Técnica EXIT como manejo de la vía aérea en masas gigantes congénitas de cuello / Ex-Utero Intrapartum Treatment for airway management in congenital giant neck masses

Resumen: Introducción: Las masas congénitas de cabeza y cuello se asocian a asfixia perinatal e injuria cerebral con elevada mortalidad. La técnica EXIT (Ex Útero Intrapartum Treatment) consiste en asegurar la vía aérea del neonato, sin interrumpir la oxigenación y perfusión materno-fetal a través del soporte placentario. Esta técnica no ha sido estandarizada en países de medianos ingresos. Objetivo: Describir el caso clínico de 2 neonatos manejados mediante la técnica EXIT. Caso Clínico: Se reportan dos casos, uno con malformación linfática diagnosticada a la semana 20 gestación y el segundo con tiromegalia y polihidramnios diagnosticados a la semana 35 de gestación. En ambos casos, duran te la cesárea se realizó la técnica EXIT con un equipo conformado por neonatólogo, ginecólogo, anestesiólogo, cirujano pediatra, otorrinolaringólogo, enfermero y terapeuta respiratorio. En los dos pacientes se logró asegurar la vía aérea mediante intubación orotraqueal al primer intento. En el caso 1 se confirmó la malformación linfática y recibió escleroterapia, y en el caso 2 se diagnosticó hipotiroidismo congénito asociado a bocio, que fue manejado con levotiroxina. Los pacientes se mantuvieron 7 y 9 días con ventilación mecánica invasiva respectivamente y egresaron sin complicaciones respiratorias. Conclusiones: La técnica EXIT en estos casos fue un procedimiento seguro, llevado a cabo sin inconvenientes. Se necesita un equipo multidisciplinario y la disponibilidad de una unidad de cuidados intensivos neonatales, con el objetivo de reducir potenciales complica ciones y garantizar el manejo postnatal. Para lograr su ejecución, es indispensable el diagnóstico prenatal oportuno.

Abstract: Introduction: Congenital head and neck masses are associated with perinatal asphyxia and brain injury, increasing the risk of death. The EXIT (Ex Utero Intrapartum Treatment) technique con sists of ensuring the newborn's airway while is still receiving placental support. This technique has not been standardized in developing countries. Objective: To describe the clinical outcomes of two infants who underwent the EXIT technique. Clinical Case: We present two cases, one with lymphatic malformation diagnosed at 20 weeks of gestational age (WGE) and the second one, a preterm newborn with thyromegaly and polyhydramnios, diagnosed at 35 WGE. In both cases, during the C-section, the EXIT technique was performed with a team of a neonatologist, a gyne cologist, an anesthesiologist, a pediatric surgeon, an otolaryngologist, a nurse, and a respiratory therapist. In both patients, the neonatologist achieved to secure the airway through orotracheal intubation at the first attempt. In the first case, lymphatic malformation was confirmed and re ceived sclerotherapy, and the second one was diagnosed with congenital hypothyroidism which was managed with levothyroxine. The patients needed invasive mechanical ventilation for 7 and 9 days, respectively, and were discharged without respiratory complications. Conclusions: In these patients, the EXIT technique was a safe procedure, carried out without inconvenience. A multi disciplinary approach and the availability of a neonatal intensive care unit are needed to reduce potential complications and ensure postnatal management. Timely prenatal diagnosis is essential to perform this technique.

Resultados del tratamiento kinésico en una paciente con lesión traumática de nervios peroneo común y tibial / Results of the kinésico treatment in a patient with traumatic injury of the common fibular and tibial nerves

Se realizó el seguimiento de una paciente de sexo femenino de 41 años de edad, con hipotrofia de miembro inferior izquierdo consecuente de un atentado en el que recibió tres heridas de arma de fuego calibre 22, lesionando los nervios peroneo común y tibial. El tratamiento realizado se basó en un protocolo de electroestimulación muscular selectiva con corrientes de baja frecuencia y ejercicios personalizados de miembros inferiores. Los mismos mejoraron la fuerza, funcionalidad y calidad de vida de la paciente, permitiéndole recuperar independencia funcional y reinserción a las actividades diarias

A monitoring was conducted to a 41 year-old female patient, with hypotrophy of the left lower limb as a consequence of an assault in which she received three gunshot wounds produced by a firearm .22 caliber, injuring both the common peroneal and tibial nerves. The executed treatment was based on a protocol of selective muscular electrostimulation of the affected muscles with low frequency current and personalized exercises of the lower limbs, which have improved the patient's strength, functionality and quality of life, allowing her to regain functional independence and reintegration to daily activities.

Retalho superior delgado nas mamoplastias / Thin superior flap in mammoplasty procedures

INTRODUÇÃO: A cirurgia plástica da mama, por se tratar de um dos procedimentos mais realizados no nosso meio, traz consigo muitas variações técnicas e de táticas cirúrgicas, que proporcionam ao profissional da área da Cirurgia Plástica várias opções técnicas. O objetivo foi avaliar a técnica do retalho superior delgado nas mamoplastias. MÉTODOS: Foram selecionadas 30 pacientes, no período de 2 anos, que apresentavam hipertrofia mamária e/ou ptose mamária. Foi realizada uma técnica utilizando a marcação em T invertido e um retalho inferior número IV de Ribeiro. A modificação introduzida foi a confecção do retalho superior delgado com aproximadamente 2 cm de espessura computando 30% do volume mamário, sendo o retalho inferior responsável por 70% do volume. RESULTADOS: Três colegas especialistas em Cirurgia Plástica por mais de 10 anos avaliaram as pacientes e pudemos observar um resultado no qual 91,5% das pacientes avaliadas se mostraram de ótima qualidade, 6,9% de boa qualidade e apenas 1,6% de resultados regulares, sem resultados ruins. Foram computados 2,6% de complicações, com um caso de infecção, um de assimetria e dois de cicatriz inestética. CONCLUSÃO: O retalho superior delgado se mostrou muito eficaz nas mamoplastias.

INTRODUCTION: For being one of the procedures mostly performed in our environment, breast plastic surgery involves many technical variations and surgical strategies that provide the plastic surgeon with several options. The objective of this study was to evaluate the use of thin superior flap technique in mammoplasties. METHODS: Over a period of 2 years, we selected 30 patients presenting with mammary hypertrophy and/or breast ptosis. A technique based on the inverted-T marking and Ribeiro's type IV inferiorly based flap was carried out. The intervention involved the production of a thin superior flap with a thickness of approximately 2 cm. This comprised 30% of the breast volume, while the inferior flap was responsible for the remaining 70%. RESULTS: Three expert plastic surgeons evaluated the patients. The results showed that 91.5% of the women who underwent this procedure presented with excellent quality outcomes, while 6.9% had a good outcome. Further, a fair outcome was observed only in 1.6% of the patients, while poor outcomes were not obtained. The procedure had a complication rate of 2.6%, which included one case of infection, one of asymmetry, and two of unsightly scars. CONCLUSION: The thin superior flap proved to be very effective in mammoplasties.

Labiaplasty and its current status / Plástica de pequenos lábios e suas possibilidades atuais

Introduction: Nymphoplasty or labiaplasty consists of a surgical approach to hypertrophy of the labia minora, and is aimed at correcting asymmetry and removing redundant tissue of the vulva. Hypertrophy of the labia minora is characterized by tissue that exceeds the limits of the labia majora under normal conditions. Surgery is an option in patients who complain of unpleasant odor, urinary infection, interference with sexual activity, and/or personal dissatisfaction; in the latter case, the surgical indication has an aesthetic purpose. The aim of this article was to report our experience with wedge resection of the labia minora in patients with hypertrophy. Methods: We retrospectively analyzed 53 cases of labiaplasty performed with the wedge resection technique from 2010 to 2015. The results were evaluated for postoperative anatomical appearance, the degree of patient satisfaction, and the effect on sexual activity. Results: Patients were satisfied with the postoperative aesthetic appearance. There was improvement in sexual satisfaction, ability to perform physical activities, and hygiene. No complications were observed, such as suture dehiscence, infection, or tissue necrosis. One patient required reoperation in the postoperative period due to asymmetry of the labia minora. Another patient complained of excessive exposure of the clitoris, but she had preexisting clitoral hypertrophy. Conclusion: Labiaplasty using the wedge resection technique relieved personal discomfort and provided functional and aesthetic improvement. Due to the lack of validation and standardization of labiaplasty techniques, further clinical research should be performed.

Introdução: A ninfoplastia consiste na abordagem cirúrgica da hipertrofia dos pequenos lábios, que visa ao aperfeiçoamento da assimetria destes e do tecido redundante da vulva. A hipertrofia de pequenos lábios caracteriza-se por aqueles que, em posição e condições normais, sobressaem-se aos grandes lábios. A cirurgia tem sido proposta na presença de transtornos, como odor desagradável, infecção urinária, comprometimento da atividade sexual e/ou insatisfação pessoal, cuja indicação cirúrgica possui fins estéticos. O objetivo deste artigo é relatar nossa experiência com a ressecção em cunha dos pequenos lábios nas pacientes que apresentam tal hipertrofia. Métodos: Foram analisados retrospectivamente 53 casos de ninfoplastia pela técnica de ressecção em cunha, no período de 2010 a 2015. Os resultados foram analisados quanto ao aspecto anatômico no pós-operatório, o grau de satisfação das pacientes e a interferência na atividade sexual. Resultados: As pacientes se mostraram satisfeitas com o aspecto estético pós-cirúrgico. Houve melhora no desempenho sexual, na prática de atividades físicas e condições de higiene. Não foram verificadas complicações, como deiscência de sutura, infecção ou necrose tecidual. Uma paciente precisou ser reoperada devido à assimetria de pequenos lábios no pós-operatório. Outra paciente queixou-se da excessiva exposição do clitóris, porém o mesmo já apresentava discreta hipertrofia prévia. Conclusão: A ninfoplastia pela técnica de ressecção em cunha apresentou benefícios em relação ao desconforto pessoal, melhora funcional e estética. Devido à ausência de validação e padronização nas técnicas de ninfoplastia atuais, novos estudos clínicos devem ser realizados.

Condutas atuais na prevenção da hipertrofia cicatricial pós-operatória / Current management for the prevention of postoperative scar hypertrophy

Introdução: Considerando um número estimado de cerca de 51 milhões de cirurgias a cada ano apenas nos EUA, podemos dizer que a hipertrofia cicatricial é um problema relevante, já que uma cicatriz fina, de boa qualidade, pode ser a linha divisória entre um bom resultado e uma cirurgia malsucedida. O objetivo é fazer uma revisão bibliográfica acerca dos métodos de tratamento não invasivos atualmente disponíveis para a prevenção da hipertrofia cicatricial pós-cirúrgica e discutir a sua eficácia baseada em evidências. Método: Foi realizada uma pesquisa nas bases de dados Pubmed, Lilacs e SciELO, utilizando os termos "scar prevention" and "hypertrophic scars", por ensaios clínicos, meta-análises e artigos de revisão publicados a partir de 2004, em inglês ou português. Resultados e Conclusões: Foram encontrados vários trabalhos utilizando o silicone, proporcionando alguma evidência acerca da sua eficácia; foram encontrados apenas três ensaios clínicos prospectivos relacionados ao uso do Contractubex®; dois ensaios clínicos prospectivos, controlados, randomizados, sendo apenas um deles duplo-cego, com o imiquimode a 5%; foi encontrado apenas um ensaio clínico bem desenhado utilizando o esparadrapo microporoso e outro trabalho relacionado ao uso da vitamina E, que não mostrou bons resultados; não foram encontrados ensaios clínicos sobre o uso da massagem e da pressão local. Apesar das deficiências dos estudos, o silicone é considerado a primeira opção na prevenção da hipertrofia cicatricial pós-cirúrgica. Não há evidências que comprovem a eficácia do esparadrapo microporoso, da massagem, da pressão local, do Contractubex, do imiquimode a 5% e da vitamina E.

Introduction: Considering that nearly 51 million surgeries are performed annually just in the USA, we can state that scar hypertrophy is a relevant problem, since a thin, good quality scar can be the dividing line between a good outcome and an unsuccessful surgery. The objective is to perform a bibliographic review of the noninvasive methods currently available to prevent postoperative hypertrophic scars and discuss their evidence-based effectiveness. Method: A search was performed in PubMed, LILACS, and SciELO databases, using the terms "scar prevention" and "hypertrophic scars," for clinical trials, meta-analyses, and review articles published since 2004 in English or Portuguese language. Results and Conclusions: Several studies using silicone were found, providing some evidence on its effectiveness; only 3 prospective clinical trials using Contractubex® were found; 2 controlled, randomized prospective clinical trials using 5% imiquimod were found, but only one was doubleblind; one well-designed clinical trial using a micropore adhesive tape was found; a similar clinical trial using vitamin E did not show good results. Clinical trials on the use of massage and local pressure were not found. Despite the limitations of the studies, silicone is considered the first treatment option for the prevention of postoperative hypertrophic scars. There is no evidence proving the effectiveness of micropore adhesive tape, massage, local pressure, Contractubex, 5% imiquimod, or vitamin E.

Onfaloplastia secundária: descrição de uma nova proposição / Secondary omphaloplasty: description of a new proposal

Introdução: O umbigo é um componente essencial à estética do abdome. Sequelas de onfaloplastia podem comprometer o resultado final de uma dermolipectomia abdominal. Objetivo do trabalho é propor um procedimento alternativo, de fácil execução, com resultado estético favorável e bem aceito pelas pacientes. Métodos: Fizemos o levantamento dos casos de dermolipectomia abdominal operados no serviço de ensino e na clínica privada nos últimos cinco anos (433 casos) Resultados: Encontramos 30 casos (6,9%) com sequelas, assim distribuídos: 14 casos (3,2%) na cicatriz hipogástrica, e 16 casos de sequelas de umbigo (3,8%), assim caracterizados: sete casos (1,6%) constrição de umbigo e nove casos (2,07%) hipertrofia cicatricial. Conclusão: Analisamos os resultados da técnica de onfaloplastia secundária proposta quanto ao pós-operatório imediato (até 30 dias) e tardio (um ano).

Introduction: The navel is an essential component of abdominal aesthetics. Omphaloplasty sequelae can compromise the result of an abdominal abdominoplasty. The purpose of this article was to propose an alternative procedure that is simple to perform and well accepted by patients, with favorable cosmetic results. Methods: We surveyed cases of abdominal dermolipectomy in teaching hospitals and in private practice in the last 5 years (433 cases). Results: We found 30 cases (6.9%) of sequelae distributed as follows: 14 cases (3.2%) in the hypogastric scar and 16 cases in the umbilicus (3.8%). They are characterized as follows: 7 cases (1.6%) of constriction of the navel and 9 cases (2.07%) of scar hypertrophy. Conclusion: We analyzed the results of the proposed technique of secondary omphaloplasty in the immediate (up to 30 days) and late (1-year) postoperative periods.

Functional and morphological effects of resistance exercise on disuse-induced skeletal muscle atrophy

Abstract The reduction of skeletal muscle loss in pathological states, such as muscle disuse, has considerable effects in terms of rehabilitation and quality of life. Since there is no currently effective and safe treatment available for skeletal muscle atrophy, the search for new alternatives is necessary. Resistance exercise (RE) seems to be an important tool in the treatment of disuse-induced skeletal muscle atrophy by promoting positive functional (strength and power) and structural (hypertrophy and phenotypic changes) adaptive responses. Human and animal studies using different types of resistance exercise (flywheel, vascular occlusion, dynamic, isometric, and eccentric) have obtained results of great importance. However, since RE is a complex phenomenon, lack of strict control of its variables (volume, frequency, intensity, muscle action, rest intervals) limits the interpretation of the impact of the manipulation on skeletal muscle remodeling and function under disuse. The aim of this review is to critically describe the functional and morphological role of resistance exercise in disuse-induced skeletal muscle atrophy with emphasis on the principles of training.

Radiofrequency volumetric tissue reduction with and without turbinate lateralization in the management of inferior turbinate hypertrophy

Inferior turbinate hypertrophy is one of the major causes of chronic nasal obstruction. Many procedures have been suggested, however, there is no agreement on how to deal with this problem. To evaluate and compare the efficacy and morabidity of radiofrequency volumetric tissue reduction [RFVTR], with and without turbinate lateralization in the management of inferior turbinate hypertrophy. A prospective clinical study was conducted on 36 patients with chronic nasal obstruction due to inferior turbinate hypertrophy. The cases were divided into two groups, group A: 18 patients who had RFVTR and group B: 18 patients who had RFVTR in addition to lateralization of the inferior turbinate. Procedures were done under local anaesthesia. Pstoperative follow-up visits were scheduled at 3, 7 days, 3, 6, 12 and 18 months after surgery. A standard 0-to-10 visual analogue scale [VAS] was conducted by the patients preoperatively and at every follow-up visit and video-endoscopic evaluation was used to grade nasal obstruction preoperatively and one week, 3, 18 months postoperatively. Among the 36 patients included [25 males and 9 females], the age ranged between 16 and 52 years, with a mean age of 31.5 years. No marked operative or postoperative complications. VAS scores [mean +/- SD] of group A patients for the degree of nasal obstruction changed from a preoperative score of 7.52 +/- 2.18 to 2.49 +/- 1.82 at 18 months postoperatively, and in group B, it changed from a preoperative score of 7.63 +/- 2.6 to 2.45 +/- 1.37 at 18 months postoperatively. There were no statistically significant difference between the outcomes of the two groups allover the study period or in each group when comparing early and late results [3 and 18 months postoperative] regarding the degree or the frequency of nasal blockage by VAS, or the endoscopic evaluation of airway blockage [p>0.05]. RFVTR is an effective modality in treatment of chronic nasal obstruction due to inferior to turbinate hypertrophy. Although lateralization of the inferior turbinate might be a safe and easy addition to the procedure, it did not give an addional impact on the outcome

Comparison of chemical cautery (AgNo3) and steroid spray against SMD (submucosal diathermy) in the treatment of symptomatic inferior turbinate hypertrophy (ITH).

OBJECTIVE: To compare the efficacy of chemical cautery (AgNo3) and steroid nasal spray against SMD (submucosal diathermy) in the treatment of symptomatic Inferior Turbinate Hypertrophy (ITH). MATERIALS AND METHODS: Patients attending OPD in the department of ENT &HNS at KMCTH with symptomatic Inferior turbinate Hypertrophy were taken with their approval included for the study. Patients were divided into 2 Groups: in the first Group 25 patients were included and treated with chemical cautery (AgNo3) under Local Anaesthesia (LA), followed by steroid nasal spray for 3 months; in the second Group 25 patients were included and were treated with SMD (submucosal diathermy) under General Anaesthesia (GA).They all had history of use of topical nasal decongestant for different time period. Patients were followed up for 6 months. RESULTS: In Group 1, 16 patients complain of burning sensation for first week and 8 patients complain of continuous nasal blockage for 6 weeks.1 patient complain about inosmia for 2 weeks. In Group 2, nasal pain was complained by 17 patient for 2 weeks. 3 patients complain of persistent nasal blockage for 4 weeks. 3 patients complain of anosmia for 4 weeks. After completion of 6 months in Group 1, 20 patient has recurrent nasal blockage, whereas in Group 2, 10 patient has recurrent nasal blockage. Besides these, other symptoms noticed during initial phase did not appear. CONCLUSION: Chemical cautery (AgNo3) and steroid nasal spray is easy to follow, has less complication ,but failure rate is high, whereas SMD is procedure with less failure rate, but has to carried out under GA and has more discomfort postoperatively. For symptomatic inferior turbinate hypertrophy, where topical nasal decongestant has little role SMD is the choice of treatment for longer relief.

Hipertrofia muscular: caso clínico / Musclular hypertrophy: a clinical case

Introducción. En este trabajo, presentamos el tratamiento interdisciplinario y seguimiento de una paciente adolescente de 15 años con hipertrofia del músculo maseterino del lado izquierdo, con limitación de la apertura bucal y dolor, de etiología parafuncional. Objetivos: realizar terapia de apoyo y el tratamiento fonoaudiológico y kinesiológica para eliminar la sintomatología dolorosa, disminuir la asimetría facial y recuperar la funcionalidad. Evaluar los valores de movilidad mandibular, durante todo el tratamiento como indicadores funcionales. Materiales y métodos: en una primera etapa, se indicó terapia de apoyo por medio de la aplicación de calor húmedo local con fomentos y buches calientes y analgésicos cada 8 hs. El tratamiento fonoaudiológico realizado incluye ejercicios de tonificación, linguales de masticación, posturales y de movimiento mandibular y además, masajes maseterinos como terapia kinesiológica. En ejes de coordenadas en milímetros en función del tiempo, se graficaron los valores obtenidos de apertura máxima confortable, apertura máxima forzada, protrusión y lateralidades.

Hipertrofia unilateral do músculo masseter / Unilateral hipertrophy of the masseter muscle

A hipertrofia muscular constitui uma alteração causada por uma hiperatividade funcional. Neste trabalho é apresentado um caso de hipertrofia unilateral do masseter, os fatores etiológicos e o tratamento empregado.

Laser assisted turbinate reduction [LATR] comparative study

One of the major causes of chronic nasal airway obstruction is the inferior turbinate hypertrophy. There is no agreement on how to deal with this problem. Surgical treatment of nasal turbinates has been indicated when medical treatment fails. Laser surgery of inferior turbinate was first described in 1977 by Lenz et al. Laser surgery of inferior turbinates can be performed as an outpatient procedure under local anesthesia. Due to a minimally invasive and controllable coagulation and ablation of soft tissue, almost no considerable complications or bleeding were observed during the operation or postoperatively, therefore no need for nasal pack. The aim of the present work is to prove the efficacy of laser-assisted turbinate reduction [LATR] and to compare between different types of lasers with different techniques in this respect. Sixty patients with irreversible turbinate hypertrophy were selected and divided into four groups; each included 15 patients: Group 1: Turbinate Reduction using CO[2] laser [Non- contact technique]. Group 2: Turbinate Reduction using Diode laser [Contact technique]. Group 3: Turbinate Reduction using KTP laser [Interstitial technique]. Group 4: Turbinate Reduction using Nd: YAG laser [Interstitial technique]. All patients were operated upon in the National Institute of Laser Enhanced Sciences [NILES] in the period between 2001 and 2004. The results of obstruction were good and satisfactory for all types of lasers until the 6th month postoperatively, after which the results became less impressive with increasing recurrence rate. Two years postoperatively, YAG cases had the lowest recurrence rate [20%], then both KTP and Diode cases [26.6%], and finally the CO[2] cases that had the highest recurrence rate [about 40%]. It was concluded that LATR is a good short-term alternative procedure for turbinate reduction. It is rapid safe procedure, with minimal pain and bleeding, easy done under local anesthesia as an outpatient procedure, no need for nasal packing in most cases with minimal mucosal damage specially in the interstitial technique that leaves intact mucosa. It is recommended particularly for non- allergic patients as multiple sessions to achieve relatively long-term result. On the other hand, in allergic patients the allergic manifestations alleviated to some extent but with short-term effect

Tratamiento quirúrgico de la hipertrofia de los cornetes inferiores con plasma argón / Surgical treatment of the hypertrophy of the inferior turbinal bones with argon plasma

En nuestras consultas atendemos con frecuencia la obstrucción nasal crónica y la causa más frecuente es la hipertrofia de los cornetes inferiores. Cuando estos pacientes no tienen una respuesta positiva al tratamiento médico y luego de analizar los resultados del estudio de la enfermedad alérgica de estos, es que decidimos realizar la reducción quirúrgica del tamaño de los cornetes inferiores. Entre las técnicas utilizadas para este propósito se encuentra la coagulación con plasma argón, un procedimiento que utiliza corriente eléctrica de alta frecuencia y una fuente de plasma argón. La reducción efectiva de los cornetes, la posibilidad de alcanzarlo en toda la longitud de estos, la penetración limitada, el poco tiempo quirúrgico y la ausencia de complicaciones hemorrágicas entre otras ventajas, hacen de esta técnica algo excepcional. Fueron atendidos 40 pacientes diagnosticados de rinitis crónica hipertrófica, quienes fueron revisados a los 3 meses, 12 meses y 24 meses después del tratamiento. A los 24 meses, 38 pacientes (95 por ciento) refirieron una mejoría significativa de los síntomas. Se revisan y discuten las indicaciones, ventajas, complicaciones y resultados a largo plazo del uso de la coagulación con plasma argón en rinocirugía(AU)

In our consultations we frequently assist the obstruction nasal chronicle and the most frequent cause is the hipertrofia of the inferior cornetes. When these patients don't have a positive answer to the medical treatment and after analyzing the results of the study of the allergic illness of these, it is that we decide to carry out the surgical reduction of the size of the inferior cornetes. Among the techniques used for this purpose he/she meets the clotting with plasm argon, a procedure that uses electric current of high frequency and a source of plasm argon. The effective reduction of the cornetes, the possibility to reach it in all the longitude of these, the limited penetration, the little surgical time and the absence of complications hemorrágicas among other advantages, they make of this technique something exceptional. 40 diagnosed patients of rinitis chronic hipertrófica were assisted who were revised to the 3 months, 12 months and 24 months after the treatment. To the 24 months, 38 patients (95 percent) they referred a significant improvement of the symptoms. They are revised and the indications discuss, advantages, complications and long term results of the use of the clotting with plasm argon in rinocirugía(AU)

Miectomia com acesso extraoral para hipertrofia benigna de Masseter: relato de caso / An extraoral approach for miectomy in Masseter muscle hipertrophy: case report

A hipertrofia benigna de masseter é uma patologia caracteriza por um abaulamento indolor da região de ângulo mandibular, podendo ser uni ou bilateral. O diagnóstico é exclusivamente clínico, confirmado durante o ato operatório. O presente trabalho apresenta um caso de hipertrofia benigna de Masseter tratado cirurgicamente com miectomia por acesso extra-oral, onde o resultado foi satisfatório, com controle de três anos sem recidiva. Além dessa modalidade de tratamento, a hipertrofia benigna de masseter pode ser tratada com outras técnicas cirúrgicas ou modalidades conservadoras. A comparação da eficácia entre as diferentes técnicas é discutida no presente trabalho

Amyloidotic muscle pseudohypertrophy: case report

The authors report one case of amyloidosis associated with muscular pseudohypertrophy in a 46-year-old woman, who developed weakness, macroglossia and muscle hypertrophy associated with primary systemic amyloidosis. Electromyography showed a myopathic pattern and bilateral carpal tunnel syndrome. The muscle biopsy presented with a type I and II fiber hypertrophy and infiltration of amyloid material in the interstitious space and artery walls. She underwent bone marrow transplantation with stabilization and subjective improvement of the clinical picture

Estudio clínico de la hipertrofia maseterina / Clinical study of masseter hypertrophy

La hipertrofia maseterina es una condición que presentan algunos pacientes que acuden a la consulta odontológica. En muchas ocasiones son referidos por ser confundidos con una tumoración de glándulas salivales o de los maxilares, sobre todo las unilaterales. El odontólogo muchas veces se sorprende frente a esta condición que, en la mayoría de los casos, está acompañada de hábitos indeseables como masticar exagerado, el bruxismo y trastornos sicológicos asociados al estrés. Se hace una revisión de la literatura y se presenta un estudio clínico de los pacientes que asisten al servicio de postgrado de Cirugía Bucal de la Facultad, donde se encontró gran relación entre la hipertrofia maseterina clínica y el hábito del bruxismo; igualmente llama la atención el grupo etario de estos pacientes en la 2da y 3ra década de la vida. Se ofrece un aporte al conocimiento de los músculos masticatorios, en este caso del músculo masetero con una condición que prsenta relativa frecuencia de hipertrofia maseterina

Hipertrofia idiopática do masseter: consideraçöes terapêuticas e revisäo da literatura / Idiopathic hypertrophy of the masseter: considerations on treatment and review of the literature

Os autores procuram neste trabalho estudar os fatores etiológicos, a incidência e o melhor método para o tratamento da hipertrofia do músculo masseter. Realizou-se uma revisäo bibliográfica dos principais relatos e estudos das técnicas cirúrgicas descritas para o tratamento e correçäo desta condiçäo. A cirurgia preconizada é realizada por acesso extra-oral com ressecçäo de 2/3 da musculatura massetérica. A cicatriz teve evoluçäo satisfatória em todos os pacientes. O acompanhamento pós-operatório revelou um bom contorno facial e um padräo oclusal mantido, sem qualquer sintomatologia. Enfatiza-se a importância do diagnóstico correto para se evitar procedimentos inadequados no tratamento destes pacientes, ressaltando que na maioria dos casos näo existe indicaçäo cirúrgica

Hipertrofia de ninfas / Nympha hypertrophy

Embora de ocorrência nåo muito freqüente, a hipertrofia dos pequenos lábios vulvares pode trazer desconforto e embaraço para suas portadoras. O desconhecimento sobre a possibilidade de correçåo cirúrgica faz com que muitas pacientes nem cheguem a conversar com seus ginecologistas sobre o problema, que é, no entanto, de soluçåo simples e eficaz. Os autores descrevem a técnica, alguns casos e tecem consideraçöes sobre o assunto