Queiloplastia por técnica de Fisher: relato de caso / Fisher's cheiloplasty: case report

As fissuras labiopalatinas são as anomalias craniofaciais mais comuns, com uma prevalência mundial de 1 paciente para cada 1000 nascimentos, e de 1 para cada 650 nascidos no Brasil. O presente artigo relata um caso de um paciente com fissura labial unilateral completa, operado pela técnica de Fisher aos 10 meses, detalhando o método cirúrgico. Diversas técnicas de queiloplastias são descritas na literatura, com variáveis resultados estéticos e funcionais. No referido caso a técnica mostrou uma excelente qualidade de cicatriz, permitindo o trabalho fonoaudiológico para melhorar a motricidade oral... (AU)

As cleft lip and palate are the most common craniofacial anomalies, with a worldwide prevalence of 1 patient per 1000 births and 1 per 650 born in Brazil. This article reports a case of a patient with complete unilateral cleft lip, operated by Fisher's technique at 10 months, detailing the surgical method. Several cheiloplasty techniques are described in the literature, with several aesthetic and functional results. In this case, the technique showed an excellent quality of healing, allowing speech therapy to improve oral motor skills... (AU)

The characteristics of palate and upper dental arch can be an anatomical marker for men with schizophrenia? Case-control study: Palate can be a marker for schizophrenia?

AIMS: The aim of this study was to compare individuals with and without schizophrenia through the characteristics of the palate, such as width, length, depth, palate shape, and upper dental arch shape. METHODS AND RESULTS: The sample was divided into one case group (n = 45) and two control groups (n = 90; 45 individuals each group). Groups were paired by variables: sex, age, and malocclusion type. All analyses were performed on upper dental arch plaster models. All individuals were male and the mean age was 28.56 (SD: 7.82) years. The frequency of the malocclusion type observed was 54.1% (Class I), 22.2% (Class II), and 23.7% (Class III). Statistically significant difference was observed between the case and control groups for the variables palate shape (P = .004) and upper dental arch shape (P = .003). The case group had a higher frequency of the deep or grooved palate shape (57.8%) and parabolic dental arch shape (48.9%). There was no statistically significant difference for the palate width, length, and depth (P > .05). CONCLUSIONS: There was an evidence that the deep or grooved palate shape and parabolic dental arch shape are morphological characteristics of the palate in men with schizophrenia.

Influência da aplicação de estimulação elétrica e de proteínas derivadas da matriz do esmalte no reparo de feridas em palato: dois estudos clínicos randomizados / Influence of electric stimulation and enamel matrix protein derivative application on palatal wound healing: two randomized clinical trials

Procedimentos periodontais cirúrgicos podem levar a execução de feridas na região do palato como por exemplo na remoção de enxertos autógenos. Contudo, tais abordagens podem causar ao paciente certo grau de morbidade e desconforto na área operada. Procura-se, portanto, terapias para a área palatina auxiliando a cicatrização de feridas no local doador, que eventualmente também poderiam ser utilizadas para outras finalidades. Assim, o objetivo dos presentes estudos clínicos foi avaliar clínica e imunologicamente os resultados de três meses de duas abordagens, estímulo elétrico (EE) e matriz derivada do esmalte (EMD), no reparo de feridas palatinas advindas da remoção de enxerto gengival livre para preservação de alvéolo. Dois ensaios clínicos randomizados foram realizados seguindo o CONSORT-STATEMENT 2010. (1) Selecionou-se 53 pacientes apresentando necessidade de preservação de rebordo, divididos nos grupos: Sham (n=27) - simulação de EE na ferida aberta no palato, EE (n=26) - estímulo elétrico na ferida aberta no palato. As avaliações clínicas revelaram fechamento precoce da ferida palatina, bem como epitelização desta, aos 7 e 14 dias no grupo EE quando comparado ao grupo Sham (p<0,05 e p=0,03, respectivamente). Sintomatologia dolorosa revelou-se reduzida no grupo EE em relação ao grupo Sham aos 3 dias pós-operatórios (p=0,008). Bem como, uma melhoria na qualidade de vida do paciente foi reportada após 2 dias do procedimento cirúrgico (p<0,04). A modulação de certos biomarcadores de modo favorável à reparação tecidual se fez presente com o uso da eletroterapia. Deste modo, conclui-se que o uso da eletroterapia apresenta benefícios clínicos e imunológicos no reparo de feridas. (2) Selecionou-se 44 pacientes com necessidade de preservação de rebordo, divididos nos grupos: Controle (n=22) - ferida aberta no palato sem terapia e EMD (n=22) - aplicação de Emdogain® na ferida palatina. Nenhum benefício clínico, como fechamento da ferida e epitelização, foi visto com a aplicação de EMD. Contudo, verificou-se uma modulação favorável em biomarcadores inflamatórios importantes ao reparo bem como menor sintomatologia dolorosa. Por conseguinte, o uso do EMD revelou uma modulação positiva do processo inflamatório local à resolução da ferida(AU)

Surgical periodontal procedures may favor the formation of wounds in the palatal region as for example to obtain autogenous graft. Discomfort and a certain degree of morbidity may be present in patients undergoing this procedure. Thus, treatments for the palatine donor area has been sought to aid wounds healing and eventually be useful for other functions. Therefore, the aim of the investigations was to evaluate the 3-month clinical and immunological outcomes of two approaches, electric stimulus (EE) and enamel matrix derivative (EMD), on palatal open wound healing due to harvesting a graft for socket preservation. For this, two clinical trials were carried out following the CONSORT STATEMENT 2010. (1) Fifty-three patients presenting need of ridge preservation were divided into 2 groups: Sham (n=27) - sham electrical stimulation on the open palatal wound; EE (n=26) - electrical stimulation on open palatal wound. Clinical perceptions shown early wound closure, as well as, better epithelization in 7 and 14 days after surgery in EE group when related to Sham group (p<0,05 e p=0,03, respectively). Painful symptomatology was less reported in EE group in comparison to Sham group at 3 days after surgical approach (p=0,008). Likewise, an improvement in Oral Health Impact Profile was reported after 2 days of the procedure when combinate with electrotherapy protocol (p<0,04). Biomarkers modulation occurred in a favor manner when electric stimulus was applied at the wound. Therefore, the use of electrotherapy presented benefits for clinical wound healing and influenced the expression of favorable biomarkers during injury resolution. (2) Forty-four patients presenting need of ridge preservation were allocated into 2 groups: Control (n=22) - open palatal wound without treatment and EMD (n=22) ­ Emdogain® applied on the open palatal wound. None clinical benefits, as wound closure and epithelization was seen when EMD was used. However, important biomarkers modulation for repair occurred, as well as, less painful symptomatology. In conclusion, EMD application shown a positive influence in local inflammation during wound repair(AU)

A importância de um protocolo preventivo no atendimento odontológico de pacientes fissurados: uma revisão sistemática da literatura / The importance of a preventive protocol in dental care of patients with cleft lip and palate: a systematic review of literature

Objetivo: O objetivo deste estudo foi revisar sistematicamente na literatura publicações relacionadas ao protocolo de atendimento do cirurgião-dentista frente a pacientes com fissura labiopalatal. Métodos: Foram revisados artigos publicados até março de 2018, nas línguas inglesa, portuguesa e espanhola, obtidos por meio de buscas nas bases eletrônicas PubMed, Scopus, LILACS, Bireme, SciELO e busca manual nas referências dos artigos encontrados. Resultados: A busca resultou em 141 artigos, onde após a aplicação dos critérios de exclusão foram obtidos quatro artigos. Os artigos selecionados eram de revisão de literatura, o que impossibilitou a realização de uma revisão sistemática da literatura. Todos os artigos foram lidos na íntegra e resultaram em um protocolo de atendimento dividido de acordo com as fases de erupção dental, com ênfase na prevenção. O protocolo foi separado em: fase pré-eruptiva e de dentição decídua, dentadura mista e dentição permanente. Na fase pré-eruptiva e de dentição decídua a orientação é dar ênfase na prevenção, na fase de dentadura mista tem-se o início da ortodontia preventiva além da manutenção das ações preventivas e na fase de dentição permanente trabalha-se novamente com a prevenção inicia-se a ortodontia fixa e quando necessário a realização de cirurgia ortognática. Conclusão: Em relação aos achados, fica evidente a importância da prevenção durante todas as fases, visando a manutenção do perímetro da arcada, e manutenção da integridade dos dentes permanentes. O cirurgião-dentista deve estar apto a realizar o atendimento tendo como base um protocolo para efetuar o manejo correto conforme a faixa etária e a fase de erupção dental em que o paciente se encontra. O aprimoramento do cirurgião-dentista na abordagem aos pacientes portadores de fissura labiopalatal deve ser constante, bem como a criação de vínculo afetivo com o paciente e a família visando um tratamento preciso e humanizado. (AU)

Aim: This study sought to systematically review publications in the literature related to the Dentist's Protocol as regards palatal cleft patients. Methods:This study reviewed articles published up to March 2018, in English, Portuguese, and Spanish, obtained through data searches on PubMed, Scopus, LILACS, Bireme, SciELO, as well as through a manual search in the references of the identified articles. Results: The search resulted in 141 articles; after the application of the exclusion criteria, four articles were selected. The selected articles were literature reviews, making it impossible to conduct a systematic review of the literature. All of the obtained articles were read in full, resulting in a care protocol that was divided according to the dental eruption stages, with emphasis on prevention. The protocol was divided into: the pre-eruptive and deciduous dentition stage, mixed denture, and permanent dentition. In the pre-eruptive and deciduous dentition stage, the dental advice is to emphasize prevention; in the mixed dentition stage, there is the beginning of preventive orthodontics as well as the maintenance of preventive actions; while in the permanent dentition stage, one again works with prevention. fixed orthodontics is begun, and when necessary, orthognathic surgery is also applied. Conclusion: Regarding the findings, the importance of prevention during all stages is clear, in an attempt maintain the perimeter of the dental arch and the integrity of the permanent teeth. The dentist should be able to perform the service based on a protocol for the correct handling according to the age range and dental eruption stage of the patient. The improvement of the dentist in providing dental care to patients with cleft lip and palate should be constant, as should the creation of an affective bond with the patient and the family, aimed at providing a precise and humanized treatment. (AU)

Técnica de reconstrução de rebordo alveolar utilizando tórus palatino / Reconstruction of alveolar ridge using palatine torus: technical report / Reconstruction of alveolar ridge using palatine torus: technical report

Os enxertos ósseos autógenos são considerados como padrão-ouro para reabilitações de defeitos ósseos, e a região intrabucal constitui um excelente sítio doador para a resolução de defeitos ósseos pequenos e moderados. Este relato de caso clínico teve como objetivo descrever uma técnica cirúrgica para a obtenção de enxerto ósseo autógeno proveniente do tórus palatino para a reabilitação de altura e de espessura do rebordo ósseo alveolar remanescente referente ao elemento 11. Paciente do gênero feminino, 25 anos, procurou a clínica odontológica tendo como queixa principal a ausência do dente 11, perdido devido ao insucesso de um tratamento endodôntico. Radiograficamente, observou-se defeito ósseo horizontal na região do dente 11, e clinicamente, observou-se deficiência em espessura óssea vestibulolingual que impossibilitaria a instalação imediata de implante. Ao exame físico intrabucal, notou-se a presença de tórus palatino pronunciado, que apresentava 20 mm de comprimento, localizado na região central do palato e que, como sítio doador, mostrou-se de fácil acesso para a remoção do enxerto ósseo autógeno, mostrando-se suficiente em volume para a reconstrução do rebordo envolvendo um elemento unitário. Os blocos obtidos foram fixados com parafusos corticais medindo 1,5 mm. O acompanhamento clínico mostrou que a técnica proposta para reabilitação de rebordo alveolar para posterior inserção do implante unitário mostrou-se previsível e as dimensões de altura e de espessura de osso no sítio receptor, apesar da remodelação óssea sofrida, foi aceitável após sete meses, permitindo, de forma satisfatória, a reabilitação.

Autogenous bone grafts are considered as gold standard for rehabilitation of bone defects and the intrabucal region constitutes an excellent donor site for the resolution of small and moderate bone defects. This clinical case report aimed to describe a surgical technique to obtain an autogenous bone graft from the palatine torus for rehabilitation of height and thickness of the remaining alveolar bone ridge referring to element 11. A 25-year-old female patient sought the dental clinics having as main complaint the absence of tooth 11, lost due to failure of an endodontic treatment. Radiographically, a horizontal bone defect was observed in the region of the tooth 11 and clinically a bucco-lingual bone thickness defi ciency was observed that would make it impossible to insert the implant immediately. The presence of a pronounced palatine torus that was 20 mm long, located in the central region of the palate and which, as a donor site, was easily accessible for removal of the autogenous bone graft. Sufficient volume for rebuilding the collar involving a single element. The obtained blocks were fixed with cortical screws measuring 1.5 mm. Clinical follow-up showed that the proposed technique for alveolar ridge rehabilitation for posterior implant insertion was predictable and the dimensions of height and bone thickness at the recipient site, despite the bone remodeling suffered, were acceptable after 7 months allowing the oral rehabilitation.

Utilização de exostose óssea associada com biomaterial em cirurgia de levantamento do soalho do seio maxilar / Use of bone exostosis associated with biomaterial in maxillary sinus floor elevation

Exostoses ósseas são crescimentos ósseos benignos do esqueleto craniofacial, que ocorrem ao longo da região vestibular, lingual (tórus mandibular) ou palatina (tórus palatino) dos maxilares. A presença dessas estruturas pode interferir na fonação, mastigação e adaptação de próteses parciais removíveis ou totais, devendo sua remoção ser sempre considerada. Além disso, a remoção e aproveitamento de tais estruturas deve ser considerada, também, nos casos de atrofia do rebordo alveolar, quando o objetivo é a reabilitação por meio de implantes dentários. Sendo assim, o objetivo do presente trabalho é relatar o caso clínico de uma paciente que apresentava um tórus palatino e necessitava de cirurgia para levantamento do soalho do seio maxilar, para posterior colocação de implante; o tórus foi removido e aproveitado em associação com biomaterial heterógeno...

Bone exostosis refers to benign bone growth in the craniofacial skeleton. They occur along the labial, lingual (mandibular torus) or palatal (palatal torus) regions of the jaws. The presence of these structures can affect phonation, chewing and adaptation to partial or completely removable dental prostheses. The removal of these structures should always be considered. In addition, the removal and use of these structures should also be considered in cases of atrophy of the alveolar ridge, when seeking to promote rehabilitation through the use of dental implants. Therefore, the aim of the present study was to report a clinical case in which a patient exhibited a palatal torus and required surgery for maxillary sinus floor lifting and subsequent implant placement. The palatal torus was removed and used in association with heterogeneous biomaterial...

Craniofacial changes and symptoms of sleep-disordered breathing in healthy children.

INTRODUCTION: The main cause of mouth breathing and sleep-disordered breathing (SDB) in childhood is associated with upper airway narrowing to varying degrees. OBJECTIVE: The aim of this study was to assess the prevalence of morphological and functional craniofacial changes and the main clinical symptoms of SDB in healthy children. METHODS: A cross-sectional observational study was conducted. A sample comprising 687 healthy schoolchildren, aged 7-12 years old and attending public schools, was assessed by medical history, clinical medical and dental examination, and respiratory tests. The self-perceived quality of life of mouth breathing children was obtained by a validated questionnaire. RESULTS: Out of the total sample, 520 children were nose breathers (NB) while 167 (24.3%) were mouth breathers (MB); 32.5% had severe hypertrophy of the palatine tonsils, 18% had a Mallampati score of III or IV, 26.1% had excessive overjet and 17.7% had anterior open bite malocclusion. Among the MB, 53.9% had atresic palate, 35.9% had lip incompetence, 33.5% reported sleepiness during the day, 32.2% often sneezed, 32.2% had a stuffy nose, 19.6% snored, and 9.4% reported having the feeling to stop breathing while asleep. However, the self-perception of their quality of life was considered good. CONCLUSION: High prevalence of facial changes as well as signs and symptoms of mouth breathing were found among health children, requiring early diagnosis and treatment to reduce the risk of SDB.

Redução de fenda palatina secundária adquirida em um gato: relato de caso / Acquired cleft palate repair in a cat: case report / Reducción de hendidura palatina secundaria aquirida en un gato: relato de caso

O palato é uma estrutura localizada na porção dorsal da cavidade oral a qual separa a cavidade nasal e a orofaríngea. A falha na fusão das cristas palatinas pode ser congênita ou adquirida e resulta em fenda palatina. Neste trabalho, irá relatar-se a redução de fenda palatina secundária traumática em um felino,atendido no Laboratório de Odontologia Comparada (LOC) da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (FMVZ-USP).(AU)

The palate is a structure located in the dorsal portion of the oral cavity which separates the nasal cavity and the oropharynx . Failure to merge the palatine ridges can be congenital or acquired and results incleft palate. In this work, will report the reduction of traumatic secondary cleft palate in a feline, attended the Comparative Dental Laboratory (LOC), Faculty of Veterinary Medicine and Animal Science of the University of São Paulo (USP-FMVZ).(AU)

El paladar es una estructura situada en la porción dorsal de la cavidad oral, la cual separa la cavidad nasal y la orofaringe. La falta de fusión de las crestas palatinas puede ser congênita o adquirida y resultados en paladar hendido. En este trabajo, se relatada la reducción de paladar hendido traumático secundario en un felino, atendido em el Laboratorio Dental comparativo (LOC) de la Facultad de Medicina Veterinaria y Zootecnia de la Universidad de São Paulo (USP-FMVZ).(AU)

Craniofacial changes and symptoms of sleep-disordered breathing in healthy children

INTRODUCTION: The main cause of mouth breathing and sleep-disordered breathing (SDB) in childhood is associated with upper airway narrowing to varying degrees. OBJECTIVE: The aim of this study was to assess the prevalence of morphological and functional craniofacial changes and the main clinical symptoms of SDB in healthy children. METHODS: A cross-sectional observational study was conducted. A sample comprising 687 healthy schoolchildren, aged 7-12 years old and attending public schools, was assessed by medical history, clinical medical and dental examination, and respiratory tests. The self-perceived quality of life of mouth breathing children was obtained by a validated questionnaire. RESULTS: Out of the total sample, 520 children were nose breathers (NB) while 167 (24.3%) were mouth breathers (MB); 32.5% had severe hypertrophy of the palatine tonsils, 18% had a Mallampati score of III or IV, 26.1% had excessive overjet and 17.7% had anterior open bite malocclusion. Among the MB, 53.9% had atresic palate, 35.9% had lip incompetence, 33.5% reported sleepiness during the day, 32.2% often sneezed, 32.2% had a stuffy nose, 19.6% snored, and 9.4% reported having the feeling to stop breathing while asleep. However, the self-perception of their quality of life was considered good. CONCLUSION: High prevalence of facial changes as well as signs and symptoms of mouth breathing were found among health children, requiring early diagnosis and treatment to reduce the risk of SDB. .

INTRODUÇÃO: a principal causa da respiração bucal e dos distúrbios respiratórios do sono (DRS) está associada ao estreitamento das vias aéreas superiores, em diferentes graus. OBJETIVO: avaliar a prevalência de alterações morfológicas e funcionais da face e os principais sintomas clínicos de DRS em crianças saudáveis. MÉTODOS: estudo transversal, observacional, com amostra de 687 escolares saudáveis, provenientes de escolas públicas, com idades entre 7 e 12 anos. Foram avaliados pela história clínica, exame clínico médico e odontológico e testes respiratórios. A autopercepção da qualidade de vida dos escolares com respiração bucal foi obtida por meio de um questionário validado. RESULTADOS: na amostra total, 520 crianças eram respiradoras nasais (RN) e 167 (24,3%) eram respiradoras bucais (RB); 32,5% tinham hipertrofia das amígdalas palatinas, 18% tinham índice Mallampati obstrutivo (III e IV); 26,1% tinham overjet exagerado e 17,7%, mordida aberta anterior. Entre os RB, 53,9% tinham palato atrésico; 35,9% com ausência de selamento labial; 33,5% relataram sonolência diurna; 32,2%, espirros frequentes; 32,2%, nariz entupido; 19,6% roncavam e 9,4% relataram ter a sensação de parar de respirar durante o sono. Entretanto, a autopercepção da qualidade de vida desses escolares foi considerada boa. CONCLUSÃO: foi encontrada alta prevalência de alterações faciais, de sinais e de sintomas clínicos de respiração bucal nos escolares saudáveis examinados, necessitando diagnóstico e tratamento para reduzir o risco de DRS. .

Redução de fenda palatina secundária adquirida em um gato: relato de caso / Acquired cleft palate repair in a cat: case report / Reducción de hendidura palatina secundaria aquirida en un gato: relato de caso

O palato é uma estrutura localizada na porção dorsal da cavidade oral a qual separa a cavidade nasal e a orofaríngea. A falha na fusão das cristas palatinas pode ser congênita ou adquirida e resulta em fenda palatina. Neste trabalho, irá relatar-se a redução de fenda palatina secundária traumática em um felino,atendido no Laboratório de Odontologia Comparada (LOC) da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (FMVZ-USP).

The palate is a structure located in the dorsal portion of the oral cavity which separates the nasal cavity and the oropharynx . Failure to merge the palatine ridges can be congenital or acquired and results incleft palate. In this work, will report the reduction of traumatic secondary cleft palate in a feline, attended the Comparative Dental Laboratory (LOC), Faculty of Veterinary Medicine and Animal Science of the University of São Paulo (USP-FMVZ).

El paladar es una estructura situada en la porción dorsal de la cavidad oral, la cual separa la cavidad nasal y la orofaringe. La falta de fusión de las crestas palatinas puede ser congênita o adquirida y resultados en paladar hendido. En este trabajo, se relatada la reducción de paladar hendido traumático secundario en un felino, atendido em el Laboratorio Dental comparativo (LOC) de la Facultad de Medicina Veterinaria y Zootecnia de la Universidad de São Paulo (USP-FMVZ).

A origem dos toros palatinos e mandibulares: bases para a sua interpretação clínica / Origin of torus palatinus and torus mandibularis: basis for clinical interpretation

Os toros palatinos e mandibulares são distúrbios do desenvolvimento do tipo anomalia de forma, com manifestação tardia no crescimento e maturação dos maxilares. Os casos familiares e a persistência dos toros com a idade e em desdentados lhe atribuem uma origem genética e dificultam a sua interpretação como uma resposta adaptativa à sobrecarga oclusal, ao bruxismo e outros fatores externos: os toros não são hiperplasias ou hipertrofias adaptativas. Os toros são protuberâncias ósseas sem cápsula fibrosa, o que os diferencia dos osteomas e lhes tira a natureza neoplásica, mesmo que benigna, especialmente porque também não apresentam crescimento contínuo e sem controle por parte do organismo. O tamanho dos toros se estabiliza no final do crescimento dos maxilares, ao redor dos 22 a 24 anos. Os toros são constituídos de osso normal, do ponto de vista funcional e estrutural, e podem ser utilizados como sítio de origem de transplante ósseo autógeno para outros locais, ou como sede de implantes osseointegráveis, se houver conveniências clínicas para tais procedimentos...

Torus palatinus and torus mandibularis are developmental anomalies of shape that become late manifest during growth and maturation of the jaws. Family history and the constant presence of tori with age and among edentulous patients attach a genetic origin to them and hinder their clinical interpretation as an adaptive response to occlusal overload, grinding and other external factors: tori are not a form of hyperplasia or adaptive hypertrophy. They are bone protuberances without a fibrous capsule, which differentiates them from osteomata and frees them from a neoplastic nature, albeit benign, especially because they do not grow continuously and uncontrollably in one’s organism. The size of tori stabilizes by the end of maxillary growth, at around the age of 22 to 24 years. They are composed of normal bone, from a functional and structural perspective, and might be used as autograft harvesting site or osseointegrated implant placement site within clinically acceptable conditions...

New insights on the pathophysiology of inspiratory flow limitation during sleep.

INTRODUCTION: Inspiratory flow limitation (IFL) is defined as a "flattened shape" of inspiratory airflow contour detected by nasal cannula pressure during sleep and can indicate increased upper airway resistance especially in mild sleep-related breathing disorders (SRBD). The objective of this study was to investigate the association between upper airway abnormalities and IFL in patients with mild SRBD. METHODS: This study was derived from a general population study consisting of selected individuals with apnea-hypopnea index (AHI) below 5 events/h of sleep, ("no obstructive sleep apnea" group) and individuals with AHI between 5 and 15 events/h ("mild obstructive sleep apnea" group). A total of 754 individuals were divided into four groups: group 1: AHI <5/h and <30 % of total sleep time (TST) with IFL (515 individuals), group 2: AHI <5/h and >30 % of TST with IFL (46 individuals), group 3: AHI: 5-15/h and <30 % of TST with IFL (168 individuals), and group 4: AHI: 5-15/h and >30 % of TST with IFL (25 individuals). RESULTS: Individuals with complains of oral breathing demonstrated a risk 2.7-fold larger of being group 4 compared with group 3. Abnormal nasal structure increased the chances of being in group 4 3.2-fold in comparison to group 1. Individuals with voluminous lateral wall demonstrated a risk 4.2-fold larger of being group 4 compared with group 3. CONCLUSION: More than 30 % of TST with IFL detected in sleep studies was associated with nasal and palatal anatomical abnormalities in mild SRBD patients.

General and stomatologic aspects of bardet-biedl syndrome.

OBJECTIVE: The purpose of this study is to present a clinical report of a patient with Bardet-Biedl syndrome, aiming to help the dentist to identify the general aspects, systemic changes, alterations. CLINICAL REPORT: Bardet-Biedl syndrome is defined as a genetic disorder of autosomal recessive condition; this case is a male patient, 20 years old. The general features presented by the patient were strabismus, polydactyly, hypogonadism, obesity, cognitive impairment, and autistic behavior. Dentally, this patient presents with hypotonic face, high-arched palate, dental crowding, unilateral crossbite, and difficulty in cleaning but with good-quality oral health. CONCLUSIONS: Many patients with this syndrome have compromised oral hygiene, difficulty in addressing dental cases, developmental delay, and autistic behavior. Thus, it is important to pay attention to these early children from an early age and encourage preventive approach.

Obturadores palatinos em pacientes com fissura palatina / Palatal obturators in patients with cleft palate

Avaliar a ação de obturadores palatinos auxiliares da fala em pacientes com insuficiência velofaríngea devido à fissura palatina. Método: Participaram do estudo, dez pacientes com fissuras palatinas transforame ou pós-forame com diagnóstico de insuficiência velofaríngea, a partir da análise da hipernasalidade e da emissão de ar nasal. A hipernasalidade foi avaliada durante amostra de fala espontânea e repetição de vocábulos e frases. A emissão de ar nasal foi classificada de acordo com a quantidade de escape aéreo nasal, detectada no teste do espelho, durante o sopro, a emissão prolongada de fonemas, vocábulos e frases com fonemas plosivos e fricativos. As avaliações foram feitas em três tempos: T0, T1 e T2. Resultados: Para as variáveis hipernasalidade do fonema /i/ e emissão de ar nasal, observou-se diferença estatisticamente significante para T2, não sendo observada diferença entre T0 e T1. Considerando-se as variáveis hipernasalidade do fonema /u/ e função velofaríngea, não foi observada diferença estatisticamente significante entre T0, T1 e T2. Conclusão: Com os resultados obtidos, pode-se afirmar que o emprego de obturadores palatinos auxiliares da fala, em pacientes de fissuras palatinas com insuficiência velofaríngea, aumentou a hipernasalidadedo fonema /i/ e a emissão de ar nasal. A hipernasalidade do fonema /u/ e a função velofaríngea não sofreram alterações significantes... (AU)

Objective: To evaluate the action of speech-aid palatal obturators in patients with velopharyngeal insufficiency due to cleft palate. Methods: Ten transforamen or post-foramen cleft palate patients with a diagnosis of velopharyngeal insufficiency, based on the analysis of hypernasality and nasal air emission, participated in the study. Hypernasality was assessed during spontaneous speech samples and repetition of words and phrases. Nasal air emission was classified according to the amount of nasal air escape detected by the fogged-mirror test during oral breath and prolonged emission of phonemes, words and phrases with plosive and fricative sounds. Assessments were performed at three time points: T0, T1, and T2. Results: As for hypernasality of the vowel /i/ and nasal air emission, there was a statistically significant difference at T2, but no difference between T0 and T1. Regarding hypernasality of the vowel /u/ and velopharyngeal function, there was no statistically significant difference between T0, T1, and T2. Conclusion: These results indicate that the use of speech-aid palatal obturators in cleft palate patients with velopharyngeal insufficiency increased hypernasality of the vowel /i/ and nasal air emission. Hypernasality of the vowel /u/ and velopharyngeal function showed no significant changes... (AU)

Defining new guidelines for screening the 22q11.2 deletion based on a clinical and dysmorphologic evaluation of 194 individuals and review of the literature.

The 22q11.2 deletion is the most frequent interstitial deletion in humans and presents a wide phenotypic spectrum, with over 180 clinical manifestations described. Distinct studies have detected frequencies of the deletion ranging from 0 % to 75 %, depending on the studied population and selection criteria adopted. Due to the lack of consensus in this matter, several studies have been conducted aiming to define which patients would be eligible for screening; however, the issue is still up for debate. In order to contribute to the delineation of possible clinical and dysmorphologic guidelines to optimize decision making in the clinical setting, 194 individuals with variable features of the 22q11.2 deletion syndromes (22q11.2DS) were evaluated. Group I, clinical suspicion of 22q11.2DS with palatal anomalies; Group II, clinical suspicion without palatal anomalies; Group III, cardiac malformations associated with the 22q11.2DS; and Group IV, juvenile-onset schizophrenia. Multiplex ligation-dependent probe amplification was used for screening the 22q11.2 deletion, which was detected in 45 patients (23.2 %), distributed as such: Group I, 35/101 (34.7 %); Group II, 4/18 (22.2 %); Group III, 6/52 (11.5 %); and Group IV, 0/23 (0 %). Clinical data were analyzed by frequency distribution and statistically. Based on the present results and on the review of the literature, we propose a set of guidelines for screening patients with distinct manifestations of the 22q11.2DS in order to maximize resources. In addition, we report the dysmorphic features which we found to be statistically correlated with the presence of the 22q11.2DS.

The influence of orotracheal intubation on the oral tissue development in preterm infants.

PURPOSE: Preterm children may not be prepared for extra-uterine life and thus need neonatal intensive care, such as artificial ventilation through orotracheal intubation. Oral tissue development changes as a result of the use of an orotracheal tube and its mechanical influence in preterm neonates has not been intensively studied. The purpose of the present study was to determine the association of orotracheal intubation with incidence of oral alterations in preterm infants. MATERIALS AND METHODS: A retrospective cohort of 117 subjects who were born during the period 2002-2003 in Brazil were evaluated and the data were analysed using the Fisher and Mann-Whitney exact tests. A 95% confidence interval was calculated for observed oral conditions. RESULTS: The cohort revealed that the most frequent oral conditions included anterior crossbite, superior alveolar contour and palatal deformation. CONCLUSIONS: The association between the intubated-infant group and the non-intubated-infant group suggested that mechanical trauma had an influence on the oral structure development.

Oral and systemic manifestations of mucopolysaccharidosis type VI: a report of seven cases.

Mucopolysaccharidosis (MPS) is a group of rare metabolic diseases characterized by intralysosomal accumulation of glycosaminoglycans. MPS type VI or Maroteaux-Lamy syndrome is an autosomal-recessive syndrome caused by mutations in the lysosomal enzyme arylsulfatase B. A defect in the gene leads to accumulation of nondegraded mucopolysaccharides, resulting in severe cellular dysfunction with multisystem expression. The oral manifestations of MPS VI are not well described in the literature. This paper presents a series of seven patients with MPS VI, with the description of the general clinical manifestations and focus on the still rarely studied oral manifestations of the syndrome. Among them were high palate, open bite, impacted and/or included teeth, thickening of the pericoronal follicle, and changes in the temporomandibular joint.

Absent mandibular gap in the retronasal triangle view: a clue to the diagnosis of micrognathia in the first trimester.

OBJECTIVE: To describe a new ultrasound technique that may be useful for the diagnosis of micrognathia in the first trimester of pregnancy. METHODS: The retronasal triangle (RNT) view is a technique that captures the coronal plane of the face in which the primary palate and the frontal processes of the maxilla are visualized simultaneously. Normal first-trimester fetuses display a characteristic gap between the right and left body of the mandible in this view (the 'mandibular gap'). The presence or absence of this gap was evaluated and measured prospectively during real-time scanning (n = 154) and retrospectively by analyzing three-dimensional (3D) datasets (n = 50) in normal first-trimester fetuses undergoing screening for aneuploidy at 11-13 weeks' gestation. 3D datasets from 12 fetuses with suspected micrognathia were also collected and examined retrospectively for the same features. RESULTS: The mandibular gap was identified in all 204 normal fetuses and increased linearly with increasing crown-rump length (y = 0.033x + 0.435; R(2) = 0.316), with no statistically significant differences between measurements obtained by two-dimensional ultrasound and 3D offline analysis. Among fetuses with suspected micrognathia, three 3D datasets were excluded from analysis because of poor image quality in one and the diagnosis of a normal chin in two. In the remaining nine fetuses, the mandibular gap was absent and was replaced by a bony structure representing the receding chin in seven (77.8%) cases and was not visualized due to severe retrognathia in the remaining two (22.2%) cases. All fetuses with micrognathia had associated anomalies, including seven with aneuploidy and two with skeletal dysplasia. CONCLUSIONS: The RNT view may be a helpful technique for detecting micrognathia in the first trimester. The absence of the mandibular gap or failure to identify the mandible in this view is highly suggestive of micrognathia and should prompt a targeted ultrasound scan to assess for other anomalies. Further research is needed to determine the false-positive and false-negative rates of this technique.

Avaliação do crescimento craniofacial em portadores de fissuras labiopalatinas submetidos a palatoplastia em tempo único / Evaluation of craniofacial growth in patients with cleft lip and palate undergoing one-stage palate repair

INTRODUÇÃO: As cirurgias primárias, queiloplastia e palatoplastia, interferem na morfologia e na fisiologia do complexo maxilofacial, provocando alterações em seu crescimento nos portadores de fissura transforame incisivo unilateral (FTIU). Este estudo tem por objetivo avaliar precocemente os efeitos das cirurgias sobre o crescimento maxilofacial, por meio da relação dos arcos dentários desses pacientes. MÉTODO: Foram avaliados 45 pacientes portadores de FTIU submetidos a cirurgias primárias de lábio e palato. Foi realizado estudo comparativo de modelos dos arcos dentários decíduos em que a relação maxilomandibular foi avaliada por 2 ortodontistas, que aplicaram o índice Atack. RESULTADOS: Dentre os pacientes analisados, 44,4 por cento se encontravam nos escores 1 e 2, apresentando condições mais favoráveis de crescimento maxilomandibular. O escore intermediário (escore 3) correspondeu a 40 por cento da amostra e os escores 4 e 5, a 15,6 por cento, apresentando tendência a crescimento desfavorável. A média obtida aos 4 anos de idade foi de 2,62 + 0,98. Ao relacionar os escores 1 e 2 com outros estudos, houve diferença significativa (P = 0,023) comparativamente à série de Bongaarts, que apresentou os melhores resultados. Nos resultados para os escores 3, 4 e 5, observaram-se proporções semelhantes às de três dos estudos relacionados e melhores em relação ao primeiro a utilizar o índice Atack na avaliação de suas cirurgias primárias. CONCLUSÕES: A aplicação do índice Atack possibilitou a análise dos resultados de cirurgias primárias sobre o crescimento maxilofacial e a comparação destes com os dados obtidos por centros de referência para tratamento da FTIU.

BACKGROUND: Primary surgeries such as cheiloplasty and palatoplasty interfere with the morphology and physiology of the maxillofacial complex, causing alterations in its growth and development in unilateral cleft lip and palate (UCLP) patients. The aim of the present study was to perform a preliminary analysis of the effects of surgery on maxillofacial growth through an examination of dental arch relationships. METHODS: Forty-five patients with UCLP who underwent primary surgery for the repair of cleft lip and palate were evaluated. Comparative analysis of plaster models of dental arches was performed by two orthodontists using the Atack index. RESULTS: Some patients (44.4 percent) analyzed showed scores of 1 and 2, representing the most favorable maxillofacial growth conditions. The intermediate score (score 3) was found in 40 percent of patients, while 15.6 percent showed unfavorable maxillary growth tendencies (scores 4 and 5). The mean score at 4 years of age was 2.62 + 0.98. A correlation between scores 1 and 2 in the present study with those of previous studies resulted in a significant difference (P = 0.23) in comparison to Bongaarts' series, which obtained the best results. Our results for scores 3, 4, and 5 were similar to those of 3 related studies in terms of the percentages obtained, which were better than those of the first study that used the Atack index for the evaluation of primary surgeries. CONCLUSIONS: The Atack index enabled the analysis of the effects of primary surgery on maxillofacial growth and a comparison with the results obtained by other centers for the treatment of UCLP.

Análise comparativa da expansão maxilar com três marcas de parafusos com limitador posterior: ensaio laboratorial em Typodont / Comparative analysis of rapid maxillary expansion using three brands of fan-type expander screw: laboratory trial using typodont

INTRODUÇÃO: nos pacientes com fissura labiopalatina, observa-se, usualmente, uma severa atresia da maxila, especialmente na região anterior da arcada, cujo tratamento envolve expansão maxilar. OBJETIVO: o propósito desse estudo foi avaliar o padrão de expansão de três marcas de parafusos com limitador posterior na correção da deficiência transversa. MÉTODOS: foram realizadas 18 expansões em Typodont, com 6 simulações para cada grupo: G1 - parafuso Dentaurum®, G2 - parafuso Leone®, e G3 - parafuso Morelli®. Foram realizadas, para cada ensaio, 13 ativações de 2/4 de volta, totalizando 5,2mm de abertura do parafuso. Definiram-se os momentos das medições em inicial (T1), metade das ativações (T2) e final (T3). Com o auxílio de um paquímetro, foram medidas as seguintes distâncias: interprimeiros pré-molares (IP1), interssegundos pré-molares (IP2), intermolares (IM) e comprimento da arcada (CA). Os dados obtidos foram submetidos aos testes de Kolmogorov-Smirnov, de Tukey, de Friedman e ANOVA. RESULTADOS: observou-se que todos os grupos apresentaram um padrão de abertura em forma de "V" com maior expansão na região anterior da arcada, sendo mais expressivo no grupo G3 (29,58 por cento em IP1 e 9,73 por cento em IM). O aumento na medida CA foi semelhante para os grupos G1 e G3 (+12,65 por cento e +12,13 por cento, respectivamente), com menor valor para o G2 (+8,23 por cento). CONCLUSÕES: concluiu-se que todos os parafusos com limitador posterior utilizados nesse estudo podem ser empregados no tratamento da deficiência transversa da arcada. Entretanto, o parafuso Morelli® apresentou maior abertura na região anterior em relação à posterior, característica importante no tratamento de pacientes com fissura labiopalatina. Recomenda-se a realização de estudos clínicos para confirmação desses achados.

INTRODUCTION: Cleft lip and palate patients usually have severe maxillary deficiencies, particularly in the anterior region of this arch and their treatment should include maxillary expansion.OBJECTIVE: To evaluate the expansion pattern of three brands of fan-type expander screws to correct transverse deficiencies.METHODS: Eighteen expansions on typodonts were performed with 6 simulations for each group: G1 - Dentaurum® screw; G2 - Leone® screw; and G3 - Morelli® screw. For each trial 13 activations of 2/4 of a turn each were made with a 5.2 mm screw opening. Measurements were made at baseline (T1), after half of the activations (T2) and at the end of the trial (T3). A caliper was used to make the following measurements: Inter-first premolars (IP1), inter-second premolars (IP2) and intermolar (IM) widths and arch length (AL). The Kolmogorov-Smirnov, Tukey, Friedman and ANOVA tests were used to analyze data.RESULTS: All groups had a "V" shaped opening pattern and the greater expansion was found in the anterior region of the arch, which was more evident in the G3 (29.58% in IP1 and 9.73% in IM). The increase in AL was similar in G1 and G3 (+12.65% and +12.13%) and the lowest value was found in G2 (+8.23%).CONCLUSIONS: All the fan-type expander screws used in this study may be used to treat dental arch transverse deficiencies. However, the use of the Morelli screw resulted in a greater opening in the anterior region than in the posterior region, an important characteristic in the treatment of cleft lip and palate patients. Further clinical studies should be conducted to confirm these findings.