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Dealing with the upper airways is an integral part of a maxillofacial surgeon’s daily life, and understanding how to better deal with them is one of the aims of this practice, in collaboration with other specialists.

1 Sociedade Brasileira de Cirurgia Plastica, Sao Paulo, SP, Brasil. 2 Associacao Brasileira de Cirurgia Crânio-Maxilo-Facial, Recife, PE, Brasil. 3 Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil. 4 Sociedade Brasileira de Neurocirurgia, Rio de Janeiro, RJ, Brasil. Prototyping is a process of construction in order to obtain physical prototypes from 3D digital models. The introduction of prototyping in medicine is a recent event. Case 1: An 18-year-old patient with a 192 cm2 cranial defect secondary to a decompressive craniectomy. A cranioplasty was performed using a customized prosthesis manufactured by prototyping. Case 2: A 34-year-old patient with a panfacial fracture sequelae. This patient had a relevant defect in the zygomatico-orbital complex, with great zygoma dislocation. Surgical planning was performed using the prototype, which was taken to the surgery room to support the surgery. Case 3: A 29-year-old patient with a mandibular ameloblastoma from the subcondylar region to the right parasymphysis. Prototyping of the craniofacial skeleton and fibula were carried out in addition to a model surgery that was performed on the previous day. Discussion: Prototyping can be applied to craniofacial surgery in many ways, such as customized prosthesis manufacturing, surgical planning, and education of residents and patients. In case 1, a customized prosthesis had the advantage of not requiring a donor area and resulted in excellent esthetic results. In case 2, the presence of the prototype during surgery helped identify the zygoma more quickly in order to reposition it. In case 3, the model surgery helped decrease morbidity of the donor area, define fibular osteotomy and the resection margins, mold the plate, select the screws, ensure the condylar prosthesis fit in the temporomandibular joint (TMJ ), achieve the best occlusion possible, and reduce the surgical time, anesthesia, and hospital-associated costs. ■ ABSTRACT

Este estudo caracteriza quali e quantitativamente a atividade pesqueira comercial na bacia do rio Madeira, afluente do rio Amazonas, no trecho entre Guajará-Mirim e Porto Velho, estado de Rondônia. No período de janeiro a dezembro/2004, foram registrados 460 t, correspondendo 935 viagens. A análise dos dados oriundos do monitoramento dos desembarques demonstrou que a pesca na região tem caráter artesanal de pequena escala, destacando a maior participação das canoas motorizadas (131 unidades) do que barcos pesqueiros (45 unidades; capacidade média: 3.000kg) na frota pesqueira. Os peixes migradores jaraqui (Semaprochilodus spp.), dourada (Brachyplatystoma rousseauxii), sardinha (Triportheus spp.), jatuarana/matrinxã (Brycon amazonicus e B. cephalus), curimatã (Prochilodus nigricans) e filhote (Brachyplatystoma filamentosum) se destacaram na composição das espécies desembarcadas. As informações técnicas geradas são importantes para subsidiar ações de ordenamento pesqueiro, bem como para avaliar futuras variações que possam ocorrer na atividade frente aos impactos dos empreendimentos hidrelétricos em construção na região. This study presents qualitative and quantitative information about commercial fishery in the basin of the Madeira River, tributary of the Amazon River, describing the fishing activity in the segment between Guajará-Mirim and Porto Velho, in Rondônia State. From January to December/2004, 219 fishermen and 935 trips were registered, corresponding to the capture of 460 t of fish. Data from fish landings demonstrate that fisheries in the region are small-scaled and point to a higher participation of small motorized canoes (130 units) than of fishing boats (45 units; average capacity: 3000 kg) in the fishing fleet. Migratory species like jaraqui (Semaprochilodus spp.), dourada (Brachyplatystoma rousseauxii), sardinha (Triportheus spp.), jatuarana/matrinxã (Brycon amazonicus e B. cephalus), curimatã (Prochilodus nigricans) and filhote (Brachyplatystoma filamentosum) were the most important in terms of landings. The technical information produced are very important in order to subsidize fishery management, as well as to assess future variations that might happen due to the hydro-electric enterprises under construction in the region.

INTRODUÇÃO: Os defeitos ósseos da calota craniana ocorrem frequentemente pela perda tecidual relacionada ao trauma ou para tratamento de tumores, sendo a maior causa de deformidade do crânio pós-trauma a craniectomia realizada na intervenção neurocirúrgica para tratamento da injúria cranioencefálica. As principais indicações para a correção dos defeitos cranianos incluem proteção do tecido cerebral, correção estética e melhora clínica, que envolve a pulsação de tecidos moles e a sensação de insegurança relatada pelo paciente. Defeitos extensos da calvária de espessura total são de grande desafio ao cirurgião pelo seu curso complexo, que envolve cirurgias prévias, infecções locais e osteonecrose, que leva à dificuldade na escolha do melhor método reconstrutivo. MÉTODO: Análise retrospectiva dos casos operados entre Janeiro de 2008 e Abril de 2010 para reconstrução da calota craniana realizados no Centro de Cirurgia Crânio-maxilofacial - Instituto Nacional de Traumatologia e Ortopedia (MS). RESULTADOS: Foram analisados 11 pacientes com defeitos extensos de espessura total da calota craniana operados no período, destes 9 foram submetidos a correção com enxerto ósseo autólogo de tábua externa do parietal e 2 com prótese customizada. CONCLUSÃO: O protocolo do nosso centro define que a primeira opção de reconstrução para defeitos extensos da calota craniana de espessura total é o enxerto autólogo de tábua externa do osso parietal sem craniectomia. Nos casos selecionados em que esse método reconstrutivo não pode ser utilizado, a opção é pelo uso de prótese customizada. BACKGROUND: Cranial bone deformities are most often the result of trauma or extirpation for tumors, and the principal cause of the cranial deformities after cranial trauma is related to the craniectomy realized in neurosurgical approach for the treatment of brain damage. The reconstructive goals in cranioplasty are to provide protection of the brain, restore preinjury appearance and to lead clinical improvement like soft tissue pulsation and the unsafe feeling. Large full thickness skull defects can be quite challenging for the surgeon because of its complexity course which includes previous surgery, local infection and osteonecrosis. These factors lead to the difficult choice of the best reconstructive material. METHODS: A prospective study of the patients treated, from January 2008 to April 2010, for the calvaria reconstruction at Centro de Cirurgia Crânio-maxilofacial - Instituto Nacional de Traumatologia e Ortopedia (MS). RESULTS: Eleven patients with large full thickness skull defects submitted to cranioplasty were analysed. Nine of them were treated with parietal outer table without craniectomy and two were treated with customized prosthesis. CONCLUSIONS: In large full thickness skull defects the first method of reconstruction is the parietal outer table without craniectomy. In selected cases, when this reconstructive method can not be used, the option for the cranioplasty is the customized prosthesis.

Ameloblastic fibroma is a relatively rare benign odontogenic tumor in which both the epithelial and ectomesenchymal components are neoplastic. An 8-year-old Caucasian boy was referred to the dentist for evaluation of failed eruption of the maxillary left first molar. The panoramic radiograph showed a well-circumscribed unilocular radiolucency involving an unerupted maxillary left first permanent molar. The lesion was enucleated and the material was sent for histopathologic examination. Microscopically, it was composed by cords and islands of odontogenic epithelium in a myxoid cell-rich stroma that closely resemble the dental papilla with histopathological diagnosis of ameloblastic fibroma. After 24 months of follow-up no recurrence was observed and the maxillary left first molar erupted spontaneously through the buccal mucosa and was aligned with a fixed orthodontic appliance. This case emphasized the importance of careful differential diagnosis of intraosseous oral lesions and reported a rarity of the lesion and its atypical location. Fibroma ameloblástico é um tumor odontogênico benigno relativamente raro, em que ambos os componentes epiteliais e ectomesenquimais são neoplásicos. Menino de oito anos de idade, branco, foi encaminhado ao dentista para avaliar a falha na erupção do primeiro molar maxilar do lado esquerdo. A radiografia panorâmica revelou imagem radiolúcida, unilocular, bem circunscrita, envolvendo o primeiro molar permanente maxilar esquerdo incluso. A lesão foi enucleada e o material encaminhado para avaliação histopatológica. Microscopicamente, era composta de ilhas e cordões de epitélio odontogênico num estroma mixóide rico em células, que se assemelhava à papila dentária, com diagnóstico histopatológico de fibroma amelobástico. Após 24 meses de acompanhamento, nenhuma recorrência foi observada e o primeiro molar permanente maxilar irrompeu espontaneamente através da mucosa bucal e foi alinhado com aparelho ortodôntico fixo. Esse caso enfatiza a importância do cuidadoso diagnóstico diferencial das lesões orais intra-ósseas e relato de lesão rara e sua localização atípica.