Rapunzel Syndrome. A rare cause of intestinal obstruction

BACKGROUND

Rapunzel syndrome is the formation of a trichobezoar that extends beyond the small intestine. Since its discovery few cases have been reported in the literature with variable clinical characteristics, causing important complications such as intestinal obstruction. Laparotomy is currently considered the treatment of choice.

CASE REPORT

We present the clinical case of a patient who presented with recurrent peritonitis associated with a peritoneal dialysis catheter, anorexia, nausea, vomiting, without channeling or presenting evacuations, epigastric tumor, anxiety, trichotillomania and trichophagia. Rapunzel syndrome is diagnosed and admission to the operating room is decided.

Facial paralysis, etiology and surgical treatment in a tertiary care center in plastic and reconstructive surgery in Mexico

BACKGROUND

Facial paralysis is a frequent disabling entity that causes a negative impact on the cosmetic, functional, social, psychological and economic aspects of the patient. Surgical treatment aims to restore the patient to her previous life with the fewest possible sequelae.

OBJECTIVE

Describe the experience of surgical management and propose a treatment algorithm.

METHOD

A retrospective study was carried out from 2017 to 2019 of the records of patients with facial nerve involvement. The variables were age, sex, etiology, affected side and procedures performed.

RESULTS

108 patients were obtained. The most frequent cause was development facial paralysis (41,8%), followed by resection of intracranial tumors (29%). A total of 225 procedures were performed, average per patient of 2.7. The most performed dynamic procedure was the gracilis-free flap (59%). The most frequent static procedures were the placement of a gold weight (24%) and the recreation of the nasogenian sulcus (13%).

CONCLUSIONS

The surgical treatment algorithm will depend on the evolution time, etiology, donor nerves and state of the facial musculature. The gracilis-free flap continues to be the gold standard procedure in facial paralysis reconstruction. Static procedures are additionally required to achieve a satisfactory aesthetic and functional result.

Diagnosis and treatment of speech disorders in children with Moebius syndrome

BACKGROUND

Moebius syndrome (MS) is characterized by congenital bilateral paralysis of the facial and abducens nerves. Clinical features include feeding problems, dysarthria, dysphagia, sialorrhea, strabismus, and lack of facial expression. Patients with MS frequently present with dysphagia during infancy. Further on during childhood a severe speech disorder is a common feature. However, articulation deficits in patients with MS are scarcely reported in the related scientific literature.

OBJECTIVE

The aim of this study is to describe speech deviations, intelligibility and sialorrhea in patients with MS.

MATERIAL AND METHODS

Eighty-seven patients with MS were prospectively studied. Age ranged from 4 to 18 years. A complete Speech and Language Pathology (SLP) evaluation was performed in all cases. The evaluation focused on articulation placement, sialorrhea and intelligibility of speech.

RESULTS

Sialorrhea was detected in 23% of the patients. Abnormal articulation placement of bilabial phonemes was observed in 68% of the patients. Another 50% of the patients presented with articulation placement errors in other phonemes. Intelligibility was classified as adequate in 18% of the cases. Mildly affected intelligibility was found in 51% of the patients. Speech was considered moderately unintelligible in 20% of the cases. Unintelligible speech was found in 11% of the patients.

CONCLUSIONS

From the results of this prospective study it can be concluded that a high percentage of patients with MS are at high risk of presenting with moderate to severe speech disorders. Thus, an early SLP intervention should be provided for this population in order to enhance speech development and reducing the risk of severe oral communication impairments.

Experience in the management of acute wounds by dog bite in a hospital of third level of plastic and reconstructive surgery in Mexico

Background

Dog bite injuries represent an important public health problem, involving all levels of care. They can vary in severity, from superficial wounds (skin and subcutaneous tissue) to devitalization and tissue loss, with the presence of systemic infections, aestethic and functional sequels that require specialized treatment.

Objective

To describe and share the 7-year experience in the management of dog bite wounds in a plastic and reconstructive surgery referral center in Mexico.

Method

A retrospective study was conducted where all patients with dog bite wounds that came to the plastic and reconstructive emergency department were enrolled from July 2010 to August 2017. The collected patient demographic characteristics included age, age group, and sex. The collected injury variables included anatomical location, wound characteristics, antibiotic therapy and therapeutic management.

Results

A total of 416 patients were enrolled, 63% of the dog bites occurred in children under 18 years of age. The majority of the wounds were found in an isolated anatomical region 88.2%. The most frequent location was the face in 61.3%. Of all the cases 74.3% were treated only with primary wound closure, 21.4% also required some reconstructive surgical procedure, 2.9% did not require wound closure, and 1.4% were hospitalized. All patients received prophylactic antibiotics. 2% reported infection after the management with primary wound closure.

Conclusions

The right management of dog bite wounds in all the health care levels improve the patient prognosis. Complex dog bite wounds must be treated immediately by the plastic and reconstructive surgery department in second or third levels of healthcare. Most of the wounds can be managed by primary closure and other reconstructive techniques with confidence.