Reliability of maximal respiratory nasal pressure tests in healthy young adults.

INTRODUCTION: Sniff nasal inspiratory (SNIP) and expiratory pressure (SNEP) may complement the assessment of respiratory muscle strength. Thus, specifying their reliability is relevant to improving the clinical consistency of both tests. OBJECTIVE: To assess the reliability of SNIP and SNEP in healthy young adults. METHODS: This cross-sectional study included self-reported healthy aged 18 to 29 years. SNIP was performed using a plug to occlude one nostril, while SNEP was conducted using a facemask. Participants performed 20 SNIP and SNEP maneuvers with 30-second intervals in between. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC) assessed the reliability of SNIP and SNEP. Analyses were conducted between the highest peak pressure and the first reproducible maneuver in men and women. RESULTS: The total sample comprised 32 participants: 16 men and 16 women. The ICC, SEM, and MDC for SNIP maneuvers were 0.994 (95%CI 0.988 to 0.997), 1.820 cmH2O, and 5.043 cmH2O, respectively. For SNEP, these parameters were 0.950 (95%CI 0.897 to 0.976), 6.03 cmH2O, and 16.716 cmH2O. The SNIP and SNEP in men showed ICC of 0.992 (95%CI 0.977 to 0.997) and 0.877 (95%CI 0.648 to 0.957), SEM of 2.07 and 7.66 cmH2O, and MDC of 5.74 and 21.23 cmH2O. In women, SNIP and SNEP presented ICC of 0.992 (95%CI 0.977 to 0.997) and 0.957 (95%CI 0.878 to 0.985), SEM of 1.15 and 6.11 cmH2O, and MDC of 3.19 and 16.95 cmH2O. Also, 60% of the highest SNIPs occurred among the 11th and 20th maneuvers in men and women. In men, 55% of the highest SNEPs occurred among the 11th and 20th maneuvers; this value was 50% in women. CONCLUSION: SNIP and SNEP showed excellent reliability. The reliability of SNIP and SNEP in men was good and excellent, respectively, whereas both tests had excellent reliability in women. Also, women reached the highest peak pressure faster than men in both tests.

Impact of increasing weaning age on pig performance and belly nosing prevalence in a commercial multisite production system.

The effects of increasing weaning age in a commercial production system on nursery and finishing performance were evaluated. A total of 1,176 pigs (PIC 337 × Camborough) were used in a 136-d growth trial with 14 and 10 replications/weaning age on the nursery and finishing phases, respectively. Treatments included weaning litters at 19, 22, 25, or 28 d of age. In the nursery, as weaning age increased, initial (5.04, 5.70, 6.52, and 7.26 kg) and final body weight (BW) (18.2, 19.8, 23.0, and 25.1 kg) increased (linear, P < 0.001). Increasing the weaning age reduced (linear, P < 0.001) the prevalence of pigs exhibiting belly nosing (27.6%, 15.0%, 6.5%, and 1.4%) during the first 3 wk. The percentage of pigs losing weight during the first week after weaning (35.1%, 28.7%, 12.4%, and 9.2%) decreased (linear, P < 0.001) as weaning age increased. Average daily gain (ADG; 295, 320, 374, 406 g/d) and average daily feed intake (493, 534, 619, 661 g/d) increased (linear, P < 0.001), while feed efficiency (G:F) (596, 599, 604, and 615) tended to increase (linear, P = 0.081) with weaning age. Removal rate (8.01%, 3.79%, 2.29%, and 1.65%) declined (linear, P = 0.001) as weaning age increased, while there was no evidence of difference (P = 0.463) in mortality rate (0.71%, 0.36%, 0.96%, 1.04%). In the finishing period, BW at 136 d post-weaning (114.9, 117.8, 124.7, and 126.5 kg) and ADG (1.02, 1.04, 1.08, and 1.07 kg/d) improved (linear, P < 0.001). There was no evidence of differences (P > 0.24) in removal (1.5%, 2.4%, 1.0%, and 0.0%) or mortality rates (0.9%, 1.0%, 1.0%, and 1.4%) with changes in weaning age. When performance was analyzed at a common day of life (164 d of age), no effects of weaning age (P > 0.25) were found for BW (125.2, 124.4, 128.0, and 126.5 kg) and lifetime ADG (growth rate from birth to market) (754, 751, 774, and 762 g/d). The BW sold per pig weaned increased (linear, P < 0.001) with weaning age. Even though the slope indicated a linear response, the magnitude of improvement was high until 25 d, before exhibiting diminishing returns from 25 to 28 d. Thus, the study suggests that increasing the weaning age can be an effective strategy to improve the overall performance in a commercial system. Although lifetime performance was not affected by the weaning age range studied, the consistent effect in the nursery and the increment in the number of pigs reaching the market facilitated by the improvement in the removal rate in the nursery phase imply that 25 d is the optimal weaning age.

Efectos de la expansión rápida del maxilar sobre el flujo aéreo nasal en pacientes entre 6 y 14 años de edad, con compresión maxilar, medido a través de un flujómetro nasal portátil / Effects of rapid maxillary expansion on nasal airflow of patients between 6 and 14 years of age, with maxillary compression, measured with a portable nasal flowmeter

El objetivo de nuestro estudio de tipo longitudinal prospectivo simple de medidas repetidas fue determinar la variación del flujo aéreo nasal medido con un flujómetro nasal portátil, en niños entre 6 y 14 años de edad con compresión maxilar, después de la expansión rápida del maxilar (ERM). El trabajo constó de 16 niños diagnosticados con compresión maxilar y a quienes se les indicó una disyunción maxilar rápida. Los valores de la cantidad de expansión fueron registrados y la medición del flujo inspiratorio nasal máximo (FINM) se realizó antes de la ERM (T1), inmediatamente después (T2) y al cabo de 3 meses del período de retención (T3), manteniendo las mismas condiciones iniciales. El valor máximo y el promedio de las mediciones del FINM en T2 fueron significativamente mayores que en T1 (p-valor, 0,0056) y (p-valor 0,0062) respectivamente, mientras que entre T2 y T3 no existieron tales diferencias (p-valor: 0,3021) y (p-valor: 0,3315) respectivamente. Existe un aumento significativo en los valores del FINM inmediatamente después de la expansión rápida del maxilar que se mantienen en un período de tiempo de 3 meses.

The objective of our simple prospective longitudinal type study of repeated measures, was to determine the variation of nasal airflow measured with a portable nasal flow meter, in children between 6 and 14 years of age with maxillary compression, after rapid maxillary expansion (RME). The study consisted of 16 children diagnosed with maxillary compression and those who were identified with a rapid maxillary disjunction. The values of the amount of expansion were recorded and the measurement of the peak nasal inspiratory flow (PNIF) was performed before the ERM (T1), immediately after (T2) and after 3 months of retention period (T3), maintaining the same initial conditions. Results: the value maximum and average measurements of FINM in T2 were greater than in T1 (p-value, 0.0056) and (p-value 0.0062) respectively, while between T2 and T3 there were no differences (p value: 0.3021) and (p value: 0.3315) respectively. There is a significant increase in PNIF values immediately after rapid maxillary expansion that is in a period of 3 months.

Influence of Altered Auditory Feedback on Oral-Nasal Balance in Speakers of Brazilian Portuguese.

Purpose This study explored the role of auditory feedback in the regulation of oral-nasal balance in speakers of Brazilian Portuguese. Method Twenty typical speakers of Brazilian Portuguese (10 male, 10 female) wore a Nasometer headset and headphones while continuously repeating stimuli with oral and nasal sounds. Oral-nasal balance was quantified with nasalance scores. The signals from 2 additional oral and nasal microphones were played back to the participants through the headphones. The relative loudness of the nasal channel in the mix was gradually changed, so that the speakers heard themselves as more or less nasal. Results A repeated-measures analysis of variance of the mean nasalance scores of the stimuli at baseline, minimum, and maximum nasal feedback conditions demonstrated significant effects of nasal feedback condition (p < .0001) and stimuli (p < .0001). Post hoc analyses demonstrated that the mean nasalance scores were lowest for the maximum nasal feedback condition. The scores of the minimum nasal feedback condition were significantly higher than 2 of 3 baseline feedback conditions. The speaking amplitude of the participants did not change between the nasal feedback conditions. Conclusions Increased nasal signal level feedback led to a compensatory adjustment in the opposite direction, confirming that oral-nasal balance is regulated by auditory feedback. However, reduced nasal signal level feedback resulted in a compensatory response that was lower in magnitude. This suggests that, even in Brazilian Portuguese, a language with phonetic and phonological vowel nasalization, decreased nasality was not perceived as critically as increased nasality by the speakers.

Normative nasalance scores in the production of words and syllables for Brazilian Portuguese speakers.

The objective of this study was to determine normative nasalance scores for non-cleft children, adolescents and adults, native speakers of Brazilian Portuguese, during the production of words and syllables, for cross-linguistic comparisons in populations with and without cleft palate. Nasalance was assessed in 62 individuals, aged 6-10 years (n = 20), 11-17 years (n = 20) and 18-35 years (n = 22), using a nasometer II model 6450 (KayPENTAX), during production of one sequence of nine oral words (pipa, bis, burro, tatu, pilha, cuca, gui, fila, luz) and of sequences of isolated syllables (e.g. pa, pa, pa, pa, pa, pa) composed of plosive, fricative, liquid and nasal consonants with high and low vowels. In order to validate the new nasalance stimuli, nasalance scores for traditional oral and nasal stimuli were also obtained. Differences were analyzed at a significance level of 0.01. Mean nasalance scores (±SD) during the production of the sequence of words were 18 ± 5% (children), 18 ± 7% (adolescents) and 21 ± 5% (adults). Differences between age groups were not significant. During the production of syllables, adults had the highest mean nasalance scores (except for syllable /mi/); significant differences between age groups were observed only for /pa/ ,/sa/ and /la/. Nasalance scores were significantly higher in oral and nasal syllables with high vowels than with low vowels, and in nasal syllables than in oral syllables with high and low vowels. The nasalance scores obtained for the sentences were comparable to previously established norms. In conclusion, the nasalance scores defined for Brazilian Portuguese speakers, in different stimuli, may be adopted as normative values for local and cross-language comparisons in the identification of hypernasality related to conditions such as cleft palate, neurogenic disorders and syndromes.

Nasal airflow simulations suggest convergent adaptation in Neanderthals and modern humans.

Both modern humans (MHs) and Neanderthals successfully settled across western Eurasian cold-climate landscapes. Among the many adaptations considered as essential to survival in such landscapes, changes in the nasal morphology and/or function aimed to humidify and warm the air before it reaches the lungs are of key importance. Unfortunately, the lack of soft-tissue evidence in the fossil record turns difficult any comparative study of respiratory performance. Here, we reconstruct the internal nasal cavity of a Neanderthal plus two representatives of climatically divergent MH populations (southwestern Europeans and northeastern Asians). The reconstruction includes mucosa distribution enabling a realistic simulation of the breathing cycle in different climatic conditions via computational fluid dynamics. Striking across-specimens differences in fluid residence times affecting humidification and warming performance at the anterior tract were found under cold/dry climate simulations. Specifically, the Asian model achieves a rapid air conditioning, followed by the Neanderthals, whereas the European model attains a proper conditioning only around the medium-posterior tract. In addition, quantitative-genetic evolutionary analyses of nasal morphology provided signals of stabilizing selection for MH populations, with the removal of Arctic populations turning covariation patterns compatible with evolution by genetic drift. Both results indicate that, departing from important craniofacial differences existing among Neanderthals and MHs, an advantageous species-specific respiratory performance in cold climates may have occurred in both species. Fluid dynamics and evolutionary biology independently provided evidence of nasal evolution, suggesting that adaptive explanations regarding complex functional phenotypes require interdisciplinary approaches aimed to quantify both performance and evolutionary signals on covariation patterns.

Mecanismos de la conexión nariz-pulmón / Mechanisms of nose-lung connection

La vía respiratoria, de la nariz al pulmón, actúa como un sincicio anátomo -funcional con su correlato fisiopatológico. Desde tiempos remotos los autores estudiaron los mecanismos de conexión entre la vía respiratoria superior e inferior que pudiera explicar la elevada coincidencia en la prevalencia de sus respectivas patologías. Algunos de esos mecanismos no se han podido demostrar fehacientemente y las investigaciones muestran resultados contradictorios. Otros responden a determinados fenotipos como el de la relación entre rinitis y asma alérgicas, el modelo más estudiado, en el que un fenómeno inflamatorio mediado a través del torrente circulatorio es el más aceptado. No obstante los fenotipos de enfermedad respiratoria no alérgica y el de la patología mediada por IgE local en nariz y bronquios, no tienen una conexión absolutamente resuelta por las investigaciones. En esta revisión discutiremos los distintos mecanismos de interacción nariz pulmón que por sus características anatómicas, fisiológicas y fisiopatológicas avalan la hipótesis de "una vía aérea única, una única enfermedad" aceptada en la actualidad por la mayoría de los autores. (AU)

The airway, from the nose to the lung, may be accepted as an anatomo-functional unit with its physiopathological correlate. From a long time ago the authors studied the mechanisms of connection between the upper and lower airway that could explain the high coincidence in the prevalence of their respective pathologies. Some of these mechanisms have not been proven conclusively and the research shows contradictory results. Others respond to certain phenotypes such as the relationship between rhinitis and allergic asthma, the most studied model, in which an inflammatory phenomenon mediated through the bloodstream is the most accepted. However the knowledge of phenotypes of non-allergic respiratory disease and the pathology mediated by local IgE in the nose and bronchi, they do not have a connection mechanisms completely determined by the investigations. In this review we will discuss the different mechanisms of nasal lung interaction that support its anatomical, physiological and pathophysiological characteristics responsible for "one airway, one disease" currently accepted by most authors. (AU)

Effects of diaphragmatic control on the assessment of sniff nasal inspiratory pressure and maximum relaxation rate

OBJECTIVE: To assess the influence of diaphragmatic activation control (diaphC) on Sniff Nasal-Inspiratory Pressure (SNIP) and Maximum Relaxation Rate of inspiratory muscles (MRR) in healthy subjects. METHOD: Twenty subjects (9 male; age: 23 (SD=2.9) years; BMI: 23.8 (SD=3) kg/m2; FEV1/FVC: 0.9 (SD=0.1)] performed 5 sniff maneuvers in two different moments: with or without instruction on diaphC. Before the first maneuver, a brief explanation was given to the subjects on how to perform the sniff test. For sniff test with diaphC, subjects were instructed to perform intense diaphragm activation. The best SNIP and MRR values were used for analysis. MRR was calculated as the ratio of first derivative of pressure over time (dP/dtmax) and were normalized by dividing it by peak pressure (SNIP) from the same maneuver. RESULTS: SNIP values were significantly different in maneuvers with and without diaphC [without diaphC: -100 (SD=27.1) cmH2O/ with diaphC: -72.8 (SD=22.3) cmH2O; p<0.0001], normalized MRR values were not statistically different [without diaphC: -9.7 (SD=2.6); with diaphC: -8.9 (SD=1.5); p=0.19]. Without diaphC, 40% of the sample did not reach the appropriate sniff criteria found in the literature. CONCLUSION: Diaphragmatic control performed during SNIP test influences obtained inspiratory pressure, being lower when diaphC is performed. However, there was no influence on normalized MRR.

Effects of diaphragmatic control on the assessment of sniff nasal inspiratory pressure and maximum relaxation rate.

OBJECTIVE: To assess the influence of diaphragmatic activation control (diaphC) on Sniff Nasal-Inspiratory Pressure (SNIP) and Maximum Relaxation Rate of inspiratory muscles (MRR) in healthy subjects. METHOD: Twenty subjects (9 male; age: 23 (SD=2.9) years; BMI: 23.8 (SD=3) kg/m²; FEV1/FVC: 0.9 (SD=0.1)] performed 5 sniff maneuvers in two different moments: with or without instruction on diaphC. Before the first maneuver, a brief explanation was given to the subjects on how to perform the sniff test. For sniff test with diaphC, subjects were instructed to perform intense diaphragm activation. The best SNIP and MRR values were used for analysis. MRR was calculated as the ratio of first derivative of pressure over time (dP/dtmax) and were normalized by dividing it by peak pressure (SNIP) from the same maneuver. RESULTS: SNIP values were significantly different in maneuvers with and without diaphC [without diaphC: -100 (SD=27.1) cmH2O/ with diaphC: -72.8 (SD=22.3) cmH2O; p<0.0001], normalized MRR values were not statistically different [without diaphC: -9.7 (SD=2.6); with diaphC: -8.9 (SD=1.5); p=0.19]. Without diaphC, 40% of the sample did not reach the appropriate sniff criteria found in the literature. CONCLUSION: Diaphragmatic control performed during SNIP test influences obtained inspiratory pressure, being lower when diaphC is performed. However, there was no influence on normalized MRR.

Dentofacial characteristics of oral breathers in different ages: a retrospective case-control study.

BACKGROUND: This study aimed to investigate the dental and skeletal variables associated with disturbances of craniofacial development in oral-breathing (OB) individuals and the probability that these variables are related to this condition. METHODS: This is an observational retrospective case-control study of 1596 patients divided into three groups of age n1 5-12, n2 13-18, and n3 19-57 years. Radiographic, clinical, and models data were analyzed. The control group was consisted of nasal breathing (NB) individuals. Statistical analyses of the qualitative data were performed with x (2) test to identify associations, and odds ratio (OR) tests were performed for the variables that the chi-square test (x (2)) identified an association. RESULTS: In the descriptive analysis of the data, we observed that the class II malocclusion was the most frequent in the total sample, but when divided by age group and mode of breathing, there is a random division of these variables. In n1 group, class II, (OR = 2.02) short and retruded mandible (SM and RM) (OR = 1.65 and1.89) were associated with OB and it was considered a risk factor. In n2 group, class II (OR = 1.73), SM (OR = 1.87) and increased lower anterior height (ILAFH) (OR = 1.84) seemed to be associated and to be risk factors for OB. In the n1 group, decreased lower anterior facial height (DLAFH) and brachycephalic facial pattern (BP) seemed to be associated with NB and a protective factor against oral breathing. CONCLUSIONS: This study showed that dental and skeletal factors are associated with OB in children, and it seems that it becomes more severe until adolescence. But adults showed no associations between OB and skeletal factors, only in dental variables, indicating that there is no cause-effect relationship between the dental and skeletal factors and OB. The treatment of nose breathing patient should be multidisciplinary, since OB remains even when dental and skeletal factors slow down.

Influence of age and gender in the normal values of Sino Nasal Outcome Test-22.

OBJECTIVES: Sino Nasal Outcome Test (SNOT)-22 is a disease-specific outcomes measure questionnaire that combines rhinologic issues with general health issues. These issues may have variable weight on quality of life perception, and the influence of several factors such as gender, ethnicity, age, socio-cultural status and co-morbidities is unknown. The aim of this study was to evaluate the influence of gender and age on normal values of SNOT-22. DESIGN: Cross-sectional study based on application of SNOT-22 questionnaires to healthy volunteers. Participants were divided according to gender, and each gender was subdivided into age groups: 18-30 years, 31-40 years, 41-50 years, 51-60 years and over 60 years. SETTING: Rhinology Section, Sao Paulo Federal University. PARTICIPANTS: A total of 539 healthy volunteers (253 men and 286 women) were selected, so that each age group of each gender consisted of at least 50 individuals. MAIN OUTCOMES MEASURES: We applied SNOT-22 questionnaire to volunteers with no nasal or sinus disease. Median of score distribution was used as normal reference. RESULTS: Men presented lower scores than women (7 versus 9, P = 0.005). Subjects over 60 years presented significantly lower scores than other age groups (18-30 years = 10; 31-40 years = 8; 41-50 years = 9; 51-60 years = 9; over 60 years = 7). Men presented lower scores than women especially in 41-50 year and 51-60 year groups. CONCLUSION: Men and elderly presented the lowest Brazilian version SNOT-22 scores. The range of 0-8 points seemed to be more suitable as a normal value for this instrument, but this cut-off score could be tailored to age and gender specificities.

Reconstrucción del vestíbulo nasal con colgajo libre de piel / Nasal Vestibule Reconstruction with skin free flap

Existen complicaciones tempranas y tardías derivadas de cualquier procedimiento quirúrgico; la Rinoplastia, no es una excepción a esta regla; existen complicaciones intraoperatorias, en el postoperatorio inmediato, a mediano y a largo plazo, que pueden afectar tanto la parte estética como la funcional. Objetivo: Presentar un reporte de caso donde se evidencian importantes complicaciones de la rinoplastia y describir la técnica quirúrgica empleada para la reconstrucción del vestíbulo nasal, identificando casos parecidos en la literatura. Diseño: Reporte de caso. Materiales y métodos: Se presenta un caso de una paciente de 62 años con estenosis vestibular bilateral y deformidad nasal posterior a dos rinoplastias y una infección postoperatoria, con compromiso funcional y estético. En búsqueda de consejería, esta paciente fue presentada en varios congresos internacionales, sin embargo, no se recomendaba intervención. Adicionalmente se presenta una técnica quirúrgica para reconstrucción del vestíbulo nasal usando un injerto libre de piel. Se presentan fotografías del pre-operatorio, la intervención quirúrgica y los resultados del postoperatorio. Resultados: A la fecha, la paciente se encuentra satisfecha y sin secuelas de la intervención o compromiso funcional. Conclusiones: Nuestra técnica quirúrgica, aparte de mantener el contorno de la narina debido al uso de stent nasal, permite reducir la formación de tejido de cicatrización y la contracción de la herida por parte de los miofibroblastos mediante el injerto libre de piel. Consideramos que esta técnica es reproducible para el manejo de este tipo de complicaciones...

There are early and late complications arising from any surgical procedure; rhinoplasty is not an exception to this rule, there are intraoperative complications in the immediate postoperative period, medium and long term, which can affect both the aesthetic and functional aspects. Objective: To present a case report where some major complications of rhinoplasty are shown and to describe the surgical technique used for nasal vestibule reconstruction, identifying similar cases pubished in the literature. Design: Case report. Material and methods: We present the case of a 62 year old patient with bilateral vestibular stenosis and nasal deformity secondary to two rhinoplasties and a postoperative infection. Seeking counseling, this patient was presented at several international conferences, however, no intervention was recommended. Additionally a surgical technique for reconstruction of the nasal vestibule using a free skin graft. Photographs before, during and after surgery are presented. Results: To date, the patient is satisfied without sequelae from the intervention or functional compromise. Conclusions: Our surgical technique, apart from maintaining the outline of the nostril due to the use of nasal stent, decreases the formation of scar tissue and wound contraction by myofibroblasts by free skin flap. We believe that this technique is reproducible for the management of these complications...

Maxilectomía medial en carcinoma nasosinusal. ¿Cuándo, cómo y por qué? / Medial maxillectomy in sinonasal carcinomas. When, how and why?

Existe controversia respecto al abordaje en el manejo de tumores sinonasales benignos o malignos. Dado que nos encontramos en la era de la cirugía endoscópica mínimamente invasiva, se podría pensar que los abordajes abiertos hoy día no tienen cabida. Sin embargo, la maxilectomía medial por rinotomía lateral ha sido el tratamiento de elección para la mayoría de lesiones que comprometen la pared nasal lateral, y el perfeccionamiento de la técnica ha permitido una disminución considerable de la morbilidad. Este abordaje permite una excelente exposición, la oportunidad de ampliación en caso de encontrar extensión a regiones adyacentes y la remoción en bloque de las neoplasias. Presentamos un paciente masculino de 83 años, con obstrucción nasal unilateral, epistaxis y masa exofítica en la fosa nasal derecha; se realizó estudio imagenológico con tomografía computarizada y resonancia magnética, y diagnóstico histopatológico de carcinoma escamocelular moderadamente diferenciado, T2N0M0. Recibió manejo quirúrgico mediante maxilectomía medial, a través de rinotomía lateral, y se obtuvieron adecuados márgenes de resección. No hubo complicaciones intraquirúrgicas ni posquirúrgicas. Se logró resección completa del tumor, con adecuado resultado funcional y cosmético. En la actualidad el paciente no presenta recidiva tumoral.MEDPOR)...

The surgical approach in the management of benign and malignant sinonasal tumors is controversial. Ever since we are in the endoscopic minimally invasive surgery era, it might exist the perception that open approaches do not have place anymore. However, the lateral rhinotomy and medial maxillectomy have been the treatment of choice for most lesions involving the lateral nasal wall due to its improvement in technique and decreasing morbidity. This approach provides excellent exposure to adjacent regions and allows removal of neoplasms in block. We report 83 years old male with unilateral nasal obstruction, epistaxis, and an exophitic mass in the right nasal cavity. The diagnostic of squamous cellular carcinoma with moderate differentiation, T2N0M0 was made thru tomography, resonance and histopathology studies. The patient was treated with maxillectomy trough lateral rhinotomy with complete tumor resection and negative borders. There were no intraoperative or postoperative complications. Adequate functional and cosmetic result were achieved. Currently, the patient do not have tumor recurrence...

Medpor en Hipoplasia Nasal: agenesia de tercios superior, medio y septum nasal / Medpor in nasal hypoplasia: Upper, middle third and nasal septum agenesis

El desarrollo de las estructuras faciales está a cargo de células derivadas de la cresta neural, alteraciones en la migración o proliferación celular pueden desencadenar malformaciones nasales. Los defectos nasales son tan antiguos como la humanidad, sin embargo, descripciones anatómicas detalladas de estas malformaciones nasales congénitas y sus reconstrucciones son escasas. La hipoplasia nasal puede definirse como un trastorno en el desarrollo de los huesos y cartílagos nasales, y debe ser diferenciada de la arrinia, la cual consiste en la ausencia de nariz y fosas nasales. Los tejidos autologos son los injertos preferidos para la reconstrucción nasal. El tabique nasal, el cartílago auricular, la calota y el cartílago costal son los más usados; pero, estos recursos son limitados, impredecibles y causan algún grado de morbilidad en el sitio donante. Se presenta el primer caso de ausencia de huesos nasales, septum nasal y cartílagos laterales superiores con cartílagos alares intactos. Adicionalmente se presentan los detalles de la reconstrucción usando aloplasticos de alta densidad (polietileno, MEDPOR)...

Neural crest cells are responsible for the development of facial structures, migration failure, decreased proliferation or increased apoptosis may cause nasal anomalies. Nasal defects have existed as long as man; but, detailed anatomic descriptions of congenital nasal defects are rare, the ones including surgical reconstruction are even fewer. Nasal hypoplasia could be defined as nasal bone and cartilage maldevelopment and must be differentiated from congenital arhinia consisting of an absence of nasal structures and passages. Autogenous tissues have been the gold standard graft material for nasal reconstruction; septum, ear, rib and calvarium are preferred. Here, we report the first case of a non-syndromic absence of nasal bones, upper lateral cartilages and septum, with intact lower lateral cartilages and its reconstruction using high-density polyethylene (Medpor)...

Correlation of three variables describing nasal patency (HD, MCA, NOSE score) in healthy subjects.

UNLABELLED: Rhinoresistometry and acoustic rhinometry are two established apparative methods to objectify the respiratory function of the nose. Both methods use different variables to describe nasal patency: "hydraulic diameter", HD, in rhinoresistometry, and "minimal cross-sectional area", MCA1 (nasal isthmus) and MCA2 (head of the inferior turbinate and cavernous body of the nasal septum), in acoustic rhinometry. OBJECTIVE: This study analyzes the mutual correlation of HD and MCA as a pilot study in patients without nasal pathologies. Additionally, we investigated if these objective variables correlate with the NOSE score, a validated tool to measure subjective perception of nasal patency. METHOD: Planned data collection in a collective of 24 healthy subjects without nasal pathologies. RESULTS: Statistically significant, weak to moderate correlations were found between HD and MCA2 before decongestion. A moderate correlation was found between both HD and MCA2 and the NOSE score on the narrower side. CONCLUSION: In the assessment of nasal patency, it seems advisable to determine HD, MCA1 and MCA2, but also a subjective variable such as the NOSE score, which all seem to be not fully redundant variables. In further studies, the correlation of the variables should be assessed in patients with nasal pathologies.

Correlação de três variáveis na descrição da permeabilidade nasal (HD, MCA, escala NOSE) de pacientes saudáveis / Correlation of three variables describing nasal patency (HD, MCA, NOSE score) in healthy subjects

Rinoresistometria e rinometria acústica são dois métodos utilizados na avaliação da função respiratória nasal. Ambos utilizam variáveis diferentes para descrever a permeabilidade nasal: o diâmetro hidráulico, HD, na rinoresistometria; e as áreas mínimas da seção transversal, MCA1 (istmo nasal) e MCA2 (cabeça do corneto inferior e corpo cavernoso do septo nasal), na rinometria acústica. OBJETIVO: Analisar a relação entre HD e MCA em pacientes sem afecções nasais e identificar se tais variáveis objetivas apresentam correlação com a escala NOSE, uma ferramenta validada para avaliar a percepção subjetiva de permeabilidade nasal. MÉTODO: Coleta estruturada dos dados de 24 indivíduos saudáveis sem afecções nasais. RESULTADOS: Correlações estatisticamente significativas de fracas a moderadas foram identificadas entre HD e MCA2 antes do descongestionamento. Foi identificada correlação moderada entre HD, MCA2 e escala NOSE no lado mais estreito. CONCLUSÃO: Na avaliação de permeabilidade nasal, parece ser recomendável determinar HD, MCA1 e MCA2, bem como uma variável subjetiva como a escala NOSE, que não aparentam ser variáveis completamente redundantes. Estudos futuros devem avaliar a correlação destas variáveis em pacientes com afecções nasais.

Rhinoresistometry and acoustic rhinometry are two established apparative methods to objectify the respiratory function of the nose. Both methods use different variables to describe nasal patency: "hydraulic diameter", HD, in rhinoresistometry, and "minimal cross-sectional area", MCA1 (nasal isthmus) and MCA2 (head of the inferior turbinate and cavernous body of the nasal septum), in acoustic rhinometry. OBJECTIVE: This study analyzes the mutual correlation of HD and MCA as a pilot study in patients without nasal pathologies. Additionally, we investigated if these objective variables correlate with the NOSE score, a validated tool to measure subjective perception of nasal patency. METHOD: Planned data collection in a collective of 24 healthy subjects without nasal pathologies. RESULTS: Statistically significant, weak to moderate correlations were found between HD and MCA2 before decongestion. A moderate correlation was found between both HD and MCA2 and the NOSE score on the narrower side. CONCLUSION: In the assessment of nasal patency, it seems advisable to determine HD, MCA1 and MCA2, but also a subjective variable such as the NOSE score, which all seem to be not fully redundant variables. In further studies, the correlation of the variables should be assessed in patients with nasal pathologies.

Assessment of masticatory performance, bite force, orthodontic treatment need and orofacial dysfunction in children and adolescents.

OBJECTIVES: Few studies have evaluated the relationship between morphological and functional characteristics of the masticatory apparatus in young subjects. Thus, the aim of this study was to evaluate masticatory performance (MP), maximal bite force (BF), orthodontic treatment need and orofacial dysfunction in children and adolescents. DESIGN: The sample consisted of 316 subjects of both genders, with an age range 6-16years divided into 4 groups: early mixed, intermediate mixed, late mixed and permanent dentition. MP was evaluated by the individual's ability to comminute a chewable test material in order to determine median particle size (X(50)) and distribution of particles in different sieves ("b"). BF was determined using a digital gnatodynamometer with fork strength of 10mm. Orofacial function and orthodontic treatment need were screened using the Nordic Orofacial Test-Screening (NOT-S) protocol and Index of Orthodontic Treatment Need (IOTN), respectively. The results were submitted to descriptive statistics, normality test, analysis of variance and stepwise multiple linear regression to test relationship between MP and studied independent variables. RESULTS: Variance of X(50) and b between groups was statistically significant. But evaluation of variables that significantly contributed to MP variation showed that age, body mass index (BMI), BF and the presence of sleep bruxism were negatively related to X(50) and the NOT-S clinical exam scores showed a positive relationship with X(50). CONCLUSION: In the studied sample, age, BMI, BF and the presence of sleep bruxism were related to better MP; but the increase in NOT-S scores was significantly related to poorer MP.

Correlation between peak nasal inspiratory flow and peak expiratory flow in children and adolescents.

BACKGROUND: PEAK nasal inspiratory flow (PNIF) has been proposed as a simple method to evaluate nasal patency. Asthma and allergic rhinitis are commonly associated, and lower airway assessment can provide information concerning an objective interpretation of nasal function. AIMS: TO determine whether the PNIF is correlated with peak expiratory flow (PEF) in children and adolescents. METHODS AND RESULTS: Cross-sectional study carried out in healthy students randomly chosen in 14 public schools of the city of Belo Horizonte. PNIF and PEF were assessed for each subject as the following characteristics: gender, height, weight and age. We created a linear regression model to explain the PNIF, in which we included all the variables with a p value ≤ 0.25 in a univariate analysis, and to calculate the relationship between the maximum PNIF and maximum PEF by the Spearman correlation coefficient. In total, 297 healthy subjects, aged between six and eighteen years were evaluated. A positive and significant correlation between PNIF and PEF was found. CONCLUSIONS: PEF is predictive of PNIF. However, these measures evaluate two distinct segments of the airways and should be both obtained for a more precise assessment of airflow limitation.