Frontoplastia endoscópica para tratamiento del envejecimiento facial / Endoscopic Frontoplasty for Treating Facial Aging

Introducción: En el concepto moderno de rejuvenecimiento facial, lo principal es conseguir un resultado natural sin marcas quirúrgicas. El lifting endoscópico fronto-témporo-orbitario es en la actualidad, el mejor método para conseguirlo. Objetivo: Determinar la efectividad de la técnica de frontoplastia endoscópica para el tratamiento del envejecimiento facial. Métodos: Se realizó un estudio observacional descriptivo de una serie de 28 casos con diagnóstico de envejecimiento facial atendidos en el Centro Nacional de Cirugía de Mínimo Acceso en el período comprendido entre enero de 2014 hasta enero de 2017. Se estudiaron las variables de: sexo, edad, estado civil, escolaridad, raza, tiempo quirúrgico y complicaciones transoperatorias. Resultados: La edad media fue de 54,4 (40-73) años. Predominó el sexo femenino (89,3 por ciento). El nivel medio de escolaridad 61,5 por ciento, estado civil casado 52,0 por ciento. La ptosis de las cejas con presencia de arrugas frontales y glabelares fue el diagnóstico más frecuente 13; 46,4 por ciento. El tiempo quirúrgico medio fue 80,9 (40-120) minutos. No existieron complicaciones intraoperatorias, conversiones, ni reintervenciones. En 27 pacientes (96,4 por ciento) hubo permanencia de los resultados en el tiempo. Se presentaron complicaciones en 4 pacientes (14,3 por ciento). Hubo 19 pacientes atendidos de manera ambulatoria (67,9 por ciento), con estancia hospitalaria de un día (32,1 por ciento). La totalidad mostró satisfacción con los resultados obtenidos. Conclusiones: La frontoplastia endoscópica es un método poco invasivo y muy efectivo para reposicionar las cejas descendidas además tratar las arrugas frontales y glabelares(AU)

Introduction: In the modern concept of facial rejuvenation, the main thing is to achieve a natural result without surgical marks. The endoscopic fronto-temporo-orbital lifting is currently the best method to achieve this. Objective: To determine the effectiveness of the endoscopic frontoplasty technique for the treatment of facial aging. Methods: A descriptive observational study of a series of 28 cases with a diagnosis of facial aging treated at the National Center for Minimal Access Surgery in the period from January 2014 to January 2017 was carried out. The variables of: sex, age, marital status, schooling, race, surgical time and intraoperative complications. Results: The mean age was 54.4 (40-73) years. The female sex prevailed (89.3 percent). The average level of schooling 61.5 percent, married marital status 52.0 percent. Ptosis of the eyebrows with the presence of frontal and glabellar wrinkles was the most frequent diagnosis 13; 46.4 percent. The mean surgical time was 80.9 (40-120) minutes. There were no intraoperative complications, conversions, or reinterventions. In 27 patients (96.4 percent) there was permanence of the results over time. Complications occurred in 4 patients (14.3 percent). There were 19 patients treated as outpatients (67.9 percent), with a hospital stay of one day (32.1 percent). All showed satisfaction with the results obtained. Conclusions: Endoscopic foreheadoplasty is a minimally invasive and very effective method for repositioning lowered eyebrows, as well as treating frontal and glabellar wrinkles(AU)

Uleritema ofriógenes como entidad asociada al síndrome 18p- en un paciente pediátrico / Ulerythema ophryogenes as an entity associated with 18p- syndrome in a pediatric patient

El uleritema ofriógenes es un trastorno cutáneo benigno y poco frecuente que se presenta habitualmente en la infancia. Se caracteriza por pápulas foliculares eritematosas y queratósicas en el lateral de las cejas, que con el tiempo suelen evolucionar a alopecia cicatricial. Dicha entidad puede aparecer como manifestación clínica aislada o asociada a varios síndromes congénitos (18p-, Cornelia de Lange, Noonan y Rubinstein- Taybi, entre otros). Presentamos el caso de un paciente de 13 años con síndrome 18p- que consultó por lesiones puntiformes rugosas al tacto y pérdida de pelo en ambas cejas (uleritema ofriógenes), así como por hiperqueratosis pilar en brazos. Esta tríada, conocida como síndrome de Zouboulis, ha sido poco descrita en la literatura. Se considera que el reconocimiento del uleritema ofriógenes es de crucial importancia ya que, ante su presencia, debería realizarse una anamnesis y una exploración física exhaustivas en búsqueda de otras alteraciones que pudieran orientar a la existencia de un trastorno genético subyacente.

Ulerythema ophryogenes is a benign and rare skin disorder commonly presenting in childhood. It is characterized by erythematous and keratotic follicular papules located on the side of the eyebrows, and which over time tends to evolve into scarred alopecia. This entity may appear as an isolated clinical manifestation or associated with several congenital syndromes (18p-, Cornelia de Lange, Noonan, Rubinstein-Taybi, among others). We present a 13-year-old male with 18p- syndrome who consults for rough lesions and hair loss in both eyebrows (ulerythema ophryogenes), as well as for hyperkeatosis pilaris in both arms. This triad, known as Zouboulis syndrome, has been rarely reported in the literature. We consider that the recognition of ulerythema ophryogenes is of crucial importance since, in view of its presence, comprehensive anamnesis and physical examination should be performed in search of other alterations that could guide the existence of an underlying genetic disord

Long-term comparison of the efficacies of internal and external browpexy combined with blepharoplasty / Comparação a longo prazo da eficácia de browpexy interna ou externa associada à blefaroplastia

ABSTRACT Purpose: To perform a long-term comparison of the quantitative efficacy of internal and external browpexy in combination with upper-lid blepharoplasty based on lateral and central eyebrow positions. Methods: This retrospective study evaluated internal and external browpexy with upper-lid blepharoplasty surgeries that were performed during the period between January 2012 and December 2017 in the oculoplastic surgery department of our hospital. Patients who had undergone periorbital and forehead surgery, who had ophthalmologic or neurological diseases, and who were Botox users were not included in the study. Preoperative and postoperative measurements were made on photographs taken in the same position. The distances from the pupil center and from the point of intersection between the horizontal line passing through the pupil and the vertical line passing through the lateral canthus to the upper eyebrow borders were measured. Photogrammetric analysis of eyebrow position was analyzed using Corel Draw software. Results: Preoperative and postoperative photographs of 70 eyelids were analyzed. Measurements were taken 24 months after surgery. Mean elevations of 2.10 and 3.19 mm were observed in the central region and lateral regions, respectively, in the internal browpexy group. These elevations were 2.66 and 3.03 mm in the external browpexy group and 0.48 and 0.55 mm in the control group. Eyebrow elevations in the central and lateral regions were not significantly different from baseline in the control group (p=0.126 and p=0.25). Internal and external browpexy showed statistically similar elevation values in the central and lateral regions (p=0.636 and p=0.342). Conclusions: External and internal browpexy surgery afforded adequate and similar elevations of the central and lateral brow, which were significantly different from those in the standard blepharoplasty group during long-term follow-up.

RESUMO Objetivo: Avaliar a comparação, a longo prazo, da eficácia quantitativa da sobrancelha interna e externa em combinação com a blefaroplastia da pálpebra superior com base nas posições lateral e central da sobrancelha. Métodos: Este estudo retrospectivo avaliou as cirurgias interna e externa da braquiterapia com blefaroplastia de pálpebra superior realizadas entre janeiro de 2012 e dezembro de 2017 no setor de cirurgia Oculoplástica de nosso hospital. Pacientes submetidos à cirurgia periorbitária e frontal, com doenças oftalmológicas ou neurológicas e usuários de Botox não foram incluídos no estudo. Medidas pré e pós-operatórias foram feitas em fotografias tiradas na mesma posição. Foram medidas as distâncias do centro da pupila e do ponto de intersecção entre a linha horizontal que passa pela pupila e a linha vertical que passa pelo canto lateral do olho até as bordas superiores da sobrancelha. A análise fotogramétrica da posição da sobrancelha foi analisada usando o software Corel Draw. Resultados: Foram analisadas fotografias pré e pós-operatórias de 70 pálpebras. As medidas foram feitas 24 meses após a cirurgia. Elevações médias de 2,10 e 3,19 mm foram observadas na região central e laterais, respectivamente, no grupo de sobrancelha interna. Essas elevações foram de 2,66 e 3,03 mm no grupo da sobrancelha externa e 0,48 e 0,55 mm no grupo controle (p=0,126, p=0,25). A sobrancelha interna e externa apresentou valores de elevação estatisticamente semelhantes nas regiões central e lateral (p=0,636, p=0,342). Conclusões: Cirurgia de sobrancelha externa e interna proporcionam elevações adequadas e semelhantes nas sobrancelhas central e lateral que foram significativamente diferentes daqueles no grupo de blefaroplastia padrão no acompanhamento a longo prazo.

Procedimentos cirúrgicos e não cirúrgicos para elevação das sobrancelhas: revisão sistemática e fluxograma de abordagem / Surgical and non-surgical procedures for eyebrow lift: systematic review and decision flowchart

Introdução: Realizar levantamento na literatura médica sobre os tratamentos cirúrgicos e não cirúrgicos da ptose de sobrancelha e apresentar um fluxograma de decisão para elevação da sobrancelha. Métodos: Revisão sistemática da literatura disponível no banco de dados da PUBMED seguindo critérios de inclusão e exclusão. Elaboração de um fluxograma para abordagem da queda de sobrancelha baseado na experiência dos autores. Resultados: Foi encontrada uma abundância de artigos descrevendo diversas táticas cirúrgicas e não cirúrgicas para correção da ptose de supercílio. As táticas cirúrgicas mais comuns foram a elevação interna do supercílio, elevação direta, elevação via temporal e ritidoplastia coronal / pré-triquial / endoscópica. Para a abordagem não cirúrgica foram encontradas o uso de toxina botulínica, preenchimento e fios de sustentação. Conclusão: Há diversas táticas cirúrgicas e não cirúrgicas descritas na literatura para elevação da sobrancelha, demonstrando que não há uma tática ideal para todos os pacientes. O uso de fluxograma pode ajudar a realizar uma abordagem sistemática e personalizada e considerando característica de cada paciente.

Introduction: To review the medical literature regarding the surgical and non-surgical treatments of eyebrow ptosis and to present a decision flowchart for eyebrow lift. Methods: A systematic review of the literature available was held in PUBMED following inclusion and exclusion criteria. A flowchart was elaborated to systematize the approach to eyebrow ptosis based on the experience of the authors. Results: Several articles were included describing a variety of surgical and non-surgical correction techniques for eyebrow ptosis. The most common surgical approaches were internal eyebrow elevation, direct elevation, temporal elevation, and coronal/pretrichial/endoscopic rhytidoplasty. The non-surgical approaches found were botulinum toxin injections, fillers, and fixation threads. Conclusion: There are several surgical and non-surgical procedures described in the literature for lifting of the eyebrow, demonstrating that there is no ideal method for all patients. The use of a flowchart can help carry out a systematic and personalized approach according to the characteristics of each patient.

Alteraciones estomatognáticas del síndrome 3M: reporte de dos casos / Stomatognathic alterations of 3m syndrome: two cases report

Resumen El síndrome 3M es un desorden autosómico recesivo, heterogéneo, poco común, llamado así por los tres investigadores que lo describieron por primera vez, Miller, Mckusck y Malvaux. Las características principales son retraso en el crecimiento prenatal y postnatal severo, dismorfias faciales y anomalías radiológicas. En sus manifestaciones estomatológicas presentan dolicocefalia, abombamiento frontal, cara triangular, labios gruesos, cejas pobladas, hipoplasia maxilar severa, facies melancólicas, retraso en la erupción dental severa y falta de crecimiento del macizo facial. El objetivo del artículo es la descripción de casos gemelares de 8 años y 6 meses de edad, que acuden a la Clínica de Atención Dental Avanzada de la Universidad de Monterrey, con confirmación del síndrome 3M por prueba sanguínea a los 4 años de edad por parte del Servicio de Genética del Hospital Universitario. Se realiza rehabilitación bucal de ambas niñas, y, posteriormente, son referidas a interconsulta con ortodoncia interceptiva. MÉD.UIS.2019;32(2): 59-65

Abstract 3M syndrome is very rare, it's a heterogeneous autosomal recessive disorder named after 3 researches who described it for the first time, Miller, Mckusck and Malvaux. Whose main characteristic are; delayed prenatal growth, severe postnatal growth, facial dysmorphia, radiological abnormalities, presence of dolichocephaly, frontal bulging, triangular face, thick lips, raised eyebrows, severe maxillary hypoplasia, melancholic facies, delayed severe dental eruption, lack of facial mass growth. The objective of the article is the description of twin cases that come to the Advanced Dental Care Clinic of the University of Monterrey; 8 years 6 months old, with confirmation of the 3M syndrome, with a blood test at 4 years of age by the Genetics Service of the University Hospital. MÉD.UIS.2019;32(2): 59-65

Sarcoidal granulomatous reaction due to tattoos: report of two cases

Abstract Numerous infectious, inflammatory and neoplastic complications secondary to tattoo placement have been reported in the literature. Within inflammatory complications sarcoidal granulomatous reactions have been described. We report two cases, a 55-year-old woman with yellowish infiltrated plaques on bilateral ciliary region, 16 years after the placement of a permanent tattoo in the eyebrows, and a 20-year-old tattoo artist who developed orange papules on 3 of his tattoos. Histopathology in both cases confirmed diagnosis of sarcoidal granulomatous reaction due to tattoo pigment.

Tinea faciei on the right eyebrow caused by Trichophyton interdigitale

Abstract Tinea faciei is a relatively uncommon dermatophyte infection entailing atypical clinical symptoms, usually misdiagnosed and treated with corticosteroids. The authors describe a case of tinea faciei on the right eyebrow caused by Trichophyton interdigitale. The patient was an 18-year-old girl, who had an inflammatory plaque with a scaly, pustular surface on the right eyebrow and upper eyelid, which had persisted for over 1 month. She was once misdiagnosed as having eczema and was treated using corticosteroid cream. A diagnosis of tinea faciei was made based on direct microscopy and culture. The sequencing of the nuclear ribosomal ITS region and β-tubulin gene of the isolate established its T. interdigitale lineage. The patient was cured by treatment with systemic terbinafine in combination with topical application of 1% naftifine-0.25% ketaconazole cream for 2 weeks.

Frontalis muscle flap suspension surgery for the treatment of blepharoptosis based on the anatomical study of the frontal muscle nerve in the third of the eyebrow / Cirugía de suspensión del colgajo muscular frontal en el tratamiento de blefaroptosis basado en el estudio anatómico del nervio del músculo occipitofrontal en el tercio de la ceja

The aim of this study was to investigate the course of the supraorbital nerve and temporal branch of the facial nerve, and to verify the clinical security of cutting the frontalis muscle flap to treat blepharoptosis in one-third of the eyebrow. Twenty cadavers were dissected. The relationship of the supraorbital nerve and the course of the frontotemporal branch of the facial nerve with the head and neck muscles was evaluated. Forty patients underwent clinical frontal muscular flap suspension surgery for the treatment of blepharoptosis. The postoperative curative and complication rates were determined. The courses of the supraorbital nerve and frontotemporal branch of the facial nerve were observed to determine a relatively safe area in one-third of the eyebrow. The average width of the zone was 25.0±3.5 mm. In forty cases, satisfactory results were achieved in correcting blepharoptosis by cutting the frontal muscular flap in the middle of eyebrow within the wide range of 17±2.1 mm. No secondary sensory and motor dysfunctions occurred. One-third of the eyebrow (eyebrow center, within 17±2.1 mm) was a relatively safe area and allowed for the prevention of damage to the temporal branch of the facial nerve inside the supraorbital nerve and supraorbital artery and the outer frontotemporal branch of the facial nerve.

El objetivo de este estudio fue investigar el curso del nervio supraorbital y la rama temporal del nervio facial, para verificar la seguridad clínica de cortar el vientre frontal del músculo occipitofrontal (colgajo de músculo frontal) para tratar la blefaroptosis en un tercio de la ceja. Veinte cadáveres fueron disecados. Se evaluó la relación del nervio supraorbital y el curso de la rama temporal del nervio facial con los músculos de la cabeza y cuello. Cuarenta pacientes fueron sometidos a la cirugía de confección del colgajo del músculo frontal para el tratamiento de la ptosis palpebral. Se determinaron las tasas de curación y de complicaciones postoperatorias. Se observaron los cursos del nervio supraorbital y la rama temporal del nervio facial para determinar un área relativamente segura en un tercio de la ceja. El ancho medio de la zona fue 25,0±3,5 mm. En cuarenta casos, se lograron resultados satisfactorios en la corrección de la blefaroptosis con el colgajo del músculo frontal en la mitad de la ceja en un rango de 17±2,1 mm. No se produjeron disfunciones sensoriales o motoras secundarias. El tercio de la ceja (centro del entrecejo, dentro de 17±2,1 mm) es una zona relativamente segura y permite la prevención de daños al ramo temporal del nervio facial ubicada medial al nervio supraorbitario y a la arteria supraorbitaria, además del ramo temporal lateral del nervio facial.

Classificação clínica de ptose da cauda do supercílio / Clinical classification of brow ptosis

INTRODUÇÃO: O estudo do supercílio se emoldura como um grande desafio para a cirurgia plástica por sua complexa relação com as estruturas faciais. O objetivo é descrever uma classificação clínica de ptose da cauda do supercílio. MÉTODOS: Estudo transversal, com pacientes de ambos os sexos, com idade de 18 a 100 anos, subdivididos em três grupos segundo a faixa etária. Grupo 1: 18 a 30 anos, Grupo 2: 31 a 60 anos e Grupo 3: 61 a 100 anos. Realizaram-se três medidas de cada lado por examinadores distintos, sem que cada um soubesse o valor da aferição dos demais. RESULTADOS: Total de 90 pacientes, com idades variando entre 18 e 94 anos, sendo 39 (43,3%) do sexo masculino e 51 (56,7%)do sexo feminino. As medidas do Grupo 1, considerado como normal, com média de idade de 26,7 anos, e com média de 2,14 cm em relação a medidas da ptose da cauda do supercílio. Já no Grupo 2, média da faixa etária foi de 44,2 anos e a média foi de 1,9 cm. No Grupo 3, média de idade de 72,6 anos com média de 1,27 cm. A tabela com a Classificação da Ptose da Cauda do Supercílio, em que se atribuiu a cada intervalo um grau de ptose, variando de grau I ao grau IV. Cada grau foi correlacionado com um intervalo numérico em que: > 1,8 cm representa a normalidade; 1,7-1,5 cm o grau I de ptose; 1,4-1,2 cm o grau II de ptose;1,1-0,9 cm o grau III de ptose e < 0,8 cm o grau IV de ptose. Em referência à indicação cirúrgica, essa teve sua indicação nos graus II, III e IV. CONCLUSÃO: A medida objetiva da posição da cauda do supercílio possibilitou classificação do grau de ptose e orientação quanto à necessidade de intervenção cirúrgica.

INTRODUCTION: The study of the eyebrow is a great challenge for plastic surgery because of its complex relationship with facial structures. The present study aims to describe a clinical classification of brow ptosis. METHODS: A cross-sectional study with patients of both sexes and ages ranging from 18 to 100 years, subdivided into 3 groups according to age. Group 1: 18 to 30 years of age, Group 2: 31 to 60 years of age, and Group 3: 61 to 100 years of age. Three measurements were taken on each side by different examiners blinded to each other's results. RESULTS: A total of 90 patients, with ages ranging from 18 to 94, including 39 (43.3%) men and 51 (56.7%) women, were studied. Group 1, with a mean age of 26.7 years was considered normal, with mean brow ptosis of 2.14 cm. In Group 2, with a mean age of 44.2 years, the mean brow measurement was 1.9 cm. In Group 3, the mean age was 72.6 years and the mean brow measurement was 1.27 cm. The table outlining the brow ptosis classification assigns a degree of ptosis to each interval, ranging from I to IV. Each degree was correlated with a numerical range in which > 1.8 cm is normal, 1.7-1.5 cm corresponds to degree I ptosis, 1.4-1.2 cm to degree II ptosis, 1.1-0.9 cm to degree III ptosis, and < 0.8 cm to degree IV ptosis. Surgery was indicated for degrees II, III, and IV. CONCLUSION: The objective measurement of brow tail position enabled classification of the degree of ptosis and guides surgical decision-making.

Cutaneous histoplasmosis as a complication after anti-TNF use - Case report

Anti-TNF agents are effective in the treatment of psoriasis. However, they render individuals more susceptible to infections. We report an atypical case of histoplasmosis in an immunosuppressed patient due to anti- TNF therapy. A patient who used anti-TNF for the treatment of psoriasis had had a lesion on the right eyebrow since discontinuation of the medication. The diagnostic hypothesis was basal cell carcinoma, but the histopathological examination was compatible with histoplasmosis.

Posttraumatic eyebrow reconstruction with hair-bearing temporoparietal fascia flap / Reconstrução de sobrancelha após trauma com retalho de fáscia temporoparietal associado à ilha de pele de couro cabeludo

The temporoparietal fascia flap has been extensively used in craniofacial reconstructions. However, its use for eyebrow reconstruction has been sporadically reported. We describe a successfully repaired hair-bearing temporoparietal fascia flap after traumatic avulsion of eyebrow. Temporoparietal fascia flap is a versatile tool and should be considered as a therapeutic option by all plastic surgeons.

O retalho de fáscia temporoparietal tem sido usado em inúmeras reconstruções craniofaciais. No entanto, sua utilização para a reconstrução de sobrancelha tem sido relatada esporadicamente. Descreve-se aqui o reparo com retalho de fáscia temporoparietal associado à ilha para a reconstrução de sobrancelha, após avulsão traumática, realizado com sucesso. O retalho de fáscia temporoparietal é uma ferramenta versátil e deveria ser considerada no arsenal terapêutico de todos os cirurgiões plásticos.

Minilifting fronto-temporal para suspensão de cauda de supercílio: técnica minimamente invasiva de Reis-Sundfeld / Frontotemporal minilifting for eyebrow tail suspension: Minimally invasive Reis-Sundfeld technique

INTRODUÇÃO: Um sinal importante do envelhecimento facial é a queda da cauda da sobrancelha. O minilifting frontotemporal visa reposicionar a sobrancelha e amenizar as marcas de expressão, restaurando uma aparência mais jovial. Descrever uma técnica cirúrgica, ambulatorial, capaz de elevar a cauda da sobrancelha, com cicatriz mínima e camuflada na linha capilar, melhorando o aspecto de envelhecimento facial. MÉTODO: Foram arregimentados dez pacientes sequenciais do ambulatório de cirurgia plástica da UNIFESP, que após diagnóstico de queda de supercílio foram submetidos ao minilifting. RESULTADOS: Como resultados preliminares, não houvera nenhuma complicação importante, todos pacientes eram mulheres, um caso apresentara pequena deiscência em linha de sutura após 15 dias de cirurgia. 90% apresentaram índice de imagem corporal em extremamente satisfeitos ou satisfeitos. A média de elevação da cauda do supercílio foi de 5 mm. A média de queda de supercílio pré-operatória foi de 13,3 mm, tendo sua elevação média e manutenção em 12 meses de 18,2 mm. CONCLUSÃO: A técnica sugerida pelos autores é de fácil reprodutibilidade, produz resultados comparáveis às demais técnicas da literatura com as vantagens de apresentar baixo custo, ser realizada ambulatorialmente e ter um efeito rejuvenescedor periocular, pois atenua também as rugas, marcas de expressão e flacidez da região lateral da fissura orbitária e glabelar com significativo tempo de manutenção de resultados.

INTRODUCTION: An important sign of facial aging is the fall of the eyebrow tail. Frontotemporal minilifting aims to reposition the brow and soften the expression marks to restore youthful appearance. To describe an ambulatory surgical technique capable of eyebrow tail lift with minimal scarring and wound camouflage in the capillary line that reduces the facial signs of aging. METHOD: The study included 10 consecutive patients who attended the Plastic Surgery outpatient clinic of the UNIFESP and submitted to minilifting after receiving the diagnosis of eyebrow fall. RESULTS: Preliminary results did not show the occurrence of major complications. All patients were women. One patient presented with small suture line dehiscence 15 days after surgery. A total of 90% of the patients scored their body image index as extremely satisfied or satisfied. The average eyebrow tail lift was 5 mm. The average preoperative eyebrow fall was 13.3 mm, with a mean elevation and maintenance of 18.2 mm in 12 months. CONCLUSION: The technique is easily reproducible, provides outcomes comparable to those of other procedures published in the literature, and presents the following advantages: is low cost; can be performed in an outpatient clinic; provides a rejuvenating periocular effect since it also reduces wrinkles, expression marks, and sagging of the lateral region of the orbital and glabellar fissure; and achieves significant long-lasting results.

Blefaroplastia: elevação transpalpebral das sobrancelhas / Blepharoplasty: transpalpebral brow elevation

Introdução: A descida das sobrancelhas faz parte do processo natural de envelhecimento do terço superior da face. A ação da musculatura glabelar é uma das causas desta ptose e de outros sinais de envelhecimento. Estes sinais devem ser diagnosticados e tratados de maneira adequada durante os procedimentos de blefaroplastia sob pena de piora da ptose e de resultado não satisfatório. Métodos: Ao longo dos últimos 17 anos, um total de 246 pacientes, portadores de alterações do terço superior da face e com indicação de blefaroplastia, foram submetidos à elevação transpalpebral das sobrancelhas pela técnica de McCord modificada, mediante ampla dissecção, maior número de pontos de fixação e miomectomias dos músculos corrugadores e prócerus. Os pacientes foram acompanhados com avaliações ambulatoriais e com registros fotográficos nos 6 e 12 meses de pós-operatório. Resultados: A intercorrência mais comum foi a parestesia temporária da região frontal e do couro cabeludo. Não ocorreram casos de hematomas pós-operatórios. Ao longo do tempo foram observados resultados consistentes, com manutenção da elevação das sobrancelhas e diminuição efetiva da ação da musculatura glabelar, sem cicatrizes no couro cabeludo. Conclusões: A elevação transpalpebral de sobrancelhas, associada à miomectomia glabelar, mostra-se uma alternativa adequada, segura e efetiva para tratamento dos sinais de envelhecimento do terço superior da face.

Introduction: The brows lowdown naturally occur as an aspect of the aging upper face process. The glabelar muscular action is one cause of this ptosis and also of others aging signs. These signs must be adequately treated during the blepharoplasty, to avoid the penalty of a limited final result. Methods: Along of the last 17 years, a total of 246 patients with aesthetic problems of the upper face and with blepharoplasty indication, were submitted to a transpalpebral browlift by modified McCord technique, based in a extended dissection, more fixation stitches and prócerus and corrugators muscles miomectomy. Out patients follow-up were in ambulatory conditions with photographic records after 6 and 12 months. Results: The most common intercurrence was a transient parestesia of the frontal region and of the scalp. No postoperative hematomas were registered. The results were consistent with maintenance of the eyebrows elevation and the effective reduction of the glabelar muscles action, without the necessity of any type of coronal incision. Conclusions: The transpalpebral brow elevation associated with glabellar myomectomy shows to be an adequate option, by its safe and effective procedures for the treatment of the upper face aging signs.

Quiste dermoide en la cola de la ceja / Dermoid cyst in the eyebrow tail

El quiste dermoide es un tipo de coristoma que corresponde a una anomalía congénita del desarrollo. Se presenta una transicional de dos años. Desde su nacimiento, la mamá notó un aumento de volumen a nivel de la cola de la ceja del ojo derecho, de bordes delimitados, blanda, movible, reborde orbitario libre, sin cambios de coloración, con un crecimiento acelerado clínico y ultrasonográfico en meses. Se decidió exéresis y biopsia para estudio anatomopatológico. Los resultados finales mostraron confirmación del diagnóstico de quiste dermoide en la cola de la ceja. La evolución posoperatoria fue satisfactoria sin recidiva de la lesión.

The dermoid cyst is a type of choristoma resulting from congenital development anomaly. A 2-year transitional dermoid cyst from birth was discovered by the mother when she noticed increased volume at the tail of the right eyebrow, defined edges, soft, movable, free orbital rim, no color changes with rapid clinical and ultrasonographic growth in months. It was decided to perform excision and biopsy for the pathological study. The final results showed confirmation of the diagnosis of dermoid cyst in tail of the eyebrow. The postoperative course was satisfactory without recurrent injure.

Keratosis pilaris and prevalence of acne vulgaris: a cross-sectional study

BACKGROUND: Acne vulgaris has an important genetic predisposition, as well as keratosis pilaris. Clinical observations suggest that patients with keratosis pilaris have less frequent or less severe acne breakouts; however, we found no studies on this regard OBJECTIVE: To determine if the presence of keratosis pilaris is associated with lower prevalence and severity of acne. METHODS: A cross-sectional study was conducted with dermatology outpatients aged between 14 and 35 years. We evaluated history and clinical grade of acne, demographic variables, history of atopy, smoking, and use of hormonal contraceptives. Two groups were defined by the presence or absence of moderate to severe keratosis pilaris on the arms and were compared by bivariate analysis and by conditional multiple logistic regression. RESULTS: We included 158 patients (66% women), with a median age of 23±11 years. Twenty-six percent of them had keratosis pilaris, which was associated with a history of atopy (odds ratio [OR]=2.80 [1.36 to 5.75]; p<0.01). Acne was present in 66% of subjects, and was related to family history of acne (OR=5.75 [2.47 to 13.37]; p<0.01). In bivariate and multivariate analysis, the group with keratosis pilaris had a less frequent history of acne (OR=0.32 [0.14 to 0.70]; p<0.01). CONCLUSION: The presence of moderate to severe keratosis pilaris on the arms was associated with lower prevalence of acne vulgaris and lower severity of facial lesions in adolescents and young adults. .

Do you know this syndrome? / Voce conhece esta sindrome?

Noonan Syndrome is one of the most common genetic syndromes and also an important differential diagnosis in children presenting with syndromic facies similar to Turner's syndrome phenotype. This syndrome is characterized by facial dysmorphism, congenital heart defects, short stature and also a wide phenotypic variation. This article discusses the case of a 10 year-old patient with Noonan syndrome that presented typical facies, cardiac defects (pulmonary dilatation and mitral regurgitation), dental malocclusion, micrognatism, short stature and a certain degree of learning disability.

Síndrome de Noonan é uma das mais frequentes síndromes genéticas e importante diagnóstico diferencial em crianças com fácies sindrômica similar ao fenótipo da síndrome de Turner. É caracterizada por dismorfismo facial, defeitos cardíacos congênitos, baixa estatura e uma ampla variação fenotípica. Esse artigo apresenta um caso de uma paciente de 10 anos de idade com síndrome de Noonan que apresentava fácies tiípica além de defeitos cardíacos (dilatação de artéria pulmonar e insufiência mitral), má oclusão dentária, micrognatismo, baixa estatura e dificuldade de aprendizado.

Elevación ciliar en frontoplastia. Hospital de San José (2011-2012) Bogotá DC. Colombia / Brow Lift in frontoplasty. Hospital de San José (2011-2012) Bogotá DC. Colombia

En permanencia, ninguna técnica para la fijación de la elevación ciliar en la frontoplastia ha demostrado de manera concluyente ser la mejor. Se han propuesto con sutura o tornillos tratando de que los resultados perduren. Se muestra la experiencia con estos dos métodos, con seguimiento a doce meses. Materiales y métodos: se practicó frontoplastia a 17 pacientes con elevación ciliar en un periodo de un año con seguimiento a tres meses en su totalidad y a doce en tres de ellos. En siete se utilizó fijación con tornillos, nueve con sutura y uno no se usó material de fijación. Método descriptivo prospectivo de serie de casos con mediciones mediante fotogrametría estandarizada. Resultados: ninguno tuvo recurrencia de la ptosis ciliar y todos refirieron satisfacción con el resultado. Conclusiones: en el seguimiento a doce meses no se evidenciaron recurrencias ni complicaciones Las características metodológicas del estudio no permiten dar recomendaciones, pero si crear la base para seguimiento a largo plazo con un mayor número de pacientes...

As related to permanency, no technique for brow lift fixation has conclusively demonstrated to be the best one. The use of sutures and screws, have been proposed, seeking results to remain. Experience with these two techniques is shown in this work through a 12-month follow-up. Materials and Methods: a frontoplasty with brow lift was practiced in 17 patients over a 1-year period conducting a 3-month follow-up to the whole group and a 12-month follow-up in 3 patients. Screw fixation was practiced in 7, suture fixation in 9 and no fixation material was used in one patient. Method: descriptive prospective case series using standardized photogrammetry measurements. Results: none had brow ptosis recurrence and all patients stated to be satisfied with the results. Conclusions: no recurrence or complications were evidenced at 12-month follow-up. Methodology characteristics of the study do not allow recommendations to be posed but allow the creation of a long-term follow-up basis including a larger number of patients...

Ptose palpebral: avaliação do posicionamento palpebral por imagens digitais / Palpebral ptosis: evaluation of eyelid positioning using digital images

OBJETIVO: Avaliar a posição palpebral de portadores de ptose congênita e adquirida, procurando identificar diferenças entre elas. MÉTODOS: Foi realizada avaliação retrospectiva de portadores de ptose palpebral atendidos no Ambulatório de Plástica Ocular da Faculdade de Medicina de Botucatu-UNESP, no período de 1995 a 2006, com dados recuperados de fichas de atendimento e de arquivo de imagens digitais. Foram avaliados dados de 87 pacientes, como idade, sexo e dados relativos à ptose. As ptoses foram separadas em dois grandes grupos: congênita e adquirida. Foram realizadas medidas digitais da distância margem-reflexo (DMR), distância margem-sulco palpebral superior (DMSC) e distância margem supercílio (DMSP). A unidade de medida considerada foi o diâmetro corneano de cada um dos indivíduos. Todos os dados foram transferidos para tabela Excel e receberam análise estatística. RESULTADOS: A análise mostrou que não existe associação entre a presença de ptose e sexo, assim como tipo de ptose e sexo. Houve diferença significativa entre pálpebras com ptose e sem ptose para DMR. A DMR não apresentou diferença significativa nas ptoses congênita ou adquirida. No que tange a DMSP e DMSC, a ptose adquirida possui valores superiores aos obtidos para portadores de ptose congênita. CONCLUSÃO: A avaliação do posicionamento palpebral confirmou que a DMR é menor nos portadores de ptose palpebral e que as ptoses congênitas e adquiridas possuem DMR semelhantes. A DMSC e a DMSP apresentam valores superiores em portadores de ptose adquirida.

OBJECTIVES: To assess the palpebral position in patients with congenital or acquired ptosis, related to margin, sulcus and eyebrow, trying to identify differences between types of ptosis. METHODS: A retrospective evaluation of patients with palpebral ptosis treated at the Ambulatory of Ophthalmic Plastic Surgery - Faculdade de Medicina de Botucatu (UNESP) was conducted, from 1995 to 2006. Data were recovered from electronic medical charts as well as digital image files. Eighty-seven patients were assessed, according to age, gender and data related to ptosis, such as time of appearance and type of palpebral ptosis. Palpebral ptosis was classified in two groups: congenital and acquired ptosis. Measurements were taken of margin-reflex distance (MRD), margin sulcus distance (MSD) and margin eyebrow distance (MED) using digital measurements of photos obtained. The corneal diameter of each individual patients was the unit of measure used. All data was transferred to an Excel Spreadsheet and received statistical treatment. RESULTS: Statistical analysis revealed there is no association between the presence of ptosis and gender, or the type of ptosis and gender. There was a significant difference between eyelid with and without ptosis for MRD. However, in relation to the type of ptosis (congenital or acquired), MRD did not present any significant difference. The MSD and MED measurements were higher in acquired ptosis when compared to congenital ptosis. CONCLUSION: Assessment of palpebral positioning using digital measures endorse that MRD is smaller in patients with palpebral ptosis and similar in congenital or acquired ptosis, whereas MSD and MED presented higher values in acquired ptosis.

Ceratose pilar e ulerythema ophryogenes em mulher com monossomia do braço curto do cromosomo 18 / Keratosis pilaris and ulerythema ophryogenes in a woman with monosomy of the short arm of chromosome 18

A monossomia parcial do braço curto do cromosomo 18 (síndrome do 18p) caracteriza-se, principalmente, por atraso na aquisição da fala, retardo mental leve a moderado e baixa estatura. Relatamos o caso de uma paciente com esta síndrome associada à ceratose pilar extensa e ulerythema ophryogenes. Este é o quarto relato de caso que descreve tal associação, que desperta considerável interesse porque pode revelar uma região candidata a sede de genes responsáveis pela queratinização folicular.

Partial monosomy of the short arm of chromosome 18 (18p- syndrome) is characterized mainly by speech delay, mild to moderate mental retardation and short stature. We describe a patient with the 18psyndrome and widespread severe keratosis pilaris and ulerythema ophryogenes. This is the fourth case in which such an association has been reported. This association is of considerable interest because it may uncover a candidate genomic region and help to identify the gene responsible for follicular keratinization.