Fong Siu Lai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 187-196). / Acknowledgement --- p.v / Abstract --- p.vii / Chapter Chapter One --- INTRODUCTION --- p.1 / Chapter Chapter Two --- LITERATURE REVIEW --- p.4 / Chapter 1 --- STRUCTURE OF SKIN --- p.4 / Chapter 1.1 --- epidermis / Chapter 1.1.1 --- stratum corneum / Chapter 1.1.2 --- stratum lucidum / Chapter 1.1.3 --- stratum granulosum / Chapter 1.1.4 --- stratum spinosum / Chapter 1.1.5 --- stratum germinativum / Chapter 1.2 --- dermis / Chapter 1.2.1 --- collagen / Chapter 1.2.2 --- elastin / Chapter 1.2.3 --- reticulin / Chapter 1.2.4 --- fibroblasts / Chapter 1.2.5 --- ground subsatnce / Chapter 1.3 --- dermo-epidermal junction / Chapter 1.4 --- skin appendages / Chapter 1.4.1 --- hair / Chapter 1.4.2 --- nails / Chapter 1.4.3 --- glands / Chapter 1.5 --- cutaneous vascular system / Chapter 1.5.1 --- cutaneous blood flow and its significance / Chapter 1.5.2 --- cutaneous lymphatic flow / Chapter 2 --- FUNCTIONS OF SKIN --- p.24 / Chapter 2.1 --- protection / Chapter 2.2 --- sensation / Chapter 2.3 --- thermal regulation / Chapter 2.4 --- absorption / Chapter 2.5 --- protection against ultraviolet radiation / Chapter 2.6 --- storage / Chapter 3 --- BIOMECHANICS OF SKIN --- p.28 / Chapter 3.1 --- skin elasticity and the physical variation / Chapter 3.2 --- mechanical properties / Chapter 3.2.1 --- tensile strength / Chapter 3.2.2 --- distensibility / Chapter 3.2.3 --- Young's modulus / Chapter 3.2.4 --- visco-elastic character / Chapter 3.2.5 --- hysteresis / Chapter 3.3 --- fibre orientation / Chapter 3.4 --- mechanical considerations / Chapter 3.5 --- physiological factors / Chapter 3.6 --- clinical application / Chapter 4 --- PHYSIOLOGICAL RESPONSE OF HUMAN SKIN --- p.47 / Chapter 4.1 --- response to mechanical loading / Chapter 4.1.1 --- triple response / Chapter 4.1.2 --- reactive hyperaemia / Chapter 4.2 --- thermal response / Chapter 4.2.1 --- skin temperature / Chapter 4.2.2 --- response to heat / Chapter 4.2.3 --- response to cold / Chapter 4.3 --- local tissue response to burn / Chapter Chapter Three --- BACKGROUND OF THE PRESENT STUDY --- p.55 / Chapter 1 --- BURN INJURIES --- p.55 / Chapter 1.1 --- nature / Chapter 1.2 --- depth / Chapter 1.3 --- extent / Chapter 1.4 --- location of burn / Chapter 1.5 --- age / Chapter 1.6 --- "associated major trauma, inhalation injury" / Chapter 1.7 --- general health status / Chapter 2 --- WOUND HEALING PROCESS --- p.65 / Chapter 2.1 --- role of collagen in wound healing / Chapter 2.2 --- role of oxygen in wound healing / Chapter 2.3 --- role of fibroblasts and myofibroblasts in wound healing / Chapter 2.4 --- role of mast cells in wound healing / Chapter 3 --- HYPERTROPHIC SCAR --- p.71 / Chapter 3.1 --- aetiological factors / Chapter 3.1.1 --- age / Chapter 3.1.2 --- time for wound healing / Chapter 3.1.3 --- racial factor / Chapter 3.1.4 --- depth of injury / Chapter 3.1.5 --- location / Chapter 3.1.6 --- tension / Chapter 3.2 --- characteristics / Chapter 3.3 --- pathogenesis of hypertrophic scar / Chapter 3.3.1 --- blood flow / Chapter 3.3.2 --- tissue gas / Chapter 3.3.3 --- filamentous material / Chapter 3.3.4 --- mast cells / Chapter 3.3.5 --- chondroitin sulfate / Chapter 3.3.6 --- enzyme proline hydroxylase / Chapter 3.4 --- histopathology / Chapter 3.5 --- response towards pressure / Chapter 4 --- TREATMENT OF POST-BURN HYPERTROPHIC SCAR AND THEIR RESPONSE --- p.92 / Chapter 4.1 --- surgery / Chapter 4.2 --- radiotherapy / Chapter 4.3 --- ultrasonics / Chapter 4.4 --- chemotherapy/ intralesional injection of steroid / Chapter 4.5 --- pressure therapy / Chapter 4.6 --- topical silicone gel / Chapter 4.6.1 --- mechanics / Chapter 4.6.2 --- bacteriology / Chapter 4.6.3 --- water-vapour transmission rate / Chapter 4.6.4 --- appearance in the Scanning Electronic Microscope / Chapter 4.7 --- prevention of hypertrophic scar and scar contracture / Chapter 5 --- ASSESSMENT TOOLS FOR HYPERTROPHIC SCAR AND THE CLINICAL APPLICATION --- p.105 / Chapter 5.1 --- clinical observation of the appearance / Chapter 5.2 --- ultrasonography and thickness / Chapter 5.2.1 --- ultrasound / Chapter 5.2.2 --- pulse-echo distance measurement / Chapter 5.2.3 --- echo generation / Chapter 5.2.4 --- transducer beam pattern / Chapter 5.2.5 --- ultrasound instrumentation / Chapter 5.2.6 --- application of ultrasound in the study of hypertrophic scar thickness / Chapter 5.3 --- elastometry (Cutometer) and elasticity / Chapter 5.4 --- application of elastometry / Chapter Chapter Four --- OBJECTIVES & METHODOLOGY OF THE STUDY --- p.123 / Chapter 1 --- Objectives of the study --- p.123 / Chapter 2 --- Study subjects --- p.123 / Chapter 3 --- Methodology --- p.125 / Chapter 4 --- Assessment of thickness of hypertrophic scar --- p.128 / Chapter 5 --- Assessment of visco-elasticity of hypertrophic scar --- p.130 / Chapter 6 --- Clinical rating scale --- p.133 / Chapter 7 --- Study of normal skin as control --- p.133 / Chapter 8 --- Reliability of the ultrasound and cutometer measurement --- p.134 / Chapter Chapter Five --- RESULTS --- p.136 / Chapter 1 --- Inter- and intra- examiner variations of the ultrasound and cutometer measurement --- p.136 / Chapter 2 --- Comparison with normal skin control --- p.138 / Chapter 3 --- Results of ultrasonographic measurements of thickness of hypertrophic scar and its correlation with the clinical grading --- p.139 / Chapter 4 --- Results of Cutometer reading (visco-elastic properties) and the correlation with clinical grading --- p.142 / Chapter 5 --- Observation from raw data --- p.152 / Chapter Chapter Six --- DISCUSSION --- p.154 / Chapter 1 --- Measuring thickness with ultrasonography and clinical grading --- p.157 / Chapter 2 --- Elastic properties of hypertrophic scar and clinical grading --- p.158 / Chapter 3 --- The predictive value of the ultrasonography and elastometry through monthly longitudinal measurement --- p.161 / Chapter 4 --- Inter- and intra- examinar reliability of the ultrasonography and elastometry in the assessmetn of post-burn hypertrophic scar --- p.164 / Chapter 5 --- "The use of a composite ""Visco-elasticity-Thickness Chart"" and case studies" --- p.165 / Chapter 6 --- Limitations of the study --- p.182 / Chapter Chapter Seven --- CONCLUSION AND RECOMMENDATION FOR FURTHER STUDY --- p.184 / REFERENCES --- p.187 / APPENDICES --- p.197 / Appendix 1 Patients' record --- p.197 / Appendix 2 Record of the scars --- p.200 / Appendix 3 Clinical Grading of the hypertrophic scar --- p.202 / Appendix 4 Measurement of the visco-elastic properties --- p.204 / Appendix 5 Ultrasonic measurements of the hypertrophic scars --- p.235 / Appendix 6 List of graphs --- p.237 / Appendix 7 List of figures --- p.238 / Appendix 8 List of tables --- p.240

by Cheng Chi Wa. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 110-120). / Abstract also in Chinese. / Title --- p.i / Abstract --- p.ii / Acknowledgement --- p.iv / Abbreviations --- p.v / Abbreviation Table for Amino Acids --- p.vi / Table of Contents --- p.vii / List of Figures --- p.xii / List of Tables --- p.xv / Chapter Chapter 1 --- Introduction --- p.1 / Chapter Chapter 2 --- Literature review --- p.2 / Chapter Part I --- Hypertrophic Scar / Chapter 2.1 --- Definition of hypertrophic scar --- p.2 / Chapter 2.2 --- Pathology --- p.2 / Chapter 2.3 --- Epidemiology findings --- p.3 / Chapter 2.3.1 --- Ethnicity --- p.3 / Chapter 2.3.2 --- Age --- p.3 / Chapter 2.3.3 --- Body location --- p.3 / Chapter 2.4 --- Mechanism of cutaneous wound healing --- p.4 / Chapter 2.4.1 --- Phase I - Haemostasis and inflammation --- p.4 / Chapter 2.4.1.1 --- Haemostasis --- p.6 / Chapter 2.4.1.2 --- Early phase of inflammation --- p.6 / Chapter 2.4.1.3 --- Late phase of inflammation --- p.7 / Chapter 2.4.2 --- Phase II - Re-epithelialization --- p.7 / Chapter 2.4.2.1 --- Migration of epidermal keratinocytes --- p.8 / Chapter 2.4.2.2 --- Migration of fibroblasts --- p.8 / Chapter 2.4.2.3 --- Angiogenesis --- p.9 / Chapter 2.4.3 --- Phase III - Tissue remodeling --- p.10 / Chapter 2.4.3.1 --- Cell maturation and apoptosis --- p.10 / Chapter 2.4.3.2 --- Exrtracellular matrix remodeling --- p.10 / Chapter 2.5 --- Alteration of wound healing - Possible pathogenic factors of hypertrophic scar --- p.11 / Chapter 2.5.1 --- Changes in Phase I-Inflammation --- p.13 / Chapter 2.5.2 --- Changes in Phase II - Re-epithelialization/ tissue formation --- p.14 / Chapter 2.5.3 --- Changes in Phase III - Tissue remodeling --- p.15 / Chapter 2.6 --- The Role of fibroblasts in the formation of hypertrophic scar --- p.16 / Chapter 2.6.1 --- Functions of fibroblasts in wound healing --- p.16 / Chapter 2.6.2 --- Suggested aetiological role in the formation of hypertrophic scar fibroblasts --- p.16 / Chapter 2.6.2.1 --- Fibroproliferation disorder --- p.18 / Chapter 2.6.2.2 --- Extracellular Matrix remodeling disorder --- p.18 / Chapter a) --- CoUaqen --- p.18 / Chapter b) --- Proteoglycan --- p.19 / Chapter 2.6.2.3 --- Other differentially expressed factors --- p.20 / Chapter 2.7 --- Treatment of hypertrophic scar --- p.21 / Chapter Part II --- Differential Display / Chapter 2.8 --- Current approaches for the studies of differential gene expression --- p.23 / Chapter 2.9 --- Comparison amongst different approaches --- p.23 / Chapter 2.10 --- The strategy of Differential Display RT-PCR (DDRT-PCR) --- p.24 / Chapter 2.11 --- The application of DDRT-PCR to identify differentially expressed genes --- p.26 / Chapter Chapter 3 --- Aims and Strategies --- p.27 / Chapter Chapter 4 --- Methods and Materials --- p.29 / Chapter 4.1 --- Materials --- p.29 / Chapter 4.2 --- Clinical specimen collection --- p.31 / Chapter 4.3 --- Primary explant culture --- p.31 / Chapter 4.4 --- Immunohistochemical staining --- p.32 / Chapter 4.5 --- Total RNA extraction --- p.32 / Chapter 4.6 --- DNase I digestion --- p.33 / Chapter 4.7 --- Differential display-RTPCR (DD-RTPCR) --- p.33 / Chapter 4.8 --- Polyacrylamide gel electrophoresis --- p.34 / Chapter 4.9 --- Reamplification of the differentially expressed fragments --- p.35 / Chapter 4.10 --- Molecular cloning of the DNA fragments --- p.35 / Chapter 4.11 --- Screening and miniprep of the plasmid DNA --- p.36 / Chapter 4.12 --- Cycle sequencing --- p.38 / Chapter 4.13 --- Data analysis --- p.38 / Chapter 4.14 --- RT-PCR --- p.39 / Chapter 4.15 --- Probe labeling by PCR with DIG-dUTP --- p.40 / Chapter 4.16 --- Southern blotting --- p.41 / Chapter Chapter5 --- p.42 / Chapter 5.1 --- Clinical Specimen --- p.42 / Chapter 5.2 --- Primary explant culture --- p.42 / Chapter 5.3 --- The total RNA extraction from the cultured fibroblast --- p.45 / Chapter 5.4 --- Differential display RT-PCR --- p.47 / Chapter 5.5 --- Reamplification of the DNA fragments --- p.49 / Chapter 5.6 --- Molecular cloning of the DNA fragment --- p.53 / Chapter 5.7 --- DNA sequencing of the inserts --- p.58 / Chapter 5.8 --- Analysis and identification of the DNA sequences --- p.62 / Chapter 5.9 --- Semi-quantitative RT-PCR analysis of the differentially expressed genes --- p.76 / Chapter Chapter6 --- p.87 / Chapter Part I --- Validity of the Findings / Chapter 6.1 --- The Limitation of Tissue Sampling --- p.87 / Chapter 6.2 --- Tissue Culture model --- p.88 / Chapter 6.3 --- Differential Display RT-PCR --- p.89 / Chapter 6.3.1 --- Identification of the differentially expressed genes --- p.89 / Chapter 6.3.2 --- Confirmation of the differentially expressed genes --- p.91 / Chapter 6.4 --- Technical difficulties and Limitations --- p.92 / Chapter 6.4.1 --- Sampling --- p.92 / Chapter 6.4.2 --- Primary tissue culture --- p.93 / Chapter Part II --- Significance and Future Studies / Chapter 6.5 --- Down-regulation of thrombospondin 1 (TSP 1) in the hypertrophic scar fibroblasts --- p.94 / Chapter 6.6 --- Biochemical and biological functions of TSP1 --- p.96 / Chapter 6.6.1 --- The biochemical functions of TSP1 --- p.96 / Chapter 6.6.2 --- The biochemical functions of TSP1 --- p.97 / Chapter 6.7 --- The role of TSP 1 in the pathogenesis of hypertrophic scar --- p.98 / Chapter 6.7.1 --- Down-regulation of TSP 1 may be responsible for the excessive microvessels in hypertrophic scar --- p.98 / Chapter 6.7.2 --- Down-regulation of TSP 1 may be responsible for the failure of the apoptosis of the fibroblasts in the hypertrophic scar --- p.101 / Chapter 6.8 --- Expression of TSP 1 during wound healing --- p.103 / Chapter 6.9 --- Expression of TSP 1 in hypertrophic scarring --- p.107 / Chapter 6.10 --- Cytochrome b561 and its biological function --- p.109 / Chapter 6.11 --- Future studies --- p.108 / Chapter 6.11.1 --- The expression of TSP 1 in hypertrophic scarring and normal wound healing --- p.108 / Chapter 6.11.2 --- The expression of cytochrome b561 --- p.109 / Chapter 6.11.3 --- A full scale study of differential display RT-PCR --- p.109 / References --- p.110 / Appendices --- p.121 / Chapter I --- The complete mRNA sequence of thrombospondin1 precursor --- p.121 / Chapter II --- The mRNA sequence of cytochrome b561 --- p.123

Orientador: Agrício Nubiato Crespo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T18:54:33Z (GMT). No. of bitstreams: 1 Maunsell_RebeccaChristinaKathleen_D.pdf: 9219065 bytes, checksum: 7a2dbabb91abc053959ca5648b8d5f88 (MD5) Previous issue date: 2012 / Resumo: Alterações benignas das pregas vocais são causas importantes de disfonia e compreendem parte significativa dos casos atendidos pelo otorrinolaringologista na prática diária. Nas últimas décadas diversas técnicas foram descritas para o tratamento cirúrgico destas lesões, com sucesso variável. Para uma excelente qualidade vocal é necessária a preservação do complexo movimento ondulatório da superfície das pregas vocais. A presença de cicatriz nas pregas vocais pode comprometer o resultado da cirurgia e constitui hoje um dos principais desafios da fonocirurgia. Existem inúmeros tratamentos das cicatrizes das pregas vocais e, ainda hoje, com resultados bastante insatisfatórios. Diversos autores têm estudado o processo cicatricial procurando meios de intervir para interromper a produção de substâncias que alterem definitivamente as propriedades vibratórias das pregas vocais. Laringologistas com grandes séries de pacientes tratados cirurgicamente descrevem resultados excelentes com uma ou outra variação de suas técnicas cirúrgicas. Faltam, no entanto, estudos controlados que confirmem o melhor efeito de uma técnica sobre outra. Relatos clínicos tendem a favorecer uma ou outra técnica conforme a experiência e formação do cirurgião, disponibilidade de material e instrumental cirúrgico. Existem divergências quanto à necessidade de fechamento da incisão por meio de sutura, utilização de cola de fibrina ou permitir que a reepitelização ocorra por segunda intenção. Objetivo: Comparar os aspectos cicatriciais resultantes da técnica de microflap das pregas vocais quando utilizadas cola de fibrina, sutura e cicatrização por segunda intenção. Material e Métodos: Realizou-se estudo experimental em coelhos comparando as técnicas: microflap, microflap e seu fechamento com sutura e microflap e seu fechamento com cola de fibrina com o objetivo de avaliar os efeitos de cada técnica na cicatrização das pregas vocais. A cicatrização foi avaliada histologicamente em três tempos pós-operatórios: sete dias, trinta dias e três meses. Avaliou-se a concentração de colágeno, presença de células inflamatórias, espessuras do epitélio e da lâmina própria. Resultados: As três técnicas provocaram um aumento significativo na concentração de colágeno em comparação com grupo controle normal, não operado. A cicatrização por segunda intenção provocou menor concentração de colágeno aos 90 dias. Todas as técnicas apresentaram aumento significativo da espessura epitelial uma semana após as intervenções. O grupo submetido a sutura atingiu níveis semelhantes ao do grupo controle após 90 dias. Após sete dias a espessura da lâmina própria obteve valores próximos aos normais com todas as técnicas. Após 90 dias apenas o grupo submetido a confecção do microflap e uso de cola manteve espessura semelhante ao grupo controle, todos os outros tiveram uma significativa redução da espessura. O número de células inflamatórias aumentou significativamente com todas as técnicas exceto nas pregas vocais submetidas a microflap e cola após 30 dias e, também, nas pregas vocais submetidas à microflap e sutura após 90 dias. Conclusão: Apesar do uso da cola de fibrina e suturas em microfonocirurgia serem seguros e resultar em bons resultados conforme relatados por outros autores, ainda não há evidência científica que justifique seu uso / Abstract: Benign lesions of the vocal cords are an important cause of dysphonia and represent a significant number of patients attended by the otolaryngologist specialist. Several techniques have been described for the surgical treatment of these lesions with variable outcome. Satisfactory vocal quality is imperative when considering a good or bad surgical outcome. To achieve satisfactory vocal quality the complex vibratory movement of the vocal folds must be preserved and kept at its best. Scarring of the vocal folds may compromise vocal outcome and this is the main challenge in microphonosurgery nowadays. Several treatments have been described to solve the problem of scar formation on the vocal folds. Nevertheless, satisfactory long-term vocal quality has been described as quite disappointing. Studies have focused on the early stages of the scarring process of the vocal cords and on the refinement of surgical techniques to prevent or minimize scar formation. There is, a lack of studies comparing surgical techniques and their impact on scar formation. Clinical reports tend to favor one or other technique but these vary depending on the surgeons personal experience and training, instrumentation and material availability. There is a consensus on the need of maximum preservation of the epithelium and superficial lamina propria and minimal exposure of vocal ligament. On the other hand the need of microsuture or glue to cover the wound is controversial. Objective: To compare scarring characteristics of microflap in vocal folds when left to heal by second intention and when the defect was closed with sutures or fibrin glue. Material and methods: A comparative experimental study comparing the microflap technique alone, microflap with microsuture and microflap with fibrin glue was carried out. The experiments were performed out on a rabbit model to evaluate the effects of each technique on vocal cord healing and scar formation. Healing was evaluated histologically one week, 30 and 90 days after surgical intervention. Scar formation was evaluated based on: collagen concentration, inflammatory cell infiltration, epithelium and lamina propria thickness. Results: A significant increase in collagen concentration was observed with all three techniques when compared to normal control vocal folds. Vocal folds submitted to microflap alone presented the smallest values for collagen concentration at 90 days. Conclusion: All techniques showed significant increase in epithelium thickness one week after the procedures. At 90 days epithelium thickness had decreased in all techniques but reached values similar to control vocal folds only in the suture group. Lamina propria thickness was similar to the control group in all groups after one week, after 90 days only the fibrin glue group was not significantly different from the control group. Inflammatory cells where significantly increased in all groups except for the suture group at 90 days. Although the use of sutures and glue is safe and can produce good vocal results as reported by experienced surgeons there remains to be no evidence consistently justifying its use in microphonosurgery / Doutorado / Otorrinolaringologia / Doutora em Ciências Médicas

Diss. (sammanfattning) Linköping : Linköpings universitet, 2008. / Härtill 4 uppsatser.

Introdução: as sequelas de queimaduras na morfologia, mobilidade das estruturas motoras orais e nas funções orofaciais, como mastigação, deglutição e fala, são frequentes em pacientes com queimaduras graves na região de cabeça e pescoço. Objetivo: verificar a efetividade de um programa de reabilitação fonoaudiológica da motricidade orofacial em pacientes com queimaduras em cabeça e pescoço. Método: participaram da pesquisa 29 indivíduos encaminhados para avaliação e reabilitação ao Ambulatório de Funções da Face da Divisão de Fonoaudiologia do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de abril de 2016 a abril de 2018. Os critérios inclusão adotados na pesquisa foram: idade > = 6 anos; queimadura de terceiro grau caracterizada por perda epidérmica e dérmica em áreas de cabeça e pescoço; realização de tratamento cirúrgico prévio da ferida; ausência de falhas dentárias; presença de queixas relacionadas às alterações motoras orais; quadro clínico estável (conforme registros em prontuários médicos); alimentação por via oral exclusiva. Os pacientes foram divididos em dois grupos considerando o tempo da queimadura: Grupo 1 (G1) - pacientes com até um ano após a queimadura; Grupo 2 (G2) - pacientes com mais de um ano após a queimadura. A gravidade da queimadura foi determinada pela escala ABSI (The Abbreviated Burn Severity Index), aplicada no primeiro atendimento hospitalar do paciente. Todos os participantes foram submetidos à avaliação fonoaudiológica em dois momentos distintos, pré e pós-programa terapêutico. A avaliação foi composta pelos seguintes protocolos clínicos: Avaliação Miofuncional Orofacial com Escores Expandido (AMIOFE-E), verificação da amplitude mandibular (abertura oral máxima, lateralização para a direita e esquerda e protrusão mandibular) e medida antropométrica do canto de olho à comissura labial. O programa terapêutico adotado foi composto por 8 sessões semanais individuais, com duração de trinta minutos cada. O programa terapêutico foi composto por: manobras de compressão e alongamento em tecido cicatricial, manobras de alongamento intra e extra orais dos músculos da face, exercícios para mobilidade da musculatura da face e região cervical e exercícios para a adequação das funções de mastigação e deglutição. Resultados: a análise estatística evidenciou que o G2 apresentou idade significativamente maior que o G1. Nas análises intragrupos, tanto G1 quanto G2 apresentaram diferenças estatísticas para todos os itens do AMIOFE-E: aparência e condição postural; mobilidade e funções orofaciais (mastigação e deglutição). Quanto às medidas de amplitude mandibular, ambos os grupos apresentaram aumento significativo da medida de abertura oral máxima. Nas análises intergrupos, não foram observadas diferenças significativas entre G1 e G2, indicando que a melhora foi semelhante para ambos os grupos. Conclusão: a pesquisa comprova a eficácia do programa fonoaudiológico, baseado em evidências e com controle de resultados, em pacientes com queimaduras de terceiro grau em cabeça e pescoço. Os resultados demonstraram que ambos os grupos apresentaram melhora significativa na atividade miofuncional oral e na amplitude mandibular. Quando comparados os resultados obtidos entre G1 e G2, não foi observada diferença relevante, indicando que o tratamento proposto foi eficiente, independentemente do tempo entre a queimadura e o início do tratamento / Introduction: alterations in the morphology and mobility of the oral motor structures, and orofacial functions (i.e. mastication, swallowing and speech) are often observed in patients who suffered severe head and neck burns. Purpose: the purpose of the present study was to verify the effectiveness of a myofunctional orofacial rehabilitation program for patients with head and neck burns. Method: participants of this study were 29 individuals referred to the Division of Orofacial Myology of Instituto Central do Hospital das Clínicas of the School of Medicine, University of São Paulo, between April 2016 and April 2018, for oral motor assessment and rehabilitation. Inclusion criteria were as follows: age >= 6 years; third degree burns to the head and neck (i.e. epidermal and dermal loss); previous surgical treatment to the wound; complete dentition; oral motor alterations deficits; medical stability (according to medical records); receiving all nutrition by mouth. Patients were divided in two groups according to the onset of the injury: Group 1 (G1) - patients with injuries less than a year old; Group 2 (G2) - patients with injuries more than a year old. Burn severity was determined by the ABSI (The Abbreviated Burn Severity Index) according to the patient\'s first hospital record. All participants underwent clinical assessment that involved an oral motor evaluation (Expanded Protocol of Orofacial Myofunctional Evaluation with Scores - OMES-E), the assessment of the mandibular range of movements (maximal incisor distance, right and left lateral excursions and protrusion) and an anthropometric assessment (measurement of the distance between the commissures of mouth and the corners of the eyes). For comparison purposes, assessments were performed pre and post-treatment. The rehabilitation program involved 8 individual 30 minute weekly sessions. The rehabilitation program involved: compression and stretching maneuvers on the scar tissue; intra and extra oral stretching maneuvers of the facial muscles; facial and cervical muscles mobility exercises; mastication and swallowing exercises. Results: the statistical analysis indicated that G2 was significantly older than G1. When comparing pre and post-treatment results, both group of patients presented significant differences considering the items on the OMES-E (i.e. appearance and posture, mobility and orofacial functions), and the maximal incisor opening. The analysis comparing the performance of G1 and G2 did not indicate differences between the groups. Conclusion: The results of the study indicated that the rehabilitation program was effective for third degree burns on the head and neck, demonstrating significant improvement of the oral myofunctional parameters and of the maximal incisor opening. The results also suggest that the maturation of the scar tissue did not have an influence on the results of the treatment program

Introdução: as sequelas de queimaduras na morfologia, mobilidade das estruturas motoras orais e nas funções orofaciais, como mastigação, deglutição e fala, são frequentes em pacientes com queimaduras graves na região de cabeça e pescoço. Objetivo: verificar a efetividade de um programa de reabilitação fonoaudiológica da motricidade orofacial em pacientes com queimaduras em cabeça e pescoço. Método: participaram da pesquisa 29 indivíduos encaminhados para avaliação e reabilitação ao Ambulatório de Funções da Face da Divisão de Fonoaudiologia do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de abril de 2016 a abril de 2018. Os critérios inclusão adotados na pesquisa foram: idade > = 6 anos; queimadura de terceiro grau caracterizada por perda epidérmica e dérmica em áreas de cabeça e pescoço; realização de tratamento cirúrgico prévio da ferida; ausência de falhas dentárias; presença de queixas relacionadas às alterações motoras orais; quadro clínico estável (conforme registros em prontuários médicos); alimentação por via oral exclusiva. Os pacientes foram divididos em dois grupos considerando o tempo da queimadura: Grupo 1 (G1) - pacientes com até um ano após a queimadura; Grupo 2 (G2) - pacientes com mais de um ano após a queimadura. A gravidade da queimadura foi determinada pela escala ABSI (The Abbreviated Burn Severity Index), aplicada no primeiro atendimento hospitalar do paciente. Todos os participantes foram submetidos à avaliação fonoaudiológica em dois momentos distintos, pré e pós-programa terapêutico. A avaliação foi composta pelos seguintes protocolos clínicos: Avaliação Miofuncional Orofacial com Escores Expandido (AMIOFE-E), verificação da amplitude mandibular (abertura oral máxima, lateralização para a direita e esquerda e protrusão mandibular) e medida antropométrica do canto de olho à comissura labial. O programa terapêutico adotado foi composto por 8 sessões semanais individuais, com duração de trinta minutos cada. O programa terapêutico foi composto por: manobras de compressão e alongamento em tecido cicatricial, manobras de alongamento intra e extra orais dos músculos da face, exercícios para mobilidade da musculatura da face e região cervical e exercícios para a adequação das funções de mastigação e deglutição. Resultados: a análise estatística evidenciou que o G2 apresentou idade significativamente maior que o G1. Nas análises intragrupos, tanto G1 quanto G2 apresentaram diferenças estatísticas para todos os itens do AMIOFE-E: aparência e condição postural; mobilidade e funções orofaciais (mastigação e deglutição). Quanto às medidas de amplitude mandibular, ambos os grupos apresentaram aumento significativo da medida de abertura oral máxima. Nas análises intergrupos, não foram observadas diferenças significativas entre G1 e G2, indicando que a melhora foi semelhante para ambos os grupos. Conclusão: a pesquisa comprova a eficácia do programa fonoaudiológico, baseado em evidências e com controle de resultados, em pacientes com queimaduras de terceiro grau em cabeça e pescoço. Os resultados demonstraram que ambos os grupos apresentaram melhora significativa na atividade miofuncional oral e na amplitude mandibular. Quando comparados os resultados obtidos entre G1 e G2, não foi observada diferença relevante, indicando que o tratamento proposto foi eficiente, independentemente do tempo entre a queimadura e o início do tratamento / Introduction: alterations in the morphology and mobility of the oral motor structures, and orofacial functions (i.e. mastication, swallowing and speech) are often observed in patients who suffered severe head and neck burns. Purpose: the purpose of the present study was to verify the effectiveness of a myofunctional orofacial rehabilitation program for patients with head and neck burns. Method: participants of this study were 29 individuals referred to the Division of Orofacial Myology of Instituto Central do Hospital das Clínicas of the School of Medicine, University of São Paulo, between April 2016 and April 2018, for oral motor assessment and rehabilitation. Inclusion criteria were as follows: age >= 6 years; third degree burns to the head and neck (i.e. epidermal and dermal loss); previous surgical treatment to the wound; complete dentition; oral motor alterations deficits; medical stability (according to medical records); receiving all nutrition by mouth. Patients were divided in two groups according to the onset of the injury: Group 1 (G1) - patients with injuries less than a year old; Group 2 (G2) - patients with injuries more than a year old. Burn severity was determined by the ABSI (The Abbreviated Burn Severity Index) according to the patient\'s first hospital record. All participants underwent clinical assessment that involved an oral motor evaluation (Expanded Protocol of Orofacial Myofunctional Evaluation with Scores - OMES-E), the assessment of the mandibular range of movements (maximal incisor distance, right and left lateral excursions and protrusion) and an anthropometric assessment (measurement of the distance between the commissures of mouth and the corners of the eyes). For comparison purposes, assessments were performed pre and post-treatment. The rehabilitation program involved 8 individual 30 minute weekly sessions. The rehabilitation program involved: compression and stretching maneuvers on the scar tissue; intra and extra oral stretching maneuvers of the facial muscles; facial and cervical muscles mobility exercises; mastication and swallowing exercises. Results: the statistical analysis indicated that G2 was significantly older than G1. When comparing pre and post-treatment results, both group of patients presented significant differences considering the items on the OMES-E (i.e. appearance and posture, mobility and orofacial functions), and the maximal incisor opening. The analysis comparing the performance of G1 and G2 did not indicate differences between the groups. Conclusion: The results of the study indicated that the rehabilitation program was effective for third degree burns on the head and neck, demonstrating significant improvement of the oral myofunctional parameters and of the maximal incisor opening. The results also suggest that the maturation of the scar tissue did not have an influence on the results of the treatment program

Introdução: As cicatrizes de acne representam um problema difícil para médico e paciente. Os tratamentos das cicatrizes atróficas, embora numerosos, têm sido dificultados pelas inadequadas respostas clínicas e prolongados períodos de pós-opératório. O tratamento com os lasers não-ablativos tem mostrado significante efeito na remodelação do colágeno com mínimos efeitos colaterais pós-tratamento. Objetivos: Avaliar a eficácia e segurança do laser Nd:Yag 1064 nm no tratamento das cicatrizes de acne. Casuística e Método: Doze patientes (fototipo II-V) apresentando cicatrizes de acne, moderadas a severas, foram submetidos a cinco sessões mensais com o laser Nd:Yag 1064 nm (120J/cm2, pulso triplo, 7.0/7.0/7.0 milisegundos de duração e intervalo entre os pulsos de 75 milisegundos). Os pacientes foram avaliados por três dermatologistas, através de fotografias digitais que foram tiradas antes, no meio do tratamento e 6 meses após o último tratamento realizado. Avaliações histológicas de biópsias cutâneas foram obtidas antes do tratamento e 1 mês após a última sessão. A quantificação das fibras colágenas e elásticas, por área, antes e depois do tratamento foi feita pela morfometria com a análise de imagens analisadas por computador (método digital). A satisfação do patiente usando uma escala de graduação foi obtida no final do estudo. Resultados: Melhora suave a moderada foi observada depois dos cinco tratamentos na maioria dos pacientes estudados. A avaliação objetiva comparando as fotografias antes e depois do tratamento revelou melhora cosmética visível em 11 dos pacientes. A quantificação das fibras colágenas pela morfometria mostrou aumento delas após o tratamento, com significância estatística. Os efeitos colaterais foram limitados a um eritema transitório e suave, além de um aumento na sensibilidade da pele logo após o procedimento. Conclusões: O laser Nd:Yag 1064 nm é uma técnica não-ablativa, segura e eficaz para o tratamento das cicatrizes de acne. Ele pode ser usado em peles escuras e se constitui numa alternativa para pacientes que não desejam passar por um longo período de recuperação e estão satisfeitos com resultados menores que os obtidos com as técnicas de resurfacing / troduction: Post-acne scarring is a very distressing and difficult problem for both physicians and patients. Atrophic scar revision techniques, although numerous, have been hampered by inadequate clinical responses and prolonged postoperative recovery periods. Nonablative laser treatment has shown significant effect on dermal collagen remodeling with minimal posttreatment side effects. Objectives: To study the efficacy and safety of the nonablative 1064 nm neodymium: yttrium-aluminum-garnet (Nd:Yag) laser in the treatment of facial atrophic scars: a histological and clinical analysis. Casuistry and Method: Twelve subjects (skin phototypes II-V) with mild to severe atrophic facial acne scars received five-monthly treatment with 1064 nm Nd:Yag laser (120 J/cm², triple pulse, 7.0/7.0/7.0- millisecond pulse duration, 75-millisecond delay). Patients were evaluated by using digital photography that were taken before treatment, in the middle of the treatment and 6 months after the last treatment was performed. Histologic evaluations of cutaneous biopsies were obtained before treatment and 1 month after the last session.The quantification of collagen and elastic fibers, per area, was carried out through the use of morphometry before and after the treatment, with image analysis by computer (digital method). Patient satisfaction surveys and clinical assessment by three dermatologists using a standard grading scale were obtained at the end of the study. Results: Mild to moderate clinical improvement was observed after the series of five treatments in the majority of patients studied. Objective assessment of scar improvement by comparing baseline to posttreatment photographs reported visible cosmetic improvement in eleven patients. All patients were satisfied with the treatment. The collagen quantification, per morphometry, showed a statistically significant increase after treatment. Side effects were limited to mild transient erythema and an increase in skin sensibility after the procedure. Conclusions: The 1064 nm Nd:Yag laser is a safe and effective nonablative modality for the treatment of atrophic scars. It can be safely used in darker skin. It could be an alternative in pacients who do not want a long downtime recovery and are satisfied with less significant results than those obtained by the resurfacing techniques

Introdução: As cicatrizes de acne representam um problema difícil para médico e paciente. Os tratamentos das cicatrizes atróficas, embora numerosos, têm sido dificultados pelas inadequadas respostas clínicas e prolongados períodos de pós-opératório. O tratamento com os lasers não-ablativos tem mostrado significante efeito na remodelação do colágeno com mínimos efeitos colaterais pós-tratamento. Objetivos: Avaliar a eficácia e segurança do laser Nd:Yag 1064 nm no tratamento das cicatrizes de acne. Casuística e Método: Doze patientes (fototipo II-V) apresentando cicatrizes de acne, moderadas a severas, foram submetidos a cinco sessões mensais com o laser Nd:Yag 1064 nm (120J/cm2, pulso triplo, 7.0/7.0/7.0 milisegundos de duração e intervalo entre os pulsos de 75 milisegundos). Os pacientes foram avaliados por três dermatologistas, através de fotografias digitais que foram tiradas antes, no meio do tratamento e 6 meses após o último tratamento realizado. Avaliações histológicas de biópsias cutâneas foram obtidas antes do tratamento e 1 mês após a última sessão. A quantificação das fibras colágenas e elásticas, por área, antes e depois do tratamento foi feita pela morfometria com a análise de imagens analisadas por computador (método digital). A satisfação do patiente usando uma escala de graduação foi obtida no final do estudo. Resultados: Melhora suave a moderada foi observada depois dos cinco tratamentos na maioria dos pacientes estudados. A avaliação objetiva comparando as fotografias antes e depois do tratamento revelou melhora cosmética visível em 11 dos pacientes. A quantificação das fibras colágenas pela morfometria mostrou aumento delas após o tratamento, com significância estatística. Os efeitos colaterais foram limitados a um eritema transitório e suave, além de um aumento na sensibilidade da pele logo após o procedimento. Conclusões: O laser Nd:Yag 1064 nm é uma técnica não-ablativa, segura e eficaz para o tratamento das cicatrizes de acne. Ele pode ser usado em peles escuras e se constitui numa alternativa para pacientes que não desejam passar por um longo período de recuperação e estão satisfeitos com resultados menores que os obtidos com as técnicas de resurfacing / troduction: Post-acne scarring is a very distressing and difficult problem for both physicians and patients. Atrophic scar revision techniques, although numerous, have been hampered by inadequate clinical responses and prolonged postoperative recovery periods. Nonablative laser treatment has shown significant effect on dermal collagen remodeling with minimal posttreatment side effects. Objectives: To study the efficacy and safety of the nonablative 1064 nm neodymium: yttrium-aluminum-garnet (Nd:Yag) laser in the treatment of facial atrophic scars: a histological and clinical analysis. Casuistry and Method: Twelve subjects (skin phototypes II-V) with mild to severe atrophic facial acne scars received five-monthly treatment with 1064 nm Nd:Yag laser (120 J/cm², triple pulse, 7.0/7.0/7.0- millisecond pulse duration, 75-millisecond delay). Patients were evaluated by using digital photography that were taken before treatment, in the middle of the treatment and 6 months after the last treatment was performed. Histologic evaluations of cutaneous biopsies were obtained before treatment and 1 month after the last session.The quantification of collagen and elastic fibers, per area, was carried out through the use of morphometry before and after the treatment, with image analysis by computer (digital method). Patient satisfaction surveys and clinical assessment by three dermatologists using a standard grading scale were obtained at the end of the study. Results: Mild to moderate clinical improvement was observed after the series of five treatments in the majority of patients studied. Objective assessment of scar improvement by comparing baseline to posttreatment photographs reported visible cosmetic improvement in eleven patients. All patients were satisfied with the treatment. The collagen quantification, per morphometry, showed a statistically significant increase after treatment. Side effects were limited to mild transient erythema and an increase in skin sensibility after the procedure. Conclusions: The 1064 nm Nd:Yag laser is a safe and effective nonablative modality for the treatment of atrophic scars. It can be safely used in darker skin. It could be an alternative in pacients who do not want a long downtime recovery and are satisfied with less significant results than those obtained by the resurfacing techniques

Diss. (sammanfattning) Linköping : Linköpings universitet, 2009.

Apesar do grande avanço da laringologia nas últimas décadas, o tratamento da rigidez da prega vocal continua sendo um desafio. A rigidez da prega vocal pode estar associada a alterações estruturais mínimas como no sulco vocal profundo ou decorrente da fibrose cicatricial como nos casos de cicatriz pós-operatória. Em ambos os casos, há perda dos elementos da matriz extracelular da camada superficial da lâmina própria (Espaço de Reinke) que se encontra substituída por tecido cicatricial. O objetivo do tratamento é recuperar a deficiência volumétrica e restabelecer a microarquitetura histológica da prega vocal. O tecido areolar perifascial constitui uma excelente alternativa por suas propriedades viscoelásticas semelhantes à da camada superficial da lâmina própria, por sua fácil obtenção e baixo custo. O objetivo deste estudo foi avaliar as alterações histológicas que ocorrem no enxerto e na prega vocal enxertada e comparar os resultados encontrados com a prega vocal contralateral, submetida apenas à manipulação cirúrgica. Trinta coelhos foram submetidos ao procedimento cirúrgico que consistiu na confecção de um bolsão na lâmina própria de ambas as pregas vocais. O enxerto foi colocado na prega vocal direita e a prega esquerda utilizada como controle. Os animais foram divididos randomicamente em três grupos diferindo no tempo da análise histológica: 15 dias (Grupo I), três meses (Grupo II) e seis meses (Grupo III). As lâminas foram coradas com hematoxicilina-eosina e pelo Sírius-red, uma coloração específica para fibras colágenas. Observou-se uma mudança gradual do enxerto com aumento progressivo da densidade das fibras colágenas no interior do enxerto e uma mudança progressiva do padrão de birrefringência das mesmas, de um predomínio de fibras colágenas amarelo-esverdeadas para um predomínio de fibras laranja-avermelhadas. A laplicação do teste estatístico Anova one-way mostrou um aumento estatisticamente significativo da densidade de colágeno total no interior do enxerto entre os animais dos Grupos I e II (p=0,004) e um aumento significativo da porcentagem de fibras laranja-avermelhadas entre o Grupo II e III (p=0,011). A densidade do colágeno na região adjacente ao enxerto na prega vocal enxertada foi estatisticamente maior que a densidade de colágeno na incisão cirúrgica na prega vocal controle em todos os grupos de estudo (p 0,001). A aplicação do Teste de Fisher na análise semiquantitativa do processo inflamatório não evidenciou diferença estatisticamente significativa entre a prega vocal enxertada e a prega vocal controle em nenhum dos tempos estudados. Entretanto, quando avaliamos o processo inflamatório temporalmente para cada prega vocal evidenciamos uma diminuição significativa do processo inflamatório entre os animais do grupo de 15 dias e três meses (p=0,032 para o grupo enxertado e p=0,035 para o grupo controle). Nossos achados sugerem que o tecido areolar perifascial apresenta baixa tendência a promover reação inflamatória e permanece na prega vocal do coelho por pelo menos seis meses. Entretanto, há uma importante mudança da composição do colágeno dentro do enxerto e no tecido ao redor deste sugerindo não ser um tecido ideal para substituir a lâmina própria. Outros estudos devem ser realizados para avaliar o seu papel no tratamento da rigidez da prega vocal. / Besides the great development of phonosurgery over the previous decades, vocal fold stiffness is a difficult disease that remains a therapeutic challenge. It may be either caused by cicatricial fibrosis or be associated with minor structural alterations of the vocal fold mucosa, mainly represented by deep sulcus vocalis. In both cases, there is loss and disorganization of extracellular matrix components of the superficial layer of the lamina propria (Reinkes Space), which is replaced by fibrotic tissue. The treatment goal is to re-establish the physical volume and the microarchitecture of the vocal folds. The perifascial tissue consists of a loose areolar tissue with viscoelasticity properties close to those of the superficial layer of the lamina propria. Thus, the aim of this experiment was to evaluate the histological changes of the graft and in the host tissue after placing a strip of this tissue into rabbits vocal folds. Thirty rabbits were operated. The graft was implanted in pockets surgically created in the right vocal fold. The left vocal fold was used as control. The animals were randomically divided in three groups for evaluation at 15 days (Group I), 3 months (Group II) and 6 months (Group III) and their larynx reviewed histologically. Histological sections underwent hematoxylin-eosin and specific staining method to quantify collagen fibers (Picrosirius-polarization method). Histological changes of the graft were observed since 15 days post-operatively and were characterized by a progressive increase of the density of collagen fibers and decrease of vascularization. Examination of Picrosirius-red stained section with polarizing microscopy revealed a gradual change of collagen fibers pattern with a predominance of greenish-yellow range observed in the original tissue and in Group I and mostly redish-orange range in the grafts of Group II and III. Statistical analysis (Anova one-way) showed a significant increase of the liitotal collagen density in the graft between Group I and II (p=0.004) and a significant predominance of redish-orange pattern between Groups II e III (p=0.011). The collagen density of the surrounding area of the graft in the implanted vocal fold was significantly increased when compared to control in all periods (p 0.001). The inflammatory process was not statistically different between the implanted vocal folds and controls according to Fisher´s test for any of the studied groups. Nonetheless, when the inflammatory process of each vocal fold was individually assessed on a long-term basis, a significant decrease of the inflammatory process was seen in the host (p=0.032) and control vocal fold (p=0.035) between Group I and II. Our findings suggest that the PAT has some advantages as a substance for vocal fold augmentation: it has low tendency to promote inflammatory response and low rate of absorption since it remains in the vocal fold for at least six months. However, the histological changes that take place in the graft and in the host tissue suggest that the PAT is not an ideal material as a substitute for the lamina propria and new studies are needed to determine its role on the treatment of vocal fold scarring.