DISTRACTION OSTEOGENESIS OF THE MIDFACE WITH RIGID EXTERNAL DETRACTORS: PRELIMINARY
EXPERIENCE IN TWO CASES
AUTOR
Nivaldo Alonso, MD, PhDt; Dov Charles Goldenberg, MD, MSc2; Danlel Santos Correa Lima, MD3;
Paulo Roberto Pelucio Cgrnara, DDS4; Hamilton Matushita, MD, PhD5; Marcus Castro Ferreira, MD, PhD
Distraction osteogenesis has been usedto advance the midface ofpatients presenting syndromic craniosynostosis.
In these cases, the resistance offered by the underlying soft tissues may hinder the stability of results, mainly
when a major degree of advancement is necessaw Therefore, distraction is a peecsto lution, since both bone
and soft tissues may be lengthened gradually The aim of the present study was to describe the preliminary
experience and results obtained with the use of rigdexfemal distraction in the treatment of severe hypoplasia of
the midface in patients with syndromic craniosynostosis. Two patients (Crouzon and Aped syndromes) were
assessed. Le Fort type 111 osteotomy and fronto-facial monobloc advancement were carried out, with gradual
bone segment advance, using a rigid external distraction device. The Crouzon patient was submitted to Le Fort
111; 15-mm monobloc advancement was achieved. in the Aped syndrome case, 12.5-mm advancement was
achieved with fronto-facial monobloc osteotomy There was no morbidity associated with the device or with the
distraction process. Treatment objectives were achieved. However, the long-tern results of this procedure are
not established, and further research must be carried out.
Andrea Fernandes de Oliveira, MD1; Max Domingues Pereira, PhDZ; Srgio Cavalheiro, PhD3;
Lydia Masako Ferreira, PhD4
Amniotic band syndrome has a number of different synonyms: amniotic band disruption complex or sequence,
annular constriction bands andaberrant tissue bands. The incidence of amniotic band syndrome is unknown and
its etiology is also unclear: Clinicalmanifestations are extremely varied, and abnormalities may be isolated, such
as the presence of a single constriction ring, or multiple, as in the cases herein described. Limb constrictions are
the most common findings, andcraniofacialanomalies are the most serious ones, due to the high-level functions
of the organs involved. This paper reports on two cases of patients with amniotic band syndrome. One patient
was male and the other female. Both presented encephalocele, facial clefts and constriction rings on upper and
lower limbs. The diagnosis of this syndrome is based on clinical findings that include, in addition to the patient's
anatomicalanomalies, an examination of the placenta and the amniotic membranes. Prognosis is poor when the
central nervous system is affected and, in the rare cases in which such children survive, sequelae are severe,
which makes the study of this disease important.
KEY WORDS
Amniotic bands; amniotic band syndrome; congenital defects; abnormalities; neonatal diseases.
TÍTULO
ORAL AND MAXILLOFACIAL PROSTHESES
AUTOR
Savio Jose Miranda Costa'; Elifas Levy Nunes2
The authors describe oral andmaxillofacialprostheses (ocular, nasal, auricularprostheses andpaiataiobturators)
and their current indications. They comment on the role of prosthetists and their areas of competence and
demonstrate how, with the use of oral and maxillofacial prostheses, this speciaoy is capable of reintegrating
facially mutilatedpatients into society
TRANSMAXILLARY APPROACH
FOR BASILAR IMPRESSION TREATMENT:
CASE HISTORY AND LITERATURE REVIEW
AUTOR
Marcus Vinicius Martins Collares, MD, PhD'; Albert Brazil, MD2; Rinaldo De Angeli Pinto, MD3;
Luis Carlos Acevedo-Rangel, MD4; Ciro Paz Portinho, MD5; Rafael Marques de Souza, MDB
The authors present the case of a patient with basilar impression (61). An 8-year old Caucasian male began with
upper-limb coordination deficit and disphony. Magnetic resonance (MR) demonstrated basilar impression and
syringomyelia. Two months after symptoms had started, the child underwent surgery with double approach.
Dufi~gth e anterior approach, a maxiIIotomy (Le Fort I) and an odontoidectomy were performed. After that, a
posterior approach was created through a posterior craniectomy, in order to provide cervical spine arthrodesis.
The patient had a good outcome, with complete resolution of neural and behavioral symptoms. BI is a cranialverlebral
junction deformity caused by migration of cervical spine into the cranium. It can be either a primaiy or
a secondary condition, the latter being a consequence ofbone thinning disorders. Clinicalpresentation has signs
and symptoms related to direct neural compression, liquor flow obstruction and vascular involvement. Almost all
of these patients have headache. IB can lead to secondary syringomyelia. MR is the imaging exam of choice for
diagnosis. Nowadays, it is a consensus that anteriorneuroauial compression shouldbe treated with decompression
through an anterior approach (usually a maxillotomy). Anterior approach for odontoidectomy is an adequate
procedure. It should be performed by experienced surgeons in transfacial accesses, with care to prevent tooth
buddamage in chiidren (a high Le Fort I shouidbe made), andreconstructingpalate in orderto avoidvelopharyngeal
sphincteralterations.
KEY WORDS
Basilar impression; odonfoidprocess; spine; cervical vertebrae; m&lla; surgery
TÍTULO
SEVERE ORBITAL COMPLICATION
RELATED TO MUCOCELES OF THE
MAXILLARY SINUS: CASE REPORT
The following afticle is a report of the case history of a patient who sought treatment at the ophthalmology service
wmplaining of red eye and diplopia. Basedon physical examination, the ophthalmologist diagnosed exophthalmia
and, suspecting an expansion, referred the patient to our craniomaxillofacial surgery service. We asked for a CT
scan that showed a lesion on the left maxillary sinus, obliterating the anterior bone wall structure and bone of the
lower wall of the eye floor. Progress to date is satisfactory.
