CIR MAXFAC - Artigos
Permanent URI for this collection
Browse
Browsing CIR MAXFAC - Artigos by Title
Now showing 1 - 7 of 7
Results Per Page
Sort Options
- Intra- and Interreader Variability of Orbital Volume Quantification Using 3D Computed Tomography for Reconstructed Orbital FracturesPublication . Gomes de Oliveira, P; Perry da Câmara, C; Valejo Coelho, PPurpose: Management of orbital fractures continues to present some difficulties, particularly regarding the prediction of late complications. Radiographic assessment provides a detailed evaluation, but the results lack consistency to be considered a standard factor in the decision-making process. Studies focusing on reliability of post-operative imaging are lacking. Materials and methods: We performed a retrospective study using patients from a major trauma center with unilateral orbital floor fracture who underwent surgery. Using three-dimensional volume assessment software, we performed a volume calculation and determined the intra- and interreader variation by intraclass correlation coefficient analysis. Results: Twenty-four orbits were assessed. Mean orbital volume (SD) was 24.02 (2,43) cm3 for reader 1 and 24.08 (2,51) cm3 for reader 2. The intraclass correlation coefficient (95% CI) was 0.95 (0.91-0.98) between readers and 0.96 (0.91-0.98) for intra-reader variability. Normal and reconstructed orbits assessed separately also showed very high correlation coefficient for both intra- and inter-subject variability. Conclusion: Results show an almost perfect agreement of volume assessment between readers. The presence of reconstruction material does not seem to add variability. Although reproducible and reliable, radiological volume assessments have not yet shown a clear correlation with clinical outcomes and post-operative management decisions should be based mainly on clinical findings.
- New Perspectives on the Conservative Management of Osteoradionecrosis of the Mandible: a Literature ReviewPublication . Alpuim Costa, D; Porfírio Costa, T; Netto, E; Joaquim, N; Ventura, I; Pratas, AC; Winckler, P; Pires Silva, I; Pinho, AC; Goulão Sargento, I; Gamito Guerreiro, F; Moreira, AOver the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.
- Odontoameloblastoma: a Propósito de um Caso ClínicoPublication . Semedo, C; Nunes da Silva, L; Foreid, S; Gomes, B; Pratas, AC; Valejo Coelho, PO odontoameloblastoma é um tumor odontogénico misto muito raro. Reportam-se 29 casos bem documentados na literatura inglesa consultada, dos quais apenas 5 têm envolvimento do segmento anterior da mandíbula. Um homem de 51 anos apresentava um tumor da região anterior da mandíbula, com tumefacção dura, difusa e indolor na região parassinfisária direita da mandíbula. Radiograficamente existia extensa lesão radiolucente, bem delimitada, desde o dente 46 ao dente 34, com pequenas estruturas calcificadas no interior. Observava-se expansão óssea com provável perfuração cortical e reabsorções radiculares. Após biópsia realizou-se resseção cirúrgica. O exame anatomopatológico permitiu o diagnóstico de odontoameloblastoma. Não houve recorrência nos 30 meses de seguimento. O odontoameloblastoma é um tumor localmente agressivo com comportamento aparentemente semelhante ao dos ameloblastomas, em termos de crescimento, expansão óssea, rizólise e recorrência, parecendo prudente adotar o mesmo critério terapêutico para ambos.
- Oral Self-Mutilation in Lesch-Nyhan Syndrome: A Case ReportPublication . Ferrão, J; Rodrigues Barros, C; Figueiredo, L; Fernandes, ALesch-Nyhan syndrome (LNS) is an inherited recessive X-related disorder caused by a deficiency of the purine salvage enzyme hypoxanthine-guanine phosphoribosyltransferase. It is characterized by dystonia and compulsive self-mutilation, in particular, biting behavior on the oral mucosa, tongue, lips, fingers, and shoulders, typically before one year of age. The majority of these patients require several procedures, including dental extractions, to prevent significant secondary lesions. This article aims to report a clinical case of a 12-year-old boy with an LNS diagnosis who was referred to the Paediatric Stomatology Department of Central Lisbon University Hospital. Since the age of eight, the patient had displayed self-harm behavior, with arm and oral injuries. On evaluation, he presented with deep ulcerated lesions on the lips and tongue, with substance loss associated with a significant decrease in food intake and consequent weight loss. The management included conservative therapy with gabapentin, lorazepam, and botulinum toxin injections. A successful reduction of self-mutilation with no signs of new lesions in the oral cavity and an improvement in nutritional status were reported. The therapeutic approach is essential to provide the best quality of life for patients and their caregivers. To delay radical treatments, multiple therapeutic options can be used. The oral pathology team considered that the most appropriate therapy was botulinum toxin A injections along with therapeutic adjustment, which was effective in wound healing and self-mutilation behavior ceasing at the two-month follow-up.
- Pilomatrixoma Recurring As Giant FormPublication . Tavares, AT; Neiva-Sousa, M; Semedo, C; Martins, M; Gomes, PPilomatrixoma is a benign skin tumor that originates from the hair matrix. It usually appears in children and young adults and is preferably in the head and neck region. It clinically presents as an asymptomatic firm, solitary subcutaneous mass of less than 3 cm. When located in the preauricular area, it is often misdiagnosed as benign or malignant parotids, skin tumors, or sebaceous cysts. Its treatment of choice is surgery, and recurrence is due to incomplete excision. We present a case of a male referred to our hospital with a diagnosis of recurrent pilomatrixoma in its giant form. The lesion was fully excised with no signs of recurrence and no functional impairment.
- Pseudoaneurysm of the Facial Artery Territory in an Odontogenic Infection SettingPublication . Lopes Oliveira, MJ; Semedo, C; Quintela, MJ; Fragata, I; Gonçalves Coelho, C; Valejo Coelho, PA pseudoaneurysm of the facial artery is a rare event. It results from vessel wall disruption with blood tamponade from the surrounding tissues, and is usually caused by blunt facial trauma, with other etiologies rarely reported. We present two cases of a pseudoaneurysm in the facial artery territory in an odontogenic infection setting, highlighting the importance of computed tomography angiography for diagnosis and hastening treatment by vascular embolization.
- Retrospective Study of 114 Free Flaps for Head and Neck Oncological Reconstruction in a Portuguese Tertiary Cancer CenterPublication . Silva, A; Caixeirinho, P; Vilares, M; Semedo, C; Martins, M; Zagalo, C; Casal, DIntroduction: The Portuguese experience in microsurgical reconstruction of the head and neck after oncological surgery is scantly described. The primary aim of this study was to characterize the use of microvascular reconstruction after head and neck tumor resection in a Portuguese tertiary oncological centerMaterial and Methods: The authors retrospectively evaluated 114 microvascular free flap procedures performed for head and neck reconstruction after oncological resection in a department of Head and Neck Surgery of a Portuguese tertiary oncological center. Patients were operated on from January 2012 to May 2018. Data on patient demographic features, tumour characteristics, perioperative complications, postoperative aesthetic and functional results, survival time and time to recurrence were extracted. Results: Most tumours mandating microsurgical reconstruction were mucosal squamous cell carcinomas (85%) and were located in the oral region (95.6%). Around 45% of the patients had a T4a tumour and 30% a T2 tumour. Cervical metastases were present in 45.6% of the cases. The radial forearm flap and the fibular flap were the most commonly used microsurgical reconstructive options (58% and 41%, respectively). More than 80% of patients had no post-operative complications. Partial necrosis of the flap occurred in 6.1% of patients, while total flap necrosis occurred in 3.5% of cases. Aesthetic and functional results were considered at least satisfactory in all patients in which the flaps survived. Discussion: This study is by far the largest series of microsurgical head and neck reconstruction after oncological surgery reported by a single tertiary centre in Portugal. Survival and functional benefits are similar to those reported in other large oncological centres in the world. Conclusion: Microvascular reconstruction seems like a reliable treatment option in head and neck oncological surgery at our institution.