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.

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.

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.

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.

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.

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.

Mandibular fracture: analysis of 293 patients treated in the Hospital of Clinics, Federal University of Uberlândia.

UNLABELLED: Mandibular fracture is the second most common facial fracture and there has been a significant increase in number of cases in the last years. Misidentification and inadequate treatment can take to permanent aesthetic or functional deformity. AIM: Evaluate cases of mandibular fracture reduction in the Hospital of Clinics of the Federal University of Uberlândia, from January of 1974 to December of 2002. STUDY DESIGN: Historical cohort. PATIENT AND METHOD: Two hundred and ninety-three cases of reduction of mandibular fractures were retrospectively analyzed according to factors related to: patient, trauma, signs and symptoms, and surgical treatment. RESULTS: There has been a clear tendency of increase of the number of mandibular fractures along the years. There was higher prevalence in male (4:1), with occurrence peak between 20 to 29 years old. The principal causes of fracture in this study were traffic accidents and violence, representing 72.4%. One hundred and thirty-five patients presented only one fracture. The most injured sites were, in decreasing order, symphysis, condyle, angle, body, ramus, and coronoid. We performed closed reduction (28), open reduction (213) and association of the two (11 patients); 56.8% of the patients were treated within the first 3 days; and, 50.4% were discharged from the hospital until the first postoperative day. About 10% of the patients presented complications, being osteomyelitis the most frequent one. CONCLUSION: The incidence of mandibular fractures was remarkably larger in the male sex, during the third decade of life. The most common cause was traffic accident, and symphysis and condyle were the most injured sites. Isolated fractures occurred in over half of the cases. Most of the patients were treated in the first three days and were discharged until the first postoperative visit. Closed reduction was the treatment most commonly employed. The most frequent complication was osteomyelitis.

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.

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.

Fratura de mandíbula: análise de 293 pacientes tratados no Hospital de Clínicas da Universidade Federal de Uberlândia / Mandibular fracture: analysis of 293 patients treated in the Hospital of Clinics, Federal University of Uberlândia

A fratura de mandíbula ocupa o segundo lugar entre as fraturas dos ossos da face, tendo havido aumento significativo de casos nos últimos anos. A não-identificação e o tratamento inadequado podem levar à deformidade estética ou funcional permanente. OBJETIVO: Avaliar os casos submetidos à redução de fratura de mandíbula no Hospital de Clínicas da Universidade Federal de Uberlândia, entre janeiro de 1974 e dezembro de 2002. FORMA DE ESTUDO: coorte historica. PACIENTES E MÉTODO: Duzentos e noventa e três pacientes foram submetidos à redução de fratura de mandíbula e retrospectivamente foram avaliados segundo fatores relacionados a: paciente, trauma, quadro clínico e tratamento cirúrgico. RESULTADOS: Houve uma clara tendência de aumento do número de fraturas de mandíbula ao longo dos anos. Houve um predomínio no sexo masculino (4:1), com pico de ocorrência entre 20 a 29 anos. As principais causas de fratura da mandíbula neste estudo foram acidentes de trânsito e violência, perfazendo juntas 72,4 por cento. Cento e trinta e cinco pacientes apresentavam fratura única. Os sítios mais acometidos foram, em ordem decrescente, sínfise, côndilo, ângulo, corpo, ramo e processo coronóide. Foram realizadas redução incruenta (28), cruenta (213) e associação das duas (11 pacientes), sendo que 56,8 por cento dos pacientes foram tratados nos primeiros 3 dias e 50,4 por cento recebeu a alta hospitalar até o primeiro pós-operatório. Cerca de 10 por cento dos pacientes apresentaram complicações, sendo osteomielite a mais freqüente. CONCLUSÃO: A incidência de fraturas de mandíbula foi marcadamente maior no sexo masculino, durante a terceira década de vida. A causa mais comum foi o acidente de trânsito e as regiões mais atingidas foram sínfise e côndilo. As fraturas isoladas de mandíbula ocorreram em mais de metade dos casos. A maioria dos pacientes foi tratada nos primeiros três dias e recebeu alta até o primeiro pós-operatório. A redução cruenta foi tratamento mais comumente empregado. A complicação mais freqüente foi a osteomielite.

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

Trismus as the first manifestation of cholangiocarcinoma

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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)

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.