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.

Avaliação temporal e espacial do balanço de radiação, de energia e da evapotranspiraçâo no noroeste paulista, face a mudança no uso do solo

Pós-graduação em Agronomia - FEIS

Sexualidade e infância: contribuições da educação sexual em face da erotização da criança em veículos midiáticos

This article proposes to show the contributions of the sex education in the school as a way to mitigate the effects of the media, which sometimes leads to early sexualisation of children. Bibliographical in nature, it points out some aspects of sexuality in childhood, and reveals the issues brought by the media, particularly for the formation of the child, when addressing sexual issues, highlighting the role of sex education for a more reflective thinking about this theme.

Tendência de crescimento facial em ortodontia e ortopedia funcional dos maxilares

The knowledge of the facial growth trend is very important in orthodontic treatment. A lateral headfilm is recommended in all young patients undergoing a preorthodontic guidance program to anticipate the best time to begin any mechanical procedures and the possibilities to determine the type of facial growth trend. In type A it will be observed that the middle and lower face are growing forward and downward in unison, with no change in ANB angle. Type B growth trends reveals that growth is downward and forward, with the middle face growing forward more rapidly than the lower and in type C the lower face is growing downward and forward more rapidly than the middle face revealing a decrease in the size of the ANB angle.

Manejo das fraturas nasais com manutenção das vias aéreas superiores

Nasal fractures are extremely frequent. The nasal bones are the third most frequently fractured bones in the human skeleton. This is due to their prominent position on the face and to the diminished bone thickness. As a result, weak forces can cause nasal fractures, while stronger forces can comminute the nasal bones. In general, assaults, falls and sports injuries are the etiologies most commonly involved in nasal trauma. The diagnosis of such fractures is basically clinical and their treatment is usually by closed reduction with good results reported in all the relevant literature. Thus, the aim of this paper is to report a modification of the closed reduction technique for the treatment of these fractures.

Estudo cefalométrico comparativo dos traçados predictivos e resultados ortodôntico-cirúrgicos em pacientes com face longa

The purpose of this research was to compare, by cephalometric analysis (McNamara and Legan & Burstone) the predictive tracings (by methods manual, and by softwares Dentofacial Planner Plus and Dolphin Image) with the post surgical results. Were selected the pre and post surgical lateral telerradiograph (six months after orthognatic surgery) of the 25 long face patients treated with combined orthognatic surgery. Were made the prediction tracings for each method and comparing cephalometrically with the post surgical results. This protocol was repeated once more for the error method evaluation, and the statistical was made by variance analysis and Tuckey overtest. The results show more frequency of the cephalometric values' aproximation of the post surgical results when the manual method (50% of the similarity with the post surgical result), followed of the DFPlus (31,2%) and Dolphin (18,8%) softwares. The experimental condition permits to conclude that the manual method had more precision, although the previsibility of the digital methods was reasonable satisfactory.

Até os ossos: escavando o último romance de Graciliano Ramos

Starting from the set wherein Vidas Secas (1938) stands out, it is possible to establish parameters that make of Graciliano Ramos’ oeuvre the overcoming of realism due to the scope of representation and the quality of formal handling developed by the author, imbibed in the Brazilian and universal literary tradition, and whose result the criticism of Antonio Candido, skilful in taking into account the former critique, points out with precision. Perusing the facts that mark the creation and reception of Vidas Secas (including the production of the movie by Nelson Pereira dos Santos in 1963), the present work is a preamble for analyses that take into account the coherence of Graciliano Ramos with the absorption of expressive resources used by American and European practitioners of a literature engaged in adjusting the expression of contrasts and in reformulating the so-called regionalism

Osteologia do neurocrânio de Iguana iguana iguana (Squamata: Iguanidae)

Skull represents the segment with conspicuous adaptations that, in lizards, may be conservative or promoted by selective pressures. The aim of assisting the morphological knowledge of reptiles, we provide a detailed description of the neurocranium of Iguana iguana iguana based on analysis of three dried adult skeletons. The skull of this species has basal characteristics in lizards without closure of cranial openings and general triangular shape. Bony structures that form the caudal base have many fusions, especially on the floor. In the caudal face the exoccipital and the opisthotic are fused and form the otooccipital, which contributes to the formation of the lateral part of the condyle. The central part is formed by the condyle supraocciopital. Fusions and skeletal structures in Iguana are similar to other lizards. There are no autopomorphies in the neurocranium for this species.

Estudo comparativo entre traçados cefalométricos predictivo e pós operatório imediato de pacientes que foram submetidos à cirurgia ortognática para correção da síndrome da face longa

The aim of this research was to verify the accuracy of the prediction trace. Records in 15 patients admitted for orthognathic surgical treatment were analysed. Predictive and postoperative positíons of maxilla were compared with linear measurements. Statistically significant difference between predicted and postoperative position were demonstrated, but the prediction trace revealed to be very useful to help in decision of direction of movements, easy to do at low cost

Tratamento conservador de fratura de arco zigomátio: uma visão conservadora

Introduction: The zygomatic maxillary complex is the second most affected area of the face due to injuries, surpassed only by the nasal bones. The zygomatic arch fracture is under the direct action of trauma (punch, head butt), its fragile structure, losing its normal convex curvature in the temporal area. Objective: To report a case, using a reduction technique of zygomatic arch fracture using a hook or Ginestet Barros. Case report: A male patient, 25 years of age, leukoderma, showing zygomatic arch fracture right. The patient underwent closed reduction with the hook adapted to the skin. The patient was instructed to keep care of the region for at least four weeks

Relationship between the morphology of the maxillary central incisor and horizontal and vertical measurements of the face

Purpose: In order to assist in the selection of artificial teeth for complete dentures, this study aimed to assess the relationship between horizontal and vertical measurements of the face and the morphology of the maxillary central incisor. Materials and Methods: This was a study of 50 plaster casts and 100 teleradiographs - 50 in lateral norm and 50 in frontal norm, belonging to 50 individuals, Caucasian, with a naturally optimal occlusion, matching at least four of the six keys of Andrews. Images of the upper central incisors were obtained by scanning the plaster casts (three-dimensional) and subjectively classified by three examiners as oval, triangular or quadrangular. Facial measures (vertical and horizontal) were defined by means of teleradiographs. In order to check inter-examiner agreement on the classification of central incisor, the Kappa test was used. To verify whether data had normal distribution, the Kolmogorov-Smirnov test was used ( P > 0.2) was used. One-way analysis of variance was employed to assess the association between variables (P > 0.05). Results: When vertical measurements were compared with the three incisor shapes, there was no statistically significant difference (P > 0.05): Triangular (0.54), oval (0.63) and quadrangular (0.51). Similarly, no difference (P > 0.05) was found for facial width (139.08, 143.37, 141.65), maxillary width (76.68, 78.99, 76.91) and mandibular width (103.47, 105.50, 103.11). Conclusions: The majority of cases showed that horizontal and vertical measurements of the face cannot be used as a reference for determining the morphology of the maxillary central incisor crown. It is relevant to analyze and compare other morphological structures to improve the oral health-related quality of life for the conventional denture wearer.