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OBJECTIVE: This work aims to review the existing use of robotics in plastic surgery. METHODS: A meticulous selection process identified 22 articles relevant to this scoping review. RESULTS: The literature on the use of robotics in plastic surgery is sparse. Nonetheless, this review highlights emerging benefits in microsurgery, breast reconstruction, and transoral surgery. CONCLUSION: This scoping review identifies critical articles reporting the emerging use of robotics in plastic surgery. While the scientific medical community has yet to extensively document its use, the available evidence suggests a promising future for robotics in this field.

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ABSTRACT Objective This work aims to review the existing use of robotics in plastic surgery. Methods A meticulous selection process identified 22 articles relevant to this scoping review. Results The literature on the use of robotics in plastic surgery is sparse. Nonetheless, this review highlights emerging benefits in microsurgery, breast reconstruction, and transoral surgery. Conclusion This scoping review identifies critical articles reporting the emerging use of robotics in plastic surgery. While the scientific medical community has yet to extensively document its use, the available evidence suggests a promising future for robotics in this field.

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Le Fort I osteotomy is a frequent surgical procedure used in orthognathic surgeries to treat severe malocclusions and is associated with relatively rare surgical complications. Here, the authors report a case of thrombotic ischemic stroke as a result of this procedure, a complication still not described in the literature. A 19-year-old man with class II malocclusion and retrognathia underwent orthognathic surgery for aesthetic purposes. The surgery included a Le Fort I maxillary osteotomy with vertical impaction, bilateral sagittal split ramus osteotomy for mandibular advancement, and genioplasty. Postoperatively, the patient developed left eye blindness, headache, somnolence, aphasia, and right hemiplegia. Medical imaging showed the Le Fort I line of fracture extending from the maxillary osteotomy to the left optic canal and to the left carotid canal, with osseous fragments impinging the petrous segment of the internal carotid artery, left carotid artery occlusion and associated to an ischemic stroke at the left middle cerebral artery territory. Treatment required decompressive craniectomy and later focused on clinical stabilization, infection management, orthognathic care, neurorehabilitation, and cranioplasty. The hemiplegia and aphasia partially recovered during 12 months, and final dental occlusion was appropriate. Our report demonstrates that an unfavorable Le Fort I fracture trajectory can lead to ischemic stroke and severe neurological deficits.

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Introdução: Devido à crise sanitária mundial provocada pela disseminação da COVID-19, muitos serviços de saúde interromperam a realização de procedimentos cirúrgicos não urgentes. No cenário da Cirurgia Plástica, no qual a maioria das cirurgias são eletivas, estimam-se consequências socioeconômicas a estes especialistas. O objetivo deste estudo é dimensionar este impacto. Métodos: Os efeitos da pandemia dentro da prática clínica dos cirurgiões plásticos brasileiros foi investigada por meio de um questionário on-line, endereçado aos associados da Sociedade Brasileira de Cirurgia Plástica. Resultados: A pesquisa foi aplicada a 645 cirurgiões. A maioria dos entrevistados relatou restrições operacionais à realização de procedimentos e redução da renda, sobretudo nas regiões severamente afetadas pela pandemia. Cirurgiões plásticos com mais de 10 anos de formação foram os mais prejudicados. Elevada taxa de contaminação, sobrecarga mental, diminuição na prática de atividades físicas e uso de medicações psiquiátricas também foram relatados. Conclusão: A pandemia da COVID-19 trouxe mudanças no cenário pessoal e profissional do cirurgião plástico brasileiro. Devido à importante redução no volume de trabalho, houve impacto financeiro nos especialistas de todas as regiões do país, além de reflexos na saúde física e mental. Adaptações foram necessárias para manutenção dos atendimentos, além de exploração de novas áreas de atuação para suprir a baixa demanda de cirurgias estéticas durante a crise.

Introduction: Global sanitary crisis caused by the spread of COVID-19 induced many health services to stop performing non-urgent surgical procedures. In the scenario of plastic surgery, where most procedures are elective, socioeconomic consequences are estimated for these specialists. The objective of this study is to measure this impact. Methods: Effects of the pandemic within the clinical practice of Brazilian plastic surgeons were investigated through an online questionnaire addressed to members of the Sociedade Brasileira de Cirurgia Plástica. Results: A survey was applied to 645 surgeons. Most respondents reported operation restrictions on procedures and income reduction, especially in regions severely affected by the pandemic. Plastic surgeons with more than 10 years of experience were the most affected. High contamination rates, mental overload, decreased physical activity, and psychiatric medications have also been reported. Conclusion: COVID-19 pandemic brought changes to the personal and professional life of the Brazilian plastic surgeon. Due to the significant reduction in the workload, there were financial impacts on specialists from all country regions, besides physical and mental health issues. Adaptations were mandatory to maintain services and explore new areas of activity to supply the low demand for cosmetic surgery during the crisis.

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Abstract Introduction: Trismus has been considered a late complication of cancer treatment. It can occur prior to treatment, mainly caused by tumor invasion or muscle spasms induced by the presence of the tumor. Objective: In this study, we evaluated the incidence of trismus and its effect on oral health in patients with malignant neoplasms of the oral cavity before performing the cancer treatment. Methods: This review was carried out via interviews, visual clinical inspection and objective measurement of maximal mouth opening in 35 consecutive patients. Trismus was defined as a maximal mouth opening <35 mm. Results: Trismus was observed in 15 patients, with a total incidence of 42%. A high rate of tooth loss was recorded, and trismus association with tooth loss was statistically verified using the Chi-square and Fisher's exact tests, the t-student test and Mann-Whitney non-parametric test. All tests were performed at p < 0.05. Conclusion: Edentulous patients are eight times more likely to have trismus compared to patients that are partially and fully dentate. Trismus was demonstrated to be correlated with tooth loss; however other oral health conditions were not shown to be a modifying factor.

Resumo Introdução: O trismo tem sido considerado uma complicação tardia do tratamento do câncer, pode ocorrer antes do tratamento, causado principalmente por invasão tumoral ou espasmos musculares induzidos pela presença do tumor. Objetivo: Avaliar a incidência do trismo e seu efeito sobre a saúde bucal em pacientes com neoplasias malignas da cavidade bucal antes de se submeterem ao tratamento do câncer. Método: Esta revisão foi realizada por meio de entrevistas, inspeção clínica visual e mensuração objetiva da abertura bucal máxima em 35 pacientes consecutivos. O trismo foi definido como abertura bucal máxima < 35 mm. Resultados: O trismo foi observado em 15 pacientes, com uma incidência de 42%. Uma alta taxa de perda dentária foi registrada e a associação do trismo com a perda dentária foi verificada estatisticamente com os testes qui-quadrado, exato de Fisher, t de Student e não paramétrico de Mann-Whitney. Todos os testes foram realizada com p < 0,05. Conclusão: Pacientes edêntulos são oito vezes mais propensos a ter trismo do que os pacientes parcial e totalmente dentados. O trismo demonstrou estar correlacionado com a perda dentária. Entretanto, as outras condições de saúde bucal não se mostraram um fator modificador.

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A assimetria mamária é um diagnóstico prevalente com diversas modalidades cirúrgicas para seu tratamento. O correto diagnóstico, levando-se em conta os sistemas de classificação existentes é imperativo para que os melhores resultados sejam alcançados. Através de revisão da literatura foram levantadas as principais e mais aceitas propostas de classificação e tratamento das assimetrias mamárias. Estas classificações disponíveis datam da década de 60 e 70 e carecem de atualização para o contexto clínico atual. Após ampla revisão da literatura foi proposta uma classificação mais simplificada e reprodutível, levando-se em conta as assimetrias mais frequentes nos consultórios de cirurgia plástica estética, com seus respectivos guias de tratamento. Cinco grupos foram criados: 1 - mamas hipotróficas com assimetria de volume; 2 - hipotrofia com assimetria de volume e contorno; 3 - mamas normotróficas, ptóticas e sem desejo de aumento do volume; 4 - mamas normotróficas, ptóticas e com desejo de aumento do volume final; 5 - mamas assimétricas e hipertróficas. Baseado nos achados clínicos, foi criado um algoritmo de tratamento para cada subtipo de assimetria, incluindo neste arsenal, próteses mamárias de volumes diferentes, mastopexias, mamoplastia redutoras, além da lipoenxertia. Importante ressaltar que a assimetria mamária é a regra e não a exceção, entretanto, é motivo de insatisfação das pacientes e um desafio para o cirurgião plástico.

Breast asymmetry is a prevalent diagnosis that has several surgical modalities for its treatment. The correct diagnosis, taking into account the existing classification systems, is imperative for achieving the best results. The leading and most accepted proposals for the classification and treatment of breast asymmetries were raised through the literature review. These available classifications date from the 60s and 70s and need to be updated to the current clinical context. A more simplified and reproducible classification was proposed after a comprehensive literature review, considering the most frequent asymmetries in aesthetic plastic surgery offices, with their respective treatment guides. Five groups were created: 1 - hypotrophic breasts with volume asymmetry; 2 - hypotrophy with volume and contour asymmetry; 3 - normotrophic, ptotic breasts and with no desire to increase the volume; 4 - normotrophic, ptotic breasts and with a desire to increase the final volume; 5 - asymmetric and hypertrophic breasts. Based on the clinical findings, a treatment algorithm was created for each subtype of asymmetry, including in this arsenal, breast implants of different volumes, mastopexies, reduction mammoplasty, and fat grafting. It is important to emphasize that breast asymmetry is the rule and not the exception, therefore, it is a reason for patient dissatisfaction and a challenge for the plastic surgeon.

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BACKGROUND: The Hospital das Clínicas - University of Sao Paulo Medical School (HCFMUSP) is the largest university hospital complex in Brazil. HCFMUSP has been converted into a reference center for coronavirus disease 2019. The Division of Plastic Surgery postponed non-essential surgeries and outpatient consultations, accomplishing new guidelines (ANG) of national and international organizations. Even with these challenges arising from the pandemic, alternatives were considered to maintain institutional characteristics. This study aims to analyze this new scenario and the impact on patients' assistance and Plastic Surgery residents training. METHODS: Total number of surgeries, type of procedures, and outpatient consultations in 2020, before (pre-ANG) and after (post-ANG) ANG, were compared with the same period in 2019 (2019-pre and 2020-post). RESULTS: A marked reduction in the total number of surgeries and outpatient consultations was observed in the post-ANG period. In the post-ANG period, 267 operations were performed (26.7 ± 20.3/week), while in the 2019-post period, 1036 surgeries were performed (103.6 ± 9.7/week) (p = 0.0002). Similarly, 1571 consultations were conducted in the post-ANG period (157.1 ± 93.6/week), while in the 2019-post period, 3907 were performed (390.7 ± 43.1/week) (p = 0.0003). However, in the post-ANG period, an increase in the proportion of reconstructive compared with aesthetic surgery was observed. The maintenance of highly complex procedures such as microsurgical transplants was also identified. CONCLUSIONS: The predominant profile of reconstructive surgeries at the Division of Plastic Surgery allowed the continuity of procedures at all technical complexity levels, patient care maintenance, and Plastic Surgery residents training.Level of evidence: not ratable.