Ovariectomy by left flank approach in prepubertal Nelore (Bos indicus) heifers

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Ovariectomy by laparotomy, a video-assisted approach or a complete laparoscopic technique in Santa Ines sheep

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Conservative approach to the treatment of keratocystic odontogenic tumor

The odontogenic keratocyst, also known as the keratocystic odontogenic tumor, is an aggressive, intraosseous lesion of odontogenic origin that presents a high rate of recurrence. Treatment modalities include aggressive surgical procedures and more conservative approaches that significantly influence the lesion's recurrence potential. The purpose of this case report was to demonstrate a conservative approach in the treatment of an extensive keratocystic odontogenic tumor, located in the mandible's posterior region, using decompression and enucleation.

Functional and esthetic rehabilitation with In-Ceram alumina and zirconia system: A multidisciplinary approach

The development of all-ceramic systems following metalceramics restorations allowed simulation of natural dentition due to favorable esthetics and resistance. In-Ceram is an alternative when esthetics is primordial as well as resistance required in rehabilitation. However, an ideal smile is associated to not only shape, color, texture and translucency but also harmony with gingival tissue. So, the aim of this study is to report a clinical case based on periodontal and fixed partial dentures principles to perform periodontal plastic surgery followed by esthetic rehabilitation. A female patient, 40-year-old, presented complaint about dental esthetics. After clinical and radiographic exams, metal-ceramics crowns (teeth 11, 12, 13, 21, 22 and 23) were considered unsatisfactory due to marginal leakage, color change in gingival tissue associated to metallic margin, and gummy smile. So, a crown lengthening surgery of anterior teeth was performed followed by rehabilitation of superior teeth with In-Ceram single crowns. Clinical significance: The interaction between periodontics and fixed prosthodontic area is the key of an adequated treatment planning which involves gingival smile to provide function and an esthetic condition in association with an esthetic, resistant and predictable material.

Subluxation of the crystalline lens: A no-ring approach

Purpose: To report the surgical technique and outcomes of a no-ring approach to posterior chamber intraocular lens (IOL) implantation in children and young adults with subluxation of the crystalline lens. Methods: A three-piece 5.5-mm hydrophobic acrylic IOL was implanted in which the optic and one haptic were inside the capsular bag and the other haptic was in the ciliary sulcus. The implantations were done in 13 eyes of 10 patients with lens subluxation. One haptic was fixated in the ciliary sulcus by passing it through an operculum-shaped opening in the capsular bag edge, made between 2 and 3 clock hours, clockwise from the middle point of the subluxated area. Results: The mean age of the 10 patients was 12.61 ± 8.04 years and the mean follow-up was 21.38 ± 11.29 months. The mean preoperative and postoperative best-corrected visual acuity (BCVA) was 1.15 ± 0.58 and 0.37 ± 0.17 logarithm of the minimum angle of resolution, respectively, in 11 measured eyes. The postoperative BCVA was 20/40 or better in 4 eyes (36.36%), between 20/40 and 20/60 in 6 eyes (54.54%), and between 20/80 and 20/100 in 1 eye (9.09%). The BCVA improved in all eyes. Postoperative IOL decentration between 1.0 and 1.5 mm occurred in 3 of 13 eyes (23.08%). Conclusion: The results indicate that the no-ring technique allows centration of an IOL implanted into a subluxated capsular bag without using capsule tension rings. © SLACK Incorporated.

Association of fixed partial denture and gingival prosthesis as alternative approach to recover esthetics and function in anterior maxillary region

Tooth replacement in the maxillary anterior region is especially difficult when the loss includes significant amounts of the residual ridge and the soft tissue. Several techniques are available, such as dental implants or fixed partial denture, and bone and gingival grafts or gingival prostheses, respectively. This article showed a clinical case of an elderly who was treated with a collarless metal-ceramic fixed partial denture and acrylic removable gingival prosthesis to recover the esthetics in the maxillary anterior region. The association of a metal-ceramic fixed denture and gingival prosthesis was an excellent alternative in cases when surgical procedures are contraindicated. © 2012 Japan Prosthodontic Society.

An alternative approach to deal with the absence of clinical trials: a proportional meta-analysis of case series studies

PURPOSE: Systematic reviews are criticized for frequently offering inconsistent evidences and absence of straightforward recommendations. Their value seems to be depreciated when the conclusions are uncertain. To describe an alternative approach of evaluating case series studies in health care when there is absence of clinical trials. METHODS: We provide illustrations from recent experiences. Proportional meta-analysis was performed on surgical outcomes: (a) case series studies, (b) use of cryoablation or radiofrequency ablation, and (c) patients with small renal cell carcinoma. The statistically significant difference between both interventions studied was defined if their combined 95% confidential interval (CI) did not overlap. RESULTS: As demonstrated by the example, this analysis is an alternative approach to provide some evidence of the intervention´s effects under evaluation and plotting all available case series in the absence of clinical trials for the health field. CONCLUSIONS: Although we are leading to a low level of evidence to determine efficacy, effectiveness and safety of interventions this alternative approach can help surgeons, physicians and health professionals for a provisionally decision in health care along with their clinical expertise and the patient´s wishes and circumstances in the absence of high-quality primary studies. It´s not a replacement for the gold standard randomized clinical trial, but an alternative analysis for clinical research.

Endoscopic approach for a laryngeal neoplasm in a dog

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Central Giant Cell Granuloma in Pediatric Maxilla: Surgical Management

Central giant cell granuloma (CGCG) is an intraosseous lesion consisting of fibrous cellular tissue that contains multiple foci of hemorrhage, multinucleated giant cells, and occasional trabeculae of woven bone. An 8-year-old boy presented himself complaining of a painless swelling in the left maxilla that had started 1 year. Computed tomography (CT) scan confirmed a poorly defined multilocular radiolucent lesion in the left maxilla crossing the midline. The patient underwent enucleation through an intraoral approach of the lesion. The biopsy revealed multinucleated giant cells in a fibrous stroma. A CT was taken approximately 1 year postoperatively. There was no clinical or radiographic evidence of recurrence. Therefore, surgical treatment of CGCG can be performed, trying to preserve the surrounding anatomic structures, which can be maintained in case the lesion does not show an aggressive clinical behavior, avoiding large surgical defects which are undesirable in children.

Minimally Invasive Selective Neck Dissection: A Prospective Study of Endoscopically Assisted Dissection via a Small Submandibular Approach in cT(1-2)N(0) Oral Squamous Cell Carcinoma

Selective neck dissection (SND) in clinical N-0 (cN(0)) cases of oral squamous cell carcinoma (SCC) has been performed by surgeons using a retroauricular or modified facelift approach with robotic or endoscopic assistance. However, these procedures provide cosmetic satisfaction at the cost of possible maximal invasiveness. In this prospective study, we introduced and evaluated the feasibility as well as surgical invasiveness and cosmetic outcome of endoscopically-assisted SND via a small submandibular approach.Forty-four patients with cT(1-2)N(0) oral SCC (OSCC) were randomly divided into two groups of endoscopically-assisted SND and conventional SND. Perioperative and postoperative outcomes of patients were evaluated, including the length of the incision, operating time for neck dissection, estimated blood loss during the operation, amount and duration of drainage, total hospitalization period, total number of lymph nodes retrieved, satisfaction scores based on the cosmetic results, perioperative local complications, shoulder syndrome, and follow-up information.The mean operation time in the endoscopically-assisted group (126.04 +/- A 12.67 min) was longer than that in the conventional group (75.67 +/- A 16.67 min). However, the mean length of the incision was 4.33 +/- A 0.76 cm in the endoscopically-assisted SND group, and the amount and duration of drainage, total hospital stay, postoperative shoulder pain score, and cosmetic outcomes were superior in the endoscopically-assisted SND group. Additionally, the retrieved lymph nodes and complications were comparable.Endoscopically-assisted SND via a small submandibular approach had a longer operation time than the conventional approach. However, endoscopically-assisted SND was feasible and reliable while providing minimal invasiveness and satisfactory appearance.

Schwartz-Jampel Syndrome: a paediatric dentistry approach

Schwartz-Jampel syndrome (SJS) is a rare recessive disorder characterized mainly by myotonia. As the clinical signs and symptoms are manifested in the oromaxillofacial region, paediatric dentists may be first choice of parents that seek information and assistance to their children. A female patient diagnosed with SJS was brought to our clinic for dental treatment with main complain of difficulty on oral hygiene and mastication due to tooth crowding. The treatment included preventive measures, extraction of a supernumerary tooth and the maxillary primary second molars. Furthermore, the patient was referred to orthodontic treatment for correction of tooth crowding. When dealing with children with confirmed diagnosis of SSJ, paediatric dentists should be understand the need of planning the dental treatment considering the characteristics and possible complications associated with the syndrome in order to reduce the risks to patients, especially when surgical procedures are necessary.

A combined approach for the treatment of resorbed fresh sockets allowing immediate implant restoration: a 2-year follow-up

Introduction: The demand for optimal esthetics has increased with the advance of the implant dentistry and with the desire for easier, safer and faster technique allowing predictable outcomes. Thus, the aim of this case report was to describe a combined approach for the treatment of a periodontally compromised tooth by means of atraumatic tooth extraction, immediate flapless implant placement, autogenous block and particulate bone graft followed by connective tissue graft and immediate provisionalization of the crown in the same operatory time. Case Report: A 27-year-old woman underwent the proposed surgical procedures for the treatment of her compromised maxillary right first premolar. The tooth was removed atraumatically with a periotome without incision. A dental implant was inserted 3 mm apical to the cement-enamel junction of the adjacent teeth enabling the ideal tridimensional implant position. An osteotomy was performed in the maxillary tuber for block bone graft harvesting that allowed the reconstruction of the alveolar buccal plate. Thereafter, an autogenous connective tissue graft was placed to increase both the horizontal and vertical dimensions of the alveolar socket reaching the patient functional and esthetic expectations. Conclusion: This treatment protocol was efficient to create a harmonious gingival architecture with sufficient width and thickness, maintaining the stability of the alveolar bone crest yielding excellent aesthetic results after 2-years of follow-up. We suggest that this approach can be considered a viable alternative for the treatment of periodontally compromised tooth in the maxillary esthetic area enhancing patient comfort and satisfaction.

Surgical time and complications of total transvaginal (total-NOTES), single-port laparoscopic-assisted and conventional ovariohysterectomy in bitches

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Internal carotid artery pseudoaneurysm after tonsillectomy treated by endovascular approach. A case report

Surgery on the head and neck region may be complicated by vascular trauma, caused by direct injury on the vascular wall. Lesions of the arteries are more dangerous than the venous one. The traumatic lesion may cause laceration of the artery wall, spasm, dissection, arteriovenous fistula, occlusion or pseudoaneurysm. We present a case of a child with a giant ICA pseudoaneurysm after tonsillectomy, manifested by pulsing mass and respiratory distress, which was treated by endovascular approach, occluding the lesion and the proximal artery with Histoacryl. We reinforce that the endovascular approach is the better way to treat most of the traumatic vascular lesions.

Supratarsal approach to treatment of zygomatic complex fractures

Many incisions have been described for approaches to zygomatic fractures. Precise repositioning of zygomatic complex fractures is difficult. The traditional approach is through an eyebrow incision, but it can produce a scar that causes aesthetic and psychological problems for the patient. We describe the supratarsal fold approach to expose the frontozygomatic suture and to reduce small displacements of frontal sinus anterior wall; it gives good access and excellent aesthetic results.