Monostotic Fibrous Dysplasia of the Mandible

Fibrous dysplasia is a benign fibro-osseous disease that affects 1 or more bones. Deformities leading to aesthetic and functional disorders are observed in almost all cases. Plastic surgery is often recommended when the jaws are involved. Monostotic fibrous dysplasia of the mandible is an unusual manifestation of the disease that is usually benign, occurs in young individuals, and is managed by conservative curettage or debridement, such as surgical sculpting. The authors report a case of a 15-year-old patient with a large monostotic fibrous dysplasia located in the right mandible, which was treated by contouring bone. The lesion did not recur on follow-up for 4 years after the surgical procedure.

2 END-TO-SIDE NEURORRHAPHIES AND NERVE GRAFT WITH REMOVAL OF THE EPINEURAL SHEATH - EXPERIMENTAL-STUDY IN RATS

We have studied a new type of end-to-side nerve repair in rats. The healthy (donor) nerve was not divided but an epineural window was created. In our experiment, a nerve graft bridged the tibial nerve to the distal end of the divided peroneal nerve. Electrophysiological studies showed electrical impulses conducted through both end-to-side nerve junctions. Histological studies demonstrated axons leaving the lateral surface of the healthy (donor) nerve. Based on these observations, we suggest that end-to-side neurorrhaphy from a healthy nerve may bridge a neural deficit.

FAT-TISSUE INJECTION VERSUS GRAFT - EXPERIMENTAL-STUDY IN RABBITS

An experimental study of fat-tissue implants in the ears and frontal regions of rabbits was conducted, starting with blocks of tissue for surgical implantation or with multifragmented pieces for injection. The implants were observed from day 7 to month 12. Low integration levels were observed in all animals, except for 1 case that had 20% and 42% of integration, respectively, for the block grafts and for the injected multifragmented tissue.

Aesthetic correction of a hypertrophic sinus frontalis: A long-term follow-up evaluation and refinement of the method

Two cases treated for hypertrophy of the frontal sinus are presented. In both patients, the excised frontal bone was inverted, and the resultant cavity was filled with either bone dust from the parietal region or Medpor. The first patient is shown with an excellent result after a follow-up period of 16 years. The second patient, who also achieved an excellent result, is presented after a follow-up period of 5 years. Using Medpor instead of bone dust resulted in the advantage that the operation could be performed with the patient under local anesthesia with sedation and prevention of an additional donor site. The use of Medpor has certain advantages over the use of hydroxyapatite, not least of which is its significant lower cost.

Osteointegration of poly(L-lactic acid)PLLA and poly(L-lactic acid)PLLA/poly(ethylene oxide)PEO implants in rat tibiae

Natural or synthetic materials may be used to aid tissue repair of fracture or pathologies where there has been a loss of bone mass. Polymeric materials have been widely studied, aiming at their use in orthopaedics and aesthetic plastic surgery. Polymeric biodegradable blends formed from two or more kinds of polymers could present faster degradation rate than homopolymers. The purpose of this work was to compare the biological response of two biomaterials: poly(L-lactic acid)PLLA and poly(L-lactic acid)PLLA/poly(ethylene oxide)PEO blend. Forty four-week-old rats were divided into two groups of 20 animals, of which one group received PLLA and the other PLLA/PEO implants. In each of the animals, one of the biomaterials was implanted in the proximal epiphysis of the right tibia. Each group was divided into subgroups of 5 animals, and sacrificed 2, 4, 8 and 16 weeks after surgery, respectively. Samples were then processed for analysis by light microscopy. Newly formed bone was found around both PLLA and PLLA/PEO implants. PLLA/PEO blends had a porous morphology after immersion in a buffer solution and in vivo implantation. The proportion 50/50 PLLA/PEO blend was adequate to promote this porous morphology, which resulted in gradual bone tissue growth into the implant.

Complicações da blefaroplastia superior

The blepharoplasty has been performed with great frequency due to the appreciation of aesthetic surgery. The complications related to this procedure are rare. This case report aims to emphasize complications that can occur. T.J.S.P., 45 years old, female, white, resident of Botucatu City, presented dermatocalase bilaterally. We opted to perform upper blepharoplasty bilateral, by removing skin and fat of the upper eyelid. In the postoperative period was observed left eyelid ptosis. We decided to reinsert the levator muscle of the left upper eyelid. One month after the ptosis correction, retraction was observed in both upper eyelid. The patient was then submitted to surgery for the correction of eyelid retraction by disinsertion of the muscle of Muller. Two months after this last surgery, the patient presented right eyelid ptosis and worsening of eyelid retraction to the left. New surgery for correction of the eyelid retraction was made, using free graft sclera for elongation of the left eyelid levator muscle, with good results.The authors presented a patient who underwent a blepharoplasty and developed ptosis in the post-operative period, followed by eyelid retraction. These two possibilities may occur as a complication of blepharoplasty and the surgeon must be careful to handle in an appropriate way, in order to get the result that the patient expects to have.

Cranioplasty: The autograft option

We present our clinical experience in cranioplasty with autograft as follows: conchal cartilage for losses up to 2 cm2, outer table grafts for defects up to 100 cm2, and, for larger defects still, split rib grafts, which may be combined with outer table grafts. We conclude that autograft is superior to alloplastic material in cranioplasty.

Treatment of gingival recession: Comparative study between subepithelial connective tissue graft and guided tissue regeneration

Background: Various procedures have been proposed to treat gingival recession, but few studies compare these procedures to each other. The purpose of this study was to evaluate a clinical comparison of subepithelial connective tissue graft (SCTG) and guided tissue regeneration (GTR) with a collagen membrane in the treatment of gingival recessions in humans. Methods: Twenty-four defects were treated in 12 patients who presented canine or pre-molar Miller Class I and/or II bilateral gingival recessions. Both treatments were performed in all patients, and clinical measurements were obtained at baseline and 18 months after surgery. These clinical measurements included gingival recession height (GR), root coverage (RC), probing depth (PD), keratinized tissue width (KT), and final esthetic result. Results: Both SCTG and GTR with a bioabsorbable membrane and bone graft demonstrated significant clinical and esthetic improvement for gingival recession coverage. The SCTG group was statistically significantly better than GTR for height of GR (SCTG = 0.2 mm, GTR = 1.12 mm, P = 0.02) and KT (SCTG = 4.58 mm, GTR = 2.5 mm, P <0.0001). However, PD was statistically significantly better for GTR than SCTG treatment (GTR = 1.66 mm, SCTG = 1.00, P = 0.01). The 2 procedures were statistically similar in root coverage (SCTG = 95.6%, GTR = 84.2%, P = 0.073). The esthetic condition after both treatments was satisfactory (P = 0.024). Conclusions: It was concluded that the gingival recessions treated with the SCTG group were superior for GR, RC, and KT clinical parameters, while GTR demonstrated better PD reduction. The final esthetic results were similar using both techniques.

Prototipagem como forma alternativa para realização de cranioplastia com metilmetacrilato: Nota técnica

The prototyping is a method for reconstruction of human body segments by computer software. It has been used in neurosurgery for cranial reproduction in patients allowing the programming of surgical procedures and the production of prosthesis to reconstruct bone failures in the skull. We present two cases of cranioplasty performed with the use of acrylic prosthesis constructed by prototyping. After 10 months of follow-up, they donot present signs of infection and show good aesthetic result. The advantages pointed at the literature for this method (reduction of surgical time, easy technical handle, and good aesthetic result) were confirmed.

Fenda cervical mediana

The midline cervical cleft is an unusual congenital anomaly of the ventral neck and fewer than 100 cases have been reported overall and the first described by Bailey in 1924. This anomaly is report in association with median cleft of lower lip, cleft mandible and tongue, and hypoplasia of other midline neck structures. Its considered an anomaly originated from the two first branchial arches. The treatment of this cleft is a vertical complete excision and a closure with multiple Z-plasty. Many authors recommend avoid linear closure and prefer multiple Z-plasty for evicted fibrosis and local retraction. In this paper we report 2 case of this anomaly and the literature is reviewed.

Aesthetic and functional ocular rehabilitation

The ocular losses are embarrassing to the bearer because they commit the face which has the essential organs for the human relationship. The present study shows the multidiscipline interaction in the treatment of a child who lost his left eye victim of a fire gun and needed an ocular plastic surgery for a correct prosthesis insertion. The ocular prosthesis fills in the ocular cavity simulating the facial growth and restoring its symmetry. Therefore, there are aesthetics, anatomic and physiological improvement on the child's face that allows her to be reinstated in society without being discriminated for her differences. © 2005 Elsevier Ltd. All rights reserved.

A comparison of human and porcine acellular dermal tissues in the subcutaneous space of a rat model

The study compared the host response to a human and a porcine acellular dermal tissue implanted in the subcutaneous space of a rat model. The human and porcine acellular grafts were surgically implanted in the subcutaneous tissue of rats (5 rats/group) and the materials were evaluated at 7, 15, 30, 60 and 180 postoperative days (PO). The histological immune response was quantified using a digital image analysis system, which evaluated the number of vessels present in the implants and in the surrounding soft tissue, the area of inflammatory cell infiltration in the grafts, the width of the capsular formation present around the tissues and the area of implants absorbed. The data were submitted to statistical analysis. Light microscopy showed mononuclear cellular infiltration, the presence of a capsular formation surrounding the grafts and the presence of vacuolar structures (optically empty spaces) inside the implants. The image analysis comparing both materials showed significant inflammatory cells in the human graft at 15 and 30 PO, thicker capsular formation in the porcine tissue at 60 PO, increased number of vessels inside the implants and in the surrounding tissues in the porcine graft and a similar absorption pattern in both materials at 180 PO. The histological findings showed that both tissues were well-tolerated when implanted in the subcutaneous tissue of rats, allowing us to consider the porcine acellular dermal graft as a provisional alternative material for reconstructive plastic surgery. Copyright © 2005 Taylor & Francis LLC.

Influence of implant positioning in extraction sockets on osseointegration: Histomorphometric analyses in dogs

Aim: To evaluate the influence of implant positioning into extraction sockets on osseointegration. Material and methods: Implants were installed immediately into extraction sockets in the mandibles of six Labrador dogs. In the control sites, the implants were positioned in the center of the alveolus, while in the test sites, the implants were positioned 0.8 mm deeper and more lingually. After 4 months of healing, the resorptive patterns of the alveolar crest were evaluated histomorphometrically. Results: All implants were integrated in mineralized bone, mainly composed of mature lamellar bone. The alveolar crest underwent resorption at the control as well as at the test sites. After 4 months of healing, at the buccal aspects of the control and test sites, the location of the implant rough/smooth limit to the alveolar crest was 2±0.9 mm and 0.6±0.9 mm, respectively (P<0.05). At the lingual aspect, the bony crest was located 0.4 mm apically and 0.2 mm coronally to the implant rough/smooth limit at the control and test sites, respectively (NS). Conclusions: From a clinical point of view, implants installed into extraction sockets should be positioned approximately 1 mm deeper than the level of the buccal alveolar crest and in a lingual position in relation to the center of the alveolus in order to reduce or eliminate the exposure above the alveolar crest of the endosseous (rough) portion of the implant. © 2009 John Wiley & Sons A/S.

Lip cavernous hemangioma in a young child

Hemangiomas are benign tumors of infancy and childhood, characterized by a phase of fast growth with endothelial cell proliferation, occurring in 10-12% of children at 1 year of age. It is known that hemangiomas of infancy are most commonly located on the head and neck region (around 60% of cases) and occur more frequently in the lips, tongue, and palate. Approximately 50% of hemangiomas have complete resolution, and 90% of them are resolved up to the age of 9. Complications occur in only 20% of the cases, the most common problem being ulceration with or without infection. The treatment depends on lesion location, size and evolution stage, and the patient's age. Surgery is usually indicated when there is no response to systemic treatments, or even for esthetic reasons, being performed as a simple excision in combination or not with plastic surgery. This paper reports a case of lip cavernous hemangioma in a 4-year-old child, who was submitted to 3 sessions of vascular sclerosis due to the size of the lesion, before undergoing simple excision of the hemangioma. Two years of postoperative clinical follow-up shows treatment success with no recurrence of the lesion.