A systematic review of penile prosthesis infection and meta-analysis of diabetes mellitus role.

BACKGROUND: Infection is the most feared complication of a penile prosthesis. Diabetes mellitus (DM) is widely known to increase the risk of several infections, but its role in the penile prosthesis is still controversial. This systematic review aims to show the contemporary scenario of penile prosthesis infection and present a meta-analysis about DM contribution to penile prosthesis infection. METHODS: The review was performed with no language or time limitation, including ten databases. The included articles were about the male population who received a penile prosthesis with no model restriction, with a minimum follow up of 1 year, and outcomes adequately reported. RESULTS: The mean infection incidence of penile prosthesis ranged from 0.33 to 11.4%. In early 2000, the general incidence of infection was 3 to 5%, then, the introduction of coated materials decreased it to 0.3 to 2.7%. The meta-analysis showed that diabetes mellitus is related to an increased risk of penile prosthesis infection with an odds ratio of 1.53 (95% CI 1.15-2.04). CONCLUSIONS: Penile prosthesis infection decreased in the last decades but remains a significant cause of reoperation, and it is related to lower prosthesis survival. Meta-analysis concludes that diabetes mellitus is related to a higher risk of penile prosthesis infection.

Resorbable Versus Titanium Fixation of Le Fort I Osteotomy.

Resorbable and titanium systems have been used in maxillary fixation. The aim of this review was to evaluate stability and morbidity of Le Fort I osteotomy by comparing both systems. It was performed in 11 databases, and reported according to preferred reporting items for systematic reviews and meta-analysis. Randomized and nonrandomized clinical trials, and retrospective comparative studies with patients who underwent nonsegmented Le Fort I osteotomy were included. Eleven articles were selected, with a total of 262 patients treated with resorbable and 252 with titanium fixation. The meta-analysis showed that when measured at point A, horizontal stability was 0.06 mm (95% confidence interval [CI] -0.19, 0.30), vertical stability for impaction was -0.43 mm (95% CI -0.94, 0.07), and for inferior repositioning was -1.29 mm (95% CI -2.62, 0.04). Morbidity was similar in the groups. Regarding infection, resorbable presented an absolute risk (AR) = 0.032, and titanium an AR = 0.025 (P = 1.0). For soft tissue reaction, an AR = 0.120 was shown for resorbable, and an AR = 0.132 for titanium (P = 0.85). Removal of fixation showed an AR = 0.024 for resorbable, and an AR = 0.025 for titanium (P = 1.0). Based on these results, resorbable and metal fixation systems seem to be equivalent with respect to stability and morbidity. This review was limited by the quality of the studies. Future studies should address these quality limitations to improve comparison between these 2 fixation approaches.

Cone-Beam Computed Tomography-Based Three-Dimensional McNamara Cephalometric Analysis.

This article introduces a method that extends the McNamara cephalometric analysis to produce 3-dimensional (3D) measurement values from cone-beam computed tomography images. In the extended method, the cephalometric landmarks are represented by 3D points; the bilateral cephalometric landmarks are identified on both sides of the skull; the cephalometric lines, with the exception of the facial axis, are represented by 3D lines; the cephalometric planes, with the exception of the facial plane, are represented by planes; the effective mandibular length, the effective midfacial length, and the lower anterior facial height are measured as 3D point-to-point distances; the nasion perpendicular to point A, the pogonion to nasion perpendicular, the upper incisor to point A vertical, and the lower incisor to point A-pogonion line are measured each as components of a vector; the facial axis angle is measured as a line-to-plane angle; and the mandibular plane angle is measured as a plane-to-plane angle. As a result, the method provides real effective lengths of the maxilla and mandible on both sides of the skull; real height of the lower anterior face; directed distances from the point A to the nasion perpendicular, from the pogonion to the nasion perpendicular, from the left and right upper incisor to the point A vertical, and from the left and right lower incisor to the point A-pogonion line for both the lateral and posteroanterior views of the skull; and real angles of the facial axis and the mandibular plane. Additionality, the method enables the identification of craniofacial asymmetries.

Finite Element Evaluation of Stable Fixation in Combined Mandibular Fractures.

PURPOSE: The fixation of combined mandibular fractures, especially symphyseal-condylar fractures, although occurring commonly and having a higher complication rate in the clinic, is rarely investigated regarding predictable therapeutic approaches. Thus this study's aim was to assess different forms of condylar fixation when combined with symphyseal fracture fixation. MATERIALS AND METHODS: Using finite element models, we analyzed the stress distribution that occurs when a condylar fracture is fixed with 1 miniplate, 2 miniplates, or a trapezoidal condylar miniplate and when a symphyseal fracture is fixed with 2 parallel plates, 2 perpendicular plates, or 2 lag screws. The null hypothesis was that there would be no differences among the different fixation techniques. RESULTS: The results showed a stress concentration in the anterior region of the condyle, close to the sigmoid notch. Moreover, adequate fixation in the symphysis could result in less tension at the condylar region. Therefore, when the symphysis was fixed with a lag-screw technique, condylar fixation was less required, showing a more adequate stress distribution when the condyle was fixed with 1 or 2 plates. Conversely, when the symphyseal fixation was less effective, by use of perpendicular plates, there was a change in the stress distribution at the condylar region, altering fixation behavior and resulting in more tension and displacement in the condyle, especially when a trapezoidal plate was used. CONCLUSIONS: A lag screw and parallel double plates appear to be suitable for symphyseal fixation, whereas 2 straightly positioned plates and a trapezoidal plate are suitable for condylar fixation. However, the combination of perpendicular plates in symphyseal fixation and a trapezoidal plate in condylar fixation showed an altered stress distribution.

Evaluation of Nasal Obstruction in Various Sagittal Skeletal Deformity of Jaws.

Nasal obstruction (NO) is a common symptom present in 25% of the general population, which significantly interferes with the quality of life. The different facial profiles and malocclusion patterns could be associated with the degree of NO. In order to evaluate the nasal function in patients with different facial morphology patterns, the authors developed a prospective study in which 88 patients from a dentofacial deformities center were included. These patients were submitted to fibrorhinoscopy (Mashida, ENT PIII) with a 3.2-mm cannula under topical anesthesia to evaluate septal deviation, inferior and medium turbinates, and pharyngeal tonsils. The 88 patients included in the study were divided into 3 groups according to the classification of the facial profile, distributed as follows: 32 class I, 28 class II, and 28 class III; the data collected was statistically analyzed by analysis of variance and the results are shown. The patients included in this study presented similar prevalence of NO with the reduction of airway function efficiency. Although it was not a statistically different, the group II presented higher mean Nasal Obstruction Syndrome Evaluation scores.

Influence of different setups of the Frankfort horizontal plane on 3-dimensional cephalometric measurements.

INTRODUCTION: The Frankfort horizontal (FH) is a plane that intersects both porions and the left orbitale. However, other combinations of points have also been used to define this plane in 3-dimensional cephalometry. These variations are based on the hypothesis that they do not affect the cephalometric analysis. We investigated the validity of this hypothesis. METHODS: The material included cone-beam computed tomography data sets of 82 adult subjects with Class I molar relationship. A third-party method of cone-beam computed tomography-based 3-dimensional cephalometry was performed using 7 setups of the FH plane. Six lateral cephalometric hard tissue measurements relative to the FH plane were carried out for each setup. Measurement differences were calculated for each pair of setups of the FH plane. The number of occurrences of differences greater than the limits of agreement was counted for each of the 6 measurements. RESULTS: Only 3 of 21 pairs of setups had no occurrences for the 6 measurements. No measurement had no occurrences for the 21 pairs of setups. Setups based on left or right porion and both orbitales had the greatest number of occurrences for the 6 measurements. CONCLUSIONS: This investigation showed that significant and undesirable measurement differences can be produced by varying the definition of the FH plane.

Correlation between the Friedman Staging System and the upper airway volume in patients with obstructive sleep apnea.

PURPOSE: This study was designed to evaluate the correlation between computed tomography findings and data from the physical examination and the Friedman Staging System (FSS) in patients with obstructive sleep apnea (OSA). PATIENTS AND METHODS: We performed a retrospective evaluation by reviewing the medical records of 33 patients (19 male and 14 female patients) with a mean body mass index of 30.38 kg/m(2) and mean age of 49.35 years. Among these patients, 14 presented with severe OSA, 7 had moderate OSA, 7 had mild OSA, and 5 were healthy. RESULTS: The patients were divided into 2 groups according to the FSS: Group A comprised patients with FSS stage I or II, and group B comprised patients with FSS stage III. By use of the Fisher exact test, a positive relationship between the FSS stage and apnea-hypopnea index (P = .011) and between the FSS stage and body mass index (P = .012) was found. There was no correlation between age (P = .55) and gender (P = .53) with the FSS stage. The analysis of variance test comparing the upper airway volume between the 2 groups showed P = .018. CONCLUSIONS: In this sample the FSS and upper airway volume showed an inverse correlation and were useful in analyzing the mechanisms of airway collapse in patients with OSA.

Etiology, treatment, and complications of mandibular fractures.

The objective of this retrospective study was to evaluate some epidemiological characteristics, surgical treatment methods, and complications of cases involving mandibular fractures. Records from 119 patients treated for mandibular fractures between January 2006 and December 2011 were analyzed. We find mandibular fractures mostly affect Caucasian (72.2%) men (80.7%). The mean age of the patients was 28.1 years. Road traffic accidents (RTA) caused the most fractures (49.5%), followed by physical violence, including gunshot wounds (21%). Motorcycle accidents were the most common cause of RTA (76.2%). The most affected mandibular regions were the parasymphysis (26.9%) and the mandible angle (25.1%). Both surgical and nonsurgical treatments were applied (90.4% and 9.6%, respectively). The most common surgical approach was the intraoral (64.9%), using the 2.0-mm fixation system (88.0%). Complications such as postoperative infections, malocclusion, and paresthesia occurred in 36 patients (30.2%). This research revealed interesting features about the etiology of mandibular fractures that were mostly associated with RTA. Severity of the trauma and noncompliance of the patients were factors that contributed to the development of postoperative complications.

Inferior alveolar nerve function after sagittal split osteotomy by reciprocating saw or piezosurgery instrument: prospective double-blinded study.

PURPOSE: The aim of this prospective study was to objectively evaluate inferior alveolar nerve (IAN) sensory disturbances in patients who underwent sagittal split ramus osteotomy (SSRO) by comparing 1 side treated with a reciprocating saw with the other side treated with a piezosurgery device. MATERIALS AND METHODS: Clinical evaluation of IAN sensory disturbance was undertaken preoperatively and at 1 week, 4 weeks, 2 months, and 6 months postoperatively in 20 patients who underwent SSRO at the Division of Oral and Maxillofacial Surgery, Araraquara Dental School, São Paulo State University. The 20 patients were examined at all periods for IAN functionality by Semmes-Weinstein testing; neither the patients nor the examiner knew which side was treated using piezosurgery or a reciprocating saw. RESULTS: The mean age of the patients was 28.4 years (range, 20 to 48 yr). Before surgery, no patient had impaired function of the IAN in any of the 8 zones in the mental and inferior lip areas. All patients reported feeling the first monofilament at the time of the preoperative test. Seven days postoperatively, all patients reported some kind of altered sensitivity in at least 1 zone evaluated. CONCLUSIONS: The results of this study suggest there was no statistically significant difference in the sensitivity of the labiomental area regarding the instrument used to perform the osteotomy. Future studies will focus on enlarging the sample and evaluating the results.

Cutaneous sensibility impairment after mandibular sagittal split osteotomy: a prospective clinical study of the spontaneous recovery.

PURPOSE: The aim of this prospective study was to objectively evaluate the inferior alveolar nerve (IAN) sensory disturbances in patients who underwent sagittal split ramus osteotomy (SSRO) and its spontaneous recovery and to define the incidence of sensibility loss, time, and area at which the recovery occurs. PATIENTS AND METHODS: Clinical evaluation of the IAN sensory disturbance was undertaken preoperatively and at the first week, fourth week, 2 months, and 6 months postoperatively in 30 patients who underwent SSRO at the Oral and Maxillofacial Surgery Division of the Araraquara Dental School--Unesp and at the Plastic Surgery Division of the Medical Sciences School--Unicamp. The 30 patients were examined at all periods regarding the IAN functionality by Semmes-Weinstein testing. RESULTS: The mean age of the patients included in this study was 29.36 years old. All patients showed sensibility loss at the 7-day evaluation time. The comparison between sides, gender, and age did not show any significant difference. In most of the examined zone, the data collected at 6 months were statistically similar to the data collected at the preoperative period. All zones presented significant recovery, starting from 30 days after surgery. Twenty patients had total spontaneous recovery at the final period, in all examined zones. CONCLUSIONS: The SSRO presents the disadvantage of temporary paresthesia; however, spontaneous nerve function recovery does occur. The Semmes-Weinstein test is a reliable, inexpensive, and easy-to-apply tool, which can be used for clinical evaluation on a daily basis at offices and hospitals.

An in vitro evaluation of rigid internal fixation techniques for sagittal split ramus osteotomies: setback surgery.

PURPOSE: The aim of this study was to evaluate the biomechanical features of 3 different methods of rigid internal fixation for sagittal split ramus osteotomy for mandibular setback in vitro. MATERIALS AND METHODS: Sixty polyurethane replicas of human hemimandibles were used as substrates, simulating a 5-mm setback surgery by sagittal split ramus osteotomy. These replicas served to reproduce 3 different techniques of fixation, including 1) a 4-hole plate and 4 monocortical screws (miniplate group), 2) a 4-hole plate and 4 monocortical screws with 1 additional bicortical positional screw (hybrid group), and 3) 3 bicortical positional screws in a traditional inverted-L pattern (inverted-L group). After fixation, hemimandibles were adapted to a test support and subjected to lateral torsional forces on the buccal molar surface and vertical cantilever loading on the incisal edge with an Instron 4411 mechanical testing unit. Peak loadings at 1, 3, 5, and 10 mm of displacement were recorded. Means and standard deviation were analyzed using analysis of variance and Tukey test with a 5% level of significance, and failures during tests were recorded. RESULTS: Regardless of the amount of displacement and direction of force, the miniplate group always showed the lowest load peak scores (P < .01) compared with the other fixation techniques. The hybrid group demonstrated behavior similar to the inverted-L group in lateral and vertical forces at any loading displacement (P > .05). Molar load tests required more force than incisal load tests to promote the same displacement in the mandibular setback model (P < .05). CONCLUSION: For mandibular setback surgery of 5 mm, this study concluded that the fixation technique based on the miniplate group was significantly less rigid than the fixation observed in the hybrid and inverted-L groups. Mechanically, adding 1 bicortical positional screw in the retromolar region in the miniplate technique may achieve the same stabilization offered by inverted-L fixation for mandibular sagittal split ramus osteotomy setback surgery in vitro.

How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters.

INTRODUCTION: Obstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance. OBJECTIVE: This study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea. METHODS: The study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy. RESULTS: Analysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m2. Obese and non-obese groups were determined by using cut-off 30 kg/m2. In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p = 0.02), NOSE instrument (p = 0.033) and inferior turbinate hypertrophy (p = 0.036), with odds ratio 1.983 (95% IC 1.048 - 3.753). nasal septum deviation (p = 0.126) and nasal airway volume evaluation (p = 0.177) showed no significant results. CONCLUSION: Obesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation. LEVEL OF EVIDENCE: 3b - Individual case-control study.

Mechanical evaluation of different techniques for symphysis fracture fixation--an in vitro polyurethane mandible study.

PURPOSE: The aim of this study was to make a comparative evaluation of the mechanical behavior of 4 different internal fixation systems for mandibular symphysis fractures. MATERIALS AND METHODS: Forty polyurethane mandible replicas (Nacional, Jaú, SP, Brazil) were used. These were divided into 4 groups of different fixation methods: group 1P, 1 2.0-mm miniplate; group 2PLL, 2 2.0-mm parallel miniplates; group 2PERP, 2 2.0-mm perpendicular miniplates; and group LST, 2 2.0-mm lag screws. Each group was subjected to linear vertical loading in the molar region in an Instron 4411 servohydraulic mechanical testing unit (Instron Corporation, Norwood, MA). The load resistance values were measured at load application displacements of 1, 3, 5, and 10 mm. Means and standard deviations were compared with respect to statistical significance using analysis of variance (P < .05) and compared by the Tukey test. RESULTS: Group 1P showed the lowest peak load scores compared with other fixation methods. Group LST showed a statistically significant higher resistance than group 2PLL for all displacements. Group 2PERP showed lower resistance than group LST when displacements were 1 and 3 mm and statically significant similarity at displacements of 5 and 10 mm. However, group 2PERP showed no statistically significant differences compared with group 2PLL. CONCLUSIONS: The LST showed better mechanical behavior for symphysis fracture fixation than the other systems when the fixation methods were subjected to linear vertical loading in the molar region.

An in vitro evaluation of rigid internal fixation techniques for sagittal split ramus osteotomies: advancement surgery.

PURPOSE: This in vitro investigation was developed with the purpose of comparing the biomechanical features of 3 different methods of rigid internal fixation for sagittal split ramus osteotomies for mandibular advancement. MATERIALS AND METHODS: Rigid internal fixation techniques included a 4-hole plate and 4 monocortical screws (miniplate group), a 4-hole plate and 4 monocortical screws with 1 additional bicortical positional screw (hybrid group), and 3 bicortical positional screws in a traditional inverted-L pattern (inverted-L group). Screws and miniplates were made of titanium and from a 2.0-mm system (MDT, Rio Claro, SP, Brazil). Sixty polyurethane replicas of human hemimandibles (Nacional, Jaú, SP, Brazil) were used as substrates, simulating a 5-mm advancement surgery by a sagittal split ramus osteotomy. They were adapted to a test support, and were submitted to lateral torsional forces on the buccal molar surface and vertical cantilever loading on the incisal edge by an Instron 4411 mechanical testing unit (Instron, Norwood, MA) for recording peak loading at 1 mm, 3 mm, 5 mm, and 10 mm of displacement. Each group was formed by 10 replicas, subjected to a linear noncyclical testing only once. Means and standard deviation were analyzed using analysis of variance and Tukey tests, with a 5% level of significance. Testing failures were also recorded. RESULTS: The miniplate group showed lowest load peak scores (P < .01) when compared with the other fixation techniques, irrespective of the direction of force. The inverted-L group showed higher resistance (P < .01) than the hybrid group when vertical forces were applied. For molar load, the hybrid and inverted-L groups showed no significant difference. CONCLUSIONS: For mandibular advancement surgery of 5 mm, it was concluded that the rigid internal fixation technique for sagittal split ramus osteotomies based on 3 bicortical screws in the inverted-L pattern was the most stable in a laboratory environment. Furthermore, the results suggested that installation of a bicortical positional screw in the retromolar region may significantly optimize the resistance of the miniplate and monocortical screw fixation.

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis.

OBJECTIVE: To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis). METHODS: A Markov model was developed to capture long-term clinical and economic outcomes. The model's population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost - in BRL, and effectiveness - measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS: Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS: The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.

Complications of mandible fractures related to substance abuse.

PURPOSE: To analyze different epidemiologic factors related to patients who abuse legal and illegal substances, and the relationship between substance abuse and postsurgical complications of mandibular fractures. PATIENTS AND METHODS: The study was performed over a 5-year period by the Division of Oral and Maxillofacial Surgery, State University of Campinas, São Paulo, Brazil. In total, 1,399 patients were analyzed via a data form covering age, gender, socioeconomic activity, etiology, and time lapse between trauma and medical attention. Patients were categorized according to whether they reported no substance abuse, smoking, chronic abuse of alcohol, or abuse of intravenous or nonintravenous drugs. Information on the complications presented and corresponding treatments was also included. RESULTS: Of 1,399 patients, 472 presented with 699 mandibular fractures, and 11.4% of these patients had postsurgical complications. The breakdown of subgroup size in terms of percentage of the total, and the corresponding incidence of postsurgical complications, were: for those reporting no substance abuse (52.5%), 8.5% of total complications; for smokers (35.3%), 14.9% of total complications; for patients who self-reported chronic alcohol abuse (30.9 %), 17.1% of total complications; for the nonintravenous drug user subgroup (6.1%), 14.2% of total complications; and for the intravenous drug user subgroup (1.8%), 37.5% of total complications. CONCLUSIONS: There is evidently a close correlation between substance abuse and postsurgical complications in patients with mandibular fractures, because of both physiologic alterations and patient behavior. Assault-related injuries were the primary cause of trauma in the substance abuse groups, and infections represented the predominant complication.

Oral manifestation of systemic lupus erythematosus: lupus nephritis--report of a case.

Systemic lupus erythematosus (SLE) is a disease of unknown origin that can affect organs and cause severe damage. Lupus is diagnosed through biopsies and laboratory examinations; however, certain clinical characteristics and the presence of lesions can help with early diagnosis and improve the disease prognosis. SLE patients generally receive immunosuppressants that may cause systemic implications---such as suture dehiscence, increased risk of infection, and delayed healing--that deserve specific attention during dental treatment. This article presents a case of a SLE patient with oral manifestations: ulcerative lesions in the mouth and development of lupus nephritis. This article seeks to emphasize the importance of recognizing the lesions related to SLE, which may help the dentist to establish an early diagnosis.

Automatic repositioning of jaw segments for three-dimensional virtual treatment planning of orthognathic surgery.

PURPOSE: To develop a computer-based method for automating the repositioning of jaw segments in the skull during three-dimensional virtual treatment planning of orthognathic surgery. The method speeds up the planning phase of the orthognathic procedure, releasing surgeons from laborious and time-consuming tasks. MATERIALS AND METHODS: The method finds the optimal positions for the maxilla, mandibular body, and bony chin in the skull. Minimization of cephalometric differences between measured and standard values is considered. Cone-beam computed tomographic images acquired from four preoperative patients with skeletal malocclusion were used for evaluating the method. RESULTS: Dentofacial problems of the four patients were rectified, including skeletal malocclusion, facial asymmetry, and jaw discrepancies. CONCLUSIONS: The results show that the method is potentially able to be used in routine clinical practice as support for treatment-planning decisions in orthognathic surgery.

Volumetric evaluation of pharyngeal segments in obstructive sleep apnea patients.

INTRODUCTION: Obstructive sleep apnea occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea) or partial (hypopnea) reduction of the airflow and has intimate relation with changes in the upper airway. Cone Beam CT allows the analysis of the upper airway and its volume by three-dimensional reconstruction. OBJECTIVE: To evaluate a possible correlation between the volume of the upper airway and the severity of the obstructive sleep apnea. METHODS: A retrospective study was performed reviewing polysomnographic data and Cone Beam CT records of 29 patients (13 males and 16 females). The correlation between the volume of the nasopharynx, the oropharynx and the total superior pharynx with the AHI was assessed by Pearson's rank correlation coefficient. RESULTS: The obstructive sleep apnea severity division was: ten patients had severe, 7 had moderate, 6 had mild and 6 of them were healthy. The correlation between the nasopharynx, the oropharynx and the total superior pharynx volumes and the Apnea-Hypopnea-Index was respectively: -0.415 (p=0.025), 0.186 (p=0.334) and -0329 (p=0.089). The Spearman's rank controlled by the Body Mass Index, the age and the gender was: -0.206 (p=0.304), -0.155 (p=0.439) and 0.242 (p=0.284). CONCLUSION: There is no correlation between the volume of the airway and the obstructive sleep apnea, assessed by Apnea-Hypopnea-Index and controlled by the Body Mass Index, the age and the gender. The volume of the upper airways as an isolated parameter did not correlate to the severity of the obstructive sleep apnea syndrome, and should be evaluated together with other factors.

How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters / Como a obesidade afeta a função nasal na apneia obstrutiva do sono: parâmetros anatômicos e volumétricos,

Abstract Introduction Obstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance. Objective This study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea. Methods The study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy. Results Analysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m2. Obese and non-obese groups were determined by using cut-off 30 kg/m2. In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p= 0.02), NOSE instrument (p= 0.033) and inferior turbinate hypertrophy (p= 0.036), with odds ratio 1.983 (95% IC 1.048 − 3.753). nasal septum deviation (p= 0.126) and nasal airway volume evaluation (p= 0.177) showed no significant results. Conclusion Obesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation. Level of Evidence 3b - Individual case-control study.

Resumo Introdução A apneia obstrutiva do sono é consequência do colapso das vias aéreas superiores Qualquer região de obstrução nas vias aéreas superiores pode contribuir para o colapso da faringe. A obesidade e os distúrbios relacionados à obesidade desempenham um papel importante na apneia obstrutiva do sono e sua relação com o aumento da resistência das vias aéreas superiores. Objetivo Avaliar a relação entre a obesidade e as propriedades da cavidade nasal em pacientes com apneia obstrutiva do sono. Método O estudo foi feito retrospectivamente através da revisão de prontuários médicos de pacientes adultos. O instrumento de avaliação NOSE, do inglês nasal obstruction symptom evaluation, foi usado para avaliar a obstrução nasal. Os distúrbios respiratórios do sono foram avaliados através de exames polissonográficos. O volume nasal foi obtido por tomografia computadorizada e a reconstrução volumétrica das vias aéreas nasais. As alterações anatômicas nasais foram avaliadas por endoscopia nasal. Resultados A análise dos prontuários de 83 pacientes, entre os quais 54 eram do sexo masculino e 29 do feminino, encontrou um índice de massa corporal médio de 28,69 kg/m2. Os grupos obeso e não obeso foram determinados com o ponto de corte de 30 kg/m2. Na comparação entre os grupos, o grupo obeso apresentou correlação positiva e significante com o índice de apneia/hipopneia (p = 0,02), instrumento NOSE (p = 0,033) e hipertrofia da concha inferior (p = 0,036), com uma odds ratio de 1,983 (IC95%: 1,048 a 3,753). A avaliação do desvio do septo nasal (p = 0,126) e do volume das vias aéreas nasais (p = 0,177) não mostrou resultados significantes. Conclusão A obesidade correlacionou-se significantemente com a obstrução nasal subjetiva pela escala NOSE e hipertrofia de concha inferior em pacientes com apneia obstrutiva do sono. Não houve correlação com a avaliação do volume nasal. Nível de evidência 3b. Estudo de caso-controle individual.