Three-dimensional Analysis of the Muscles Related to the So-Called "Pterygomandibular Raphe": An Anatomical and Histological Study.

The pterygomandibular raphe (PMR) is a tendinous bundle between the bucinator (BM) and the superior constrictor of pharynx (SC) and has been considered essential for swallowing. Despite its functional significance, previous studies reported that the PMR is not always present. Another study reported presence of the connecting fascia between the BM and deep temporalis tendon (dTT). Therefore, the present study analyzed the three-dimensional relationship between the BM, SC, and dTT. We examined 13 halves of 11 heads from adult Japanese and Caucasian cadavers: eight halves macroscopically and five halves histologically. There was no clear border between the BM and SC in any specimens macroscopically. The BM attachment varied depending on its levels. At the level of the superior part of the internal oblique line, the BM fused with the SC with no clear border. At the level of the midpart of the internal oblique line of the mandible, the BM attached to the dTT directly, and the SC attached to the dTT via collagen fibers and the BM. Based on these results, these muscles should be described as the BM/dTT/SC (BTS) complex. The three-dimensional relationship of the BTS complex might result in the so-called "pterygomandibular raphe." The BTS complex could be important as a muscle coordination center in chewing and swallowing.

The palatopharyngeal muscle in otolaryngology practice: an anatomical-based surgical report.

OBJECTIVES: The author discusses current otolaryngological procedures employing the palatopharyngeus muscle, based on the surgical anatomy of the muscle and its neural supply. These techniques should be deeply revised for more conservative, anatomically-based maneuvers. METHODS: Revision of anatomical and surgical research and comments with the provision of a primary concept. RESULTS: The palatopharyngeus muscle is innervated by the pharyngeal plexus (the vagus and the accessory nerves) with additional fibers from the lesser palatine nerves. The innervation enters the muscle mainly through its lateral border. CONCLUSIONS: The palatopharyngeus muscle has a fundamental role in swallowing and speech. The muscle helps other dilators to maintain upper airway patency. Sphincter pharyngoplasty should be revised as regards its role as a sphincter. Palatopharyngeal procedures for OSA employing the palatopharyngeus muscle should follow the conservative, anatomically-based, and non-neural ablation concept.

Exploring long-term changes and influencing factors of the upper airway in patients with a skeletal Class II relationship after mandibular advancement with maxillary setback surgery: A comprehensive 2-year follow-up investigation.

INTRODUCTION: The objective of this study was to investigate the 2-year postoperative change and influencing factors of the upper airway after mandibular advancement with maxillary setback surgery for patients with a skeletal Class II relationship. METHODS: Fifty-seven participants who underwent mandibular advancement with maxillary setback surgery were enrolled consecutively. Cone-beam computed tomography was performed preoperatively, 3 months postoperatively (T1), and 2 years (T2) postoperatively. All parameters were measured using Dolphin Imaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif). RESULTS: The total volume (V), minimum cross-sectional area (CSAmin), and glossopharynx increased significantly in both the short-term (V, 13.33%; CSAmin, 33.03%; glossopharynx, 26.73%) and long-term (V, 10.19%; CSAmin, 23.18%; glossopharynx, 18.27%) after the surgery. Mandibular advancement, mandibular width increase, preoperative CSAmin, and body mass index (BMI) significantly affected 2-year postoperative V increases. Mandibular advancement and BMI significantly affected 2-year postoperative glossopharynx increases. Backward movement of point PNS may lead to a reduction of the nasopharynx; however, downward movement of point PNS, upward movement of point A, and increased maxillary width may compensate for this effect by increasing the likelihood of the nasopharynx opening. Furthermore, mandibular body length at T1 is positively associated with relapse rate ([T2 - T1] / T1) of V and CSAmin. CONCLUSIONS: Mandibular advancement amount, mandibular width increase, preoperative CSAmin, and BMI are the 4 factors for long-term V changes. Patients with a longer mandibular body length might have a lower relapse rate.

Do patients with different craniofacial patterns have differences in upper airway volume? A systematic review with network meta-analysis.

BACKGROUND: Craniofacial skeletal discrepancies have been associated with upper airway dimensions. OBJECTIVE: To identify differences in upper airway volume across different sagittal and vertical skeletal patterns. SEARCH METHODS: Unrestricted literature searches in eight databases/registers for human studies until May 2023. SELECTION CRITERIA: Cross-sectional studies measuring upper airway volumes using three-dimensional imaging in healthy patients of different sagittal (Class I, Class II, and Class III) or vertical (normodivergent, hypodivergent, and hyperdivergent) craniofacial morphology. DATA COLLECTION AND ANALYSIS: Duplicate independent study selection, data extraction, and risk of bias assessment. Random-effects frequentist network meta-analysis was performed followed by subgroup-analyses and assessment of the quality of clinical recommendations (confidence in effect estimates) with the CINeMA (Confidence in Network Meta-Analysis) approach. RESULTS: Seventy publications pertaining to 66 unique studies were included with 56 studies (5734 patients) contributing to meta-analyses. Statistically significant differences were found for total  pharyngeal airway volume, with Class II having decreased airway volume (-2256.06 mm3; 95% Confidence Interval [CI] -3201.61 to -1310.51 mm3) and Class III increased airway volume (1098.93 mm3; 95% CI 25.41 to 2172.45 mm3) compared to Class I. Significant airway volume reductions for Class II were localized mostly at the oropharynx, followed by the palatopharynx, and the glossopharynx. Significant airway volume increases for Class III were localized mostly at the oropharynx, followed by the intraoral cavity, and hypopharynx. Statistically significant differences according to vertical skeletal configuration were seen only for the oropharynx, where hyperdivergent patients had reduced volumes compared to normodivergent patients (-1716.77 mm3; 95% CI -3296.42 to -137.12 mm3). Airway differences for Class II and Class III configurations (compared to Class I) were more pronounced in adults than in children and the confidence for all estimates was very low according to CINeMA. CONCLUSIONS: Considerable differences in upper airway volume were found between sagittal and vertical skeletal configurations. However, results should be interpreted with caution due to the high risk of bias, owing to the retrospective study design, inconsistencies in anatomic compartment boundaries used, samples of mixed children-adult patients, and incomplete reporting. CLINICAL TRIAL REGISTRATION: PROSPERO (CRD42022366928).

Comparative microscopic anatomy of Schizomida - 2. The rostrosoma and the pharyngeal suction pump.

This paper tests hypotheses of independent parallel evolution of the rostrosoma among euchelicerate taxa by analyzing the microscopic anatomy and histology of the rostrosoma of Uropygi (Schizomida and Thelyphonida) and comparing it with the morphology of the snout region in other euchelicerates. The study employs analysis of multiple histological serial sections, µCT-imaging, and graphical as well as computer-based 3D reconstruction. Results of the study are that Thelyphonida and Schizomida share the same morphology of the rostrosoma. The rostrosoma of both groups contains a unique arrangement of musculature that is functionally interpreted as pre-oral suction pump. This is followed by a pharyngeal suction pump. The muscles of the pharyngeal suction pump attach to the epistome and the epipharyngeal sclerite. Neither Schizomida nor Thelyphonida possess a postcerebral suction pump as reported earlier. The microscopic anatomy of the rostrosoma of both taxa is unique and does not compare with any of the other euchelicerates, thus supporting the idea of independent evolutionary origin of the rostrosoma. Thelyphonida, Amblypygi and Scorpiones share the occurrence of a large epipharyngeal/epistomal sclerite with associated musculature, which is a feature that lines up with the Arachnopulmonata concept. A comparison with all Euchelicerata taxa shows that the snout region is formed by homologous morphological elements but the specific arrangement, additions and reductions shape the formation of the rostrosoma, so that parallel evolution of homologous parts of the arachnid ground pattern can be assumed that has formed those elements into convergent morphologies.

Effects of the deformation and size of the upper airway on the deposition of aerosols.

Aerosol drug delivery in the human airway is significantly affected by the morphology and size of the airway. This work developed a CFD-DEM model to simulate and analyze air flow and powder dynamics in combined inhaler-airway systems with different degrees of airway deformation (non-deformed, 50%, and 75% deformed) and sizes (adult, 0.80, and 0.62 scaled). The airways were generated based on a regular airway constructed from the MRI images through finite element method (for deformed airways) or scaling-down (for smaller airways). The airways were connected to Turbuhaler® through a connector. The results showed that under the same flow rate, the variation in the airway geometry and size had a minimum impact on the flow field and powder deposition in the device and the connector. However, deformation caused more particle deposition in the deformed region. Notably, the airway with 50% deformation had the most particles passing through the airway with the largest particle sizes due to its lower air velocity in the deformed area. Reducing airway size resulted in more powder deposition on the airway, particularly at the pharynx and mouth regions. This was because, with the same flow rate, the flow velocity in the smaller airway was higher, causing more particle-wall collisions in the mouth and pharynx regions. More importantly, the deposition efficiency in the 0.62-scaled airway was significantly higher than the other two airways, highlighting the importance of the different administration of aerosol drugs for young children.

The effect of different functional appliances on the sagittal pharyngeal airway dimension in skeletal class II: a retrospective study.

The aim of this study was to compare the changes in the sagittal pharyngeal airway dimension (SPAD) in adolescents with Class II mandibular retrusion treated with Invisalign Mandibular Advancement (IMA), prefabricated Myobrace (MB), and Twin block (TB). For this retrospective study, the pre-treatment and post-treatment lateral cephalograms of 60 patients who underwent myofunctional treatment, using either one of the tested appliances were gathered from the files of treated patients. Changes in the SPAD were measured in each group, and comparisons were carried out between the three study groups. Additionally, sagittal skeletal measurements were carried out. Comparisons of the study variables at T0 and T1 between the three groups were performed using one-way ANOVA, while comparisons of the difference (T1-T0) were performed using Kruskal Wallis test. A significant SPAD increase has been reported using the three tested appliances (p < 0.05), with the least change documented with MB use (p < 0.05). Significant antero-posterior improvements have been found with IMA, MB, and TB with an increase in the SNB°, and a decrease in ANB° and Wits appraisal (p < 0.05). Non-significant FMA° changes have been observed post-treatment in the three test groups (p > 0.05). The IMA, MB, and TB generated significant SPAD and sagittal changes, with both IMA and TB surpassing MB in the airway area improvement post-treatment. Moreover, the three tested Class II functional appliances did not affect the vertical dimension.

Innervation and osteoclast distribution in the inferior pharyngeal jaw of the cichlid Nile tilapia (Oreochromis niloticus).

In addition to an oral jaw, cichlids have a pharyngeal jaw, which is used for crushing and processing captured prey. The teeth and morphology of the pharyngeal jaw bones adapt to changes in prey in response to changes in the growing environment. This study aimed to explore the possible involvement of the peripheral nervous system in remodeling the cichlid pharyngeal jaw by examining the innervation of the inferior pharyngeal jaw in the Nile tilapia, Oreochromis niloticus. Vagal innervation was identified in the Nile tilapia inferior pharyngeal jaw. Double staining with tartrate-resistant acid phosphatase and immunostaining with the neuronal markers, protein gene product 9.5, and acetylated tubulin, revealed that osteoclasts, which play an important role in remodeling, were distributed in the vicinity of the nerves and were in apposition with the nerve terminals. This contact between peripheral nerves and osteoclasts suggests that the peripheral nervous system may play a role in remodeling the inferior pharyngeal jaw in cichlids.

Assessment of upper airway changes after interpositional arthroplasty: a cephalometric analysis.

This prospective cohort study examined the changes in airway area and soft tissue parameters following interpositional arthroplasty for temporomandibular joint (TMJ) ankylosis. Ten patients with TMJ ankylosis underwent surgery, and preoperative and postoperative skeletal and soft tissue measurements were obtained. A significant rise in soft tissue parameters was observed following surgery, although only minor changes in skeletal parameters were seen. The nasoropharyngeal area, oral area, soft palate area, and tongue area were examined. After the surgery, increases in values were observed in the nasoropharyngeal area (from 3482.4 mm2 to 3618.7 mm2), the oral area (from 2731.8 mm2 to 2840.8 mm2), the soft palate area (from 204.9 mm2 to 217.3 mm2), and the tongue area (from 2577.5 mm2 to 2600.8 mm2). These findings suggest that interpositional arthroplasty can improve airway area and soft tissue dimensions, affecting the stomatognathic system's aesthetic and functional aspects. Further research is needed to validate these results and assess long-term stability.

Medium-term effects of rapid maxillary expansion on nasal cavity and pharyngeal airway volumes considering age as a factor: A retrospective study.

OBJECTIVES: The medium-term effects of rapid maxillary expansion (RME) on nasal cavity (NC) and upper airway (UA) dimensions based on chronological age are still unclear. This retrospective study evaluated the medium-term changes occurring in the NC and pharyngeal airways (PA) after RME in two distinct age-based cohorts of patients. METHODS: This retrospective study included 48 subjects who underwent RME grouped in two cohorts: a 6-9-year-old group (EEG group: early expansion group - 25 subjects) and an 11-14-year-old group (LEG group: late expansion group - 23 subjects). NC and PA volumes were analyzed from CBCT imaging segmentation before RME (T0) and twelve months after RME (T1). The amount of maxillary expansion (PW) and minimal cross-sectional area (CSmin) were also considered. RESULTS: All PAs' volumetric sub-regions, CSmin and PW showed a significant volumetric increment (p < 0.05). Inter-group comparisons showed significant differences (p < 0.05) for nasopharynx and CSmin parameters (p < 0.05), while no significant changes were recorded for the other UA's sub-regions and PW (p > 0.05). According to a deviation analysis, part of the UA increase (more marked for the nasopharynx area) may have occurred due to reduced adenotonsillar tissues, which were larger in the EEG group. CONCLUSIONS: Twelve months after treatment, clinicians should not expect changes in the UAs dimensions to be solely related to treatment effects of RME; instead, normal craniofacial growth changes and spontaneous regression of the adenotonsillar tissue could represent the most significant factors influencing UAs changes. CLINICAL SIGNIFICANCE: From the clinical perspective, the results of the present study encourage caution when considering the therapeutic effects of RME on airways dimensions.

3D analysis of upper airway morphology related to obstructive sleep apnea severity.

BACKGROUND: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by repetitive collapse of the upper airway during sleep. However, little evidence is available on the differences between the sub-regions of the upper airway morphology and OSA severity. Since orthodontists frequently perform cone beam computed tomography (CBCT) in the neck area, we aimed to investigate the relationship and the differences between upper airway morphology and OSA severity using CBCT. MATERIALS AND METHODS: The medical records, CBCT imaging of 21 OSA patients diagnosed by polysomnography, and the apnea-hypopnea index (AHI) results were included to classify OSA severity as mild, moderate, or severe. The minimum cross-sectional areas (MCA) and volumes of the upper pharyngeal airway boundaries in four sub-regions: nasopharynx, retropalatal, retroglossal, and hypopharynx were measured. Dolphin Imaging software was used for upper airway segmentation. The correlation coefficient (r), one-way ANOVA, and the least significant difference post hoc multiple comparison test were applied to fulfill the objectives. RESULTS: A statistically significant relationship was found between the MCA of the nasopharynx and the AHI (r = -0.473, P < 0.05). Furthermore, a difference was found between mild and moderate and moderate and severe OSA severity in the MCA results of the retroglossal region (P < 0.05). However, no relationship was found between the upper airway volume and OSA severity. CONCLUSIONS: MCA was moderately negatively correlated to AHI only in the nasopharynx subregion. Moderate OSA presented significantly less MCA than mild and severe OSA only in the oropharynx and retroglossal subregions.

Effect of Bimaxillary Orthognathic Surgery on Pharyngeal Airway Volume / Efecto de Cirugía Ortognática Bimaxilar en el Volumen de la Vía Aérea Faríngea

SUMMARY: Subjects with maxillary skeletal classes II and III not only express alterations in the hard and soft maxillofacial tissues, but also in the morphology and dimensions of the upper airway. A small space in the upper airway has been associated with sleep disorders, such as snoring and mainly obstructive sleep apnea/hypopnea syndrome (OSAHS). Consequently, interest has increased due to the influence of orthognathic surgery in the airway space. Although there are studies in the literature that have compared upper airway spaces, most have evaluated the changes using two-dimensional images, mainly lateral skull X-rays. The present study aimed to determine the airway volume in subjects with skeletal classes II and III who underwent bimaxillary orthognathic surgery. 80 CBCT exams from 40 subjects obtained before and 6 months after surgery were used. There were 20 class II and 20 class III subjects. For the volumetric analysis, a 3D rendering of the upper airway was made in previously established segments, and then the airway volume was calculated using the 3D Slicer® software version 4.11 (Slicer, USA). The statistical analysis by t-test of related samples revealed statistically significant volumetric increases in the nasopharynx, laryngopharynx, and total volume in class II patients. However, in class III patients, there were significant increases in the nasopharynx and total volume, while the volume was maintained in the oropharynx and laryngopharynx.

Sujetos con clases esqueletales II y III maxilares, no solamente expresan alteraciones en los tejidos duros y blandos maxilofaciales, sino también en la morfología y dimensiones de la vía aérea superior. Un espacio reducido a nivel de la vía aérea superior se asocia a trastornos del sueño como ronquidos y principalmente el síndrome de apnea/hipoapnea obstructiva del sueño (AOS); debido a esto, ha aumentado el interés por la influencia de la cirugía ortognática en el espacio de la vía aérea. Si bien existen en la literatura estudios que han comparado los espacios de la vía aérea superior, la mayoría de los estudios han evaluado los cambios utilizando imágenes bidimensionales, principalmente radiografías laterales de cráneo. El objetivo del presente estudio fue determinar el volumen de la vía aérea en sujetos con clases esqueletales II y III sometidos a cirugía ortognática bimaxilar. Se utilizaron 80 exámenes CBCT pertenecientes a 40 sujetos obtenidos previo a la cirugía y 6 meses después de realizada. Veinte sujetos clase II y 20 clase III. Para el análisis volumétrico se realizó un renderizado 3D de la vía área superior en segmentos previamente establecidos y posteriormente se calculó el volumen de dicha vía aérea con la utilización del software 3D Slicer ®versión 4.11 (Slicer, USA). El análisis estadístico realizado por t-test de muestras relacionadas, arrojó en pacientes clase II aumentos volumétricos estadísticamente significativos en nasofaringe, laringofaringe y volumen total. Mientras que en pacientes clase III, se observó aumentos significativos en Nasofaringe y volumen total y mantención de volumen en orofaringe y laringofaringe.

Changes in the airway after mentoplasty (genioplasty): systematic review / Cambios en la vía aérea después de una mentoplastia (genioplastia): una revisión sistemática

SUMMARY: The aim of this research was to evaluate the changes obtained with the mentoplasty technique in the increase of the airway imaging. A systemic review was performed using the parameters of the prism matrix, in the PubMed, Science Direct, Redalyc database, covering the years 1984 to 2019 with the use of defined inclusion criteria. The authors independently applied the selected parameter of data extraction, study selection and risk-to-bias assessment. A total of 1,251 articles were obtained among the 3 databases, of which 10 met the inclusion criteria. The variables studied were: type of research, sample size, sex, age, dento-skeletal diagnosis, airway classification, diagnosis of obstructive sleep apnea syndrome (OSAS), type of imaging evaluation, variables evaluated in the image, pre and post-operative values, surgical technique and type of fixation used, other surgical procedures applied, and complications. In the cases of linear evaluation with cephalometric analysis (9 articles) they used PAS (posterior airspace), MP-H (mandibular plane to the hyoid) and SNB (saddle-nasion-point B), and SCSA (section area as the most relevant points, smallest cross section) and VT (total volume) in the volumetric evaluations (2 articles). The average change in posterior airspace achieved by the cited authors is 4.2 mm with standard deviation of 1.4 mm with the use of advancement mentoplasty. The most widely used technique was mentoplasty with a horizontal osteotomy by 5 authors. Based on the research there is a positive relationship between the increase in the airway and the advancement mentoplasty procedure, however, more standardized studies associated with the way of measuring and evaluating the relationship between advancement and the airway are necessary.

RESUMEN: El objetivo de esta investigación fue evaluar los cambios obtenidos con la técnica de mentoplastia en el incremento de la via aérea. Una revisión sistemática fue realizada utilizando parámetros de la matriz prisma, en PubMed, Science Direct, Redalyc database, cubriendo los años 1984 a 2019 con criterios de inclusión definidos. Los autores aplicaron de forma independiente los parámetros de selección y extracción de datos, selección de estudios y riesgos de sesgo. Un total de 1251 artículos fueron obtenidos de las 3 bases de dato, donde 10 artículos cumplieron los criterios de inclusión. Las variables estudiadas fueron: tipo de investigación, tamaño de la muestra, genero, edad, diagnóstico dento esqueletal, clasificación de la vía aérea, diagnostico de síndrome de apnea del sueño (SAOS), tipo de evaluación de la imagen, variables evaluadas en la imagen en pre y postoperatorio, técnica quirúrgica y tipo de fijación utilizada, otros procedimientos quirúrgicos y complicaciones. En el caso de la evaluación linear con cefalometria (9 artículos), usaron PAS (posterior airspace), MP-H (plano mandibular hacia el hueso hioide) y SNB (silla turca-nasion- punto B) y SCSA (sección de puntos mas relevantes, menores transfversales) y el VT (volumen total) en las evaluaciones volumétricas (2 artículos). El promedio de cambio posterior de la vía aérea citado por autores fue de 4,2 mm con una desviación estándar de 1,4 mm con el uso de la mentoplastia de avance. La técnica mas habitual fue la mentoplastia con osteotomía horizontal (5 autores). Basados en esta investigación existe una relación positiva entre el incremento de la vía aérea y el avance con genioplastia; sin embargo, mas estudios estandarizados junto con medidas definidas y la evaluación correcta del avance y la vía área son necesarios.

El paciente roncador: evaluación y alternativas terapéuticas / The snoring patient: evaluation and therapeutic alternatives

El ronquido es un problema altamente prevalente, que afecta a millones de personas a nivel mundial. Impacta negativamente en la calidad de vida al afectar la relación de pareja y la calidad de sueño, además de constituir un factor de riesgo cardiovascular. El objetivo de esta revisión es analizar y discutir los aspectos más relevantes de esta condición, desde su etiopatogenia hasta las diferentes alternativas terapéuticas disponibles. En la evaluación del paciente roncador se debe realizar un minucioso examen de nariz, boca, faringe, cuello y esqueleto facial, además de estimar el riesgo de que exista una apnea obstructiva del sueño asociada. Son de utilidad una serie de cuestionarios que permiten asignar puntaje a la sintomatología del paciente y evaluar su impacto en la vida diaria. En general, el estudio deberá incluir exámenes radiológicos, endoscopías de la vía aérea superior (con el paciente despierto y bajo sueño inducido por medicamentos) y estudios del sueño, que se pueden realizar tanto en forma ambulatoria como hospitalizado. Existe una amplia gama de tratamientos disponibles para el ronquido, los que han demostrado una alta efectividad en diferentes subgrupos de pacientes: bajar de peso, dejar de fumar, medicamentos antialérgicos, terapia postural, ejercicios faríngeos, dispositivos de avance mandibular y procedimientos quirúrgicos que van desde intervenciones mínimamente invasivas hasta procedimientos avanzados como cirugía robótica, avances máxilo-mandibulares y la estimulación del nervio hipogloso. Es clave para manejar exitosamente el ronquido el realizar una evaluación detallada del paciente y establecer un plan terapéutico personalizado.

Snoring is a highly prevalent problem, affecting millions of people worldwide. It negatively impacts quality of life by affecting couple relationships and sleep quality, as well as being a cardiovascular risk factor. The aim of this review article is to analyze and discuss the most relevant aspects of this condition, ranging from its etiology and pathogenesis to the different available therapeutic options. When evaluating a snoring patient, a thorough examination of the nose, mouth, pharynx, neck and facial skeleton should be performed, and the risk of having an associated obstructive sleep apnea must be estimated. A series of questionnaires are useful to assign scores to the patient's symptoms and assess their impact on daily life. In general terms, patient evaluation should include radiological examinations, upper airway endoscopies (awake and under drug-induced sleep) and sleep studies, which can be performed both on an outpatient or inpatient basis. There is a wide range of treatments available for snoring, which have shown high effectiveness in different patient subgroups: weight loss, quitting smoking, anti-allergic medications, postural therapy, pharyngeal exercises, mandibular-advancement devices and surgical procedures ranging from minimally invasive interventions to advanced procedures such as robotic surgery, maxillomandibular advancement and hypoglossal nerve stimulation. The cornerstone for a successful snoring management is to perform a detailed patient evaluation and to establish a personalized therapeutic plan.

Avaliação do volume das vias aéreas superiores conforme o padrão facial / Upperairway volume assessment accordingto facial pattern

Objetivo: analisar o volume da via aérea superior (VAS) em pacientes adultos saudáveis, a partir de exames de tomografia computadorizada de feixe cônico, comparando os padrões faciais esqueléticos I, II e III, considerando a idade e o sexo. Método: um estudo retrospectivo de análise do banco de dados de uma clínica radiológica, com uma amostra de 129 exames de face total em formato DICOM, datados de 2015 a 2018. Após a divisão da amostra em três grupos, conforme o padrão esquelético, as medidas volumétricas foram obtidas através do aplicativo ITK-SNAP versão 3.6.0, um processador gratuito de segmentação anatômica 3D. Resultados: a amostra foi separada em padrão I com 60 exames, padrão II com 48 exames e padrão III com 21 exames. O sexo feminino foi o mais frequente, com 69,8% (n = 90), e a média de idade foi definida em 35 anos. O volume médio geral foi de 22.774,2 mm³ e a média entre os padrões esqueléticos não apresentou diferença significante (p = 0,251), segundo o teste não paramétrico de Kruskal-Wallis (p < 0,05). Na análise do dimorfismo sexual, os homens apresentaram maior volume, com diferença estatística (p = 0,033) através do teste de Mann-Whitney. Conclusão: o volume médio da VAS entre indivíduos saudáveis com padrões faciais I, II e III não apresentou diferença significativa, apenas uma discreta variação, sendo o padrão III maior em 14,8% do que o padrão I. O sexo masculino se destacou com maior volume, e a variação da idade não teve correlação com o volume do espaço aéreo faríngeo.(AU)

Aims: Analyze upper airway volume in healthy adult patients from CBCT examinations, comparing skeletal facial patterns I, II and III, considering age and gender. Methods: A retrospective study of a radiological clinic database analysis, with a sample of 129 full-face DICOM exams, dated between 2015 and 2018. After dividing the sample into three groups, according to skeletal pattern, volumetric measurements were obtained through the application ITK-SNAP version 3.6.0, a free 3D anatomical segmentation process. Results: The sample was separated into pattern I with 60 exams, pattern II with 48 and pattern III with 21 exams. Females were the most frequent with 69.8% (n = 90) and the mean age was defined as 35 years. The overall mean volume was 22,774.2 mm³ and the mean between skeletal patterns showed no significant difference (p = 0,251), according to the nonparametric Kruskal-Wallis test (p < 0,05). In the analysis of sexual dimorphism, men presented higher volume, with statistical difference (p = 0,033) through the Mann-Whitney test. Conclusion: The mean upper airway volume among healthy individuals with facial patterns I, II and III showed no significant difference, only a slight variation, pattern III being 14.8% higher than pattern I. The male gender stood out with greater volume and the age variation had no correlation with the pharyngeal space volume.(AU)

Comparison of airway dimensions in skeletal Class I malocclusion subjects with different vertical facial patterns

ABSTRACT Objective: The aim of this study was to compare upper airway widths among skeletal Class I malocclusion subjects with different vertical facial patterns. Methods: The sample included a total of 99 lateral cephalograms of post pubertal individuals (18.19 ± 1.76 years old). The vertical facial pattern was determined by the Vert index. The McNamara method was used to quantify upper airway widths. ANOVA test and Student's t test for independent groups were used, when normal distribution was not supported Kruskal-Wallis test and U-Mann-Whitney test were used. A multiple linear regression analysis was also performed. Results: Statistically significant differences in several nasopharyngeal widths were found among the distinct vertical facial patterns. Subjects with brachyfacial pattern presented larger nasopharyngeal widths than subjects with mesofacial (p= 0.030) or dolichofacial (p= 0.034) patterns. The larger the Vert value, the larger the nasopharyngeal widths (R2= 26.2%, p< 0.001). At the level of oropharynx no statistically significant differences were found. Conclusion: It was concluded that nasopharyngeal linear anteroposterior widths in Class I malocclusion brachyfacial are larger than in mesofacial and dolichofacial individuals. The Vert index only explained 25% of the total variability. No correlation was found for the oropharyngeal widths.

RESUMO Objetivo: o objetivo desse estudo foi comparar as dimensões das vias aéreas superiores em indivíduos portadores de má oclusão de Classe I esquelética com diferentes padrões faciais verticais. Métodos: a amostra consistiu de 99 cefalogramas laterais de indivíduos na pós-puberdade (18,19 ± 1,76 anos). O padrão facial vertical foi determinado por meio do índice VERT. O método de McNamara foi utilizado para quantificar as dimensões das vias aéreas superiores. O teste ANOVA e o teste t de Student para grupos independentes foram utilizados e, quando a distribuição normal não era possível, o teste de Kruskal-Wallis e o teste U de Mann-Whitney foram aplicados. Foi também realizada uma análise de regressão linear múltipla. Resultados: diferenças estatisticamente significativas nas dimensões da nasofaringe foram encontradas entre os diferentes padrões faciais verticais. Os indivíduos com padrão braquifacial apresentaram dimensões nasofaríngeas maiores do que os indivíduos com padrão mesofacial (p= 0,030) ou dolicofacial (p= 0,034). Quanto maior o valor do VERT, maior a dimensão nasofaríngea (R2 = 26,2%, p< 0,001). Não foram encontradas, entretanto, diferenças estatisticamente significativas ao nível da orofaringe. Conclusão: pode-se concluir que as dimensões anteroposteriores lineares da nasofaringe nos indivíduos braquifaciais com má oclusão de Classe I são maiores do que nos indivíduos mesofaciais e dolicofaciais. O índice VERT foi capaz de explicar apenas 25% da variabilidade total. Não foi encontrada correlação para as dimensões da orofaringe.

Avaliação da cavidade orofaríngea da tartaruga da Amazônia, Podocnemis expansa (Schweigger, 1812) / Evaluation of the oropharyngeal cavity of Giant South American turtle Podocnemis expansa (Schweigger, 1812)

Os quelônios são importantes como fonte alimentar e econômica para as comunidades da região amazônica. Sendo assim, a caça, a pesca e a procura por ovos destes animais tem ocorrido frequentemente. Podocnemis expansa (Tartaruga da Amazônia) é o maior quelônio de água doce da América do Sul. É uma espécie largamente distribuída, porém, nota-se que aspectos anatômicos da espécie são insuficientemente descritos. O objetivo desse estudo foi descrever a cavidade orofaríngea desses quelônios. Foram utilizadas 12 cabeças de P. expansa adultas, de ambos os sexos, com idade entre 3 a 8 anos, com peso corpóreo de 5 a 22kg (média de 7,5kg). P. expansa conta com a presença de rafontecas afiadas e bem desenvolvidas que, associadas à musculatura potente da mandíbula e à língua volumosa e bem distribuída no assoalho da orofaringe, atuam na apreensão e deglutição do alimento, garantindo uma maior adaptação em diversos ambientes...

Turtles are important as food and economic resources for the Amazon communities and there is a large demand on its meat and eggs. Podocnemis expansa (Giant South American turtle) is the largest freshwater chelonian of South America. This turtle is a widely distributed specie, however its anatomical features are poorly described. The objective of this study was to describe the oropharyngeal cavity of the turtle. Twelve heads of 3 to 8-year-old female and male P. expansa turtles with an average body weight of 7.5kg were used. P. expansa has a sharp and well developed rhamphotheca, which together with a powerful jaw muscles and a large tongue uniformly distributed on the oropharynx floor works for the apprehension and swallowing of food, what ensures good adaptation in different environments...

Pharyngeal airway space in subjects with class II and class III facial deformities / Espacio de la vía aérea faríngea en sujetos con deformidad facial clase II y clase III

Facial deformities are related to morphological differences and the mandible position shows differences in maxillomandible relation. The aim of this research was to compare the pharyngeal airway space (PAS) in subjects with class II and class III facial deformities We included 28 adult subjects with skeletal characteristics associated to class II or class III according to the SNA angle and dental overjet; subjects with facial asymmetry and other facial deformities and subjects with facial trauma or facial surgery history were excluded. Cone beam computed tomography was realized (CBCT) to asses the nasopharynx, oropharynx, hypopharynx, as well as the distance measured between the mandible genial spine and hyoid bone; data analysis were realized by descriptive analysis and statistical analysis using t test with 0.05 to show statistical differences. Class II subjects presented minor values in all of the measurements; in the oropharynx and the hypopharynx we observed the most important differences, with nasopharynx showing statistically significant differences (p<0.05). In conclusion class II subjects presented a minor pharyngeal airway space and it is suggested that this information should be used in the diagnosis process and prior to surgical treatment.

Las deformidades faciales son asociadas a diferencias en la posición mandibular evidenciando diferencias en la relación maxilomandibular. El objetivo de esta investigación fue comparar el espacio aéreo faríngeo en sujetos con deformidad facial clase II y clase III. Se incluyeron 28 sujetos con características esqueletales asociadas a clase II o clase III seguidos de la evaluación del angulo SNA y el resalte dentario; se excluyeron los sujetos con asimetría facial y otras deformidades faciales y sujetos con historia de trauma facial o historia de cirugía facial; se realizó la tomografía computadorizada cone beam para evaluar el área de nasofaringe, orofaringe, hipofaringe y la distancia entre la espina geni mandibular y el hueso hioides; los datos se analizaron con estadística descriptiva y la prueba t usando un valor de 0,05 para establecer significancia estadística. Se observó que los sujetos de clase II presentaron valores menores a los sujetos clase III en todas las mediciones realizadas; en el área de orofaringe e hipofaringe se observaron las diferencias mas importantes, estadísticamente significativas (p<0,05). Se puede concluir que los sujetos con deformidad facial clase II presentan un espacio de vía aérea faríngea más estrecho y se sugiere que este temática sea resuelta en la etapa de diagnóstico previo a la selección de tratamientos quirúrgicos o no quirúrgicos.

Cephalometric evaluation of the airway space and hyoid bone in children with normal and atypical deglutition: correlation study / Avaliação cefalométrica de via aérea e do osso hioide em crianças com deglutição normal e atípica: estudo de correlações

CONTEXT AND OBJECTIVE: Although there is a close relationship between swallowing and breathing, there are no studies evaluating the radiographic anatomy of the airway and its possible correlation with the radiographic position of the hyoid bone. The aim of this study was to evaluate the possible correlation of the radiographic position of the hyoid bone and airway space (PAS) in lateral radiographs on children with atypical deglutition, in comparison with those with normal swallowing. DESIGN AND SETTING: Cross-sectional analytical study with control group in a public university. METHODS: Using cephalometric analysis on lateral teleradiographs, the distance from the hyoid bone to the mandibular plane (MP-H) and the distance from the hyoid bone to the tuber (T-H) were correlated with the PAS measurement (airway) in two groups: 55 teleradiographs in the experimental group (with atypical deglutition) and 55 teleradiographs in the control group (normal deglutition). Both groups included subjects at the mixed dentition stage. RESULTS: The variable T-H presented a statistically significant correlation with PAS (0.0286) and the variable MP-H had a significant correlation with the variable PAS (0.0053). This positive correlation was significant only in the control group and not in the group with atypical swallowing. CONCLUSIONS: There was a positive correlation between the MP-H and PAS measurements and between the T-H and PAS measurements only in the group with normal swallowing. These correlations were not observed in the group with atypical swallowing.

CONTEXTO E OBJETIVO: Embora haja estreita relação entre respiração e deglutição, não existem estudos que avaliem a anatomia radiográfica de via aérea e sua possível correlação com a posição radiográfica do osso hioide. O objetivo deste estudo foi avaliar possível correlação da posição radiográfica do osso hioide e do espaço aéreo na radiografia lateral de crianças com deglutição atípica quando comparada com aquelas com deglutição normal. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico com grupo controle em universidade pública. MÉTODOS: Por meio de análise cefalométrica em telerradiografias laterais, foi correlacionada a distância do osso hioide ao plano mandibular (MP-H) e do túber ao osso hioide (T-H) com a medida do espaço da via aérea (PAS) em dois grupos: 55 telerradiografias do grupo experimental (com deglutição atípica) e 55 telerradiografias do grupo controle (deglutição normal). Ambos os grupos incluíram indivíduos em fase de dentição mista. RESULTADOS: A variável T-H apresentou correlação estatisticamente significativa com PAS (0,0286) e a variável MP-H teve correlação significativa com a variável PAS (0,0053). Esta correlação positiva foi significativa apenas no grupo controle e não no grupo de deglutição atípica. CONCLUSÕES: Há correlação positiva entre as medidas MP-H e PAS e entre as medidas T-H e PAS somente no grupo de deglutição normal. Estas correlações não foram observadas no grupo de deglutição atípica.

Gross anatomical features of the oropharyngeal cavity of the ostrich (Struthio camelus) / Características macroscópicas da cavidade orofaríngea de avestruz (Struthio camelus)

Most descriptions of the ostrich oropharynx and oesophagus are superficial and supply little meaningful morphological data. The aim of this investigation is describe the ostrich oropharingeal cavity, in order to supply the deficiency of macroscopic data about this important animal. Five heads of 12 to 14-month-old ostriches of either sex were anatomically dissected to expose the oropharynx. The ostrich oropharynx was "bell-shaped" composed by the maxillary and mandibular ramphoteca. The roof and floor presented two distinct regions different in colour of the mucosa. The rostral region was pale pink contrasting to creamy-pink coloured caudal region. The median longitudinal ridge extended rostrally from the apex of the choana to the tip of the beak in the roof and it is clearly more prominent and rigid than the homolog in the floor that appeared thin and stretched rostrally, continuing caudally surrounding the tongue and the laryngeal mound eventually merging with the oesophageal mucosa. The floor was formed by the interramal region, tongue and laryngeal mound containing shield-shaped glottis. It can be concluded that the present study, in addition to confirming the basic features of the oropharynx previously described for the ostrich, clarified the contradictory information presented in the literature and also provided new, unreported morphological data, some of which may be important when studying nutrition and health in these birds.

Os estudos já realizados sobre a cavidade orofaríngea da avestruz são escassos e não elucidam completamente sua morfologia. O objetivo desse estudo foi descrever macroscopicamente a cavidade orofaríngea de avestruzes com o intuito de suprir a deficiência de informação nesta espécie. Foram utilizadas 5 cabeças de avestruzes com doze a quatorze meses de idade dissecadas seguindo padrões anatômicos de modo a expor a orofaringe. A orofaringe de avestruzes tem formato de sino e é composta pelas ranfotecas maxilar e mandibular. O teto e o assoalho apresentavam duas regiões distintas diferindo quanto à coloração da mucosa. A porção mais rostral era de coloração rosa pálida contrastando com a coloração mais fortemente rosada da porção mais caudal. A ruga palatina mediana estendia-se rostralmente do ápice da coana até a ponta do bico. No teto esta era mais proeminente e rígida que a do assoalho que se apresentava delgada e se estendia ao longo da porção rostral da região interramal, continuando caudalmente ao redor da coana e laringe e estendendo-se até o esôfago. O assoalho estava formado pela região interramal, língua e uma laringe com uma glote em forma de escudo. Pode-se concluir o presente estudo, além de confirmar as características básicas da orofaringe da avestruz previamente descritas, clarificam a informação contraditória presente na literatura e também novas informações morfológicas não previamente descritas são destacadas de forma a amparar outros estudos sobre a nutrição e saúde destas aves.