brazilian journal of craniomaxillofacial surgery
Transcription
brazilian journal of craniomaxillofacial surgery
BRAZILIAN JOURNAL OF CRANIOMAXILLOFACIAL SURGERY ISSN 151 6-4187 Official publication of the Brazilian Society of Craniomaxillofacial Surgery - P - Volume 5 Number 1 June 2002 *di *- @* Sociedade Brasileira de Cirurgia Craniomaxilofacial Brazilian Society of Craniomaxillofacial Surgery President Vice President Nivaldo Alonso (SP! Ricardo Lopes da Cruz (RJ) Secretary Treasurer Marcus Vinicius Martins Collares (RS) Max Domingues Pereira (SP) Please s e n d correspondence t o t h e Editor a t t h e f o l l o w i n g address: Rua HilArio Ribeiro 2021406. CEP 9 0 5 1 0-040, P o r t o Alegre, RS, Brazil E-mail: [email protected] Editorial office1 Consultoria editorial: Scientific Linguagem Ltda. Publishing/EditoracGo: Scientific Linguagem Ltda. Phoneifax: +55-51-3388.5000 E-mail: [email protected] http://www.scientific.com.br Arte&ComposicSo Phone: + 55-51 -3338.601 9 E-mail: [email protected] DesignlPrograma~GoVisual: Claudia Koch 55-51-9103.6565 + i t i c a lrnpressora Phone: +55-51-3337.4322 E-mail: etica@eticaim~ressora.com.br BrazilianJournal of CraniomaxillofacialSurgery1Sociedade Brasileira de Cirurgia Craniomaxilofacial. - Vo1.5, n.1 (Jun.2002). - Porto Alegre : SBCC, 1998 . v. : il. : 30cm. - Dois n h e r o s por ano, em ingles. ISSN 1516-4187 1. Cirurgia Bucal I. Brazilian Journal of Craniornaxillofacial Surgery. II. Sociedade Brasileira de Cirurgia Craniomaxilofacial. CDD: 61 7.522 CDU: 616.31-089 BRAZILIAN JOURNAL OF CRANIOMAXILLOFACIAL SURGERY Official publication of the Brazilian Society of Craniomaxillofacial Surgery EDITOR ASSOCIATE EDITOR Marcus Vinicius Martins Collares, MD, PhD Sflvio AntBnio Zanini, MD Hospital de Clinicas de Pono Alegre Hospital de Reabilitacso de Anomalias Craniofaciais Universidade Federal do Rio Grande do Sul Universidade de SBo Paulo Brazil Brazil SCIENTIFIC COUNCIL Nivaldo Alonso, MD, PhD (Brazil) Elisa Altmann, MD (Brazil) Cassio Raposo do Amaral, MD (Brazil) Carlos Alberto Ballin, MD (Brazil) Vera Nocchi Cardim, MD (Brazil) Roberto Corrga Chem, MD, PhD (Brazil) Edgard Alves Costa, MD (Brazil) S6rgio Moreira da Costa, MD (Brazil) Ricardo Lopes da Cruz, MD (Brazil) Pedro Dogliotti, MD (Argentina) Jose Carlos Ferreira, MD, PhD (Brazil) Luis Francisco Fontoura, MD (Brazil) Omar Gabriel, DDS (Brazil) Eduardo Grossmann, DDS, PhD (Brazil) Paulo Hvenegaard, MD (Brazil) Ian Thomas Jackson, MD (United States of America) Lufs Paulo Kovalski, MD (Brazil) Jose Alberto Landeiro, MD (Brazil) Luis Tresserra Llauradd, MD, PhD (Spain) Michael T. Longaker, MD (United States o f America) Gilvani Azor de Oliveira e Cruz, MD (Brazil) Antonio Richieri-Costa, MD, PhD (Brazil) Diogenes Lakrcio Rocha, MD (Brazil) Flavio M. Sturla, MD (Argentina) Fausto Viterbo, MD, PhD (Brazil) RETROSPECTIVE, DESCRIPTIVE EPIDEMIOLOGIC ASSESSMENT OF FACIAL BONEFRACTURES IN GROWING PATIENTS, FROM 1992 TO 2001, AT HOSPITAL CRISTO REDENTOR, PORTOALEGRE,RS ..................................... 11 Eduardo Seixas Cardoso, Renata Pittella Canqado, Marilia Gehardt Oliveira, Salete Maria Pretto USEOF VIDEOENDOSCOPY IN THE DIAGNOSIS OF ORBITAL FLOOR FRACTURES ...... 11 Fernando Cesar A. Lima, Weber Leo Cavalcante, Ricardo Lopes da Cruz VIDEO-ASSISTED TREATMENT OF FACIAL FRACTURES: INDICATIONS, TECHNICAL ASPECTS, AND INITIAL EXPERIENCE ............................. Dov C. Goldenberg, Nivaldo Alonso, Luiz Gustavo B. Cruz, Claudio E. P. de Souza, Daniel S.C. Lima, Marcus C. Ferreira COMPLEX FACIAL FRACTURES: TREATMENT ALGORITHM ....................... ClAudio Eduardo Pereira de Souza, Dov Charles Goldenberg, Mauro Leonardis, Daniel Santos Correa Lima, Nivaldo Alonso, Marcus C. Ferreira EFFICACY OF THE CONVENTIONAL TREATMENT OF MANDIBULAR FRACTURES CAUSED BY GUNSHOTS ................................................................................ Thiago de Almeida Furtado, Adriano do Valle Fernandes, Marcelo Drummond Naves, Gustavo Bellozi de Araujo, Evandro Magalhges Nunes VESTIBULAR ACCESSROUTES AND THE TREATMENT OF COMPLEX MANDIBULAR FRACTURES ................................. Belini Freire Maia, Bruno Ramos Chcanovic, Leandro Napier de Souza HYPERTELEORBITISM: ORBITAL MEDIALIZATION WITH THE FIXED CENTRAL T TECHNIQUE AND NO FLOOR MOBILIZATION ........ Sergio Pablo Pimentel Vela, Felipe Hund, Vera LLicia Nocchi Cardim BECKWITH-WIEDEMANN'S SYNDROME: REPORT OF A CASE WITH AN 18-YEAR SEQUENTIAL FOLLOW-UP .... Lidia D'Agostino, Rolf Rode, Paulo Clrnara FREEMAN-SHELDON'S SYNDROME: MULTIDISCIPLINARY MANAGEMENT (A CASEREPORT).................... Fabiana Correia Monteiro, Lidia D'Agostino, Marcia Andre, Fabiana Rufino. Margareth Torrecillas Lopez 14 FOLLOWING CRANIOFACIAL DISJUNCTION IN OSTEOGENIC DISTRACTION PROCEDURES ................................. Rodrigo de Faria Valle Dornelles, Rolf Lucas Salomons, Vera Lucia Nocchi Cardim THEUSEOF OSTEOGENIC MANDIBULAR DISTRACTION IN NEONATES WITH THE PIERRE-ROBIN SEQUENCE ........................ Marcus Vinicius Martins Collares, Rinaldo de Angeli Pinto, Roberto Correia Chem, Ant6nio Carlos Pinto Oliveira, Gustavo Berlim, Ciro Paz Portinho ORTHODONTICS AND FACIAL ORTHOPEDICS ASSOCIATED WITH OSTEOGENIC DISTRACTION IN CASES OF CONGENITAL MICROGNATHIA .......... Daniela Franco Bueno, Nelson Bardella Filho, Marcelo P. Vaccari Mazzetti, Lucy Dalva Lopes APPLICATIONS OF OSTEOGENIC DISTRACTION IN THE TREATMENT OF CRANIOMAXILLOFACIAL DYSPLASIAS ....... Nelson Bardella Filho, Ana Lucia C. Bardella, Lucy Dalva Lopes, Dulce M. F. Soares Martins, Lydia Masako Ferreira INCIDENCE OF PATIENTS WITH CLEFTLIPAND PALATE AT INSTITUTO DE CIRURGIA PLASTICA CRAN~OFACIAL (SOBRAPAR) .......... Celso Luiz Buzzo, Cassio Raposo Menezes do Amaral, Rita Mancebo Bianco, Cinthia Regina Seraphim, Clariane Viero Vargas, Eliane Teixeira Caixeta Maiello COLUMELLAR RECONSTRUCTION WITH NASOGENIAN FLAPS ............. Celso Luiz Buzzo, Cassio Raposo Menezes do Amaral, Rita Mancebo Blanco, Clariane Viero Vargas, Cinthia Regina Seraphim. Eliane Teixeira Caixeta Maiello THEUSEOF LABIORH~NOPLASTY IN CASES OF UNILATERAL FISSURES .................. 20 Celso Luiz Buzzo, Cassio Raposo Menezes do Amaral, Jcpiter Neewler Lopes Duarte ACRYLIC CONDYLE AFTER RESECTION OF A SOLID AMELOBLASTOMA: CASEREPORT .......................................................................................... , AND AN A Christian Barros Ferreira, Jan Peter llg, Andre Caroli Rocha, Araldo Ayres Monteiro Junior TREATMENT OF AMELOBLASTOMA WITH MARGINAL MANDIBULECTOMY, INFERIOR ALVEOLAR NERVE DISSECTION AND PRESERVATION, AND IMMEDIATE BONE RECONSTRUCTION ..................................... Adalberto Novaes Silva, Paulo Cesar de Jesus Dias ASSESSMENT OF SEPTAL DEFORMITIES USINGNASAL VIDEOFIBROSCOPY IN ADULTPATIENTS WITH TRANSVERSAL MAXILLARY ATRESIA ...................... Adalberto Novaes Silva, Wilma T. Anselmo Lima ESTHETIC AND FUNCTIONAL REHABILITATION OF THE MAXILLA AND ALVEOLAR RIDGESWITH CALVARIAL BONEGRAFTS ................. Wilson Cintra Junior, Nivaldo Alonso THEUSEOF TITANIUM MICROANCHORS IN THE TREATMENT OF DISPLACEMENT OF MEDIAL CANTHI .................................. Dov Charles Goldenberg, Nivaldo Alonso, Marcus Castro Ferraira MANDIBULAR FIBROSARCOMA ................................... Marcela Azevedo Brito, SBrgio Luiz de Miranda COMPLICATIONS OF PROCEDURES USEDIN THE TREATMENT OF SLEEP-RELATED RESPIRATORY DISORDERS ....................... Nelson E. P. Colombini, Jose A. Pinto, Gustavo J. Faller OBSTRUCTIVE SLEEPAPNEA- A NEWOPTION FOR THE CRANIOMAXILLOFACIAL SURGEON (CONCEPTION AND BASIC SURGICAL PROTOCOL) ............................... 26 Nelson E. P. Colombini, Gustavo J. Faller, Wolney B. D'Azevedo AN ALTERNATIVE IN FACIAL RECONSTRUCTION PROCEDURES ..... Sonja Ellen Lobo IDIOPATHIC BONECAVITYIN THE MANDIBULAR CONDYLE ............................ Adriano do Valle Fernandes, Evandro Nunes Magalhaes, Gustavo Bellozi de Aralijo, Marcelo Drummond Naves, M6nica Vieira Salgado, Wagner Rodrigues dos Santos A SURGICAL APPROACH TO CRANIOFACIAL NEUROFIBROMATOSIS - A CASE REPORT ..................................................................................................... 27 Clarissa Leite Turrer, Ricardo Lopes Cruz MAXILLARY SINUSLIR. USINGMANDIBULAR RAMUS ........................................ BONEGRAFTS - TECHNICAL CONSIDERATIONS Davidson Rodarte Feliz de Oliveira, Ant6nio Albuquerque de Brito, Aloisio Borges Coelho ZYGOMATIC FIXATION - AN ALTERNATIVE PROCEDURE FOR THE REHABILITATION OF SEVERELY ATROPHIED MAXILLA ......... Waldemar Daut Polido, Eduardo Marini SEQUELAE - A CASEREPORT ......................................................... Blas Antonio F. Santander, Mayra Cristina Kimura, Patricia de Paula Shimabuku, Rejane Aparecida de Lima, Vera Lljcia Nocchi Cardim MULTIDISCIPLINARY TREATMENT OF A PROGNATHIC PATIENT WITH HYPOMAXILLISM ................................................... Rejane Aparecida de Lima, Mayra C. Kimura, Rodrigo Dornelles, Rolf L. Salomons. Vera L. N. Cardim ZYGOMATICOPLASTY: AN ESTHETIC COMPLEMENT TO ORTHOGNATIC SURGERY (TECHNIQUES AND ALTERNATIVES) ...... Nelson E. Colombini, Wolney B. D'Azevedo, Einar F. Oquendo PALATINE DISJUNCTION THROUGH ENDONASAL MICROSURGERY ................. Nelson E. P. Colombini, Wolney B. D'Azevedo, Gustavo J. Faller FUNCTIONAL GENIOPLASTY ....................................................... Rodrigo 0. M. Marinho, David S. Precious - OF A - CLINICAL CASE......................................................................... Paulo Roberto Pelucio CBmara TREATMENT OF THE ANTEROPOSTERIOR MAXILLARY EXCESS WITH LE FORT I OSTEOTOMY: REPORT OF TWO CASES AND DISCUSSION ...................................................................... AntBnio Albuquerque de Brito, Davidson Rodaite Felix de Oliveira, Yumara Siqueira de Castro A f t e r the first biennial Brazilian Congress on Craniomaxillofacial Surgery is held, we will be able to make a preliminary evaluation of the changes in the fields of education and research regarding craniomaxillofacial surgery. The downside of holding these meetings every two years is the restricted dissemination of knowledge outside the Si3o PauloIRio de Janeiro route, in addition to the difficulty in having scientific studies for ~ublication. The advantages include the strengthening of extension courses in SBo Paulo (coached by Nivaldo Alonso) and in Rio de Janeiro (led by Ricardo Cruz), and an expected increase in the number of papers submitted for presentation. These facts led us to the decision to publish the abstracts of the papers presented at the Congress as volume 5 , issue 1 of the Brazilian Journal of CraniomaxillofacialSurgery. As we can see, the current issue of the journal features interesting studies. They comprise all fields of craniomaxillofacial surgery. We wish to have their extended version, not only on oral presentation, in the near future. Hopefully, we will have a better view of the matter after the next meeting, to be held in Rio de Janeirol2004. Moreover, we expect to have fulfilled the requests to have the journal indexed by then. We also strongly suggest that new measures should be taken by the board of the Brazilian Society of Craniomaxillofacial Surgery to improve the scientific quality of our journal. Marcus Wcius Mattins Collares, MD, PhD Editor We welcome Original research Clinical reports Case reports Letters t o the editor Book reviews Announcements Please submit to: Marcus Vinicius Martins Collares, MD, PhD Editor Brazilian Journal of Craniomaxillofacial Surgery Rua Hilario Ribeiro, 2021406 CEP 905 10-040 Porto Alegre, RS Brazil VII Congresso Brasileiro de Cirurgia Craniomaxilofaciai - Abstracts RETROSPECTIVE, DESCRIPTIVE EPIDEMIOLOGIC ASSESSMENT QF FACIAL BONE FRACTURES IN GROWING PATIENTS, FROM 1992 TO 2001, AT HOSPITAL CRISTO REDENTOR, PORT0 ALEGRE, RS Eduardo Seixas Cardoso, Renata Pittella Canqado, Marilia Gehardt Oliveira, Salete Maria Pretto Pontificia Universidade Catolica d o Rio Grande d o Sul (PUCRS) Porto Alegre, Brazil - OBJECTIVE To assess the prevalence and epidemiologic characteristics of facial bone fractures occurred in growing patients. MATERIALS AND METHODS Paradigm: quantitative; study model: retrospective,descriptive; statistical analysis: parametric, descriptive, non-inferential;data collection: manual and computer-based;data base: medical records; variables: age, gender, fracture etiology, fracture location, mode of treatment, presence of associated lesions, and period of the year. RESULTS From 1992 to 2001,2,410 trauma patients were hospitalized at Hospital Cristo Redentor, Potto Alegre, state of Rio Grande do Sul, southern Brazil. Of this total, only 60 individuals (2.49%) presented facial bone fractures and had up to 12 years of age. Excluding nasal and dento-alveolar fractures, the prevalence observed corresponds to 1.95%, i.e., 47 patients and 61 fractures. Most of these affected the mandibular bone, more precisely the parasymphysis and articular process regions, followed by the zygoma and the arch. Female patients were more common than males, and children from 6 to 12 years of age were the most prevalent group. The most frequent etiologic factor was runover accidents, followed by car accidents and falls. Most hospitalizations took place in the summer quarter, and lasted 7 to 12 days, on average. In relation to modes of treatment, mandibular bone fractures were usually treated with non-surgical options, while fractures of the middle third of the face were usually treated with surgery. Finally, in the assessment of associated facial lesions, of the 47 patients included in the study, 15 showed associated lesions cranioencephalic trauma was the most common one. USE OF VIDEOENDOSCOPY IN THE DIAGNOSIS OF ORBITAL FLOOR FRACTURES Fernando Cesar A. Lima, Weber Leo Cavalcante, Ricardo Lopes da Cruz Hospital Geral de lpanema Rio de Janeiro, Brazil - BACKGROUND Orbital floor fracture is a relatively common consequence of facial traumas, and it often remains undiagnosed. The fracture can be easily diagnosed with computed tomography, but not with conventional radiography. The present study was developed to show how videoendoscopy, when well indicated, can help in the precise diagnosis of orbital floor fracture. Braz J Craniomaxiilofac Surg 2002;5(1) 11 VII Congress0 Brasileiro de Cirurgia Craniomaxilofacial- Abstracts OBJECTIVE To demonstrate the use of videoendoscopy in the diagnosis of orbital floor fracture MATERIALS AND METHODS Clinical case reports in which a precise diagnosis of orbital floor fracture was not possible were selected to undergo a videoendoscopic test for confirmation of the clinical status. RESULTSICONCLUSION Videoendoscopy is a rapid and easy method to be used in the diagnosis of orbital floor fractures, and it should be indicated whenever a precise diagnosis cannot be obtained via physical examination and computed tomography. VIDEO-ASSISTED TREATMENT OF FACIAL FRACTURES: INDICATIONS, TECHNICAL ASPECTS, AND INITIAL EXPERIENCE Dov C. Goldenberg, Nivaldo Alonso, Luiz Gustavo B. Cruz, Claudio E.P. de Souza, Daniel S. C. Lima, Marcus C. Ferreira Hospital das Clhicas da Faculdade de Medicina da Universidade de S6o Paulo - SHo Paulo, Brazil INTRODUCTION The conventional access routes used in the treatment of facial fractures may result in unesthetic scars and operative complications, in addition to interfering with the adequate visualization of the fracture focus and the positioning of bone grafts, in some cases. The introductionof video-assistedsurgical methods in plastic surgery has helped in the treatment of several conditions. In the case of facial fractures, it has shown to be useful as a diagnostic tool, as a treatment complement, and also as a method of treatment in itself. Fractures affecting the frontal region, orbital floor and mandibular condyle have been the most common indications for video-assisted surgeries. OBJECTIVES This study aimed at assessing the indications and technical aspects of the video-assisted performanceof access routes in cases of fractures affectingthe frontal bone, orbital floor, and mandibular condyle, based on the initial experience of the authors. PATIENTS AND METHODS Between March 2001 and March 2002, 14 patients presentingwith facial bone fractures were submitted to video-assisted treatment. Six of the fractures were condylar, 5 were orbital, and 3 affected the frontal bones. Access routes and the associated advantages, disadvantages, and contraindications were assessed. RESULTS in the cases of frontal fracture, 3 incisions made into the scalp allowed for adequate instrumentation and focus reduction; a small superciliary incision also had to be performed, for the placement of plates and screws. In the orbital fractures, the transmaxillary access route allowed the diagnosis of floor fractures, the visualization 12 Braz J Craniomaxillofac Surg 2002;5111 ViI Congresso Brasileiro de Cirurgia Craniornaxiiofacial - Abstracts of hernia and its reduction, and also helped in the placement of bone grafls and their adequate positioning. In condylar fractures, the intraoral access route, associatedwith two extraoral, punctiform incisions for the passage of transcutaneous screws and with the traction applied on the ramus, ensured an adequate visualization. All these aspects reinforcedthe indicationof the method for the treatment of lower condylar and subcondylar fractures. CONCLUSIONS The video-assisted performance of access routes showed to be useful in the treatment of facial fractures, and constitutes an additional alternative method, with potential advantages in terms of reduction of external scars, improved visualization and consequent reduction of the fracture focus. COMPLEX FACIAL FRACTURES: TREATMENT ALGORITHM Claudio Eduardo Pereira de Souza, Dov Charles Goldenberg, Mauro Leonardis, Daniel Santos Correa Lima, Nivaldo Alonso, Marcus C. Ferreira Hospital das Clinicas da Faculdade de Medicina da Universidade de SSio Paulo Sfio Paulo. Brazil - OBJECTIVES This study aimed at showing the most frequent etiologies that are present in complex facial traumas and at assessing the association of facial fractures with othertraumas, in addition to clinical and complementarydiagnoses, time and planning of the surgical treatment. MATERIALS AND METHODS From February 1999 to April 2001,112 patients submitted to surgery for facial fractures were selected. Of these, 16 presented complex fractures, which affected several bones (extremely severe traumas). Fourteen patients were males, and two were females, with a mean age of 24 years. Surgery was performed as early as possible, and the approach was chosen taking into consideration aspects such as exposure of the fracture focus, standard incisions, and rigid fixation. Afler the performance of initial measures and image diagnosis, treatment was definedaccordingto the presencelabsence of neurosurgicaltraumaand of concomitant mandibular and upperlmiddle third fractures. RESULTS The most frequent cause of trauma was car accident (13 cases), followed by physical violence. Complex fractures usually affected the orbits, naso-orbito-ethmoidal bone, maxilla, and frontal bone fractures. Multiple fractures affecting both the upper and middle thirds of the face and the mandible occurred in only 4 cases. Neurologic impairment was observed in 8 of the 16 cases, and the eyes were affected in 9 (partial loss of sight in 7 cases, and total loss in 2). Late complications, such as enophthalmus and telecanthus, were observed in 5 and 6 cases, respectively. CONCLUSIONS Complex facial traumas still represent a significant portion of cases seen at a tertiary hospital. The involvement of the upper and middle thirds of the face, more common when compared to the lower third, seems to be related to the mechanism of trauma. The standard, sequential approach used in the study helped in the management of conditions and was associated with improved results. Braz J Craniomaxiilofac Surg 2002;5/11 1 3 Vii Congress0 Brasileiro de Cimrgia Craniornaxilofaciai - Abstracts EFFICACY OF THE CONVENTIONAL TREATMENT OF MANDIBULAR FRACTURES CAUSED BY GUNSHOTS Thiago de Almeida Furtado, Adriano do Valle Fernandes, Marcelo Drummond Naves, Gustavo Bellozi de Araujo, Evandro Magalhies Nunes Hospital Maria Amelia Links (FHEMIG), Faculdade de Odontologia, Universidade Federal de Minas Gerais Belo Horizonte, Brazil - OBJECTIVE To analyze the efficacy of the conventional treatment of mandibularfracturescaused by gunshots, namely, the non-surgical approach. MATERIALS AND METHODS The conventional treatment was applied to 23 patients diagnosed with mandibular fractures caused by gunshots at the Service of Bucomaxillofacial Surgery at Hospital Maria Amelia Lins. Patients were followed and assessed in the pre- and trans-operativeperiods and for up to 180 days immediately afler surgery. Clinical and radiographic data were observed, and data were recorded in a descriptive data sheet. RESULTS In our study, 21 patients were males, and most were 21 to 25 years old (21%) and 31 to 35 years old (30%). A total of 30 mandibular fractures were diagnosed, predominantly at the corpus (46.5%) and the angle (23%). Of all fractures, 52% were caused by 38 caliber guns. Fractures were usually compound (73%) and comminuted (84%). On examination, clinical signs such as bone mobility and crackling (87%), absence of infection signs (82%), and limited mouth opening (82%) were common. Treatment was successful in 53% of cases and unsuccessful in 13%; in addition, 34% of patients left the study prior to completing the postoperative follow-up period. CONCLUSIONS Mandibular fractures caused by gunshots were mostly compound and comminuted, and the conventional treatment showed to be effective in these cases. In view of the social origin and difficulties faced by the group of patients studied, an adequate postoperativefollow-up and consequent assessment of results is often impossible. VESTIBULAR ACCESS ROUTES AND THE TREATMENT OF COMPLEX MANDIBULAR FRACTURES Belini Freire Maia, Bruno Ramos Chcanovic, Leandro Napier de Souza Mandibular fractures have been treated with wire osteosynthesis associated with intermaxillary blocking for several years. With the introduction of rigid internal fixation, in the end of the 60s, extremely rigid systems employing plates and screws started to be used for the treatment of these fractures, and several innovations have already been made to the method since then. Finally, in the 70s, asa result of studies carried out in France by Michelet (1971) and Champy (1975), a new system was developed, in which miniature plates and screws were used via an intraoral access route. This new procedure was soon known all over the world, and since then it is the treatment of choice for cases of mandibular fractures, independently of complexity. The present study will present the case of a complex mandibularfracturesurgically treated via a wide vestibular access route, with exposure of the whole symphysis and mandibular corpus bilaterally, and the following application of miniplates and screws according to the model preconized by Champy. 14 Braz J Craniomaxillofac Surg 2002;5/1/ VII Congress0 Brasileiro de Cirurgia Craniomawilofacial- Abstracts HYPERTELEORBITISM: ORBITAL MEDlALlZATlON WlTH THE FIXED CENTRAL T TECHNIQUE AND NO FLOOR MOBILIZATION Sergio Pablo Pimentel Vela, Felipe Hund, Vera Lucia Nocchi Cardim Hospital SBo Joaquim da Real e Benemerita Sociedade Portuguesa de Beneficiencia SIio Paulo, Brazil - OBJECTIVES To show the result of the fixed central T technique with orbital medialization and without floor mobilization, as used in the treatment of hyperteleorbitism. MATERIALS AND METHODS We report the case of M.A.F.F., a 16-year old patient submitted to surgery for the treatment of Tessier's hyperteleorbitism level Ill. The patient did not present dysraphia, and middle third of the face was normal. Due to the presenceof primary frontonasal dysplasia, the orbital medialization technique was employed (fixed central T) with no mobilizationof the floor. Surgery was carried out intracranially,via acoronal and longitudinal transnasal access route, as in the form of an horizontal Z, whosecentral axis was positioned in parallel with internal ligaments. RESULTS Tomographic control showed a variation in the angle of oculomotor nelve axes from 82 to 72 *, and in the internal interorbital distance from 40 to 33 mm. CONCLUSION The technique herein described is an alternative mode of treatment with effective results (from a esthetic and functional point of view) and low morbidity. BECKWITH-WIEDEMANN'S SYNDROME: REPORT OF A CASE WlTH AN 18-YEAR SEQUENTIAL FOLLOW-UP Lidia D'Agostino, Rolf Rode, Paulo CSmara lnstituto de Cirurgia Plastlca Santa Cruz The authors report the case of A.A.J., male, diagnosed with Beckwith-Wiedemann'ssyndrome, currently with 22 years of age and followed since the chronological age of 4 years. The syndrome is characterized by skeletal and dentofacial abnormalities, in addition to macroglossia. In this specific case, speech therapy was used with the aim of improving muscle tonus and correcting tongue position so as to normalize stomatognatic functions and prevent the need for partial giossectomy.Treatment plan included isometric and isotonic exercises (carried out in weekly sessions) for adequacy of the muscle tonus of the tongue and lips. In view of difficulties related to the maintenance of tongue position and lip sealing, caused by the patient's anterior cross and open bite, a resin-made device aimed at limiting the tongue position was developed. The device was molded on the patient's lower teeth and filled the sublingual space, simulating the postoperative position of the mandible. The use of the device contributed to the proprioceptionof the tongue and consequently to the success of the speech therapist's job. Tongue retroposition was successful, since it coapted to the palate. The authors conclude that the diagnosis of macroglossia should be followed by a careful study of the patient's muscle tonus and facial skeletal conditions, mainly in terms of the oral cavity, so as to establish a treatment plan that is able to eliminate the effects of this problem on the patient's dento-osteo-mandibulargrowih,consequently minimizingfuture surgical intewentions and preventing the need for invasive and unnecessary procedures, as is the case of partial glossecomy. Braz J Craniomaxillofac Surg 2002;5/11 15 VII Congresso Brasileiro de Cirurgia Craniomaxilofacial- Abstracts FREEMAN-SHELDON'S SYNDROME: MULTIDISCIPLINARY MANAGEMENT (A CASE REPORT) Fabiana ~ o r r e i aMonteiro, Lidia D'Agostino, Marcia Andre, Fabiana Rufino, Margareth Torrecillas Lopez Hospital BeneficEncia Portuguesa, School of Dentistry, Universidade de SHo Paulo, and lnstituto de Cirurgia PlAstica Santa Cruz Sgo Paulo, Brazil - The Freeman-Sheldonsyndrome is also known ascraniocarpotarsaldystrophy, distal type II arthrogryposis, Windmiil-Vane-Hand's syndrome, or whistling face syndrome. Freeman-Sheldon'ssyndrome is a rare congenital myopathy, characterized by three main signs: a whistling-likefacial expression; ulnar deviation of the hand, with flexion contracture at the fingers; foot deformities. Patients affected by this syndrome present multiple facial contractures, which are associated with microstomy, micrognathia, and neck stiffness - these are the conditions that resul in the "whistling face". Hypertelorism is also present, as well as narrow and antimongoloid eyelid folds, a saddle nose, and an ogival palate. Finally, in addition to limb myopathy, several patients develop visible scoliosis and stature deficiency. The case of R.A.S., a byear old male patient born to clinically normal and non-consanguineous parents, was seen at the School of Dentistry at Universidadede Sao Paulo with adiagnosis of Freeman-Sheldon's syndrome. On clinical examination, important manifestationsof the syndrome were observed: great difficulty in opening the mouth, caries-relatedlesions, and dental malocclusion. Due to the complexity of the pathology,a multidisciplinary treatment plan was developed so as to prioritize myofunctional aspects, followed by dental and orthodontic treatment. The results obtained up to the present moment confirm the advantages of multidisciplinary management. ELASTIC TRACTION OF THE MIDDLE THIRD OF THE FACE FOLLOWING CRANIOFACIAL DISJUNCTION IN OSTEOGENIC DISTRACTION PROCEDURES Rodrigo de Faria Valle Dornelles, Rolf Lucas Salomons, Vera L ~ i c i aNocchi Cardim Hospital S3o Joaquim da Real e Benemerita Sociedade Portuguesa de Beneficiencia, SHo Paulo, Brazil OBJECTIVES Osteogenic distraction of the middle third of the face, carried out with elastics and Erich arch bars applied to the teeth, allow the growth and maintenance of results obtained in advancement procedures in patients presenting craniofaciostenoses. MATERIALS AND METHODS Between 1981 and 2001.42 patientswith craniofaciostenoses were operated using class Ill elastic traction at the middle third of the face, after craniofacial disjunction, for advancement of the frontomaxillary monoblock. Bone grafts were used only on the lateral walls of the orbits, with semi-rigidfixation, so that the maxilla remained initially retropositioned.Afler a7-day latency period, elastic traction was applied to the maxilla,which was gradually placed in a more anterior position, reaching a class II occlusion afler approximately 4 days. After this time, elastic traction was decreased with the aim of maintaining the result obtained. 16 Braz J Craniomaxillofac Surg 2002;5(11 VII Congresso Brasileiro de Cirurgia Craniornaxilofacial-Abstracts RESULTS The pterigomaxillary area presented perfect ossification in all cases. In addition, the result was definitively maintained in adult patients, and maintainedfor 1.5 year in children; of these, 52.6% maintained the result until the adult age. CONCLUSION Elastic traction only requires the placement of Erich arch bars on the patients' teeth, making the procedure more simple when compared to the use of distractors, with a similar osteogenic result. THE USE OF OSTEOGENIC MANDIBULAR DISTRACTION IN NEONATES WITH THE PIERRE-ROBIN SEQUENCE Marcus Vinicius Martins Collares, Rinaldo de Angeli Pinto, Roberto Correia Chern, AntBnio Carlos Pinto Oliveira, Gustavo Berlim, Ciro Paz Portinho Hospital de Clinicas de Porto Alegre - Porto Alegre, Brazil INTRODUCTION The Pierre-Robin sequence (PRS) is characterizedby micrognathia,glossoptosis, palatal anomalies, and severe respiratory and nutritional dysfunctions. Several techniques have been used to treat the condition, such as positional therapy, labio-lingual suture, pelviplasty, and tracheostomy. Osteogenic distraction is a mandibular lengthening technique based on the llizarov principle that has been used in children older than 2 years. OBJECTIVES To analyze the result of osteogenic mandibular distraction in the treatment respiratory and dietary dysfunctions in neonates presenting PRS and to propose the systematization of the management of these patients according to clinical classification. METHODS The study describes a series of 16 patients with PRS submitted to osteogenic mandibular distraction with external distraction devices provided with four pins (using external approach and osteotomy).The applicationof traction started on the 1st postoperative day at a rate of 0.5 mm twice a day. The consolidation period was either equal to the duration of distraction or set at 2 weeks (minimum). The following aspects were assessed: age at the beginning of treatment, distraction distance, duration of distraction, complications, time to extubation (postoperatively)and oral nutrition during the postoperative period, presencelabsenceof apnea after distraction, and mean oxygen saturation values before and after distraction. RESULTS Mandibular growth and bone consolidation were observed in all cases. The main respiratory parameters analyzed (SaO,) and the nutritional pattern also showed improvement. There were no important complications associatedwith the method. Braz J Craniomaxillofac Surg 2002;5/11 17 1/11Congresso Brasileiro de Cirurgia Craniomaxilofacial - Abstracts DISCUSSION We propose the following classification for the management of patients with PSR: type I (no dysfunction), clinical treatment; type II (no respiratory dysfunction,with nutritional dysfunction),clinical therapy, with surgeryon the 15th to 30th day of life if no improvement is observed; type Ill (respiratory difficulty only while at rest, significant nutritional impairment), clinical therapy, with surgeryon the 10th to 15th day of life if no improvement is observed; type IV (sleep apnea, with our without nutritional impairment), same as type II; type V (unable to breathe without mechanical help), surgery on the 5th day of life. CONCLUSION Osteogenic distraction is an effective (with low morbidity and high resolution rates) treatment for respiratory and nutritional abnormalities resultingfrommicrognathia in PRS, even in less severe manifestations of the sequence. ORTHODONTICS AND FACIAL ORTHOPEDICS ASSOCIATED WITH OSTEOGENIC DISTRACTION IN CASES OF CONGENITAL MICROGNATHIA Daniela Franco Bueno, Nelson Bardella Filho, Marcelo P. Vaccari Mauetti, Lucy Dalva Lopes Centro de ReabilitaqHo das Deformidades Faciais S2o Paulo, Brazil - OBJECTIVES To assess the importance of early multidisciplinary management of congenital mandibular deformities, such as Pierre-Robin sequence, Treacher Collins'syndrome, and hemifacial microsomies, through the association of orthodontics and facial orthopedics with craniofacial surgeries (osteogenic distraction). This is important mainly in more severe cases, where the obtainment of good functional results contributes to the survival of these patients. MATERIALS AND METHODS Patients (newborns up to 12-year old children) carrying severe congenital mandibular deformities and referred to osteogenic distraction were seen at our rehabilitation center. In cases presenting risk of death, distraction was performed prior to maxillary orthopedic intervention. In the other cases, early or preventive orthopedic treatment was carried out prior to, during and after osteogenic distraction. Radiographs, models, photos and tomographs were used to determine diagnosis and treatment plan. At the end of the treatment, new radiographs, tomographs and models were obtained for the assessment of esthetic and functional results. RESULTS Esthetic and functional results were satisfactory. Improvement was observed in respiration and suction in newborns, and in respiration, mastication and deglutition in children (due to the mandibular increase resulting from the association of osteogenic distraction and orthopedicslorthodontics). CONCLUSION In severe cases of congenital micrognathia, maxillary orthopedics and orthodontics, associated with osteogenic distraction, allowed for mandibular and facial growth within normal standards, reestablishing these patients' vital functions and providing a satisfactory estheticlfunctional result in view of the limitations of these pathologies. 18 Braz J Craniomaxillofac Surg 2002;5/11 VII Congress0 Brasileiro de Cirurgia Craniomaxilofacial - Abstracts APPLICATIONS OF OSTEOGENIC DISTRACTION IN THE TREATMENT OF CRANIOMAXILLOFACIAL DYSPLASIAS Nelson Bardella Filho, Ana Lucia C. Bardella, Lucy Dalva Lopes, Dulce M. F. Soares Martins, Lydia Masako Ferreira Universidade Federal de SLo Paulo - SBo Paulo, Brazil Bone deficiency is a very common characteristic of craniomaxillofacial anomalies, and its treatment has always been challenging to health practitionersthat act in this field. One of the main concerns in the treatment of this condition is related to the acquisition of an organic materialthat is identicalto that of the patient to be treated. Along the past few years, osteogenic distraction has become an alternative technique in the treatment of craniomaxillofacial dysplasias, minimizing the need for the use of bone grafts. The aim of this study was to present some alternativeapplications of osteogenic distraction that have been successfully used in the treatment of patients carrying craniomaxillofacialanomalies. The study was carried out based on the history of osteogenic distractionfound in the literature produced by the national and internationalscientific communities, and aimed at comparing the benefits brought by these techniques with those of conventional procedures. INCIDENCE OF PATIENTS WITH CLEFT LIP AND PALATE AT INSTITUTO DE CIRURGIA PLASTICA CRANIOFACIAL (SOBRAPAR) celso Luiz Buzzo, Cassio Raposo Menezes do Amaral, Rita Mancebo Blanco, Cinthia Regina Seraphim, Clariane Viero Vargas, Eliane Teixeira Caixeta Maiello lnstituto de Cirurgia Plastica Craniofacial (Sobrapar) Campinas, Brazil - OBJECTIVES To assess the incidence and predisposing factors associated with cleft lip and palate in a period of 2 years. MATERIALS AND METHODS The authors performed a retrospective evaluation of 86 patients presenting cleft lip and palate who were admitted to the hospital of our institution (Sobrapar) between March 2000 and March 2002, and who had not been submitted to any previous treatment. The following data were analyzed: origin, sex, age, skin color, birth weight and stature, type of fissure, associated pathologies, family history, as well as data referring to maternal habits during gestation. RESULTS Most patientscamefromthecountlyside of thestateof SBo Paulo, more preciselyfrom the region of Campinas. Most children were admitted during the 1st month of life. No prevalence was observed in terms of age, and most patientswere whites. Mean birthweight was 3108 g, and mean stature at birth was 46.7 cm. Among cleft lip cases, unilateral fissures were the most common ones, and they were more prevalent in males. Cases of posterior cleft palate also predominated, but there was no predominance of sex. Unilateral cleft lip and palate occurred more frequently in females, and bilateralcases in males. In 32.55% (28) of the patients assessed,there were intercurrences during gestation. In addition, 19.76% (17) presented family history of cleft lip and palate. A total of 18 mothers (20.93%) were tobacco smokers, while 12 (13.95%) consumed alcohol during pregnancy. CONCLUSIONS Afler assessment of the data obtained, it was possible to outline the current incidence and predisposing factors associated with cleft lip and palate at our service. We conclude that, with some minor exceptions, our results confirmed those found in the literature. Braz J Craniomax;llofac Surg 2002;5/11 19 VN Congresso Brasileiro de Cirurgia Craniomaxilofacial - Abstracts COLUMELLAR RECONSTRUCTION WITH NASOGENIAN FLAPS Celso Luiz Buuo, Cassio Raposo Menezes do Amaral, Rita Mancebo Blanco, Clariane Viero Vargas, Cinthia Regina Seraphim, Eliane Teixeira Caixeta Maiello lnstituto de Cirurgia Plastica Craniofacial (Sobrapar) Campinas, Brazil - OBJECTIVES To report the case of a patient presenting nasal deformity (at the columeila and anterior portion of the cartilaginous septum) caused by an infectious process. The deformity was repaired with a nasogenian flap, aiming at restoring the patient's facial appearance as well as anatomical, functional, and esthetic functions. MATERIALS AND METHODS Surgical treatment was carried out with a nasogenianflap (left side), preserving local vascuiarization,followed by the rotation of the flap and its passage through a subcutaneous tunnel directed to the midline of the nasal base. The flap was fixed to the middle third of the nasal base and tip with simple 5.0 mononyion sutures, and oral mucosa was grafted into the posterior portion. RESULT The nasogenian flap showed to be adequate and provided a satisfactory esthetic result at the donor site (imperceptible scar). CONCLUSIONS The nasogenian flap showed to be a reliable method for wlumellar reconstruction. In addition, it has advantages related to scars and to the color and texture of skin, as well as with the reestablishment of functional and esthetic functions. THE USE OF LABIORHINOPLASTY IN CASES OF UNILATERAL FISSURES Celso Luiz B u u o , Cassio Raposo Menezes do Amaral, Jupiter Neewler Lopes Duarte lnstituto de Cirurgia Plastica Craniofacial (Sobrapar) - Campinas, Brazil OBJECTIVES This study aimed at presenting a new technique for iabiorhinoplasty, which was developed in our service in association with the University of Goteborg (Sweden). MATERIALS AND METHODS Labiohinoplasties were carried out in 53 patients presenting cleft lip and palate. Age ranged from 0 to 2 years, and patients were followed for approximately 7 years. RESULTS Excellent esthetic and functional results were observed. CONCLUSION In afollow-up period of 7 years, the alternative technique showed to result in more symmetric nostrils, and scars were well positioned, with no retractions or level differences in the mucocutaneous line. 20 Braz J Craniomaxillofac Surg 2002;5/11 VII Congress0 Brasileiro de Cirugia Craniomaxilofacial- Abstracts MANDIBULAR RECONSTRUCTION WlTH A RECONSTRUCTIVE PLATE AND AN ACRYLIC CONDYLE AFTER RESECTION OF A SOLID AMELOBLASTOMA: A CASE REPORT Christian Barros Ferreira, Jan Peter Ilg, Andre Caroli Rocha, Araldo Ayres Monteiro Jlinior Hospital das Clinicas da Faculdade de Medicina da Universidade de S5o Paulo - SSo Paulo, Brazil OBJECTIVES To present a case of resection of mandibular solid ameloblastoma followed by reconstruction using an acrylic condyle and a reconstructive plate, and to discuss the characteristics of the tumor and its therapeutic aspects. MATERIALS AND METHODS Report of the case of a male, 19-yearold patient (light brown skin), who presentedwith asymptomaticvolume increase in the left hemiface lasting for 1Oyears. Panoramic radiographof the mandible and computed tomography of the face were requested. The initially predictive diagnosis of solid ameloblastoma was later confirmed by an incisionalbiopsy. Surgerywasplanned to becaniedoutviaasubmandibularaccessroute (goingfrom the symphysis to the left mandibular angle), and consisted of segmental mandibulectomy followed by disarticulation and posterior reconstructionof the defect with an endoprosthesis (reconstructiveplate and acrylic condyle), RESULTS Postoperative radiographic examinations showed that the endoprosthesis was well positioned, and no relapse was obsewed along a 4-year follow-up. The patient developed skin and mucosa anesthesia at the left hemimandible,as a result of the resection of the inferior alveolar nerve. The extraoral scar presented a satisfactory aspect, the patient's face was symmetric, and mouth opening had no deviations, with normal lateral movements to the left and right. In addition, the patient showed no signs of motor deficit. CONCLUSIONS Ameloblastorna is the most significant odontogenic neoplasia found in the clinical practice due to its prevalenceand treatment difficulties that result from its locally aggressive behavior. Diagnosis should be based on incisional biopsy. Treatment of thecase herein described was based on tumor extension, which did not allow the use of less invasive methods. Reconstructionwith the reconstructive plate and the acrylic condyle showed adequate esthetic, functional, and biological results. TREATMENT OF AMELOBLASTOMA WlTH MARGINAL MANDIBULECTOMY, INFERIOR ALVEOLAR NERVE DISSECTION AND PRESERVATION, AND IMMEDIATE BONE RECONSTRUCTION Adalberto Novaes Silva, Paulo Cesar de Jesus Dias Hospital Unlversitario da Universidade Federal de Mato Grosso Cuiaba, Brazil - INTRODUCTION Amelobiastoma is a benign neopiasia with great clinical importance, due to its invasive behavior and potential relapse after conventional surgical treatment. Braz J Craniomaxillofac Surg 2002;5/1) 21 VII Congress0 Brasileiro de Cirurgia Craniornaxilofacial - Abstracts OBJECTIVES To discuss the therapeutic management of ameloblastomas affecting the mandibles of young patients (adolescents). MATERIALS AND METHODS Two cases of ameloblastoma in adolescents, with involvement of the mandibular corpus and angle, will be described and discussed. Treatment was similar in both cases, with the use of an intraoral access route. First, marginal resection of the mandible was carried out, aimed at providing a safety margin and maintaining the mandibular base. The inferior alveolar nerve was dissected and preserved. Then, immediate bone reconstruction was carried out with the use of a block graft taken from the anterior iliac bone and fixed to the receptor site with titanium plate and screws. Teeth affected by the neoplasia were temporarily replaced with a partially removable prosthesis in order to prevent extrusion of the corresponding superior dentoalveolar segment. RESULTS Along 2 years of follow-up, no evidence of clinicallradiological relapse has been observed, and the reconstructed area presents the necessary conditions to undergo rehabilitation with osteointegrated implants. Complaints of paresthesia in the mentonian region (at the operated side) are present in both patients, but are not significant. CONCLUSIONS The surgical treatment of ameloblastomas with preservation of the mandibular base and inferior alveolar bone was carried out taking into consideration the patients' age. The use of the intraoral access route favored the obtainment of adequate esthetic results. The follow-up of the present cases was too short to assure the impossibility of relapse. However, the technique described in this study should be considered in some specific circumstances. ASSESSMENT OF SEPTAL DEFORMITIES USING NASAL VIDEOFIBROSCOPY IN ADULT PATIENTS WITH TRANSVERSAL MAXILLARY ATRESIA Adalberto Novaes Silva, Wilma T. Anselmo Lima Hospital Universitario da Universidade Federal de Mato Grosso Cuiaba, Brazil - INTRODUCTION The occurrence of maxillary deformities in associationwith respiratory problems, mainly nasal obstruction, has called the attention of several investigators for the possibility of an interrelation betweenthese two conditions. The objectives of the present study were to assess the co-occurrenceof nasal obstruction and septa1deformities in adult patients presenting posterior cross bite and to discuss the performanceof an integratedsurgical treatment (maxillary surgerylseptoplasty) in these patients. 22 Braz J Craniomaxillofac Surg 2002;5/1/ VII Congresso Brasileiro de Cirurgia Craniomaxilofacial- Abstracts MATERIALS AND METHODS Otorhinola~yngological assessment with emphasis on the examination of the nasal cavity was carried out through nasofibroswpy in 30 adult patients presenting posterior cross bite and an indication for orthodontic1 surgical treatment (surgically assisted maxillary advancement). RESULTS Of the patients studied, 56.7% reported nasal obstruction, and 43.3% has not complaints of respiratory problems. Taking the nasofibroscopic results into consideration, septal deformities were present in 100% of the cases, and their topographic classification, according to Cottle, were as follows: compromising of area I in 13.4%, area II in 83.3%, area Ill in 90%, area IV in 83.3%, and area V in 3.3%. CONCLUSIONS We observed that adult patients with posterior cross bite do not necessarily present nasal obstruction. The nasofibroscopic examination showed to be of extreme importance for the diagnosis of septal deformities in adult patientswith posterior cross bite. We emphasize the importance of the co-work of the maxillofacialsurgeon and the otorhinolaryngologist, so as to carry out both surgeries (maxillary osteotomy and septoplasty) simultaneously in cases where both procedures are necessary. ESTHETIC AND FUNCTIONAL REHABILITATION OF THE MAXILLA AND ALVEOLAR RIDGES WITH CALVARIAL BONE GRAFTS Wilson Cintra Junior, Nivaldo Alonso Hospital Professor Edmundo Vasconcelos SSo Paulo, Brazil - OBJECTIVE Patients (mainly youngsters) with maxillary and alveolar ridge atrophy resulting from loss of teeth caused by severe trauma or periodontal diseases should be submitted to a surgical procedure aiming at increasing bone tissue height and thickness so as to allow the placement of osteointegratedimplants or dental prostheses. The objective of the present study was to describe a cortical bone graft technique carried out in the maxillary sinus floor and alveolar ridges with the aim of increasing bone density (both horizontally and vertically) and consequently improving the esthetic and functional oral rehabilitation process. PATIENTS AND METHODS After clinical evaluation, maxillofacial physical examination, and radiological assessment (including face radiograph, panoramic radiograph of the mandible, and thin-slice computed tomography or dental scan), 17 patients with ages ranging from 32 to 55 years were operated between July 1998 and June 2001,with the aim of creating a bone site where osteointegrated implants or dental prostheses could posteriorly be placed. Postoperative clinical and radiological assessments were also carried out. RESULTS All patients obtained sufficient bone thickness at the end of treatment and could start oral rehabilitation. After a mean periodof 6 months postoperatively,14 patients started rehabilitationtreatment with osteointegranted implants, and three patientsstattedto use a removabledental prosthesis, with satisfactory esthetic and functional Braz J Craniomaxillofac Surg 2002;5(11 23 Vll Congress0 Brasileiro de Cirurgia Craniornaxilofacial - Abslracts results in all cases. Two patients presented partial dehiscence of the mucosal sutures, but the performanceof complementary surgeries and continuous aseptic routines assured synthesis completion - the rate of bone absorption resulting from this complication was not significant and had no effects on final results. CONCLUSIONS In spite of the small size of our sample, the bone graft technique provided satisfactory esthetic and functional results and allowed the beginning of rehabilitation in all operated patients, with the use of either osteointegrated implants or removable prostheses. A small rate of cortical bone graft reabsorption was observed, which is in accordance with data found in the literature. THE USE OF TITANIUM MICROANCHORS IN THE TREATMENT OF DISPLACEMENT OF MEDIAL CANTHl Dov Charles Goldenberg, Nivaldo Alonso, Marcus Castro Ferraira Hospital das Clinicas da Faculdade de Medicina da Universidade de SZio Paulo SZo Paulo, Brazil - OBJECTIVES The treatment of deformities affecting the medial canthus of the orbit is still considered a challenge in the field of craniofacial surgery. The classical techniques, namely transnasal canthoplasty and canthopexy, have been associated with a high rate of relapse and inadequate positioning of the medial canthal tendon, in addition to the risk for contralateral ocular lesion. On the other hand, ipsilateral techniques are associated with technical difficulties, and results are not always satisfactory. The present study proposes a new treatment option for cases of deformities of the medial canthus of the orbit, through the use of titanium microanchors. PATIENTS AND METHODS Six cases of patients presenting telecanthus and displacement of the medial canthi of posttraumatic, tumoral and congenital etiology were submitted to medial canthoplasty with microanchors. Results were assessed by means of anthropometric measurements of the orbital region prior to and right after surgery, and also 1 month, 6 months, and 1 year after surgery. The following measurements were included: intercanthal distance, distance between the medial canthus and the midline, orbital width, and distance between the lateral canthus and the midline. RESULTS At 6 months and 1 year after surgery, the technique presented satisfactory results in terms of clinical aspects and method stability. In addition, it allowed for the safe and fast ipsilateral fixation of the medial canthal tendon. CONCLUSIONS The performance of ipsilateral canthoplasty with microanchors proved to be a safe, simple, and effective method for the treatment of displacement of the medial canthi and posttraumatictelecanthus. Due to its recency, the assessment of long-term results is necessary in order to certify this therapeutic option. 24 Braz J Craniomaxillofac Surg 2002;5/11 VII Congress0 Brasileiro de Cirurgia Craniomaxilofacial- Abstracts MANDIBULAR FIBROSARCOMA Marcela Azevedo Brito, Sergio Luiz de Miranda Hospital lsraelita Albert Einsten and Universidade de Santo Amaro Santo Amaro, Brazil - OBJECTIVES To describe an extremely rare clinical case of malign odontogenic tumor of mesenchymal origin. MATERIALS AND METHODS Diagnosis was based on anatomopathologicalexamination and was originally defined as arneloblastoma. Once the tumor started to present an abnormal evolution, a new examination was carried out; this second test yielded a diagnosis of ameloblastic fibrosarcoma. This change in diagnosis required the performanceof a more radical form of treatment: partial hemimandibulectomy associated with radiotherapy. RESULTS First diagnosis consisted of ameloblastoma, and the condition was treated twice at another service with the conventional method. After some time, the neoplasia evolved to an ameloblastic fibrosarcoma. The patient sought medical assistance again, and this time surgery and radiotherapy were carried out. After treatment, no local relapse was observed, but there were metastases in the pulmonary, hepatic, and abdominal areas, which caused the patient's death. CONCLUSIONS Fibrosarcomais an odontogenic neoplasia whose mesenchymalcomponent makes it resemble a sarcoma, while its epithelial component makes it take the appearance of a benign lesion. The tumor affects young adults more frequently, and there is no predominance of sex. The mandible is the most commonly affected organ. Frequent signs and symptoms include pain, edema, and rapid growth, leading to significant bone destNcti0n and dental mobility in some cases. Conventional treatment is usually followed by relapses, which may or may not be accompanied by local or distant metastases. COMPLICATIONS OF PROCEDURES USED IN THE TREATMENT OF SLEEPRELATED RESPIRATORY DISORDERS Nelson E. P. Colombini, Jose A. Pinto, Gustavo J. Faller Clinica Medica Nelson Colombini SHo Paulo. Brazil - OBJECTIVES To show the incidence of complications associated with the surgical treatment of sleep-related respiratoly disorders. We report the spectrum of complications found in our case series, with a focus on anesthetic, transoperative and postoperative complications. METHODS Ourseriesof 785 patients diagnosed with sleep-related respiratory disorders was selected between F e b r u ~ n ~ 1996 and January 2002. Braz J Craniomaxillofac Surg 2002;5111 25 v,r Congresso Brasileiro de Cirurgia Craniomaxilofacial- Abstracts RESULTS The rate and type of complications observed in a total of 945 procedures were assessed. The most commonly observed were: hemorrhage, loco-regional hematomas, edema causing upper airway obstruction, infections, loss of fixation in skeletal procedures, hypoesthesia of the lower dental nerve and loss of occlusion relation. These complicationswere effectively controlled with either complementary surgical procedures or clinical treatment, and did not result in death or in the need for blood transfusion in any case. Tracheostomy was required in 12 cases. CONCLUSION The rate of complicationsobserved in our series is not different from the data found in the medical literature. However, we emphasizethe morbidity that is usually associatedwith surgical procedures carried out in the upper airways, and which is significantly increased in patients presenting moderate and severe apnea. OBSTRUCTIVE SLEEP APNEA - A NEW OPTION FOR THE CRANIOMAXILLOFACIAL SURGEON (CONCEPTION AND BASIC SURGICAL PROTOCOL) Nelson E. P. Colombini, Gustavo J. Faller, Wolney B. D'Azevedo Clinica Medica Nelson E. P. Colombini - SZo Paulo, Brazil OBJECTIVES To focus on the importance of the rnaxillofacialsurgeon in the treatment of patients with apnea, since the procedures recommended for these cases belong to the field of this specialist. MATERIALS AND METHODS A multicenter assessment of 785 cases surgically treated between 1995 and 2000 was carried out, with the subsequent establishment of a protocol aimed at guiding professionals interested in treating these cases. RESULTS The protocol showed to be effective in 70 to 98% of patients. In cases of mild apnea, results were positive in about 90% (reduction of the apnealhypoapnea index); in cases of moderate apnea, treatment effectiveness was more difficult to be achieved, due to the craniofacial alterations presented by patients and to associated morbidities (in our series, the success rate ranged between 70 and 95%); severe apnea with a corporeal mass index of up to 33 was controlled in 98% of cases, with the use of maxillomandibular advancement associated with laser-assistedmidline glossectomy. CONCLUSION Significant improvement has been observed in the surgical procedures used to treat obstructive sleep apnea, mainly in terms of evolution of surgical procedures and comprehension of the inter-relation between the craniofacial and pharyngeal structures. Each case presents variables that should be taken into consideration in the selection of surgical procedures. Some examples include: corporeal mass index, hypoapnea, and desaturation during sleep. The comprehension of facial typology and its effect on the disease studied are the key factors for the success of treatment. 26 Braz J Craniomaxillofac Surg 2002;5/11 VII Congresso Brasiieiro de Cirurgia Craniomaxiiofaciai - Abstracts TISSUE ENGINEERING: AN ALTERNATIVE IN FACIAL RECONSTRUCTION PROCEDURES Sonja Ellen Lobo Several materiais have been studied and used in tissue reconstructionprocedures, including bioceramics with calcium radicals. The respect fortissue engineering principles is a main factor forthe obtainment of effective results, as is the respect for architectonic, surface topography, porosity, and biocompatibility characteristics, in addition to the properties of osteoconductionand osteoinduction related to the material used. All these aspects contribute to a compatible and adequate tissue neoformation. These aspects will be discussed in the present study, and some clinical cases will be presented. IDIOPATHIC BONE CAVITY IN THE MANDIBULAR CONDYLE Adrlano do Valle Fernandes, Evandro Nunes MagalhBes, Gustavo Bellozi de Araujo, Marceio Drummond Naves, M6nica Vieira Salgado, Wagner Rodrigues dos Santos Hospital Maria Amelia Lins Belo Horizonte, Brazil - Report of the case of F.P.S., a female, leukodermic, 18-year old patient who was referredto the Service of Bucomaxillofacial Surgery and Traumatology of our hospital by an orthodontist due to the asymptomatic radiographic finding of an alteration at the right mandibular condyle region during a routine examination. The patient presented no history of trauma. On clinical examination, the skin and mucosa of the surrounding areas presented normal color and texture, with no volume increase, no limitation to mandibular movements, and no other sign of articular dysfunction. On conventional and tomographic radiography, a well-defined radiolucid area was detected at the region of the right mandibular condyle, measuring about 4 x 6 mm in diameter, with no signs of cortical expansion or bone continuity solution. Aspiration punch biopsy was carried out, followed by the preparation of cytological slides for histopathologicalexamination, which revealed the presence of sanguineous cells. This finding, in association with the clinical and radiographicfindings above mentionedand the postoperative evolution of the case, determinedthe diagnosis of idiopathic bone cavity. Radiographic follow-up every 3 months along 1 year showed complete cicatrization of the bone. A SURGICAL APPROACH TO CRANIOFACIAL NEUROFIBROMATOSIS A CASE REPORT - Clarissa Leite Turrer, Ricardo Lopes Cruz lnstituto Fernandes Figueiras (FIOCRUZ) Rio de Janeiro, Brazil - Neurofibromatosis was first described by Von Recklinghausen in 1882 as a syndrome characterized by multiplefibromas, skin pigmentation, alterations in the central nelvous system and skeletal anomalies. It consists of an autosomic dominant inherited disease, and the gene mutations associated with it result in a various range of clinical statuses, of different severity. The most severe forms of neurofibromatosis are associatedwith deformities that compromise the patient's life. The present study describes a clinical case of craniofacial neurofibromatosis affecting the orbitopalpebralarea, as well as the steps of the transdisciplinarysurgical treatment carried out with the aim of providing ocular rehabilitation.We also describe technical limitations and results of the treatment, as well as the subsequent improvement of the patient's clinical status and life. Braz J Craniomaxillofac Surg 2002;5(11 27 VII Congress0 Brasileiro de Cirurgia Craniornaxilofacial - Abstracts MAXILLARY SINUS LIFT USING MANDIBULAR RAMUS BONE GRAFTS TECHNICAL CONSIDERATIONS - Davidson Rodarte Feliz de Oliveira, AntBnio Albuquerque de Brito, Aloisio Borges Coelho The height of the posterior regions of the maxilla represents a limiting factor to its rehabilitation with grafts in a great part of the Brazilian population. This is partly due to early tooth extractions, very common in oursetting, which lead to high rates of alveolar bone reabsorptionalong the patient's life, and consequently tothe pneurnatization of the maxillary sinuses. The lift of maxillary sinuses using bone grafts constitutes an important surgical technique in the viabilization of the use of osteointegrated implants in the posterior regions of the maxilla. Several grafl donor sites have already been described in the literature. The present study proposes the use of mandibular ramus bone grafts due to several advantages: easy access, low morbidity, availability of bone volume, and the same origin (intramembranous) as that of the receptor site. ZYGOMATIC FIXATION - A N ALTERNATIVE PROCEDURE FOR THE REHABILITATION OF SEVERELY ATROPHIED MAXILLA Waldemar Daut Polido, Eduardo Marini M5e de Deus Center Porto Alegre, Brazil - Reconstruction of the atrophied maxilla usually requires the use of iliac crest bone graft. The techniques most frequently used to treat this problem take grafts from other sites and therefore require hospitalization, a long time without the use of total prostheses, and a long time of treatment. Although the success rate associated with the use of bone grafts is relatively high, it rarely goes over 90%. Taking these data into consideration, and due to the current need for solving severe cases of maxiilectomy, Professor Branemark and his team developed a fixation technique aimed at providing efficient bone anchorage to allow rehabilitation with a fixed prosthesis, thus discarding the need for longer and more invasive surgical procedures. In 1989, zygomatic fixation started to be used as an alternative procedure for the rehabilitation of severely atrophied maxillas, and its indications and contraindications, advantages and disadvantages started to be studied. A MULTIDISCIPLINARY APPROACH TO THE ASSESSMENT AND TREATMENT OF A PATIENT PRESENTING PROGNATHISM, HYPOMAXILLISM, AND BURN SEQUELAE - A CASE REPORT Blas Antonio F. Santander, Mayra Cristina Kimura, Patricia de Paula Shimabuku, Rejane Aparecida de Lima, Vera Lucia Nocchi Cardim Hospital da Real e Benemerita Sociedade Portuguesa de Beneficencia de SSo Paulo - SSo Paulo. Brazil OBJECTIVES The authors describe the clinical case of a patient with maxillomandibular disproportion and the assessment and therapeutic approach carried out in the case. Through the description of speech-related, orthodontic and surgical aspects, the routine of the service is described, as well as the intercurrences observed in the specific case herein described. 28 Braz J Craniomaxillofac Surg 2002;5(11 VII Congresso Brasileiro de Cirurgia Craniornaxilofacial- Abstracts MATERIALS AND METHODS A 42-year old male patient presenting progmathism, hypomaxillism and cicatricial retraction due to burn sequelae was submitted to orthodontic and oral preparation for a combined surgery involving advancement of the mid third of the face and mandibular retrusion, together with the filling of the pyriform fossa with a bone graft taken from the mandibular external cortical bone. Due to the compromise of teeth (absence of upper molars), transskeletal maxillary orthopedic treatment was carried out for the maintenance of results. RESULTS After 6 months of treatment with myofunctionaltherapy and orthodonticcare, the patient started to use the definitive prosthesis, with unequivocal esthetic and functional gains. CONCLUSION The use of a multidisciplinaryapproach in the care, treatment and follow-up of patients potentially submitted to orthognatic surgery is of paramount importance in the detection of problems, in the management of cases and in the posterior maintenance of surgically-obtained results. MULTIDISCIPLINARY TREATMENT O F A PROGNATHIC PATIENT WITH HYPOMAXILLISM Rejane Aparecida de Lima, Mayra C. Kirnura, Rodrigo Dornelles, Rolf L. Salornons, Vera L. N. Cardim Hospital Beneficencia Portuguesa de Sao Paulo Silo Paulo, Brazil - OBJECTIVE Patients presenting maxillomandibular disproportion require a multidisciplinary treatment, with the participation of a speech therapist working in conjunction with plastic surgeons and dentists, among other professionals, in order to contribute to the diagnosis, planning and pre- and postoperative management of cases. In orthognatic surgery, inter-related structural and functional elements are involved, and speech therapy aims at assessing the maxiilofacial complex in its dynamic form, thus associating functional problems with structural elements that may negatively interfere with surgical results. MATERIALS AND METHODS The use if orofacial myotherapy, with isometric (focused on tonicity) and isotonic (focused on mobility) exercises, was selected to correct functional and muscular alterations. The authors report the case of S.L.M.F, 34 years old, who presented with maxillomandibular disproportion and was treated by a multidisciplinary team, with pre- and postoperative follow-up focused on speech-related aspects. RESULTS After 1.5 year of postoperative follow-up, the patient was rehabilitated, and surgicaVorthodontic results were maintained. CONCLUSION The multidisciplinary management of patients presenting maxillornandibulardisproportion, with the help of a speech therapist so as to adequately restore the speech function, promotes balance among functional and structural elements, resulting in facial harmony and preventing relapse. Braz J Craniomaxillofac Surg 2002;5/11 29 Vll Congresso Brasileiro de Cirurgia Craniomaxilofacial - Abstracts ZYGOMATICOPLASTY: AN ESTHETIC COMPLEMENT TO ORTHOGNATIC SURGERY (TECHNIQUES AND ALTERNATIVES) Nelson E. Colombini, Wolney B. D'Azevedo, Einar F. Oquendo Clinica Medica Nelson Colombini SBo Paulo, Brazil - OBJECTIVES In the present study, we describe the application of different zygomaticoplasty techniques in conjunction with lower Le Fort I osteotomy in cases where correction of the nasogenian segment can be carried out with a Z osteotomy and where the zygomatic component can be esthetically repaired with less complex techniques. MATERIALS AND METHODS Eight cases were submitted to osteotomy as suggested by Powell & Hilley, together or not with orthognatic surgery. The procedure consists in the filling of a gap with lyophilized or autogenous bone grafts, followed or not by fixation with miniplates and screws of with 1.5 mm in diameter. In women, procedures of zygomaticfeminilization may still be improved by the inversion of the Bichat ball to cover the osteotomized region. RESULTS The esthetic results obtained with zygomaticoplasty are as good as or better than those obtained with quadrangular osteotomy or upper Le Fort I osteotomy, as observed the cases herein described. CONCLUSIONS The use of Powell's technique in zygomaticopiasties is fast, efficient, associated with low morbidity and satisfactory esthetic results. It may be performed in combination of lower Le Fort I osteotomy or alone. In addition, its association with blepharoplasty is also advocated by the authors. PALATINE DISJUNCTION THROUGH ENDONASAL MICROSURGERY Nelson E. P. Colombini, Wolney B. D'Azevedo, Gustavo J. Faller Clinica Medica Nelson Colombini SSo Paulo, Brazil - OBJECTIVES To describe the petformance of palatine disjunction via an endonasal access route and to discuss the advantages and observations made along a 6-year experience. MATERIALS AND METHODS We describe 6 cases operated between 1996 and 2001, and report its advantages and indications. RESULTS The use of an endonasai access route in the performance of palatine disjunction is totally adequate to the patient concerning physiological aspects. In addition, in one only surgical procedure, it allows forthe correction of nasal cavities and cornets and for the manipulation of the osteomeatal space (whenever necessary). Surgically30 Braz J Craniomaxillofac Surg 2002;5/11 VII Congresso Brasileiro de Cirurgia Craniornavilofacial- Abstracts assisted palatine disjunction is of paramount importance in the treatment of two basic situations: cases of insufficient upper maxilla (above 5 mm from one side to the other), where it can help both in the preparation for surgery (in association with orthodontia) and during the orthognatic period (postorthodontia); and cases of lower septa1 deviations or problems in the valvular area or Cottle's area. None of our patients presented complications related to the procedure. CONCLUSION We used the basic septoplasty technique, with amplification of Cottle's lower tunel, in order to make room for the entry of the modified microsaw. The modified technique herein described showed to be a natural, little aggressive, and equally effective procedure for the performance of palatine disjunction, and is likely to be widely used in maxillofacial surgeries in the future. FUNCTIONAL GENIOPLASTY Rodrigo 0. M. Marinho, David S. Precious Hospital Lifecenter - Belo Horizonte, Brazil, and Dalhousie University Halifax, Canada - INTRODUCTION The term "genioplasty" has classically been used to name as a cosmetic surgical procedure. However, it is known that changes in form (anatomy) lead to changes in function. Functional genioplasty is a typical example of this principle, due to the alteration of the position and anatomical form of the menton and its myocutaneous structures. OBJECTIVES AND CASE REPORT This study has the aim of defining clinical indications for the use of functional genioplasty. In addition, differences between this surgical technique and the classical treatment are reported based on the presentation of clinical cases. RESULTS In all cases submitted to this surgical technique, excellent functional and cosmetic results were obtained. It is important to emphasize the simplicity of the technique, the low morbidity levels associated with it and the extremely low incidence of functional alterations in the mentonian nerve. CONCLUSION Functional genioplasty is a simple surgical procedure that may be used to correct functional and cosmetic problems in patients who carry dentofacial deformities. It allows for the anatomical and functional improvement of the menton, once it restores bones, muscles and the skin of the anterior and lower portions of the face. Braz J Craniomaxillofac Surg 2002;5/11 31 VII Congresso Brasileiro de Cirurgia Cran~ornaxilofacial- Abstracts SURGICALLY-ASSISTED RAPID MAXILLARY EXPANSION REPORT OF A CLINICAL CASE Paulo Roberto Pelucio CBmara Occlusion problems are assessed in antero-posterior, vertical, and transversal directions. The variables that determine whether a case should receive orthodontic or orthosurgical treatment include the intensity of the problem and the degree of esthetic and/or functional compromise associated with the lesion. Treatment of transversal problems usually implies the performance of maxillary expansion and, depending on the patient's age, either removable devices (higher effect on teeth) or fixed expanders, such as Haas's or Hyrax's models (significant effect on the maxillary bone), may be used. However, when the growing phase is over, the palatine suture closes, and the orthopedic results commonly obtained with this form of treatment are lost. In these cases, it is recommended to use a surgical procedure, so that the effect of expansion over bone tissues may be effective and so that the upper and lower dental arches obtain an adequate coordination. The objective of this study was to describe a clinical case and to show the effects of expansion on the maxilla of an adult patients submitted to surgery in association with use of Hyrax-type expanders. TREATMENT OF THE ANTEROPOSTERIOR MAXILLARY EXCESS WITH LE FORT I OSTEOTOMY: REPORT OF TWO CASES AND DISCUSSION AntBnio Albuquerque de Brito, Davidson Rodarte Felix de Ollvelra, Yumara Siqueira de Castro INTRODUCTION Le Fort I maxillary osteotomy, as proposed by Bell in 1975, gave origin to a wide range of surgical techniques aimed at the treatment of maxillary deformities. However, some procedures present a higher morbidity rate, so that extreme care must be taken in the planning of treatment, as is the case of maxillary anteroposterior retraction. OBJECTIVE To report two cases of dentofacial deformity with anteroposterior maxillary excess treated with horizontal retraction. In addition, we aim at discussing, based on the literature and on the experience of the authors, considerations on the surgical technique and treatment plan. RESULTS Surgeries were performed without intercurrences, and lasted 4 hours and 18 minutes on average; hospitalizations lasted 33 hours, on average. Patients showed an adequate evolution in the postoperative period, with dental and skeletal stability and no manifestations of respiratory, speech, sleep or deglutition alterations. CONCLUSIONS 1) versatility of Le Fort I osteotomy; 2) reliability of the osteotomized maxilla vascularization; 3) need for preoperative assessment of velo-pharyngeal competency; 4) versatility in the plan of treatment, focusing on esthetic results; 5) need for the presence of less conventional procedures among the therapeutic options; 6) attention to the treatment plan, in order not to confer an "old" appearance to the patient. 32 Braz J Craniornaxillofac Surg 2002;5(11 BRAZILIAN JOURNAL OF CRANIOMAXILLOFACIAL SURGERY Official publication o f the Brazilian Society o f Craniomaxillofacial Surgery Available at www.scientific.com.br Guidelines for Manuscript Submission Authors will send three copies of the manuscript along w i t h a covering letter addressed t o the Editor. Manuscripts should be typed double-spaced, w i t h 1 in (2.5 cm) margins, o n A 4 ( 2 1 x 29.7 cm) paper. All pages must be numbered, beginning w i t h the face page. 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Med J Aust 1996;164:282-4. No author given: Cancer in South Africa [editorial]. S Afr Med J 1994;84:15. Volume with supplement: Shen HM, Zhang QF. Risk assessment of nickel carcinogenicity and occupational lung cancer. Environ Health Perspect 1994;102 Suppl 1:275-82. Issue with supplement: Payne OK, Sullivan MD, Massie MJ. Women's psychological reactions t o breast cancer. Semin Oncol 1996;23(1 Suppl 2):89-97. Letters and other special articles: Enzensberger W, Fischer PA. Metronome in Parkinson's disease [letter]. Lancet 1996;347:1337. Chapter in a book: Phillips SJ, Whisnant JP. Hypertension and stroke. In: Laragh JH, Brenner BM, editors. Hypertension: pathophysiology, diagnosis and management. 2nd ed. New York: Raven Press; 1995. p. 465-78. Conference proceedings: Kimura J, Shibasaki H, editors. Recent advances in clinical neurophysiology. Proceedings of the 10th International Congress of EMG and Clinical Neurophysiology; 1995 Oct 15-19; Kyoto, Japan. Amsterdam: Elsevier; 1996. Conference paper: Bengtsson S, Solheim BG. Enforcement of data protection, privacy and security in medical informatics. In: Lun KC, Degoulet P, Piemme TE, Rienhoff 0, editors. MEDINFO 92. Proceedings of the 7th World Congress on Medical Informatics; 1992 Sep 6-1 0; Geneva, Switzerland. Amsterdam: North-Holland; 1992. p. 1561-5. Dissertation: Kaplan SJ. Post-hospital home health care: the elderly's access and utilization [dissertationl. St Louis (MO): Washington Univ; 1995. Forthcoming publications: Leshner Al. Molecular mechanisms of cocaine addiction. N Engl J Med. In press 1996. Electronic material Journal article in electronic format: Morse SS. Factors in the emergence of infectious diseases. Emerg Infect Dis [serial online1 1995 Jan-Mar [cited 1996 Jun 51; 1(1):[24 screens]. Available from: URL:http://www.cdc.govl ncidodiEID/eid.htm Monograph in electronic format: CDI, clinical dermatology illustrated [monograph on CDROMI. Reeves JRT, Maibach H. 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Disclaimer The statements and opinions in the articles of the Brazilian Journal of Craniomaxillofacial Surgery ale: solely those of the individual authors and contributors and not of the Journalor of the Brazilian Society of Craniomaxillofacial Surgery. 36 Braz J Craniomaxillofac Surg 2002;5/11 ' - 0 trauma craniomaxilofacial associado ao pod€ r ~ s u l t a rEm IESOES trauma cranio~nc~falico ou s ~ q i j ~ l a do s S i s t ~ m aN ~ r v o s oC ~ n t r ad~ l alta c o m p l ~ x i d a d ~€. p o r ESSE motivo q u ~a T ~ c h n i c a rtrabalha ~ e invest€ na ~ d u c a c a o continuada. Para a T~chnicare nao basta aptznas trazcr materiais d~ alta t~cnologiaE rtzalizar cirurgias craniomaxilofaciais, mas sim fazer p a r t € da p r ~ v ~ n t ; ad~ o a c i d ~ n t ~muitas s, VEZES causados por falta dc scguranga. As rEgras d~ sEguransa dependem d~ cada um. A Tcchnicare cab€ tcntar minimiza-las. Ao d i r i g i r , U S E o c i n t o d sEguranga. Ao praticar ~ s p o r t c s , USE os c q u i p a m ~ n t o s n ~ c ~ s s a r i oas sua seguranga. T ~ c h n i c a r ~trabalhando , q u a l i d a d ~d~ vida. p ~ l a m ~ l h o r i a da - Ja Luiz Carlos PPES~ES. 410 Gr. 3 0 6 - Barra da Tijuca - Rio d~ J a n ~ i M Brasil C E ~22715-030 : TE~.:(0~x21)2430-9640 TEI fax: (0~x21)2430-964 website www.t~chnicarc.corn.br€-mail: t~c@t~chnicar~.com.br I