Annelyse Cristine Ballin

Long-term efficacy, safety and durability of Juvéderm® XC

Over the last decade, there has been increasing interest in minimally invasive cosmetic treatments, especially for facial rejuvenation. Next to botulinum toxin injection, the injection of soft tissue fillers is the second most frequent minimally invasive procedure performed in the USA. Hyaluronic acid (HA) is the most commonly used dermal filler. One of patients’ main concerns about filler injections pertains to pain and discomfort. Topical anesthetics, nerve blocks, and/or the incorporation of lidocaine to the filler have been applied in order to reduce distress and pain. Despite nerve blocks being an effective form of anesthesia, they may distort the area to be treated, as well as lengthen and complicate the procedure. Studies have shown that the incorporation of lidocaine to HA fillers significantly reduces pain and discomfort. Yet, one of the dilemmas about the addition of lidocaine solution to HA fillers is the possible alteration of the physical characteristics of the product by negatively impacting the efficacy and/or duration of the filler. The concern is that the addition of lidocaine could dilute the product, creating less correction per mL, changing the product’s viscosity and consequently the “lifting” ability. Also, this dilution could reduce the product’s duration. There may be a difference between a physician adding an aqueous solution into a lidocaine-free version of HA and the pre-incorporated lidocaine version of HA. An aqueous solution might dilute the product, while the pre-incorporated powder lidocaine appears to avoid this problem. Juvéderm® XC is manufactured with powder lidocaine 0.3%; it is associated with significantly less injection pain than Juvéderm® and other lidocaine-free versions of HA. Studies have shown that lidocaine enhances treatment comfort and optimizes the injection experience while maintaining a similar safety and effectiveness profile. Regarding the longevity, further study is necessary to determine if there is any difference in durability.

Dermal Fillers: An Update

Injection of dermal fillers is the second most frequent nonsurgical cosmetic procedure performed in the USA. Dermal fillers are an option in the treatment of volume deficiency, scars, and rhytides; facial sculpting; facial contouring; and augmentation of specific anatomical sites such as the lips. The number of injectable dermal fillers available on the market increases yearly. Dermatologists and cosmetic surgeons should regularly review treatment options to provide patients with safe and effective filler options. This paper extensively reviews the properties of the available fillers, such as their rheology, longevity, and adverse effects, and how these properties affect the choice of filler agent for a particular patient or a particular site. Also, trends in dermal filler injections are discussed.

Assimetria de tonsilas palatinas: experiência de 10 anos do serviço de otorrinolaringologia do hospital de clínicas da Universidade Federal do Paraná

INTRODUCTION: A few patients with asymmetric palatine tonsils have lymphoma; but most lymphomas in palatine tonsils evolve with tonsillar asymmetry. OBJECTIVE: To report the profile of patients and histopathological changes in patients submitted to adenotonsillectomy/tonsillectomy with disproportional palatine tonsils. METHOD: Retrospective study based on data analysis from the Pathologic Anatomy Service Database and in the review of reports of patients submitted to adenotonsillectomy and tonsillectomy with palatine tonsils asymmetry during the period from October 1999 through October 2009 at the Clinical Hospital (HC) of the Federal University of Parana (UFPR). RESULTS: 50 patients took part, aged between 3 to 53 years old, mean age of 14.05 years. The anatomopathological exam confirmed 48 patients (96%) with lymphoid hyperplasia and 2 cases of lymphoma (4%). These included men aged from 40 to 53 yeas with complaint of unilateral increase of the tonsil, one of whom had other symptoms (asthenia and weight loss). Upon physical examination: tonsils disproportion without involvement of other organs or lymph nodes. CONCLUSION: Our study is according to the literature as regards the fact the lymphomas are more common in men, the patient is the first one to notice the increase in volume and the asymmetry is larger than 2 degrees between palatine tonsils in cases of lymphoma. Although it is rare, even in the presence of differences, there are chances for the asymmetry to evolve to a malignant profile. The need for anatomopathological evaluation of a part must be considered along with other clinical data that suggests a malignant profile.

Treatment of retroauricular keloids: revision of cases treated at the ENT service of HC/UFPR

Summary Introduction: Keloids are benign tumors arising from abnormal healing of the skin, and there are several procedures available for their treatment. Objective: The objective of this study was to evaluate the outcomes of patients undergoing treatment of keloids after ear, nose, and throat (ENT) surgeries at our service center. Method: We conducted thorough, retrospective and prospective analysis of records of patients undergoing treatment of retroauricular keloids at our center. Results: Nine patients were evaluated, and 6 underwent resection and adjuvant beta-therapy, 2 underwent resection with local application of corticosteroids, and only 1 underwent resection without adjuvant therapy. There was no recurrence of keloids in patients that were treated with beta-therapy in the early postoperative period. One patient had relapsed despite corticosteroid administration and late beta-therapy. Discussion: Several techniques have been used for the treatment of retroauricular keloids, and beta-therapy is thought to yield the best results, followed by the use of intralesional corticosteroids. Conclusion: Treatment of retroauricular keloids remains a challenge. While new techniques are being developed, resection followed by early beta-therapy is still the best treatment option.

Eficácia da cirurgia endoscópica nasal no tratamento da Rinossinusite crônica

INTRODUCTION: The endoscopic sinus surgery (FESS) is currently regarded as the gold standard in the treatment of chronic rhinosinusitis (RNSC), with or without nasal polyposis refractory to medical therapy optimized. OBJECTIVE: To evaluate the improvement of symptoms after FESS RNSC, through a questionnaire. METHOD: This is a prospective study, which included 34 patients undergoing FESS during the year 2009, the Service of Otorhinolaryngology, Hospital das Clinicas / UFPR. Of these, 22 were diagnosed as RNSC RNSC and 12 had associated nasal polyps. All patients underwent a questionnaire on preoperative symptoms, comorbidities and degree of symptom improvement after surgery, six months after the procedure. RESULTS: The percentage improvement of symptoms more prevalent in the group with RNSC was as follows: nasal obstruction 87.4%, 80.5% headache, pain / facial pressure 91.6% 81.2% posterior nasal discharge. In the group with polyposis associated improvement was nasal obstruction 76.6%, 76.6% posterior nasal discharge, hyposmia, 68.7%, headache 83%. In our study we found an overall improvement in symptoms of 83.74% in patients with RNSC and 80.5% in patients with associated nasal polyposis. CONCLUSION: FESS is highly effective in controlling symptoms of RNSC with or without polyposis and is, in our study, its efficacy similar to that found in the literature. With respect to patients with nasal polyposis, studies are needed with longer follow up, since this disease has a high degree of recurrence.

Avaliação sistematizada da dificuldade de exposição das pregas vocais na microcirurgia da laringe

INTRODUCTION: Several studies addressing preoperative factors that predict difficulty of endotracheal intubation graduated by anesthesiologists, for the scale of the Cormack-Lehane. These parameters were evaluated for the difficulty of location of the laryngoscope in microsurgery of the larynx. There is not a standard scale of difficulty targeted to surgeons of the larynx. OBJECTIVE: Create a standard scale of difficulty leasing the laryngoscope during microsurgery of the larynx, with a focus on exposure of the vocal folds (vocal cords) to evaluate which clinical parameters predict difficulty of exposure of their vocal folds and verify the improvement of laryngeal exposure with the hanger of the laryngoscope. METHOD: A prospective randomized study, 57 patients undergoing laryngeal microsurgery. The preoperative parameters were evaluated: three epidemiological data, two of history and 13 physical examination. Intraoperatively: the anesthesiologist evaluated the Cormack-Lehane score and the surgeon evaluated according to the proposed scale, before and after placement of the hanger. RESULTS AND CONCLUSION: Several parameters showed sensitivity, specificity, positive predictive value for high inadequate exposure of the larynx. But only distance hiomentual <6.05 cm (p = 0.003) and 2 classes of Cormack-Lehane (p = 0.04) with statistical significance and high sensitivity of 100% and 81% respectively. The use of the hanger of laryngoscope laryngeal exposure improved significantly (p = 0.04). The proposed scale standardizes the visualization and grades the difficulty of exposure of their vocal folds, facilitating comparisons between studies and communication between otolaryngologists.

Scars and Stress

Scars are the result of the wound healing process in the skin and other body tissues. Even though they are part of the normal process of healing, they can sometimes be bothersome. Inadequate scars can lead to loss of function, restriction of growth, restriction of movement (particularly because of contractures over joints), poor aesthetics, and adverse psychological effects. Although there are multitudes of options for the treatment of scars, prevention is still the best option. In this chapter we aim to show evidence that stress can affect wound healing producing unaesthetic scars such as keloids, as well as suggest possible solutions.

Endoscopic Management of Orbital Fractures

Abstract The main indications for surgical correction of orbital fracture are diplopia, enophthalmos, signs of herniation of orbital contents into the ethmoid and maxillary sinuses, orbital muscle incarceration leading to reduced ocular motility, decreased visual acuity, persistent infraorbital hypoesthesia, and hypo-ophthalmia. The location of the fracture is important in determining the treatment approach. Endoscopic repair of orbital fractures has received increased attention since the development of better endoscopic materials and high-tech fiberoptics. This article reviews the endoscopic treatment of orbital fractures.

Atypical Presentations of Pleomorphic Adenoma

Objective: Report 2 cases of pleomorphic adenoma with different clinical presentations and unusual locations—the uvula and inferior nasal turbinate (INT)—and discuss the variety of presentings in this type of tumor. Method: Report of 2 cases of pleomorphic adenoma in unusual places. Results: Case 1: For 20 years, the patient complained of frequent choking and progressive growth of lesions in the uvula, then underwent uvuloplasty with total excision of the lesion. Case 2: The patient complained of progressive nasal obstruction in the right nasal cavity and had septoplasty and turbinectomy performed. CT of the paranasal sinuses revealed an extensive mass of inferior nasal turbinate to the right choana. An endoscopic right turbinectomy procedure was conducted. The pathology suggested pleomorphic adenoma. Conclusion: Pleomorphic adenoma located either in the uvula or the inferior nasal turbinate are rare. This neoplasm should always be considered in the differential diagnosis of head and neck injuries so that early surgical treatment might prevent its progression to malignancy.

Anthropometric Study of the Caucasian Nose in the City of Curitiba: Importance of Population Assessment

Objective: 1) Evaluate the aesthetic parameters of Caucasian noses of Curitiba, Brazil, and compare them with standard aesthetic ideals from the literature. Method: Prospective cohort study through assessment of anthropometric measurements (intercanthal width [IW], alar width [AW], length, nasofrontal angle [NFA], nasolabial angle [NLA], nasal tip projection) of the Caucasian noses from photographs and comparison with the ideal of literature, with statistical analysis. Results: A total of 100 volunteers were evaluated, including students and employees connected to the Health Department of HC/UFPR. Met IW0 (sd:8), NLA range 105,430 (sd:10,5) and nasal tip projection 0.63 (GoodeMethod) and 2.1:1 (Baum Method). The naso-frontal angle showed statistical significance between genders (p = 0.0008). Conclusion: Caucasian noses of Curitiba are shorter, with a wider base, and less projected than the aesthetic ideal, showing possible miscegenation of the population and the importance of population studies for evaluation, preoperative counseling, and surgical planning.