Alternativas terapéuticas para el síndrome de apnea e hipoapnea obstructiva del sueño en niños con anomalías intermaxilares sagitales o transversales: Revisión narrativa / Therapeutic alternatives for obstructive sleep apnea syndrome in children with sagittal and transverse intermaxillary anomalies: Narrative review

RESUMEN: Introducción: El síndrome de apnea e hipoapnea obstructiva del sueño corresponde a un trastorno respiratorio del sueño muy prevalente en niños. Muchas alternativas terapéuticas buscan controlar los factores desencadenantes y la progresión de los signos y síntomas. El objetivo de esta revisión es describir los efectos de los tratamientos para síndrome de apnea e hipoapnea del sueño en niños con anomalías intermaxilares sagitales o transversales. Material y método: Se realizó una búsqueda electrónica en las bases de datos: PubMed, Epistemónikos, EBSCO, TripDataBase y The Cochrane Library, con las palabras clave: "Obstructive sleep apnea", "Obstructive sleep apnoea", "Sleep apnea syndrome", "Sleep apnoea syndrome", "Sleep apnea", "Sleep apnoea", "hypoapnea", "OSA", "Treatment", "Therapy", "Children", "Pediatric", "Craniofacial abnormalities", "Craniofacial anomalies", "Craniofacial abnormality", "Orthodontic" y una búsqueda retrógrada en los textos seleccionados. Resultados: Se incluyeron 23 artículos; 12 ensayos clínicos, 6 revisiones sistemáticas, 1 estudio observacional y 4 revisiones narrativas. Conclusión: Los tratamientos ortopédicos para el síndrome de apnea e hipoapnea son la expansión rápida maxilar y dispositivos de avance mandibular. No se encontró suficiente evidencia para determinar que estos dispositivos resuelvan completamente el síndrome, pero disminuyen el índice de apnea e hipoapnea y sus signos y síntomas.

ABSTRACT: Introduction: Obstructive sleep apnea and hypoapnea syndrome refers to a respiratory sleep disorder with an increased prevalence among children. There are many therapeutic alternatives, focused on controlling trigger factors and the signs and symptoms progression. The objective of this review is to describe the effects of the available treatments for sleep apnea and hypoapnea syndrome in children with sagittal and transverse intermaxillary anomalies. Materials and Method: An electronic search was performed in PubMed database, Epistemonikos, EBSCO, Tripdatabase, and The Cochrane Library, using the keywords "Obstructive sleep apnea", "Obstructive sleep apnoea", "Sleep apnea syndrome", "Sleep apnoea syndrome", "Sleep apnea", "Sleep apnoea", "hypoapnea", "OSA", "Treatment", "Therapy", "Children", "Pediatric", "Craniofacial abnormalities", "Craniofacial anomalies", "Craniofacial abnormality" and "Orthodontic". Also, a retrieval search in the selected articles references was performed. Results: 23 articles were included; 12 clinical trials, 6 systematic reviews, 1 observational study and 4 narrative reviews. Conclusion: There are two types of orthopedic treatment for sleep apnea and hypoapnea syndrome in children with sagittal and transverse intermaxillary anomalies: rapid maxillary expansion and mandibular advancement devices. There was not enough evidence to determine that these devices achieve the syndrome's complete resolution. An important decrease in the apnea and hypoapnea index and signs and symptoms were observed.

Absceso alveolar agudo en pacientes mayores de 19 años. Municipio Unión de Reyes / Acute alveolar abscess in patients elder 19 years old. Municipality Union de Reyes

Introducción: frecuentemente las infecciones de la cavidad bucal son el resultado del deterioro que provoca la caries con exposición de la pulpa dental. Una higiene dental descuidada o inadecuada, y complicaciones asociadas a enfermedades periodontales, son otras de las causas, que pueden incidir en la aparición de procesos infecciosos. Objetivo: caracterizar el comportamiento del absceso alveolar agudo en los pacientes mayores de 19 años en la consulta de urgencia estomatológica del poblado de Alacranes, Municipio Unión de Reyes. Materiales y Métodos: se realizó un estudio observacional descriptivo en pacientes mayores de 19 años, del área de Alacranes municipio Unión de Reyes. El universo de estudio estuvo constituido por los pacientes que acudieron a la consulta de urgencia estomatológica, de enero de 2011 a enero 2012. Con previo consentimiento informado la muestra la constituyó 135 pacientes, con patológica de absceso alveolar agudo, teniendo en cuenta las variables: edad, sexo, etiología y complicaciones. Los datos obtenidos fueron registrados en una base de datos y se procesaron estadísticamente. Resultados: los grupos de 20-29 años y el sexo masculino fueron los más afectados, con 38 % y 54.8 %, respectivamente. La causa fundamental fue la caries dental con un 91.8 %. La celulitis facial resultó la complicación más frecuente. Conclusiones: la etiología más usual del absceso alveolar agudo fue la caries dental. Los pacientes afectados que no recibieron una puntual asistencia sufrieron complicaciones (AU).

Introduction: frequently, oral cavity infections are due to the deterioration caused by caries with dental pulp exposition. An inadequate and careless dental hygiene and complications associated to periodontal diseases are other reasons the may lead to the occurrence of infectious processes. Objective: Characterise the behaviour of the absceso alveolar acute in the greater patients of 19 years in the query of urgency estomatológica of the populated of Alacranes, municipality Union de Reyes. Materials and Methods: a descriptive, observational study was carried out in patients elder 19 years old, in the health area Alacranes, municipality Union de Reyes. The studied universe was formed by the patients assisting to the dentist emergency consultation from January 2011 to January 2012. With previous informed consent, the sample was formed by 135 patients with acute alveolar abscess, taking into account the following variables: age, sex, etiology and complications. The obtained data were recorded in the database and statistically processed. Results: the most affected groups were the 20-29 years-old group and the male sex, with 38 % and 54.8 % respectively. Dental caries was the main cause with 91.8 %. Facial cellulitis was the most frequent complication. Conclusions: dental caries was the most usual etiology of the acute alveolar abscess. The affected patients who did not receive opportune health care suffered complications (AU).

Características orofaciais e risco para apneia obstrutiva do sono em hipertensos / Caracteristicas orofaciales y riesgo de anea obstructiva del sueño em hipertensos / Orofacial characteristics and risk for obstructive sleep apnea in hypertensive individuals

Anormalidades da anatomia orofacial estão envolvidas na patogênese da Apnéia Obstrutiva do Sono porfacilitarem o fechamento das vias áreas. O estudo objetivou associar a presença de alterações orofaciais ao risco deApnéia Obstrutiva do Sono em hipertensos. 95 indivíduos (46% homens e 54% mulheres, 64 ± 10 anos) foram avaliadosquanto à distância tireomentoniana, Mallampati, palato ogival, grau de Angle, índice de massa corpórea, circunferênciasabdominal e pescoço. O risco para Apnéia Obstrutiva do Sono foi obtido pelo Questionário de Berlim.Foram observadosíndice de massa corpórea de 30 ± 5 Kg/m2, circunferência abdominal de 101 ± 12 cm e do pescoço 39 ± 3cm. Correlaçõespositivas foram observadas entre classificação de Mallampati, circunferências abdominal e do pescoço (p= 0,025 e 0,03,respectivamente). Pelo Questionário de Berlim, 46 indivíduos (48%) apresentavam alto risco, dos quais76% classificadoscomo Mallampati III/ IV, 69% distância tireomentoniana < 6 cm, 26% Angle II e 10% palato ogival. A prevalência dealterações orofaciais foi maior nos indivíduos comrisco elevado (93%) do que nos de baixo risco (50%). Alterações naanatomia orofacial, particularmente Mallampati, reiteram risco de Apnéia Obstrutiva do Sono e podem facilitar a triagemclínica como diagnóstico precoce.

Anormalidades dentofaciais em pacientes portadores de fissuras labiopalatais no Estado do Ceará / Dentafacial abnormalities in patients with clefts labiopalatal in the State of Ceará

O objetivo desta dissertação foi caracterizar as anormalidades dentofaciais de indivíduoscom fissura labiopalatal atendidos pelo SUS no estado do Ceará entre 2004 e 2007. A dissertação é apresentada com uma introdução e revisão de literatura sobre o tema. Segue-se com a descrição detalhada da metodologia utilizada e o artigo que inclui os resultados. A amostra incluiu 117 pacientes de 6 a 37 anos de idade cadastrados no CEO-Centro em Fortaleza, unidade de referência do estado. Foi investigado o perfil demográfico e socioeconômico, aspectos hereditários e familiares dos sujeitos. O tipo de padrão facial e maloclusão foram determinados por exames radiográficos e análise demodelos dentários. Além disso, foram investigados o tipo, localização e grupo de fissuras. Para análise da maloclusão foram empregadas a Classificação de Angle, registro de mordida aberta, mordida cruzada e apinhamento dentário (6 a 12 anos de idade) e o Índice de Estética Dental (DAI) (idade (...) 13 anos). A idade média dos pacientes foi de 14,7 (...) 7,4 anos, com predomínio da cor parda (76 por cento), renda familiar de 1 a 3 salários mínimos (73,5 por cento), baixa escolaridade dos pais e classe econômica D (56,4 por cento). A fissura transforame unilateral foi a de maior prevalência (60,6 por cento), sendo observada uma freqüência de 39,3 por cento de tabagismo materno durante a gestação e a ocorrência de 21,4 por cento de fissuras labiopalatais na família. Na faixa etária de 6 a 12 anos,observou-se uma freqüência de anormalidade oclusal de 41,1 por cento e 50 por cento para molares e caninos, além de uma alta prevalência de mordida cruzada anterior (60,7 por cento), apinhamento superior (69,6 por cento) e inferior (66,1 por cento). Todos aqueles com idade (...) 13 anosforam classificados como maloclusão muito grave ou incapacitante. Em ambas faixas etárias as características de anormalidade oclusal foram heterogêneas entre os indivíduos com fissuras pré-forame incisivo e com fissuras transforame incisivo. Indivíduos portadores de fissuras labiopalatais usuários do SUS no Ceará necessitam de atenção especializada para tratamento de deformidades dento-faciais.

Orthodontic and surgical treatment of a patient with an ankylosed temporomandibular joint.

This article describes the surgical and orthodontic treatment of a girl with facial deformities and functional involvement. The left temporomandibular joint was ankylosed, and the lower third of the face was markedly deficient, with mandibular retrusion and severe laterognathism to the left side. Mouth-opening was limited, and the patient had problems speaking and chewing. Two surgical procedures had been performed previously at another institution. We treated the patient with condylar surgery while she was still growing, followed by orthodontic treatment and orthognathic surgery after growth was complete. Twelve-year follow-up records are presented.

Dental findings and muscular-skeletal features in Schwartz-Jampel syndrome: case report of two affected siblings.

Schwartz-Jampel syndrome (SJS) is a rare, inherited disorder defined by myotonia, skeletal malformations, muscular stiffness, and growth retardation. The clinical signs and symptoms of SJS are seen in the maxillofacial region. The combination of skeletal and muscular abnormalities predisposes affected individuals to a number of primary and secondary orodental manifestations. Although several studies have discussed the clinical features of SJS from a medical perspective, few reports have addressed the oral findings or dental treatment in children and adolescents with the disorder. This article reviews the dental manifestations and impairments of Schwartz-Jampel syndrome. The case histories of two siblings diagnosed with this disorder are described as well as their dental care.

Lingual frenulum: classification and speech interference.

PURPOSE: To propose a classification of the different lingual frenulum and to relate them to speech disorders. METHODS: We evaluated 1402 patients' frenulum with an age range of 5 years 8 months to 62 years 10 months between 1978 and 2002. Pictures were taken of the altered frenulum. Measures of maximal mouth opening, with and without tongue suction, were taken with a sliding caliper. Speech samples were also taken. Frenulum were then classified as normal; short; with anterior insertion, and short with anterior insertion. RESULTS: From the 1402 patients evaluated, 127 (9%) presented with an altered frenulum insertion. For this study we considered only those with short or with anterior insertion. For those who had an altered frenulum, 62 (48.81%) presented with speech disorders. The more frequent speech disorders were: omission and substitution of /r/; {R}, and consonant clusters with /r/, and of /s/ and /z/. Frontal and lateral lisps also occurred. The frenulum of 21 patients was classified as short and of these, 12 patients (57%) presented with speech disorders. Of the 106 patients with anterior insertion, 50 (47.2%) presented with a speech disorder. After statistical analyses the relation between altered frenulum and speech disorders was considered significant with p<0.001. CONCLUSION: The lingual frenulum was classified as normal, short and with anterior insertion. An altered frenulum may predispose the individual to exhibit an accompanying speech disorder.

Early lingual frenectomy assisted by CO2 laser helps prevention and treatment of functional alterations caused by ankyloglossia.

Incorrectly produced speech sounds, the presence of dentofacial alterations and acquired functional adaptations may be due to a short and inadequate lingual frenum. When frenectomy is indicated, it should be performed as early as possible to prevent functional alterations. This study presents a literature review on correct lingual positioning in relation to orthodontic and phonetic function as well as an assessment of 15 patients who underwent frenectomy utilizing the carbon dioxide laser. The results demonstrated that this technique is safe, effective and perfect for use in young children and can be performed in an outpatient unit.

O uso do binário no tratamento das mordidas profundas / The use of Twin Plates for the treatment of over bites

Os autores propöem um novo método de tratamento para as maloclusöes de classe II de Angle com mordida profunda, correlacionando as anomalias dento faciais com o estímulo dado pelo aparelho na boca durante a deglutiçäo, restaurando-se assim a harmonia perdida