Neurectomía selectiva del nervio facial en el tratamiento de la hipercinesia contralateral en parálisis facial / Selective neurectomy of the facial nerve in the treatment of contralateral hyperkinesia in facial paralysis

Introducción y objetivo: En el abordaje clínico de la parálisis facial periférica existen opciones terapéuticas enfocadas a restaurar la función motora facial, como son las cirugías estáticas y dinámicas; sin embargo, la asimetría facial es un problema persistente. La neurectomía selectiva del nervio facial (NSNF) es una cirugía utilizada recientemente para el manejo de las sincinesias e hipercinesias producidas como secuela en parálisis facial. El objetivo del presente trabajo es analizar los resultados en la mejoría de la asimetría facial de nuestros pacientes sometidos a NSNF para el tratamiento de la hipercinesia contralateral de la parálisis facial mediante la implementación de la escala Sunnybrook Facial Grading Scale (SFGS). Material y método: Estudio prospectivo observacional descriptivo analizando una muestra de 100 pacientes con diagnóstico de parálisis facial periférica atendidos en el Hospital de San José, Bogotá, Colombia. Describimos variables demográficas, y una vez identificados los pacientes sometidos a NSNF, utilizamos la historia clínica para hacer la estadificación de la escala descrita y comparamos los resultados en el pre y postoperatorio. Describimos también la técnica quirúrgica utilizada. Resultados: Evidenciamos una diferencia en la puntuación de la escala SFGS dada por un incremento en la puntuación en 4 pacientes sometidos al procedimiento, con diferencias estadísticamente significativas. Conclusiones: En nuestra experiencia, La NSNF es útil en el manejo de la asimetría facial persistente como secuela de parálisis facial. Nivel de evidencia científica 4c Terapéutico.(AU)

Background and objective: In the clinical approach of the peripheral facial paralysis there are therapeutic options focused on restoring facial motor function, such as static and dynamic surgeries; however, facial asymmetry is a persistent problem. Selective facial nerve neurectomy (SFNN) is a widely used surgery for the management of synkinesias and hyperkinesias as sequelae of pasalysis. Our objective is to analyze the results in the improvement of facial asymmetry of patients undergoing SFNN for the treatment of contralateral hyperkinesia of facial paralysis through the implementation of the Sunnybrook Facial Grading Scale (SFGS). Methods: A prospective observational descriptive study is designed for a sample of 100 patients diagnosed with peripheral facial paralysis treated at the Hospital de San José, Bogotá, Colombia. Demographic variables were described, and once the patients undergoing SFNN were identified, the clinical history is used to carry out the staging of the scale described and the results are compared in the pre and postoperative period. A description of the surgical technique used was made. Results: A difference in the SFGS scale classification score was identified due to an increase in the score in the postoperative period of 4 patients that were treated with SFNN with statistically significant differences. Conclusions: In our experience, SFNN is useful in the management of persistent facial asymmetry as a consequence of facial palsy.Level of evidence 4c Terapeutic.(AU)

ASIA syndrome symptoms induced by gluteal biopolymer injections: Case-series and narrative review.

BACKGROUND: The number of plastic surgery procedures have been rising in the last few years. The morbi-mortality due to illegal use of biopolymers is a public health problem. One of the clinical consequences, foreign body modelling reaction, may be a precursor of ASIA (Autoimmune/Inflammatory disease induced by adjuvants) syndrome.The objective of this article is to present a case-series study of patients who developed ASIA syndrome following gluteal injection with biopolymers and emphasize the importance of toxic exposure in triggering autoimmune responses. A surgical technique used on some of the patients in the study is described. METHODS: A group of thirteen patients, diagnosed with foreign body modelling reaction, who developed ASIA syndrome confirmed by approved criteria was followed between May 2016 and May 2018. The "Butterfly Wings Technique," a new surgical procedure for patients who have medium to severe compromise, was used on five of them.A narrative literature review was done to look for subjects with ASIA syndrome and gluteal biopolymer infiltration. RESULTS: All the patients in the present case-series with foreign body modelling reaction developed ASIA syndrome. Some of them had a background of familial autoimmunity. Five of the patients were surgically treated and saw a clinical improvement after the extraction of the biopolymer with the proposed technique.The narrative literature review identified 7 articles related to the disease through the database search. CONCLUSIONS: We suggest that foreign body modelling reaction should be considered a precursor to ASIA syndrome. New research projects will be needed in the future to evaluate the factors that determine when ASIA syndrome is triggered in a patient with this reaction.

Reconstruction with Free Flaps of Head and Neck Cancer Defects: A National Cohort Study.

The purpose of this study was to determine the perioperative mortality rate, reintervention rate, and total healthcare costs for head and neck cancer patients who underwent free tissue transfer (FTT) in Colombia. The prognostic factors associated with those results were estimated. METHODS: A retrospective cohort study was performed using administrative data from patients of all ages diagnosed with head and neck cancer who underwent FTT between 2013 and 2016 in Colombia's contributory health system. Postoperative mortality rates were estimated at 30, 90, and 180 days, as well as reintervention rates at 30 and 90 days. Total healthcare costs were calculated. Generalized linear models were generated to determine prognostic factors associated with outcomes. RESULTS: A total of 485 patients were included, 215 (44.33%) of which were women. Mean age was 61.4 years. Mortality rate was 3.09 at 30 days, 9.28 at 90 days, and 15.26 at 180 days, per 100 surgeries. Reintervention rate was 5.77 at 30 days and 8.25 at 90 days, per 100 surgeries. The 30-day reintervention rate was lower for 40- to 59-year-old group and for a Charlson Index ≤ 3. The median total healthcare cost of an episode was USD 12,403.68 (interquartile range, 5754-16,736). The bivariate and multivariate models determined that age, the Charlson Index, and geographic region were associated with outcomes. CONCLUSION: For patients undergoing FTT in Colombia, differences in reintervention and total costs incurred by the national health system exist, and these differences are associated with age, the Charlson Index, and the geographic region.

Mandibular Reconstruction in a Patient With Rosai-Dorfman Disease.

OBJECTIVE: The Rosai-Dorfman disease (RDD) is a rare disorder known as sinus histiocytosis with massive lymphadenopathy which affects other organs besides the lymphatic nodes. The most frequent clinical presentation is the skin involvement, but the most serious one is when the central nervous system is compromised. There are not clinical cases in the literature reporting the mandibular involvement and its management. The aim of this study is to report the case of a patient with this disease, her treatment, and her follow-up. STUDY: A 32-year-old woman with RDD, who underwent a right mandibulectomy to treat osteomyelitis, and who suffered hemolytic anemia, lymphoproliferative syndrome, and bacterial meningitis by meningococcus treated successfully, is presented. She also had osteosynthesis plate exposure in 3 occasions. The authors performed a mandibular reconstruction with a fibula free flap. Vertical osteogenic distraction was done to improve the vertical height of the bone for osteointegrated implants and later oral rehabilitation. METHODS: The senior authors performed mandibular reconstruction with a fibula free flap. Vertical osteogenic distraction was performed to improve the vertical height of the bone for osteointegrated implants and later oral rehabilitation. The patient achieved adequate function with a good mandibular height and occlusion. RESULTS: The patient had a follow-up of 6 months. She is highly satisfied with her result. Preoperative and postoperative photos are shown. DISCUSSION: In this rare case, the authors show the difficulties when treating this disease. The follow-up of the patient showed a successful reconstruction with good functional results.

Trastornos del comportamiento alimentario en pacientes de cirugía plástica estética: ¿Es o no una población en riesgo? / Plastic surgery patients and eating disorders: Are they a population at risk?

En la actualidad no se conoce la frecuencia de los trastornos de alimentación en pacientes de cirugía estética, pero se sospecha que sea mayor a la población general. Hay diferentes pruebas o cuestionarios para detectar aquellos en riesgo, siendo el examen mental el que comprueba presencia de psicopatología aplicando criterios DSM IV y CIE 10. La prevalencia de trastornos del comportamiento alimentario ha venido en aumento en la población adolescente y no está claro si es un hecho real o que se ha mejorado la capacidad para detectarlos. No se puede descartar que los estereotipos de belleza actuales hacia una figura corporal más delgada, estén jugando un papel clave en la epidemiología. El conocimiento de los factores de riesgo es de vital importancia para su detección temprana y la toma de medidas preventivas que aseguren mejores resultados terapéuticos. Así se podrían identificar los casos con problemas en el posoperatorio o que no son candidatos para procedimientos quirúrgicos. El tratamiento multidisciplinario es fundamental para corregir las alteraciones nutricionales y mentales en forma paralela...

The presence of eating disorders in patients undergoing aesthetic surgery is currently unknown, but it is believed to be greater than in the general population. Various tests and questionnaires for detecting those at risk are available and a psychopathologic condition is confirmed by performing a mental assessment using the DSM IV and ICD 10 criteria. Prevalence of eating disorders has increased in the adolescent population and it is not yet clear if it is an actual fact or rather that the ability to detect these disorders has improved. It cannot be out ruled that current beauty stereotypes promoting a slimmer body image may be playing a key role in the epidemiology of these disorders. Knowledge on risk factors is critical for early detection and for taking preventive measures to assure better therapeutic outcomes.Patients with problems could be identified in the postoperative period as well as those who are not suitable candidatesfor surgical procedures. A multidisciplinary therapeutic approach is fundamental to correct nutritional and mentalalterations in a parallel manner...

A New Classification Based on the Kaban's Modification for Surgical Management of Craniofacial Microsomia.

In medicine, classifications are designed to describe accurately and reliably all anatomic and structural components, establish a prognosis, and guide a given treatment. Classifications should be useful in a universal way to facilitate communication between health professionals and to formulate management protocols. In many situations and particularly with craniofacial microsomia, there have been many different classifications that do not achieve this goal. In fact, when there are so many classifications, one can conclude that there is not a clear one that accomplishes all these ends and defines a treatment protocol. It is our intent to present a new classification based on the Pruzansky's classification, later modified by Kaban, to determine treatment protocols based on the degree of osseous deficiency present in the body, ramus, and temporomandibular joint. Different mandibular defects are presented in two patients with craniofacial microsomia type III and IV according to our classification with the corresponding management proposed for each type and adequate functional results.