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A 14-year-old patient had a low-energy facial blunt trauma that evolved to right facial paralysis caused by parotid hematoma with parotid salivary gland lesion. Computed tomography and angiography demonstrated intraparotid collection without pseudoaneurysm and without radiologic signs of fracture in the face. The patient was treated with serial punctures for hematoma deflation, resolving with regression and complete remission of facial paralysis, with no late sequela. The authors discuss the relationship between facial nerve traumatic injuries associated or not with the presence of facial fractures, emphasizing the importance of early recognition and appropriate treatment of such cases.

Uma das vantagens aventadas da vídeo-cirurgia é a possibilidade de formar menos aderências pós-operatórias. As evidências deste efeito resultam de trabalhos clínicos e experimentais, mas o real impacto desta via de acesso neste sentido ainda não foi comprovado. O objetivo da presente revisão foi avaliar as evidências científicas disponíveis sobre o assunto. Material e Métodos: revisão da literatura pertinente. Resultados: As aderências pós-operatórias foram analisadas no sítio da operação e nas incisões praticadas, porém existem poucas informações sobre aderências em locais não operados. Aderências pós-operatórias são menos freqüentes ou intensas quando se considera a via de acesso por vídeo. A despeito deste dado experimental, os desfechos clínicos de menor dor pélvica, menor número de admissões ou reoperações por obstrução intestinal e menor ocorrência de infertilidade ainda não podem ser claramente atribuídos a esta via de acesso, especialmente quando se consideram as cirurgias laparoscópicas avançadas, uma vez que nesta situação existe equivalência de área cruenta nas duas vias de acesso, à exceção da área associada às incisões. Conclusões: A via de acesso por vídeo está associada a menor formação de aderências, mas não protege de complicações relacionadas à sua ocorrência. Técnica operatória adequada e o uso de barreiras provavelmente estão mais fortemente associadas à menor formação de aderências do que a via de acesso aberta empregada para a realização das operações abdominais e pélvicas.
Laparoscopic surgery seems to be associated with less adhesion formation and complications associated to surgical access when compared to laparotomy. Experimental and clinical evidence confirm this hypothesis but the impact of laparoscopy on adhesion formation and its complications remains undetermined. The present article aims at reviewing the evidence on this issue. Method: literature review. Results: Postoperative adhesions were evaluated at operation site and at surgical scars. Nevertheless, results on adhesion formation at sites distant from them are still unavailable. Adhesion formation was less common or reduced when laparoscopic access was compared to conventional surgery. Main adverse outcomes regarding adhesion formation are pelvic pain, infertility, and intestinal obstruction. There is little evidence of reduced incidence of these adverse outcomes after laparoscopic surgery when compared to conventional access and there may be none at all when major laparoscopic operations are considered. This finding may be due to a similar extent of dissection after conventional or advanced video operations with the exception of the adhesions related to the incisions. Conclusions: Laparoscopic surgery is associated to less adhesion formation but may not protect from adverse outcomes expected after abdominal operations. Adequate surgical technique and the use of commercially available adhesion barriers may be major determinants from adhesions formation and its consequences

The loss of skin flaps (SF) due to tissue necrosis can be catastrophic, even with mortality, especially when there is exposure of large vessels or noble structures. This outcome occurs between 2 to 20% of the procedures performed. There is no currently adjuvant treatment that improves the survival of cutaneous flaps, without side effects or significant risks. Recent studies have sought to prove the efficiency of photobiomodulation (PBM) by means of Low Level Laser Therapy (LLLT) and present promising results for increased SF survival. OBJECTIVE To evaluate the effect of LLLT in dorsal skin flaps of mice in terms of tissue necrosis extent as well as biochemical analysis of pro and anti‐inflammatory cytokines. METHODS Forty‐eighth Balb/C (20–25 g) male mice were randomly distributed into two groups with twenty‐four animals each; (1) control group that was not submitted to laser irradiation and (2) experimental group that was submitted to laser irradiation on the flap pedicle with a 660 nm wavelength, exposure radiant of 2.25 J/cm2 for a total time of 20 s/point. The treatment started immediately after performing the cranial base random skin flap (3× 1 cm dimension). The animals were euthanized after the evaluation of the percentage of necrosis area, blood and skin tissue was collected for analysis of cytokines and histology on 4th, 7th and 10th postoperative days. Results demonstrated that LLLT irradiation reduced the area of necrosis, significantly decreased IL‐1, IL‐6 and TNF‐α and increased IL‐10 cytokines compared to the non‐irradiated control group. In conclusion, LLLT may improve the healing of skin flaps by decreasing pro‐inflammatory cytokines and increasing the anti‐inflammatory IL‐10. Serum Interleukines after low level laser therapy (gray) versus control group (black). Significant decrease in pro‐inflamatories interleukines 1, 6 and tumor necrosis factor alfa and significant increase in anti‐inflamatory interleukin 10 after 4, 7 and 10 days post‐op.

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