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de Souza TM, Batista ST, de Souza RXS, Rezende SE, Alessi MS, Almeida TFA, Frazão DC, Pretti H, Freitas RDS, Macari S. The Effects of NAM on the Symmetry of the Face and Maxillary Arch in Babies With Unilateral Cleft. J Craniofac Surg 2023; 34:1618-1624. [PMID: 37307242 DOI: 10.1097/scs.0000000000009469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 06/14/2023] Open
Abstract
The study aimed to evaluate the effect of nasoalveolar molding (NAM) therapy through reverse engineering, or its absence, to obtain symmetry of the face and maxillary arch. Twenty-six babies with unilateral cleft lip and palate received treatment with NAM, and 12 babies with unilateral cleft lip and palate without presurgical orthopedics (control group). Patients were molded and photographed in 2-stages: the first month of life (T1/pre) and after the use of NAM/before the cheiloplasty (T2/post). In the digital models, the analyses performed were arch perimeter, arch length, and labial frenulum angle. The photographs allowed us to analyze nasal width, mouth width, columella angle, and nostril area. The results demonstrated that there was an increase in arch perimeter and arch length in control and NAM groups in the T2 period in comparison to T1. Labial frenulum angle was reduced in the NAM group compared to the NAM-T1 and control-T2 periods. Treatment with NAM yielded a reduction in nasal width in the period of T2 compared with T1. Columella angle was enhanced after NAM use in T2 and, was different from control group. The nostril area was reduced in the NAM group in T2 compared with control group. Nasoalveolar molding therapy reduced the labial frenulum angle, contributing to a reduction in the extension of the cleft. The NAM protocol improved facial symmetry, mainly through nasal effects, whereas the absence of orthopedic therapy yielded a commitment to the face and maxillary arch symmetry.
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Affiliation(s)
- Tânia Mara de Souza
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Minas Gerais
| | - Sabrina Tailane Batista
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Minas Gerais
| | | | - Sérgio Edriane Rezende
- Department of Head and Neck Surgeon and Skull-Maxillofacial Surgeon, Federal University of Minas Gerais, Belo Horizonte
- Plastic Surgery Service-CENTRARE-Hospital of Baleia
| | | | | | - Diogo Campos Frazão
- Department of Science and Technology Applied to Dentistry, Institute of Science/Technology, Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), São José dos Campos Campus, SP
| | - Henrique Pretti
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Minas Gerais
| | - Renato da Silva Freitas
- Department of Surgery, Plastic Surgery Unit, School of Medicine, Federal University of Parana (UFPR), Curitiba, Brazil
| | - Soraia Macari
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Minas Gerais
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Freitas RDS, do Prado D, Guarezi Nasser IJ, Peressutti C, Ogawa VS. Pierre Robin Sequence and Respiratory Distress: Long-Term Evolution in Patients Submitted to the Conservative Treatment. J Craniofac Surg 2023; 34:1267-1270. [PMID: 37220722 DOI: 10.1097/scs.0000000000009090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/04/2022] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Pierre Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, cleft palate, and airway distress. The aims of initial treatment are the improvement of airway and feeding. There are many therapeutic options, including conservative techniques (prone positioning and nasopharyngeal tube) and invasive procedures (mandibular distraction and tracheostomy). In our center, initially conservative treatment is the rule and many patients have been treated with nasopharyngeal tube. OBJECTIVE The aim was to analyze of the clinical evolution of respiratory distress in infants with PRS submitted to nonsurgical treatment. METHODS A retrospective and observational descriptive evaluation was carried out with 56 patients with the PRS at Centro de Atendimento Integral ao Fissurado Labiopalatal (CAIF). 21 patients were selected to a transversal phase. RESULTS The treatment has started in an average age of 1.5 months (±2.09) and 17 (94.4%) had respiratory distress at birth. Polysomnographic exams showed an average apnea/hypopnea index of 0.93, an average number of central apnea/hour of 0.3, an average number of obstructive apnea of 0.6 and an average oxygen saturation of 92%. There was the predominance of esthetic profile in class II with 16 (88.9%) patients in this group, and orthodontic profile in class II with 15 (83.3%) patients. CONCLUSION The conservative treatment has presented remarkable results in the treatment of respiratory distress in bearers of PRS with a decrease of obstructive sleep events considering the growth of patient and the development of mandibular growth as well.
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Affiliation(s)
- Renato da Silva Freitas
- Federal University of Paraná, Head and Plastic Surgeon at Assistance Center for Cleft Lip and Palate
| | | | | | - Carolina Peressutti
- Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Vanessa S Ogawa
- Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
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Daronch OT, Rigolon LPJ, Moraes IP, Dos Santos Bredley AI, Fachin CG, da Silva Freitas R. Onfalopagus parasitic fusioned twin: A case report. Int J Surg Case Rep 2023; 106:108129. [PMID: 37148728 DOI: 10.1016/j.ijscr.2023.108129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The parasitic fetus is a kind of siamese twin, in which one of the twins is reabsorbed and some parts of the body can remain attached to the other twin. It is a very rare event, with a birth incidence that varies from 0.05 to 1.47 cases per 100,000. CASE PRESENTATION This paper reports the case of a parasitic twin diagnosed at 34 weeks of gestational age. Preoperative ultrasonography was performed and the absence of communication between vital organs and the parasite was observed, and surgery was scheduled at 10 days of life. A multidisciplinary team performed the surgical procedure and the child was discharged from the intensive care unit after 3 months. CLINICAL DISCUSSION After diagnosis and birth, it is essential to investigate the anomalies found for future surgical programming, and cases of twins who do not share vital organs, for example, heart or brain, have higher survival rates. The treatment is surgical and the objective of the surgery must be resection of the parasite. CONCLUSION The diagnosis still in the gestational period is essential to plan the best mode of delivery and neonatal care, as well as define the surgical schedule. The hospital must be tertiary and the presence of a multidisciplinary team is necessary to perform the surgery in order to present the highest success rates.
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Agell Sogbe A, Mitiko Aseka Garcia M, Souza Lima Wan-Dall B, Sierra NE, da Silva Freitas R. Comparative Study of Maxillary Growth in Patients With Unilateral Cleft Treated With and Without Pre-Surgical Orthopedics. Cleft Palate Craniofac J 2023:10556656221149784. [PMID: 36655299 DOI: 10.1177/10556656221149784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Compare the maxillary growth of patients with Unilateral Cleft treated with pre-surgical Functional Maxillary Orthopedic (FMO) and that of who underwent a surgical procedure with no previous use of appliances. Prospective study, the patients were divided into 2 groups. G1, was composed of 12 patients who received no pre-surgical intervention and cheilorhinoplasty at 6 months of age and G2, included 12 patients treated using Pre-Surgical Funtional Maxilary Orthopedic; they underwent no surgery during the study. Measurements were taken at three times: before the first month of life, at 6 months and between 9-12 months of age. Cleft distance (anterior, medium and posterior), maxillary width (anterior, medium and posterior) and minor and major segment width were analyzed. Alveolar Cleft decrease was 79.82% in G1 and 52% in G2. Posterior Cleft decrease was 24.1% in G1 and 41.77% in G2. Greater Segment Width increase was 24.53% for the patients in G1, and 37.47% for the patients in G2. As for Inter Canine Width, a decrease of 5.16% in G1 and an increase of 9.19% in G2 were found. Medium Arch Width only increased in a statistically significant manner in G2 9.02%. Surgery allowed for the closure of the alveolar cleft. FMO made it possible to close the anterior and the posterior clefts through the growth of the maxillary segments, increased the transverse growth of the maxilla and could prevent maxillary collapse. Each team must individually evaluate whether to indicate or not the use of preoperative orthopedics.
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Affiliation(s)
- Adriana Agell Sogbe
- Pediatric Oral and Maxillofacial Surgery Unit, 16810Vall d´Hebron University Hospital, Barcelona, Spain
| | | | | | - Nicolas E Sierra
- Pediatric Oral and Maxillofacial Surgery Unit, 16810Vall d´Hebron University Hospital, Barcelona, Spain
- Comprehensive Cleft Care Center, Mobile Surgery International, Oaxaca, Mexico
| | - Renato da Silva Freitas
- Plastic Surgery Unit, Department of Surgery, School of Medicine, 28122Federal University of Parana (UFPR), Curitiba, Brazil
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Soares CMC, Nassif FDJDM, Dranka D, Becker RV, Hurtado JM, Freitas RDS. Comparative study of the effectiveness of the surgical technique with and without preservation of the conchal cartilage in otoplasty through the measure of the cephalo-auricular and scapho-conchal angles. Braz J Otorhinolaryngol 2022; 89:410-416. [PMID: 36754673 PMCID: PMC10164768 DOI: 10.1016/j.bjorl.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Prominent ear abnormalities affect 5% of the population. A prospective, double-blind study of patients who underwent otoplasty procedures to correct these abnormalities was conducted to compare two surgical techniques. They diverge by the preservation or not of conchal cartilage. METHODS The two techniques were compared by measuring the cephalo-auricular and scapho-conchal angles. Measurements were performed in pre and 6-months post-operative periods using alginate molding. Twenty patients were randomly assigned to two groups (with and without cartilage preservation) with 10 participants each. Student's t-test, Covariance Analysis Model (ANCOVA), and non-parametric Mann-Whitney were used in the statistical analyses. RESULTS A significant reduction in the average of the cephalo-auricular and scapho-conchal angles was observed in both surgical procedures (p<0.001). However, no significant difference was found between them (p=0.887). CONCLUSION The two techniques analyzed in this study fulfilled their objectives. Therefore, further comparative studies are needed to confirm the superiority of one over the other. LEVEL I Evidence obtained from at least one properly designed randomized controlled trial.
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Affiliation(s)
- Caio Marcio Correia Soares
- Universidade Federal do Paraná (UFPR), Departamento de Otorrinolaringologia, Curitiba, PR, Brazil; Hospital IPO (Instituto Paranaense de Otorrinolaringologia), Curitiba, PR, Brazil.
| | | | - Daniela Dranka
- Hospital IPO (Instituto Paranaense de Otorrinolaringologia), Curitiba, PR, Brazil
| | | | - Johann Melcherts Hurtado
- Núcleo de Ensino e Pesquisa (NEP) do Hospital IPO (Instituto Paranaense de Otorrinolaringologia), Curitiba, PR, Brazil; Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Curitiba, PR, Brazil
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Fachini Cipriani RF, Fleury da Silva L, Mateus M, Martins da Silva IV, da Silva Freitas R, Krebs RK. Giant idiopathic penoscrotal lymphedema - Surgical approach with skin graft: A case report. Urol Case Rep 2022; 45:102208. [PMID: 36131718 PMCID: PMC9483772 DOI: 10.1016/j.eucr.2022.102208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022] Open
Abstract
Lymphedema is originated from the reduced lymphatic flow, causing a volumetric increase in the affected region and is physically and emotionally uncomfortable. Surgical intervention is considered the best treatment option as it brings both functional and aesthetic benefits. This is a report from the case of a previously healthy 45-year-old man who developed idiopathic penoscrotal giant lymphedema. A surgical approach was proposed. There was resection of scrotal lymphedema followed by a classic postectomy, suprapubic advancement flaps, and use of a partial skin graft from the right thigh. The results of the therapeutic approach were aesthetically and functionally satisfactory.
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Pellerin P, Tonello C, da Silva Freitas R, Tang XJ, Alonso N. Tessier's Cleft Number 6 Revisited: A Series of 26 new Cases and Literature Review of 44. Cleft Palate Craniofac J 2022:10556656221086459. [PMID: 35285292 DOI: 10.1177/10556656221086459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To fix a gray zone left in Tessier's classification of rare clefts with cleft 6 and to give a more comprehensive description of cleft 6 anatomy. DESIGN The material used for the research was a series of 26 clinical cases of patients with assessed cleft 6 and 44 cases found out of a literature review with enough data to be useful. The 70 cases were cross-examined by the authors. STUDY SETTING The authors are senior craniofacial surgeons working in high-case load department from university centers where the patients are documented and receive primary as well as secondary treatment and follow-up. PATIENTS The patients were selected out of the series of craniofacial deformities taken care of by the authors' department as rare clefts. MAIN OUTCOME We describe the full spectrum of cleft 6 as an autonomous entity that could present itself in three subtypes: 6a is the most proximal and could be associated with cleft 8. The subtype 6b is medial toward the zygomatic arch and frequently associated with a bone and teeth appendage (frequently described as a "maxillary duplication"). The subtype 6C goes toward the external ear between the helix crus and the auditory meatus. CONCLUSIONS The Tessier's opinion is that Treacher Collins syndrome was the association of clefts 6, 7, and 8 and is no longer sustainable in the light of modern genetics. Most of the cleft 6 are misdiagnosed in the literature.
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Affiliation(s)
| | - Cristiano Tonello
- Cirurgia Craniofacial HRAC-USP, Curso de Medicina, da Universidade de São Paulo, Bauru, Brazil
| | | | - Xiao Jun Tang
- 74698Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nivaldo Alonso
- Cirurgia Craniofacial HRAC-USP, Curso de Medicina, da Universidade de São Paulo, Bauru, Brazil
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8
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Souza J, do Valle DA, Santos MLSF, Colomé FB, Teive HAG, da Silva Freitas R, Herai RH. BRPF1-associated syndrome: A patient with congenital ptosis, neurological findings, and normal intellectual development. Am J Med Genet A 2022; 188:1875-1880. [PMID: 35243762 DOI: 10.1002/ajmg.a.62706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/26/2022] [Accepted: 02/05/2022] [Indexed: 01/15/2023]
Abstract
In 2017, Mattiolli et al. and Yan et al. described a series of patients with clinical findings essentially characterized by intellectual disabilities, ptosis, hypotonia, epilepsy, and weakness. They also found in these patients distinct heterozygous mutations in the BRPF1 gene, which plays a role in epigenetic regulation by promoting histone acetylation. The disease is known as Intellectual Developmental Disorder with Dysmorphic Facies and Ptosis (IDDDFP, OMIM #617333). Later, another 20 patients were also described by distinct reports, suggesting IDDDFP could be a more frequent cause of intellectual disability as it was thought before. Here, we describe a patient with normal intellectual development who had congenital ptosis, hypotonia, muscular weakness, atlanto-axial malformation, and pyramidal at the neurological examination. The patient has a rare nonsense variant on exon 3 of BRPF1 gene. We also describe a phenotypic amplification for conditions related to deficiency in histone modifications.
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Affiliation(s)
- Josiane Souza
- School of Medicine, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Puerto Rico, Brazil.,Department of Genetics, Hospital Infantil Pequeno Príncipe, Curitiba, Puerto Rico, Brazil
| | - Daniel Almeida do Valle
- Department of Pediatric Neurology, Hospital Infantil Pequeno Príncipe, Curitiba, Puerto Rico, Brazil
| | | | - Fernanda Bonilla Colomé
- Department of Pediatric Neurology, Hospital Infantil Pequeno Príncipe, Curitiba, Puerto Rico, Brazil
| | | | | | - Roberto Hirochi Herai
- School of Medicine, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Puerto Rico, Brazil.,Laboratory of Bioinformatics and Neurogenetics (LaBiN), Experimental Multiuser Laboratory (LEM), Graduate Program in Health Sciences, School of Medicine, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Puerto Rico, Brazil.,Research Division, Buko Kaesemodel Institute, Curitiba, Puerto Rico, Brazil
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Citron I, Batista J, Costa E, Lima C, Ise A, Menezes C, Roa L, Saluja S, Staffa SJ, da Silva Freitas R, de Andrade Sá ÁJ, Rocha F, Collares MV, Alonso N. Patient-perceived barriers to surgical treatment of cleft lip and palate in Brazil- A multi-region study. J Plast Reconstr Aesthet Surg 2022; 75:2375-2386. [DOI: 10.1016/j.bjps.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/04/2021] [Accepted: 02/12/2022] [Indexed: 11/25/2022]
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Abstract
OBJECTIVE This is a prospective study examining palatal casts from patients with unilateral cleft lip and palate (UCLP) in the first month of life, immediately before cheiloplasty, and immediately before palatoplasty. None of the patients receives presurgical orthopedics (nasoalveolar molding). DESIGN In this prospective study, upper arch plaster models were taken 3 times during the treatment: in the first month of life (T1), before the cheiloplasty (T2), and before the palatoplasty (T3). Anatomic landmarks were defined and linear anthropometric measurements were obtained afterward. Dimensional analysis was performed using 3D software. Two-way analysis of variance followed by Tukey test was performed for statistical analysis. SETTING Tertiary, institutional. PARTICIPANTS Twelve patients with UCLP of either sex with less than 1 month of life and without any other syndrome. INTERVENTION No intervention was performed. MAIN OUTCOME MEASURE Reduction of the cleft without using orthopedics apparatus. RESULTS There was a statistically significant reduction in the cleft gap comparing T1 to T3. There was also a significant reduction in the intercanine width comparing T2 and T3, and T1 and T3. There was significant increase in the posterior arch width comparing T2 and T3, and T1 and T3. The palatal plate's width increased in all times analyzed. CONCLUSION The palatal cleft narrows spontaneously as well in both midpoint and posterior point during the first 6 months of patient's treatment. This event was enhanced by cheiloplasty. This surgery might have a greater influence on the anterior arch width than in the posterior arch region.
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Affiliation(s)
| | | | - Renato da Silva Freitas
- Plastic Surgery Unit, Department of Surgery, School of Medicine, Federal University of Parana (UFPR), Curitiba, Brazil
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Freitas RDS, Ono MCC. Commentary of Early Weight Gain in Infants With Cleft Lip and Palate Treated With and Without Nasoalveolar Molding: A Retrospective Study. Cleft Palate Craniofac J 2021; 59:815-816. [PMID: 34155948 DOI: 10.1177/10556656211022912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Renato da Silva Freitas
- Section of Plastic and Reconstructive Surgery, 28122Federal University of Paraná, Curitiba/PR, Brazil.,Assistance Center for Cleft Lip and Palate (CAIF), Curitiba/PR, Brazil
| | - Maria Cecília Closs Ono
- Section of Plastic and Reconstructive Surgery, 28122Federal University of Paraná, Curitiba/PR, Brazil.,Assistance Center for Cleft Lip and Palate (CAIF), Curitiba/PR, Brazil
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Daronch OT, Fachin C, D'Agnoluzzo Moreira B, Freitas RDS, Andrade MÂ, Becker KA, Tosi LF, Moraes IP, Rigolon LP. Complex giant arteriovenous and lymphatic malformation of the abdominal wall. Journal of Pediatric Surgery Case Reports 2020. [DOI: 10.1016/j.epsc.2020.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Restrepo DV, Sato MH, Cardoso FS, da Silva Freitas R. Should Cleft Surgery Always be Performed During the Matutine Time? Analysis of Early and Late Postoperative Complications in a Cleft Center. Cleft Palate Craniofac J 2020; 57:1332-1335. [PMID: 32314597 DOI: 10.1177/1055665620917840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Surgeries performed in the afternoon schedule were discouraged by Smile Train Foundation for patients younger than 2 years. The aim of this study is to present the incidence of complications discriminating time of surgery (morning/afternoon) in a reference center in Curitiba (Brazil) during 2017. DESIGN Retrospective study that evaluated all cleft surgeries that were performed at Assistance Center for Cleft Lip and Palate during 2017. Complications correlated with surgery period (morning/afternoon), type of surgery, and operating surgeon were studied. Statistical analysis was performed to find any association between discrete variables. SETTING Tertiary, institutional. PARTICIPANTS One hundred eighty-seven patients with cleft lip and/or cleft palate/cleft lip and palate, who were evaluated and submitted to surgery in the center and had less than 24 months of age, were included in the study. INTERVENTIONS One hundred twenty-four cheiloplasties and 63 palatoplasties were performed. MAIN OUTCOME MEASURE Incidence of complications. RESULTS From the total of cheiloplasties, the number of complications was 2 (1.6%) and from the total of palatoplasties the number of complications was 11 (17%); 8.1% of surgeries that were performed in the morning had any complication compared to 5.1% of surgeries performed in the afternoon. Statistical analysis of discrete variables with χ2 test showed no correlation between surgery schedule and complications (χ2 = 0.62). CONCLUSION The number of complications was not higher in the afternoon scheduled surgeries. Surgeon expertise had a statistically significant correlation with the absence of complications (χ2 = 20.57).
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Affiliation(s)
- Daniel Velez Restrepo
- Assistance Center for Cleft Lip and Palate (CAIF), Federal University of Paraná, Curitiba, Brazil
| | - Marilson Hideki Sato
- Assistance Center for Cleft Lip and Palate (CAIF), Federal University of Paraná, Curitiba, Brazil
| | | | - Renato da Silva Freitas
- Craniofacial Unit, Assistance Center for Cleft Lip and Palate (CAIF), Federal University of Paraná, Curitiba, Brazil
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Junior IM, Graf RM, Ascenço ASK, Itikawa W, Balbinot P, Munhoz AM, Lopes MC, Nasser IJG, Urban LABD, da Silva Freitas R. Is There a Breast Augmentation Outcome Difference Between Subfascial and Subglandular Implant Placement? A Prospective Randomized Double-Blinded Study. Aesthetic Plast Surg 2019; 43:1429-1436. [PMID: 31363811 DOI: 10.1007/s00266-019-01465-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/18/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Subfascial breast augmentation is gaining popularity because of no distortion when the pectoral muscle is contracted and minimizing visualization of the edges of the implant. Although some studies have reported a satisfactory outcome with subfascial technique, it still is controversial the influence of the pectoral fascia and outcome compared to the subglandular technique. Therefore, this prospective randomized study aimed to investigate whether there are clinical/radiological differences between subfascial and subglandular pockets following primary breast augmentation. METHODS Twenty patient candidates for primary breast augmentation were recruited. Each patient was selected for subfascial or subglandular pockets in a randomized fashion. Both patient and surgeon were blinded. Clinical and radiological differences were evaluated through five independent surgeons and MRI (capsule, folds, fluids, base and projection). Median follow-up was 12 months. RESULTS Breast consistency (p = 0.24), implant pocket (p = 0.52), symmetry (p = 1), contour, and shape (p = 0.09) demonstrated no statistically significant difference after the surgeons' assessments at 3 and 12 months after surgery. MRIs demonstrated a larger implant base in the subfascial group (p = 0.024). No differences were observed in capsule thickness (p = 0.42), folds (p = 0.51), fluids (p = 0.28), or projection (0.20). CONCLUSION The choice between subfascial and subglandular planes shows no clinical differences and can be selected according to individual professional experience, not evidencing any advantages of one over the other. LEVEL OF EVIDENCE II 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 www.springer.com/00266.
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Affiliation(s)
- Ivan Maluf Junior
- Aesthetic and Reconstructive Plastic Surgery Service at Hospital de Clínicas, Universidade Federal Do Paraná (UFPR), Curitiba, Paraná State, Brazil.
| | - Ruth Maria Graf
- Plastic Surgery Service at Hospital de Clínicas, UFPR, Sao Paulo, Brazil
| | - Adriana Sayuri Kurogi Ascenço
- Aesthetic and Reconstructive Plastic Surgery Service at Hospital de Clínicas, Universidade Federal Do Paraná (UFPR), Curitiba, Paraná State, Brazil
| | - Willian Itikawa
- Aesthetic and Reconstructive Plastic Surgery Service at Hospital de Clínicas, Universidade Federal Do Paraná (UFPR), Curitiba, Paraná State, Brazil
| | - Priscilla Balbinot
- Aesthetic and Reconstructive Plastic Surgery Service at Hospital de Clínicas, Universidade Federal Do Paraná (UFPR), Curitiba, Paraná State, Brazil
| | | | - Marlon Câmara Lopes
- Aesthetic and Reconstructive Plastic Surgery Service at Hospital de Clínicas, Universidade Federal Do Paraná (UFPR), Curitiba, Paraná State, Brazil
| | - Isis Juliane Guarezi Nasser
- Aesthetic and Reconstructive Plastic Surgery Service at Hospital de Clínicas, Universidade Federal Do Paraná (UFPR), Curitiba, Paraná State, Brazil
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Ono MCC, Groth AK, da Silva ABD, da Silva Freitas R, Kawasaki CS, de Paula DR, Nissel MAZ. Inframammary fold subcutaneous cushion assessment using MRI (magnetic resonance imaging). Gland Surg 2019; 8:378-384. [PMID: 31538062 DOI: 10.21037/gs.2019.06.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The inframammary fold (IMF) is one of the most important elements in the determination of the aesthetic of the female breast. During mastectomies, it is important to preserve the subcutaneous portion nearby the IMF, attempting that, this preservation will greatly facilitate reconstruction allowing more satisfying aesthetic results. The aim of the present study is to evaluate the thickness of the subcutaneous IMF cushion using magnetic resonance imaging (MRI) acquisition images. Methods We have gauged the right breast IMF subcutaneous cushion from patients (all the cases without previous surgery in this topography) who were submitted to MRI in a diagnosis radiology center, between January and February of 2017. MRI images were analyzed in T1 fat saturated sequences. The assessment of the fold cushion was realized in the projection of axial measurements in sagittal plane. Results Among the 50 evaluated patients, the median measure of breast base was 9.91 cm. The median measure of the subcutaneous IMF cushion assessment in the sagittal projection of the breast base meridian was 2.40 cm (varying from 1.34 to 4.05 cm, with percentile 5% of 1.51 cm and percentile 95% of 3.55 cm). Conclusions Other studies indicate the negligible amount of breast tissue and the low incidence of neoplasia in this topography, the preservation of the IMF seems feasible. The measurements of the IMF thickness, evaluated by MRI in this study, provide reference values for maintaining a desirable inframammary crease.
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Affiliation(s)
- Maria Cecilia Closs Ono
- Department of Plastic Surgery, University Federal of Paraná, Curitiba, Brazil.,Service of Plastic Surgery, Hospital Erasto Gaertner, Curitiba, Brazil
| | - Anne Karoline Groth
- Service of Plastic Surgery, Hospital Erasto Gaertner, Curitiba, Brazil.,Positivo University, Curitiba, Brazil
| | - Alfredo Benjamin Duarte da Silva
- Department of Plastic Surgery, University Federal of Paraná, Curitiba, Brazil.,Service of Plastic Surgery, Hospital Erasto Gaertner, Curitiba, Brazil
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Ono MCC, Graf RM, de Paula DR, Lupion FG, Freitas RDS. Extended chest wall based flap and lipofilling for immediate breast reconstruction for obese patients. J Plast Reconstr Aesthet Surg 2018; 71:1664-1678. [PMID: 30172733 DOI: 10.1016/j.bjps.2018.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 06/22/2018] [Accepted: 07/28/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Maria Cecilia Closs Ono
- Department of Plastic and Reconstrucive Surgery, Federal University of Parana, Clinics Hospital, 181 General Carneiro Street, Curitiba, Paraná 80060900, Brazil.
| | - Ruth Maria Graf
- Department of Plastic and Reconstrucive Surgery, Federal University of Parana, Clinics Hospital, 181 General Carneiro Street, Curitiba, Paraná 80060900, Brazil
| | - Dayane Raquel de Paula
- Department of Plastic and Reconstrucive Surgery, Federal University of Parana, Clinics Hospital, 181 General Carneiro Street, Curitiba, Paraná 80060900, Brazil
| | - Fabiola Grigoletto Lupion
- Department of Plastic and Reconstrucive Surgery, Federal University of Parana, Clinics Hospital, 181 General Carneiro Street, Curitiba, Paraná 80060900, Brazil
| | - Renato da Silva Freitas
- Department of Plastic and Reconstrucive Surgery, Federal University of Parana, Clinics Hospital, 181 General Carneiro Street, Curitiba, Paraná 80060900, Brazil
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Amaral Neto OFD, Mizoguchi FM, Freitas RDS, Maniglia JJ, Maniglia FF, Maniglia RF. A Comparative Study between Universal Eclectic Septoplasty Technique and Cottle. Int Arch Otorhinolaryngol 2017; 21:281-285. [PMID: 28680499 PMCID: PMC5495589 DOI: 10.1055/s-0037-1599275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 01/13/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction
Since the last century surgical correction of nasal septum deviation has been improved. The Universal Eclectic Technique was recently reported and there are still few studies dedicated to address this surgical approach.
Objective
The objective of this study is to compare the results of septal deviation correction achieved using the Universal Eclectic Technique (UET) with those obtained through Cottle's Technique.
Methods
This is a prospective study with two consecutive case series totaling 90 patients (40 women and 50 men), aged between 18 and 55 years. We divided patients into two groups according to the surgical approach. Fifty-three patients underwent septoplasty through Universal Eclectic Technique (UET) and thirty-seven patients were submitted to classical Cottle's septoplasty technique. All patients have answered the Nasal Obstruction Symptom Evaluation Scale (NOSE) questionnaire to assess pre and postoperative nasal obstruction.
Results
Statistical analysis showed a significantly shorter operating time for the UET group. Nasal edema assessment performed seven days after the surgery showed a prevalence of mild edema in UET group and moderate edema in Cottle's technique group. In regard to complication rates, UET presented a single case of septal hematoma while in Cottle's technique group we observed: 02 cases of severe edemas, 01 case of incapacitating headache, and 01 complaint of nasal pain.
Conclusion
The Universal Eclectic Technique (UET) has proven to be a safe and effective surgical technique with faster symptomatic improvement, low complication rates, and reduced surgical time when compared with classical Cottle's technique.
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Affiliation(s)
- Odim Ferreira do Amaral Neto
- Hospital Paranaense de Otorrinolaringologia IPO LTDA, Curitiba, Paraná, Brazil.,Master in Sciences thesis, Post Graduate Program (Ringgold Standard), Clinical Surgery Department, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | | | - João Jairney Maniglia
- Hospital Paranaense de Otorrinolaringologia IPO LTDA, Curitiba, Paraná, Brazil.,Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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Graf RM, Ricardo Dall Oglio Tolazzi A, Balbinot P, Pazio ALB, Ascenço ASK, Freitas RDS. Response to "Long-Term Radiographic and Photographic Evaluation of the Pectoralis Muscle Loop in Reduction Mammaplasty". Aesthet Surg J 2017; 37:NP12-NP13. [PMID: 27986780 DOI: 10.1093/asj/sjw187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ruth Maria Graf
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil.
| | - André Ricardo Dall Oglio Tolazzi
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil
| | - Priscilla Balbinot
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil
| | - André Luiz Bilieri Pazio
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil
| | - Adriana Sayuri Kurogi Ascenço
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil
| | - Renato da Silva Freitas
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil
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Graf R, Ricardo Dall Oglio Tolazzi A, Balbinot P, Pazio A, Miguel Valente P, da Silva Freitas R. Influence of the Pectoralis Major Muscle Sling in Chest Wall-Based Flap Suspension After Vertical Mammaplasty: Ten-Year Follow-Up. Aesthet Surg J 2016; 36:1113-1121. [PMID: 27402787 DOI: 10.1093/asj/sjw114] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The pectoralis muscle sling has proven to be a suitable alternative technique for long-term results in breast parenchyma suspension. Although the pectoralis muscle sling has been subjectively observed to reduce the bottoming-out effect with a bipedicled muscle flap (muscular loop), there has not been a study to objectively or numerically prove it. OBJECTIVES This study aimed to radiologically evaluate the influence of a pectoralis muscle sling in supporting the chest wall-based flap after a vertical breast-reduction technique. METHODS Twenty-one female patients underwent a vertical breast reduction with the chest wall-based flap and were randomly divided into two subgroups. Ten patients were in subgroup (S), which consisted of patients with a muscle sling. Eleven patients without the muscle sling technique were assigned as a control group (C). Periodic radiological examinations were performed at 1, 3, 6, and 12 months and then at 10 years postoperatively to analyze the breast flap and any migration with respect to three titanium clips placed intraoperatively on the chest wall parenchyma flap. RESULTS Patients in subgroup S had a significantly higher difference in migration of the chest wall-based flaps between the first day and 10 years postoperatively when compared with patients in subgroup C (P < .001), as shown by the distances measured between titanium clip locations. CONCLUSIONS After 10 years of follow-up, there were changes in chest wall-based flap bottoming-out in patients in whom a pectoralis major muscle sling was utilized compared with those patients without it. Thus, a pectoralis major muscle sling seems to provide greater and longer-lasting support to the flap position on the patient's chest. LEVEL OF EVIDENCE 2 Therapeutic.
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Affiliation(s)
- Ruth Graf
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil
| | - André Ricardo Dall Oglio Tolazzi
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil
| | - Priscilla Balbinot
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil
| | - André Pazio
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil
| | - Pedro Miguel Valente
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil
| | - Renato da Silva Freitas
- From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil
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Berger CAS, Freitas RDS, Malafaia O, Pinto JSDP, Macedo Filho ED, Mocellin M, Fagundes MSC. Prospective study of the surgical techniques used in primary rhinoplasty on the caucasian nose and comparison of the preoperative and postoperative anthropometric nose measurements. Int Arch Otorhinolaryngol 2014; 19:34-41. [PMID: 25992149 PMCID: PMC4392525 DOI: 10.1055/s-0034-1393721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/13/2014] [Indexed: 10/26/2022] Open
Abstract
Introduction The knowledge and study of surgical techniques and anthropometric measurements of the nose make possible a qualitative and quantitative analysis of surgical results. Objective Study the main technique used in rhinoplasty on Caucasian noses and compare preoperative and postoperative anthropometric measurements of the nose. Methods A prospective study with 170 patients was performed at a private hospital. Data were collected using the Electronic System Integrated of Protocols software (Sistema Integrado de Protocolos Eletrônicos, SINPE©). The surgical techniques used in the nasal dorsum and tip were evaluated. Preoperative and 12-month follow-up photos as well as the measurements compared with the ideal aesthetic standard of a Caucasian nose were analyzed objectively. Student t test and standard deviation test were applied. Results There was a predominance of endonasal access (94.4%). The most common dorsum technique was hump removal (33.33%), and the predominance of sutures (24.76%) was observed on the nasal tip, with the lateral intercrural the most frequent (32.39%). Comparison between preoperative and postoperative photos found statistically significant alterations on the anthropometric measurements of the noses. Conclusion The main surgical techniques on Caucasian noses were evaluated, and a great variety was found. The evaluation of anthropometric measurements of the nose proved the efficiency of the performed procedures.
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Affiliation(s)
- Cezar Augusto Sarraf Berger
- Fellowship Program on Facial Plastic Surgery, IPO Hospital, Curitiba, Paraná, Brazil ; MSc in Surgical Practice, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil ; Department of Otolaryngology, UFPR Clinical Hospital (HC/UFPR), Curitiba, Paraná, Brazil
| | | | - Osvaldo Malafaia
- Titular Professor of Surgery, UFPR, Curitiba, Paraná, Brazil ; Institute of Medical Research and of the Postgraduate Program; MSc and PhD on Surgery Principles, Evangélico University Hospital, Curitiba, Paraná, Brazil
| | | | - Evaldo Dacheux Macedo Filho
- Department of Otolaryngology, UFPR Clinical Hospital (HC/UFPR), Curitiba, Paraná, Brazil ; Department of NEP, IPO Hospital, Curitiba, Paraná, Brazil
| | - Marcos Mocellin
- Department of Otolaryngology, UFPR Clinical Hospital (HC/UFPR), Curitiba, Paraná, Brazil
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Maluf Junior I, Lopes MAC, Ascenço ASK, Berri DT, Matioski AR, Carbonieri F, Balbinot P, Nasser I, Maluf RCP, Freitas RDS. [Is professional recognition in plastic surgery related to activity in research]. Rev Col Bras Cir 2014; 41:224-7. [PMID: 25140656 DOI: 10.1590/s0100-69912014000300015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 08/20/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the relation of medical research, with the participation of prominent plastic surgeon in Congress. METHODS We reviewed the scientific programs of the last 3 Brazilian Congress of Surgery, were selected 21 Brazilian plástic surgeons invited to serve as panelists or speakers in roundtable sessions in the last 3 congresses (Group 1). We randomly selected and paired by other members (associates) of the Brazilian Society of Plastic Surgery, with no participation in congress as speaker (Group 2). We conducted a search for articles published in journals indexed in Medline, Lilacs and SciELO for all doctors selected during the entire academic career and the last 5 years from March 2007 until March 2012. We assessed the research activity through the simple counting of the number of publications in indexed journals for each professional. The number of publications groups was compared. RESULTS articles produced throughout career: Group 1- 639 articles (average of 30.42 items each). Group 2- 79 articles (mean 3.95 articles each). Difference between medias: p <0.001. CONCLUSION The results demonstrate that the Brazilian Society of Plastic Surgery seeking professionals with a greater number of publications and journals of higher impact. This approach encourages new members to pursue a higher qualification, and give security to congressmen, they can rely on the existence of a technical criterion in the choice of speakers.
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Roça GB, Graf R, da Silva Freitas R, Salles G, Francisco JC, Noronha L, Maluf I. Autologous Fat Grafting for Treatment of Breast Implant Capsular Contracture: A Study in Pigs. Aesthet Surg J 2014; 34:769-75. [PMID: 24963064 DOI: 10.1177/1090820x14533184] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Capsular contracture (CC) is a common complication after breast augmentation. Autologous fat grafting may be effective for restoring tissue vascularization and function. OBJECTIVE The authors evaluated the efficacy of autologous fat grafting in a porcine model as a treatment for CC after breast augmentation. METHODS This prospective study was performed in 20 female 30-day-old pigs. Each animal was implanted with three 30-cc textured silicone implants (stage 1 of the experiment). Group A served as the untreated control group. To induce CC, 2 mL of autologous fibrin glue was applied to the pericapsular space in group B and C animals at implantation. Three months after implantation (stage 2), the CCs of all groups were assessed by Baker classification and applanation tonometry (AT). Liposuction was performed in group B to harvest fat for these animals. Three months after group B underwent fat grafting, all 3 groups were reevaluated. Reassessments included Baker classification, AT, histologic analysis, and tensiometry (stage 3). RESULTS The deposition of mature and immature collagen was similar for the 3 groups. The amount of fat remaining around the implanted capsules did not differ significantly between the groups. At stage 3, group B exhibited significantly larger tonometry areas than did group C. The CCs in groups B and C were significantly thicker than those of group A, but the difference between groups B and C was not significant. Capsule rupture forces did not differ significantly between groups A and B but were significantly higher in group C compared with the other groups. CONCLUSIONS Results in this animal model indicate that pericapsular lipoinjection may be a promising treatment for CC in humans.
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Affiliation(s)
| | - Ruth Graf
- Dr Graf is Professor, Dr Freitas is Professor and Head of Unit, and Mr Maluf is a resident in the Plastic Surgery Unit, Federal University of Paraná, Brazil
| | - Renato da Silva Freitas
- Dr Graf is Professor, Dr Freitas is Professor and Head of Unit, and Mr Maluf is a resident in the Plastic Surgery Unit, Federal University of Paraná, Brazil
| | - Guataçara Salles
- Drs Salles, Francisco, and Noronha are Professors at Pontifical Catholic University of Paraná, Brazil
| | - Julio Cesar Francisco
- Drs Salles, Francisco, and Noronha are Professors at Pontifical Catholic University of Paraná, Brazil
| | - Lucia Noronha
- Drs Salles, Francisco, and Noronha are Professors at Pontifical Catholic University of Paraná, Brazil
| | - Ivan Maluf
- Dr Graf is Professor, Dr Freitas is Professor and Head of Unit, and Mr Maluf is a resident in the Plastic Surgery Unit, Federal University of Paraná, Brazil
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Maluf Junior I, da Silva ABD, Groth AK, Lopes MAC, Kurogi AS, Freitas RDS, Tomasich FDS. An alternative experimental model for training in microsurgery. Rev Col Bras Cir 2014. [PMID: 24770778 DOI: 10.1590/s0100-69912014000100014.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to describe a new model of training in microsurgery with pig spleen after splenectomy performed by undergraduate students of the Discipline of Operative Technique of the UFPR Medical School. METHODS after the completion of splenectomy we performed dissection of the vascular pedicle, distal and proximal to the ligation performed for removal of the spleen. After complete dissection of the splenic artery and vein with microscope, clamps were placed and the vessels were cut. We then made the anastomosis of the vessels with 9.0 nylon. RESULT the microsurgical training with a well-defined routine, qualified supervision and using low cost experimental materials proved to be effective in the practice of initial microvascular surgery. CONCLUSION the use of pig spleen, which would be discarded after splenectomy, is an excellent model for microsurgical training, since besides having the consistency and sensitivity of a real model, it saves the sacrifice of a new animal model in the initial learning phase of this technique.
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Affiliation(s)
- Ivan Maluf Junior
- Clinics Hospital, Federal University of Paraná, Curitiba, PR, Brazil
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Scomação IR, Graf RM, Maluf I, Forte AJ, da Silva Freitas R. Evaluation of Photographic Variables in Patients with Indication for Facial Rejuvenation. Aesthetic Plast Surg 2013; 37:1114-1119. [PMID: 24122069 DOI: 10.1007/s00266-013-0222-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/08/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Photography standardization is paramount for appropriate critical analysis of aesthetic surgery outcomes. Therefore, the authors designed a study to evaluate the influence of different variables in photos of patients with indications for undergoing facial rejuvenation. METHODS This blinded prospective study was conducted by the Section of Plastic Surgery in the Hospital das Clínicas at the Federal University of Paraná. In the study, 29 patients had their photos taken in two separate settings. Photo 1, termed "preoperative" (Pre), was obtained according to the same pattern for all patients. Photo 2, termed "postoperative" (Post), was acquired on the same day using different variables to manipulate the photo outcome. No surgery was actually performed. Both photos (Pre and Post) were sent to five experienced Brazilian plastic surgeons, who provided a score for photo 2 that varied from -10 to +10 compared with photo 1. RESULTS The photos were examined by 119 plastic surgeons. No significant improvement was observed in most of the groups, except for the group that used a flash for the Post photography (p = 0.035). Almost half of the scores (45.37 %) were above zero. The highest score was found to be ten for two photographs of the makeup group. A score of zero was assigned to 54.62 % of the photos, which means no changes occurred between the Pre and Post photos. CONCLUSION Inadequate photographic technique can change assessments of photos in a meaningful way. All the factors evaluated had a positive impact, but the only statistically significant variable was the use of a flash in the Post group. LEVEL OF EVIDENCE II 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 www.springer.com/00266 .
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Affiliation(s)
- Isis Raulino Scomação
- Hospital de Clinicas da, UFPR, Rua General Carneiro, 181, Alto da Glória Curitiba, Curitiba, PR, 80060-900, Brazil
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Werner B, Carvalho VO, Nacif SB, Abbage KT, Freitas RDS, Colpo PG. Desmoplastic hypopigmented hairless nevus: a variant with progressive depigmentation, induration, and overgrowth. Pediatr Dermatol 2012; 29:336-40. [PMID: 21575045 DOI: 10.1111/j.1525-1470.2011.01423.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Large congenital melanocytic nevus rarely presents itself without hairs, with hardened skin and progressive depigmentation. We report a girl who presented with a large congenital melanocytic nevus in the left cheek. Over the years, the nevus became pruriginous, light brown, bumpy, and hard. Histology revealed nevus cells interspersed with dense fibrosclerotic collagen bundles. There are few reported cases of large congenital melanocytic nevus with this evolution, so-called desmoplastic hypopigmented hairless nevus.
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Affiliation(s)
- Betina Werner
- Division of Basic Pathology, Department of Pathology, Federal University of Paraná, Curitiba, Paraná, Brazil
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Alonso N, Tanikawa DYS, Freitas RDS, Canan L, Ozawa TO, Rocha DL. Evaluation of maxillary alveolar reconstruction using a resorbable collagen sponge with recombinant human bone morphogenetic protein-2 in cleft lip and palate patients. Tissue Eng Part C Methods 2011; 16:1183-9. [PMID: 20163243 DOI: 10.1089/ten.tec.2009.0824] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A resorbable collagen matrix with recombinant human bone morphogenetic protein (rhBMP-2) was compared with traditional iliac crest bone graft for the closure of alveolar defects during secondary dental eruption. METHODS Sixteen patients with unilateral cleft lip and palate, aged 8 to 12 years, were selected and randomly assigned to group 1 (rhBMP-2) or group 2 (iliac crest bone graft). Computed tomography was performed to assess both groups preoperatively and at months 6 and 12 postoperatively. Bone height and defect volume were calculated through Osirix Dicom Viewer (Pixmeo, Apple Inc.). Overall morbidity was recorded. RESULTS Preoperative and follow-up examinations revealed progressive alveolar bone union in all patients. For group 1, final completion of the defect with a 65.0% mean bone height was detected 12 months postoperatively. For group 2, final completion of the defect with an 83.8% mean bone height was detected 6 months postoperatively. Dental eruption routinely occurred in both groups. Clinical complications included significant swelling in three group 1 patients (37.5%) and significant donor-site pain in seven group 2 patients (87.5%). CONCLUSIONS For this select group of patients with immature skeleton, rhBMP-2 therapy resulted in satisfactory bone healing and reduced morbidity compared with traditional iliac crest bone grafting.
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Affiliation(s)
- Nivaldo Alonso
- Division of Plastic Surgery, University of São Paulo Medical School, São Paulo, Brazil.
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da Silva Freitas R, Alonso N, Shin JH, Busato L, Dall'Oglio Tolazzi A, de Oliveria e Cruz GA. The Tessier Number 5 Facial Cleft: Surgical Strategies and Outcomes in Six Patients. Cleft Palate Craniofac J 2009; 46:179-86. [DOI: 10.1597/07-192.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Tessier no. 5 facial cleft is an extremely rare congenital malformation. Only 26 cases have been described in the English-language literature. The cleft begins in the upper lip just medial to the oral commissure, extending across the cheek as a groove ending at the junction of the middle and lateral thirds of the lower eyelid. The bone involvement usually includes an alveolar cleft in the premolar region, extends across the maxilla lateral to the infraorbital nerve, up to the infraorbital rim and orbital floor. The goals of the surgical procedure include reconstructing the lower eyelid, repositioning the lateral canthus, closure of the labiomaxillary cleft, and restoration of the skeletal continuity (including the orbital floor defect) with bone grafts. We present six patients with the Tessier no. 5 facial cleft who have been treated in our combined centers and discuss the surgical options and difficulties faced in the reconstruction of this rare and challenging craniofacial malformation. To date, we have treated six patients (two with bilateral and four with unilateral clefts). Three of the patients with unilateral clefting had an associated no. 4 cleft and one patient with a bilateral cleft had an associated no. 3 cleft. This paper represents the largest series to date documenting surgery for patients with the Tessier no. 5 facial cleft.
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Affiliation(s)
- Renato da Silva Freitas
- Plastic and Reconstructive Surgery, Federal University of Paraná, Grandar, Curitiba Brazil
- Center for Cleft Lip and Palate (CAIF), Curitiba, Brazil
- Yale Craniofacial Center, New Haven, Connecticut
| | - Nivaldo Alonso
- Craniofacial Surgery Unit, Section of Plastic Surgery, São Paulo University, São Paulo, Brazil
| | - Joseph H. Shin
- Yale Craniofacial Center, Section of Plastic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Luciano Busato
- Plastic and Reconstructive Surgery Unit, Federal University of Paraná, Grandar, Curitiba, Brazil
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da Silva Freitas R, Bertolotte W, Shin J, Busato L, Alonso N, Grande CV, de Oliveira e Cruz GA. Combination Micrografting and Tattooing in the Reconstruction of Eyebrows of Patients With Craniofacial Clefts. Ophthalmic Plast Reconstr Surg 2008; 24:340-2. [DOI: 10.1097/iop.0b013e31817dd549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tenius FP, da Silva Freitas R, Closs Ono MC. Transareolar incision with geometric broken line for breast augmentation: a novel approach. Aesthetic Plast Surg 2008; 32:546-8. [PMID: 18365269 DOI: 10.1007/s00266-008-9145-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 03/04/2008] [Indexed: 11/25/2022]
Abstract
Along with implant location and size, incision location is an important variable that influences the final result of breast augmentation. The transareolar approach is not popular because of reported lactational difficulties, higher rates of capsular contracture, visibility of scars, and potential changes in nipple sensation. We describe a geometric zigzag transareolar incision for breast augmentation that can achieve imperceptible scarring. We believe that in selected patients the transareolar zigzag incision has its place among the different approaches used in breast augmentation today.
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Affiliation(s)
- Fernando Pundek Tenius
- Section of Plastic Surgery, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil.
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Abstract
Epignathus is a rare congenital nasopharyngeal tumour that is derived from the upper jaw, palate, and sphenoid bone. It usually protrudes through the mouth, leading to an appreciable risk of obstruction of the upper airway and death soon after birth. We report two cases of unusual presentations that illustrated some uncommon and similar characteristics. Although these tumours are not consistent in origin, number, and differentiation of tissues, both contained structures that were derived from all three layers of germ cells, including different anomalous tissues internally (dental bud, fat and muscular tissues, mucosal epithelium). Externally, they contained normal epidermis (skin with fine hairs). Imaging studies and operative findings showed that both tumours originated from the anterior portion of the sphenoid bone causing a sphenoidal sinus cleft without intracranial communication.
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Affiliation(s)
- Renato da Silva Freitas
- Plastic and Reconstructive Surgery Unit, Federal University of Paraná (UFPR), Assistance Center for Cleft Lip and Palate (CAIF), Curitiba/PR, Brazil.
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Abstract
Macrostomia is a rare facial malformation caused by failure of mesodermal migration merging to obliterate the embryonic grooves between the maxillary and mandibular processes during the early phase of gestation. This kind of malformation may require the use of several surgical techniques to repair the facial structure. Bibliographic studies concerning the repair of this malformation are focused on the description of mucosa, muscle, and skin flaps disconnected between them. This article presents a description of a unique myomucosal flap from vermillion for the correction of the existing malformation in the oral commissure.
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Affiliation(s)
- Diogo Franco
- Plastic Surgery Division of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Freitas RDS, o Tolazzi ARD, Martins VDM, Knop BA, Graf RM, Cruz GADOE. Poland's syndrome: different clinical presentations and surgical reconstructions in 18 cases. Aesthetic Plast Surg 2007; 31:140-6. [PMID: 17093886 DOI: 10.1007/s00266-005-0140-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The literature reports many variations of Poland's syndrome. This article describes 18 cases of Poland's syndrome in different stages of treatment, with variable clinical presentations and reconstructive techniques. METHODS This study evaluated 15 females and 3 males, ages 2 to 43 years, for breast deformity, nipple-areolar complex position, pectoralis muscle malformation, thoracic deformities, and the presence of brachysyndactyly. Surgical treatment was performed for 14 patients, individualized for each case. RESULTS For the women, the hypoplastic breast was treated with a latissimus dorsi muscular flap associated with silicone gel implant in five cases. Two other patients still are receiving tissue expansion for a future muscular and prosthetic reconstruction. Prosthetic implants alone were used on the affected side in four cases. The nipple-areolar complex was reconstructed for two patients. Seven women underwent contralateral breast surgery: reduction mammoplasty in three cases, mastopexy in two cases, and prosthetic implants in two cases. The only man who underwent surgery was treated with endoscopic rotation of the latissimus dorsi muscle flap. CONCLUSIONS This study demonstrated several breast reconstruction options for patients with Poland's syndrome, reinforcing the importance of an individualized treatment to achieve complete and adequate rehabilitation.
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Affiliation(s)
- Renato da Silva Freitas
- Plastic and Reconstructive Surgery Unit, Hospital de Clínicas of Federal University of Paraná, R. General Carneiro, Curitiba-PR, Brazil 80060-900.
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Abstract
For many years, surgeons have sought a method to treat severe facial deformities without using bone grafts and extensive surgery. Distraction osteogenesis offers this promise. The technique used in mandibular hypoplasia follows the basic principles proposed by Ilizarov which states that the device must be elongated 1 mm per day to create optimal bone production. Despite the widespread implementation of this recommendation to include the 1-mm/day separation, doubt still exists as to whether this is the optimal treatment regimen. Intraoral devices with percutaneous activator pins were used in 16 patients with hypoplastic mandibles. The results of distraction were documented by panorex and cephalogram of the mandible. The length of the ramus as well as multiple mandible dimensions and facial angles were measured. The panorex and cephalogram of the mandible were effective in demonstrating the significant increase in length of the mandible and ramus, as well as the entire mandible, but there was no correlation between the stretching obtained by the distraction device and that measured by the radiographic studies. The S-N-B angle was the only facial angle in which there is a statistically significant increase measured and this appeared to be related to a mandible rotation. It is concluded that the mandible distraction (using an intraoral device and an external activator pin) was effective in increasing the ramus length and both the panorex and the cephalogram were effective in demonstrating this morphologic change. There was no correlation between the clinical result and the radiographic studies demonstrating that the clinical judgment still has a significant role in controlling mandible distraction.
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Abstract
As fraturas da face em crianças são infreqüentes e a melhor forma de tratamento ainda é a prevenção. Com isso nosso estudo busca caracterizar epidemiologicamente as fraturas de face em crianças enfatizando os sítios principais. Analisamos 126 fraturas de face em 98 crianças atendidas no HC-FMUSP, entre janeiro de 1990 e julho de 1996. A causa mais freqüente foi a queda de alturas e o osso da face mais acometido foi a mandíbula (29%), seguida do osso nasal (24%). Das fraturas da mandíbula, o corpo foi a região mais envolvida (31%), seguido do côndilo (27%). Traumas associados estiveram presentes em 24% dos casos, sendo traumatismo crânio-encefálico o mais freqüente. Os acidentes domésticos são as principais causas de fraturas de face em crianças, portanto, medidas preventivs simples podem ser adotadas objetivando diminuir o número desses acidentes.
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Golcman R, Golcman B, Pinto DCS, Freitas RDS. Reconstrução de pálpebra inferior pela técnica de Hughes. Arq Bras Oftalmol 1995. [DOI: 10.5935/0004-2749.19950090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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