CLAUDIO ROBERTO CERNEA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina
36 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 36
- Retrograde Approach to Facial Nerve: Indications and Technique(2012) HOJAIJ, Flavio C.; PLOPPER, Caio; CERNEA, Claudio R.
article 0 Citação(ões) na Scopus Evaluation of a Training Model for Cervical Trauma Using Cadavers(2019) SIMOES, Cesar Augusto; JR, Marcelo A. F. Ribeiro; PORTILHO, Ana Sara; FAVARO, Murillo; SANTIN, Stephanie; FERRADA, Paula; DEDIVITIS, Rogerio Aparecido; CERNEA, Claudio Roberto- Quantitative analysis of lymph nodes in neck dissection specimens. Morphologic study(2016) CAPELLI, Fabio de Aquino; PAES, Vitor Ribeiro; MACHADO, Mariangela Marinheiro; MENEZES, Camila Lohmann; SILVA, Pablo Rodrigo Andrade da; SIQUEIRA, Sheila Aparecida Coelho; ALVES, Venancio Avancini Ferreira; MATOS, Leandro Luongo; CERNEA, Claudio RobertoPURPOSE: To quantify the amount of lymph nodes harvested in modified radical neck dissection. METHODS: Cross-sectional anatomical study conducted in 28 non-preserved cadavers. RESULTS: The mean number of lymph nodes found in each nodal level of the 56 modified radical neck dissections performed were: level IA - 1.5 (95% CI: 1.1 - 1.8), level IB - 2.5 (95% CI: 2.1 - 2.9), level IIA - 7.2 (95% CI: 6.0 - 8.5), IIB level - 6.5 (95% CI: 5.5 - 7.4), level III - 6.6 (95% CI: 5.7 - 7.4), level IV - 8.6 (95% CI: 7.1 - 10.1), level V - 11 (95% CI: 9.2 - 12.7), totalizing 43.8 lymph nodes (95% CI: 40.3 - 47.4). CONCLUSION: The results defined a parameter in relation to the minimum recommended nodal yield in a modified radical neck dissection, as well as the number of lymph nodes in each level of this dissection, performed in clinical practice.
- Use of Single Chimeric Free Flaps or Double Free Flaps for Complex Head and Neck Reconstruction(2021) RAGHURAM, Anjali C.; MANFRO, Gabriel; TEIXEIRA, Gilberto V.; CERNEA, Claudio R.; DIAS, Fernando L.; MARCO, Mauricio De; POLO, Roger; ABU-GHNAME, Amjed; MARICEVICH, MarcoBackground Free flaps have become the preferred reconstructive approach to restore form and function for patients presenting with complex head and neck defects. For composite, complex defects for which a regular free flap might not meet all reconstructive demands, adequate coverage can be achieved with either a single chimeric free flap or a double free flap. Methods We performed a single-center retrospective chart review of patients who underwent either single chimeric free flap or double free flap reconstruction. Indications for reconstruction included defects resultant from head and neck tumor or osteoradionecrosis resections. We extracted the following variables: tumor location, defect, flap(s) performed, and postoperative complications. Unpaired t -tests were performed to evaluate for statistically significant differences in complications encountered between the single chimeric versus the double free flap patient groups. Results In our series of 44 patients, a total of 55 single chimeric and double free flaps were performed. We found no significant difference in overall complications ( p =0.41) or flap/skin paddle loss ( p =0.45) between the groups. There were three total flap losses; two patients underwent successful salvage procedures and one patient died. The anterolateral thigh (ALT) was the most common free flap (70%) used in our series, and 98% of our patients completed successful reconstruction. Conclusion As the initial reconstructive effort is critical for achieving favorable long-term outcomes in complex head and neck cases, effective and safe techniques should be employed to ensure optimal delivery of care. We believe that single chimeric and double free flap techniques should be appropriately utilized as part of the armamentarium of head and neck reconstructive microsurgeons.
- How to Avoid Injury of the External Branch of Superior Laryngeal Nerve(2012) CERNEA, Claudio R.; DEDIVITIS, Rogerio A.; FERRAZ, Alberto R.; BRANDAO, Lenine G.
- Negative and positive predictive values of nerve monitoring in thyroidectomy(2012) CERNEA, Claudio R.; BRANDAO, Lenine G.; HOJAIJ, Flavio C.; CARLUCCI JR., Dorival De; BRANDAO, Jose; CAVALHEIRO, Beatriz; SONDERMANN, AdrianaBackground Recurrent nerve injury is 1 of the most important complications of thyroidectomy. During the last decade, nerve monitoring has gained increasing acceptance in several centers as a method to predict and to document nerve function at the end of the operation. We evaluated the efficacy of a nerve monitoring system in a series of patients who underwent thyroidectomy and critically analyzed the negative predictive value (NPV) and positive predictive value (PPV) of the method. Methods. NIM System efficacy was prospectively analyzed in 447 patients who underwent thyroidectomy between 2001 and 2008 (366 female/81 male; 420 white/47 nonwhite; 11 to 82 years of age; median, 43 years old). There were 421 total thyroidectomies and 26 partial thyroidectomies, leading to 868 nerves at risk. The gold standard to evaluate inferior laryngeal nerve function was early postoperative videolaryngoscopy, which was repeated after 4 to 6 months in all patients with abnormal endoscopic findings. Results. At the early evaluation, 858 nerves (98.8%) presented normal videolaryngoscopic features after surgery. Ten paretic/paralyzed nerves (1.2%) were detected (2 unexpected unilateral paresis, 2 unexpected bilateral paresis, 1 unexpected unilateral paralysis, 1 unexpected bilateral paralyses, and 1 expected unilateral paralysis). At the late videolaryngoscopy, only 2 permanent nerve paralyses were noted (0.2%), with an ultimate result of 99.8% functioning nerves. Nerve monitoring showed absent or markedly reduced electrical activity at the end of the operations in 25/868 nerves (2.9%), including all 10 endoscopically compromised nerves, with 15 false-positive results. There were no false-negative results. Therefore, the PPV was 40.0%, and the NPV was 100%. Conclusions. In the present series, nerve monitoring had a very high PPV but a low NPV for the detection of recurrent nerve injury. (C) 2011 Wiley Periodicals, Inc. Head Neck 34: 175-179, 2012
article 4 Citação(ões) na Scopus The surgical management of parotid gland tumours(2015) CASTRO, M. A. F.; DEDIVITIS, R. A.; GUIMARAES, A. V.; CERNEA, C. R.; BRANDAO, L. G.Background: The parotid tissue can give rise to a large variety of benign and malignant neoplasms. The objective of this study was to describe the management and outcome of parotid gland tumours over a 15-year period. Method: The records of consecutive patients treated by parotid gland excision from January 1995 to December 2008 were reviewed retrospectively. Data recorded were age, gender, history, physical findings, surgical procedure, fine-needle aspiration biopsy (FNAB), final pathological diagnosis and complications. Results: The vast majority of patients (306) had benign neoplasms, and 14 patients had malignant neoplasms. Overall, pleomorphic adenoma contributed to 76% of the lesions, and Warthin's tumour to 17%. The sensitivity and specificity of FNAB was 79% and 100%, respectively. There were 15 cases of marginal mandibular transitory paresis and 12 cases of seroma. Marginal mandibular definitive paralysis was observed in three cases with malignant tumour. Conclusion: Standardised parotidectomy is a safe operation, with a low complication rate.- Biometric measurements involving the terminal portion of the thoracic duct on left cervical level IV: an anatomic study(2016) LOUZADA, Andressa Cristina Sposato; LIM, Soo Jin; PALLAZZO, Jaqueline Fabiano; SILVA, Viviane Passarelli Ramin; OLIVEIRA, Ruan Vitor Silva de; YOSHIO, Alvaro Masahiro; ARAUJO-NETO, Vergilius Jose Furtado de; LEITE, Ana Kober Nogueira; SILVEIRA, Andre; SIMOES, Cesar; BRANDAO, Lenine Garcia; MATOS, Leandro Luongo de; CERNEA, Claudio RobertoTo determine the point of entrance of the thoracic duct in the venous system, as well as to evaluate some biometric measurements concerning its terminal portion, we conducted an anatomic study on 25 non-preserved cadavers. The termination of the thoracic duct occurred on the confluence between the left internal jugular vein and the left subclavian vein in 60 % of the individuals. The average results for the biometric measurements were: distance between the end of left internal jugular vein and omohyoid muscle 31.2 +/- A 2.7 mm; distance between the end of thoracic duct and the left internal jugular vein 0.0 +/- A 0.0 mm; distance between the end of thoracic duct and the left subclavian vein 3.6 +/- A 1.0 mm; distance between the end of thoracic duct and the left brachiocephalic vein 10.7 +/- A 3.1 mm. Moreover, it was identified that the left internal jugular vein length in level IV, measured between its entrance in the left subclavian vein and the omohyoid muscle, was able to predict the termination of the thoracic duct on the junction between the left internal jugular vein and the left subclavian vein (OR = 2.99) with high accuracy (79.3 %). In addition, the left internal jugular vein length at level IV was able to predict the localization of thoracic duct termination. Thus, this finding has practical value in minimizing the risk for a potential chyle leak during or after a left-sided neck dissection.
- Supraclavicular flap as a salvage procedure in reconstruction of head and neck complex defects(2019) ALVES, Helio R. N.; FARIA, Jose Carlos Marques de; SANTOS, Rafael Varella dos; CERNEA, Claudio; BUSNARDO, Fabio; GEMPERLI, RolfThe supraclavicular island flap (SCIF) is an interesting therapeutic option in head and neck reconstruction. Since popularized by Pallua in the late 90s, several clinical series have been published showing its versatility and usefulness. However, only a few studies have focused on factors associated with complications from SCIF use. In this study, we analyzed the factors contributing to SCIF unreliability. We performed a retrospective review of the data of 87 patients undergoing SCIF reconstruction between 2008 and 2015. No significant differences in mean complication rates were observed when the SCIF was used for primary or salvage reconstruction (28% versus 25%, respectively, p = 0.816) or for cutaneous or intraoral reconstruction (27% versus 28%, respectively, p= 0.932). Flap folding, preoperative radiotherapy, and microsurgery were associated with significantly increased complication rates (p =0.002, p= 0.043, and p= 0.001, respectively), whereas smoking (p =0.431) had no impact with regard to this. In conclusion, the SCIF is a versatile flap and an important therapeutic tool for use in salvage surgeries, particularly in those performed in patients with poor clinical conditions and limited flap options.
- Lymph node distribution in the central compartment of the neck: An anatomic study(2014) TAVARES, Marcos Roberto; CRUZ, Jose Arnaldo Shiomi da; WAISBERG, Daniel Reis; TOLEDO, Sergio Pereira de Almeida; TAKEDA, Flavio Roberto; CERNEA, Claudio Roberto; CAPELOZZI, Vera Luiza; BRANDAO, Lenine GarciaBackground. Dissection of the central compartment of the neck (CCN) is performed for proven or suspected lymph node metastases of thyroid carcinoma. During this procedure, the recurrent laryngeal nerves and the parathyroid glands are at risk. The purpose of this study was to determine the anatomic distribution of the lymph nodes in the CCN. Methods. The anatomic distribution of the lymph nodes in the CCN was studied by dissection of 30 fresh cadavers. The soft tissue between the cricoid cartilage and the innominate vein, carotid arteries, and prevertebral fascia was removed and divided according to CCN sublevels. Nodules were identified by palpation in the specimen and sent for pathological examination. Results. Three to 44 (18.5 +/- 10.29) nodules were identified macroscopically. Two to 42 nodules were confirmed as lymph nodes after microscopic examination. The lymph node distribution was as follows: precricoid: 0 to 2 (0.9 +/- 0.72); pretracheal: 1 of 35 (12.4 +/- 8.19); lateral to the right recurrent laryngeal nerve (RLN): 0 to 11 (3.4 +/- 2.34); and lateral to the left: 0 to 4 (1.7 +/- 1.30). Twenty-six parathyroid glands were removed by 14 dissections. The innominate vein was found at 15 mm above the superior border of the clavicles to 35 mm below on the left side of the neck and 5 to 45 mm on the right side. Conclusion. The number of confirmed lymph nodes in the central neck varied from 2 to 42. Sixty-seven percent of the lymph nodes were in the pretracheal sublevel. There was no division between level VI and VII lymph nodes. Additionally, the innominate vein was found to be from 15 mm above the superior border of the clavicles to 35 mm below on the left side of the neck and 5 to 45 mm on the right side. Parathyroid glands were identified to be far away from the thyroid gland. (C) 2014 Wiley Periodicals, Inc.