Tomas Gomes Patrocinio

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.

Solitary nasal trichoepithelioma

JCM, a male patient aged 56 years, complained of a slow-growing lesion on the dorsum of the nose during the past five years. The physical examination showed a brownish nodule on the dorsum of the nose, with visible blood vessels, a fibroe-lastic consistency, and measuring 3.0 x 2.5 cm (Figure 1A). The initial diagnosis was a basocellular carcinoma. The nodule was resected surgically (Figure 1B) and sent to the pathology department, which described islands of basaloid cells within small cystic structures filled with laminated keratin and epithelial cells to form invaginations similar to follicular papillae. A diagnosis of trichoepithelioma was confirmed and the tumor was shown to have free margins. A nasogenian flap was used for reconstruc-ting the nose (Figures 1C and 1D). The patient was monitored for 48 months with no recurrences.

A comparative study between Ketorolac and Ketoprofen in postoperative pain after uvulop alatopharyngoplasty

Summary Postoperative pain is a serious problem, requiring an appropriate response from the medical doctor. In otolaryngology special attention is needed after uvulopala topharyngoplasty (UP3). Aim: To compare the efficacy of postoperative analgesia using ketorolac and ketoprofen after UP3. Patients and Methods: A prospective, randomized, double-blind study was made of 24 patients that were divided into 2 groups (14 received ketorolac and 10 received ketoprofen). Pain intensity was based on an analog visual scale and the need for opioids (tramadol). Results: Of the 13 patients that received ketorolac, 3 (21%) required opioids; 7 of 10 (70%) patients in ketoprofen group used opioids. 12 hours after surgery, 71% of the patients that received ketorolac had mild or absence of pain. 70% of the ketoprofen users reported moderate to significant pain. 24 hours after surgery, 60% of the patients using ketoprofen reported moderate to significant pain, while 86% of the ketorolac users reported mild or absence of pain. Conclusion: We concluded that ketorolac is more effective compared to ketoprofen in the treatment of immediate postoperative pain after UP3, as patients using ketorolac had less pain and used opioids to a lesser degree.

Benign nasopharyngeal teratoma in an adult patient.

V.S., 35 years, female, presented unilateral nasal obstruction since chil-dhood. Video-nasofibroscopy showed a pedicled oval-shaped mass in the pha-ryngeal ostium of the Eustachian Tube, obstruction about 60% of her nasopharynx. Paranasal sinuses CT scan presented a mass in her left nasopharynx (Figure 1a).The patient was submitted to en-doscopic surgery under local anesthesia, with lesion exeresis after pedicle identifica-tion and resection (Figure 1b). The tumor removed measured 4x3x2cm, similar to fat tissue at touch and with smooth surface. The pathology exam reported a benign mature teratoma of the nasopharynx.The patient is being followed up in our outpatient ward for 7 months now, without recurrence of the lesion or respi-ratory symptoms.

Effect of Orbicularis Muscle Resection during Blepharoplasty on the Position of the Eyebrow

Dermatochalasis is a skin excess in the upper eyelid which may be associated with either an aesthetic and functional defect, blocking the peripheral vision. Upper blepharoplasty is the gold standard procedure for correction of dermatochalasis and to restore youthful contours to the periorbita. It is one of the most commonly performed procedures in aesthetic plastic surgery; however, there is still a lack of consensus about this procedure. The excess skin is sometimes removed alone or in conjunction with a strip of orbicularis oculi muscle. The rationale for both muscle and skin resection or skin alone preserving the muscle is uncertain. Some authors have studied the aging influence in brow position, and a few studies pointed out the influence of the upper blepharoplasty on brow height. The true effects, regarding the position of the eyebrow, of both techniques, with or without resection of the preseptal orbicularis oculi muscle, are unclear. The authors present a review of the literature to find the rationale for resecting or preserving the orbicularis oculi muscle in upper eyelid blepharoplasty and its relation to eyebrow position.

Transpalpebral Eyebrow Lift

Forehead rejuvenation goals are to raise the eyebrow, attenuate forehead wrinkles, and decrease glabellar frown lines. Endoscopic forehead lift represents a significant progress, even replacing the classic coronal and pretriquial techniques. The transpalpebral eyebrow lift allows safe direct visualization of anatomic structures comparable to the allowed by the endoscopic-assisted technique but dispenses the endoscopic instrumentation, is less expensive, and takes less time to learn. Transpalpebral eyebrow lift is a technique that produces satisfactory results in mild-to-moderate eyebrow ptosis improving eyebrow lateral third ptosis and glabellar wrinkles.