Temporomandibular joint disc position and shape in patients submitted to two protocols of rapid maxillary expansion and face mask therapy: A randomized clinical trial.

OBJECTIVE: The objective of this prospective study was to assess possible changes in the position and shape of the temporomandibular joint (TMJ) articular disc in patients treated with two protocols of rapid maxillary expansion (RME) and face mask (FM) therapy. METHODS: A sample of 88 patients with Class III or Class III subdivision malocclusions, aged between 6 and 13 years, were consecutively selected and divided into three groups (G): G1-34 patients were treated with RME, followed by FM therapy; G2-34 patients were treated using RME according to modified alternate rapid maxillary expansion and constriction (ALT-RAMEC) protocol, followed by FM therapy. These treated groups were randomly (1:1 allocation ratio) distributed according to the two treatment protocols. G3 - Control Group - 20 untreated patients were followed. Magnetic resonance imaging (MRI) TMJs were obtained before (T1) and after (T2) a treatment period or follow-up. McNemar test, Fisher's exact test and intra- and inter-observer concordance (K) were performed (p ≤ .05). RESULTS: There were no statistically significant differences in the baseline cephalometric variables at T1 between the groups. There were statistically significant differences between the groups (p < .001) in relation to the disc shape in T1, since G1 (8 TMJs -11.76%) presented higher occurrences of altered forms in comparison with G2 (no changes). No significant differences were observed in disc position CM and OM (G1 - p > .999; G2 - p = .063; G3 - p = .500) and shape (G1 - p > 0.999; G2 - p = .250; G3 - not calculable), between T1 × T2, in any of the groups studied. CONCLUSION: The two treatment protocols did not have adverse effects on the position and shape of the TMJ disc, in a short-term evaluation.

Associations between skeletal discrepancies, breathing pattern, and upper airway obstruction in Class III malocclusions.

OBJECTIVE: To verify the associations between sagittal and vertical skeletal discrepancies, changes in upper airways, and breathing pattern in children and adolescents with Angle Class III and Class III subdivision malocclusions. METHODS: Eighty-five children and adolescents with a mean age of 9.5 ± 1.74 years were selected. Cephalometry assessed the sagittal relationship (AO-BO measurement), facial types (Ricketts VERT index), nasopharynx, and oropharynx. An otorhinolaryngologist analyzed the breathing pattern and upper airway obstruction during anamnesis, physical examination, anterior rhinoscopy, and nasofibroscopy. Medical records were also reviewed. For statistical analysis, ordinary one-way ANOVA, Kruskal-Wallis (Tukey's post-hoc), unpaired t-test, Pearson's correlation, chi-square, and Fisher's exact tests (p < 0.05) were used. RESULTS: The nasopharyngeal cephalometric dimension and pharyngeal tonsil hypertrophy were associated, whereas the oropharyngeal cephalometric dimension and palatine tonsils hypertrophy were not. Sagittal discrepancies were associated with septum deviation, while facial type was associated with inferior turbinate and palatine tonsils hypertrophy. However, facial type was not associated with breathing pattern, septum deviation, and pharyngeal tonsils hypertrophy. CONCLUSIONS: Sagittal discrepancies and type of malocclusion were not associated with breathing pattern and changes in upper airways, except for the severity of septum deviation and Class III malocclusions, which were associated with large sagittal discrepancies. Although the facial types analyzed presented signs of airway obstruction, the highest prevalence of inferior turbinate and palatine tonsils hypertrophy were found in patients with dolichofacial type.

Temporomandibular joint articular disc position and shape in skeletal Class III.

OBJECTIVE: To compare the position and shape of the temporomandibular joint (TMJ) articular disc among the sagittal and vertical skeletal patterns in Angle Class III, Class III subdivision malocclusion and normal occlusion. The null hypothesis was that there was no difference in disc position and shape in different (1) malocclusions and (2) skeletal patterns. METHODS: This cross-sectional observational study evaluated 105 patients divided into 3 groups: Class III (33, 9.39 ± 1.96 years), Class III subdivision (45, 9.51 ± 1.59 years) and a normal occlusion (27, 10.24 ± 0.87 years) was included as healthy control. Severity of the maxilla-mandibular anteroposterior discrepancy and vertical facial pattern were determined using 2D cephalometry, and the position and shape of the articular discs were evaluated in magnetic resonance images. Statistical parametric and non-parametric tests and Kappa analysis for intra-observer and inter-observer assessment were used (p ≤ .05). RESULTS: Significant between-group differences were found in articular disc position. In the normal occlusion group, all the articular discs were well positioned. In Class III and Class III subdivision, the discs were displaced in 30.3% and 12.2% of the TMJs, respectively. Sagittal and vertical skeletal patterns did not affect the findings significantly. The Class III subdivision malocclusion group is probably different from the other groups, showing 97.7% of biconcave discs in both TMJs. CONCLUSION: The longitudinal follow-up of this sample becomes relevant as the two groups with malocclusion in the pre-peak phase of pubertal growth showed differences in the prevalence of displacement and form of the articular disc, with no association with their vertical facial characteristics.

Evaluation of the stability of treatment with Herbst appliance associated with Hyrax expander and fixed orthodontics through counterpart analysis: A longitudinal follow-up study.

OBJECTIVE: The aim of this study was to evaluate the stability of treatment with a Herbst appliance associated with Hyrax expander (Stage I), followed by fixed appliances (Stage II) and follow-up for an average of 4 years after Stage II, on dentoskeletal facial structures. METHODS: This study involved 50 adolescents with Angle Class II division 1 malocclusion associated with mandibular retrognathism: Treated Group (TG-25) and Control Group (CG-25). Lateral cephalometric radiographs were taken: T1, immediately before Stage I (TG) or at the beginning of the follow-up period (CG); T2, at the end of Stage I (TG) or the follow-up period (CG); T3, at the end of Stage II (TG); and T4, on average, 4 years after Stage II (TG). Enlow's counterpart analysis and some cephalometric measurements were evaluated. Parametric and non-parametric tests were used (P ≤ 0.05). RESULTS: The ramus alignment variables (P < 0.001), SNB (0.040), ANB (<0.001), 1.PP (P = 0.015), 1.MP (P < 0.001), ms/RLp (P < 0.001), mi/RLp (P < 0.001) and S-LS (P = 0.005) showed differences between TG and CG from T1 to T2. Longitudinally, there were differences in ramus alignment, P = 0.003, T1 > T2 < T3 = T4; SNB, P = 0.016, T1 < T2 = T3 = T4; ANB, P < 0.001, T1 > T2 = T3 = T4; 1.MP, P < 0.001, T1 < T2 = T3 = T4; ms/RLp, P = 0.002, T1 = T2 < T3 = T4; mi/RLp, P < 0.001, T1 < T2 = T3 = T4; S-LS, P < 0.001, T1 > T2 = T3 = T4 and S-LI, P = 0.003, T1 = T2 = T3 > T4. CONCLUSION: The nasomaxillary complex (MCF/PM alignment) tended to a retrusive effect to compensate the degree of mandibular retrusion. The protrusive effect of the lower facial third was evident after the Herbst stage and did not remain stable in the follow-up. The dentoalveolar compensation and improvement in facial profile remained stable.

Applicability of Cone Beam Computed Tomography to the Assessment of the Vocal Tract before and after Vocal Exercises in Normal Subjects.

BACKGROUND/AIMS: Cone beam computed tomography (CBCT), which represents an alternative to traditional computed tomography and magnetic resonance imaging, may be a useful instrument to study vocal tract physiology related to vocal exercises. This study aims to evaluate the applicability of CBCT to the assessment of variations in the vocal tract of healthy individuals before and after vocal exercises. METHODS: Voice recordings and CBCT images before and after vocal exercises performed by 3 speech-language pathologists without vocal complaints were collected and compared. Each participant performed 1 type of exercise, i.e., Finnish resonance tube technique, prolonged consonant "b" technique, or chewing technique. The analysis consisted of an acoustic analysis and tomographic imaging. RESULTS: Modifications of the vocal tract settings following vocal exercises were properly detected by CBCT, and changes in the acoustic parameters were, for the most part, compatible with the variations detected in image measurements. CONCLUSION: CBCT was shown to be capable of properly assessing the changes in vocal tract settings promoted by vocal exercises.

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.

Magnetic resonance imaging in the evaluation of clinical treatment of otospongiosis: a pilot study.

OBJECTIVES: To evaluate the applicability of magnetic resonance imaging (MRI) as a method for monitoring the activity of otospongiotic lesions before and after clinical treatment. STUDY DESIGN: Prospective, randomized, controlled, double-blind study. SETTING: One single tertiary care institution in a large, cosmopolitan city. METHODS: Twenty-six patients (n = 42 ears) with clinical, audiometric, and tomographic diagnosis of otosclerosis were enrolled. If computed tomography (CT) demonstrated active lesions, these patients underwent MRI to detect otospongiotic foci, seen as areas of gadolinium enhancement. Patients were divided into 3 groups and received treatment with placebo, sodium alendronate, or sodium fluoride for 6 months. After this period, clinical and audiometric evaluations and a second MRI were performed. Each MRI was evaluated by both a neuroradiologist and an otolaryngologist in a subjective (visual) and objective (using specific eFilm Workstation software) manner. RESULTS: Otospongiosis was most predominantly identified in the region anterior to the oval window, and this site was reliable for comparing pre- and posttreatment scans. The patients in the alendronate and sodium fluoride groups had MRI findings that suggested a decrease in activity of otospongiotic lesions, more relevant in the alendronate group. These findings were statistically significant for both subjective and objective MRI evaluations. CONCLUSIONS: MRI shows higher sensitivity than clinical or audiometric assessment for detecting reduction in activity of otospongiosis. The objective MRI evaluation based on software analysis was the most accurate method of monitoring clinical treatment response in otospongiosis.

Laryngeal schwannoma: a case report with emphasis on sonographic findings / Schwannoma laríngeo: relato de caso com ênfase nos achados ultrassonográficos

Schwannomas are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral, cranial and autonomic nerves. Twenty-five to forty-five percent of all schwannomas occur in the head and neck region, but location of such tumors in the larynx is rarely observed. The present report is aimed at describing a clinical case of laryngeal schwannoma, with emphasis on sonographic findings.

Schwannomas são tumores benignos derivados da bainha das células de Schwann de nervos motores, sensitivos e cranianos, sem conter elementos nervosos. Cerca de 25% a 45% dos casos ocorrem na região de cabeça e pescoço, mas a localização laríngea é rara. O objetivo do nosso estudo é descrever um caso clínico de schwannoma laríngeo, enfatizando-se os achados ultrassonográficos.

Laryngeal schwannoma: a case report with emphasis on sonographic findings.

Schwannomas are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral, cranial and autonomic nerves. Twenty-five to forty-five percent of all schwannomas occur in the head and neck region, but location of such tumors in the larynx is rarely observed. The present report is aimed at describing a clinical case of laryngeal schwannoma, with emphasis on sonographic findings.

Schwannomas são tumores benignos derivados da bainha das células de Schwann de nervos motores, sensitivos e cranianos, sem conter elementos nervosos. Cerca de 25% a 45% dos casos ocorrem na região de cabeça e pescoço, mas a localização laríngea é rara. O objetivo do nosso estudo é descrever um caso clínico de schwannoma laríngeo, enfatizando-se os achados ultrassonográficos.

Ortodontia osteogênica periodontal acelerada associada aos sistemas autoligáveis – relato de caso / Periodontally accelerated osteogenic orthodontics with self-ligating brackets – case report

A descrição de um caso clínico no qual foram usados dois procedimentos inovativos em um paciente com necessidades ortodônticas especiais, visa colocar em discussão a sua aplicação na clínica diária. Após a extração de um incisivo inferior, ortodontia osteogênica periodontal acelerada e o uso de bráquetes com prescrição diferenciada foram aplicados. O tratamento foi concluído em sete meses. Assim, concluiu-se que os procedimentos parecem ter influído favoravelmente no resultado, mas testes clínicos randomizados deverão ser feitos para a validação da sua eficiência.

A case report in which two innovative approaches have been performed in an orthodontic patient with special orthodontic needs, aiming to discuss the application of these procedures in daily practice. After extracting a mandibular incisor, periodontal accelerated osteogenic orthodontics in conjunction of a new prescription of self-ligating brackets has been performed. The treatment was concluded in seven months. Therefore it was concluded that the approach could influence positively the results, however randomized clinical trials are required to validate the its efficiency.

Morphological changes of condyles and Helkimo clinical dysfunction index in patients treated with Herbst--orthodontic appliance.

This study evaluated the morphological changes in the temporomandibular joint (TMJ) condyles and calculated the Helkimo clinical dysfunction index (CDI) in adolescents with Class II Division 1 malocclusion and mandibular retrognathism treated with the Herbst appliance (phase I) and fixed orthodontic appliances (phase II). Thirty-two consecutive adolescents underwent phase I, and 23 completed phase II. The TMJs were evaluated qualitatively using magnetic resonance imaging (MRI) at the beginning of treatment (T1), during phase I (T2), at the end of phase I (T3) and at the end of phase II (T4). The CDI was calculated at T1, T3 and T4. From T1 to T3 (p=0.326), there were no changes in condyle morphology in 86.0% of the TMJs. From T3 to T4 (p<0.05) and T1 to T4 (p<0.05), changes occurred in 39.1% and 43.4% of the condyles. No significant changes in CDI occurred from T1 to T3, T3 to T4 and T1 to T4 (p=1.000; 86.6%, 76.2% and 76.2% concordance). After phase I, there were practically no changes in condyle morphology. At the end of phase II, a mild flattening was observed in some condyles. It may be concluded that no significant changes occurred in CDI after both treatment phases.

Morphological Changes of Condyles and Helkimo Clinical Dysfunction Index in Patients Treated with Herbst - Orthodontic Appliance

This study evaluated the morphological changes in the temporomandibular joint (TMJ) condyles and calculated the Helkimo clinical dysfunction index (CDI) in adolescents with Class II Division 1 malocclusion and mandibular retrognathism treated with the Herbst appliance (phase I) and fixed orthodontic appliances (phase II). Thirty-two consecutive adolescents underwent phase I, and 23 completed phase II. The TMJs were evaluated qualitatively using magnetic resonance imaging (MRI) at the beginning of treatment (T1), during phase I (T2), at the end of phase I (T3) and at the end of phase II (T4). The CDI was calculated at T1, T3 and T4. From T1 to T3 (p=0.326), there were no changes in condyle morphology in 86.0% of the TMJs. From T3 to T4 (p<0.05) and T1 to T4 (p<0.05), changes occurred in 39.1% and 43.4% of the condyles. No significant changes in CDI occurred from T1 to T3, T3 to T4 and T1 to T4 (p=1.000; 86.6%, 76.2% and 76.2% concordance). After phase I, there were practically no changes in condyle morphology. At the end of phase II, a mild flattening was observed in some condyles. It may be concluded that no significant changes occurred in CDI after both treatment phases.

Este estudo avaliou as mudanças morfológicas nas cabeças da mandíbula das articulações temporo mandibulares (ATMs) e calculou o índex de disfunção clínico de Helkimo (IDC) em adolescentes com má oclusão de Classe II Divisão1 e retrognatismo mandibular, tratados com aparelho de Herbst (fase I) e aparelho ortodôntico fixo (fase II). Trinta e dois adolescentes consecutivos passaram pela fase I e 23 completaram a fase II. As ATMs foram avaliadas qualitativamente por meio de imagem da resonância magnética (IRM) ao início do tratamento (T1), durante a fase I (T2), no final da fase I (T3) e no final da fase II (T4). O IDC foi calculado em T1, T3 e T4. De T1 a T3 (p=0,326) não ocorreram mudanças na morfologia da cabeça da mandíbula em 86,0% das ATMs. De T3 a T4 (p<0,05) e T1 a T4 (p<0,05) ocorreram mudanças em 39,1% e 43,4% das cabeças das mandíbulas. Não ocorreram mudanças significantes no IDC de T1 a T3, T3 a T4 e T1 a T4 (p=1,000; 86,6%, 76,2% e 76,2% concordância). Após a fase I, não houve praticamente mudanças na morfologia da cabeça da mandíbula. Ao final da fase II, um leve aplainamento foi observado em algumas cabeças das mandíbulas. Pode ser concluído que não ocorreram mudanças significantes no IDC após ambas as fases de tratamento.

The effectiveness of audiometric evaluation in drug treatment for otospongiosis.

UNLABELLED: Otospongiosis is a primary osteodystrophy of the otic capsule that affects genetically predisposed individuals and leads to a progressive hearing loss. AIM: To evaluate the applicability of audiometric evaluation during drug treatment for otospongiosis. MATERIALS AND METHODS: A prospective, randomized, controlled, double-blind study involving 26 patients with clinical, audiometric and CT scan image of otosclerosis. Patients eligible for the study were divided into three groups (A, B and C) and received treatment with alendronate sodium (B), sodium fluoride (C) and placebo (A) for 6 months. After this period they were submitted to new tests. RESULTS: There were not statistically significant differences between air and bone conduction (gap). We also found no differences in the speech recognition threshold (SRT) and speech discrimination (IRF) between before and after treatment. CONCLUSION: After six months of drug treatment the audiometric evaluation kept the same hearing thresholds, suggesting stabilization of the otospongiotic lesions.

Eficácia da avaliação audiométrica no tratamento medicamentoso da otospongiose / The effectiveness of audiometric evaluation in drug treatment for otospongiosis

A otospongiose é uma osteodistrofia focal primária da cápsula ótica que acomete indivíduos geneticamente predispostos e promove perda auditiva progressiva. OBJETIVO: Verificar a aplicabilidade da avaliação audiométrica no tratamento medicamentoso da otospongiose. MATERIAL E MÉTODO: Estudo prospectivo, randomizado, controlado, duplo-cego, envolvendo 26 pacientes com diagnóstico clínico, audiométrico e tomográfico de otospongiose. Os pacientes elegíveis para o estudo foram alocados em três grupos (A, B e C) e receberam o tratamento com alendronato de sódio (B), fluoreto de sódio (C) e placebo (A) por 6 meses. Após este período, os mesmos realizaram nova avaliação audiométrica. RESULTADOS: Na análise das diferenças entre as vias aérea e óssea (gap), não houve diferença estatisticamente significante. Também não foram encontradas diferenças em relação ao limiar de reconhecimento da fala (SRT) e a discriminação vocal (IRF) entre os períodos pré e pós-tratamento. CONCLUSÃO: Após seis meses de tratamento medicamentoso, a avaliação audiométrica evidenciou manutenção dos limiares auditivos, sugerindo estabilização da atividade da lesão otospongiótica.

Otospongiosis is a primary osteodystrophy of the otic capsule that affects genetically predisposed individuals and leads to a progressive hearing loss. AIM: To evaluate the applicability of audiometric evaluation during drug treatment for otospongiosis. MATERIALS AND METHODS: A prospective, randomized, controlled, double-blind study involving 26 patients with clinical, audiometric and CT scan image of otosclerosis. Patients eligible for the study were divided into three groups (A, B and C) and received treatment with alendronate sodium (B), sodium fluoride (C) and placebo (A) for 6 months. After this period they were submitted to new tests. RESULTS: There were not statistically significant differences between air and bone conduction (gap). We also found no differences in the speech recognition threshold (SRT) and speech discrimination (IRF) between before and after treatment. CONCLUSION: After six months of drug treatment the audiometric evaluation kept the same hearing thresholds, suggesting stabilization of the otospongiotic lesions.

Estudo comparativo cefalométrico dos padrões dentofaciais de indivíduos portadores de oclusão normal e de más oclusões de Angle / Comparative cephalometric study of dentofacial patterns of individuals with normal occlusion and Angle malocclusions

OBJETIVO: avaliar os padrões dentofaciais de pacientes portadores de oclusão normal e más oclusões de Angle quanto a possíveis diferenças entre as grandezas estudadas, em relação ao sexo, dentro de cada grupo e entre os grupos. MÉTODOS: a amostra constou de 200 telerradiografias cefalométricas laterais obtidas de jovens brasileiros, de ambos os sexos, na faixa etária de 11 anos e 2 meses a 19 anos e 10 meses, apresentando dentição permanente. O material foi dividido, quanto ao tipo de oclusão, em cinco grupos: um de pacientes portadores de oclusão normal, e quatro de pacientes portadores de más oclusões de Angle, sendo cada grupo dividido igualmente quanto ao sexo. Foram avaliadas grandezas cefalométricas angulares e lineares. RESULTADOS: na grande maioria das grandezas, os sexos masculino e feminino não diferiram; entre os grupos, a posição da maxila não mostrou diferença significativa, o retrognatismo mandibular foi marcante nos grupos de Classe II divisões 1ª e 2ª e foram observados alguns desequilíbrios verticais com diferenças significativas; o padrão foi hipodivergente para os grupos de oclusão normal e Classe II, divisão 2ª, e neutro para os grupos de Classe I; Classe II, divisão 1ª; e Classe III; a compensação dentoalveolar foi evidente nos grupos de Classe III e de Classe II, divisão 2ª; o grupo de oclusão normal apresentou perfil mais convexo que os padrões americanos. CONCLUSÃO: foi possível configurar, de forma geral, algumas características da morfologia facial para alguns tipos de más oclusões. Entretanto, existe a necessidade de avaliar a face individualmente, pois algumas características permeiam entre os diferentes tipos de oclusão.

OBJECTIVE: To evaluate dentofacial patterns of patients with normal occlusion and Angle malocclusions, examining potential differences between specific cephalometric measures as they relate to gender, both intra- and intergroup.METHODS: The sample consisted of 200 lateral cephalometric radiographs obtained from young Brazilians of both genders, aged between 11 years and 2 months and 19 years and 10 months, with permanent dentition. The material was divided according to the type of occlusion into five groups: One group consisted of patients with normal occlusion and four groups of patients with Angle malocclusions, and each group was also divided by gender. Angular and linear cephalometric measures were evaluated.RESULTS: Genders did not differ in most measures. Position of the maxilla showed no significant differences between groups. Mandibular retrognathia was remarkable in groups with Class II, Divisions 1 and 2. Vertical imbalances were observed with some significant differences. The pattern was found to be hypodivergent for groups with normal occlusion and Class II, Division 2, and neutral for groups with Class I; Class II, Division 1 and Class III. Dentoalveolar compensation was evident in groups with Class III and Class II, Division 2. Finally, the normal occlusion group profile was more convex than the patterns found in the US population.CONCLUSIONS: In general, some features of facial morphology were associated with certain types of malocclusion. However, individual assessment of each face is still necessary as some of the features are shared across different types of occlusion.

MRI anatomical and morphological differences in the vocal tract between dysphonic and normal adult women.

OBJECTIVE: To analyze the vocal tract morphometry of women with vocal nodules (VN) compared with normal subjects by means of magnetic resonance imaging (MRI) at rest position. STUDY DESIGN: Prospective study. METHODS: The present research included 20 young adult women, aged 18-40 years: 10 dysphonic patients with VN and 10 normal subjects. All participants were tested using MRI; 12 measurements of the vocal tract were performed: nine in median sagittal section and three in axial section. RESULTS: The 12 measurements were smaller in the dysphonic group; statistical significance was obtained for three parameters: in the sagittal plane, the laryngeal vestibule area was significantly smaller in the dysphonic group, with P=0.012∗ (∗ = statistical significance); in the axial section, the distance between the right and left vocal processes of the arytenoids' cartilages and the distance between the anterior commissure of the glottis and the laryngeal posterior wall were also significantly lower in the dysphonic group, with P=0.036∗ and 0.010∗, respectively. Significant differences in the vocal tract morphometry of individuals with VN were observed compared with normal subjects, at rest position. CONCLUSIONS: Results obtained from this study suggest that patients with VN may present a constantly increased tension of the laryngeal muscles, even at rest; moreover, reduced anterior-posterior dimension of the larynx may be a morphological characteristic of patients with VN.

Changes in temporomandibular joint disc position and form following Herbst and fixed orthodontic treatment.

OBJECTIVE: To determine the changes in the position and form of the temporomandibular joint articular disc in adolescents with Class II division 1 malocclusion and mandibular retrognathism treated with the Herbst appliance (phase I) and fixed orthodontic appliance (phase II). MATERIALS AND METHODS: Thirty-two consecutive adolescents went through phase I of treatment and 23 completed phase II. The temporomandibular joints were evaluated qualitatively by means of magnetic resonance images at the beginning of treatment (T1), during phase I (T2), at the end of phase I (T3), and at the end of phase II (T4). RESULTS: Significant changes in disc position were not observed with the mouth closed between T1 x T3 (P = .317), T3 x T4 (P = .287), or T1 x T4 (P = .261). At T2, on average, the disc was positioned regressively. With the mouth open, no difference was observed between T1 x T3 (P = .223) or T1 x T4 (P = .082). We did observe a significant difference between T3 x T4 (P < .05). Significant changes in the disc form were found with the mouth closed between T1 x T2 (P < .001) and T2 x T3 (P < .001). CONCLUSIONS: At the end of the two-phase treatment, in general terms, the position and form of the initial articular discs were maintained; however, in some temporomandibular joints some seemingly adverse effects were observed at T4.

Avaliação longitudinal das ATMs com ressonância magnética em adolescente tratado com aparelho de Herbst e ortodontia fixa / TMJs longitudinal assessment by means of magnetic resonance of a adolescent trated with Herbst appliance and fixed Orthodontics

O objetivo do presente artigo clínico foi avaliar, por meio de imagens de ressonância magnética (IRMs), os efeitos nas articulações temporomandibulares (ATMs) provocados pelo tratamento, com aparelho de Herbst e aparelho fixo total, de uma má oclusão classe II, divisão 1, associada ao retrognatismo mandibular. As IRMs foram realizadas em cinco tempos: imediatamente antes da colocação do aparelho de Herbst (T1), dez semanas após a colocação do aparelho de Herbst (T2), após seis meses de tratamento com o aparelho de Herbst (T3), no final de 12 meses da terapia com Herbst (T4) e imediantamente após a remoção do aparelho ortodôntico fixo (T5). A avaliação qualitativa das IRMs mostrou, em T1, os côndilos e discos dentro dos padrões de normalidade. Em T2, devido ao avanço mandibular assimétrico ocasionado pelo aparelho de Herbst, os côndilos estavam fora da fossa mandibular, com maior evidência na ATM direita, e os discos articulares assumiram posição retrusiva. Em T3, os côndilos retornaram parcialmente para o interior da fossa mandibular, porém, ainda mantendo uma ligeira assimetria entre as ATMs direita e esquerda. Em T4 e T5, os côndilos e discos articulares ficaram dentro dos padrões fisiológicos. Em T2, as IRMss apresentaram, nas regiões posterossuperior dos côndilos e supradiscal, uma área com hipersinal, sugerindo acúmulo de líquido na região supradiscal e início de remodelação nos côndilos. Com base nos resultados obtidos, pôde-se concluir que, em uma avaliação a curto prazo, não ocorreram efeitos adversos nas ATMs após o tratamento com Herbst e aparelho ortodôntico fixo.

Effects of Herbst appliance treatment on temporomandibular joint disc position and morphology: a prospective magnetic resonance imaging study.

INTRODUCTION: The objective of this prospective study was to evaluate changes in the position and morphology of the disc in the temporomandibular joint (TMJ) with magnetic resonance imaging (MRI). METHODS: The subjects were 32 consecutive adolescent patients with Class II Division 1 malocclusion treated with the Herbst appliance. The MRIs were obtained immediately before treatment (T1), 8 to 10 weeks after appliance placement (T2), and 12 months later (T3). RESULTS: Qualitative evaluation of the MRIs showed that, in 42 (65.62%) of the 64 TMJs, the disc was positioned within normal limits at T1. Because of the advancements caused by the Herbst appliance, a tendency for disc retrusion was observed at T2, but at T3 the disc had returned to normal limits. In 22 TMJs (34.37%), the disc was displaced at T1, and no changes were observed at T3. In most subjects, comparison of the morphology of the disc at T1, T2, and, T3 showed no significant change. CONCLUSIONS: Herbst therapy does not cause adverse effects on the morphology and position of the articular disc in the short term.

Temporomandibular joint evaluation with magnetic resonance imaging in children with functional unilateral posterior crossbite, treated with rapid maxillary expansion.

INTRODUCTION: The purpose of this prospective study was to evaluate qualitatively articular disc position and configuration of the temporomandibular joint (TMJ) with magnetic resonance imaging (MRI) in children with functional unilateral posterior crossbite (FUPXB) treated with Haas-type orthopedic appliances. METHODS: The sample included 30 Brazilian children (60 TMJs) of both sexes (8 boys, 22 girls), aged 6.8 to 14.2 years (mean, 10.5 years; SD, 2.1 years). The MRIs were acquired in closed-mouth (CM), maximum-intercuspal (MI), and open-mouth (OM) positions in 3 stages of treatment: initial (T1), at the beginning of treatment; intermediate (T2), immediately after the removal of the expander, and final (T3), 9 months later, at the end of the observation period. RESULTS: No changes were found in articular disc positions of 96.6% of the TMJs in the CM and MI positions, and in 95% in the OM position at T1, T2, and T3. For the articular disc configuration, no changes were observed in 96.66% of the TMJs in the CM and MI positions, and in all TMJs in the OM position, at T1, T2, and T3. CONCLUSIONS: On average, this treatment method did not change articular disc positions and configurations.