Secondary Forehead Lift in Transgender Women.

Facial feminization surgery includes a series of procedures that aim to attenuate the masculine features of the face and make the face more feminine and harmonic. During the past few years, several feminization techniques have been developed or adapted to this discipline. The current intervention of the forehead for feminization is based on the setback of the anterior wall of the frontal sinus and the remodeling of the supraorbital and glabellar region, associated to brow lift and hairline advancement. Primary forehead feminization yields high patient satisfaction, quality of life, and aesthetic outcomes, with few complications. Despite this, secondary forehead lift in feminization surgery has grown rapidly in recent years due to two main reasons: (1) patients that had their primary forehead surgery 5 or more years ago kept aging; and (2) there was also a great increase in the primary surgeries, which also comes with increased unsatisfied patients that want a revision. In the present study, we will present our current approach for secondary forehead lift in transgender women and tips to avoid a revision when performing the primary forehead reconstruction.

Approach for Rhinoplasty in African Descendants.

The main objectives of rhinoplasty in African descendants are to improve the definition and projection of the nasal tip, augment the dorsum, and reduce the alar base. Open rhinoplasty using costal cartilage graft, with lateral crural tensioning and septal extension graft associated with en bloc dorsal augmentation is the workhorse. Cartilage resections should be minimal. Oral isotretinoin and triamcinolone injection may improve tip definition. Surgical success ultimately depends on the ability of the surgeon to accurately identify the anatomic variables and reconcile these anatomic realities with the patient's aesthetic expectations and his or her sense of ethnic identity.

Oral Epignathus with Maxilla Duplication: Report of a Rare Case.

Epignathus is a rare congenital oropharyngeal teratoma that arises from the oropharynx, especially the sphenoid, palatine, and ethmoid bones. Teratomas are benign tumors containing cells from ectodermal, mesodermal, and endodermal layers. The incidence of epignathus is between 1:35,000 and 1:200,000 live births with a female predominance. We reported an uncommon case of epignathus in a female newborn baby with an ill-defined oral mass protruding through a cleft in the hard palate. Computed tomography scan showed a contrast-enhanced solid mass with areas of calcification simulating a unique case of maxilla duplication. Surgery was performed, the mass was excised successfully, and microscopic analysis confirmed the diagnosis of mature teratoma. The patient evolved with good general health and showed no clinical signs of recurrence. Although epignathus is a rare condition, it should be diagnosed in the fetus as early as possible, especially to avoid fatal airway obstruction. In such cases, the treatment option is exclusively surgical, and complete resection is curative in most cases during the early neonatal period.

Effect of Orbicularis Muscle Resection during Blepharoplasty on the Position of the Eyebrow.

Dermatochalasis is a skin excess in the upper eyelid which may be associated with either an aesthetic and functional defect, blocking the peripheral vision. Upper blepharoplasty is the gold standard procedure for correction of dermatochalasis and to restore youthful contours to the periorbita. It is one of the most commonly performed procedures in aesthetic plastic surgery; however, there is still a lack of consensus about this procedure. The excess skin is sometimes removed alone or in conjunction with a strip of orbicularis oculi muscle. The rationale for both muscle and skin resection or skin alone preserving the muscle is uncertain. Some authors have studied the aging influence in brow position, and a few studies pointed out the influence of the upper blepharoplasty on brow height. The true effects, regarding the position of the eyebrow, of both techniques, with or without resection of the preseptal orbicularis oculi muscle, are unclear. The authors present a review of the literature to find the rationale for resecting or preserving the orbicularis oculi muscle in upper eyelid blepharoplasty and its relation to eyebrow position.

Evaluation of lateral crural steal in nasal tip surgery.

IMPORTANCE: Many techniques to increase nasal tip projection and rotation have been described. Some patients complain about aesthetic loss during the postoperative period. The lateral crural steal technique has been used to improve nasal tip rotation, definition, and projection. OBJECTIVE: To evaluate the lateral crural steal technique comparing immediate and late postoperative results. DESIGN, SETTING, AND PARTICIPANTS: Twenty consecutive patients in an academic tertiary care hospital underwent this rhinoplasty technique to improve nasal tip projection and rotation. INTERVENTION: The patients' noses were measured in preoperative and immediate and late postoperative periods using a digital pachymeter. MAIN OUTCOME AND MEASURE: Quantitative analysis of nasal length and nasal tip rotation and projection. RESULTS: The average lateral crural steal was 4.2 mm. There was an increase in projection and rotation in all patients when comparing preoperative and immediate postoperative measurements. The differences in preoperative and immediate postoperative measurements in nasal length (46.5 mm to 40.5 mm) and nasolabial angle (89.5° to 109.2°) were statistically significant (P = .005 and P <.001, respectively). There was no statistical difference when comparing immediate and late postoperative periods. CONCLUSIONS AND RELEVANCE: The technique described in this study was effective, with a high rate of patient satisfaction, and achieved a significant increase in the rotation of the nasal tip and a slight, but not statistically significant, increase in the projection of the nasal tip. LEVEL OF EVIDENCE: 3.

Rhinoplasty across Latin America: case discussions.

A presentation of four different rhinoplasty cases performed by four different surgeons in Latin America is presented. For each case, presurgical photographs and discussion of the patient are presented. Intrasurgical photographs and description of surgical techniques employed as well as postsurgical pictures are included for each case. This will give readers the opportunity of seeing how different surgical techniques can be used effectively in treating patients of mixed races with good cosmetic long-term results.

Subperiosteal midface-lift.

The subperiosteal midface-lift has benefited from significant technological advances in medicine. The endoscope now allows extensive subperiosteal undermining of facial soft tissue through minimal access incisions. Improved understanding of facial anatomy and the facial aging process now allow repositioning and remodeling of the soft tissue envelope with excellent aesthetic results. The subperiosteal midface-lift by a temporal approach is a procedure designed to rejuvenate the middle third of the face. After subperiosteal detachment, the soft tissues of the cheek, jowls, lateral canthus, and inferior orbital rim can be lifted to reestablish their youthful relationship with the underlying skeleton. It is a technique that produces satisfactory cosmetic results in most cases, causing malar augmentation, nasolabial fold improvement, and mild jowl improvement. We describe our preferred technique in detail and discuss its indications, complications, advantages, and limitations.

Graduated approach to refinement of the nasal lobule.

OBJECTIVE: To present a graduated approach to refining the nasal lobule (a frequent complaint during consultations for rhinoplasty) based on anatomic features and to discuss the casuistics of this procedure since we began performing it. METHODS: A retrospective evaluation of the medical charts of 1152 patients who underwent rhinoplasty from 2003 to 2006; 641 patients fulfilled the criteria for our study (55.6%). Outcomes were assessed by comparing preoperative and last follow-up photographs and considering the width, symmetry, and contour of the nasal lobule. Cases were allocated into 7 groups: (1) no surgery on nasal tip; (2) interdomal breakup; (3) cephalic trim; (4) domal suture; (5) shield-shaped graft; (6) vertical dome division; and (7) replacement of lower lateral cartilages. RESULTS: Of the 641 patients enrolled in the study, 435 were women and 206 were men. Mean follow-up period was 1.5 years. An asymmetric tip was present in 28 patients (4.4%), and a persistent width of interdomal space in 34 (5.3%). None presented overnarrowing of interdomal space. Surgical revision rate to enhance refinement of the lobule was 5.6%. CONCLUSION: Our graduated approach has shown excellent outcomes, a high rate of patient satisfaction, and a low rate of revision.

Forehead-lift: a 10-year review.

Since the earliest reports in the 1910 s, the search for long-lasting elevation of the eyebrow, reduction of transverse forehead rhytids, and elimination of vertical and oblique glabellar lines has motivated authors all around the world to publish reports of their experiences. In the last 10 years, 142 articles were published, 17 of them in the Archives of Facial Plastic Surgery. We review the most important advances on anatomy, approach, dissection plane, flap fixation, facial paralysis, minimally invasive techniques, and secondary procedures, and raise some questions that should be answered in the future.

Trismus as the first manifestation of cholangiocarcinoma.

The initial presentation of a cholangiocarcinoma (CC) as trismus due to metastasis to the parotid gland is extremely rare and no previous reports have been found in the literature. A 29-year-old woman presented trismus that initiated 2 months before admission, just after superior left third molar extraction. Physical examination revealed severe trismus and a mass in the parotid gland. Computed tomography (CT) showed a heterogeneous mass in the left parotid gland. The next day she presented jaundice, bilirubinuria, and fever, followed by massive bleeding, intravascular disseminated coagulation, and respiratory insufficiency. Two days later she died. At autopsy, the parotid tumor was identified as a metastasis from a CC of the extrabiliary tract. To our knowledge, this is the first reported case of a metastatic CC that initially presented as trismus due to a mass in the parotid gland. This case represents a rare but important diagnosis that otolaryngologists and oral surgeons should add to the catalog of uncommon causes of trismus.

Trismus as the first manifestation of cholangiocarcinoma

No disponible

The initial presentation of a cholangiocarcinoma (CC) as trismus due to metastasis to the parotid gland is extremely rare and no previous reports have been found in the literature. A 29-year-old woman presented trismus that initiated 2 months before admission, just after superior left third molar extraction. Physical examination revealed severe trismus and a mass in the parotid gland. Computed tomography (CT) showed a heterogeneous mass in the left parotid gland.The next day she presented jaundice, bilirubinuria, and fever, followed by massive bleeding, intravascular disseminated coagulation, and respiratory insufficiency. Two days later she died. At autopsy, the parotid tumor was identified as a metastasis from a CC of the extrabiliary tract. To our knowledge, this is the first reported case of a metastatic CC that initially presented as trismus due to a mass in the parotid gland. This case represents a rare but important diagnosisthat otolaryngologists and oral surgeons should add to the catalog of uncommon causes of trismus (AU)

Cirurgia endoscópica endonasal da órbita: revisão de 5 anos de casuística, resultados e complicações

Introdução: A cirurgia da órbita recebeu um grande impulso nas últimas décadas com o advento da endoscopia. O acesso endonasal possibilitou o avanço principalmente na cirurgia da oftalmopatia de Graves e da neuropatia traumática do nervo óptico. Objetivo: Apresentar nossa experiência com a cirurgia endoscópica endonasal da órbita, avaliando a casuística, os resultados e as complicações nos últimos três anos. Método: Estudo retrospectivo, de janeiro de 2003 a janeiro de 2008, dos 12 pacientes (21 órbitas) submetidos a cirurgia endonasal endoscópica da órbita. Os resultados foram avaliados com relação a acuidade visual, melhoria da proptose e complicações associadas. Técnicas cirúrgicas utilizadas são descritas. Resultados: No período, foi realizada descompressão do nervo óptico em uma paciente com pseudotumor cerebral com melhora, após seis meses, de toda a avaliação oftalmológica, e em dois pacientes com baixa de acuidade visual devido à neuropatia traumática do nervo óptico, com melhora importante em um deles. A descompressão orbitária foi realizada em 18 órbitas de 9 pacientes portadores de exoftalmia de Graves. A média de redução da proptose foi de 3,87 mm(variando de 3,09 a 4,57 mm). A acuidade visual melhorou nos dois pacientes que apresentavam déficit pré-operatório. Diplopia ocorreu em uma paciente. Conclusões: A cirurgia orbitária por acesso endoscópio endonasal demonstrou-se um tratamento cirúrgico útil para inverter e prevenir deterioração visual e melhorar a proptose, com baixo índice de complicações. Portanto, acreditamos que esta abordagem merece consideração dos cirurgiões craniofaciais quandro frente a um paciente com estes problemas.

Osso da mastóide como auto-enxerto para reconstrução do dorso nasal

Introdução: Vários enxertos e/ou implantes têm sido usados para reconstrução do dorso nasal. Em alguns casos, especialmente os narizes pós-cirurgia de câncer, traumático, acometidos por granulomatose e multioperados, a quantidade de aumento é maior que o normalmente disponível em auto-enxerto de septo e concha auricular. Objetivo: Avaliar a segurança e a eficácia do osso de mastóide como auto-enxerto para reconstrução do dorso nasal. Método: Um estudo de 20 pacientes consecutivos submetidos a reconstrução do dorso nasal com osso de mastóide, durante um período de 4 anos. O resultado foi avaliado principalmente por complicações e satisfação do paciente e cirurgião. Resultados: Os enxertos variaram de 5 a 12 mm em espessura. O período de seguimento variou de 6 meses a 4 anos. Dezessete (85%) pacientes apresentaram resultados satisfatórios para o cirurgião e o paciente. Um paciente mostrou aumento excessivo leve somente notado pelo cirurgião. Um paciente apresentou aumento deficiente, necessitando cirurgia revisional. Um paciente precisou de cirurgia de revisão devido a deslocamento do enxerto no primeiro mês de pós-operatório. Nenhum caso apresentou infecção ou absorção de enxerto. Conclusões: O osso de mastóide se apresentou como um material efetivo como auto-enxerto para reconstrução do dorso nasal. A taxa de complicação foi baixa. O seguimento a longo prazo mostrou que não ocorre absorção clinicamente significante.

Schwanoma de asa nasal

Introdução: Os schwanomas benignos são tumores comuns das bainhas dos nervos periféricos, nervos autômicos e, particularmente, pares cranianos, de crescimento lento com abundante vascularização. De 25% a 45% desses tumores estão localizados na região de cabeça e pescoço. Na cavidade nasal e seios paranasais são raros, não havendo casos descritos na região da asa nasal. Objetivo: O trabalho relata um caso de schwanoma de asa nasal tratado cirurgicamente com sucesso. Relato de caso: Paciente do sexo masculino, 23 anos, com queixa de obstrução nasal à direita há cerca de quatro anos, com surgimento de lesão obstrutiva de vestíbulo nasal. Apresentava obstrução total de vestíbulo nasal à direita e massa volumosa sob cartilagem lateral inferior do nariz. Foi realizada exérese de tumor via incisão marginal, cuja análise histopatológica diagnosticou schwanoma benigno. Conclusão: O diagnóstico diferencial de lesões em fossas nasais e seios paranasais nem sempre é fácil, sendo o diagnóstico definitivo somente alcançado após exame anatomopatológico da peça cirúrgica. Descrevemos o primeiro caso na literatura de um schwanoma de asa nasal.

Avaliaçäo da eficácia do hidrato de cloral na sedaçäo de crianças para exame nasofibroscópico / Efficay of chloral hydrate sedation in children undergoing transnasal flexible endoscopy

Material e método: Foram examinadas por videonasofibroscopia 100 crianças atendidas consecutivamente, de um a quatro anos de idade, sem alteração neurológica, com queixa de obstrução nasal. Desenho do estudo:Prospectivo clínico randomizado. Objetivo: A proposta deste estudo foi avaliar a eficácia do hidrato de cloral como sedativo para a execução destes exames, na dose de 100 mg/kg, via oral. Todos os casos foram avaliados quanto à facilitação do procedimento advinda da sedação, além das possíveis complicações. Conclusão: Houve maior tranqüilidade durante o exame, por parte do otorrinola- laringologista e dos pacientes, não havendo necessidade de anestesia geral ou contenção mais forte em nenhum dos 100 casos. Não houve complicações

LAUP x UPFP - quando indicar? / LAUP x UPFP - when operate?

Após avaliação clínica pela Escala de Epworth para Sonolência e pela Polissonografia, operamos 38 pacientes portadores de ronco simples e/ou Síndrome de Apnéia Obstrutiva do Sono leve ou moderada. Em 16, utilizamos a técnica cirúrgica de Uvulopalatoplasia a Laser de CO2, em 22 a Uvulopalatrofaringoplastia com o Bisturi de Alta Freqüência. Nestes 22, em 4 associamos a cirurgia de amigdalectomia, em 8, amigdalectomia e septoplastia, e em 10 septoplastia e turbinectomia inferior parcial bilateral.