Endoscopic Approach for Resection of Frontal Forehead Osteoma: Technical Case Report Instruction.

Forehead osteomas are benign bone tumors. They are frequently associated with exophytic growth in the outer table of the skull, causing cosmetic disfigurement of the face.1-9 The objective of this study was to present the efficacy and feasibility of the endoscopic treatment of forehead osteomas by presenting a case report with details of the surgical technique. A 40-year-old female patient presented with aesthetic complains of a progressing bulge in the forehead. A computed tomography scan with 3-dimensional reconstruction showed bone lesions on the right side of the forehead. The patient underwent surgery under general anesthesia with no noticeable incision, which was planned 2 cm behind the hairline in the midline because the osteoma was close to the midline plane on the forehead (Video 1). A retractor coupled with a 4-mm channel for endoscopy and a 30-degree optic was used to dissect, elevate the pericranium, and locate the 2 bone lesions in the forehead. The lesions were removed using a chisel, endoscopic facelifting raspatory, and a 3-mm burr drill. The tumors were resected completely, resulting in good cosmetic outcomes. The endoscopic approach for treating forehead osteomas is less invasive and facilitates complete removal of tumors, which results in good cosmetic outcomes. Neurosurgeons should consider and add this feasible approach to enhance their surgical armamentarium.

Combined Access for the Treatment of Medial Orbital Wall Fracture: Subciliary and Upper Eyelid Sulcus Incisions.

The present study presents a new surgical approach to treat medial orbital wall fractures, that is, the combined transcutaneous access through subciliary and upper eyelid sulcus incisions. The study performed the retrospective analysis of medical records belonging to 14 consecutive patients with medial orbital wall fracture, who were treated in the Plastic Surgery Division at Federal University of São Paulo, from 2005 to 2013, through the combination of subciliary and upper eyelid sulcus incisions to access the fracture foci. The mean age of the patients was 35.4 years, ranging from 8 to 66 years. Seven out of the 14 patients were women. Ten patients had fractures in the medial and inferior walls, whereas 4 patients had isolated medial wall fracture. Diplopia was found in all cases. Six patients had some type of extraocular muscle limitation. A computed tomography of the face was performed in the postoperative period to assess the orbital contour and the correct position of the grafts, whenever applicable. The patients were assessed for diplopia, enophthalmos, and scar quality. Four patients (28.6%) kept on showing diplopia at supraversion, whereas 2 patients (14.2%) evolved to enophthalmos. There was no need of reoperating the patients to reposition the grafts or the absorbable plaque. No patient evolved to ectropion or apparent scarring. The combined transcutaneous access through subciliary and upper eyelid sulcus incisions provides ample operative field, rapid exposure of the fracture foci, and adequate wall reconstruction. It can also present inconspicuous scar.

Impacto da monitoria de Cirurgia Plástica no conhecimento teórico e nas habilidades práticas em estudantes de medicina / Impact of extracurricular activities in Plastic Surgery on the knowledge and practical skills of medical students

Introdução: Avaliar o impacto da monitoria em Cirurgia Plástica da Universidade Federal de São Paulo no conhecimento e nas habilidades práticas em estudantes de Medicina. Métodos: Seis acadêmicos participantes da monitoria e oito acadêmicos não participantes foram selecionados aleatoriamente e avaliados antes e depois do programa, por meio de testes de múltipla escolha e através do instrumento Surgical Skills Assessment (SSA), para avaliação das habilidades práticas. Resultados: O Grupo estudo obteve aumento significativo nas notas de prova teórica, entre o período antes do programa (média 15,8 e desvio padrão de 2,7) e após (média 21,8 e desvio padrão 1,3) (p = 0,02). Resultado semelhante foi encontrado com o instrumento SSA entre o período antes (média 9,8 e desvio padrão 1,4) e após o programa (média de 13,5 e desvio padrão 1,6) (p = 0,02). O grupo controle não obteve mudança significativa nos testes teóricos em agosto de 2010 ( média de 14,0 e desvio padrão 4,1) e junho de 2011 ( média de 13,8 e desvio padrão de 2,6 ) (p = 0,40 ). Resultado semelhante foi encontrado com o instrumento SSA em agosto de 2010 (média de 8,5 e desvio padrão 2,2) e junho de 2011 (média de 9,6 e desvio padrão 1,7) (p = 0,18). Conclusão: Acadêmicos participantes na monitoria de Cirurgia Plástica da Universidade Federal de São Paulo apresentaram melhor conhecimento e melhores habilidades práticas em relação aos não participantes.

Introduction: To assess the impact of extracurricular activities in plastic surgery on the knowledge and practical skills of medical students at the Federal University of São Paulo. Methods: Six students participating in extracurricular activities and eight students who did not participate were randomly selected and evaluated before and after the program by using multiple-choice tests and a Surgical Skills Assessment (SSA) instrument to assess their practical skills. Results: The study group obtained higher scores in the theoretical tests, when the scores before starting the program (average, 15.8; standard deviation, 2.7) were compared with those received after their participation in extracurricular activities (average, 21.8; standard deviation, 1.3) (p = 0.02). Similar results were obtained with the SSA instrument for the period before the start of (average, 9.8; standard deviation, 1.4) and after (average, 13.5; standard deviation, 1.6) (p = 0.02) the program. The control group did not show significant changes in the scores received for theoretical tests when the period from August 2010 (average, 14.0; standard deviation, 4.1) to June 2011 (average, 13.8; standard deviation, 2.6) (p = 0.40) was evaluated. Similar results were obtained with the SSA instrument for the evaluation period between August 2010 (average, 8.5; standard deviation, 2.2) and June 2011 (average, 9.6; standard deviation, 1.7) (p = 0.18). Conclusion: The students participating in extracurricular activities in plastic surgery at the Federal University of São Paulo improved their knowledge and acquired better practical skills compared with students who did not participate.

Stability of surgically assisted rapid palatal expansion with and without retention analyzed by 3-dimensional imaging.

INTRODUCTION: Surgically assisted rapid palatal expansion (SARPE) is the procedure of choice for treatment of adults with transverse maxillary deficiency greater than 7 mm. There is no consensus about the dentoskeletal effect of an orthodontic retainer on the outcome of SARPE. Our objective was to assess the effectiveness of an orthodontic retainer on dentoskeletal stability. METHODS: Ninety digitized dental casts of 30 adults undergoing SARPE were divided into 2 groups-no retention (n = 15) and retention (n = 15)-and assessed. The dental casts were obtained at 3 checkpoints: (1) 7 days on average before SARPE (preoperatively), (2) 4 months after expansion, and (3) 10 months after expansion was completed. The retention patients received a transpalatal arch just after expander removal, at checkpoint 2. The transpalatal arch was kept for 10 months after completion of the expansion (checkpoint 3 and end of the study). The dental casts were scanned with a Vivid 9i 3D laser scanner (Konica Minolta, Wayne, NJ). The distances measured were premolar and molar intercusp distances, premolar and molar intercervical distances, premolar and molar inter-WALA (Will Andrews and Lawrence Andrews) ridge distances, and palate height at the maxillary first molar. RESULTS: The planned maxillary expansion was within the expected amount (P <0.05). Palatal height at the 4-month checkpoint decreased by 0.79 mm (4.38%) (P <0.001) and again at the 10-month checkpoint by 0.38 mm (0.98%) (P >0.05) but not significantly in both groups. The premolar intercusp distance had a relapse at checkpoint 3 of 1.84 mm (7.18%) (P <0.001) in the no-retention group. Both groups had average relapses of 0.95 mm in the premolar intercervical distances, of 0.88 mm in the premolar inter-WALA ridge distances, of 1.04 mm in the molar intercusp distances, of 0.74 mm in the molar intercervical distances, and of 0.84 mm in the molar inter-WALA ridge distances (P <0.05) at checkpoint 3. CONCLUSIONS: The analysis of relapse in both groups suggests that the use of a transpalatal arch as a retaining device does not improve dento-osseous stability.