Reconstrução de ápice nasal por meio de retalho frontal oblíquo: relato de caso / Reconstruction of nasal tip with an oblique frontal flap: case report

O objetivo do trabalho é descrever as condutas realizadas em uma vítima de ferimento acidental por projétil de arma de fogo (PAF) em região de ápice nasal. Paciente do sexo masculino, 10 anos compareceu ao Serviço de Cirurgia e Traumatologia Bucomaxilofacial (CTBMF) do Hospital de Emergência e Trauma Senador Humberto Lucena, João pessoa-PB, vítima de disparo acidental de PAF em face. Clinicamente, observou se edema em terço médio de face, ferimento pérfuro-contundente com avulsão de ápice nasal, apresentando zona de chamuscamento e esfumaçamento. No primeiro momento, realizou-se desbridamento do ferimento, retirarda dos estilhaços e da sutura. A segunda abordagem cirúrgica foi conduzida por um cirurgião plástico em conjunto com a equipe da CTBMF da própria instituição, sendo realizado o retalho frontal oblíquo para reconstruir ápice nasal e columela. Vinte dias após, foi realizado o rebatimento parcial do retalho para sua área de origem. Os acompanhamentos pós-operatórios foram realizados após sete e noventa dias, observando-se, nas duas oportunidades, a reconstrução de ápice e columela bem como ausência de deformidades. O retalho frontal oblíquo é uma opção viável na reconstrução de defeitos do ápice e dorso nasal, visto que ele é ricamente vascularizado, não apresenta pedículo com tensão e apresenta resultado estético satisfatório... (AU)

This paper reports the surgical procedures performed on the nasal tip of a victim of accidental firearm projectile injury. Ten-year-old boy was admitted to the Surgery and Maxillofacial Traumatology Service of the Senator Humberto Lucena Emergency and Trauma Hospital ­ Joao Pessoa (PB), Brazil, victim of an accidental firearm shooting on the face. Clinically, an edema was observed in the third middle of the face with avulsion of the nasal tip, presenting scorched and smoked zones. At the first moment, the wound was debrided, the shrapnel were removed and the wound was sutured. At the second surgical time, a plastic surgeon with the Hospital team led the surgery performing the oblique frontal flap to reconstruct the nasal tip and columella. After twenty days, part of the flap was returned to its original area. Post-operative follow-ups were performed after seven and ninety days - reconstruction of nasal tip and columella without deformities was observed at both times. The oblique frontal flap is a viable option in the reconstruction of nasal tip and bridge, since it is richly vascularized, has a pedicle without tension and the aesthetic outcome is satisfactory... (AU)

Immunohistochemical analysis of FoxP3+ regulatory T cells in lower lip squamous cell carcinomas

Abstract: The aim of this study was to determine the number of FoxP3+ regulatory T (Treg) cells in the microenvironment of lower lip squamous cell carcinomas (LLSCCs) and to correlate the findings with clinicopathological parameters (tumor size/extent, regional lymph node metastasis, clinical stage, and histopathological grade of malignancy). Fifty cases of LLSCC were selected. Lymphocytes exhibiting nuclear immunostaining for FoxP3 were quantified in 10 microscopic fields at the deep invasive front of LLSCCs. The results were analyzed statistically using the nonparametric Mann-Whitney test and Fisher's exact test. FoxP3+ lymphocytes were observed in all cases studied. The number of these cells tended to be higher in smaller tumors, tumors without regional lymph node metastasis, and tumors in early clinical stages, but the difference was not statistically significant (p > 0.05). Low-grade tumors contained a larger number of FoxP3+ lymphocytes than high-grade tumors (p = 0.019). Tumors with an intense inflammatory infiltrate exhibited a larger number of Treg cells (p = 0.035). On the other hand, the number of FoxP3+ lymphocytes was smaller in tumors arranged in small cell clusters (p = 0.003). No significant differences in the number of FoxP3+ lymphocytes were observed according to the degree of keratinization (p = 0.525) or nuclear pleomorphism (p = 0.343). The results suggest the participation of Treg cells in immune and inflammatory responses in the microenvironment of LLSCCs. These cells may play a more important role in early stages rather than in advanced stages of lip carcinogenesis.