Celso Buzzo - Academia.edu (original) (raw)

Papers by Celso Buzzo

World Neurosurgery, Jul 1, 2019

Patients with frontotemporal contour deformities presented improved subjective and objective fron... more Patients with frontotemporal contour deformities presented improved subjective and objective frontotemporal symmetry after an anatomical fat grafting session.

Revista Brasileira de Cirurgia Plástica, 2018

O treinamento formal em pesquisa científica aumenta a participação de residentes de Cirurgia Plás... more O treinamento formal em pesquisa científica aumenta a participação de residentes de Cirurgia Plástica em artigos revisados por pares Article

Revista Brasileira de Cirurgia Plástica, 2017

Tratamento primário da deformidade labial e nasal nas fissuras labiais e labiopalatinas unilatera... more Tratamento primário da deformidade labial e nasal nas fissuras labiais e labiopalatinas unilaterais Introduction: Cleft lip and palate, the most frequent congenital craniofacial deformity, mainly affects the upper lip, nose, and palate. One possible treatment is single-stage lip repair with primary rhinoplasty. Here we assessed the correlations among cleft severity, surgical age, and aesthetic results. Methods: A total of 26 patients with unilateral cleft lip or cleft lip and palate aged 3-12 months underwent surgical lip repair associated with the Göteborg/McComb rhinoplasty technique. Steps before and after surgery were separately evaluated by five plastic surgeons using pictures and the data were analyzed. Results: The average patient age at surgery was 6.5 ± 3.15 months, and only seven patients (26.9%) underwent surgery at 3 months of age as recommended by the protocol. Cleft severity and results quality were associated, whereas surgical age and aesthetic results were not correlated. Results in all cases were considered optimal or satisfactory. Conclusions: The lip repair technique, which presents good reproducibility and aesthetic results and can be used with other primary treatment techniques for the nose, should be adopted by treatment centers managing cleft lip and palate. Cleft severity is an important factor in results quality; the greater the severity, the worse the results. In the present study, surgical age was not correlated with results quality.

Journal of Cranio-maxillofacial Surgery, Sep 1, 2008

This is a longitudinal study that aim to correlate the bony interorbital distance relapse after t... more This is a longitudinal study that aim to correlate the bony interorbital distance relapse after the hypertelorism correction with patients age at the operation and the severity of the deformity in rare facial clefts. Material and Methods: 22 patients with rare facial clefts who has undergone to hypertelorism correction to an intracranial approach either by a box osteotomies or facial bipartition technique and had a complete documentation data as well as more than 5 years of follow up were identified. Mean follow up of our cohort was 15.5 years. Sixteen patients were studied more than 10 years postoperatively. Results: The average bony interorbital distance measured on frontal cephalograms was 42.1 mm, and the average reduction after the operation was 15.1 mm. 5/8 patients under five had orbital relapse, less relapse was seen in patients beyond 5 years of age (3/14 patients). Conclusion: In this longitudinal study, we did observe a significant relapse rate in patients under 5 years of age (50%). The overall high BIOD relapse (31.8%) is probably because of the severity of the deformity preoperatively. Considering that all of our patients had a severe hypertelorism (average of 42.1 mm of BIOD preoperatively), we observed a statistically significant differences between the orbital relapse rate in young children and adults. We concluded that severe hypertelorism correction in patients under five years of age leads to a higher orbital relapse rate. Hypertelorism correction in rare facial cleft patients should be postponed beyond 5 years of age.

The intrinsic anatomic deformities combined with changes related to growth and anatomical modific... more The intrinsic anatomic deformities combined with changes related to growth and anatomical modifications and scarring from previous procedures make secondary unilateral cleft rhinoplasty a formidable challenge for the plastic surgeons. A thorough understanding of the deformities and the surgical maneuvers forms the foundation for successful cleft nose repair. In this chapter, we include an overview of secondary unilateral cleft rhinoplasty including a brief history, the anatomy of deformity, and the therapeutic approach.

Revista Brasileira de Cirurgia Plástica, 2014

Introduction: Autogenous bone grafting is the standard treatment for alveolar bone defects. Howev... more Introduction: Autogenous bone grafting is the standard treatment for alveolar bone defects. However, morbidity in the donor area after the bone graft has been obtained continues to be a significant problem in cleft patients. This prospective randomized study compared donor area pain associated with the use of 2 bone extractors in patients with cleft lip and palate, who underwent treatment of alveolar bone defects using a bone graft obtained from the iliac crest. Method: Thirty-six patients with cleft lip and palate underwent alveolar bone defect repair using a graft from the iliac crest, harvested with either a SOBRAPAR bone extractor (group A) or UCLA bone extractor (group B). Donor area pain was evaluated in the postoperative period with the aid of a unidimensional numerical pain scale (0, "no pain"; 10, "worst pain imaginable"). Results: Comparison of the mean donor area pain score did not reveal any significant differences (p >0.05 for all comparisons) between the groups A and B, at any of the postoperative times evaluated. A significantly higher number of patients in group B reported no pain in the donor area, compared

Annals of Plastic Surgery, Aug 1, 2016

Background: To present a single-institution experience in the comprehensive and global soft-tissu... more Background: To present a single-institution experience in the comprehensive and global soft-tissue surgical approach of patients with craniofacial neurofibromatosis type 1 (NF-1). Methods: A retrospective analysis of patients with craniofacial NF-1 (n = 20) who underwent craniofacial soft-tissue reconstruction between 1993 and 2014 was conducted. Surgical treatment was individualized according to age, functional and/or aesthetic impairment, neurofibroma types, anatomical location, size, and patient/family and surgical team preferences, regardless of previously published compartmental grading systems. The surgical results were classified based on 2 previously published outcome rating scales (craniofacial symmetry improvement and need for additional surgery). Results: All patients underwent en bloc translesional surgical excisions, 12 facial suspension, 3 eyebrow suspension, 2 ear suspension, 9 lateral canthopexy, 5 horizontal shortening of the tarsus of lower eyelid, and 1 horizontal shortening of the tarsus of upper eyelid. The degree of craniofacial symmetry improvement was considered "mostly satisfactory" (75%), and the overall rate of surgical results ranked according to the need for additional surgery was 2.4 ± 0.50, with variations according to the spectrum of soft-tissue involvement. Conclusions: According to the experience and surgical outcomes presented in this study, the soft-tissue surgical approach of the craniofacial NF-1 should be global, comprehensive, and individualized.

Journal of Craniofacial Surgery, Mar 1, 2019

Journal of Craniofacial Surgery, 2020

Background: The palatal fistula is an important surgical challenge within the longitudinal follow... more Background: The palatal fistula is an important surgical challenge within the longitudinal follow-up of patients with repaired cleft palate as the success rate of palatal fistula reconstruction by adopting several surgical techniques is variable and often unsatisfactory. The purpose of this retrospective study was to report the clinical outcomes of an algorithm for the surgical management of palatal fistulae in patients with repaired cleft palate. Methods: Consecutive patients (n ¼ 101) with repaired cleft palate and palatal fistula-related symptoms who were treated according to a specific algorithm between 2009 and 2017 were included. Based on the anatomical location (Pittsburgh fistula types II-V), amount of scarring (minimal or severe scarred palate), and diameter of the fistula (5 mm or >5 mm), 1 of 3 approaches (local flaps [62.4%], buccinator myomucosal flaps [20.8%], or tongue flaps [16.8%]) was performed. For clinical outcome assessment, symptomatic and anatomical parameters (fistula-reported symptoms and residual fistula, respectively) were combined as follows: complete fistula closure with no symptoms; asymptomatic narrow fistula remained; or failure to repair the fistula (''good,'' ''fair,'' or ''poor'' outcomes, respectively). Surgical-related complication data were also collected. Results: Most patients (91.1%) presented ''good'' clinical outcomes, ranging from 86.2% to 100% (86.2%, 100%, and 100% for local flaps, buccinator flaps, and tongue flaps, respectively). All (8.9%) ''fair'' and ''poor'' outcomes were observed in fistulae reconstructed by local flaps. All ''poor'' (5%) outcomes were observed in borderline fistulae (4-5 mm). No surgical-related complications (dehiscence, infections, or necrosis) were observed, except for an episode of bleeding after the 1st stage of tongue flap-based reconstruction (1.0%). Conclusion: A high rate of fistula resolution was achieved using this algorithm for surgical management of palatal fistulae in patients with repaired cleft palate.

Plastic and Reconstructive Surgery, Mar 1, 2019

A utologous free fat grafting has become the mainstay for management of craniofacial contour defo... more A utologous free fat grafting has become the mainstay for management of craniofacial contour deformities. 1-6 Because craniofacial fat grafts have highly variable retention rates (33 to 94 percent), 7 some patients require a complementary (or secondary) procedure to obtain satisfactory craniofacial symmetry. 1-8 A complementary fat graft has been shown to achieve significantly better outcomes than an initial fat graft in adult patients with Parry-Romberg syndrome. 8 To the best of our knowledge, no craniofacial investigation has focused on evaluating complementary fat graft outcomes during the first year of follow-up and/or in subgroups of

Plastic and Reconstructive Surgery, Jul 1, 2017

A utologous free fat grafting is a technique shown to have a volume-increasing effect, and is ben... more A utologous free fat grafting is a technique shown to have a volume-increasing effect, and is beneficial as a reconstructive procedure for patients with craniofacial volume deficits resulting in asymmetry/contour irregularities because of congenital, infectious, traumatic, or postsurgical defects. 1-7 Although the unpredictability of long-term fat graft retention remains a major criticism of this technique, characterizing the potential predictive factors of retention is very important in expanding the growing body of fat graft literature that can tailor the surgical maneuvers and operative planning, and counsel patients and parents on the postoperative process. 8-10 We are not aware of any clinical investigation completely focused on evaluating the predictors of fat graft retention, particularly in the management of craniofacial contour asymmetry, although clinical and experimental investigations 1-7,11-15 have demonstrated that some variables (e.g., surgical technique, age, body mass index, donor

Journal of Craniofacial Surgery, Sep 1, 2018

Objective: To assess the electromyographic activity of the masseter and temporal muscles in cleft... more Objective: To assess the electromyographic activity of the masseter and temporal muscles in cleft patients who underwent 1-stage palate repair versus 2-stage palate repair. Methods: Thirty-two patients with nonsyndromic complete unilateral cleft lip and palate operated by 2 different protocols for palate repair, 1-stage (group 1, n ¼ 16) versus 2-stage with delayed hard palate closure (group 2, n ¼ 16) were available in the retrospective longitudinal study. Standardized electromyographic records of the masseter and anterior portion of temporal muscles were obtained with 2 repetitions during mastication and rest. Results: No statistically significant (all P > 0.05) differences were observed in the electromyographic data between the groups 1 and 2. Conclusion: There were similar electromyographic activity of masseter and temporal muscles during mastication and at rest after 1-and 2-stage palate closure.

Revista Brasileira de Cirurgia Plástica, Mar 1, 2012

Somensi RS et al. Assessment of nasal anthropometric parameters after primary cleft lip repair us... more Somensi RS et al. Assessment of nasal anthropometric parameters after primary cleft lip repair using the Mohler technique Avaliação de parâmetros antropométricos nasais após queiloplastia primária pela técnica de Mohler ABSTRACT Background: Efforts to obtain the best possible results in the nasal region of cleft patients are an ongoing process; it is therefore essential to correctly diagnose any changes in the nasal anatomy of cleft palate patients that occur over time and after surgical intervention. The aims of the present study were: (1) to evaluate the percentage of nose asymmetry in patients with either complete or incomplete unilateral cleft lip and palate who underwent primary cleft lip repair with the Mohler technique, both in the immediate postoperative period (T1) and after 1 year (T2); and (2) to compare the percentage of nasal asymmetry in both postoperative periods using the same indexes in children without cleft lip and palate. Methods: During the period from March 2007 to December 2010, 27 patients with unilateral cleft lip and palate were submitted to primary cleft lip repair. Measurements of area, height, height at ¼ of the medial width, and height of the base of the nose were obtained from two-dimensional photos by using Adobe Photoshop CS5 Extended ®. Statistical comparison of the values obtained for nasal asymmetry in the immediate postoperative period and 1 year after surgery was performed with ANOVA. Results: Percentile indexes of nasal asymmetry for cleft patients showed statistical differences in all variables when compared to controls, with the exception being the base of the nose. Conclusions: The results we obtained showed an improvement in nasal symmetry, although there was a tendency to relapse from the result obtained in T1. Patients with complete cleft were more susceptible to relapse with regard to the position of the nose.

Journal of Craniofacial Surgery, Jun 1, 2018

Background: The purposes of this study were to report autologous free fat grafting as the workhor... more Background: The purposes of this study were to report autologous free fat grafting as the workhorse procedure to augment the facial softtissue envelope and restore facial contour symmetry of patients with asymmetric facial malformations; to detail the SOBRAPAR Hospital algorithm for soft-tissue reconstruction of patients with facial contour asymmetry; and to assess facial symmetry after fat grafting. Methods: A retrospective analysis of consecutive patients (n ¼ 178) who underwent fat grafting to restore the facial contour symmetry according to the SOBRAPAR Hospital algorithm between 2009 and 2016 was conducted. Computerized photogrammetric quantitative and qualitative facial symmetry analyses were performed. Results: There were significant (all P < 0.05) postoperative quantitative facial symmetry enhancement and an overall qualitative facial symmetry enhancement, with a mean fat graft procedures per patient of 1.6 AE 0.7, ranging of 1 to 3. Conclusion: A significant improvement of facial contour symmetry was obtained in a subset of patients using fat grafting according to the SOBRAPAR Hospital algorithm.

Revista Brasileira de Cirurgia Plástica, 2014

Introduction: The Parry-Romberg Syndrome (PRS) is characterized by progressive hemifacial atrophy... more Introduction: The Parry-Romberg Syndrome (PRS) is characterized by progressive hemifacial atrophy that often leads to severe esthetic and functional difficulties. Although there are systems for grading disease severity, none have proven ideal in optimizing the therapeutic approach to these patients. This study aimed to establish the surgical strategies for the treatment of PRS based on a new system for severity grading of the disease. Methods: This retrospective study included PRS patients undergoing surgery between 2005 and 2011. The surgical strategies were adapted for each patient according to a clinical severity grading system based on disease progression: type I, affecting the epidermis, dermis, and subcutaneous tissue; type II, type I + muscle involvement; and type III, Types I+ II + bone involvement. The sample included four patients (28.57%) with PRS type I, six patients (42.85%) with PRS type II, and four patients (28.57%) with PRS type III. Results: Forty-seven procedures were performed. Free-fat grafts were used in all patients. Dermal fat grafts were used in all type II patients and one type III patient (25%). Bone grafts with temporoparietal fascia flaps were performed for the treatment of all type III patients. One type III patient (25%) underwent orthognathic surgery. All patients were improved in their overall facial appearance and there were no procedure-related complications. Conclusion: Our proposed system for grading PRS severity can facilitate the choice of therapeutic approaches and with a combination of surgical techniques based on the severity of the disease partially satisfactory outcomes can be attained.

Revista Brasileira de Cirurgia Plástica, 2015

Introduction: Defects in the lower lips after the excision of squamous cell carcinoma (SCC) are u... more Introduction: Defects in the lower lips after the excision of squamous cell carcinoma (SCC) are usually repaired using several surgical techniques. However, the functional reconstruction of full-thickness defects in the lower lip remains a challenge. Therefore, the objectives of this study were to describe surgical strategies for the reconstruction of full-thickness defects of the lower lip after surgical excision of the SCC and evaluate the functional results. Methods: This was a retrospective study of all patients with full-thickness defects in the lower lip after excisions of SCC that were greater than one third of the lip that were repaired using the Bernard-Webster flap between 2011 and 2014. The functional results (sphincteric, motor and sensory function) were evaluated according to previously used criteria. Results: Six lip defects were reconstructed without complications using Bernard-Webster flaps. During the postoperative period, the patients reported liquid incontinence (16.67%), intermittent salivary incontinence (16.67%), and difficulty fully opening the mouth (33.33%). The tests revealed sensory deficits in the labiomental areas (100%) and lower lip (33.33%). There was full recovery of all functional changes an average of 3 months after surgery. The observed late functional results were considered satisfactory. Conclusions: The Bernard-Webster flap was an excellent alternative to repairing the defects that affect more than one third of the lower lip since it allowed the use of similar local tissues, a single surgery could be performed, and the result was functionally efficient.

Annals of Plastic Surgery, Nov 1, 2019

Background: Fat grafting is a widely adopted method for reconstructing upper lip asymmetries. How... more Background: Fat grafting is a widely adopted method for reconstructing upper lip asymmetries. However, most surgical techniques are difficult to reproduce, and none follow anatomical principles. Objectives: The aim of this study was to assess the clinical outcomes of upper lip contour asymmetry and lip cant correction by anatomical upper lip fat grafting using the subunit and fat compartment principles. Methods: A prospective analysis was conducted of 113 consecutive patients who underwent anatomical upper lip fat grafting using the subunit and fat compartment principles for the management of lip cant and/or upper lip contour (volumetric) asymmetry. Quantitative photogrammetric upper lip symmetry and lip cant measurements were blindly performed preoperatively and at 3 and 12 months postoperatively. A panel assessment (by 8 blinded external plastic surgeons and 8 laypersons) was obtained to grade the qualitative upper lip symmetry. Bivariate and multivariate analyses were performed to identify independent variables associated with the 12-month postoperative lip cant change. Results: There was significant (all P < 0.05) postoperative quantitative and qualitative upper lip symmetry and lip cant enhancement (preoperative < postoperative) after a single upper lip fat grafting procedure, and the outcomes were maintained (all P > 0.05) from 3 to 12 months postoperatively. Parry-Romberg syndrome was negatively associated (P < 0.05) with the 12-month postoperative lip cant change. Conclusions: Anatomical upper lip fat grafting, using the subunit and fat compartment principles, improves lip cant and symmetry in patients with unilateral upper lip asymmetries.

Revista do Colégio Brasileiro de Cirurgiões, Apr 1, 2017

Implantes de acrílico customizados para a reconstrução de defeitos extensos da calota craniana: u... more Implantes de acrílico customizados para a reconstrução de defeitos extensos da calota craniana: uma abordagem de exceção para pacientes selecionados

World Neurosurgery, Jul 1, 2019

Patients with frontotemporal contour deformities presented improved subjective and objective fron... more Patients with frontotemporal contour deformities presented improved subjective and objective frontotemporal symmetry after an anatomical fat grafting session.

Revista Brasileira de Cirurgia Plástica, 2018

O treinamento formal em pesquisa científica aumenta a participação de residentes de Cirurgia Plás... more O treinamento formal em pesquisa científica aumenta a participação de residentes de Cirurgia Plástica em artigos revisados por pares Article

Revista Brasileira de Cirurgia Plástica, 2017

Tratamento primário da deformidade labial e nasal nas fissuras labiais e labiopalatinas unilatera... more Tratamento primário da deformidade labial e nasal nas fissuras labiais e labiopalatinas unilaterais Introduction: Cleft lip and palate, the most frequent congenital craniofacial deformity, mainly affects the upper lip, nose, and palate. One possible treatment is single-stage lip repair with primary rhinoplasty. Here we assessed the correlations among cleft severity, surgical age, and aesthetic results. Methods: A total of 26 patients with unilateral cleft lip or cleft lip and palate aged 3-12 months underwent surgical lip repair associated with the Göteborg/McComb rhinoplasty technique. Steps before and after surgery were separately evaluated by five plastic surgeons using pictures and the data were analyzed. Results: The average patient age at surgery was 6.5 ± 3.15 months, and only seven patients (26.9%) underwent surgery at 3 months of age as recommended by the protocol. Cleft severity and results quality were associated, whereas surgical age and aesthetic results were not correlated. Results in all cases were considered optimal or satisfactory. Conclusions: The lip repair technique, which presents good reproducibility and aesthetic results and can be used with other primary treatment techniques for the nose, should be adopted by treatment centers managing cleft lip and palate. Cleft severity is an important factor in results quality; the greater the severity, the worse the results. In the present study, surgical age was not correlated with results quality.

Journal of Cranio-maxillofacial Surgery, Sep 1, 2008

This is a longitudinal study that aim to correlate the bony interorbital distance relapse after t... more This is a longitudinal study that aim to correlate the bony interorbital distance relapse after the hypertelorism correction with patients age at the operation and the severity of the deformity in rare facial clefts. Material and Methods: 22 patients with rare facial clefts who has undergone to hypertelorism correction to an intracranial approach either by a box osteotomies or facial bipartition technique and had a complete documentation data as well as more than 5 years of follow up were identified. Mean follow up of our cohort was 15.5 years. Sixteen patients were studied more than 10 years postoperatively. Results: The average bony interorbital distance measured on frontal cephalograms was 42.1 mm, and the average reduction after the operation was 15.1 mm. 5/8 patients under five had orbital relapse, less relapse was seen in patients beyond 5 years of age (3/14 patients). Conclusion: In this longitudinal study, we did observe a significant relapse rate in patients under 5 years of age (50%). The overall high BIOD relapse (31.8%) is probably because of the severity of the deformity preoperatively. Considering that all of our patients had a severe hypertelorism (average of 42.1 mm of BIOD preoperatively), we observed a statistically significant differences between the orbital relapse rate in young children and adults. We concluded that severe hypertelorism correction in patients under five years of age leads to a higher orbital relapse rate. Hypertelorism correction in rare facial cleft patients should be postponed beyond 5 years of age.

The intrinsic anatomic deformities combined with changes related to growth and anatomical modific... more The intrinsic anatomic deformities combined with changes related to growth and anatomical modifications and scarring from previous procedures make secondary unilateral cleft rhinoplasty a formidable challenge for the plastic surgeons. A thorough understanding of the deformities and the surgical maneuvers forms the foundation for successful cleft nose repair. In this chapter, we include an overview of secondary unilateral cleft rhinoplasty including a brief history, the anatomy of deformity, and the therapeutic approach.

Revista Brasileira de Cirurgia Plástica, 2014

Introduction: Autogenous bone grafting is the standard treatment for alveolar bone defects. Howev... more Introduction: Autogenous bone grafting is the standard treatment for alveolar bone defects. However, morbidity in the donor area after the bone graft has been obtained continues to be a significant problem in cleft patients. This prospective randomized study compared donor area pain associated with the use of 2 bone extractors in patients with cleft lip and palate, who underwent treatment of alveolar bone defects using a bone graft obtained from the iliac crest. Method: Thirty-six patients with cleft lip and palate underwent alveolar bone defect repair using a graft from the iliac crest, harvested with either a SOBRAPAR bone extractor (group A) or UCLA bone extractor (group B). Donor area pain was evaluated in the postoperative period with the aid of a unidimensional numerical pain scale (0, "no pain"; 10, "worst pain imaginable"). Results: Comparison of the mean donor area pain score did not reveal any significant differences (p >0.05 for all comparisons) between the groups A and B, at any of the postoperative times evaluated. A significantly higher number of patients in group B reported no pain in the donor area, compared

Annals of Plastic Surgery, Aug 1, 2016

Background: To present a single-institution experience in the comprehensive and global soft-tissu... more Background: To present a single-institution experience in the comprehensive and global soft-tissue surgical approach of patients with craniofacial neurofibromatosis type 1 (NF-1). Methods: A retrospective analysis of patients with craniofacial NF-1 (n = 20) who underwent craniofacial soft-tissue reconstruction between 1993 and 2014 was conducted. Surgical treatment was individualized according to age, functional and/or aesthetic impairment, neurofibroma types, anatomical location, size, and patient/family and surgical team preferences, regardless of previously published compartmental grading systems. The surgical results were classified based on 2 previously published outcome rating scales (craniofacial symmetry improvement and need for additional surgery). Results: All patients underwent en bloc translesional surgical excisions, 12 facial suspension, 3 eyebrow suspension, 2 ear suspension, 9 lateral canthopexy, 5 horizontal shortening of the tarsus of lower eyelid, and 1 horizontal shortening of the tarsus of upper eyelid. The degree of craniofacial symmetry improvement was considered "mostly satisfactory" (75%), and the overall rate of surgical results ranked according to the need for additional surgery was 2.4 ± 0.50, with variations according to the spectrum of soft-tissue involvement. Conclusions: According to the experience and surgical outcomes presented in this study, the soft-tissue surgical approach of the craniofacial NF-1 should be global, comprehensive, and individualized.

Journal of Craniofacial Surgery, Mar 1, 2019

Journal of Craniofacial Surgery, 2020

Background: The palatal fistula is an important surgical challenge within the longitudinal follow... more Background: The palatal fistula is an important surgical challenge within the longitudinal follow-up of patients with repaired cleft palate as the success rate of palatal fistula reconstruction by adopting several surgical techniques is variable and often unsatisfactory. The purpose of this retrospective study was to report the clinical outcomes of an algorithm for the surgical management of palatal fistulae in patients with repaired cleft palate. Methods: Consecutive patients (n ¼ 101) with repaired cleft palate and palatal fistula-related symptoms who were treated according to a specific algorithm between 2009 and 2017 were included. Based on the anatomical location (Pittsburgh fistula types II-V), amount of scarring (minimal or severe scarred palate), and diameter of the fistula (5 mm or >5 mm), 1 of 3 approaches (local flaps [62.4%], buccinator myomucosal flaps [20.8%], or tongue flaps [16.8%]) was performed. For clinical outcome assessment, symptomatic and anatomical parameters (fistula-reported symptoms and residual fistula, respectively) were combined as follows: complete fistula closure with no symptoms; asymptomatic narrow fistula remained; or failure to repair the fistula (''good,'' ''fair,'' or ''poor'' outcomes, respectively). Surgical-related complication data were also collected. Results: Most patients (91.1%) presented ''good'' clinical outcomes, ranging from 86.2% to 100% (86.2%, 100%, and 100% for local flaps, buccinator flaps, and tongue flaps, respectively). All (8.9%) ''fair'' and ''poor'' outcomes were observed in fistulae reconstructed by local flaps. All ''poor'' (5%) outcomes were observed in borderline fistulae (4-5 mm). No surgical-related complications (dehiscence, infections, or necrosis) were observed, except for an episode of bleeding after the 1st stage of tongue flap-based reconstruction (1.0%). Conclusion: A high rate of fistula resolution was achieved using this algorithm for surgical management of palatal fistulae in patients with repaired cleft palate.

Plastic and Reconstructive Surgery, Mar 1, 2019

A utologous free fat grafting has become the mainstay for management of craniofacial contour defo... more A utologous free fat grafting has become the mainstay for management of craniofacial contour deformities. 1-6 Because craniofacial fat grafts have highly variable retention rates (33 to 94 percent), 7 some patients require a complementary (or secondary) procedure to obtain satisfactory craniofacial symmetry. 1-8 A complementary fat graft has been shown to achieve significantly better outcomes than an initial fat graft in adult patients with Parry-Romberg syndrome. 8 To the best of our knowledge, no craniofacial investigation has focused on evaluating complementary fat graft outcomes during the first year of follow-up and/or in subgroups of

Plastic and Reconstructive Surgery, Jul 1, 2017

A utologous free fat grafting is a technique shown to have a volume-increasing effect, and is ben... more A utologous free fat grafting is a technique shown to have a volume-increasing effect, and is beneficial as a reconstructive procedure for patients with craniofacial volume deficits resulting in asymmetry/contour irregularities because of congenital, infectious, traumatic, or postsurgical defects. 1-7 Although the unpredictability of long-term fat graft retention remains a major criticism of this technique, characterizing the potential predictive factors of retention is very important in expanding the growing body of fat graft literature that can tailor the surgical maneuvers and operative planning, and counsel patients and parents on the postoperative process. 8-10 We are not aware of any clinical investigation completely focused on evaluating the predictors of fat graft retention, particularly in the management of craniofacial contour asymmetry, although clinical and experimental investigations 1-7,11-15 have demonstrated that some variables (e.g., surgical technique, age, body mass index, donor

Journal of Craniofacial Surgery, Sep 1, 2018

Objective: To assess the electromyographic activity of the masseter and temporal muscles in cleft... more Objective: To assess the electromyographic activity of the masseter and temporal muscles in cleft patients who underwent 1-stage palate repair versus 2-stage palate repair. Methods: Thirty-two patients with nonsyndromic complete unilateral cleft lip and palate operated by 2 different protocols for palate repair, 1-stage (group 1, n ¼ 16) versus 2-stage with delayed hard palate closure (group 2, n ¼ 16) were available in the retrospective longitudinal study. Standardized electromyographic records of the masseter and anterior portion of temporal muscles were obtained with 2 repetitions during mastication and rest. Results: No statistically significant (all P > 0.05) differences were observed in the electromyographic data between the groups 1 and 2. Conclusion: There were similar electromyographic activity of masseter and temporal muscles during mastication and at rest after 1-and 2-stage palate closure.

Revista Brasileira de Cirurgia Plástica, Mar 1, 2012

Somensi RS et al. Assessment of nasal anthropometric parameters after primary cleft lip repair us... more Somensi RS et al. Assessment of nasal anthropometric parameters after primary cleft lip repair using the Mohler technique Avaliação de parâmetros antropométricos nasais após queiloplastia primária pela técnica de Mohler ABSTRACT Background: Efforts to obtain the best possible results in the nasal region of cleft patients are an ongoing process; it is therefore essential to correctly diagnose any changes in the nasal anatomy of cleft palate patients that occur over time and after surgical intervention. The aims of the present study were: (1) to evaluate the percentage of nose asymmetry in patients with either complete or incomplete unilateral cleft lip and palate who underwent primary cleft lip repair with the Mohler technique, both in the immediate postoperative period (T1) and after 1 year (T2); and (2) to compare the percentage of nasal asymmetry in both postoperative periods using the same indexes in children without cleft lip and palate. Methods: During the period from March 2007 to December 2010, 27 patients with unilateral cleft lip and palate were submitted to primary cleft lip repair. Measurements of area, height, height at ¼ of the medial width, and height of the base of the nose were obtained from two-dimensional photos by using Adobe Photoshop CS5 Extended ®. Statistical comparison of the values obtained for nasal asymmetry in the immediate postoperative period and 1 year after surgery was performed with ANOVA. Results: Percentile indexes of nasal asymmetry for cleft patients showed statistical differences in all variables when compared to controls, with the exception being the base of the nose. Conclusions: The results we obtained showed an improvement in nasal symmetry, although there was a tendency to relapse from the result obtained in T1. Patients with complete cleft were more susceptible to relapse with regard to the position of the nose.

Journal of Craniofacial Surgery, Jun 1, 2018

Background: The purposes of this study were to report autologous free fat grafting as the workhor... more Background: The purposes of this study were to report autologous free fat grafting as the workhorse procedure to augment the facial softtissue envelope and restore facial contour symmetry of patients with asymmetric facial malformations; to detail the SOBRAPAR Hospital algorithm for soft-tissue reconstruction of patients with facial contour asymmetry; and to assess facial symmetry after fat grafting. Methods: A retrospective analysis of consecutive patients (n ¼ 178) who underwent fat grafting to restore the facial contour symmetry according to the SOBRAPAR Hospital algorithm between 2009 and 2016 was conducted. Computerized photogrammetric quantitative and qualitative facial symmetry analyses were performed. Results: There were significant (all P < 0.05) postoperative quantitative facial symmetry enhancement and an overall qualitative facial symmetry enhancement, with a mean fat graft procedures per patient of 1.6 AE 0.7, ranging of 1 to 3. Conclusion: A significant improvement of facial contour symmetry was obtained in a subset of patients using fat grafting according to the SOBRAPAR Hospital algorithm.

Revista Brasileira de Cirurgia Plástica, 2014

Introduction: The Parry-Romberg Syndrome (PRS) is characterized by progressive hemifacial atrophy... more Introduction: The Parry-Romberg Syndrome (PRS) is characterized by progressive hemifacial atrophy that often leads to severe esthetic and functional difficulties. Although there are systems for grading disease severity, none have proven ideal in optimizing the therapeutic approach to these patients. This study aimed to establish the surgical strategies for the treatment of PRS based on a new system for severity grading of the disease. Methods: This retrospective study included PRS patients undergoing surgery between 2005 and 2011. The surgical strategies were adapted for each patient according to a clinical severity grading system based on disease progression: type I, affecting the epidermis, dermis, and subcutaneous tissue; type II, type I + muscle involvement; and type III, Types I+ II + bone involvement. The sample included four patients (28.57%) with PRS type I, six patients (42.85%) with PRS type II, and four patients (28.57%) with PRS type III. Results: Forty-seven procedures were performed. Free-fat grafts were used in all patients. Dermal fat grafts were used in all type II patients and one type III patient (25%). Bone grafts with temporoparietal fascia flaps were performed for the treatment of all type III patients. One type III patient (25%) underwent orthognathic surgery. All patients were improved in their overall facial appearance and there were no procedure-related complications. Conclusion: Our proposed system for grading PRS severity can facilitate the choice of therapeutic approaches and with a combination of surgical techniques based on the severity of the disease partially satisfactory outcomes can be attained.

Revista Brasileira de Cirurgia Plástica, 2015

Introduction: Defects in the lower lips after the excision of squamous cell carcinoma (SCC) are u... more Introduction: Defects in the lower lips after the excision of squamous cell carcinoma (SCC) are usually repaired using several surgical techniques. However, the functional reconstruction of full-thickness defects in the lower lip remains a challenge. Therefore, the objectives of this study were to describe surgical strategies for the reconstruction of full-thickness defects of the lower lip after surgical excision of the SCC and evaluate the functional results. Methods: This was a retrospective study of all patients with full-thickness defects in the lower lip after excisions of SCC that were greater than one third of the lip that were repaired using the Bernard-Webster flap between 2011 and 2014. The functional results (sphincteric, motor and sensory function) were evaluated according to previously used criteria. Results: Six lip defects were reconstructed without complications using Bernard-Webster flaps. During the postoperative period, the patients reported liquid incontinence (16.67%), intermittent salivary incontinence (16.67%), and difficulty fully opening the mouth (33.33%). The tests revealed sensory deficits in the labiomental areas (100%) and lower lip (33.33%). There was full recovery of all functional changes an average of 3 months after surgery. The observed late functional results were considered satisfactory. Conclusions: The Bernard-Webster flap was an excellent alternative to repairing the defects that affect more than one third of the lower lip since it allowed the use of similar local tissues, a single surgery could be performed, and the result was functionally efficient.

Annals of Plastic Surgery, Nov 1, 2019

Background: Fat grafting is a widely adopted method for reconstructing upper lip asymmetries. How... more Background: Fat grafting is a widely adopted method for reconstructing upper lip asymmetries. However, most surgical techniques are difficult to reproduce, and none follow anatomical principles. Objectives: The aim of this study was to assess the clinical outcomes of upper lip contour asymmetry and lip cant correction by anatomical upper lip fat grafting using the subunit and fat compartment principles. Methods: A prospective analysis was conducted of 113 consecutive patients who underwent anatomical upper lip fat grafting using the subunit and fat compartment principles for the management of lip cant and/or upper lip contour (volumetric) asymmetry. Quantitative photogrammetric upper lip symmetry and lip cant measurements were blindly performed preoperatively and at 3 and 12 months postoperatively. A panel assessment (by 8 blinded external plastic surgeons and 8 laypersons) was obtained to grade the qualitative upper lip symmetry. Bivariate and multivariate analyses were performed to identify independent variables associated with the 12-month postoperative lip cant change. Results: There was significant (all P < 0.05) postoperative quantitative and qualitative upper lip symmetry and lip cant enhancement (preoperative < postoperative) after a single upper lip fat grafting procedure, and the outcomes were maintained (all P > 0.05) from 3 to 12 months postoperatively. Parry-Romberg syndrome was negatively associated (P < 0.05) with the 12-month postoperative lip cant change. Conclusions: Anatomical upper lip fat grafting, using the subunit and fat compartment principles, improves lip cant and symmetry in patients with unilateral upper lip asymmetries.

Revista do Colégio Brasileiro de Cirurgiões, Apr 1, 2017

Implantes de acrílico customizados para a reconstrução de defeitos extensos da calota craniana: u... more Implantes de acrílico customizados para a reconstrução de defeitos extensos da calota craniana: uma abordagem de exceção para pacientes selecionados