RESUMO
Background and Objectives: This paper presents a unique study that links the physical conditions in the nasal passage with conditions that favour the development of bacterial strains and the colonization of the mucous membranes of the nose and paranasal sinuses. The physical parameters considered were air flow, pressure, humidity, and temperature. Materials and Methods: Numerical models of the human nose and maxillary sinus were retrospectively reconstructed from CT images of generally healthy young subjects. The state-of-the-art numerical methods and tools were then used to determine the temperature, humidity, airflow velocity, and pressure at specific anatomical locations. Results: The results were compared with optimal conditions for bacterial growth in the nose and sinuses. Conclusions: Temperature, humidity, air velocity, and pressure were shown to play critical roles in the selection and distribution of microorganisms. Furthermore, certain combinations of physical parameters can favour mucosal colonisation by various strains of bacteria.
Assuntos
Seio Maxilar , Cavidade Nasal , Humanos , Seio Maxilar/diagnóstico por imagem , Estudos Retrospectivos , Cavidade Nasal/diagnóstico por imagem , Simulação por Computador , TemperaturaRESUMO
: A condylectomy of the mandibular condyle is considered to be the treatment of choice in most cases of condylar head hyperactivity. The aim of the procedure is to remove the growth center of the mandible which is responsible for the mandibular enlargement and asymmetry. This surgical procedure has an impact on the condyle shape and position, but the restoration of mandibular movement and a stable joint position (namely, the proper alignment of the newly shaped condylar head within the condyle fossa) should also be considered important surgical outcomes. In this article, the authors present their own experience in performing condylectomies with an arthroplasty procedure and a special forced suturing technique (FST) in terms of achieving early, accurate mandibular movement and maintaining a stable condyle position in early and late outcomes. MATERIALS AND METHODS: A modified high condylectomy with arthroplasty and FST results had been studied in anatomical, radiological, and clinical model. RESULTS: Early findings after FST are promising. A slight improvement in lateral jaw movement was noted after condylectomy with arthroplasty (Pâ<â0.05) both in early and late follow-up. Incisal opening, mandibular protrusion, and lateral movement were sustained. A stable condyle position within the fossa was achieved in each case of condylectomy with arthroplasty (Pâ<â0.05). CONCLUSIONS: The FST condylectomy and reattachment of the lateral pterygoid muscle in a new, wider position provided an improvement in lateral jaw movement as well as in incisal opening and mandibular protrusion in early follow-up examination compared to the presurgical values. It seems that the FST enabled a better new condylar head position in the glenoid fossa and improved early functional mandibular movement.
Assuntos
Côndilo Mandibular/cirurgia , Osteotomia , Adulto , Feminino , Humanos , Masculino , Músculos Pterigoides/cirurgia , Adulto JovemRESUMO
PURPOSE: The aim of the study was to assess potential endoprosthesis loosening in patients after revision total hip arthroplasty, based on monochromatic dual-energy computed tomography (DECT) images obtained with and without metal artifact reduction software (MARS) and comparison with the clinical examination and hip function. MATERIALS AND METHODS: Twenty-five consecutive patients underwent DECT examinations. Two monochromatic data sets were generated: with MARS (75-keV MARS) and without MARS (140-keV non-MARS) and evaluated for signs of loosening, using a dedicated radiological score. The Harris Hip Score (HHS) was used to evaluate patients' hip function. RESULTS: The mean radiological score for loosening in the non-MARS group was 16.2, in the MARS group 17.0 and was significantly higher (P < 0.001). Radiological loosening evaluation in non-MARS images correlated with the HHS score (ρ = 0.43, P = 0.03), whereas there was no correlation between MARS images and HHS (ρ = 0.15, P = 0.47). New MARS-related artifacts, which hinder implant-bone interface evaluation, were found in 75-keV MARS images ("pseudo-loosening" in 33 of 34 prostheses, "ground-glass blurring" in 20 of 32). CONCLUSIONS: High-energy monochromatic DECT images are superior to low-energy DECT MARS images in assessment of the potential loosening and correlate better with the clinical examination outcomes. For revision total hip arthroplasty evaluation, 2 data sets should be assessed inseparably because of extra artifacts in MARS images.
Assuntos
Artroplastia de Quadril/instrumentação , Prótese de Quadril/efeitos adversos , Quadril/diagnóstico por imagem , Falha de Prótese/efeitos adversos , Reoperação/instrumentação , Feminino , Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Sensibilidade e Especificidade , Software , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVES: Correct positioning of the acetabular component is a key factor in minimizing the risk of dislocation after total hip replacement (THR) surgery. A "safe" orientation of the cup is usually defined by 2 angles measured between its geometric axis and the anterior pelvic plane. However, in the current state-of-the-art approach to THR surgery, the intraoperative orientation of the anterior pelvic plane cannot be measured. Even less is known about the functional orientation of the pelvis, which determines the postoperative orientation of the cup during the patient's everyday activities. The aim of this article is to present an original approach to personalized THR surgery, in which the necessary measurements are done preoperatively without interfering with the surgical work flow, and the individual orientation of the cup is obtained without navigation using standard tools that are available in the operating room. METHODS: To quantify the effect of the anatomic conditions on the final orientation of the cup, we measured the orientation of the anterior pelvic plane in 43 patients scheduled for THR using a newly developed noninvasive method based on ultrasonography and mobile devices. RESULTS: Our results confirm a large variability of the pelvic orientation in both supine and standing positions. We further show how this variability affects the final position of the cup and discuss its consequences for the patient. Finally, we explore a few practical solutions for individualized cup placement, including our own approach, which is based on tilting of the operating table. CONCLUSIONS: In this work, we show that the common guidelines used today for cup implantation can only be effectively applied to a small portion of the population. In most cases, it is crucial that the orientation of the cup is readjusted for the particular anatomy of the individual patient.
Assuntos
Acetábulo/diagnóstico por imagem , Artroplastia de Quadril/métodos , Prótese de Quadril , Cuidados Pré-Operatórios/métodos , Ultrassonografia/métodos , Idoso , Feminino , Articulação do Quadril , Humanos , MasculinoRESUMO
OBJECTIVES: Correct positioning of the acetabular cup is the key for successful total-hip replacement. In common clinical practice, the target alignment of the cup is defined with respect to the anterior pelvic plane. In patients with substantial anterior pelvic plane inclination, this condition may lead to inappropriate distribution of the load on the cup, as most of the forces exerted within the hip joint act along the vertical axis. With the known pelvic inclination, it is possible to readjust the position of the cup with respect to the individual posture of the patient. In this work, we present the first clinical evaluation of a new approach to measurement of the pelvic tilt angle using navigated ultrasound. METHODS: In our method, the ultrasound probe is tracked with an optical localizer implemented on a handheld mobile device. The method was tested by taking preoperative measurements from 20 patients with osteoarthritis in standing, sitting, and supine positions. RESULTS: The mean values of the measured angles were consistent with the corresponding results reported by other authors. CONCLUSIONS: Considering the noninvasiveness of the method and affordability of the hardware used in our system, it can be used in preoperative and postoperative measurements of pelvic orientation for supporting surgery planning and evaluation of treatment outcomes.
Assuntos
Pontos de Referência Anatômicos/diagnóstico por imagem , Artroplastia de Quadril/métodos , Aumento da Imagem/instrumentação , Osteoartrite do Quadril/diagnóstico por imagem , Posicionamento do Paciente/instrumentação , Ossos Pélvicos/diagnóstico por imagem , Ultrassonografia/instrumentação , Algoritmos , Artroplastia de Quadril/instrumentação , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Osteoartrite do Quadril/cirurgia , Posicionamento do Paciente/métodos , Imagens de Fantasmas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ultrassonografia/métodosRESUMO
The aim of the study was to compare visualisation of the surgically relevant anatomical structures via low- and standard-dose multidetector CT protocol in patients with chronic rhinosinusitis (CRS) and higher risk for perioperative complications (i.e. presence of bronchial asthma, history of sinus surgery and advanced nasal polyposis). 135 adult CRS patients were divided randomly into standard-dose (120 kVp, 100 mAs) or low-dose CT groups (120 kVp, 45 mAs). The detectability of the vital anatomical structures (anterior ethmoid artery, optic nerve, cribriform plate and lamina papyracea) was scored using a five-point scale (from excellent to unacceptable) by a radiologist and sinus surgeon. Polyp sizes were quantified endoscopically according to the Lildholdt's scale (LS). Olfactory function was tested with the "Sniffin' Sticks" test. On the low-dose CT images, detectability ranged from 2.42 (better than poor) for cribriform plate among anosmic cases to 4.11 (better than good) for lamina papyracea in cases without nasal polyps. Identification of lamina papyracea on low-dose scans was significantly worse in each group and the same was the case with cribriform plates in patients with advanced polyposis and anosmia. Cribriform plates were the most poorly identified (between poor and average) among all the structures on low-dose images. Identification of anterior ethmoid artery (AEA) with reduced dose was insignificantly worse than with standard-dose examination. The AEA was scored as an average-defined structure and was the second weakest visualised. In conclusion, preoperatively, low-dose protocols may not sufficiently visualise the surgically relevant anatomical structures in patients with CRS and bronchial asthma, advanced nasal polyps (LS > 2) and history of sinus surgery. Low mAs value enables comparable detectability of sinonasal landmarks with standard-dose protocols in patients without analysed risk factors. In the context of planned surgery, the current preferences of the tube should be carefully evaluated for different patient constitutions to minimise the risk of complications.
Assuntos
Tomografia Computadorizada Multidetectores , Doses de Radiação , Rinite/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Adulto , Asma/complicações , Doença Crônica , Estudos Transversais , Endoscopia , Osso Etmoide/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Transtornos do Olfato/complicações , Rinite/complicações , Método Simples-Cego , Sinusite/complicações , Adulto JovemRESUMO
The external auditory canal cholesteatoma is a rare and difficult to diagnose disease. Symptoms are similar to the external ear canal inflammation and can be masked by retained cerumen. In the article we described a case of 22 year old, mentally impairment women with bilateral otorrhea, in the past treated for external ear canal inflammation. The otoscopic examination showed bilateral congenital auditory canal stenosis, with masses obstructing ear canals. Imaging and histopathologic studies revealed bilateral external ear canal cholesteatoma. The patient was qualified for surgery, which, together with a guardian, did not consent. Presented case indicates the necessity for widening the diagnostic of recurrent external ear canal inflammation.
Assuntos
Colesteatoma/diagnóstico , Meato Acústico Externo , Otopatias/diagnóstico , Adulto , Feminino , Humanos , Otoscopia , Adulto JovemRESUMO
The role of low-dose computed tomography (LDCT) in surgical planning can be assessed based on the correlation among bone density (BD/HU), radiographic values, and the histopathological appearance of hyperplastic overgrowth in mandibular condyles (hemimandibular hyperplasia/osteochondroma). The aim of this study was to evaluate the correlation between LDCT indices of bone-density measurements in surgical planning and histopathological specimens. The patients incuded in this study underwent detailed radiological evaluation as preparation for further clinical procedures. Excised condyles were evaluated in terms of bone density index using LDCT, and then histopathologically to investigate the accuracy of surgical procedures and set the basis for future surgical planning. An index value between both condyles' bone densities represented the relative difference between the healthy condyle and the side with hemimandibular hyperplasia (HH). Patients with unilateral condylar hyperplasia (UCH) showed a statistical correlation between condyle heads with increased bone density (BD) and scintigraphic (SCI) values (p < 0.001). On the other hand, correlation between BD and histopathological studies alone was significant (p < 0.001). With the increase in BD measured in HU in UCH condyles, the overall value of fibrous cartilage layer thickness decreased (p < 0.001). Furthermore, histopathological evaluation indicated that increased bone density on the UCH side resulted in increased total thickness (p > 0.001). The proposed index measurements in the mandibular condyles based on LDCT/BD can be used to estimate the degree of required surgical resection. Results from LDCT radiographic studies correlate with histopathological specimens more than scintigraphy.
Assuntos
Densidade Óssea , Neoplasias Ósseas , Humanos , Estudos Retrospectivos , Hiperplasia/diagnóstico por imagem , Hiperplasia/patologia , Assimetria Facial/diagnóstico por imagem , Assimetria Facial/cirurgia , Assimetria Facial/patologia , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/cirurgia , Côndilo Mandibular/patologia , Tomografia Computadorizada por Raios X , Neoplasias Ósseas/patologiaRESUMO
BACKGROUND: The focus on health-related quality of life (HRQOL) in medical research is becoming more and more intensive, with attention being paid to the patient's subjective feelings and assessment of one's health status. Smell disorders can significantly impact human life. The Questionnaire of Olfactory Disorders (QOD) is a self-monitoring questionnaire that provides subjective information about olfactory disorders. OBJECTIVES: This study aimed to check the reliability and validation of the Polish version of QOD (QOD-PL) for use in patients with olfactory impairment in Poland. MATERIAL AND METHODS: A total of 158 patients (76 females, mean age (Mage) 45.97 ±16.37 years), suffering from chronic rhinosinusitis (CRS), whose olfactory function was measured using the Sniffin' Sticks test (SST), were studied. All patients completed 3 validated questionnaires: Importance of Olfaction (IO), Sino-Nasal Outcome Test-22 (SNOT-22) and QOD-PL. RESULTS: Internal consistency and test-retest reliability of the entire QOD-PL scale were good (Cronbach's α = 0.88). The convergent validity of the QOD-PL and its subscales correlated with IO and SNOT-22. The life quality statements in the QOD-PL (QOD-PL-LQ) score, its negative statements, and the mean score for VAS scales were significantly and positively correlated with all symptoms measured with SNOT-22 and none of the IO scales. CONCLUSIONS: The QOD-PL is a reliable, valid and important tool for assessing HRQOL in patients with olfactory disorders. However, it is important to note that not all of its subscales can be considered and interpreted separately.
Assuntos
Transtornos do Olfato , Rinossinusite , Sinusite , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Olfato , Polônia , Qualidade de Vida , Reprodutibilidade dos Testes , Transtornos do Olfato/diagnóstico , Sinusite/diagnóstico , Inquéritos e Questionários , Doença CrônicaRESUMO
Introduction. The presence of bone septum in the maxillary sinus is one of the most common anatomical findings. So-called Underwood septa (US) are an atypical bone formation in the maxillary sinuses. Mostly they are quite easily found in CBCT studies and have major importance in sinus lift procedures in dental surgery. Furthermore, the shape, location, and size of the bony septa are important in each maxillary sinus surgery. Material and methods. A retrospective study of 120CBCT scans from the authors' own database was conducted. Results. Approximately 37.5% of each CBCT was associated with the occurrence of US, while just 25% had a full septum, and a total of only 14 patients had a half septa. More females have US, while healthy pneumatized maxillary sinus is most commonly found (82.22%). There is no correlation between the occurrence of silent sinus syndrome (p = 0.174), mucosal thickening (p = 0.325), or retention cyst formation (p = 0.272). Most sinuses are without any opacification in CBCT evaluation (91.11%), while other syndromes are not statistically relevant. Conclusions. It seems that the occurrence of Underwood septa is not statistically related to any clinical, radiological, or pathological condition within the sinus (p > 0.05). Furthermore, a more full or partial appearance of US was found in female patients.
RESUMO
The aim of this randomized, controlled trial was to determine whether children undergoing otolaryngological procedures (adenoidectomy, adenotonsillotomy, or tonsillectomy) benefit from pre-emptive analgesia in the postoperative period. Methods: Fifty-five children were assessed for eligibility for the research. Four children refused to participate during the first stage of the study, leaving fifty-one (n = 51) to be randomly assigned either to receive pre-emptive analgesic acetaminophen (15 mg/kg; n = 26) or a placebo (n = 25) in addition to midazolam (0.5 mg/kg) as premedication. All children were anesthetized with sevoflurane, propofol (2−4 mg/kg), and fentanyl (2 mcg/kg). Postoperative pain was assessed using the Visual Analogue Scale (VAS), the Wong−Baker Faces Pain Rating Scale, and the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. The postoperative pain was measured 1, 2, 4, and 6 h after the surgery. Results: The clinical trial reported a statistically significant correlation between administering pre-emptive analgesia (acetaminophen) and reducing pain in children after otolaryngological procedures compared to placebo. The ratio of boys to girls and age were similar among the groups (p > 0.05), so the groups of children were not divided by gender or age. Conclusions: Standard pre-emptive analgesia reduced the severity of pain in the postoperative period after otolaryngological procedures in children. Acetaminophen given before surgery reduces postoperative pain in children undergoing otolaryngological procedures.
RESUMO
In order to fully evaluate and establish the degree of bone overgrowth, various radiological studies are essential in the careful planning of the amount of surgical excision. In the presented paper, the authors use self-designed anatomo-topographical reference points for planning the surgeries. Routine panoramic radiographs and low-dose computed tomography based on anatomical landmarks help in measuring the proportions of mandibular bone overgrowth with the following preoperative anatomical landmarks: (Go-Go), (Go(Right)-Gn), (Go(Left)-Gn), and (Me−Gn). Measurements taken at selected points and landmarks (gonion-gnathion/gnathion-menton) are easy to conduct. In the authors' proposal, the main key factor is total chin correction, which is necessary in cases of severe overgrowth; when F0 > C and Go-Gn>, there is >7 mm of vertical bone overgrowth, and the mandibular canal is positioned <5 mm from the inferior mandibular borderMIB. Larger overgrowths (>7 mm) have a greater outcome on the final symmetry than smaller overgrowths. As no guidelines are known, the authors present their own proposal.
Assuntos
Mandíbula , Tomografia Computadorizada por Raios X , Queixo , Humanos , Hiperplasia , Mandíbula/diagnóstico por imagem , Mandíbula/patologia , Mandíbula/cirurgia , RadiografiaRESUMO
In chronic upper respiratory tract diseases, increased cell proliferative activity is observed, which is coordinated by BCL-2 proteins and small non-coding RNAs. This study aimed to determine the expression of critical apoptosis markers at the mRNA and miRNA levels in patients with chronic rhinosinusitis with nasal polyps (CSRwNP). The study group consisted of ten patients with CSRwNP and ten healthy subjects. To detect in situ apoptosis in the maxillary sinus mucosa, TUNEL staining was performed. The expression of transcripts was determined by RT-qPCR and included the detection of markers associated with cell survival and apoptosis, i.e., BAX, p53, p21, CASP3, CASP9, c-MYC, CCND1, BRIC5, and APAF1. Levels of miR-17-5p, miR-145-5p, miR-146a-5p, and miR-203a-3p were also measured by RT-qPCR. The obtained results indicated increased apoptosis determined by a TUNEL assay in CSRwNP patients and accompanied by an increased expression of BAX, P21, P53, CASP3, CASP9, c-MYC, and APAF-1 transcripts and decreased mRNA levels of BCL-2 and BIRC5. Furthermore, the nasal sinus epithelium of patients with CSRwNP showed increased levels of miR-203a-3p while also showing a decreased expression of miR-17-5p and miR-145-5p. Our results showed that pro-apoptotic transcripts detected at mRNA and miRNA levels might be involved in the pathogenesis of chronic sinusitis with polyps. The identification of those key molecular mediators may be applicable for the specific diagnostic and/or development of targeted therapies for chronic sinusitis with polyps.
RESUMO
OBJECTIVE: Acromegaly is a rare disease, which symptoms are caused by excess secretion of a growth hormone (GH) from the anterior pituitary benign tumor - adenoma. Authors present an evaluation of computed tomography (CT) and magnetic resonance (MR) images of temporal bone and paranasal sinuses of patients with acromegaly. CONCLUSIONS: 1. In all patients with acromegaly, morphological changes in paranasal sinuses were shown. They were mostly pronounced within the maxillary sinuses including the mucosa thickening up to 6 mm and encysted fluid occurrence. 2. CT of temporal bone did not reveal structural changes of internal and median ear. 3. There is a need for further studies on hearing impairment in patients with acromegaly.
Assuntos
Acromegalia/patologia , Imageamento por Ressonância Magnética , Seios Paranasais/patologia , Osso Temporal/patologia , Tomografia Computadorizada por Raios X , Acromegalia/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais/diagnóstico por imagem , Osso Temporal/diagnóstico por imagemRESUMO
Pain is one of the most common complaints expressed by hospital patients and is the main reason they seek medical help. Pain is always subjective, so its severity should be assessed individually for each patient. The main issue with pain management in children is the difficulty involved in evaluating it. Numerous studies have developed tools that would allow for an accurate assessment of the intensity of pain in children in the postoperative period. Adequate postoperative pain assessment in pediatric patients may significantly improve their comfort and quality of life. Postoperative pain prolongs recovery and hospitalization; therefore, the severity of the pain should be part of a routine assessment. Whichever tool is applied to measure pain, it should take into account the child's age, language, ethnicity, and cognitive ability. There is no one universal method for pain assessment which is appropriate for every pediatric patient. This article provides a review of the available subjective methods of postoperative pain assessment, including new objective diagnostic methods and the latest guidelines for postoperative pain therapy in a group of pediatric patients.
Assuntos
Manejo da Dor , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/terapia , Qualidade de Vida , Criança , Humanos , Período Pós-OperatórioRESUMO
Solitary median maxillary central incisor syndrome (SMMCI) is a rare congenital oronasal-dental midline anomaly. The aim of this paper is a presentation of a patient with SMMCI without other visible dentofacial anomalies, with a potentially new molecular etiology consisting of a gene-gene reaction and conservative therapeutic approach to nasal obstruction. Potentially pathogenic variants in the SMO gene (p.Gly422Glu) and in P2RY13 gene (p.Trp205*) inherited from the probant's father, and in the PLD2 gene (p.Gln319fs), inherited from the mother were found. A multidisciplinary approach is necessary for the management of patients with SMMCI, including a genetic consultation with genetic tests.
Assuntos
Anodontia/genética , Atresia das Cóanas/genética , Incisivo/anormalidades , Fosfolipase D/genética , Receptores Purinérgicos P2/genética , Receptor Smoothened/genética , Anodontia/diagnóstico , Atresia das Cóanas/diagnóstico por imagem , Atresia das Cóanas/cirurgia , Cisterna Magna/anormalidades , Cisterna Magna/diagnóstico por imagem , Proteínas Hedgehog/genética , Heterozigoto , Humanos , Imageamento Tridimensional , Recém-Nascido , Masculino , Palato Duro/anormalidades , Fenótipo , Transdução de Sinais , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The downfracture access to septoand turbinoplasty during maxillary osteotomy may be recommended in many cases. One or both of these laryngological interventions may be necessary when, after the patient's clinical evaluation, either an impaired function of nasal breathing or a deviated septum are present. The main postsurgical risk of the procedure is the destabilization of the cartilaginous septum position and its relation to adjacent anatomical structures, a change in the shape of the nose and the presence of a supratip break. OBJECTIVES: In this paper, the authors present their own experience in intranasal procedures, the relevant surgical techniques and possible complications, based on their own clinical findings and on a literature review. MATERIAL AND METHODS: The general aim of the study was to describe the key points and differences between septoand turbinoplasty performed classically and during Le Fort I osteotomy based on 90 orthognathic surgery patient cases. The procedures have been evaluated and compared regarding their advantages and disadvantages. RESULTS: Intraoperative downfracture of the maxilla facilitates the performance of various subsequent procedures in the regions of the nasal cavities and sinuses. Due to a very convenient access to the nasal cavities, it is possible to perform septoor turbinoplasty in patients with nasal airway breathing problems, a deviated septum, and in others. CONCLUSIONS: A combined effort of an otolaryngologist and a maxillofacial team improves the overall nasal breathing with a limited amount of complications. Endoscopy with low-dose computed tomography (CT) is a valuable diagnostic tool for measuring any breathing improvements in nasal capacity. Objective patient nasal breathing problems should be always investigated.
Assuntos
Cavidade Nasal/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteotomia de Le Fort/métodos , Humanos , Maxila , Septo Nasal , OtorrinolaringologistasRESUMO
OBJECTIVE: The aim of the present study is to determine and compare the range of pH value in nasal and sinus cavities in vivo regarding the presence of bacteria colonizing sinonasal mucosa among healthy subjects. METHODS: The nasal pH value measurement using a portable pH meter (Dx-pH System, Restech) and the microbiological culture swab were taken from beneath the middle turbinate and in the sinus cavity in 39 healthy subjects during maxillary bone corrective osteotomy with the Le Fort I technique. RESULTS: The mean pH value (independently of sex, P = .441) in the healthy sinus cavity was statistically higher than in the nasal middle meatus: 7.96 (SD ± 0.29) versus 7.83 (SD ± 0.30) (P = .032). Forty-eight strains of bacteria were cultured from sinus maxillaries cavities-aerobic 36.8%, aerobic and anaerobic 52.6%, anaerobic only 10.5%-and 23 strains from the nasal meatus-aerobic 25%, aerobic and anaerobic 75%. A statistically significant correlation was found between the type and location of 8 microorganisms, especially Propionibacterium acnes, identified only in the sinus cavities. CONCLUSIONS: Differences in the pH value between the middle nasal meatus and the maxillary sinus are characteristic of healthy subjects and could be associated with the diverse bacterial flora. The role of bacteria Propionibacterium acnes seems to be crucial for the pH range and sinus flora in healthy subjects.
Assuntos
Seio Maxilar , Cavidade Nasal , Propionibacterium acnes/isolamento & purificação , Adulto , Correlação de Dados , Feminino , Voluntários Saudáveis , Humanos , Concentração de Íons de Hidrogênio , Masculino , Seio Maxilar/química , Seio Maxilar/microbiologia , Microbiota , Pessoa de Meia-Idade , Cavidade Nasal/química , Cavidade Nasal/microbiologiaRESUMO
INTRODUCTION: The full epidemiology and etiology of hemimandibular hyperplasia (HH) has not yet been clarified. In most cases it starts before puberty and results in various forms of dento-alveolar and skeletal discrepancies. This study is the first attempt at evaluating and describing some of the authors' key experiences, clinical philosophical approach, and gathered demographic data on hemimandibular hyperplasia and hemimandibular elongation (HE) among the Polish population. MATERIAL AND METHOD: A total of 45 patients (M = 8; F = 37; p < 0.05) with HE (n = 16; 35.6%; p < 0.05), HH (n = 28; 62.2%; p < 0.05), or HH + HE (n = 1; 2.2%; p > 0.05) had been diagnosed and treated. Epidemiological, geographical, and clinical data concerning the occurrence and treatment protocols in these mandibular malformations were measured in the Polish study groups. RESULTS: Women more often suffered from these mandibular malformations (82-87%). The occurrence of the first symptoms was highest at the age of 13-15 years and was statistically significant for both sides (p < 0.05). The disorders were found earlier in young girls, therefore an early compensatory orthodontic treatment in some cases had been used with a limited degree of success (p > 0.05). All values of bone scintigraphy were significant (p < 0.001). CONCLUSIONS: A very fast growth with visible major asymmetry and enlarged condylar head should be an indication for condylectomy. Women's expectations from surgery and treatment are more demanding than men's, a fact that is connected with the predominance of females in the study group. Almost all possible treatment alternatives are not only related with the degree of skeletal deformity, but also with the patient's willingness to undergo any necessary treatment protocols, which in most cases involve more than one stage. Skeletal scintigraphy tests are an important factor in estimating bone growth and possible surgical approaches in these disorders.
Assuntos
Demografia , Assimetria Facial/epidemiologia , Hiperplasia/epidemiologia , Má Oclusão/etiologia , Adolescente , Adulto , Fatores Etários , Criança , Assimetria Facial/cirurgia , Assimetria Facial/terapia , Feminino , Humanos , Hiperplasia/diagnóstico por imagem , Hiperplasia/cirurgia , Hiperplasia/terapia , Masculino , Mandíbula/cirurgia , Côndilo Mandibular/cirurgia , Osteotomia Mandibular/métodos , Polônia/epidemiologia , Cintilografia/métodos , Fatores Sexuais , Adulto JovemRESUMO
OBJECTIVE: The aim of this cross-sectional in vitro study was to evaluate the mucosal surfaces of healthy maxillary sinuses, explore different forms of bacterial microorganism colonies present on the mucous membrane, and determine a mucosal surface area they occupy. METHODS: Samples of the maxillary sinus mucosa were collected from 30 healthy patients (M = 11; F = 19). The material was obtained during the Le Fort I osteotomy performed during corrective jaw surgery. The morphological and morphometric analysis of sinus mucosa and bacterial film that was grown on it was performed using scanning electron microscopy (SEM) as well as imaging software. RESULTS: Scanning electron microscopy analysis showed the presence of different bacterium and bacteria-like structures in all the analyzed samples. In most cases, the bacterial film was mostly composed of diplococci-like and streptococci-like structures on the mucosa of the paranasal sinus. In any case, the mucous layer did not cover the whole lining of the evaluated sample. Each colony consists of more than 20 single bacterial cells, which has grown in aggregates. CONCLUSIONS: Under the conditions of normal homeostasis of the body, the maxillary sinuses present diverse bacterial colonization. The bacteria are dispersed or concentrated in single microcolonies of the biofilm on the border of the mucous covering the ciliary epithelium. There is no uniform layer of the biofilm covering the mucosa of the maxillary sinuses. Because the biofilm is detected on healthy individuals sinus mucosa, the clinical question if it may become pathogenic is unclear and require an explanation.