Daño nasal por abuso de cocaína. Reporte de caso clínico / Nasal damage cocaine abuse. Case report

La cocaína proviene de la hoja de coca, es una sustancia que cuando se consume por la vía inhalatoria puede producir lesiones graves a nivel nasal, con lesiones que se inician a nivel de la mucosa, perforación septal, con pérdida del soporte a nivel de la punta nasal, retracción alar, compromiso de y retracción de ambas alas, planos de cobertura y piso de fosas nasales. La reconstrucción es un desafío para el cirujano plástico. Abarcando un arsenal terapéutico que va desde solo confeccionar un marco cartilaginoso para soporte de la columela y dorso nasal con costilla, hasta cobertura interna y externa con colgajos más sofisticados. Creemos que estos pacientes para su tratamiento deben presentar conocimiento de que es un camino largo que requiere muchos tiempos quirúrgicos y que en estadios avanzados la cobertura de mucosa es el mayor desafío.

Cocaine comes from the coca leaf, it is a substance that when consumed by inhalation can cause serious injuries to the nose. With lesions that start at the level of the mucosa, septal perforation, with loss of support at the level of the nasal tip, alar retraction, compromise and retraction of both wings, coverage planes, and floor of the nostrils. Reconstruction is a challenge for the plastic surgeon. A therapeutic arsenal that goes from just making a cartilaginous framework to support the columella and nasal dorsum with rib, to internal and external coverage with more sophisticated flaps. We believe that in order to treat these patients, they must be aware that it is a long road that requires many surgical times and that in advanced stages mucosal coverage is the greatest challenge

Avaliação da equimose após osteotomia nasal lateral contínua interna e externa na rinoplastia aberta / Ecchymosis evaluation after internal and external continuous lateral nasal osteotomy in open rhinoplasty

INTRODUÇÃO: O objetivo é avaliar a presença de equimose com 7 e 15 dias após osteotomia nasal lateral interna e externa na rinoplastia aberta. Métodos: Análise prospectiva, dos pacientes submetidos à rinoplastia aberta, com osteotomia nasal lateral com total de 15 pacientes. Os pacientes foram alocados em dois grupos. Aqueles submetidos à osteotomia nasal lateral externa formaram o grupo A (n = 6) e os submetidos à osteotomia interna, o grupo B (n = 9). Foram avaliados com 7 e 15 dias de pós-operatório e registrada a presença ou ausência de equimose. Resultados: Dentro do grupo A evidenciamos no 7º dia de pós-operatório 3 (50%) pacientes com equimose e 3 (50%) sem alteração na tonalidade da pele. Com 15 dias de pós-operatório, o mesmo grupo apresentava 2 (25%) pacientes com equimose e 4 (75%) sem alteração. Já no grupo B foram identificados no 7º dia após o procedimento 3 (33,4%) pacientes com presença de equimose e 6 (66,6%) sem alteração. O mesmo grupo após 15 dias do procedimento apresentou 1 (11,1%) paciente com equimose e 8 (88,9%) sem alteração. Conclusão: Apesar da fratura interna apresentar menor incidência de equimose no sétimo e décimo quinto dias de pós-operatório, não houve relevância estatística na comparação entre as técnicas.

Introduction: The objective is to evaluate the presence of ecchymosis 7 and 15 days after internal and external lateral nasal osteotomy in open rhinoplasty. Methods: A prospective evaluation of 15 patients who underwent open rhinoplasty with lateral nasal osteotomy was conducted. The patients were allocated into two groups. Those who underwent external lateral nasal osteotomy were included in group A (n = 6), while those who underwent internal osteotomy were included in group B (n = 9). The patients were evaluated on postoperative days 7 and 15, and the presence or absence of ecchymosis was recorded. Results: In group A, we observed that on postoperative day 7, 3 patients (50%) had ecchymosis and 3 (50%) showed no changes in skin color. On postoperative day 15, the same group had 2 patients (25%) with ecchymosis and 4 (75%) without changes. On the other hand, in group B, 3 patients (33.4%) had ecchymosis and 6 (66.6%) showed no changes on postoperative day 7. In the same group, 1 patient (11.1%) had ecchymosis and 8 (88.9%) showed no changes 15 days after surgery. Conclusion: Despite the lower incidence of ecchymosis in internal fractures on postoperative days 7 and 15, no statistical significance was observed between the two techniques.

Resultados de rinoplastia abierta en pacientes portadores de deformidades nasales / Results of open rhinoplasty in patients with nasal deformities

Fundamento: La rinoplastia es un procedimiento quirúrgico para solucionar problemas estéticos o funcionales. Aunque es rechazado por muchos cirujanos debido a la incisión externa de la columela, es muy útil en casos difíciles.Objetivo: describir los resultados de rinoplastia abierta en pacientes con deformidades nasales.Métodos: se realizó un estudio descriptivo, de 55 pacientes operados en el periodo 2005-2012 en el hospital Gustavo Aldereguía Lima, de Cienfuegos, mediante la técnica de rinoplastia abierta. Las variables analizadas fueron: edad, sexo, color de la piel y tipo de incisión.Resultados: la mayoría de los pacientes fueron menores de 30 años, siendo la edad mínima 14 años y la máxima 50 años. El tipo de incisión más utilizado fue la de V invertida. En ninguno de los pacientes operados se presentó queloide. El 100 por ciento de los pacientes manifestó un alto grado de satisfacción respecto al resultado de la operación.Conclusión: la rinoplastia abierta ofrece una serie de ventajas que garantizan al cirujano el éxito de la intervención quirúrgica. Si se adoptan las medidas necesarias el riesgo quirúrgico es mínimo, al igual que las probabilidades de aparición de cicatriz queloide, la cual es más frecuente en pacientes mestizos y negros, quienes también son los que más demandan este tipo de cirugía en la serie estudiada(AU)

Foundation: Rhinoplasty is a surgical procedure to solve aesthetic and functional problems. Although it is refused by many surgeons due to the external incision of the columella, it is highly useful in difficult cases.Objective: To describe the results of open rhinoplasty in patients with nasal deformities.Methods: A descriptive study was realized, of patients operated through the technique of open rhinoplasty in the period 2005-2012 in the Hospital Gustavo Aldereguía Lima. Cienfuegos. The variables analyzed were: age, sex, race, and type of incision.Results: Most of the patients were under 30 years old; the lowest age was 14 and the maximum 50 years old. The type of incision mostly used was inverted V. In none of the operated patients a keloid appeared. The 100 percent of patients manifested a high degree of satisfaction with respects to the results of the operation.Conclusion: Open rhinoplasty offers a series of advantages which guarantee the success of the surgical intervention to the surgeon. If the necessary measures are adopted the surgical risk is minimal, similarly the probabilities of appearance of a keloid scar which is more frequent in mestizo and black patients who are also those who demand this type of surgery in the studied series(AU)

Resultados de rinoplastias de la punta nasal en Cienfuegos / Results of rhinoplasties of the nasal tip in Cienfuegos

Fundamento: La rinoplastia de la punta nasal es una de las cirugías estéticas más difíciles y desafiantes a las que se enfrenta el cirujano dedicado a las deformidades nasales. Objetivo: exponer los resultados de la rinoplastia realizada a pacientes con deformidades nasales. Métodos: se realizó un estudio descriptivo de los resultados obtenidos en 145 pacientes, a los cuales se realizó cirugía para corregir deformidades nasales. Fueron atendidos en el Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos, en un periodo de 10 años. Resultados: en 56 pacientes la cirugía estuvo encaminada a estrechar la punta nasal; en 45 pacientes a la rotación de la punta nasal; y en 44 pacientes a la proyección de la punta nasal. Se utilizó la técnica del estandarte con injerto de cartílago del septo y de la oreja. Conclusiones: en el periodo analizado, las rinoplastias realizadas en la provincia Cienfuegos tuvieron resultados satisfactorios, ya que se logró satisfacer las expectativas de los pacientes, con una reducción de los costos y de los riesgos para estos debido al uso de anestesia local(AU)

Background: the rhinoplasty of the nasal tip is one of the most difficult and challenging plastic surgeries the surgeon dedicated to the nasal deformities faces. Objective: exposing the results of the rhinoplasty accomplished to patients with nasal deformities. Methods: a descriptive study of results obtained in 145 patients who had a surgery to correct nasal deformities. They were attended at Dr Gustavo Aldereguía Lima University General Hospital of Cienfuegos, in a period of 10 years. Results: in 56 patients surgery was headed for embracing the nasal tip; in 45 patients to the rotation of the nasal tip; and in 44 patients to the projection of the nasal tip. The technique of the banner with graft of cartilage of the septum and the ear was used. Conclusion: in the analyzed period, the rhinoplasty accomplished in the province of Cienfuegos had satisfactory results, because the patients expectations were satisfied with a reduction of the costs of risks for them due to the use of local anesthesia(AU)

Nose tip collapse through loss of chondro mucous substance (Repair of nasal Lining) / ver

The authgor presents the repair of the nasal lining in leprosy in cases of nose tip collapse through loss of chondro mucous substance. Two methods are used frontal flap and nasolabial flaps. Both methods are considered by the author to give excellent results. he mentions gillies method freeskin garft and prosthesis and finds that besides the complexity of its execution the late results are precarious.