NIVALDO ALONSO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder
13 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 13
- Versatility of the buccinator myomucosal flap in atypical palate reconstructions(2014) FRANCO, Diogo; ROCHA, Diogenes; ARNAUT JR., Marcio; FREITAS, Renato; ALONSO, NivaldoInitially described for the treatment of cleft palate, the anatomical bases of the buccinator myomucosal flap were described by Bozola et al. (1989). A meticulous search found several reports of its use for the correction of post-palatoplasty oronasal fistulas, with only a few reports of its use for other palate-related pathologies. A retrospective analysis was undertaken of patients treated by the Plastic Surgery Units at the Rio de Janeiro Federal University Hospital (HU-UFRJ) and the Sao Paulo University Hospital (HC-USP), suffering from palatal lesions not associated with a cleft palate and treated through the use of buccinator myomucosal flaps. The average age was 47 years, with 70% of the patients being male. Assorted aetiologies were noted for palatal defects. When there was significant damage to the soft palate, a superior base pharyngeal flap was used. Of this total, in 71% of the cases only the buccinator myomucosal flap was used. In all cases, the flaps were unilateral, adequately covering the defects in question. The buccinator myomucosal flap is a good option for reconstructing medium to large palate defects, as it is a flap with good vascularization and dimension, in addition to an ample arc of rotation, with primary closure of the donor site, without adding significant morbidity.
- Congenital Midline Cervical Cleft: A Variant of Tessier Number 30 Cleft Causing Micrognathia(2021) TONELLO, Cristiano; MATOS, Ines Correia Pinto de; FEITOSA, Leonardo Bezerra; PEIXOTO, Adriano Porto; ALONSO, NivaldoCongenital midline cervical cleft is a rare and generally isolated malformation of the ventral neck region with no clear etiology established. Mandibular deformities, such as micrognathia, could be considered as a consequence of a cleft cervical contracture. Complete surgical excision of the subcutaneous fibrous cord at an early age is the primary treatment modality, minimizing growth development problems on surrounding affected tissue. The aim of this study is to describe the clinical, surgical, and histological findings in a female child with congenital midline cervical cleft along with a relevant literature review. Three years follow-up after surgery exhibited satisfactory functional and cosmetic results.
- Normal angulation of skull base in Apert syndrome(2018) LU, Xiaona; FORTE, Antonio Jorge; SAWH-MARTINEZ, Rajendra; WU, Robin; CABREJO, Raysa; STEINBACHER, Derek M.; ALPEROVICH, Michael; ALONSO, Nivaldo; PERSING, John A.Apert syndrome is characterized by the severe craniofacial deformities. The subsequent process of skeletal maldevelopment is likely to be influenced by multiple interactions at several levels, at a given time. In this study, we aimed to explore the evolution of cranial basal dysmorphology and the chronology of these deformities in Apert syndrome, by objectively analyzing three-dimensional measurements. Fifty-four CT scans from unoperated patients (Apert, n = 18; control, n = 36) were included in this study, with age range from 3 days to 24 years. Before 6 months of age, Apert's anterior cranial base was widened 60%. Between 6 months and 2 years of age, the whole cranial base length, anterior cranial base length and posterior cranial base length decreased 8%, 8% and 14%, respectively. The greater sphenoid wing angle was wider by 26.0 degrees, and continued into adulthood. The cranial base angles did not produce significant changes throughout life. The extra cranial distances synchronously and almost proportionally shortened after later infancy. The anterior and posterior cranial base length shortened at an almost proportional rate. The malformations of the skull vault are additive effects with cranial base fusion on skull length restriction, but the angulation of the skull base is virtually normal.
- Common 3-dimensional coordinate system for assessment of directional changes Response(2016) RUELLAS, Antonio Carlos de Oliveira; TONELLO, Cristiano; ALONSO, Nivaldo; CEVIDANES, Lucia Helena Soares; GOMES, Liliane Rosas; GONCALVES, Joao Roberto; MACRON, Lucie; LOPINTO, Julia; YATABE, Marilia Sayako; GARIB, Daniela Gamba; SOUKI, Bernardo Quiroga; COQUEIRO, Raildo da Silva
- Simulation-Based Comprehensive Cleft Care Workshops: A Reproducible Model for Sustainable Education(2020) KANTAR, Rami S.; BREUGEM, Corstiaan C.; KEITH, Kristen; KASSAM, Serena; VIJAYAKUMAR, Charanya; BOW, Mikaela; ALFONSO, Allyson R.; CHAHINE, Elsa M.; GHOTMI, Lilian H.; PATEL, Krishna G.; SHETYE, Pradip R.; SANTIAGO, Pedro E.; LOSEE, Joseph E.; STEINBACHER, Derek M.; ROSSELL-PERRY, Percy; GARIB, Daniela G.; ALONSO, Nivaldo; MANN, Robert J.; PRADA-MADRID, Jose Rolando; ESENLIK, Elcin; PAMPLONA, Maria del Carmen; COLLARES, Marcus Vinicius Martins; BENNUN, Ricardo D.; KUMMER, Ann; GIUGLIANO, Carlos; PADWA, Bonnie L.; RAPOSO-AMARAL, Cassio Eduardo; TSE, Raymond; SOMMERLAD, Brian; FLORES, Roberto L.; HAMDAN, Usama S.Objective: Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact. Design: Cross-sectional survey-based evaluation. Setting: Simulation-based comprehensive cleft care workshop. Participants: Total of 180 participants. Interventions: Three-day simulation-based comprehensive cleft care workshop. Main Outcome Measures: Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice. Results: The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 +/- 5.7 vs 25.7 +/- 7.6;P< .001) and palate (32.4 +/- 7.1 vs 23.7 +/- 6.6;P< .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices. Conclusion: Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants' clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.
- Common 3-dimensional coordinate system for assessment of directional changes(2016) RUELLAS, Antonio Carlos de Oliveira; TONELLO, Cristiano; GOMES, Liliane Rosas; YATABE, Marilia Sayako; MACRON, Lucie; LOPINTO, Julia; GONCALVES, Joao Roberto; CARREIRA, Daniela Gamba Garib; ALONSO, Nivaldo; SOUKI, Bernardo Quiroga; COQUEIRO, Raildo da Silva; CEVIDANES, Lucia Helena SoaresIntroduction: The aims of this study were to evaluate how head orientation interferes with the amounts of directional change in 3-dimensional (3D) space and to propose a method to obtain a common coordinate system using 3D surface models. Methods: Three-dimensional volumetric label maps were built for pretreatment (T1) and posttreatment (T2) from cone-beam computed tomography images of 30 growing subjects. Seven landmarks were labeled in all T1 and T2 volumetric label maps. Registrations of T1 and T2 images relative to the cranial base were performed, and 3D surface models were generated. All T1 surface models were moved by orienting the Frankfort horizontal, midsagittal, and transporionic planes to match the axial, sagittal, and coronal planes, respectively, at a common coordinate system in the Slicer software (open-source, version 4.3.1; http://www.slicer.org). The matrix generated for each T1 model was applied to each corresponding registered T2 surface model, obtaining a common head orientation. The 3D differences between the T1 and registered T2 models, and the amounts of directional change in each plane of the 3D space, were quantified for before and after head orientation. Two assessments were performed: (1) at 1 time point (mandibular width and length), and (2) for longitudinal changes (maxillary and mandibular differences). The differences between measurements before and after head orientation were quantified. Statistical analysis was performed by evaluating the means and standard deviations with paired t tests (mandibular width and length) and Wilcoxon tests (longitudinal changes). For 16 subjects, 2 observers working independently performed the head orientations twice with a 1-week interval between them. Intraclass correlation coefficients and the Bland-Altman method tested intraobserver and interobserver agreements of the x, y, and z coordinates for 7 landmarks. Results: The 3D differences were not affected by the head orientation. The amounts of directional change in each plane of 3D space at 1 time point were strongly influenced by head orientation. The longitudinal changes in each plane of 3D space showed differences smaller than 0.5 mm. Excellent intraobserver and interobserver repeatability and reproducibility (>99%) were observed. Conclusions: The amount of directional change in each plane of 3D space is strongly influenced by head orientation. The proposed method of head orientation to obtain a common 3D coordinate system is reproducible.
- Patient-Perceived Barriers to Accessing Cleft Care at a Tertiary Referral Center in Sao Paulo, Brazil(2019) ISE, Ananda; MENEZES, Camila; NETO, Joao Batista; SALUJA, Saurab; AMUNDSON, Julia R.; JENNY, Hillary; MASSENBURG, Ben; CITRON, Isabelle; ALONSO, NivaldoBackground: In low- and middle-income countries, poor access to care can result in delayed surgical repair of orofacial clefts leading to poor functional outcomes. Even in Brazil, an upper middle-income country with free comprehensive cleft care, delayed repair of orofacial clefts commonly occurs. This study aims to assess patient-perceived barriers to cleft care at a referral center in Sao Paulo. Methods: A 29-item questionnaire assessing the barriers to care was administered to 101 consecutive patients (or their guardians) undergoing orofacial cleft surgery in the Plastic Surgery Department in Hospital das Clinicas, in Sao Paulo, Brazil, between February 2016 and January 2017. Results: A total of 54.4% of patients had their first surgery beyond the recommended time frame of 6 months for a cleft lip or cleft lip and palate and 18 months for a cleft palate. There was a greater proportion of isolated cleft palates in the delayed group (66.7% vs 33.3%). Almost all patients had a timely diagnosis, but delays occurred from diagnosis to repair. The mean number of barriers reported for each patient was 3.8. The most frequently cited barriers related to lack of access to care include (1) lack of hospitals available to perform the surgery (54%) and (2) lack of availability of doctors (51%). Conclusion: Delays from diagnosis to treatment result in patients receiving delayed primary repairs. The commonest patient-perceived barriers are related to a lack of access to cleft care, which may represent a lack of awareness of available services.
- Orbitofacial morphology changes with different suture synostoses in Crouzon syndrome(2022) LU, Xiaona; FORTE, Antonio Jorge; JUNN, Alexandra; DINIS, Jacob; ALPEROVICH, Michael; ALONSO, Nivaldo; PERSING, John A.This study aims to investigate the influence of different cranial vault suture synostoses on orbital and periorbital morphological development in Crouzon syndrome. Computed tomography (CT) scans of Crouzon syndrome patients who had not undergone operation were subgrouped as follows: type I: bicoronal synostosis; type II: sagittal synostosis; type III: pansynostosis; type IV: perpendicular combinations of suture synostoses; and type V: bilateral squamosal synostosis. CT scans were measured using Materialise software. CT scans of 80 Crouzon syndrome patients and 72 normal controls were included. Orbital bony cavity volume was reduced in all subgroups (16-24%), including type V bilateral squamosal synostosis (16%, p = 0.003), although the reduction in type II sagittal synostosis Crouzon patients failed to reach statistical significance (p = 0.071). Globe volume was reduced only in type I bicoronal synostosis (9%, p = 0.018), while the retrobulbar soft tissue volume decreased in type III pansynostosis group by 11% (p = 0.005). Globe volume projection beyond the orbital rim was increased in all groups (p < 0.001), with the greatest increase in type IV perpendicular combination of sutures synostoses, by 100% (p < 0.001). The anteroposterior length of maxilla was significantly shortened in type I (10%, p = 0.028) and type III (9%, p = 0.022) but developed normally in other groups, although the maxilla was posteriorly displaced in all groups (all p <= 0.026). The influence of squamosal synostosis on craniofacial malformation is not equivalent to that of a major vault suture. Therefore, subtype suture fusion individualized surgical interventions, after initial occipital expansion, likely provide additional benefits in mitigating oculo-orbital disproportion.
- Enlarged anterior cranial fossa and restricted posterior cranial fossa, the disproportionate growth of basicranium in Crouzon syndrome(2019) LU, Xiaona; FORTE, Antonio Jorge; STEINBACHER, Derek M.; ALPEROVICH, Michael; ALONSO, Nivaldo; PERSING, John A.Crouzon syndrome patients develop normal intracranial volume and potential restricted posterior cranial fossa volume with growth. This study aims to trace the segmental anterior, middle and posterior cranial fossae volume, and structural morphology in these patients, in order to help discern more focused and individualized surgical treatment plan. Ninety-two preoperative CT scans (Crouzon, n = 36; control, n = 56) were included, and divided into 5 age related subgroups. CT scans were measured using Mimics and 3-matics software. Overall, Crouzon syndrome patients grew to a 27% (p = 0.011) increased anterior cranial fossa volume and a 20% (p = 0.001) decreased posterior cranial fossa volume, with normal middle cranial fossa and entire intracranial volume measurement. The posterior cranial fossa of Crouzon syndrome initially developed significantly reduced volume (19%, p = 0.032), compared to normals, from 6 months of age, and remained reduced thereafter. The 7.63 mm shortening of posterior cranial fossa length contributed most to the shortened entire cranial length (9.30 mm, p = 0.046). Although the entire cranial volume of Crouzon syndrome is normal overall, the segmental anterior, middle and posterior cranial fossae developed disproportionately. The early significant and lifelong restricted posterior cranial fossa addresses the importance of early posterior cranial expansion. Ideally expansion would have vectors in all three dimensions. (C) 2019 Published by Elsevier Ltd on behalf of European Association for Cranio-Maxillo-Facial Surgery.
- The First Hybrid International Educational Comprehensive Cleft Care Workshop(2023) KANTAR, Rami S.; ESENLIK, Elcin; ABYAD, Omar S. Al; MELHEM, Antonio; YOUNAN, Robert A.; HADDAD, Mario; KEITH, Kristen; KASSAM, Serena; ANNAN, Beyhan; VIJAYAKUMAR, Charanya; PICARD, Arnaud; PADWA, Bonnie L.; SOMMERLAD, Brian; RAPOSO-AMARAL, Cassio Eduardo; FORREST, Christopher R.; GILLETT, David A.; STEINBACHER, Derek M.; RUNYAN, Christopher M.; TANIKAWA, Daniela Y. S.; CHONG, David K.; FISHER, David M.; MARK, Hans; CANTER, Halil Ibrahim; LOSEE, Joseph E.; PATEL, Krishna G.; HARTZELL, Larry D.; JOHNSON, Adam B.; COLLARES, Marcus Vinicius Martins; ALONSO, Nivaldo; CHEN, Philip Kuo-Ting; TSE, Raymond; MANN, Robert J.; PRADA-MADRID, Jose Rolando; KOBAYASHI, Shinji; HUSSAIN, Syed Altaf; KUMMER, Ann; SELL, Debbie A.; PEREIRA, Valerie J.; MABRY, Kelly; GONSOULIN, Courtney K.; PERSSON, Martin; DAVIES, Gareth; SETHNA, Navil F.; MUNOZ-PAREJA, Jennifer C.; KUIJPERS-JAGTMAN, Anne Marie; GRAYSON, Barry H.; GROLLEMUND, Bruno; GARIB, Daniela G.; MEAZZINI, Maria Costanza; KHARBANDA, Om P.; SANTIAGO, Pedro E.; NALABOTHU, Prasad; BATRA, Puneet; STIEBER, Erin; PRASAD, Dushyant; BREWSTER, Hugh; AYALA, Ruben; ERBAY, Elif; AKCAM, M. Okan; GRIOT, J. Peter W. Don; VYAS, Raj M.; FLORES, Roberto L.; BREUGEM, Corstiaan C.; HAMDAN, Usama S.Objective Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance. Design Cross-sectional survey-based evaluation. Setting International comprehensive cleft care workshop. Participants Total of 489 participants. Interventions Three-day simulation-based hybrid comprehensive cleft care workshop. Main Outcome Measures Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance. Results The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 +/- 3.08 vs 27.63 +/- 3.93; P = .04) and perceived impact on their clinical practice (22.37 +/- 3.42 vs 21.02 +/- 3.45 P = .01). Conclusion Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.