Francisco Veríssimo de Mello Filho

Use of a platysma myocutaneous flap for the reimplantation of a severed ear: experience with five cases

CONTEXT The traumatic loss of an ear greatly affects the patient because of the severe aesthetic deformity it entails. The characteristic format of the ear, with a fine skin covering a thin and elastic cartilage, is not found anywhere else in the human body. Thus, to reconstruct an ear, the surgeon may try to imitate it by sculpting cartilage and covering it with skin. OBJECTIVE To use a platysma myocutaneous flap for the reimplantation of a severed ear in humans. DESIGN Case report. SETTING Emergency unit of the university hospital, Faculty of Medicine, Ribeirão Preto - USP. CASE REPORT Five cases are reported, with whole ear reimplantation in 3 of them and only segments in 2 cases. The surgical technique used was original and was based on the principle of auricular cartilage revascularization using the platysma muscle. We implanted traumatically severed auricular cartilage into the platysma muscle. The prefabricated ear was later transferred to its original site in the form of a myocutaneous-cartilaginous flap. Of the 5 cases treated using this technique, 4 were successful. In these 4 cases the reimplanted ears showed no short- or long-term problems, with an aesthetic result quite close to natural appearance. In one case there was necrosis of the entire flap, with total loss of the ear. The surgical technique described is simple and utilizes the severed ear of the patient. Its application is excellent for skin losses in the auricular region or for the ear itself, thus obviating the need for microsurgery or the use of protheses or grafts.

Two-Stage Treatment of Facial Asymmetry Caused by Unilateral Condylar Hyperplasia

Condylar hyperplasia (CH) is a rare, self-limiting process manifesting between the first and third decades of life. CH causes facial asymmetry and derangement of the occlusion. Management involves resection of the condylar head and orthognathic surgery. This paper describes the case of a 37-year-old woman with spontaneous onset of CH over a span of approximately 25 years. The condition was managed with resection of the condyle alone, which dramatically improved facial asymmetry and altered the occlusion within a few months of follow up. Orthodontic treatment was then carried out and the patient underwent orthognathic surgery after 3 years. The patient is currently satisfied with her appearance and function and there are no signs of recurrence.

A Giant Primary Hemangioma of the Thyroid Gland

An 80-yr-old woman was referred with a 40-yr history of a slowly enlarging anterior neck mass. She had no compressivesymptoms,historyoftrauma,previousfine-needle aspiration biopsy, or other neck procedures. There was no family history of thyroid diseases. Physical examination showedagiant (circumference,50cm)painlessgoiter (Fig.1, A and B). Serum TSH (1.97 mIU/liter; normal range, 0.4– 4.0) and free T4 (18.0 pmol/liter; normal range, 10.3–24.5) levels were normal, and no antithyroid antibodies were detected.Computedtomography(Fig.1C)showedalargesolid mass (16 16 17 cm) with multiple peripheral calcifications in the left lobe of the thyroid, with deviation of the tracheaandcervical structures to theright side.Noabnormal findings in the right lobe of the thyroid were found, and surrounding lymph nodes were not detected. Cytological examination obtained by aspiration was inconclusive because only blood could be aspirated. A left-side hemithyroidectomy was performed, and a 22 21 17-cm encapsulated mass weighing 2800 g was removed (Fig. 1D). A cavernous hemangiomawasdiagnosedbyhistologicalanalysis.Thepatient had no complications after surgery and 3 yr later remains asymptomatic. Hemangiomas are an extremely rare category of thyroid nodules that often escape preoperative diagnosis. In most cases, a hemangioma of the thyroid gland is secondary to trauma or fine-needle aspiration biopsy, and they may be considered as a development of vascular proliferation that follows the organization of a hematoma (1). Primary thyroid hemangiomas are infrequent, and they are a development anomaly resulting from the inability of the angioblastic mesenchyma to form canals (2). The hemangioma presents as a hypoechoic area within the thyroid gland, without specific, distinct characteristics. Even experienced radiologists may find this lesion difficult to diagnose. Coarse calcifications, when present, are suggested as a reliable sign of the presence of a hemangioma. More specific studies such as magnetic resonance imaging, single photon angiography, and red blood cellscansmayimprovediagnosticability.Atpresent,mostofthe reported cases had the diagnosis confirmed only after pathological examination of a surgical specimen. There are only nine casesofprimarythyroidhemangiomareportedintheliterature. These cases have had male predominance with variable age at diagnosis and clinical features (Table 1). The present case appears to represent the largest size hemangioma.

Viability of a 12-ring complete tracheal segment transferred in the form of a compound flap: an experimental study in dogs.

Introduction: There is a lack of an ideal substitute for the injured tracheal tissues. Autologous or homologous grafts and prostheses are inadequate because of their unreliable and nonviable nature for the reconstruction of a complete tracheal segment (CTS).

Rupture of the aorta due to a malpositioned tracheal cannula in a 4-month-old baby☆

Complications of tracheostomy are not rare and are even more common in children. They may be acute or chronic and sometimes may have serious consequences. We report here a rare situation in which a malpositioned tracheal cannula in a false tract from the neck to the mediastinum induced necrosis and rupture of the aorta and of the left carotid artery with fatal hemorrhage.

Multiple Supernumerary Teeth in a Nonsyndromic 12-Year-Old Female Patient - A Case Report

Supernumerary teeth (ST) are uncommon alterations of development that may appear in either of the dental arches and that are frequently associated with syndromes such as cleidocranial dysplasia and Gardner syndrome. Multiple ST in individuals with no other disease or syndrome are very rare. In view of this situation, correct diagnosis, treatment and evaluation of ST with the use of appropriate imaging techniques are highly important. This case report presents radiographic images of a nonsyndromic 12-year-old female patient who presented with 14 supernumerary teeth and was treated under general anesthesia, with the extraction of all ST in a single surgical intervention. During the postoperative period, the patient did not complain of pain nor did she present any signs or symptoms of infection. During late follow-up period, due to difficulty in traction of the maxillary right canine and mandibular left first premolar towards the dental arch, it was necessary to extract these teeth under local anesthesia. Radiographic examination 3 years after surgery revealed the absence of ST and of diseases related to the existence of these teeth.