RESUMO

One of the first signs of aging belongs to the upper third of the face. With the aging process, mestizo facial features become more prominent. The thicker skin-soft tissue envelope (S-STE) has a tendency to sag more, hooding of the eyelids tends to be more pronounced, and there is a tendency for eyebrows to droop, specifically the tail of the brows, because of the loss of support. A "tired" or "sad" look implies that the complex eyebrow-upper eyelid is showing one or more of these signs. Different surgical as well as non-surgical techniques have been described to treat this area, every one of them aiming at making the patient look rested and natural. The objective of this study is to describe a technique for endoscopic brow lifting, consisting on minimal incisions, a biplanar dissection, and a different fixation technique designed for helping reshape the brow. This particular surgical technique has shown the advantage of being minimally invasive and effective. Careful analysis of the patient should be made to decide both the technique and the changes desired by the patient and the surgeon. The authors believe the technique described is another option for approaching and fixating the heavy eyebrows in mestizo patients.

Assuntos

RESUMO

Los paragangliomas son las neoplasias vasculares benignas más comunes del cuello. Surgen de células paragangliónicas extraadrenales derivadas de la cresta neural. El 90% se presentan en el tejido adrenal y 10% en tejidos extraadrenales de los cuales el 85% son abdominales, 12% torácicos y 3% en cabeza y cuello. El sitio más común de presentación es el cuerpo carotídeo, seguido por yugulotimpánicos y vagales. Otros sitios infrecuentes incluyen laringe, cavidad nasal, órbita, tráquea, cuerpo aórtico y mediastino. Se presentan los casos de dos pacientes con paragangliomas laríngeos en quienes se realizó faringotomía lateral y laringofisura, para connotar la importancia de tener presentes los diagnósticos diferenciales ante el hallazgo de una masa supraglótica y plantear un flujograma diagnóstico y terapéutico. Aunque con ambos abordajes se logra la remoción completa, son comunes las complicaciones postoperatorias; la faringotomía lateral es técnicamente más difícil y las complicaciones potenciales son más serias que con laringofisura.

Paragangliomas are the most common type of benign vascular tumors of the neck. Extraadrenal paraganglionicas arise from cells derived from the neural crest. 90% occur in the adrenal tissue and 10% in extra-adrenal tissues of which 85% are abdominal, thoracic 12% and 3% in head and neck. The most common site is the carotid body, followed by yugulotimpánicos and vagal. Other rare sites include the larynx, nasal cavity, orbit, trachea, mediastinum and aortic body. We present the cases of two patients with laryngeal paragangliomas who underwent to pharyngotomy and laryngofi ssure; in order to connote the importance of differential diagnoses present before a fi nding of a supraglottic mass and pose diagnostic and therapeutic fl owchart. Although both approaches allows the complete removal of the mass; postoperative complications are common; pharyngotomy approach is technically more diffi cult and potential complications are more serious than laryngofi ssure.

Assuntos

RESUMO

One of the first signs of aging belongs to the upper third of the face. At the same time, the height and shape of the eyebrows are key points of the periorbital aesthetics. A "tired" or "sad" look implies that the complex eyebrow-upper eyelid are showing one or more of these signs. Different surgical techniques as well as nonsurgical have been described to treat this area, every one of them aiming at making the patient look rested and natural. The objective of this study is to describe a technique for endoscopic browlifting, consisting of minimal incisions, a biplanar dissection, and a different fixation technique designed for helping reshape the brow. Twenty-five patients who fulfilled the criteria for the study were analyzed for brow-position changes in height and shape. All the patients were treated by the senior authors using the technique described. This particular surgical technique has shown the advantage of being minimally invasive and effective. Careful analysis of the patient should be made to decide both the technique and the changes desired by the patient and the surgeon. The authors believe the technique described is another option for approaching and fixating the eyebrow.

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RESUMO

Mucormycosis is a lethal opportunistic fungal infection, described mostly in immunocompromised patients. A comparative cohort study was conducted to compare the evolution of the study group patients with rhino-orbital mucormycosis, in which a therapeutic protocol was instituted, in which the pterygomaxillary fossa is systematically surgically approached and orbital exenteration is performed or not based on the spreading of the infection to the orbital apex or the orbital fissure, with a historical group where these criteria were not applied. Fifteen cases were included, eight in historic group A and seven in the study group B. Medical treatment was provided with control of the underlying disease (amphotericin B and low molecular weight heparin) as well as surgical treatment with extensive debridement including endoscopic ethmoidectomy and exploration of the pterygomaxillary fossa, also performing orbital exenteration only in patients who presented orbital apex syndrome in group B. In group A, there was a mortality rate of 50%, in group B all patients were clinical cured; however, the two patients with hematologic diseases died of complications not related to the fungal infection. With the standardization of a diagnostic and therapeutic protocol, good results in healing and survival of patients can be obtained.

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