Planificación, resultados y anatomía de la vía aérea superior en síndrome de apnea/hipopnea obstructiva del sueño tras avance bimaxilar: 20 casos / Planning, results and anatomy of the upper airway in obstructive sleep apnea/hypopnea syndrome after bimaxillary advancement: 20 cases

OBJETIVOS: El objetivo es presentar el protocolo de trabajo, resultados clínicos y cambios en la vía aérea superior de una cohorte de 20 pacientes con síndrome de apnea/hipopnea obstructiva del sueño, intervenidos de avance maxilomandibular con rotación antihoraria. MATERIAL Y MÉTODOS: Un comité multidisciplinar determina la indicación quirúrgica, que los pacientes consienten. Se llevan a cabo tomografías computarizadas y polisomnografías antes y después de la cirugía, como protocolo habitual de trabajo. El comité ético de investigación clínica regional aprobó el estudio. Longitudes, volúmenes, área mínima, dimensión anteroposterior, dimensión transversal y otras medidas son determinadas en la vía aérea. El análisis estadístico es descriptivo y comparativo por pares con p < 0,05. RESULTADOS: Los movimientos planificados son 10,40 mm de avance y 2,11 mm de impactación anterior. El índice de apnea/hipopnea se reduce 30,50 puntos y la saturación de oxígeno capilar periférica mínima aumenta 5,00 puntos. Los resultados clínica y estadísticamente significativos son: 10,98 mm de acortamiento y 6,26 mm3 de incremento de volumen, especialmente en el compartimento retro-palatal; 91,45 mm2, 3,68 mm y 8,00 mm de aumento de área, dimensión antero-posterior y dimensión transversal respectivamente; el hioides avanza 1,92 mm. CONCLUSIONES: El avance maxilomandibular con rotación antihoraria en síndrome de apnea/hipopnea del sueño moderado-severo logra a corto plazo índice de apnea/hipopnea < 15 en el 80 % y saturación de oxígeno periférica capilar > 85 en el 75 % de nuestra serie. Los principales cambios en vía aérea son: acortamiento, incremento de volumen y áreas, forma elíptica y posicionamiento antero-superior del hioides

OBJECTIVES: To present the working protocol, clinical outcomes and upper airway changes of a 20-patient cohort with moderate-severe obstructive sleep apnea/hypopnea syndrome undergoing maxillo-mandibular advancement with counterclockwise rotation. MATERIAL AND METHODS: A multidisciplinary committee determines the surgical indication, which patients consent. Computed tomographies and polysomnographies are performed before and after surgery, as the usual clinical practice protocol. The clinical investigation ethics institutional review board approved the study. Lengths, volumes, minimum area, antero-posterior dimension, transverse dimension and other measurements are determined in the upper airway. Statistical analysis is descriptive and comparative by pairs with p < 0.05. RESULTS: Planned movements are 10.40 mm of advance and 2.11 mm of anterior impaction. Apnea/hypopnea index reduces by 30.50 points and minimum peripheral capillary oxygen saturation increases by 5.00 points. Clinically and statistical significant findings are: 10.98 mm of shortening and 6.26 mm3 of volume enlargement, especially in the retro-palatal compartment; 91.45 mm2, 3.68 mm and 8.00 mm of area, antero-posterior dimension and transverse dimension widening respectively; hyoid bone advances 1.92 mm. CONCLUSIONS: Maxillo-mandibular advancement with counterclockwise rotation in moderatesevere obstructive sleep apnea/hypopnea syndrome achieves in short-term follow-up apnea/hypopnea index < 15 in 80 % and minimum peripheral capillary oxygen saturation > 85 in 75 % of our series. Main upper airway changes are: shortening, volume and area increase, elliptical shape, and antero-superior hyoid bone movement

Guías y miniplacas personalizadas: un protocolo guiado para cirugía ortognática / Customised guides and mini-plates: a guided-protocol for orthognathic surgery

Introducción. Los avances tecnológicos en planificación e impresión 3D permiten sinterizar productos sanitarios personalizados mediante un flujo de trabajo completamente digital. El objetivo de este trabajo es presentar y evaluar un nuevo sistema posicionador para cirugía ortognática (SPO), basado en el uso de una guía hueso-soportada y una miniplaca personalizada, que permite posicionar el fragmento maxilar sin la necesidad de una férula oclusal intermaxilar. Material y métodos. Se trata de un estudio prospectivo observacional sobre 10 casos de cirugía bimaxilar en los que se ha seguido un protocolo de planificación inversa. Tanto la guía como la miniplaca personalizada fueron diseñadas con tecnología computer aided-desing/manufacturing (CAD-CAM) y fabricadas por sinterizado láser de polvo de titanio puro comercial. Para analizar la precisión obtenida, se realizó un estudio comparativo superponiendo la planificación con una tomografía computarizada realizada un mes posterior a la cirugía. Resultados. El SPO se pudo aplicar con éxito en todos los casos sin observarse fenómenos de intolerancia al material. Permitió simplificar notablemente el procedimiento y reducir los tiempos quirúrgicos, al evitar la fijación intermaxilar, el moldeado de la miniplaca y la necesidad de realizar mediciones intraoperatorias. En el estudio postoperatorio se obtuvo una precisión media del 68,1% ±1mm. Conclusiones. Los sistemas de posicionamiento para cirugía ortognática que incluyan sistemas personalizados de osteosíntesis pueden ser una opción de futuro que permita incrementar la precisión y la seguridad del procedimiento, así como reducir los tiempos quirúrgicos (AU)

Introduction. Technological advances in preoperative planning and 3D printing allow custom-made biomedical devices to be synthesised using a completely digital workflow. The aim of this paper is to present and critically evaluate a new Orthognathic Positioning System (OPS) for Orthognathic Surgery. The OPS used bone-supported guides and a custom mini-plate to allow maxillary fragment positioning and fixation without the need for an inter-maxillary occlusal splint. Materials and methods. A prospective observational study was conducted on 10 cases of bimaxillary surgery using an inverse planning protocol. The guide and the custom-made mini-plate were designed using CAD-CAM software and synthesised by laser from commercially pure titanium powder. Accuracy was evaluated by overlap comparison of the virtual planning and 1-month postoperative CT scan. Operation times, complications, and overall safety profile were analysed. Results. The OPS was successfully applied to all cases, and was well tolerated. Operation times were reduced by avoiding inter-maxillary fixation, mini-plate bending, and obviating the need for intra-operative measurements. A mean postoperative accuracy of 1mm was obtained in 68.1% of cases. Conclusions. The positioning systems for orthognathic surgery that involve custom made systems of osteosynthesis, can be a future option that could increase accuracy and the safety of the procedure, as well as the surgical times. We believe this novel technology is a step forward in optimising and improving the delivery of orthognathic surgery care (AU)

Guía española de práctica clínica utilización de los dispositivos de avance mandibular (DAM) en el tratamiento de pacientes adultos con síndrome de apneas-hipopneas del sueño / Spanish guide to clinical practice using mandibular advancement devices (MAD) in the treatment of adult patients with sleep apnea-hypopnea syndrome

Objetivos: La GPC se orienta a los profesionales encuadrados en unidades de sueño en el diagnóstico del SAOS y de su tratamiento, especialmente con CPAP nasal. Asimismo el presente documento aspira a ser de utilidad para las distintas especialidades involucradas en el seguimiento de pacientes con SAOS. Objetivos: - Valorar la eficacia de los dispositivos de avance mandibular en el tratamiento de los pacientes adultos con síndrome de apneas-hipopneas obstructivas del sueño (SAOS). - Valorar los factores predictores de buena respuesta al tratamiento con dispositivos de avance mandibular en pacientes adultos diagnosticados de SAOS. - Valorar la metodología de implementación y seguimiento del tratamiento con DAM en pacientes adultos diagnósticados de SAOS. Finalmente, pretende aportar información de interés para los pacientes adultos diagnosticados de SAOS.

Experimental evidence of pharmacological management of anchorage in Orthodontics: A systematic review.

INTRODUCTION: Orthodontic anchorage is one of the most challenging aspects of Orthodontics. Preventing undesired movement of teeth could result in safer and less complicated orthodontic treatment. Recently, several reviews have been published about the effects of different molecules on bone physiology and the clinical side effects in Orthodontics. However, the effects of local application of these substances on the rate of orthodontic tooth movement have not been assessed. OBJECTIVES: The aim of this research was to analyze the scientific evidence published in the literature about the effects of different molecules on orthodontic anchorage. METHODS: The literature was systematically reviewed using PubMed/Medline, Scopus and Cochrane databases from 2000 up to July 31st, 2014. Articles were independently selected by two different researchers based on previously established inclusion and exclusion criteria, with a concordance Kappa index of 0.86. The methodological quality of the reviewed papers was performed. RESULTS: Search strategy identified 270 articles. Twenty-five of them were selected after application of inclusion/exclusion criteria, and only 11 qualified for final analysis. Molecules involved in orthodontic anchorage were divided into three main groups: osteoprotegerin (OPG), bisphosphonates (BPs) and other molecules (OMs). CONCLUSIONS: Different drugs are able to alter the bone remodeling cycle, influencing osteoclast function and, therefore, tooth movement. Thus, they could be used in order to provide maximal anchorage while preventing undesired movements. OPG was found the most effective molecule in blocking the action of osteoclasts, thereby reducing undesired movements.

Experimental evidence of pharmacological management of anchorage in Orthodontics: A systematic review

Introduction: Orthodontic anchorage is one of the most challenging aspects of Orthodontics. Preventing undesired movement of teeth could result in safer and less complicated orthodontic treatment. Recently, several reviews have been published about the effects of different molecules on bone physiology and the clinical side effects in Orthodontics. However, the effects of local application of these substances on the rate of orthodontic tooth movement have not been assessed.Objectives: The aim of this research was to analyze the scientific evidence published in the literature about the effects of different molecules on orthodontic anchorage.Methods: The literature was systematically reviewed using PubMed/Medline, Scopus and Cochrane databases from 2000 up to July 31st, 2014. Articles were independently selected by two different researchers based on previously established inclusion and exclusion criteria, with a concordance Kappa index of 0.86. The methodological quality of the reviewed papers was performed.Results: Search strategy identified 270 articles. Twenty-five of them were selected after application of inclusion/exclusion criteria, and only 11 qualified for final analysis. Molecules involved in orthodontic anchorage were divided into three main groups: osteoprotegerin (OPG), bisphosphonates (BPs) and other molecules (OMs).Conclusions: Different drugs are able to alter the bone remodeling cycle, influencing osteoclast function and, therefore, tooth movement. Thus, they could be used in order to provide maximal anchorage while preventing undesired movements. OPG was found the most effective molecule in blocking the action of osteoclasts, thereby reducing undesired movements.

Introdução: a ancoragem ortodôntica é um dos aspectos mais desafiadores da Ortodontia. A prevenção de movimentos dentários indesejados poderia resultar em um tratamento ortodôntico mais seguro e menos complexo. Recentemente, foram publicadas várias revisões de literatura sobre os efeitos de diferentes substâncias na fisiologia do tecido ósseo e os efeitos colaterais clínicos na Ortodontia. Porém, os efeitos da aplicação local dessas substâncias no grau de movimentação dentária ortodôntica não foram avaliados.Objetivos: o objetivo da presente pesquisa foi analisar a evidência científica publicada na literatura sobre os efeitos de diferentes substâncias na ancoragem ortodôntica.Métodos: a literatura foi sistematicamente revisada utilizando-se as bases de dados PubMed/Medline, Scopus e Cochrane, de 2000 a 31 de julho de 2014. Os artigos foram selecionados, de maneira independente, por dois pesquisadores diferentes, tendo como base critérios de inclusão e exclusão previamente estabelecidos, com um índice Kappa de concordância de 0,86. A qualidade metodológica dos artigos revisados foi analisada.Resultados: a estratégia de pesquisa identificou 270 artigos; 25 artigos foram selecionados após a aplicação dos critérios de inclusão e exclusão, mas apenas 11 foram qualificados para a análise final. As substâncias envolvidas na ancoragem ortodôntica foram divididas em três grupos principais: osteoprotegerina (OPG), bisfosfonatos (BFs) e outras substâncias (OSs).Conclusões: diferentes substâncias são capazes de alterar o ciclo de remodelação óssea, influenciando na função dos osteoclastos e, portanto, na movimentação dentária. Sendo assim, essas substâncias podem ser utilizadas para promover o máximo de ancoragem e prevenir movimentos indesejados. A OPG foi a substância mais eficaz no bloqueio da ação dos osteoclastos, reduzindo os movimentos indesejados.

Caracterización epidemiológica de las gestantes expuestas a factores ambientales / Epidemilogic characterization of pregnant women exposed to environmental factors

Desde hace tiempo se conoce que la exposición del feto al humo inhalado por la madre fumadora produce un riesgo significativamente superior de abortos espontáneos, embarazos ectópicos y bajo peso al nacer. Se realizó un estudio retrospectivo en la provincia de Las Tunas, en el período comprendido desde enero 2007 a diciembre 2008, con el objetivo de caracterizar epidemiológicamente los defectos congénitos, diagnosticados por consulta de genética en el centro provincial de Genética Médica. La muestra estuvo constituida por 122 casos, el mayor número de malformaciones congénitas correspondió al grupo de edades entre 20 a 24 años, en la valoración nutricional se encontró una relación directa entre el bajo peso de las gestantes y las malformaciones digestivas, así como los factores ambientales, a los que estuvieron expuestas las gestantes, fue el hábito de fumar y los medicamentos (AU)

Since long ago, it has been known that fetus exposition to smoke coming from smoking mothers produces a significant and superior risk to spontaneous abortions, ectopic pregnancies and low weight at birth. A retrospective study was carried out in Las Tunas province in the period from January 2007 to December 2008 with the objective of making the epidemiological characterization of congenital defects diagnosed by the genetics consultation at the provincial Center of Medical Genetics. The sample was formed by 122 cases, the highest number of congenital malformations corresponded to the age group between 20 and 24 years old. The nutritional evaluation revealed a direct relation between the low weight of pregnant women and digestive malformations, as well as the environmental factors to which they were exposed: smoking habits and medicines (AU)

Caracterización de las cardiopatías congénitas según su relación con el diagnóstico prenatal / Characterization of Congenital Cardiopathies According to its Relation with Prenatal Diagnosis

Las cardiopatías congénitas son causas frecuentes de morbilidad y mortalidad en la infancia. Se realizó un estudio descriptivo sobre las cardiopatías congénitas en la provincia de Las Tunas en los hospitales Dr Ernesto Guevara de la Serna y Mártires de Las Tunas, además del Centro de Genética Médica, desde enero del 2004 a diciembre del 2006, con el objetivo de determinar su incidencia, posible etiología, exposición de los factores ambientales . La muestra fue compuesta de 122 casos; el registro primario fue el cuaderno de recogida de datos. El estudio indicó una alta incidencia de defectos cardiovasculares, la etiología multifactorial prevaleció, seguida de las cromosómicas. Los factores ambientales que más se observaron fueron el hábito de fumar, la ingestión de medicamentos y la exposición a la radiografía por las gestantes(AU)

Congenital cardiopathies are frequent causes of morbility and mortality during childhood. A descriptive study was carried out at Dr Ernesto Guevara de la Serna General Provincial Teaching Hospital , Martires de las Tunas Provincial Pediatric Hospital , and the Provincial Medical Genetic Center from Las Tunas Province, from January 2004 to December 2006, with the objective of determining the incidence, possible etiologies and the exposition to enviromental factors.The sample consisted of 122 cases; the primary information was taken from the records where details are controlled.The study indicated a high incidence of cardiovascular defects; multifactorial etiology was more predominant, followed by the chromosomic ones. The enviromental factors that were mostly observed were the smoking habit; medication intake and exposition of pregnant women to radiographies(AU)