Alexandre Siqueira Franco Fonseca

Seating position, seat belt wearing, and the consequences in facial fractures in car occupants

INTRODUCTION Trauma caused by traffic accidents is among the main etiologies involved in the occurrence of facial fractures throughout the world. However, the trauma mechanisms involved are different according to the location where the study was performed, due to different conditions of development, legislation, and culture. A retrospective study was done between February 2001 and July 2006, with the purpose of determining the epidemiology and the mechanisms involved in the occurrence of facial fractures among car occupants in the metropolitan area of São Paulo. METHODS Data were collected from 297 patients admitted with facial fractures to the emergency room of the Hospital das Clínicas, São Paulo University Medical School. Within this period, 151 individuals had been involved in traffic accidents, among which 56 (37.08%) were inside passenger cars. These were grouped based on the seating position that they were occupying at the time of the accident and the wearing of seat belts. Data concerning the number and location of fracture lines were obtained from the different groups, and a fracture/patient index (F/P I) was calculated to compare and make reference to the impact energy among these groups, for subsequent analysis and discussion. RESULTS 323 fracture lines occurred among 56 patients who were car occupants. By applying the F/P I, we obtained higher values in the group of rear-seat passengers who were not wearing seat belts (7.23 fractures per patient), followed by the group of drivers not wearing seat belts (6.33 fractures per patient), the group of front-seat passengers not wearing seat belts (5.58 fractures per patient), the group of drivers wearing seat belts (5.54 fractures per patient) and, finally, the group of front-seat passengers wearing seat belts (4.00 fractures per patient). None of the rear-seat passengers was wearing seat belts. CONCLUSION The data collected indicate that the driver position shows a high incidence of facial fractures, not being effectively protected by the seat belt, although the wearing of seat belts seems to have a protective role against the occurrence of facial fractures in front-seat passengers. It was not possible to evaluate the wearing of seat belts among rear-seat passengers, even though the high incidence of fractures in this group showed its high susceptibility to the occurrence of facial fractures, which highlights the need of taking protective measures against this situation.

Blindness as a complication of monobloc frontofacial advancement with distraction.

Abstract The monobloc frontofacial osteotomy provides aesthetic and functional improvement in the treatment of various craniofacial deformities. This procedure, through highly complex, has had some significant associated complication, such as cerebrospinal fluid leakage, hematoma, infection, and bone resorption. Distraction has been successfully used to gradually elongate bone and soft tissue. This method seems to provide improved results over conventional surgery, with less morbidity. We present a case of a patient with Apert syndrome who underwent monobloc advancement using the Rigid External Device (RED) device and who developed a transient bilateral amaurosis on the fourth postoperative day before distraction. A second procedure was performed to push back the frontal bandeau, maintaining the device in position. The blindness was resolved with this procedure as well as treatment with systemic steroids. The distraction was started thereafter, and the desired improvement was acquired. To our knowledge, this is the first case of transient bilateral amaurosis in a patient undergoing monobloc distraction.

Surgical treatment for eyelid deformity in Crouzon syndrome associated with acanthosis nigricans: case report

The combination of Crouzon syndrome with acanthosis nigricans is unusual. The incidence of this combination is still uncertain, and there are only 30 cases reported in the medical literature. 1–3 Crouzon syndrome is caused by mutation of the gene FGFR3 (fibroblast growth factor receptor 3). In this gene, other mutations can cause a kind of nanism that is lethal during the first weeks of life. Recent biomolecular studies have indicated that the association of Crouzon syndrome with acanthosis nigricans should be considered as a different pathology, as opposed to Crouzon syndrome in isolation, because acanthosis nigricans would originate from a different gene and from a diverse chromosome mutation. 4 Crouzon syndrome is an autosomal dominant disease that involves craniosynostosis, exophthalmia, hypoplasia of the middle third of the face, and irregularities of dental occlusion. Its incidence is about 1 in 300,000 live births. Acanthosis nigricans is a rare illness related to the skin. It is characterized by hyperplasia and hypertrophy, with hyperkeratosis and slight hyperpigmentation on the inner skin layer, without melanocytic hyperplasia. The epidermis presents as a wavy surface (Figure 2). It can affect the neck, armpits, normally folding areas, and the orbital region. The etiology of acanthosis nigricans is variable and can be one of the following: - Hereditary with dominant autosomal transmission. - Associated with genetic abnormalities or endocrine dis

Validation of Videoconference With Smartphones in Telemedicine Facial Trauma Care: Analysis of Concordance to On-Site Evaluation.

BackgroundThe continental size of some countries and heterogeneous hospital network prevents patients who live in remote areas from getting adequate initial assessment of facial trauma. The authors present an alternative model for trauma assessment by videoconference via smartphones and analyze the concordance between telemedicine and face-to-face management. MethodsFifty patients with either a confirmed or suspected diagnosis of facial trauma were independently evaluated by 2 teams of physicians: Face-to-face and telemedicine-based. The face-to-face team attended patients at bedside (physical examination and computed tomography scan analysis). The telemedicine team consisted of a general surgery resident on duty in the emergency room and a plastic surgeon researcher remotely communicating via smartphones. Both teams answered a questionnaire, which contained data concerning patient’s epidemiology, physical examination, computed tomography (CT) scan findings, and treatment option to be followed. Data were analyzed and compared regarding the similarity of answers. ResultsThe sample studied was consistent with the literature, showing a predominance of young males. Traffic accidents and personal violence were the main causes of trauma. The concurrency of answers for physical examination findings was considered substantial (&kgr; = 0.720). For CT scan findings, it was almost perfect (&kgr; = 0.899); for defining the treatment option, it was almost perfect (&kgr; = 0.891). High concurrency of face CT scan findings was observed after we calculated the positive predictive value (89.9%), negative predictive value (99.3%), sensitivity (94.2%), specificity (98.8%), and accuracy (98.3%). ConclusionsThe proposed model to facial assessment trauma by videoconference via smartphones is feasible, showing high concordance level with face-to-face assessment.

Lipoinjerto laminar: un tratamiento prometedor con factores vasculares estromales para las vulvo-vaginitis crónicas

One of the most inconvenient situations for a woman, mostly if young, is the recurrent vulvo-vaginitis. With the presence of a returning genital herpes infec...

Abdominoplasty: Pearls and Pitfalls

The experience of the authors is carefully described, discussing their points of view about abdominoplasty, since the best technique for each case, way of performing the surgery, risks, complications, and suggestions of neoumbilicoplasty, in a complete description, are fully illustrated.

Evaluation of the infection rate of implants used for breast reconstruction at the Cancer Institute of the State of São Paulo

Introduction: Placement of breast implants is the most commonly used form of breast reconstruction. Despite its advantages, infection of the implant, either in the tissue expander or mammary prosthesis, can be a significant problem, including the need to remove it. The objective of this work is to evaluate the infection rate of breast implants used for breast reconstruction in patients submitted to surgery at the Cancer Institute of the State of São Paulo (ICESP), as well as its correlation with clinical, oncological, and surgical factors. Patients and methods: This is a retrospective study on 120 patients submitted to breast reconstruction with breast implants at the ICESP from February 2009 to March 2010. Results: The infection rate (24.3%) was statistically related to immediate reconstruction (88.9%), diabetes mellitus (25%), body mass index >30 (52.8%), systemic arterial hypertension (52.8%), and skin injury due to mastectomy (27.8%). Of the infected implants, 44% were removed, most of which were expanders placed during immediate reconstruction. Conclusions: Breast reconstruction with implants is the safest and most effective form of treatment. However, consideration should be given to patients who are prone to the development of infection, in order to optimize its prevention and attempt to perform its treatment at an early stage.

Método de avaliação da suspensão do SMAS no rejuvenescimento facial

BACKGROUND: The superficial musculo-aponeurotic system (SMAS) suspension is a globally accepted procedure in rhytidoplasties. In order to evaluate the efficacy of suspension performed with the round block SMAS treatment, the authors planned a method in which the wound area reduction is measured to assure its functionality, based in clear evidence. METHODS: Twenty consecutive rhytidoplasties were evaluated, all of them done by the same surgeon, using the same standards. Twelve measures were taken in each side of the face, 7 before suspension and 5 after, allowing for the elaboration of 40 diagrams comprising the areas evaluated before and after suspension. The software ImageJ (NIH Image) was used to evaluate the surfaces. RESULTS: The undermined area in the 40 measures had a mean of 52.6 cm², which changed to a mean of 32.6 cm² after suspension, with a mean reduction of 38%. The diagrams also showed the exact handled points of the face. CONCLUSIONS: The described methodology confirms that the round block SMAS treatment technique is efficient regarding the suspension of the superficial muscular aponeurotic system, with significant reduction of the undermined area, consequently reducing the dead space, and may be a parameter to comparison of different techniques.