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PURPOSE: Evaluate the impact of counterclockwise rotation of the occlusal plane (CCWROP) on pharynx morphology and polysomnography in maxillomandibular advancement (MMA) surgery to treat obstructive sleep apnea (OSA) patients. METHODS: Prospective clinical trial of patients with OSA treated by MMA. Computed tomography and polysomnography were performed pre- and postoperatively and the parameters were compared. The surgery classified the patients into two groups: with (R) and without (NR) CCWROP. RESULTS: The study sample comprised 38 individuals: R (n = 19) and NR (n = 19). An anterior mandible advancement of 0.71 mm was identified for each degree of CCWROP (p < 0.001). As for polysomnography, the apnea-hypopnea index was reduced by 80% and 62% in R and NR, showing final values of 6.8 and 13.0, respectively. The apnea index changed equally in both groups. Reduction of 68 and 26% in the hypopnea index was observed for R and NR, respectively, with no statistically significant difference. Total volume increased by 45% in R and 30% in NR. Retropalatal and retrolingual volumes increased by 49% and 4% in R and 43% and 15% in NR, respectively. The minimum axial area increased by 92% in the retropalatal region and 97% in the retrolingual region in R, whereas these increases were of 76% and 31% in NR, respectively. CONCLUSION: Anterior mandibular advancement of 0.71 mm for each degree of CCWROP is of great importance for surgical planning. As a result of this resource, individuals in R presented better results than those in NR in all parameters assessed, especially regarding the retrolingual region.
Assuntos
Avanço Mandibular , Procedimentos Cirúrgicos Ortognáticos , Faringe/cirurgia , Polissonografia , Apneia Obstrutiva do Sono/cirurgia , Adulto , Feminino , Humanos , Masculino , Avanço Mandibular/métodos , Avanço Mandibular/normas , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Ortognáticos/métodos , Procedimentos Cirúrgicos Ortognáticos/normas , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos ProspectivosRESUMO
Objective: This study aimed to introduce a spirit level device for mounting maxillary casts to compare the reproducibility between the facebow and this new technique.Methods: The maxillary casts of 10 participants were mounted in three different situations: 1) with the facebow; 2) with the spirit level device, the participant in seated position; and 3) with the spirit level device with participant in standing position. Each procedure was performed by three different evaluators. The values obtained were calculated using the Technical Error of Measurement (TEM) and the inter-evaluator Coefficient of Variation (CV).Results: The mean values obtained were 4.3 mm, 2.2 mm, and 2.6 mm for absolute TEM; 8.7%, 5.4%, and 6.4% for relative TEM; and 7.3%, 4.5%, and 5.6% for CV.Conclusion: These results show that the facebow is less reproducible compared to the new device, demonstrating that the new technique can be satisfactorily used in clinical practice.
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Articuladores Dentários , Oclusão Dentária , Aparelhos de Tração Extrabucal , Humanos , Registro da Relação Maxilomandibular , Modelos Dentários , Reprodutibilidade dos TestesRESUMO
PURPOSE: To assess the effects of transverse maxillomandibular distraction osteogenesis (TMDO) on the treatment of obstructive sleep apnea (OSA) and on the morphology of the pharynx. METHODS: A clinical trial was conducted with seven patients with OSA and with transverse maxillomandibular deficiency, two women and five men aged on average 41.16 ± 10.9 years on the day of surgery. All participants were submitted to computed tomography (CT) and full-night polysomnography (PSG) before and approximately 9 months after surgery. A 95% confidence interval was defined. RESULTS: The AHI and RDI of the participants were reduced by about 62% (from 27.65 ± 36.65 to 10.73 ± 11.78, p = 0.031 and from 41.21 ± 32.73 to 15.30 ± 13.87, p = 0.015, respectively). The airway showed a surprising mean reduction in volume of 10% (from 5.78 ± 2.53 to 4.71 ± 1.42, p = 0.437, for the upper pharynx; from 6.98 ± 2.23 to 6.23 ± 2.05, p = 0.437, for the lower pharynx; and from 12.76 ± 1.56 to 10.94 ± 2.42, p = 0.625, for the total pharynx). However, the site of the smallest area of the pharynx was considerably increased both in the anteroposterior and transverse direction and in its total area (from 0.88 ± 7.11 to 0.99 ± 0.39, p = 0.625; from 1.78 ± 0.81 to 2.05 ± 0.61, p = 0.812; and from 0.99 ± 0.74 to 1.40 ± 0.51, p = 0.180, respectively). CONCLUSION: TMDO proved to be efficient in reducing or curing OSA, producing modifications of upper pharynx morphology with an increase of the smallest area of the pharynx.
Assuntos
Avanço Mandibular/métodos , Procedimentos Cirúrgicos Bucais/métodos , Osteogênese por Distração/métodos , Técnica de Expansão Palatina/instrumentação , Apneia Obstrutiva do Sono/cirurgia , Adulto , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Pessoa de Meia-Idade , Faringe/fisiopatologia , Polissonografia/métodos , Resultado do TratamentoRESUMO
BACKGROUND: The malignant transformation of laryngeal papillomatosis (LP) into squamous cell carcinoma (SCC) can occur in up to 4% of LP cases. The low-risk HPV types 6 and 11 are those that are most commonly related to LP; however, high-risk HPV types may be present. The present study reviews the literature on cases of malignant transformation of LP in adults and reports a clinical case. CASE REPORT: A 47-year-old male patient exhibiting hoarseness for 4 months presented an exophytic lesion in the right palatine tonsil and a digitiform-like lesion in the right vocal fold. The biopsy revealed a well-differentiated SCC in the vocal cord, which showed a transition zone with a squamous papillomatous lesion. By using the chromogenic in situ hybridization (CISH) test, both lesions showed a positive result for high-risk HPV types 16 and 18 and negative for low-risk HPV types 6 and 11. The final diagnosis was SCC arising from LP. The patient underwent surgical treatment. After 36 months of follow-up, no signs of recurrence were observed. RESULTS: The literature review revealed 25 cases of malignant transformation into SCC of LP with adult onset. Of these, only 9 cases were assessed by CISH and/or PCR for HPV identification, of which 7 were positive. The current study focuses on the eighth case, suggesting the involvement of the high-risk HPV types in its pathogenesis. CONCLUSIONS: LP is considered a benign lesion with the potential for malignant transformation, which reinforces the need for its early diagnosis and the constant monitoring of patients with LP.
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PURPOSE: The aim of this study was to determine the rate of success and complications of juvenile nasoangiofibroma resection by Le Fort I osteotomy. MATERIAL AND METHODS: Data were obtained from the medical records of 40 patients with a diagnosis of juvenile nasoangiofibroma confirmed by anatomopathological examination. All tumors were resected by Le Fort I osteotomy between 1983 and 2010. The data obtained were gender, age, symptoms, sites of invasion, preoperative embolization, routes of surgical access, duration of surgery, complications, need for transfusion, relapses, and follow-up time. RESULTS: All patients were male, ranging in age from 7 to 27 years. The most common symptom was nasal obstruction, and central nervous system (CNS) invasion was present in 27.5% of cases. Craniotomy was associated with Le Fort I osteotomy in only one case. The mean duration of surgery was 216 min. Complications occurred in 15% of cases, with intraoperative bleeding being the most frequent one. Relapses occurred in 5% of cases. The mean follow-up was 48.8 months. CONCLUSION: Exclusively surgical treatment by Le Fort I access proved to be a safe and effective method for the treatment of nasoangiofibromas, permitting the removal of tumors even in patients with extension to the CNS, with a low rate of complications and relapses.
Assuntos
Angiofibroma/cirurgia , Maxila/cirurgia , Neoplasias Nasais/cirurgia , Osteotomia de Le Fort/métodos , Adolescente , Adulto , Angiofibroma/patologia , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Neoplasias do Sistema Nervoso Central/patologia , Criança , Embolização Terapêutica/métodos , Seguimentos , Humanos , Complicações Intraoperatórias , Masculino , Obstrução Nasal/patologia , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Nasais/patologia , Duração da Cirurgia , Cuidados Pré-Operatórios , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Condylar hyperplasia (CH) is a rare, self-limiting process manifesting between the first and third decades of life. CH causes facial asymmetry and derangement of the occlusion. Management involves resection of the condylar head and orthognathic surgery. This paper describes the case of a 37-year-old woman with spontaneous onset of CH over a span of approximately 25 years. The condition was managed with resection of the condyle alone, which dramatically improved facial asymmetry and altered the occlusion within a few months of follow up. Orthodontic treatment was then carried out and the patient underwent orthognathic surgery after 3 years. The patient is currently satisfied with her appearance and function and there are no signs of recurrence.
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Face/anatomia & histologia , Hiperplasia , Côndilo Mandibular/patologia , Adulto , Feminino , HumanosRESUMO
OBJECTIVE: To determine whether the retrolingual pharynx shows the same morphometric modifications during the Muller manoeuvre and during drug-induced sleep endoscopy (DISE) with propofol in patients submitted for maxillomandibular advancement surgery. SUBJECTS AND METHODS: Eighteen patients submitted for maxillomandibular advancement surgery (MMAS) were evaluated endoscopically before and 6 month after surgery in the region of the retrolingual pharynx while seated and lying in dorsal decubitus (supine) while performing the Muller manoeuvre and during DISE with propofol, to verify and measure if the same morphometric changes occur in the retrolingual pharynx during the Muller manoeuvre and during DISE with propofol. The area, anteroposterior, and laterolateral retrolingual pharynx images were acquired using the Sony Vegas 8.0 software and recorded on a DVD. The Image J software was used to measure and compare these images. RESULTS: An increase in the pharyngeal aperture was observed in all measurements after surgery, specifically in area retrolingual pharynx images. When the Muller manoeuvre was performed, a greater gain (113%) in area retrolingual pharynx measurement was observed when the patient was awake and seated. With the patient was in dorsal decubitus during DISE with propofol there was a greater gain in area retrolingual pharynx measurement (201.33%) in the smaller aperture. CONCLUSION: The Muller manoeuvre after MMAS does not simulate the dimensions of the pharynx that occur during sleep.
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Faringe/patologia , Postura/fisiologia , Apneia Obstrutiva do Sono/cirurgia , Sono/fisiologia , Adulto , Anestésicos Intravenosos/administração & dosagem , Cefalometria/métodos , Feminino , Seguimentos , Humanos , Inalação/fisiologia , Laringoscopia/métodos , Masculino , Avanço Mandibular/métodos , Maxila/cirurgia , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Faringe/cirurgia , Polissonografia/métodos , Propofol/administração & dosagem , Sono/efeitos dos fármacos , Apneia Obstrutiva do Sono/patologia , Decúbito Dorsal/fisiologia , Gravação em Vídeo/métodosRESUMO
Ameloblastoma is a relatively uncommon benign odontogenic tumor, which is locally aggressive and has a high tendency to recur, despite its benign histopathologic features. This pathology can be classified into 4 groups: unicystic, solid or multicystic, peripheral, and malignant. There are 3 variants of unicystic ameloblastoma, as luminal, intraluminal, and mural. Therefore, in mural ameloblastoma, the fibrous wall of the cyst is infiltrated with tumor nodules, and for this reason it is considered the most aggressive variant of unicystic ameloblastomas. Various treatment techniques for ameloblastomas have been proposed, which include decompression, enucleation/curettage, sclerotizing solution, cryosurgery, marginal resection, and aggressive resection. Literature shows treatment of this lesion continues to be a subject of intense interest and some controversy. Thus, the authors aimed to describe a case of a mural unicystic ameloblastoma of follicular subtype in a 19-year-old subject who was successfully treated using conservative approaches, as decompression. The patient has been followed up for 3 years, and has remained clinically and radiographically disease-free.
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Ameloblastoma/cirurgia , Descompressão Cirúrgica/métodos , Neoplasias Mandibulares/cirurgia , Ameloblastoma/diagnóstico por imagem , Ameloblastoma/patologia , Feminino , Humanos , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/patologia , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Radiografia Panorâmica , Dente Impactado/diagnóstico por imagem , Dente Impactado/patologia , Dente Impactado/cirurgia , Adulto JovemRESUMO
Introduction There is currently no consensus regarding the best method for predicting the changes in soft tissues due to the modification of hard tissues in orthognathic surgery. Objective To measure the changes in soft tissues of the upper lip, lower lip, and chin regions due to the modifications of hard tissues caused by orthognathic maxillary advancement surgery using a cephalometric methodology. Methods The study was conducted on 35 patients with dentoskeletal and facial deformities submitted to orthognathic maxillary advancement surgery. Two teleradiographs were taken: one during the preoperative period and the other 1 year after the surgery, on which the cephalometric tracing was drawn. Results A strong correlation (r = 0.747) was demonstrated in the horizontal analysis between the hard A (Ah) point (located in the deepest point of the anterior curvature of the maxilla) and the soft A (As) point in the advancement of the maxilla, with a mean variation of 0.859% occurring in As with each 1% variation of the Ah point. A mean variation of 0.698% occurred in the superior soft prostion point (prolongation of the superior hard prostion point to its corresponding point on soft tissue) for each 1% variation in the superior hard prostion point (bone point located at the junction of the alveolar process with the crown of the upper incisors). Conclusion The cephalometric methodology applied here revealed that the soft tissues of the upper lip accompanied 70 to 80% of the movement of hard tissues in maxillary advancement and that the soft tissues of the lower lip did not change or showed no significant changes.
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Ameloblastoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Ameloblastoma/diagnóstico por imagem , Ameloblastoma/patologia , Biópsia , Feminino , Humanos , Mandíbula , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia , Tomografia Computadorizada por Raios XRESUMO
Firearm injuries in the lower jaw may cause significant loss of hard and soft facial tissues, resulting in aesthetic and functional deformity. In this article, we present a case of a patient who suffered avulsion of the soft and hard tissues of the left mandible body and symphysis. After the emergency treatment, the patient was referred to our service, and the treatment was performed in 3 stages: surgical reconstruction with vascularized fibula flap, distraction osteogenesis, and dental implant rehabilitation. During 5 years of follow-up period, the aesthetic and functional condition of the patient improved considerably.
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Traumatismos Mandibulares/cirurgia , Reconstrução Mandibular/métodos , Ferimentos por Arma de Fogo/cirurgia , Adulto , Desbridamento , Feminino , Fíbula/transplante , Humanos , Traumatismos Mandibulares/diagnóstico por imagem , Radiografia Panorâmica , Retalhos Cirúrgicos , Ferimentos por Arma de Fogo/diagnóstico por imagemRESUMO
INTRODUCTION: Maxillomandibular advancement (MMA) has been reported to be the most effective surgical treatment of obstructive sleep apnea (OSA). Most reports about MMA aim to confirm the efficiency of this treatment modality, but few describe the anatomical changes produced in the pharynx by the surgery. Thus, the objective of the present investigation was to quantify the anatomical changes of the pharynx that occur in patients with OSA after MMA surgery using magnetic resonance (MR). METHODS: Twenty patients with a polysomnographic diagnosis of OSA participated in the study. All patients were submitted to image acquisition by MR performed during wakefulness. Polysomnography and MR were performed preoperatively and 6 months after MMA. Volume analysis (in cubic millimeters) was performed as the sum of the areas multiplied by their thickness, with no intervals between sections. The pharyngeal air space of the region between the hard palate and the base of the epiglottis was divided into a retropalatal (RP) region and a retrolingual (RL) region. RESULTS: Postoperative MR showed a mean volumetric increase of 26.72 % in the RP region and of 27.2 % in the RL region. DISCUSSION: MMA increases the air space of the pharynx by expanding the facial skeletal structure to which the soft tissues of the pharynx and tongue are fixed, with a consequent reduction of collapsibility in the presence of negative pressure during inspiration. This reduced possibility of pharyngeal collapse may contribute to the reduction of obstructive events.
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Aumento da Imagem , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Avanço Mandibular/métodos , Faringe/patologia , Polissonografia , Complicações Pós-Operatórias/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/cirurgia , Adulto , Cefalometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: Prophylactic neck dissection (PND) is indicated when the chance of occult lymph node metastases from head and neck tumors is significant. There is no consensus regarding which tumor size PND would be indicated in cases of lip cancer. METHODS: A total of 139 patients with surgically treated lip cancer were selected. The size of the lesion (T) and the presence of lymph node metastases (N) were assessed by examining the medical records. For analysis purposes, the T2 group was divided into T2a (2 to 3 cm) and T2b (3 to 4 cm). RESULTS: The following distribution of incidence of neck metastases was observed in the study groups: 11.7% in T1, 9% in T2a, 43.7% in T2b, and 52.2% in T3+T4. Statistical comparison of the groups (p) revealed the following results: T2aXT2b=0.03; T2aXT3+T4=0.001. CONCLUSION: PND is indicated for tumors larger than 3 cm.
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Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/secundário , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Labiais/patologia , Excisão de Linfonodo , Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Metástase Linfática , Carcinoma de Células Escamosas de Cabeça e PescoçoRESUMO
The aim of this study is to report the case of a quick growing brown tumour in the jaw after a parathyroidectomy due to the presence of a rare fifth parathyroid gland. The patient had chronic renal disease and the diagnosis was tertiary hyperparathyroidism. Thirty days after the parathyroidectomy, the patient returned with a significant increase in the tumour size. The suspicion of a supernumerary gland was confirmed by parathyroid scintigraphy. The treatment of brown tumour is dependent on the treatment of the hyperparathyroidism. However, curettage should be considered if a large lesion is disturbing mastication. In conclusion, this case should attract the attention of general practitioner dentists, since they may be the first professionals who have contact with the patient with a brown tumour in the jaws. Likewise, this case emphasises the importance of knowing the type of hyperparathyroidism involved to allow for effective treatment planning.
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Hiperparatireoidismo Secundário/etiologia , Doenças Mandibulares/etiologia , Osteíte Fibrosa Cística/etiologia , Glândulas Paratireoides/anormalidades , Granuloma de Células Gigantes/etiologia , Granuloma de Células Gigantes/cirurgia , Humanos , Hiperparatireoidismo Secundário/cirurgia , Masculino , Doenças Mandibulares/cirurgia , Osteíte Fibrosa Cística/cirurgia , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Paratireoidectomia , Complicações Pós-Operatórias , Cintilografia , Insuficiência Renal Crônica/complicações , Adulto JovemRESUMO
PURPOSE: The aims of the study were to measure endoscopically the retrolingual pharynx during wakefulness and sleep before and after maxillomandibular advancement surgery and to quantify the changes observed. MATERIALS AND METHODS: Eighteen patients with mild to severe grade obstructive sleep apnea hypopnea were evaluated during wakefulness while sitting and lying down and during induced sleep in dorsal decubitus while breathing naturally. Images of the retrolingual region of the pharynx were captured with a nasofibroscope and recorded on a DVD using the Sony Vegas 8.0 software (Sony Creative Software, Madison, WI). The images captured in greater and smaller aperture were measured with the Image J software (produced by Wayne Rasband, United States National Institutes of Health, Bethesda, MD) in linear anteroposterior and linear laterolateral areas. A correction factor was then applied to equalize the size of the images and thus compare them to one another. RESULTS: The postoperative dimensions of the pharynx always increased significantly in all measurements compared with the preoperative ones. During induced sleep in dorsal decubitus, there was a greater gain in the area of smaller aperture (201.33%). CONCLUSIONS: The proposed method showed that the dimensions of the pharynx always increased significantly after surgery for maxillomandibular advancement, although the gain was not homogeneous in all dimensions and also varied according to state of consciousness. The greatest gain was observed in the area of smaller aperture with the patient in induced sleep, thus reducing the collapse of the pharynx.
Assuntos
Laringoscopia/métodos , Faringe/patologia , Síndromes da Apneia do Sono/diagnóstico , Adulto , Idoso , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Polissonografia , Síndromes da Apneia do Sono/fisiopatologia , VigíliaRESUMO
OBJECTIVES: The objective of the present study was to evaluate intraluminal esophageal pressure during voice and speech emission in speaking laryngectomees with a tracheoesophageal prosthesis. METHODS: In our prospective analysis in a tertiary-care academic hospital, 25 laryngectomees were divided into 2 groups: 11 speaking individuals with a tracheoesophageal prosthesis and a control group of 14 nonspeaking laryngectomees. All patients were subjected to manometry during voice and speech emission tests. We determined the pressures achieved in the distal, middle, and proximal parts of the esophagus. RESULTS: Statistical analysis revealed that the amplitude of pressure in the distal esophagus during sound emission was higher in speaking laryngectomees; in the middle esophagus, intraluminal pressure during emission of the sentence was higher in speaking subjects, and in the proximal esophagus there was no difference between the groups. CONCLUSIONS: During the manometric evaluation of the distal and middle esophagus in the presence of voice and speech emission, the intraluminal pressure revealed a significant difference for the speaking laryngectomees with a tracheoesophageal prosthesis. The proximal esophagus behaved similarly in the groups of speakers and nonspeakers. Speaking laryngectomees with a tracheoesophageal prosthesis depend on a differentiated performance of the middle and distal parts of the esophagus.
Assuntos
Esôfago/fisiopatologia , Laringectomia , Laringe Artificial , Voz Alaríngea , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , PressãoRESUMO
OBJECTIVE: To test the viability of a tracheal autotransplant, with an original technique using a prefabricated flap from a complete tracheal neovascularized segment (CTNVS) of the sternohyoid muscle anastomosed by a microsurgical technique. STUDY DESIGN: An experimental study using dogs as an animal model. METHODS: Ten mongrel dogs weighing 23 to 40 kg were divided into two groups: group I (control), five animals submitted to autotransplant of the CTNVS without a microsurgical vascular anastomosis; and group II, five dogs submitted to autotransplant of the CTNVS with a microsurgical vascular anastomosis. RESULTS: All group I dogs developed respiratory insufficiency and died because of necrosis and stenosis of the autotransplanted CTNVS, whereas all group II dogs completed a minimum period of 90 days of observation without any clinical changes. Macro- and microscopic analysis revealed intact tracheal structures. CONCLUSIONS: The present clinical and morphological findings demonstrate that the CTNVS autotransplant is viable, when a microsurgical vascular anastomosis is used.
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Microcirurgia/métodos , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Obtenção de Tecidos e Órgãos/métodos , Traqueia/transplante , Doenças da Traqueia/cirurgia , Animais , Modelos Animais de Doenças , Cães , Feminino , Seguimentos , Masculino , Neovascularização Fisiológica , Traqueia/irrigação sanguínea , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
OBJECTIVE: To determine the histologic finds of autologous fat graft (AFG) in 24 paralyzed canine left vocal folds 12 weeks after introduction. STUDY DESIGN: Animal model. Experimental prospective study. METHODS: Twenty-four mongrel dogs of both genders weighing 15 to 20 kg were divided into three study groups (SGs) of eight dogs each, whose larynges were grafted by vocal fold lipoinjection (VFL-SGA), vocal fold lipoinjection plus insulin (VFLI-SGB), and by fat graft medialization laryngoplasty (FGML-SGC), respectively, and observed for 12 weeks, followed by immediate sacrifice. All 24 dogs were submitted to left vagal and recurrent laryngeal nerve resection. All animals were confirmed to have a left vocal fold paralysis four weeks later, when 2 mL of autologous fat graft were placed inside the left paraglottic space. The larynges were removed at pre-established times and, after they were studied for remaining fat graft volume by magnetic resonance imaging, they were studied histologically to evaluate the influence of the different techniques on the histologic behavior of the graft. RESULTS: Each of the three study groups had its specific finds for fat graft detection and fat absorption, and its characteristics identified and compared statistically. The groups were not statistically different. CONCLUSION: The histologic findings for the AFG applied to a vocal fold were similar in groups VFL-SGA, VFLI-SGB and FGML-SGC 12 weeks after grafting, with no statistically significant differences between groups, and revealed an almost total loss of the grafted fat.
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Tecido Adiposo/transplante , Laringe/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/cirurgia , Animais , Modelos Animais de Doenças , Cães , Injeções Intralesionais , Estudos Prospectivos , Transplante AutólogoRESUMO
BACKGROUND: Major skull defects, especially in the anterior region, can present as a most disturbing deformity. Reconstructive cranioplasty can restore cerebral protection and improve craniofacial aesthetics. Complex and large skull defects in children often present reconstructive difficulties. MATERIALS AND METHODS: In this paper, an unusual case of a very large post-traumatic defect (318 cm(2)) in a child managed by a multidisciplinary team is described. The literature is reviewed. CONCLUSION: The management of a large complex skull defect in children is still controversial. Each case should be extensively debated in craniofacial units. In our case, bioceramics proved to be an effective and good alternative for final skull reconstruction.