Human levator veli palatini muscle: a novel source of mesenchymal stromal cells for use in the rehabilitation of patients with congenital craniofacial malformations.

BACKGROUND: Bone reconstruction in congenital craniofacial differences, which affect about 2-3% of newborns, has long been the focus of intensive research in the field of bone tissue engineering. The possibility of using mesenchymal stromal cells in regenerative medicine protocols has opened a new field of investigation aimed at finding optimal sources of multipotent cells that can be isolated via non-invasive procedures. In this study, we analyzed whether levator veli palatini muscle fragments, which can be readily obtained in non-invasive manner during palatoplasty in cleft palate patients, represent a novel source of MSCs with osteogenic potential. METHODS: We obtained levator veli palatini muscle fragments (3-5 mm3), during surgical repair of cleft palate in 5 unrelated patients. Mesenchymal stromal cells were isolated from the muscle using a pre-plating technique and other standard practices. The multipotent nature of the isolated stromal cells was demonstrated via flow cytometry analysis and by induction along osteogenic, adipogenic, and chondrogenic differentiation pathways. To demonstrate the osteogenic potential of these cells in vivo, they were used to reconstruct a critical-sized full-thickness calvarial defect model in immunocompetent rats. RESULTS: Flow cytometry analysis showed that the isolated stromal cells were positive for mesenchymal stem cell antigens (CD29, CD44, CD73, CD90, and CD105) and negative for hematopoietic (CD34 and CD45) or endothelial cell markers (CD31). The cells successfully underwent osteogenic, chondrogenic, and adipogenic cell differentiation under appropriate cell culture conditions. Calvarial defects treated with CellCeram™ scaffolds seeded with the isolated levator veli palatini muscle cells showed greater bone healing compared to defects treated with acellular scaffolds. CONCLUSION: Cells derived from levator veli palatini muscle have phenotypic characteristics similar to other mesenchymal stromal cells, both in vitro and in vivo. Our findings suggest that these cells may have clinical relevance in the surgical rehabilitation of patients with cleft palate and other craniofacial anomalies characterized by significant bone deficit.

Deciduous Dental Pulp Stem Cells for Maxillary Alveolar Reconstruction in Cleft Lip and Palate Patients.

BACKGROUND: To reduce morbidity to cleft patients, new approaches have been developed and here, we report for the first time the use of deciduous dental pulp stem cells (DDPSC) associated with a hydroxyapatite-collagen sponge (Bio-Oss Collagen® 250 mg, Geistlich) for closing alveolar defects during secondary dental eruption, further comparing these results to historical controls. METHODS: Six patients, aged 8 to 12, were selected. Autologous DDPSC were isolated from each patient, then associated with the biomaterial and this bone tissue engineered set was used to fill the alveolar defect. Computed tomography was performed to assess both preoperative and 6- and 12-month postoperative outcomes. Overall morbidity was recorded. Historical controls consisted of sixteen patients previously selected and randomly assigned to group one (rhBMP-2) or group two (iliac crest bone graft). RESULTS: DDPSC could be isolated and characterized as mesenchymal stem cells. Progressive alveolar bone union has occurred in all patients. Similarly to group two 75.4%, SD ± 4.0, p > 0.999, but statistically different from group one (59.6%, SD ± 9.9, p > 0.999, but statistically different from group one (59.6%, SD ± 9.9. CONCLUSION: For this selected group of patients, DDPSC therapy resulted in satisfactory bone healing with excellent feasibility and safety, which adds significantly to the prospect of stem cell use in clinical settings. Clinical Question/Level of Evidence. Therapeutic, II. This trial is registered with https://clinicaltrials.gov/ct2/show/NCT01932164?term=NCT01932164&rank=1.

Facial and Nasolabial Aesthetics of Complete UCLP Submitted to 2-Stage Palate Repair With Vomer Flap.

OBJECTIVE: To evaluate the aesthetics of nasolabial appearance and facial profile of children with unilateral cleft lip and palate (UCLP) submitted to 2-stage palate repair with vomerine flap. DESIGN: Retrospective. SETTING: Single center. PATIENTS: Forty patients with UCLP, mean age of 7.81 years of both sexes, rehabilitated at a single center by 1 plastic surgeon. INTERVENTIONS: Lip and anterior palate repair with nasal alar repositioning was performed at 3 to 6 months of age by Millard technique and vomer flap, respectively. Posterior palate was repaired at 18 months by Von Langenbeck technique. MAIN OUTCOME MEASURE(S): Four cropped digital facial photographs of each patient were evaluated by 3 orthodontists to score the nasolabial aesthetics and profile. Frequencies of each score as well means and medians were calculated. Kappa test was used for evaluating inter- and intrarater reproducibility. RESULTS: The nasal form and deviation was scored as good/very good in 70%, fair in 22.5%, and poor in 7.5% of the sample. The nasal-subnasal aesthetic was considered good/very good in 55%, fair in 30%, and poor in 15% of the sample. The lip vermilion border and the white part of surgical scar aesthetics were good/very good in 77.5% and 80%, fair in 17.5% for both categories, and poor in 5% and 2.5% of the cases, respectively. In all, 67.5% showed convex facial profile, 20% was straight, and 12.5% was concave profile. CONCLUSIONS: Two-stage palatoplasty presented an adequate aesthetical results for the majority of patients with UCLP in the mixed dentition.

Ortho-surgical management of a Conradi-Hünermann syndrome patient: rare case report.

The Conradi-Hünermann Disease is a rare syndrome, which affects the cranial development and the anatomy of dental occlusion. After interdisciplinary treatment completion, the patient reached satisfactory facial anatomy, as well as regular occlusal relationship, attested 2 years of accompaniment.

Programa bolsa família: a condicionante saúde realmente existe? / Family grant program: does the health conditionality really exist?

Historicamente, o Sistema de Proteção Social do Brasil se caracteriza por apresentar uma estrutura dual de seguridade social: aos grupos mais vulneráveis socialmente e não inseridos no mercado de trabalho, destina-se a assistência social, enquanto os trabalhadores inseridos no mercado formal de trabalho vinculam-se à previdência social. As camadas pobres da sociedade brasileira, marcadas pela quase ausência de pressão social e sem posição sócio-ocupacional definida, em alguns momentos históricos, foram beneficiadas, e seu atendimento sempre foi justificado como um ato humanitário ou uma moeda política(1).Nesse aspecto, destaca-se o Programa Bolsa Família (PBF), como um programa de combate à pobreza, criado através de Medida Provisória n.o 132/2003, transformado em Lei n.o 10.836/2004 e regulamentado por Decreto n.o 5.209/2004. Foi iniciado em outubro de 2003 e constituído através da unificação de quatro programas de transferência de renda: Bolsa Escola, Auxílio-Gás, Bolsa Alimentação e Cartão Alimentação(2).A gestão do Programa Bolsa Família é descentralizada e compartilhada entre União, estados, Distrito Federal e municípios. Os entes federados trabalham em conjunto para aperfeiçoar, ampliar e fiscalizar a execução. O programa é destinado a famílias em situações de extrema pobreza e pobreza(3).Desde 2004, o PBF encontra-se vinculado ao Ministério do Desenvolvimento Social e Combate à Fome (MDS), mais especificamente à Secretaria Nacional de Renda de Cidadania (Senarc). A inserção das famílias no programa é feita mediante inscrição no Cadastro Único (CadÚnico), de gestão municipal, do qual são selecionadas, de acordo com os critérios do governo federal para o recebimento do benefício(4).Uma das questões mais polêmicas sobre os programas de combate à pobreza é o alcance de sua efetividade. Em pesquisa realizada em 2006(1), em João Pessoa-PB, junto a vinte mães beneficiárias do PBF, os dados evidenciaram que 65% das mães consideram o benefício um favor do Estado. Os autores também apontaram que a assistência social no Brasil ainda é vista como caridade, implicando em direitos sociais minimizados e insuficientes, não garantindo o seu caráter de universalidade, e que o Bolsa Família se afasta cada vez mais de um princípio universal e da garantia de uma renda mínima sem mecanismos seletivos e burocráticos de acessibilidade.As condicionalidades do Programa Bolsa Família são responsabilidades relacionadas ao cumprimento de ações nas áreas de saúde, educação e assistência social para melhorar as condições de desenvolvimento familiar, principalmente das crianças e adolescentes. Entretanto, essas condicionalidades assumidas pela família e pelo poder público são: na área da educação, matrícula e frequência de 85% da carga horária escolar mensal para crianças de 6 a 15 anos, e matrícula e freqüência escolar de 75% para adolescentes de 16 a 17 anos; na área da saúde, calendário de vacinação de menores de sete anos, aferição de peso e estatura, serem examinados conforme o Ministério da Saúde (MS) e acompanhamento de gestantes e nutrizes; na assistência social, fortalecimento do Programa de Erradicação do Trabalho Infantil para crianças e adolescentes de até 15 anos.Bolsa Família representa um avanço no campo social, mas se limita quando não atinge sua universalidade nem consegue chegar a todos os que precisam de proteção social(1). Limita-se, também, quando suas condicionalidades determinam que crianças e adolescentes tenham quefrequentar escolas públicas, mas não garantem qualidade de ensino; ou quando exigem acompanhamento nas unidades de saúde, mas os profissionais não estão ?preparados? para essa função. Superar a pobreza significa ir além dos aspectos burocráticos e seletivos para verdadeiramente atingir a todos, incondicionalmente.Quando nos referimos aos profissionais de saúde ?não preparados? para a função, queremos, na verdade, salientar o que ocorre na prática. Percebe-se, no monitoramento das condicionalidades do PBF na área da saúde, que ambos os sexos não são beneficiados da mesma forma, valendo apenas o acompanhamento do crescimento, desenvolvimento e calendário de vacinação de crianças menores de sete anos e acompanhamento de gestantes e nutrizes, apontando uma lacuna para as crianças acima de 7 anos e, principalmente, para adolescentes do gênero masculino.Apesar de, muito antes do PBF, o MS instituir o Programa Saúde do Adolescente (PROSAD), este nunca foi implantado como deveria. Vale ressaltar que, na Política Nacional de Atenção Integral à Saúde de Adolescentes e Jovens (PNAISAJ), a adolescência e a juventude abrangem a faixa etária de 10 a 24 anos e, na Política Nacional de Atenção Integral à Saúde do Homem (PNAISH), o foco de atenção aponta para o grupo de homens na faixa etária de 25 a 59 anos(5,6). O recorte etário realizado pelas Ciências Biológicas, Ciências Políticas, Ciências Jurídicas e Políticas Sociais ignora as características desse segmento populacional nas orientações de práticas sociais, na elaboração de políticas de desenvolvimento coletivo, na investigação epidemiológica e no conhecimento de certas especialidades. Há uma parcela significativa da população adolescente brasileira ? em torno de 30% a 33% da população total ao longo da primeira década do século XXI, segundo fontes do Instituto Brasileiro de Geografia e Estatística (IBGE) ? que é negligenciada pela sociedade no que diz respeito à saúde e participação social(5).Na definição das linhas de ação para o atendimento da criança e do adolescente, o Estatuto da Criança e do Adolescente (ECA) destaca as políticas e programas de assistência social, determinando o fortalecimento e a ampliação de benefícios assistenciais e políticas compensatórias como estratégia para redução dos riscos e agravos de saúde dos jovens. Esses são os novos marcos ético-legais que devem nortear as políticas nacionais de atenção à saúde dos jovens no Sistema Único de Saúde(7).Diante desse contexto, pergunta-se: os beneficiários do Programa Bolsa Família têm conhecimento sobre a condicionante saúde? A saúde pública tem conhecimentosobre a importância dessa condicionante para a nossa população jovem? Acreditamos que a condicionante saúde existe, mas, infelizmente, muito aquém do que realmente a nossa população merece e necessita.

Historically, the social protection system in Brazil has been characterized by presenting a dual structure of social security: to the most socially vulnerable groups, which are not included in the labour market, is addressed the social assistance, while the workers inserted into the formal labour market are bound to the social security. The poor strata of Brazilian society, marked by nearly complete absence of social pressure and no defined socio-occupational position, have gained benefits in certain historical moments, and providing to them has always been justified as a humanitarian act or a political currency(1).In this regard, the Family Grant Program (FGP) stands out as a program to fight poverty, created by Provisional Measure no. 132/2003, converted into Law no. 10,836/2004 and regulated by Decree no. 5,209/2004. It was started in October2003 and constituted by unifying four income transfer programs: School Grant, Gas Assistance, Food Grant and Food Card(2).The management of the Family Grant Program is decentralized and shared among the Union, states, Federal District, and municipalities. The federal entitieswork together to enhance, expand and supervise the implementation. The program is aimed at families in situations of extreme poverty and poverty(3).Since 2004, the FGP has been under the Ministry of Social Development and Fight Against Hunger (Ministério de Desenvolvimento Social e Combate à Fome - MDS), more particularly to the National Secretariat of Citizenship Income (Secretaria Nacional de Renda de Cidadania - Senarc). The inclusion of familiesin the program is made upon registration in the city-managed Single Registry (CadÚnico), from which they are selected according to the federal governmentcriteria for receiving the benefit(4).One of the most controversial issues regarding the anti-poverty programs is the extent of their effectiveness. In a survey conducted in 2006(1), in João Pessoa,PB, along with twenty FGP beneficiary mothers, data showed that 65% of mothers consider the benefit a state benevolence. The authors also pointed out that social assistance in Brazil is still seen as charity, resulting in minimized and insufficient social rights, not ensuring its universality character, and that the Family Grant Program moves more and more away from a universal principle and from the guarantee of minimum income without selective and bureaucratic mechanisms of accessibility.The Family Grant Program conditionalities are responsibilities related to the accomplishment of actions in health, education and social assistance areas to improve the family development situation, particularly children and adolescents?.Such conditionalities, which are assumed by the family and the government are: in education area, enrollment and 85% school hours monthly attendance for children aged 6-15 years, enrollment and 75% school attendance for adolescents aged 16 to 17 years; in health area, vaccination schedule for children under seven years of age, weight and height measurement, being examined following the Ministry of Health (MoH) criteria, and monitoring of pregnant women and nursing mothers; in social assistance, strengthening of the Child Labour Eradication Program for children and adolescents up to 15 years of age.The Family Grant is an improvement in the social , but it is limited when it does not achieve its universality nor manages to reach all those in need of social protection(1). It is also limited when its conditionalities determine that children and adolescents must attend public schools but do not guarantee quality education; or when they demand monitoring in health facilities, though professionals are not ?prepared? for this function. Overcoming poverty meansgoing beyond bureaucratic and selective aspects to reach everyone, genuinely and unconditionally.When referring to health professionals being ?not prepared? for the function, we actually want to point out what happens in practice. In the monitoring of FGPconditionalities in health area, it can be seen that both sexes do not benefit in the same way, only being valid the growth, development, and vaccination schedule monitoring for children under seven years, along with the monitoring of pregnant women and nursing mothers, thus pointing a gap for children over 7 years, and especially for male adolescents.Despite the establishment of the Adolescent Health Program (PROSAD - Programa de Saúde do Adolescente) by the Ministry of Health long before the FGP, this was never implemented as recommended. It is noteworthy that, in the National Comprehensive Healthcare for Adolescents and Youth Policy (PNAISAJ - Política Nacional de Atenção Integral à Saúde de Adolescentes e Jovens), adolescence and youth cover the age range from 10 to 24 years and, in the National Policy for Comprehensive Attention to Men?s Health (PNAISH - Política Nacional de Atenção Integral à Saúde do Homem), the focus of attention points to the group of men aged 25 to 59 years(5,6).The age cut performed by Biological Sciences, Political Sciences, Law Sciences, and Social Policies ignores the characteristics of this population segment in thesocial practices guidelines, in public policy development, in epidemiological research, and in the knowledge of certain specialties. There is a significant portion of the Brazilian adolescent population - around 30% to 33% of the totalpopulation during the first decade of this century, according to the Brazilian Institute of Geography and Statistics (IBGE - Instituto Brasileiro de Geografia e Estatística) sources - which is neglected by society in terms of health and social participation(5).In defining the lines of action for child and adolescents care, the Statute of Children and Adolescents (ECA - Estatuto da Criança e do Adolescente) highlights the social assistance programs and policies, determining the strengthening and expansion of welfare benefits and compensatory policies as a strategy for the reduction of risks and health disorders among youth. These are the new ethical and legal landmarks that should guide the national policies for healthcare to young people in the Unified Health System(7).Within this context, it is asked: do the beneficiaries of the Family Grant Program have knowledge about the health conditionality? Is public health aware of the importance of this conditional for our young population? We believe that the health conditionality exists, although, unfortunately, far beneath what our population really deserves and needs.

Autopercepção dos pacientes fibromiálgicos sobre o tratamento fisioterápico / Self-perception of patients with fibromyalgia on the physiotherapy treatment / Autopercepción de los pacientes con fibromialgia sobre El tratamiento fisioterápico

Compreender a autopercepção do paciente com fibromialgia em relação à suapatologia e à fisioterapia e mostrá-la como um instrumento de aperfeiçoamento na prática dos profissionais de saúde Métodos: Pesquisa com abordagem qualitativa, com características descritivas e exploratórias, realizada em um centro de tratamento fisioterápico do município de Fortaleza-Ceará, em 2013. Fizeram parte do estudo 10 pessoas com diagnóstico clínico de fibromialgia em tratamento fisioterapêutico. Os dados foram coletados através de entrevista semiestruturada e analisados à luz da análise de conteúdo. Pôde-se agrupar o texto com os seguintes temas: Relação entre dor e cansaço; A fibromialgia resumida como uma dor, pessoal, física e mental; Fisioterapia, a oficina funcional do corpo; A perspectiva do sadio e a incerteza; e O fisioterapeuta humanizado. Resultados: A dor foi relatada como o maior fator incapacitante e por isso se dizem cansados e estressados. Compreendem a importânciada Fisioterapia no seu processo de adaptação de limites físicos e na convivência com a dor, e conhecem o fisioterapeuta como um profissional humanizado. Conclusão: Os relatos mostram que os pacientes, em atendimento fisioterapêutico, têm a percepção de sua condição como enfermo, sabendo da importância da fisioterapia na sua condição funcional. As falas dão um feedback, ao profissional, que identifica os objetivos e os fatores que interferem no tratamento, podendo sugerir também a necessidade de intervenções de outras especialidades...

To understand the self-perception of the patient with fibromyalgia regarding the pathology and physiotherapy and show it as an instrument for improving the practice of health professionals. Methods: A qualitative, exploratory and descriptive research conducted at a physiotherapy center in the municipality of Fortaleza, Ceará, in 2013. The study comprised 10 people with a clinical diagnosis of fibromyalgia undergoing physiotherapy treatment. Data were collected through semi-structured interview and underwent content analysis. The text could be grouped into the following themes: Relationship between pain and fatigue; Fibromyalgia defined as a personal, physical and mental pain; Physiotherapy, the functional workshop of the body; The idea of being healthy and uncertainty; and the humanized physiotherapist. Results: Pain was reported as the most disabling factor and, because of that, they feel tired and stressed. They understand the importance of physiotherapy in the process of adaptation to physical limits and coping with pain, and recognize the physiotherapist as a humanized professional. Conclusion: The reports show that patients undergoing physiotherapy recognize they are sick and know the importance of physiotherapy for their functional condition. The speeches give a feedback to the professional who identifies the objectives and factors that interfere with treatment, and may also suggest the need for interventions by other professionals...

Objetivo: Comprender la autopercepción del paciente com fibromialgia respecto su patología y la fisioterapia y presentarla como instrumento de perfeccionamiento en la práctica de los profesionales de la salud. Métodos: Investigación de abordaje cualitativo con características descriptivas y exploratórias realizada en un centro de tratamiento fisioterápico del município de Fortaleza-Ceará, en 2013. Participaron del estudio 10 personas con diagnóstico clínico de fibromialgia y en tratamiento de fisioterapia. Los datos fueron recogidos a través de entrevista semi-estructurada y analizados a la luz del análisis de contenido. Se agrupo el texto en los siguientes temas: Relación de dolor y cansancio; La fibromialgia resumida como un dolor personal, físico y mental; Fisioterapia, el taller funcional del cuerpo; La perspectiva del sano y la incertidumbre; y El fisioterapeuta humanizado. Resultados: El dolor fue relatado como el mayor factor incapacitante y por ello se dicen cansados y estresados. Los pacientes comprenden la importancia de la Fisioterapia em su proceso de adaptación de límites físicos y vivencia con el dolor y reconocen el fisioterapeuta como un profesional humanizado. Conclusión: Los relatos muestran que los pacientes asistidos por la fisioterapia tienen la percepción de su condición de enfermo consciente de la importancia de la Fisioterapia en su condición funcional. Las hablas ofrecen un feedback al profesional que identifica los objetivos y los factores que interfieren en el tratamiento lo que también sugiere la necesidad de intervenciones de otras especialidades...

Versatility of the buccinator myomucosal flap in atypical palate reconstructions.

Initially described for the treatment of cleft palate, the anatomical bases of the buccinator myomucosal flap were described by Bozola et al. (1989). A meticulous search found several reports of its use for the correction of post-palatoplasty oronasal fistulas, with only a few reports of its use for other palate-related pathologies. A retrospective analysis was undertaken of patients treated by the Plastic Surgery Units at the Rio de Janeiro Federal University Hospital (HU-UFRJ) and the São Paulo University Hospital (HC-USP), suffering from palatal lesions not associated with a cleft palate and treated through the use of buccinator myomucosal flaps. The average age was 47 years, with 70% of the patients being male. Assorted aetiologies were noted for palatal defects. When there was significant damage to the soft palate, a superior base pharyngeal flap was used. Of this total, in 71% of the cases only the buccinator myomucosal flap was used. In all cases, the flaps were unilateral, adequately covering the defects in question. The buccinator myomucosal flap is a good option for reconstructing medium to large palate defects, as it is a flap with good vascularization and dimension, in addition to an ample arc of rotation, with primary closure of the donor site, without adding significant morbidity.

Abordagem clínica de enfermagem na prevenção do pé diabético / Nursing clinical approach in the prevention of diabetic foot / Abordaje clínico de enfermería en la prevención del pie diabético

Identificar as condutas utilizadas durante a consulta de enfermagem à pessoa comdiabetes mellitus, na prevenção do pé diabético. Métodos: Estudo descritivo, observacional e quantitativo, realizado em uma instituição de atendimento secundário em diabetes e hipertensão do estado do Ceará entre agosto e setembro de 2011. Os dados foram coletados por ocasião da consulta de enfermagem, através de um formulário, sendo organizados em quadros com análise descritiva. Resultados: A abordagem clínica do pé diabético é realizada com pouca ênfase, excluindo-se perguntas relevantes sobre os hábitos do paciente, tais como: andar descalço, corte das unhas, cuidados com os calos e hidratação dos pés. Além disso, são negligenciadas orientações, como a informação sobre o melhor horário de comprar o sapato, o tipo de meia a ser usado e não poder andar descalço. Conclusão: Constatou-se que a conduta utilizada nas consultas realizadas pelas enfermeiras da presente pesquisa não foi a ideal, pois a anamnese e o exame físico dos pés ocorreram de modo incompleto, deixando de cumprir etapas importantes na prevenção ao desenvolvimento do pé diabético ou das potenciais complicações a ele associadas...

To identify the procedures adopted during nursing consultation to the person with diabetes mellitus, in the prevention of diabetic foot. Methods: Descriptive, observational and quantitative study, carried out in an institution of secondary care on diabetes and hypertension of the Ceará State, between August and September 2011. Data was collected through a form during the nursing consultation, being organized in pictures with descriptive analysis. Results: The clinical management of diabetic foot is performed by nurses with little emphasis, omitting relevant questions about the patient?s habits, such as walking barefoot, nails cutting, attention to calluses and feet moisturizing. Furthermore, some guidance is neglected, as to inform about the best time to buy the shoe, type of socks to be used and the fact they cannot walk barefoot. Conclusion: The procedures adopted during consultation by the nurses in this study were not the ideal ones, as the anamnesis and clinical examination of feet occurred incompletely, missing important steps for the prevention of diabetic foot or the potential complications associated to it...

Identificar las conductas utilizadas durante la consulta de enfermería a la persona con diabetes mellitus en la prevención del pie diabético. Métodos: Estudio descriptivo, observacional y cuantitativo realizado en una institución de atención secundaria en diabetes y hipertensión del estado de Ceará entre agosto y septiembre de 2011. Los datos fueron recogidos por ocasión de la consulta de enfermería a través de un formulario y organizados en cuadros con análisis descriptivo. Resultados: El abordaje clínico del pie diabético ES realizado con poca énfasis excluyéndose preguntas relevantes sobre los hábitos del paciente tales como andar descalzo, corte de las uñas, cuidados con los callos y hidratación de lospies. Además, orientaciones como la información sobre el mejor horario para la compra del zapato, el tipo de calcetín a ser usado y el hecho de no poder andar descalzo son negligenciadas. Conclusión: Se constató que la conducta utilizada en las consultas realizadas por las enfermeras de la presente investigación no fue la ideal pues el anamnesis y el examen físico de los pies ocurrieron de modo incompleto, sin cumplir etapas importantes em la prevención al desarrollo del pie diabético o de las potenciales complicaciones a él asociadas...

Comparative study and histomorphometric analysis of bone allografts lyophilized and sterilized by autoclaving, gamma irradiation and ethylene oxide in rats.

PURPOSE: To compare three sterilization methods (autoclave, gamma irradiation and ethylene oxide) over non demineralized lyophilized bone allografts. METHODS: Bone allografts were implanted on paravertebral muscles of 21 rats. After 30 days animals were sacrificed and grafts underwent comparative analysis regarding histomorphometric and macroscopic parameters. RESULTS: Allografts that underwent the three sterilization methods presents similar weight gain, cortical thickness similar to control group, and less fibrosis than the control group. Grafts that underwent sterilization in autoclave presented less presence of multinucleated giant cells, although not statistically significant. There was also no statistically significant difference regarding mineralization on the three groups. CONCLUSION: The three sterilization methods cause similar effects on bone allografts regarding macroscopic and histomorphometric parameters.

Comparative study and histomorphometric analysis of bone allografts lyophilized and sterilized by autoclaving, gamma irradiation and ethylene oxide in rats

PURPOSE: To compare three sterilization methods (autoclave, gamma irradiation and ethylene oxide) over non demineralized lyophilized bone allografts. METHODS: Bone allografts were implanted on paravertebral muscles of 21 rats. After 30 days animals were sacrificed and grafts underwent comparative analysis regarding histomorphometric and macroscopic parameters. RESULTS: Allografts that underwent the three sterilization methods presents similar weight gain, cortical thickness similar to control group, and less fibrosis than the control group. Grafts that underwent sterilization in autoclave presented less presence of multinucleated giant cells, although not statistically significant. There was also no statistically significant difference regarding mineralization on the three groups. CONCLUSION: The three sterilization methods cause similar effects on bone allografts regarding macroscopic and histomorphometric parameters.

Human bone morphogenetic protein-2 use for maxillary reconstruction in cleft lip and palate patients.

BACKGROUND: The conventional methods of maxillary alveolar reconstruction in patient with cleft are the periosteoplasty and autologous bone grafting. As an important alternative of bone substitution, there is the recombinant human bone morphogenetic protein-2 (rhBMP-2). This study compares the rhBMP-2 with periosteoplasty and autologous bone grafting. METHODS: Patients with cleft and alveolar defect were divided into 3 groups of 6 patients who underwent to autologous iliac crest bone grafting, resorbable collagen sponge with rhBMP2, and periosteoplasty, respectively. The analysis was performed through computed tomographic scan preoperatively and at months 3, 6, and 12 postoperatively. The variables analyzed were the alveolar defect volume, formed bone volume, bone formation rate, maxillary height repair rate, and the formed bone density mean. RESULTS: The formed bone volume was similar comparing the bone graft and BMP groups at 1-year postoperative analysis (P = 0.58). Both of them had the formed bone volume significantly larger than the periosteoplasty group at 3 and 6 months postoperatively. In this last group, the 1-year follow-up was canceled because the bone formation was insufficient. The bone formation rate, the maxillary height repair rate, and the mean of density of the formed bone were similar in the bone graft and BMP groups at 1-year follow-up with P values of 0.93, 0.90, and 0.81, respectively. CONCLUSIONS: The amount of formed bone in the periosteoplasty group was insufficient. There was no difference among the bone graft and rhBMP-2 therapy considering the parameters analyzed.

Evaluation of primary cleft nose repair: severity of the cleft versus final position of the nose.

BACKGROUND: Since 1957, when the concept of rotation-advancement repair was introduced by Millard, this technique has become the procedure of choice for unilateral cleft lip worldwide. More recently, modifications described by Noordhoof, Mohler, Skoog, and McComb started being jointly performed so that better results could be obtained. In this study, the nasal position was evaluated and related to the size of the cleft. The primary unilateral cleft lip repair was performed through a modified technique. METHODS: Forty-five patients with unilateral cleft lip underwent primary surgical repair through this technique. To analyze aesthetic results, a severity classification of deformities and a scoring system for evaluation of the results were established based on nasal alar lateralization, dome position, alignment of bone segments, and deviation of the columella. RESULTS: By means of the established system, 26.6% of mild forms, 13.4% of moderate forms, and 60% of severe forms were observed. Among aesthetic results, 17.8% were found to be good, and 82.2% were considered excellent. Among aspects considered negative, late deformity of the lower lateral cartilage prevailed. CONCLUSIONS: Through the presented evaluation, the authors observed that there was no relation between severity of the cleft and final position of the nose. Among the 27 patients considered to have had severe forms of cleft deformity, 22 were classified as excellent results (81.5%). To obtain better results along time, technical refinements and the critical analysis of results must be performed on a routinely basis.

Modificação na rinoqueiloplastia primária do paciente com fissura labial unilateral / Primary rhinocheiloplasty modification for unilateral cleft lip patients

Introdução: Desde 1957, quando Millard introduziu o conceito de reparo tipo avanço e rotação, este se tornou o procedimento de escolha para o reparo da fissura labial unilateral em todo o mundo. Mais recentemente, modificações descritas por Noordhoof, Mohler, Skoog e McComb passaram a ser realizadas em associação para que melhores resultados pudessem ser obtidos. Neste trabalho, os resultados estéticos e o padrão de crescimento ósseo facial do reparo primário da fissura labial unilateral através de técnica modificada são sistematicamente apresentados. Método: Quarenta e cinco pacientes portadores de fissura labial unilateral foram submetidos ao reparo cirúrgico primário por meio da técnica proposta. Para a análise dos resultados, foi estabelecido um sistema de pontuação dos resultados estéticos e a avaliação do padrão de crescimento ósseo facial foi realizada com emprego do índicede Atack. Resultados: Verificamos que 17,8% dos pacientes apresentaram bons resultados estéticos e 82,2%, resultados considerados excelentes. Entre os aspectos considerados negativos, houve predomínio da deformidade tardia da cartilagem lateral inferior (37,8%). Quanto ao índice de Atack, 83,4% dos pacientes apresentaram índice 1 e 16,6% índice 2 de Atack. Conclusões: Por meio da abordagem para rinoqueiloplastia primária apresentada, independentemente do tipo de fenda, é possível a obtenção de bons resultados estéticos e funcionais. Para que melhores resultados possam ser obtidos ao longo do tempo, refinamentos técnicos e a análise criteriosa dos resultados devem ser rotineiramente buscados.

Introduction: Since 1957, when Millard introduced the concept of rotation-advancement repair, this technique has become the procedure of choice for unilateral cleft lip worldwide. More recently, modifications described by Noordhoof, Mohler, Skoog, and McComb started being jointly performed so that better results could be obtained. In this study, the aesthetic results and the facial growth pattern after primary unilateral cleft lip repair through a modified technique are presented. Methods: Forty-five patients with unilateral cleft lip underwent primary surgical repair through this technique. For results analysis, a scoring system for aesthetic results was established and to evaluate the facial bone growth pattern the Atack’ Index was used. Results: By means of the established technique, 17.8% presented good aesthetic results and 82.2% were considered excellent results. Among aspects considered negative, late deformity of the lower lateral cartilage prevailed (37.8%). We observed that 83.4% had Atack’ Index 1 and 16.6% had Atack’ Index 2. Conclusions: Through the presented primary rhinocheiloplasty approach, regardless of cleft type, it is possible to obtain good aesthetic and functional results. In order to obtain better results along time, technical refinements and the criterial analysis of results must be performed on a routinely basis.

Evaluation of maxillary alveolar reconstruction using a resorbable collagen sponge with recombinant human bone morphogenetic protein-2 in cleft lip and palate patients.

INTRODUCTION: A resorbable collagen matrix with recombinant human bone morphogenetic protein (rhBMP-2) was compared with traditional iliac crest bone graft for the closure of alveolar defects during secondary dental eruption. METHODS: Sixteen patients with unilateral cleft lip and palate, aged 8 to 12 years, were selected and randomly assigned to group 1 (rhBMP-2) or group 2 (iliac crest bone graft). Computed tomography was performed to assess both groups preoperatively and at months 6 and 12 postoperatively. Bone height and defect volume were calculated through Osirix Dicom Viewer (Pixmeo, Apple Inc.). Overall morbidity was recorded. RESULTS: Preoperative and follow-up examinations revealed progressive alveolar bone union in all patients. For group 1, final completion of the defect with a 65.0% mean bone height was detected 12 months postoperatively. For group 2, final completion of the defect with an 83.8% mean bone height was detected 6 months postoperatively. Dental eruption routinely occurred in both groups. Clinical complications included significant swelling in three group 1 patients (37.5%) and significant donor-site pain in seven group 2 patients (87.5%). CONCLUSIONS: For this select group of patients with immature skeleton, rhBMP-2 therapy resulted in satisfactory bone healing and reduced morbidity compared with traditional iliac crest bone grafting.

Fissuras labiopalatinas: protocolo de atendimento multidisciplinar e seguimento longitudinal em 91 pacientes consecutivos / Cleft lip and palate: protocol of multidisciplinary team treatment and longitudinal

Introdução: A fissura labiopalatina é a malformação congênita mais frequente da face. É imperativaa necessidade dos pacientes fissurados serem avaliados e acompanhados em centrosde referência por equipe multidisciplinar. Atualmente, não há consenso na literatura quanto aomelhor protocolo de tratamento a ser seguido, estudos comparativos entre a escolha do tipode técnica, momento ideal para as intervenções cirúrgicas e para o apoio multidisciplinar sãoamplamente realizados. Objetivo: Este estudo tem por objetivo apresentar o protocolo utilizadopor centro de referência multidisciplinar nacional, demonstrando sua experiência anual.Método: Estudo prospectivo, no qual 91 pacientes portadores de fissura labiopalatina foramoperados no período de 12 meses, submetidos a tratamento mediante protocolo pré-determinadoe analisados de acordo com a localização da deformidade, características morfológicase tipo de procedimento realizado. Resultados: Oito categorias cirúrgicas foram relatadas;palatoplastia (41,58%) foi a mais realizada, seguida por queiloplastia (unilateral e bilateral),sendo 90% primária. A técnica descrita por Von Langenbeck associada a veloplastia intravelarestendida foi realizada em 97,5% dos casos. Todos os casos de queiloplastia unilateral foramsubmetidos a uma variante da técnica de Millard 2. Realizou-se enxerto ósseo alveolar secundárioem 70% dos casos. Faringoplastia foi realizada em dois pacientes e em 15 casos foramnecessários procedimentos de revisão de lábio e nariz. Conclusão: Análises periódicas dosdados obtidos devem ser realizadas, com objetivo de obter em longo prazo consensos quantoao melhor planejamento terapêutico do paciente portador de fissura labiopalatina.

Introduction: The cleft lip and palate is the most frequent congenital malformation of theface. It’s imperative that cleft lip and palate patients be evaluated and seen in centers ofreference by multidisciplinary teams. At present, there’s no consensus in the literature asto the best treatment protocol to be followed, although comparative studies on the choicesof technique types, the ideal moment for the surgical interventions and the multidisciplinarysupport are broadly carried out. Objectives: Present the protocol utilized by nationalmultidisciplinary reference center, showing its annual experience. Methods: Prospectivestudy, 91 patients with cleft lip and palate were operated in 12 months period, submittedto treatment following pre-determined protocol and analyzed according to location of thedeformity, morphologic characteristics and kind of procedure carried out. Results: Eightsurgical categories were related, palate repair (41.58%) was the most utilized one followedby lip repair (unilateral and bilateral), 90% of it primary. The technique described by VonLangenbeck associated to the extended intravelar veloplasty was carried out in 97.5% of thecases. The technique of unilateral cleft lip repair was variant of the Millard 2 procedure. In83.5% of the bilateral ones, the Spina technique was carried out and in the remainder, thevariant one of the Millard 2 technique was chosen. Secondary alveolar bone graft was performedin 70% of the cases. Conclusion: Periodic analyses of the data obtained must be done;to achieve, tire long term consensus as for the best therapeutic planning of these patients.

Fraturas de face: analise de 130 de casos / Facial fractures: analysis of 130 cases

A violencia dos grandes centros urbanos tem contribuido em muito para manter a elevada incidencia de fraturas de face. Sao casos que devem ser tratados adequadamente para evitar sequelas esteticas e funcionais e poder reintegrar os pacientes a sociedade. A partir de 1990, com a organizacao de equipe de Cirurgia Plastica no Pronto-Socorro do Hospital das Clinicas da Faculdade de Medicina de Sao Paulo, as fraturas de face vem sendo tratadas por elas. Em levantamento dos pacientes atendidos consecutivamente em 28 meses, analisamos os agentes etiologicos envolvidos e a frequencia dos diversos tipos de trauma. Em 130 casos analisados, o principal agente etiologico foi o acidente automobilistico (51 por cento) e a fratura mais encontrada foi a de mandibula (46 por cento). Uma correlacao entre o tipo trauma e o tipo de fratura foi realizada.

Classificaçäo das fissuras lábio-palatais: breve histórico, consideraçöes clínicas e sugestäo de modificaçäo / Classification of cleft lip and palate: brief review, clinical considerations and suggestion of modification

Após descrita a classificaçäo de Spina e cols. e exemplificada a apresentaçäo de casos clínicos, é apresentada uma proposta de modificaçäo, que consiste em acrescentar no grupo II (fissura transforame incisivo) a fissura mediana, tornando assim a presente classificaçäo mais completa, como esquematizado a seguir: Grupo II - fissura transforame incisivo: unilateral (lado esquerdo/lado direito); bilateral; mediana