José Antônio Patrocínio

Mandibular fracture: analysis of 293 patients treated in the Hospital of Clinics, Federal University of Uberlândia

UNLABELLED Mandibular fracture is the second most common facial fracture and there has been a significant increase in number of cases in the last years. Misidentification and inadequate treatment can take to permanent aesthetic or functional deformity. AIM Evaluate cases of mandibular fracture reduction in the Hospital of Clinics of the Federal University of Uberlândia, from January of 1974 to December of 2002. STUDY DESIGN Historical cohort. PATIENT AND METHOD Two hundred and ninety-three cases of reduction of mandibular fractures were retrospectively analyzed according to factors related to: patient, trauma, signs and symptoms, and surgical treatment. RESULTS There has been a clear tendency of increase of the number of mandibular fractures along the years. There was higher prevalence in male (4:1), with occurrence peak between 20 to 29 years old. The principal causes of fracture in this study were traffic accidents and violence, representing 72.4%. One hundred and thirty-five patients presented only one fracture. The most injured sites were, in decreasing order, symphysis, condyle, angle, body, ramus, and coronoid. We performed closed reduction (28), open reduction (213) and association of the two (11 patients); 56.8% of the patients were treated within the first 3 days; and, 50.4% were discharged from the hospital until the first postoperative day. About 10% of the patients presented complications, being osteomyelitis the most frequent one. CONCLUSION The incidence of mandibular fractures was remarkably larger in the male sex, during the third decade of life. The most common cause was traffic accident, and symphysis and condyle were the most injured sites. Isolated fractures occurred in over half of the cases. Most of the patients were treated in the first three days and were discharged until the first postoperative visit. Closed reduction was the treatment most commonly employed. The most frequent complication was osteomyelitis.

Fratura de mandíbula: análise de 293 pacientes tratados no Hospital de Clínicas da Universidade Federal de Uberlândia

Mandibular fracture is the second most common facial fracture and there has been a significant increase in number of cases in the last years. Misidentification and inadequate treatment can take to permanent aesthetic or functional deformity. AIM: Evaluate cases of mandibular fracture reduction in the Hospital of Clinics of the Federal University of Uberlândia, from January of 1974 to December of 2002. STUDY DESIGN: historical cohort. PATIENT AND METHOD: Two hundred and ninety-three cases of reduction of mandibular fractures were retrospectively analyzed according to factors related to: patient, trauma, signs and symptoms, and surgical treatment. RESULTS: There has been a clear tendency of increase of the number of mandibular fractures along the years. There was higher prevalence in male (4:1), with occurrence peak between 20 to 29 years old. The principal causes of fracture in this study were traffic accidents and violence, representing 72.4%. One hundred and thirty-five patients presented only one fracture. The most injured sites were, in decreasing order, symphysis, condyle, angle, body, ramus, and coronoid. We performed closed reduction (28), open reduction (213) and association of the two (11 patients); 56.8% of the patients were treated within the first 3 days; and, 50.4% were discharged from the hospital until the first postoperative day. About 10% of the patients presented complications, being osteomyelitis the most frequent one. CONCLUSION: The incidence of mandibular fractures was remarkably larger in the male sex, during the third decade of life. The most common cause was traffic accident, and symphysis and condyle were the most injured sites. Isolated fractures occurred in over half of the cases. Most of the patients were treated in the first three days and were discharged until the first postoperative visit. Closed reduction was the treatment most commonly employed. The most frequent complication was osteomyelitis.

Complications in blepharoplasty: how to avoid and manage them

C omplications in blepharoplasty are uncommon and, when they occur, they are usually mild and transient, such as hematomas and chemosis. However, sometimes ...UNLABELLED Complications in blepharoplasty are uncommon and, when they occur, they are usually mild and transient, such as hematomas and chemosis. However, sometimes they can be severe, such as blindness, or they might require surgical correction, such as ectropion. OBJECTIVE To evaluate the results and complications of transcutaneous blepharoplasty performed in the same procedure, discussing how to treat and how to avoid them. METHODS A retrospective study of 200 medical records of consecutive patients that underwent transcutaneous blepharoplasty from January 2007 to January 2009. The variables analyzed were age, gender, complications, clinical outcome, patient satisfaction, and photographic documentation. RESULTS The incidence of complications was 9.5% (19 patients). The complications were 1 hematoma, 12 cases of chemosis and 13 patients who underwent canthoplasty, 6 patients with malposition of the lower eyelid (5 retractions and 1 ectropion). Medical treatment was performed in 12 patients and revision surgery in 7 cases of all the patients who had complications. CONCLUSIONS We demonstrated that blepharoplasty is a procedure with a high satisfaction and a low complication rate, and it is an excellent surgical procedure, when properly indicated.

Graduated Approach to Refinement of the Nasal Lobule

OBJECTIVE To present a graduated approach to refining the nasal lobule (a frequent complaint during consultations for rhinoplasty) based on anatomic features and to discuss the casuistics of this procedure since we began performing it. METHODS A retrospective evaluation of the medical charts of 1152 patients who underwent rhinoplasty from 2003 to 2006; 641 patients fulfilled the criteria for our study (55.6%). Outcomes were assessed by comparing preoperative and last follow-up photographs and considering the width, symmetry, and contour of the nasal lobule. Cases were allocated into 7 groups: (1) no surgery on nasal tip; (2) interdomal breakup; (3) cephalic trim; (4) domal suture; (5) shield-shaped graft; (6) vertical dome division; and (7) replacement of lower lateral cartilages. RESULTS Of the 641 patients enrolled in the study, 435 were women and 206 were men. Mean follow-up period was 1.5 years. An asymmetric tip was present in 28 patients (4.4%), and a persistent width of interdomal space in 34 (5.3%). None presented overnarrowing of interdomal space. Surgical revision rate to enhance refinement of the lobule was 5.6%. CONCLUSION Our graduated approach has shown excellent outcomes, a high rate of patient satisfaction, and a low rate of revision.

Forehead-lift: A 10-Year Review

Since the earliest reports in the 1910 s, the search for long-lasting elevation of the eyebrow, reduction of transverse forehead rhytids, and elimination of vertical and oblique glabellar lines has motivated authors all around the world to publish reports of their experiences. In the last 10 years, 142 articles were published, 17 of them in the Archives of Facial Plastic Surgery. We review the most important advances on anatomy, approach, dissection plane, flap fixation, facial paralysis, minimally invasive techniques, and secondary procedures, and raise some questions that should be answered in the future.

Contribution of nasal biopsy to leprosy diagnosis.

Background The nasal mucosa plays the main role as the entry and the exit of leprosy bacilli and the nasal involvement may precede the skin lesions by several years. Nasal biopsy has been used in research but its clinical application has not been described. We evaluated the contribution of the nasal biopsy for the diagnosis of leprosy and its correlation to skin biopsy and skin smear in untreated patients. Methods We evaluated changes in nasal biopsy in 227 leprosy patients. Patients were clinically classified and skin and nasal biopsies and skin smear were performed. Results Nasal biopsy showed positivity in 100% of the lepromatous spectrum decreasing toward the tuberculoid (TT) pole. Patients with TT or indeterminate forms did not present any nasal alterations, showing that they are the true paucibacillary forms. Also, the nasal biopsies of two patients were the only exam to show positivity. The bacillary index of the nasal biopsy was strongly correlated to skin biopsy and slit-skin smear. Additionally, the agreement among the exams was good, revealing the reliability of the nasal biopsy in leprosy diagnosis. Conclusion The present study showed a rate of 48% of positivity in nasal biopsy of untreated patients, correlating well with skin biopsy and skin smear. Thus, the method in leprosy diagnosis and clinical form classification has shown great reliability.

Temporomandibular joint synovial chondromatosis

Synovial chondromatosis (SC) is a rare, benign cartilaginous metaplasia that affects the joints, usually only one joint. Chondromatosis is a hard to diagnose disease because of its somewhat vague symptoms, especially those in the temporomandibular joint (TMJ), which does not fit those from the most prevalent disease sites (knee, elbow and shoulder). There is only one case of TMJ chondromatosis in the Brazilian Literature. The goal of the present investigation is to report a case of TMJ chondromatosis, discussing its pathological aspects and treatment.

Estudo comparativo entre cetorolaco e cetoprofeno no controle da dor pós-operatória de uvulopalatofaringoplastia

A dor no pos-operatorio imediato apresenta-se como um grave problema, requerendo do medico uma adequada assistencia. Na Otorrinolaringologia, merece atencao especial a dor apos uvulopalatofaringoplastia (UPFP). OBJETIVO: Comparar a eficacia na analgesia pos-operatoria do cetorolaco com o cetoprofeno em UPFP. PACIENTES E METODOS: Estudo prospectivo, randomizado, duplo-cego com 24 pacientes submetidos a UPFP, divididos em 2 grupos, sendo que 14 receberam cetorolaco e 10 cetoprofeno. Avaliacao da intensidade da dor atraves de escala visual analogica e necessidade do uso associado de opioide (tramadol). RESULTADOS: Dos 14 pacientes que receberam cetorolaco, apenas 3 (21%) necessitaram uso complementar de opioide, enquanto que 7 (70%) do grupo do cetoprofeno o fizeram. Apos 12 horas de cirurgia, houve um predominio de 71% dos pacientes que receberam cetorolaco, com dor leve ou ate ausencia desta, enquanto 70% dos do cetoprofeno referiram dor moderada ou incomoda. Apos 24 horas de cirurgia, 60% dos pacientes que fizeram uso de cetoprofeno referiam dor moderada a incomoda, ao passo que 86% dos do cetorolaco referiram dor leve a ausencia. CONCLUSAO: Conclui-se que o cetorolaco e mais eficaz em relacao ao cetoprofeno no tratamento da dor pos-operatoria imediata de UPFP, pois houve dor de menor intensidade e menor uso de opioide.

Subperiosteal midface-lift.

The subperiosteal midface-lift has benefited from significant technological advances in medicine. The endoscope now allows extensive subperiosteal undermining of facial soft tissue through minimal access incisions. Improved understanding of facial anatomy and the facial aging process now allow repositioning and remodeling of the soft tissue envelope with excellent aesthetic results. The subperiosteal midface-lift by a temporal approach is a procedure designed to rejuvenate the middle third of the face. After subperiosteal detachment, the soft tissues of the cheek, jowls, lateral canthus, and inferior orbital rim can be lifted to reestablish their youthful relationship with the underlying skeleton. It is a technique that produces satisfactory cosmetic results in most cases, causing malar augmentation, nasolabial fold improvement, and mild jowl improvement. We describe our preferred technique in detail and discuss its indications, complications, advantages, and limitations.

Inflammatory myofibroblastic tumor in the larynx

inflammatory myofibroblastic pseudotumors were initially described in the lung, only then to be identified in various extrapulmonary sites. in the head and neck, this disease is more frequently found in the paranasal sinuses, and has already been described in the orbits, palatine tonsils, ears, gingiva, pterygomaxillary space, and periodontal tissues. it will rarely involve the larynx. only twenty-two cases of inflammatory myofibroblastic pseudotumor in the larynx have been described in the indexed literature. this paper aims to describe a rare case of laryngeal inflammatory myofibroblastic pseudotumor and discuss its diagnostic and therapeutic aspects.