Bichectomia: sistematização técnica aplicada a 27 casos consecutivos / Bichectomy: technical systematization applied in 27 consecutive cases

Introdução: Embora realizada há muito tempo, a remoção da bola de Bichat ganhou notoriedade nos últimos anos devido a sua grande procura nos consultórios do cirurgião plástico. Mesmo quando adequadamente indicada, ainda é considerada um procedimento controverso, uma vez que ainda não existe uma técnica cirúrgica sistematizada na literatura atual, visando torná-la segura e reprodutível. Métodos: A técnica da bichectomia intraoral descrita no trabalho foi aplicada de maneira sistemática em uma série de 27 pacientes consecutivos, no período de 5 de janeiro de 2016 a 15 de dezembro de 2016. Resultados: A idade média dos pacientes foi de 32 anos, sendo 15% do sexo masculino e 85% do sexo feminino. A bichectomia foi realizada isoladamente em 6 pacientes (22%) e em conjunto com outros procedimentos em 21 pacientes (78%). O procedimento mais comumente associado foi a lipoaspiração cervical, realizada em 55% dos pacientes. A imensa maioria dos casos foram operados com anestesia geral (93%). Nenhuma complicação permanente e importante foi verificada no pósoperatório, apenas um caso de neuropatia transitória do ramo bucal e um caso de edema mais pronunciado, que prontamente se resolveram nas semanas seguintes. Conclusão: A remoção de gordura bucal pode ser realizada de forma previsível, rápida e segura, proporcionando diminuição volumétrica do terço inferior facial, com maior realce dos contornos faciais. Quando aplicada em um ambiente cirúrgico seguro, seguindo todos os padrões de segurança da cirurgia e respeitando os complexos limites anatômicos da região, nossa técnica levará os cirurgiões e pacientes a um resultado seguro e satisfatório.

Introduction: Despite buccal fat removal having been performed for a long time, its popularity has increased only in recent years, leading to a rise in the demand for bichectomy in plastic surgery clinics. Buccal fat pad removal is still considered controversial, even when properly indicated, especially with the lack of a systematized surgical technique to make it safe and reproducible. Methods: The intraoral bichectomy described herein was systematically applied in 27 consecutive patients from January 5, 2016 to December 15, 2016. Results: The mean patient age was 32 years; 15% were men, and 85% were women. Isolated buccal fat pad removal was performed in six patients (22%) and in combination with other procedures in 21 patients (78%). The main procedure combined was neck liposuction (55%), and most patients were operated under general anesthesia (93%). No permanent or significant complications occurred, and there were only two minor complications, i.e., inferior mandibular neuropathy and significant swelling, which improved without treatment during the following weeks. Conclusions: Buccal fat removal can be performed in a predictable, fast, and safe manner, leading to volumetric reduction of the lower third of the face, enhancing facial shape. When applied in a safe surgical environment, following all surgical security standards and considering the complex anatomical boundaries of the cheek, our technique can yield secure and satisfactory outcomes both for surgeons and patients.

Acúmulo de sementes de Acrocomia aculeata (Arecaceae) na bochecha de búfalos no Pará / Acumulation of the seeds of Acrocomia aculeata (Arecaceae) in the cheeks of buffaloes in the State of Pará, Brazil

Foi demonstrado que uma condição em búfalos caracterizada pelo aumento de uma das bochechas é causada pelo acúmulo das sementes da palmeira "mucajá"(Acrocomia aculeata, fam. Arecaceae) e de capim no vestíbulo oral, durante a ruminação. Esse acúmulo de sementes causou atrofia por compressão com adelgaçamento e desvio medial do osso mandibular correspondente e exposição das raízes dos dentes molares. Aparentemente os frutos dessa palmeira possuem boa palatabilidade para búfalos.

A condition of buffaloes characterized by an increased volume of one of the cheeks was shown to be due to accumulation of the seeds of the palm-tree "mucaja" (Acrocomia aculeata) and of grass, in the oral vestibulum during rumination. This caused compressive atrophy with thinning and medial deviation of the corresponding submaxillary bone and exposition of the roots of molar teeth. The seeds appear to be of good palatability to the buffaloes.

An unusual cause of recurrent cheek abscess: a clinical case

We report the case of a 16-year-old female who presented to us with a recurrent cheek abscess following a blow to the cheek. On drainage of the abscess, a piece of betel nut was retrieved from the cheek. The patient recalled having a betel nut in her mouth at the time of the blow.

Venous malformation of the cheek: treatment selection based on C.T. scan evaluation

Venous malformations represent a great cosmetic and functional problem to the patients; especially those lesions occurring in the face. Although a variety of treatments of this condition exist in the field of plastic surgery, yet the selection of the appropriate modality is not clear in the literature. In the current paper, 15 patients -suffering from venous malformation of the cheek area- were selected from a large pool of patients presented to the plastic surgery department of Ain-Shams University. They were classified into two groups [localized and diffuse] according to the clinical examination and the CT. scan findings. The first group was treated by surgical excision; while the second group was subjected to Nd.:YAG laser photocoagulation. The results, of the classification and the different treatments were presented and discussed

Experimental paracoccidioidomycosis of hamster inoculated in the cheek pouch

We comparaed the granuloma morphology and immune response of hamsters inoculated with Paracoccidioides brasiliensis (Pb) into the cheek pouch, which lacks lymphatic drainage, and the ffotpad, which is rich in lymphatics. Our objective was to better understand the modulation of Pb granuloma in an immunocompetent animal inoculated in an immunologically privileged site. The humoral immune response (ELISA) and cell mediated immunity (footpad test) became positive on days 7 and 14, respectively in animal inoculated into footpad and on days 35 and 60 in animals inoculated into the pouch. Typical epithelioid granulomas were observed at both sites on day 14. The number of fungi gradually decreased from the beginning of the experiment in footpad lesions, but only after day 35 in pouch granulomas, when cell mediated immunity was detectable. The results indicate that typical epithelioid paracoccidioidomycotic granulomas may develop in the absence of a detectable immune response; however, they are incapable of controlling fungal reproduction. Lack of lymphatic drainage delays the appearance of a detectable immune response, but with time fungi escape from the pouch, elicit an immune response and reach other organs. Our results further indicate the importance of the lymphatics in the pathogenesis of paracoccidioidomycosis.