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1.
Facial Plast Surg ; 36(4): 395-403, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32866977

RESUMO

Over the history of facial rejuvenation surgery there has been a progressive assimilation of knowledge about the anatomy of neck structures that are central to the manifestations of the aging neck. These advances in knowledge have been accompanied by the innovation and introduction of several surgical techniques to restore the neck to a more youthful appearance. The rejuvenation of the aging neck frequently incorporates a consideration and execution of accepted methods to restore the platysma muscles to a more aesthetic form. Lasting and dependable surgical techniques remain somewhat elusive and late failures in the neck continue to be a frustration for both patients and surgeons.In this manuscript, the author reviews some of the more enduring and innovative methods to manage the platysma in facelifting and cites the rationale and limitations of the various techniques. The concept of the restoration of an effective platysma "sling" in the upper neck to eliminate platysma bands and recreate a defined jawline is highlighted. A framework of patient evaluation and decision making is presented, and a suggested individualized application of accepted surgical maneuvers is suggested.


Assuntos
Ritidoplastia , Estética Dentária , Humanos , Pescoço/cirurgia , Músculos do Pescoço/cirurgia , Rejuvenescimento
2.
Facial Plast Surg ; 36(4): 430-446, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32866980

RESUMO

Energy-based facelifting techniques are a relatively new genre of surgery. In this approach, the energy-based device-whether laser, radiofrequency plasma, or ultrasound-can be used in the superficial plane to elevate skin flaps before performing more traditional facelift techniques involving the superficial musculoaponeurotic system (SMAS) or platysma. The initial reports of utilizing fiber lasers as surgical tools date back to approximately 2007 and initial lipolasers were used to elevate facial skin flaps. The other energy-based devices were also tested. The author has probably the largest series of energy-based facial rejuvenation procedures, having performed over 3,000 of these procedures. The advantages of laser-assisted rhytidectomy include hemostasis, facilitated dissection in areas hard to elevate conventionally such as nasolabial folds or distal neck and the remodeling and tightening of tissue that results from the activation of the wound healing cascade of neocollagenesis and wound contraction. The author currently has a preference for energy device used during rhytidectomy and it is a high frequency ultrasound energy delivered by a five-ring 2.9- and 3.7-mm probe. The use of the ultrasound dissector in both superficial and deep procedures is highlighted in this article with emphasis on its use for deep cervicoplasty and subplatysmal procedures as well as sub-SMAS elevations of the facial deep plane.


Assuntos
Ritidoplastia , Sistema Musculoaponeurótico Superficial/cirurgia , Dissecação , Pescoço/cirurgia , Rejuvenescimento
3.
J Craniofac Surg ; 31(6): e630-e633, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32649560

RESUMO

The recent pandemic has led to an unprecedented overload of sanitary systems around the world. Despite that a maxillofacial department is not a frontline specialty in the treatment of coronavirus disease 2019 infections, our department has found itself faced with numerous problems in keeping the care system active and efficient while ensuring safety for patients and healthcare professionals. Massive redistribution of health personnel was needed to improve prevention and personal safety measures. The education and training system has been kept active, giving residents a decisive role in managing the state of emergency response. This article outlines new guidelines for infection prevention: from clinical control, treatment processes, clinical management, protection, and disinfection of healthcare professionals.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Cabeça/cirurgia , Maxila/cirurgia , Pescoço/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/transmissão
4.
J Craniofac Surg ; 31(6): e644-e649, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32649566

RESUMO

At the end of December, 2019, a new virus was named severe acute respiratory syndrome coronavirus 2 appeared in Wuhan, China, and the disease caused is called as coronavirus disease 2019 (COVID-19) by World Health Organization, which to date having infected more than 3,588,773 people worldwide, as well as causing 247,503 deaths. A human to human transmission is thought to be predominantly by droplet spread, and direct contact with the patient or contaminated surfaces. This study aims to provide a comprehensive overview as well as to highlight essential evidence-based guidelines for how head and neck surgeon and healthcare providers need to take into consideration during their management of the upper airway during the COVID-19 pandemic safely and effectively to avoid the spread of the virus to the health provider.


Assuntos
Manuseio das Vias Aéreas , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Cabeça/cirurgia , Pescoço/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Surtos de Doenças , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Cirurgiões
5.
Br J Oral Maxillofac Surg ; 58(6): 704-707, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32513429

RESUMO

The COVID-19 pandemic has had a dramatic impact on international medicine practice. The propensity for head and neck surgery to generate aerosols needs special consideration over and above simply adopting personal protective equipment. This study sought to interrogate the literature and evaluate whether which additional measures might provide benefit if routinely adopted in minimising viral transmission.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Aerossóis , Cabeça/cirurgia , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Pescoço/cirurgia , Equipamento de Proteção Individual
6.
J Otolaryngol Head Neck Surg ; 49(1): 30, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: covidwho-272492

RESUMO

The 2019 novel coronavirus disease (COVID-19) epidemic originated in Wuhan, China and spread rapidly worldwide, leading the World Health Organization to declare an official global COVID-19 pandemic in March 2020. In Hong Kong, clinicians and other healthcare personnel collaborated closely to combat the outbreak of COVID-19 and minimize the cross-transmission of disease among hospital staff members. In the field of otorhinolaryngology-head and neck surgery (OHNS) and its various subspecialties, contingency plans were required for patient bookings in outpatient clinics, surgeries in operating rooms, protocols in wards and other services. Infected patients may shed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) particles into their environments via body secretions. Therefore, otolaryngologists and other healthcare personnel in this specialty face a high risk of contracting COVID-19 and must remain vigilant when performing examinations and procedures involving the nose and throat. In this article, we share our experiences of the planning and logistics undertaken to provide safe and efficient OHNS practices over the last 2 months, during the COVID-19 pandemic. We hope that our experiences will serve as pearls for otolaryngologists and other healthcare personnel working in institutes that serve large numbers of patients every day, particularly with regard to the sharing of clinical and administrative tasks during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Otolaringologia/normas , Pandemias , Assistência ao Paciente/normas , Pneumonia Viral/transmissão , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Cabeça/cirurgia , Educação em Saúde , Hong Kong , Hospitalização , Humanos , Controle de Infecções/organização & administração , Pescoço/cirurgia , Otolaringologia/organização & administração , Ambulatório Hospitalar/organização & administração , Ambulatório Hospitalar/normas , Pandemias/prevenção & controle , Assistência ao Paciente/métodos , Pneumonia Viral/prevenção & controle , Telemedicina
8.
PLoS One ; 15(5): e0232510, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365136

RESUMO

In the obese, the evidence for the choice of the optimal emergency front-of-neck access technique is very limited and conflicting. We compared cannula and scalpel-bougie emergency front-of-neck access techniques in an anaesthetised porcine model with thick pretracheal tissue. Cannula and scalpel-bougie cricothyroidotomy techniques were performed in 11 and 12 anaesthetised pigs, respectively. Following successful tracheal access, oxygenation was commenced and continued for 5 min using Rapid-O2 device for cannula and circle breathing system for scalpel-bougie study groups. The primary outcome was a successful rescue oxygenation determined by maintenance of arterial oxygen saturation >90% 5 min after the beginning of oxygenation. Secondary outcomes included success rate of airway device placement, time to successful airway device placement, and trauma to the neck and airway. The success rate of rescue oxygenation was 18% after cannula, and 83% after scalpel-bougie technique (P = 0.003). The success rate of airway device placement was 73% with cannula and 92% with scalpel-bougie technique (P = 0.317). Median (inter-quartile-range) times to successful airway device placement were 108 (30-256) and 90 (63-188) seconds (P = 0.762) for cannula and scalpel-bougie emergency front-of-neck access, respectively. Proportion of animals with iatrogenic trauma additional to the procedure itself was 27% for cannula and 75% for scalpel-bougie technique (P = 0.039). Thus, in the porcine model of obesity, the scalpel-bougie technique was more successful in establishing and maintaining rescue oxygenation than cannula-based technique; however, it was associated with a higher risk of severe trauma.


Assuntos
Manuseio das Vias Aéreas/métodos , Modelos Anatômicos , Sus scrofa/cirurgia , Manuseio das Vias Aéreas/instrumentação , Animais , Cartilagem Cricoide/cirurgia , Tratamento de Emergência/instrumentação , Tratamento de Emergência/métodos , Feminino , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Modelos Animais , Pescoço/cirurgia , Obesidade/cirurgia , Oxigênio/administração & dosagem , Instrumentos Cirúrgicos , Fatores de Tempo , Traqueostomia/instrumentação , Traqueostomia/métodos
9.
J Oral Maxillofac Surg ; 78(9): 1653.e1-1653.e6, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32428462

RESUMO

Regional flaps remain a cornerstone of head and neck reconstruction. Among their many functions, they serve a vital role in salvage surgery and for those in whom medical comorbidities preclude the use of microvascular free flaps. Recent research has also examined their potential benefit in value-based healthcare metrics such as operative time, cost, intensive care unit care, and length of stay as compared to free-flap reconstruction. The submental island flap is one such entity that is well described and validated to provide predictable, oncologically sound coverage for defects of the lower third of the face and oral cavity. Its application has also been documented for repair of defects of the midface, temporal region, oropharynx, and hypopharynx, albeit less frequently. Since its original description, there have been several modifications of this axial-based flap, though none of a vertically oriented long axis. We describe a case of a vertically based submental island flap for maxillary reconstruction that allowed for debulking and recontouring of prior pectoralis flap and correction of submental ptosis.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Face/cirurgia , Humanos , Pescoço/cirurgia , Músculos Peitorais
10.
J Otolaryngol Head Neck Surg ; 49(1): 30, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32414407

RESUMO

The 2019 novel coronavirus disease (COVID-19) epidemic originated in Wuhan, China and spread rapidly worldwide, leading the World Health Organization to declare an official global COVID-19 pandemic in March 2020. In Hong Kong, clinicians and other healthcare personnel collaborated closely to combat the outbreak of COVID-19 and minimize the cross-transmission of disease among hospital staff members. In the field of otorhinolaryngology-head and neck surgery (OHNS) and its various subspecialties, contingency plans were required for patient bookings in outpatient clinics, surgeries in operating rooms, protocols in wards and other services. Infected patients may shed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) particles into their environments via body secretions. Therefore, otolaryngologists and other healthcare personnel in this specialty face a high risk of contracting COVID-19 and must remain vigilant when performing examinations and procedures involving the nose and throat. In this article, we share our experiences of the planning and logistics undertaken to provide safe and efficient OHNS practices over the last 2 months, during the COVID-19 pandemic. We hope that our experiences will serve as pearls for otolaryngologists and other healthcare personnel working in institutes that serve large numbers of patients every day, particularly with regard to the sharing of clinical and administrative tasks during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Otolaringologia/normas , Pandemias , Assistência ao Paciente/normas , Pneumonia Viral/transmissão , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Cabeça/cirurgia , Educação em Saúde , Hong Kong , Hospitalização , Humanos , Controle de Infecções/organização & administração , Pescoço/cirurgia , Otolaringologia/organização & administração , Ambulatório Hospitalar/organização & administração , Ambulatório Hospitalar/normas , Pandemias/prevenção & controle , Assistência ao Paciente/métodos , Pneumonia Viral/prevenção & controle , Telemedicina
14.
Otolaryngol Head Neck Surg ; 162(6): 795-796, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-38313

RESUMO

The recent Italian outbreak of coronavirus disease 2019 led to an unprecedented burden on our health care system. Despite head and neck-otolaryngology not being a front-line specialty in dealing with this disease, our department had to face several specific issues. Despite a massive reallocation of resources in the hospital, we managed to keep the service active, improving safety measures for our personnel, specifically during common otolaryngologic maneuvers known to produce aerosols. Furthermore, we strived to maintain our teaching role, giving residents an inclusive role in managing the response to the emergency state, and we progressively integrated our inactive specialists into other service rotations to relieve front-line colleagues' burden. Specific issues and management decisions are discussed in detail in the article.


Assuntos
Infecções por Coronavirus/epidemiologia , Efeitos Psicossociais da Doença , Surtos de Doenças/economia , Gastos em Saúde , Otolaringologia/economia , Pneumonia Viral/epidemiologia , Betacoronavirus , Infecções por Coronavirus/patologia , Surtos de Doenças/estatística & dados numéricos , Feminino , Cabeça/fisiopatologia , Cabeça/cirurgia , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/cirurgia , Recursos em Saúde/economia , Departamentos Hospitalares/economia , Humanos , Itália , Masculino , Pescoço/fisiopatologia , Pescoço/cirurgia , Otolaringologia/estatística & dados numéricos , Pandemias , Pneumonia Viral/patologia , Medição de Risco , Papel (figurativo)
15.
Otolaryngol Head Neck Surg ; 162(6): 804-808, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-52517

RESUMO

The novel coronavirus disease 2019 (COVID-19) pandemic has unfolded with remarkable speed, posing unprecedented challenges for health care systems and society. Otolaryngologists have a special role in responding to this crisis by virtue of expertise in airway management. Against the backdrop of nations struggling to contain the virus's spread and to manage hospital strain, otolaryngologists must partner with anesthesiologists and front-line health care teams to provide expert services in high-risk situations while reducing transmission. Airway management and airway endoscopy, whether awake or sedated, expose operators to infectious aerosols, posing risks to staff. This commentary provides background on the outbreak, highlights critical considerations around mitigating infectious aerosol contact, and outlines best practices for airway-related clinical decision making during the COVID-19 pandemic. What otolaryngologists need to know and what actions are required are considered alongside the implications of increasing demand for tracheostomy. Approaches to managing the airway are presented, emphasizing safety of patients and the health care team.


Assuntos
Manuseio das Vias Aéreas/normas , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Otorrinolaringologistas/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Traqueostomia/normas , Manuseio das Vias Aéreas/métodos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Cabeça/cirurgia , Humanos , Masculino , Pescoço/cirurgia , Saúde do Trabalhador , Pandemias/estatística & dados numéricos , Segurança do Paciente , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Gestão da Segurança/métodos , Gestão da Segurança/normas
17.
Medicine (Baltimore) ; 99(16): e19809, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311998

RESUMO

According to the 2015 American Thyroid Association guidelines, either lobectomy or total thyroidectomy was recommended for patients with papillary thyroid carcinoma (PTC) of 1 to 4 cm without extrathyroidal extension and lymph node metastasis. However, lymph node metastases showed strong association with recurrence and low survival rate, especially in PTC patients with more than 5 metastatic lymph nodes. Therefore, this study aimed to investigate the predictive factors of more than 5 central lymph nodes metastases (CLNM) in PTC patients with tumor sizes of 1 to 4 cm. A total of 382 patients with clinically node-negative (cN0) ipsilateral PTC who underwent thyroidectomy with central neck dissection between January 2012 and December 2016 were retrospectively analyzed. CLNMs of >5 were found in 54 (14.1%) patients, while CLNM was detected in 230 (60.2%) patients. Multivariate logistic regression revealed age < 45 years (P < .001), male gender (P = .013), and tumor sizes of >2 cm (P = .001) as independent predictive factors of >5 CLNMs in cN0 ipsilateral PTC patients with tumor sizes 1 to 4 cm. The prediction equation (Y = 1.694 × age + 0.807 × gender + 1.190 × tumor size - 3.530) was developed, with a sensitivity (57.4%) and a specificity (80.8%), respectively, at an optimal cut-off point of -1.685. Therefore, if the predictive value was higher than -1.685 according to the equation in cN0 ipsilateral PTC patients with tumor sizes 1 to 4 cm, then total thyroidectomy might be considered.


Assuntos
Linfonodos/patologia , Pescoço/patologia , Câncer Papilífero da Tireoide/patologia , Carga Tumoral/fisiologia , Adulto , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Pescoço/cirurgia , Esvaziamento Cervical/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Taxa de Sobrevida , Câncer Papilífero da Tireoide/mortalidade , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/métodos
19.
J Craniofac Surg ; 31(3): 642-647, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32282663

RESUMO

BACKGROUND: Utilizing the concept of Barton's high superficial musculo-aponeurotic system (SMAS) technique, the authors performed the more extensive skin-attached SMAS/platysma flap elevation and the 'dual deep tissue support' technique involving multiple plications of the parotid-masseteric fascia, repositioning of the SMAS, and platysma muscle. Our aim was to demonstrate a specific surgical procedure for face and neck lift and offer its pitfalls and outcomes. METHODS: This study included 83 patients aged between 54 and 73 years. The pre- and 10-month postoperative photographs of all patients were used to assess the extent of the nasolabial folds, the labiomental fold, and the cervical band (platysma band). Each patient's subjective aesthetic satisfaction was also evaluated. RESULTS: At 3 and 6 months postoperatively, 94% (n = 3) of patients achieved "minimal" and "mild" nasolabial folds. Most patients (89.1%, n = 74) were satisfied with their outcomes. Two minor hematomas (2.4%) occurred locally over the temporal or retro-auricular area. No incidence of skin flap necrosis or permanent facial nerve injury was observed. CONCLUSIONS: Our extensive skin-attached SMAS/platysma flap elevation with dual deep tissue support, both by multiple parotic masseteric plication and SMAS/platysma repositioning, provided not only the definite lifting effect in the immediate postoperative period, but also resulted in long-lasting lifting outcomes without remission. LEVEL OF EVIDENCE: IV.


Assuntos
Ritidoplastia/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sulco Nasogeniano/cirurgia , Pescoço/cirurgia , Glândula Parótida/cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias , Sistema Musculoaponeurótico Superficial/cirurgia , Retalhos Cirúrgicos/cirurgia
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