A comparison of tooth-borne and bone-anchored expansion devices in SARME.

PURPOSE: Major adult maxillary transverse discrepancies are usually treated with surgically assisted rapid maxillary expansion (SARME), utilizing a combination of surgical and orthodontic techniques. Unfortunately, a consensus has not been reached on topics ranging from the best surgical technique that should be performed to the ideal expander type that should be installed. The present study sought to evaluate the efficiency and stability of the maxillary expansion achieved with two types of expanders following the same SARME procedure without pterygomaxillary disjunction (PMD). METHODS: Twenty-four patients with a maxillary transverse deficiency were enrolled in the study. All patients underwent the same SARME, and 12 received a bone-anchored (KLS Martin®) and 12 were installed with a tooth-borne (Hyrax®) expander. Dental impressions were collected both preoperatively and 1 year postoperatively. These casts were scanned and the distances between specific interdental and intergingival points were measured and analyzed. Statistical analyses were performed to assess the effects expander type had on the efficiency of the maxillary expansion and long-term stability. RESULTS: Expansion in the anterior maxillary and premolar regions was found to be similar in both groups. In contrast, the tooth-borne device resulted in a significantly greater expansion in the molar region. CONCLUSION: The SARME technique without PMD is highly effective at treating adults with maxillary transverse deficiencies, and the type of expander selected depends on the location of the larger maxillary constriction region of each patient.

Cancer of the larynx: correlation of clinical characteristics, site of origin, stage, histology and diagnostic delay.

The authors studied the records of 108 cases of cancer of the larynx registered at the Department of Otolaryngology--Clinics Hospital--Faculty of Medicine of University of São Paulo, from 1985 to 1995. Dysphonia was the most common symptom observed (85.2%), independently of the site of the tumor. Dysphagia, dyspnea and weight loss had a similar incidence (32.4%; 34.3%; and 29.6%, respectively), with dysphagia more frequent in tumors which affected the supraglottis and dyspnea in glottic and subglottic tumors. As to staging, 45.8% presented at stage IV at the first consultation, and only 13.5% at stage I. No association was observed between tumor size (according to the TNM classification), presence of lymph node involvement, and delay, in diagnosis, taking the period between the beginning of symptoms and the first consultation at the hospital. In relation to the presenting symptom those with dysphonia sought medical help later. There was no correlation between histological invasion and tumor stage. It was concluded that the stage at presentation of tumors of the larynx is possibly more related to intrinsic differences in the tumor's aggressiveness and in host characteristics than to the diagnostic delay, and that it is necessary to warn the population about symptoms which may suggest the presence of cancer of the larynx.

Septic thrombosis of orbital vessels due to cutaneous nasal infection.

The authors describe two cases of cutaneous nose infection that quickly spread and extended to the orbital venous complex. At first glance, the clinical presentation could be mistaken for a complicated sinusal infection; therefore, the evaluation of the sinuses, by means of physical examination and radiological investigation, was of great concern, showing that there was no important pathology in the sinuses. The CT scan and the color Doppler imaging (orbital ultrasound with Doppler) demonstrated, throughout the development of the disease, that the superior ophthalmic vein was affected in both patients and the cavernous sinus in one of them. On physical examination, chemosis of the conjunctiva, proptosis, and edema of the eyelids were prominent. Patients improved only after appropriate intravenous antibiotic therapy against staphylococcus (clindamycin) and corticosteroids, making one conclude that treatment of this disease should be initiated as soon as possible in order to decrease morbidity and mortality.