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
21 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 21
- 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.
- Racial disparity of Crouzon syndrome in maxilla and mandible(2020) LU, X.; FORTE, A. J.; FAN, F.; ZHANG, Z.; TANG, L.; YANG, B.; ALPEROVICH, M.; STEINBACHER, D. M.; ALONSO, N.; PERSING, J. A.The racial disparity of facial features in craniosynostosis patients is not fully understood. The aim of this study was to explore the difference in maxillary and mandibular morphology and spatial position in Asian and Caucasian Crouzon syndrome patients. Ninety-one computed tomography scans were included (12 Asian Crouzon syndrome patients, 22 Asian controls; 16 Caucasian Crouzon syndrome patients, 41 Caucasian controls) and measured using Materialise software. The maxillary and mandibular volumes of Asian patients were both reduced by 19% (P = 0.102 and P = 0.187), and those of Caucasian patients were reduced by 15% (P = 0.142) and 14% (P = 0.211) when compared to the respective race-specific controls. Maxilla length of Asian patients was reduced by 6.36 mm (14%, P = 0.003), while the reduction in Caucasian patients was 4.88 mm (10%, P = 0.038). ANS was retracted 11.99 mm (P < 0.001) in Asian patients and 11.54 mm (P < 0.001) in Caucasian patients. The ANB angle was narrowed by 13.17 degrees (P < 0.001) in Asian patients compared to Asian controls, and by 7.02 degrees (P < 0.001) in Caucasian patients compared to Caucasian controls. The retrusive midface profiles of Asian and Caucasian Crouzon syndrome look similar; both result from the combined effect of hypoplastic size and backward displacement. However, the insufficiency was found to be more a failure of the anteroposterior maxillary length in Asian patients, and more due to posterior maxillary positioning in Caucasian patients. Therefore, prognathism in Crouzon syndrome patients is more likely caused by displacement rather than elongation of mandibular length in both races. Crouzon syndrome results in the same extent of overall volume deficiency of the maxilla and mandible in these races.
- Anterior convex lateral orbital wall: distinctive morphology in Apert syndrome(2018) LU, X.; FORTE, A. J.; SAWH-MARTINEZ, R.; WU, R.; CABREJO, R.; STEINBACHER, M.; ALPEROVICH, M.; ALONSO, N.; PERSING, J. A.Bony malformations of the orbit and alterations to the soft tissue in Apert syndrome contribute to ophthalmic dysfunction. Recognised structural malformation of the sphenoid and ethmoid sinuses, together with corresponding deformities in the anterior and middle cranial base, are characteristic. Our aim was to explore the underlying structural components of disfigurement and the consequent development of the orbit in patients with Apert syndrome over time by studying 18 preoperative computed tomographic (CT) scans of affected patients and 36 scans from controls. Cephalometric measurements related to the orbit were collected, and analysed with Materialise software. The patients with Apert syndrome had larger than normal external orbital horizontal angles between the ages of 6 months and 2 years. The inside horizontal angle was narrower at 16.36 degrees before 6 months, and continued to decrease into adulthood. The ethmoid and sphenoid side angles in affected patients consistently increased, starting at 7.93% and 14.68% of the external horizontal angle, respectively, during the first 6 months of age, and becoming 20.55% and 11.69%, respectively, in adulthood. In unaffected patients, both angles were less than 3% of the external horizontal angle overall. The orbital vertical angle also changed synchronously, with increasingly wide lateral orbits and shortened anteroposterior orbits. The anterior protrusion of the lateral orbital wall resulted from superior and posterior rotation of a curved, greater wing of the sphenoid, while the widened median orbital wall was caused by the widened ethmoid sinus. These resulted in bony deformities of the orbit, which predisposed to the visual impairments of Apert syndrome.
- Does different cranial suture synostosis influence orbit volume and morphology in Apert syndrome?(2022) LU, X.; FORTE, A. J.; ALPEROVICH, M.; ALONSO, N.; PERSING, J. A.This study was performed to compare the orbital and peri-orbital morphological variations in Apert syndrome patients with different cranial vault suture synostosis, so as to provide an anatomic basis for individualized surgical planning. Computed tomography scans of 57 unoperated Apert syndrome patients and 59 controls were subgrouped as follows: type I, bilateral coronal synostosis; type II, pansynostosis; type III, perpendicular combinations of cranial vault suture synostoses. Orbit bony cavity volume was significantly reduced in type I and type II, by 19% (P < 0.001) and 24% (P < 0.001), respectively. However, the reduction of orbital cavity volume in type III did not reach statistical significance. Globe volume projection beyond the orbital rim, however, increased by 76% (P < 0.001) in type III, versus an increase of 54% (P < 0.001) in type I and 53% (P < 0.001) in type II, due to different ethmoid and sphenoid bone malformations. Maxillary bone volume was only significantly reduced in type I bicoronal synostosis (by 24%, P = 0.048). Both type I and type II developed relatively less zygoma and sphenoid bone volume. Different cranial vault suture synostoses have varied influence on peri-orbital development in Apert syndrome. Instead of mitigating the abnormalities resulting from bicoronal synostosis in type I, additional midline suture synostosis worsens the exorbitism due to a more misshaped ethmoid.
- 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.
- Racial disparity in orbital morphology and spatial relations in unoperated Crouzon patients(2021) LU, X.; FORTE, A. J.; FAN, F.; ZHANG, Z.; TENG, L.; YANG, B.; ALPEROVICH, M.; STEINBACHER, D. M.; ALONSO, N.; PERSING, J. A.The altered orbital morphology of patients with Crouzon syndrome could have an impact on the planning of treatment in diverse populations, in spite of the confounding influences of different cranial suture synostosis. This study attempted to explore the differences in orbital characteristics between Asian, Caucasian patients with Crouzon syndrome, associated pansynostosis. Eighty-six preoperative computed tomograms (CT) were included (Asian Crouzon syndrome: n=10; Asian controls: n=24; Caucasian Crouzon syndrome: n=19; Caucasian controls: n=33) and measured using Mimics software (Materialise). Unique cephalometric measurements related to orbital morphology and position were designed. Crouzon syndrome and race both have interactive effects on protrusion of the globe (p=0.009) and medial horizontal angle (p=0.012) in the assessment of orbital morphology. They also interact in the width of the ethmoid sinus (p=0.009) and influence bilateral orbital relations. The anteroposterior orbital roof in Caucasian patients with Crouzon syndrome was shortened by 4.09 mm (p=0.002) compared with Caucasian controls. However, in Asian patients this dimension developed normally. The anteroposterior orbital floor was significantly reduced to a similar extent in both Asian and Caucasian Crouzon patients (both p<0.001). The visual axes in Caucasian patients with Crouzon showed more inferior rotation, by 4.38 degrees (p=0.031) than they did in Caucasian controls, but did not achieve a statistically significant difference in other comparisons. The effect of Crouzon syndrome on orbital malformation and placement is influenced by race, especially structures related to the ethmoid sinus. Asian patients need greater infraorbital advancement for better correction of orbital proptosis and aesthetic benefits, but may require less fronto-orbital advancement than Caucasian patients.
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