Search

Copyright of Revista de la Facultad de Medicina de la UNAM is the property of UNAM, Facultad de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Stahl's ear presents a low incidence, even in specialized ear reconstruction centers. It is characterized by an abno rmal cartilaginous remnant, extending from the antihelix to the edge of the helix, forming a third crura. Case report: A 117-year-old man presented an ear deformity characterized by hypoplasia of the root of the antihelix and the presence of a third crura, which communicates the antihelix to the helix. A resection of third crura and cartilaginous reconstruction of the auricular pavilion was performed, achieving an adequate reconstruction, with good aesthetic results, without size alteration in comparison to the contralateral ear. Conclusions: Stahl's deformity is a rare ear deformity that can lead to significant social disruption and stigma. Surgical treatment is the preferential option for handling this deformity, and focuses mainly on the correction of the third crura. [ABSTRACT FROM AUTHOR]

Objetivo: Describir el manejo de las lesiones nerviosas de extremidad inferior atendidas en un centro de referencia en cirugía plástica y reconstructiva en la Ciudad de México., Método: Estudio descriptivo, transversal y retrospectivo, en el que se evaluaron los expedientes clínicos de pacientes atendidos por lesiones nerviosas de extremidad inferior entre 2010 y 2018., Resultados: Se incluyeron 21 pacientes, 14 hombres (66.6%) y 7 mujeres (33.3%), con una edad promedio de 30.00 ± 8.89 años. Las lesiones en la extremidad derecha fueron más prevalentes (52.3%). El mecanismo de lesión más común fue por herida por proyectil de arma de fuego (28.5%) o por accidente automovilístico (13.6%). Los nervios más afectados fueron el ciático (38.0%) y el peroneo (38.0%), seguidos por el tibial (9.5%), el peroneo y el tibial simultáneamente (9.5%) y el femoral (4.7%). Las medidas de tratamiento más empleadas fueron las transferencias nerviosas (7 casos, 33.3%) y la aplicación de injertos nerviosos para el manejo de brechas (7 casos, 33.3%)., Conclusiones: La reparación de las estructuras nerviosas de la extremidad inferior ha recibido poca atención. Sin embargo, nuestro estudio muestra que es posible aplicar diversas estrategias reconstructivas microquirúrgicas, buscando mejorar los desenlaces funcionales de los pacientes., Objective: To describe the management of lower extremity nerve injuries at a plastic and reconstructive surgery referral center in Mexico City., Method: A descriptive, transversal and retrospective study was performed, evaluating clinical records of patients with lower extremity nerve injuries managed in our center between 2010 and 2018., Results: Twenty-one patients were included, 14 males (66.6%) and 7 females (33.3%); mean age was 30.00 ± 8.89 years. Right-sided injuries were more prevalent (52.3%). The most common etiologies were gunshot injuries (28.5%) and motor vehicle accidents (13.6%). The most frequently affected nerves were the sciatic (38.0%) and the peroneal nerves (38.0%), followed by the tibial (9.5%), simultaneous tibial and peroneal nerve injury (9.5%) and the femoral nerve (4.7%). Nerve transfers (7 cases, 33.3%) and autologous nerve grafts (7 cases, 33.3%) were the preferred surgical techniques for injury management., Conclusions: Repair of lower extremity nerve injuries has not been popularized, however our study shows that several microsurgical reconstructive strategies are available in order to improve functional outcomes., (Copyright: © 2021 Permanyer.)

Background: Facial paralysis is a frequent disabling entity that causes a negative impact on the cosmetic, functional, social, psychological and economic aspects of the patient. Surgical treatment aims to restore the patient to her previous life with the fewest possible sequelae., Objective: Describe the experience of surgical management and propose a treatment algorithm., Method: A retrospective study was carried out from 2017 to 2019 of the records of patients with facial nerve involvement. The variables were age, sex, etiology, affected side and procedures performed., Results: 108 patients were obtained. The most frequent cause was development facial paralysis (41,8%), followed by resection of intracranial tumors (29%). A total of 225 procedures were performed, average per patient of 2.7. The most performed dynamic procedure was the gracilis-free flap (59%). The most frequent static procedures were the placement of a gold weight (24%) and the recreation of the nasogenian sulcus (13%)., Conclusions: The surgical treatment algorithm will depend on the evolution time, etiology, donor nerves and state of the facial musculature. The gracilis-free flap continues to be the gold standard procedure in facial paralysis reconstruction. Static procedures are additionally required to achieve a satisfactory aesthetic and functional result.

Background: Moebius syndrome is a clinical entity characterized by bilateral facial and abducens nerve palsies; other cranial nerver might be affected as well. So far, no studies have reported the electromyographic responses of the facial musculature in this group of patients., Objective: The objective of our study is to describe the electromyographic responses of the facial muscle and the main donor nerves for facial reanimation in patients with Moebius syndrome., Method: We analyzed electromyographies from the facial, hypoglossal, masseterine (trigeminal) and accessory nerves from patients with Moebius syndrome treated between 2010 and 2016. Results are presented as percentages and central tendency measures., Results: 24 patients were included, mean age 11.79 ± 9.39 years. The facial nerve showed complete unilateral recruitment in 4 patients, partial bilaterally in 11, 7 showed no activity bilaterally and two had unilateral inactivity. The masseterine was normal in 14 patients, had partial recruitment bilaterally in 4 and unilaterally in 4 cases. The accessory nerve was normal in 20 patients, showed partial recruitment bilaterally in 3 and unilaterally in 1 patients. The hypoglossal was normal in 22 patients, and altered in 2 cases., Conclusion: Patients with Moebius syndrome show several degrees of alteration in electromyographic evaluation of the facial nerve. Electromyography is a useful tool in evaluating potential motor donor nerves for facial reanimation surgery., (Copyright: © 2020 Permanyer.)

Introduction: Extended major histocompatibility complex (MHC) haplotypes are associated with several autoimmune diseases, and these appear to depend on ancestry., Objective: To evaluate the association of extended MHC gene frequencies, ancestry, and acute rejection., Material and Methods: 127 living kidney transplant recipients who underwent kidney transplantation in Mexico City between January 2004 and October 2007 with follow up until October 2008. The primary outcome was biopsy proven acute rejection. Ancestry was considered as either Amerindian or admixtures with Caucasian, African or Oriental genes. Allele and haplotype frequencies were estimated for HLA A, B and DR loci. Hardy Weinberg (HW) and delta values were analyzed to test for linkage disequilibrium (LD)., Results: There were no significant differences in the baseline characteristics between groups. 50% were men, and 28, 61 and 10% of the patients shared zero, one or two haplotypes, respectively. The whole population was Hispanic and born in Mexico. Median PRA was 0%. Allelic variance in all MCH loci was in HW equilibrium, 14% developed acute rejection. There was a high frequency of Amerindian haplotypes; admixture genes and LD were higher in the group with acute rejection. When compared to the group without acute rejection, the haplotype A1*B8*DR3 was more frequent in donors in whom their recipients had acute rejection (p = 0.008), while A28*B39*DR4 was more common in the recipients with acute rejection (p = 0.003). Multivariate Cox regression models did not attenuate these associations., Conclusions: Ancestry and LD may be associated with risk of acute rejection and may therefore be useful in directing immunosuppression.