Facial Reanimation Utilizing Combined Orthodromic Temporalis Muscle Flap and End-to-Side Cross-Face Nerve Grafts

Individuals with facial paralysis of 6 months or more without evidence of clinical or electromyographic improvement have been successfully reanimated utilizing an orthodromic temporalis transfer in conjunction with end-to-side cross-face nerve grafts. The temporalis muscle insertion is released from the coronoid process of the mandible and sutured to a fascia lata graft that is secured distally to the commissure and paralyzed hemilip. The orthodromic transfer of the temporalis muscle overcomes the concave temporal deformity and zygomatic fullness produced by the turning down of the central third of the muscle (Gillies procedure) while yielding stronger muscle contraction and a more symmetric smile. The muscle flap is combined with cross-face sural nerve grafts utilizing end-to-side neurorrhaphies to import myelinated motor fibers to the paralyzed muscles of facial expression in the midface and perioral region. Cross-face nerve grafting provides the potential for true spontaneous facial motion. We feel that the synergy created by the combination of techniques can perhaps produce a more symmetrical and synchronized smile than either procedure in isolation.Nineteen patients underwent an orthodromic temporalis muscle flap in conjunction with cross-face (buccal-buccal with end-to-side neurorrhaphy) nerve grafts. To evaluate the symmetry of the smile, we measured the length of the two hemilips (normal and affected) using the CorelDRAW X3 software. Measurements were obtained in the pre- and postoperative period and compared for symmetry.There was significant improvement in smile symmetry in 89.5 % of patients.Orthodromic temporalis muscle transfer in conjunction with cross face nerve grafts creates a synergistic effect frequently producing an aesthetic, symmetric smile.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.spinger.com/00266.

Bonding of facial silicon with nanoparticles to an acrylic resin substrate

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

Risk factors for facial melasma in women: a case-control study

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

Sistemas suplementares e alternativos de comunicação nas habilidades expressivas de um aluno com paralisia cerebral

The objective of this research was to describe the use of an augmentative and alternative system for a student with cerebral palsy during intervention. A 10-year-old male student with cerebral palsy participated in this investigation. He attended special classes for people with disability in a public school in a city of the interior of Sao Paulo. The scheduled activities were carried out twice a week for two years at the Laboratory of Special Education of a public University of São Paulo. All of the tapes describing the activities that were filmed during the assessment and implementation of augmentative and alternative communication resource were watched and described using a specific protocol. Based on the information from the protocols, the sessions with intervals greater than 20 days and the ones with activities involving the communication board with the time equal or greater than 20 minutes during the first year of intervention were selected. The chosen sessions were transcribed in full and, after analyzing the text, the following categories were established, according to the stated goal: the graphic system helped the student with utterances of vertical structure (56%) associated with the oral (14%) and non-oral and non-verbal form (30%), while the use of the graphic system along with other forms collaborated to enhance statements, enabling better understanding of the child s intention. The use of augmentative and alternative communication systems provided the expansion of effective dialogical situations for the student during the activities carried out in speech therapy.

Tecnologia assistiva para a criança com paralisia cerebral na escola: identificação das necessidades

Studies about Assistive Technology have emphasized the need to integrate resources, services and strategies for inclusion and special education to foster the learning process and skill development of students with disabilities. The literature describes that the first step towards implementing assistive technology in schools should enable professionals to understand the situation involving the student in order to expand his or her participation in the teaching and learning process. This study aimed to identify the need for assistive technology services, resources and strategies for students with cerebral palsy in school. Two children with cerebral palsy and their teachers were selected. The data collection phase included three successive procedures: interviews with teachers, completing the identification protocol of the school routine and participant observation conducted in the classroom using filming and field diary. Based on the material gained from these three procedures, data triangulation was proposed, i.e., grouping information in a single document in order to establish categories of analysis. After preparing the material, the categories were assessed by judges from the field of knowledge. The results showed that after understanding the situation of the disabled student within the school context, it was possible to establish his or her skills and needs to indicate the appropriate assistive technology resources for the teacher's planning and thus provide proper teaching and learning for the children with disabilities. The study identified the need to establish specific procedures, an organized pedagogical plan and participation of health professionals as consultants on using assistive technology in school.

Efeitos da comunicação alternativa na interação professor-aluno com paralisia cerebral não-falante

Speech has been regarded as a social communicative modality required for building relationships in different contexts and cultures. Nevertheless, this is not always a readily available resource, especially for those who have developmental disorders. In this sense, Augmentative and Alternative Communication resources and strategies have been used by nonspeaking students with disabilities as useful tools to achieve greater social participation in different environments. Therefore, the present study examined the interaction between teachers and a student with cerebral palsy before and after the use of Alternative Communication strategies in the classroom. The study had a quantitative and qualitative nature and was designed as an intervention study. There were four main stages: 1) filming before the introduction of the resources in the classroom, 2) training the school teachers 3) providing technical assistance regarding the use of alternative communication to the child's teacher 4) filming teacher-student interactions using these technological resources. The interactions were transcribed and grouped into links. In this research, a link means the initiator's behavior directed to the exchange partner and the response in sequence from the interlocutor back to the initiator. It was found that the established interactions presented a maximum of four links, with greater frequency for episodes of 1st and 2nd links. After the intervention, there were different contexts with the presence of interactions up to the 6th link, often greater frequency for episodes of 1st, 2nd and 3rd links. In addition, the teacher showed a tendency to use symbols only as a tool for evaluating and teaching concepts. This perception changed as the teacher became familiarized with the Augmentative and Alternative Communication technology resources.

Uma análise nos livros de ocorrência de uma escola periférica

O objetivo geral desta pesquisa foi dar continuidade aos projetos de investigação sobre a temática: Jovens e Violência, e analisar uma parte do Projeto aprovado pela Fapesp “Violência de Jovens e violência escolar: estudo sob a ótica do imaginário escolar e da Inserção Social.” Tendo como objetivos específicos, identificar as principais ações registradas nos Livros de Ocorrência pelos professores e as principais providencias tomadas pela escola. Para tanto foram analisados os livros de ocorrência de uma escola situada em um bairro da periferia da cidade de Rio Claro. Esta pesquisa teve como Metodologia a Pesquisa Bibliográfica e Análise Documental, através de registros da escola

Contribuição da amplitude de movimento articular do joelho na marcha de crianças com paralisia cerebral espástica

Individuals with spastic cerebral palsy show muscle weakness, difficulties in the control of agonist and antagonist muscles, decreased range of motion and tonus and sensibility alterations, especially in knee joint. These problems can interfere on the performance of functional activities such gait. The aim of this study was to analyze the contribution of knee range of motion on gait of hemiplegic and diplegic children considering their asymmetries. Twelve children, 6 hemiplegics e 6 diplegics from 7 to 12 years of age (age average= 9,5 ± 1,93) took part. Spasticity was assessed by the Ashworth’s Modified Scale and the passive knee range of motion by an eletrogoniometer. The task was to walk on a walkway of 8m long, in their preferred speed, in 6 attempts, been 3 on right and 3 on left sagital planes. Eigth passive markers were bilaterally fixed for the kinematic record. Orthogonally to the walkway, two digital camcorders were assembled on the sagital plane. The fotogrametric procedures were performed by the Dvideow 6.3 software. The Matlab 7.0.1 software was used to filter and to calculate the dependent variables. The U test of Mann- Whitney found differences to the cerebral palsy type for knee extension/hiperextension (U = - 2.943; p= 0.003), knee relative angle at heel contact (U = - 5.992; p= 0.001) and knee range during stride (U = - 4.099; p= 0.001). The Wilcoxon’s test revealed differences according to the asymmetries for the hemiplegics only for the knee relative angle at heel contact (T= - 2.635; p<0.008). The contributions of passive knee range of motion, revealed by the Spearman correlations, for the more afected limb of the diplegics, showed that the knee extension/hiperextension interfere on the cadence, stride duration and step width; the knee relative angle at heel contact change the stride length and duration and cadence; and the...(Complete abstract click electronic access below)

Avaliação Postural de Criança com Paralisia Cerebral Através do Software de Avaliação Postural (SAPO)

O presente estudo, que aborda a avaliação postural de crianças com Paralisia Cerebral (PC), teve como objetivos: avaliar o alinhamento da postura e controle postural nessas crianças e descrever o posicionamento dos segmentos corporais na postura ereta em vista anterior, posterior, lateral direita e esquerda. Foram avaliados, através do SAPO, 7 indivíduos com PC que se mantinham na posição ortostática sem apoio. Foi feita estatística descritiva e uma comparação dos valores de referência (teste t-Student) com nível de significância 5% para todas variáveis. No ângulo Q esquerdo (vista anterior), houve diferença significativa do valor de referência p=0,476. O ângulo perna/retropé direito (vista posterior) apresentou p=0,0257. Para a vista lateral direita: Alinhamento horizontal da cabeça (C7) obteve p<0,001; Ângulo do quadril (tronco e coxa), p=0,0126; Alinhamento horizontal da pelve, p=0,0043 e o Ângulo do Tornozelo p<0,001. Para a vista lateral esquerda: Alinhamento horizontal da cabeça (C7), p<0,001; Alinhamento horizontal da pelve p=0,0332 e o Ângulo do tornozelo obteve p-valor<0,001. Houve evidente anteversão pélvica dos sujeitos com possível aumento da lordose lombar, alterações relacionadas a joelhos e tornozelos que podem ser causadas por assimetrias das forças atuantes em seguimentos superiores e anteriorização da cabeça. Seis das sete crianças apresentaram seu centro de gravidade deslocado para o lado contralateral ao hemicorpo afetado. Sendo a PC uma desordem do movimento e postura e, levando em consideração que alterações posturais decorrentes desta desordem podem interferir no desempenho motor, sugerimos estudos que relacionem esses fatores, promovendo uma intervenção em crianças com PC baseada em evidências

Relação solo-paisagem em um transecto da depressão periférica e do planalto ocidental, região de Rio Claro (SP)

As unidades de paisagens naturais se diferenciam pelo relevo, clima, cobertura vegetal, solos ou até mesmo pelo arranjo estrutural e do tipo de litologia. A caracterização pedológica e o entendimento das relações entre pedologia, geologia e geomorfologia são importantes para a compreensão da distribuição dos solos numa paisagem. Considerando esta como sendo uma combinação dinâmica e instável de elementos físicos, biológicos e antrópicos, e estando em constante evolução, realizou-se o estudo das características químicas, físicas, mineralógicas e morfológicas das coberturas superficiais de uma mesma Unidade Fisiográfica na região do Planalto Ocidental e da Depressão Periférica Paulista nas proximidades de Rio Claro – SP, para a compreensão de suas relações genéticas e cronológicas na evolução das paisagens da área. Para isso foram comparados os solos de dois transectos dentro dos compartimentos, levantando e analisando as características citadas para que se possa obter informações que permitiram o diagnóstico da evolução da área, visando contribuir para o avanço das coberturas superficiais e sua relação com a evolução da paisagem. Foi possível compreender determinados processos e produtos que deram origem às coberturas superficiais e consequentemente a algumas paisagens representativas da Quadrícula de São Carlos a partir dos métodos empregados. O estudo das coberturas de alteração intempérica da região centro-oeste paulista, e seu reconhecimento, são fundamentais para o ordenamento territorial e seu planejamento regional

Avaliação da prevalência do tipo de crescimento crânio facial nas diferentes más oclusões, de acordo com a classificação de angle

During the orthodontic correction planning in addition to dental-jaw correction, facial aesthetics is the orthodontist's and patient's major concern. To prevent facial aesthetics damage is really important to take into account the type of craniofacial growth: mesofacial (balanced), dolichofacial (vertical) or brachyfacial (horizontal). We evaluated 152 documentation files from the Department of Orthodontics of Dental University of Sao Jose dos Campos- UNESP in order to analyze what kind of growth occurs in most Class I malocclusions, Class II and Class III Angle of treated individuals from 6 to 12 years old. From the randomly collected samples, 15 of them belonged to Class I Angle malocclusions; 123 belonged to Angle Class II and 14 to Class III malocclusion. The results showed that in Class I, 66.67% were classified as dolicocephalic; in Class II, 64.23% were classified as dolicocephalic and in Class III, 50% were brachycephalic. We conclude that the dolichofacial was the type which ocurred the most, both in females and males and both in malocclusion Class I and Class II. The brachyfacial type most occurred in Class III malocclusion and the mesofacial type occurred in smaller numbers in the three malocclusions studied

Prevalência de equinos quarto de milha portadores das mutações causadoras da miopatia por acúmulo de polissacarídeo tipo 1, paralisia periódica hipercalêmica e hipertermia maligna no Brasil

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

Expressão gênica e protéica de receptores de estrogênio β e progesterona no melasma facial de mulheres e na pele sã adjacente

Pós-graduação em Patologia - FMB

Qualidade de vida em portadores de paralisia cerebral: associação com nível funcional e aspectos sócio-demográficos

Pós-graduação em Saúde Coletiva - FMB

Paralisia cerebral, extensão universitária e trabalho voluntário: práticas da reflexividade

Report of voluntary work with youngsters suffering from cerebral palsy syndrome. Objective is to highlight information about this syndrome and possibilities of their treatment, especially referred to the method of conductive education. It aims to promote a training experience of a reflexive identity of mother and family of these patients.