Introduction: The Keratocystic Odontogenic Tumor (KCOT) is a benign odontogenic tumor with an infiltrative and potentially aggressive behavior with high recurrence rates. The KCOT occurs more often in men than women, with a frequency of 2:1, being more frequent in the mandible with a predilection for the body and branch. Treatment of KCOT remains controversial. Treatment usually includes enucleation, marsupialization, peripheral ostectomy, curettage associated with Carnoy solution and resection. objective: To report a case of a KCOT located in the mandible. Case report: male patient, 15 years, with a KCOT on the right side of the mandible treated by enucleation and peripheral ostectomy, with four years of preservation, with no signs of recurrence. Final Comments: The treatment by enucleation associated with peripheral ostectomy reduces the relapse rate, preserves anatomical structures and can avoid a second surgical procedure for reconstruction of bone defects generated in surgery en bloc resection.
Introduction: The odontogenic keratocyst tumor (OKT) derived from dental lamina rests with particularities and specific histological features, with high rates of relapse and aggressive clinical behavior. Presents certain predilection for males, affecting the mandible of 60% to 80% of cases may be related to impacted tooth 25 to 45% of cases. objective: To highlight the clinical, histopathological and imaging procedures of the OKT, as well as discuss the treatment of this injury. Case Report: To report a case of 10 years of age to look for the orthodontist to correct anterior open bite was observed in panoramic radiography radiolucent area in the region of the body of the mandible associated with pathological inclusion of the lower premolar. It was performed an incisional biopsy of the lesion and the histopathologic diagnosis was odontogenic keratocyst tumor. It was performed a CT scan to assess the extent of the injury and its relation to anatomic structures. How to conduct, we opted for the extraction of the deciduous molar and enucleation of the lesion, preserving the premolar included. The same goes on clinical and radiographic control 18 months, after removal of OKT obtaining the eruption of premolar that was involved in the injury. Final Comments: It is necessary to adopt protocols that include dental care knowledge of oral diagnosis, medical history and careful clinical evaluation without forgetting the need for histopathological confirmation.
Introduction: The tumor odontogenic keratocyst (toq) is a benign disorder, which is controversial in its diagnosis and treatment. It is characterized by a true neoplasms arising from remnants the dental lamina. It occurs predominantly in the angle mandible, which may or may not be related to a tooth and whose importance is due to its aggressive behavior and high recurrence rate. The causes of the high recurrence rates. The thin capsule and friable tissue may favor the toq retention of epithelial debris and, moreover, the presence of satellite cells in the lesion site is responsible for the increased proliferative capacity of clinical entity. objective: To present the peculiarities toq inherent in using a clinical case of toq in mandible. Case report: TOQ in the jaw in patient, 16 years old male presenting important lesion radiographically radiolucent related to the impacted tooth. Final comments: In consideration of the high rate of recurrence chosen treatment proved effective and was not any evidence of recurrence.
Introduction: The mandibular injuries account for about 20% to 50% of cases of facial fractures. Some consider the jaw the second most commonly fractured bone of the skull, and is the only mobile bone of the facial framework, which results in decreased stability compared to the trauma. When one takes into account the degree of airway obstruction in patients with facial fractures, the problem becomes much more serious since it is one of the most troubling complications of trauma. objective: the relevance of the topic is aimed to report a case of a patient victim of mandibular fracture associated with trauma to the trachea. Case report: Case report: Patient 24 years old patient with tracheal trauma concomitant mandibular fracture surgically treated in conjunction with the thoracic surgeon. After 5 months postoperatively, the patient is in good condition general, no complaints. Final comments: This form is observed that the key to proper treatment of tracheal trauma associated with facial fractures is the knowledge of the type of injury, and an accurate diagnosis multidisciplinary.
BACKGROUND: Prominent ear is the most common congenital defect of the ear, with an incidence of 5% in Caucasians. Surgical treatment should correct the auriculocephalic and conchoscaphal angles as well as protrusion of the lobe when present. This paper aims to report the experience of our service in the treatment of prominent ears with a combination of several available techniques. METHODS: Forty-seven patients operated with a combination of previously described techniques were evaluated, and cartilaginous incision, Mustarde sutures for antihelix definition, and concha-mastoid fixation were performed. Patients less than 15 years of age were operated under general and local anesthesia, while the remaining patients underwent only local anesthesia. All patients were reassessed on the first postoperative day. RESULTS: The postoperative results were considered satisfactory by both patients and surgical staff, with no stigma development in the operated ear. CONCLUSIONS: The best treatment of prominent ears is achieved by a combination of techniques. The approach used on the studied patients has produced natural-looking results with low complication rates, satisfying the surgical staff and, most importantly, the patients.
Background: Hyperhidrosis is characterized by excessive sweating of the forehead, hands, feet, and armpits, either alone or in combination. It affects about 1% of the population. This study aimed to observe the effects of botulinum toxin in patients with hyperhidrosis and demonstrates the application technique of botulinum toxin, the areas of incidence of the disease, and the duration of the results. Methods: A retrospective analysis of 39 patients with primary hyperhidrosis treated between July 2000 and July 2010 and followed up for 12 months was carried out. Of these patients, 36% were male and 64% were female. Patient ages ranged from 16 to 41 years. A total of 135 areas were treated. Treatment consisted of intradermal injections of botulinum toxin. The total dose applied ranged from 37.5 U to 150 U, with an average dose of 75 U for each treated area. Results: The therapeutic effect of botulinum toxin was observed from the third day after treatment, with a 50% reduction in symptoms within the first week of treatment and up to 94% reduction in the number of hyperhidrosis events after the second week. The reduction of symptoms lasted, on average, for 7 months. No cases of compensatory hyperhidrosis or mortality were observed. Conclusions: The treatment of primary hyperhidrosis with type A botulinum toxin, although temporary, is an effective, safe, and minimally invasive treatment option. It has a high degree of satisfaction and allows patients to return to their professional activities on the same day. Side effects and complications are temporary, infrequent, and regress without sequelae.
INTRODUÇÃO: As vantagens dos cianoacrilatos em síntese cutânea têm sido sobejamente demonstradas na literatura. Entretanto, esses produtos têm sido subutilizados no Brasil, em decorrência dos elevados custos do octilcianoacrilato. Ademais, a forma mais economicamente acessível, etilcianoacrilato, tem sido pouco estudada como adesivo cutâneo. O objetivo deste estudo foi avaliar a eficiência do etilcianoacrilato na síntese de excisões cutâneas. MÉTODO: Estudo retrospectivo realizado em pacientes portadores de lesões cutâneas superficiais submetidos a excisão elíptica e reparo por fechamento primário. As excisões foram fechadas por meio de suturas profundas relaxadoras e, na superfície da pele, foi utilizado etilcianoacrilato (grupo caso - GCa) ou sutura intradérmica (grupo gontrole - GCo). RESULTADOS: Foram encontrados 33 pacientes portadores de 43 lesões cutâneas (GCa = 20 excisões; GCo = 23 excisões). Cicatrizes inestéticas (GCa = 20%; GCo = 48%), irritação ocular (GCa = 15%; GCo = 0), deiscência (GCa = 5%; GCo = 0), infecção (GCa = 0; GCo = 4,3%) e dermatite de contato (GCa = 0; GCo = 4,3%) foram os problemas encontrados. Os resultados cosméticos foram considerados satisfatórios na maioria das excisões (GCa = 100%, GCO = 95,7%). CONCLUSÕES: O etilcianoacrilato foi adequadamente tolerado neste grupo de estudo, sem induzir necrose, reações alérgicas ou infecções, apresentando diversas vantagens de uso em relação à sutura, incluindo reduzido índice de complicações e grande satisfação dos pacientes.BACKGROUND: The advantages of cyanoacrylates in cutaneous wound closure have been widely demonstrated in the literature. However, these products have not been widely used in Brazil due to the high costs of octyl cyanoacrylates. Moreover, there have been only a few studies on the most affordable product, ethyl cyanoacrylate, as a cutaneous adhesive. The objective of this study was to evaluate the efficacy of ethyl cyanoacrylate in cutaneous excision repair. METHODS: A retrospective study conducted in patients with superficial skin lesions who underwent elliptical excision and repair by primary closure. The excisions were closed using deep relaxing sutures and either ethyl cyanoacrylate (case group; CaG) or intradermal suture (control group; CoG) on the skin surface. RESULTS: Thirty-three patients were identified with 43 cutaneous lesions (CaG, n = 20; CoG, n = 23). Unsightly scars (CaG = 20%; CoG = 48%), eye irritation (CaG = 15%; CoG = 0), dehiscence (CaG = 5%; CoG = 0), infection (CaG = 0; CoG = 4.3%), and contact dermatitis (CaG = 0; CoG = 4.3%) were the problems observed. The cosmetic results were satisfactory in almost all excisions (CaG = 100%; CoG = 95.7%). CONCLUSIONS: Ethyl cyanoacrylate was adequately tolerated in this study group, with no necrosis, allergic reactions, or infections. Ethyl cyanoacrylate presented several advantages over suture use, including low complication rates and high patient satisfaction.
Introducao: O tratamento das fraturas mandibulares passou por diversas mudancas, especialmente apos a introducao de tecnicas de fixacao interna rigida e o desenvolvimento de novos materiais. Atualmente, destaca-se a utilizacao de materiais absorviveis, os quais apresentam algumas vantagens sobre dispositivos metalicos, especialmente quando sao aplicados nas criancas. objetivo: Os autores realizam uma discussao a respeito das controversias envolvidas no tratamento das fraturas mandibulares em criancas, principalmente relacionada a fixacao das fraturas. Relato de Caso: Neste trabalho, sera apresentado um caso clinico de uma crianca de 5 anos de idade, com fratura de corpo mandibular tratada por meio de reducao cruenta e fixacao interna rigida com placas e parafusos de titânio. Comentarios Finais: Com o intento de nao causar interferencias no desenvolvimento dos germes dentarios, bem como do crescimento osseo mandibular, neste tratamento, indica-se um segundo ato cirurgico, para remocao do sistema de fixacao.
5 summaRy objectives: Analyse the expression of galectin-3 and distribution of matrix proteins, laminin, fibronectin and collagen IV, in 30 paraffinated samples of nasopharynx carcinoma (NFC); and correlate the to clinicopathological characteristics, as tumor aggressiveness and survival of individuals. study design: retrospective clinical study. methods: The analyses were performed by immunohistochemistry study the expression of the matrix protein and galectin-3 in 30 tissue samples of 26 patients diagnosed with nasopharyngeal carcinoma. Results: The analysis showed that the patients mean age was 48 years-old, with the age peak prevalence was from 60 to 69 years-old, with male predominance of 2:1. The undifferentiated non-keratinized squamous cell carcinoma was predominant in 23 samples (79%), differentiated non-keratinized squamous cell carcinoma was found in 4 samples (13.3%) and keratinized squamous cell carcinoma was found in 3 samples (10%). The laminin expression, which is normally restricted to the vessel walls and lamina propria, was increased in the neoplasic cell matrix in 23 samples (76.7%). Fibronectin was positive in 23 samples (43%). Galectin-3 was observed in 21 samples (70%). Seven cases showed positive correlation between all three proteins. Eleven cases presented positive correlation of laminin and galectin-3 immunoexpression. Conclusions: Fibronectin presence seems to reduce the chance of tumor recurrence and also, increase the survival rate, differently from laminin and galectin-3.
Introduction: Nasal fractures are common injuries, frequently considered to be minor. Nevertheless, they may cause significant damage, from both a functional and aesthetic perspective. Methods: Medical records of 144 patients admitted for nasal fracture treatment between February 2002 and October 2008 to the Plastic Surgery Area of the Unicamp Clinical Hospital were analyzed. Results: Patients were predominantly male (75.7%), with a male to female ratio of 3.1:1. The most number of cases was observed in 21 to 30 year olds, and the majority of fractures (31.8%) were caused by physical aggression. Closed reductions were performed on all patients under local and topical anesthesia after an average of 8 days. Among the studied patients, 31 experienced residual deformity. Conclusions: Patients typically affected by nasal fractures are young male adults. Closed reduction surgical treatment yields acceptable results, with correct injury evaluation and treatment timing.
INTRODUCAO: Queimaduras sao lesoes aos tecidos orgânicos causadas por agentes externos, com destruicao do revestimento epitelial. O objetivo deste estudo e divulgar o perfil epidemiologico das queimaduras do maior centro de queimados da America Latina, localizado no Hospital Joao XXIII, em Belo Horizonte, MG, Brazil. METODO: Foi criado um banco de dados com 687 pacientes internados no Hospital Joao XXIII, no periodo de fevereiro de 2009 a julho de 2010, incluindo identificacao dos pacientes, etiologia da queimadura, superficie e areas queimadas, intencionalidade, tempo de internacao e perfil dos obitos, entre outros dados. RESULTADOS: A maioria dos pacientes internados era do sexo masculino (62,5%), com media de idade de 29 anos, sendo 66% provenientes de Belo Horizonte e 34%, do interior ou de outros estados. O alcool foi o agente etiologico mais frequente (34,4%), o causador das queimaduras mais extensas (media de 28% de superficie corporal queimada) e o maior responsavel pelos obitos (52,7%). Quanto a intencionalidade, 79% foram queimaduras acidentais, seguidas pelas tentativas de autoexterminio (12%) e agressao (9%). A media do tempo de internacao foi de 23,5 dias, com taxa de mortalidade de 16,3%, que vem caindo progressivamente. Foram realizados 984 desbridamentos e 584 enxertias durante o periodo de acompanhamento. CONCLUSOES: Os dados obtidos sao similares aos disponiveis na literatura e evidenciam a importância da prevencao e da fiscalizacao na forma de comercializacao dos produtos inflamaveis para diminuir a morbidade e a mortalidade causadas pelas queimaduras, uma vez que a maioria e acidental e decorrente do alcool liquido.
INTRODUÇÃO: O adequado conhecimento da anatomia do ser humano é crucial para o desenvolvimento de uma técnica cirúrgica apurada. O treinamento com peças anatômicas no meio universitário, muitas vezes, é insuficiente para o aprendizado. Assim, o uso de cadáveres para o ensino de anatomia e habilidades cirúrgicas na graduação e pós-graduação tem sua importância reforçada. O objetivo deste estudo foi relatar a produtividade do Serviço de Cirurgia Plástica do Hospital Universitário Professor Edgard Santos (HUPES) da Universidade Federal da Bahia, no que se refere às atividades de dissecção de cadáveres realizadas de 2009 a 2011, bem como a importância dessa atividade no treinamento dos residentes do serviço. MÉTODO: Foi realizada análise observacional retrospectiva da produção do serviço em decorrência das atividades de treinamento em dissecção de cadáveres, no período de 2009 a 2011. RESULTADOS: Foram desenvolvidas atividades no âmbito de ensino, pesquisa e extensão por meio de convênio firmado entre o Serviço de Cirurgia Plástica do HUPES e o Instituto Médico Legal do Estado da Bahia. Entre as ações pedagógicas empreendidas, a atividade de dissecção proporcionou a criação de um material rico de ensino que inclui diversos retalhos importantes para a prática diária dos médicos residentes. Em relação à pesquisa, foram desenvolvidos diversos artigos científicos que geraram publicações e apresentações em eventos científicos. Essa atividade deu origem, ainda, a uma monografia de conclusão de residência e a uma tese de doutorado. Por meio do convênio firmado, foi realizado estágio extracurricular para os acadêmicos de medicina, membros da Liga Baiana de Cirurgia Plástica (LBCP), em que puderam desenvolver habilidades não praticadas na universidade. CONCLUSÕES: Pode-se concluir que o Serviço de Cirurgia Plástica do HUPES obteve ganhos consideráveis com o desenvolvimento das atividades de dissecção cadavérica. Isso demonstra que o serviço vem consolidando sua atuação nos três pilares da educação: ensino, pesquisa e extensão.BACKGROUND: Understanding human anatomy is crucial to the development of accurate surgical techniques. Training with anatomical specimens in the university environment is often insufficient for learning. Thus, the importance of using cadavers to teach anatomy and surgical skills in undergraduate and post-graduate courses is reinforced. This study aimed to report scientific outcomes related to cadaver dissection in the Plastic Surgery Service of Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia, from 2009 to 2011, and the importance of this activity for plastic surgery resident training. METHODS: We performed a retrospective observational analysis of scientific production resulting from training activities related to cadaver dissection for the period from 2009 to 2011. RESULTS: We developed activities related to education, research, and extension by means of an agreement signed between the HUPES and the Forensic Medicine Institute of the State of Bahia. Among the educational activities undertaken, dissection activities led to the creation of rich educational materials relevant to the daily practice of resident physicians. With regard to research, several papers have been written, resulting in publications and presentations at scientific meetings. Cadaver dissection also was the subject of a conclusion dissertation and a PhD thesis. Through the partnership, extracurricular training was conducted for medical students as well as members of the Plastic Surgery League of Bahia (LBCP), allowing them to develop skills that had previously not been practiced at the university. CONCLUSIONS: The Plastic Surgery Department - HUPES obtained considerable gains by developing activities related to cadaver dissection. The service is contributing to progress in the three pillars of education: education, research, and extension.
INTRODUCAO: A retracao palpebral nos seus diversos graus e uma complicacao temida, mas frequentemente observada no pos-operatorio da blefaroplastia inferior. Pode se apresentar desde uma discreta esclera aparente ate um grave e sintomatico ectropio. OBJETIVO: Sistematizar o tratamento das retracoes palpebrais secundarias a blefaroplastia nos seus diversos graus. METODO: Tres grupos foram divididos pela gravidade e tipo de retracao palpebral, que orientaria o tratamento a ser recebido. No grupo 1, foram incluidas as retracoes palpebrais confinadas ao canto lateral. Este grupo foi tratado com cantoplastia. No grupo 2, foram incluidas as alteracoes de canto lateral e terco medial da palpebra causadas por deficiencia da lamela media, anterior ou uma combinacao entre as duas, mas que nao causavam eversao da margem palpebral. Este grupo foi submetido a cantoplastia com retalho de tarso, perfuracao lateral da orbita e liberacao das retracoes da lamela. No grupo 3, foram incluidos pacientes com evidente retracao de lamela media, anterior ou uma combinacao entre as duas, causando ectropio franco. Esses pacientes foram submetidos a cantoplastia com retalho de tarso, liberacao das retracoes da lamela media e enxerto de mucosa de palato duro como espacador (spacer graft). RESULTADOS: A abordagem sugerida efetivamente corrigiu o mau posicionamento palpebral inferior e melhorou a sintomatologia nos tres grupos propostos. CONCLUSAO: O correto diagnostico das causas da retracao palpebral permite a escolha do tratamento adequado. Mais importante que o tratamento, no entanto, e a profilaxia deste tipo de complicacao, que so e alcancada apos entendimento amplo da anatomia periorbitaria e avaliacao meticulosa pre-operatoria da funcao tarso ligamentar e outros parâmetros envolvidos.
INTRODUCAO: A inadequacao da fala e da voz decorrente da insuficiencia velofaringea e o principal estigma do paciente fissurado; assim, o estudo dessa condicao clinica e fundamental, proporcionando melhor desenvolvimento das criancas e de suas relacoes sociais. O objetivo do presente estudo e avaliar alteracoes fonoaudiologicas, do esfincter velofaringeo, da laringe de pacientes fissurados palatais e labiopalatais tratados com queiloplastia, palatoplastia e fonoterapia, que desenvolveram insuficiencia velofaringea transitoria, e fissurados palatais e labiopalatais, que desenvolveram insuficiencia velofaringea persistente tratados com queiloplastia, palatoplastia, fonoterapia, faringoplastia e fonoterapia complementar. METODO: No periodo de junho de 1997 a maio de 2002, foram avaliados 132 fissurados palatais e labiopalatais que desenvolveram insuficiencia velofaringea transitoria e insuficiencia velofaringea persistente, com idade entre 4 anos e 11 meses e 19 anos e 3 meses. Observando-se os criterios de inclusao e exclusao, 44 pacientes, sendo 18 do genero feminino e 26 do genero masculino, foram divididos em 2 grupos: grupo I, 20 pacientes submetidos a queiloplastia, palatoplastia e fonoterapia; e grupo II, 24 pacientes submetidos a queiloplastia, palatoplastia, fonoterapia, faringoplastia e fonoterapia complementar. O tratamento fonoaudiologico consistiu de terapia articulatoria de fluxo aereo bucal, terapia miofuncional, tecnica de aquisicao fonemica rapida e terapia de voz. O tratamento cirurgico consistiu de confeccao de retalho da parede posterior da faringe, de pediculo superior. RESULTADOS: As alteracoes fonoaudiologicas, do esfincter velofaringeo e da laringe foram mais frequentes nos pacientes do grupo I, quando comparados aos do grupo II. CONCLUSOES: Pacientes fissurados que evoluiram para insuficiencia velofaringea persistente devem ser tratados com faringoplastia e fonoterapia complementar para correcao das alteracoes fonoaudiologicas, do esfincter velofaringeo e da laringe.
Universidade Estadual Paulista Julio de Mesquita Filho, Departamento de Morfologia, Faculdade de Odontologia de Araraquara, Araraquara, Rua Humaita, 1680, Centro, CEP 14801-903, SP, Brasil
