Tomas Gomes Patrocínio

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.

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.

Avaliação da eficácia do hidrato de cloral na sedação de crianças para exame nasofibroscópico

Material and method: A hundred consecutive subjects, aged one to four years, without neurological deficits and with complaints of nasal obstruction were examined by transnasal flexible endoscopy (TFE). Study design: Prospective clinical randomized. Aim: The proposal of the present study was to evaluate the efficacy of choral hydrate as a sedative for the conduction of the exams, in the dose of 100 mg/kg PO. We assessed facility of the procedure as a result of the sedation and possible complications. All the 100 patients were sufficiently sedated with the administration of chloral hydrate in the described dose. Conclusion: It allowed conduction of TFE with no need for movement restriction by parents, association of another more powerful drug nor general anesthesia. There were no complications.

Avaliaçäo de necessidades para um currículo de otorrinolaringologia na graduaçäo

Introduction: all over the world, specialists in Medical Education have been looking for improvement of teaching. In the area of Otorhinolaryngology (ENT), mainly in Brazil, few studies have been performed about teaching and curricular change. Aim: For such, we aimed to assess the needs for an undergraduate ENT curriculum, in the vision of otolaryngologists and general physicians. Study design: clinical. Material and method: Questionnaires were applied to two groups: Group 1 - otolaryngologists; Group 2 - general physicians. The questionnaire contained a list of 88 areas of knowledge and 65 of skills in ENT. Result: The interviewees evaluated each area in accordance with a scale of relevance for the undergraduate curriculum, being 4 indispensable, 3 important, 2 useful for few general physicians, 1 interesting, but unnecessary its inclusion, and 0 dispensable. Based on this score system, the average was calculated for each area. Areas of knowledge as tonsillitis, otitis, allergic rhinitis, epistaxis, sinusitis and pharyngitis received the highest scores. The otolaryngologists prioritized complications of otitis and sinusitis. In the areas of skills, the topics with highest scores were: history taking; otoscopy; physical examination of ENT; cranial nerves examination; anterior nasal packing. The general physicians prioritized removal of foreign body from ear and nose and cleaning cerumen from ear canal. Conclusion: This study showed data that may subsidize medical educators when reformulating undergraduate ENT curriculum.