

Mucormicose é uma infecçäo fúngica com alta mortalidade, existindo sob as formas: craniofacial, pulmonar, cutânea, gastrointestinal e disseminada; ocorrendo em pacientes debilitados, devido a patologias crônicas. Relatamos aqui um caso de mucormicose renicerebral em paciente diabético, tratado com cirurgia e medicamento (U)

Diagnóstico de 2 casos de mucormicosis rino-facio-cerebral en pacientes diabeticos / Diagnosis two cases de rhino-facio-cerebral mucomycosis in diabetic patients

Se presentan dos casos de mucormicosis rino-facio-cerebral de evolución lenta, en pacientes diabéticos. El diagnóstico se realizó por el hallazgo del hongo en el exámen histopatológico y exámenes microcópicos de los materiales drenados de los senos maxilares, que mostraron hifas no septadas y abundantes. En ninguno de los casos se pudo recuperar el agente etiológico por cultivo, debido a la labilidad de los mucorales y por la presencia de un material necrótico de fácil contaminación microbiana