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.

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.

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.

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.

Herbst appliance therapy and temporomandibular joint disc position: a prospective longitudinal magnetic resonance imaging study.

INTRODUCTION: The objective of this prospective study was to verify changes in the position of the temporomandibular joint (TMJ) disc by means of magnetic resonance images (MRIs) in adolescent patients treated with the Herbst appliance. METHODS: Twenty consecutive Class II Division 1 patients treated with Herbst appliances were selected for the study. MRIs were analyzed at 3 stages: immediately before Herbst treatment (T1), 8 to 10 weeks after appliance placement (T2), and at the end of the 12-month Herbst treatment, immediately after appliance removal (T3). RESULTS: Class I or overcorrected Class I dental-arch relationships were observed after Herbst therapy. The qualitative evaluation showed that each patient had the disc within normal limits at T1. At T2, a slight tendency toward disc retrusion because of mandibular advancement was observed, but, at T3, the disc returned to normal, similar to T1 values. By using a quantitative evaluation, parasagittal MRIs (central, medial, and lateral slices) of the TMJs showed that there was no change of disc position from T1 to T3, except in the central slice, which had a retrusive position of the articular disc at T3. CONCLUSIONS: During the 12-month period of Herbst appliance treatment, mild changes in the position of the disc occurred in patients whose articular discs were within normal limits at T1. These changes were within normal physiological limits when evaluated in the short term.

Computed tomography in the diagnosis of otosclerosis.

OBJECTIVES: To identify the main tomographic findings of otosclerosis and to evaluate the usefulness of high-resolution computed tomography as a diagnostic method for this osteodystrophy. STUDY DESIGN AND SETTING: A prospective and multicenter study consisting of computed tomography (CT) of the temporal bone was conducted on 54 patients with a clinical and surgical diagnosis of otosclerosis. Twenty-two patients were included in the control group. RESULTS: The CT scan was positive in 87% of the patients. The tomographic findings were mainly bilateral and fenestral foci were more prevalent. CONCLUSIONS: CT showed a high rate of positivity, mainly for fenestral lesions. Foci anterior to the oval window were the most prevalent in this population. SIGNIFICANCE: CT is useful as a diagnostic method and therapeutic indicator of otosclerosis. EBM RATING: B-3b.

Assessment of mandibular growth and response to orthopedic treatment with 3-dimensional magnetic resonance images.

INTRODUCTION: Three-dimensional (3D) craniofacial images are commonly used in clinical studies in orthodontics to study developmental and morphologic relationships. METHODS: We used 3D magnetic resonance imaging to study relationships among craniofacial components during the pubertal growth spurt and in response to Fränkel appliance therapy. The sample for this prospective study was 156 high-resolution magnetic resonance images with 1 mm isotropic voxel resolution of 78 subjects taken initially (T1) and 18 +/- 1 months (T2) after treatment or an observation period. The subjects were Brazilian children; 28 were treated and 25 were untreated for Class II malocclusion, and 25 were untreated with normal occlusions. A Procrustes geometric transformation of 3D skeletal landmarks was used to assess growth or treatment alterations from T1 to T2. The landmarks were located on the mandibular rami and the other craniofacial parts specifically related to the mandibular growth (the middle cranial fossae and the posterior part of the bilateral nasomaxilla). This allowed visualization of the entire volumetric dataset with an interactive 3D display. RESULTS: Statistically significant differences were found in the relative 3D skeletal growth directions from T1 to T2 for treated vs untreated Class II children (Bonferroni-adjusted P < .001) and for treated Class II vs normal-occlusion subjects ( P < .001). The major differences in the treated group were increased mandibular rami vertical dimensions and more forward rami relative to the posterior nasomaxilla and the middle cranial fossae. Principal component analysis made it possible to show individual variability and group differences in the principal dimensions of skeletal change. CONCLUSIONS: These methods are generalizable to other imaging techniques and 3D samples, and significantly enhance the potential of systematically controlled data collection and analysis of bony structures in 3 dimensions for quantitative assessment of patient parameters in craniofacial biology.

Avaliação por meio de ressonância magnética das mudanças da posição dos côndilos nas ATMs de adolescentes com retrognatismo mandibular tratados com aparelho de Herbst / Evaluation by means of magnetic resonance of the changes in the condyle position of TMJ's of adolescents with mandibular retrognatism and treated with the Herbst appliance

O objetivo deste estudo prospectivo foi avaliar a posição do côndilo das articulações temporomandibulares (ATMs), por meio da ressonância magnética (RM), em adolescentes portadores de maloclusão de classe II, divisão 1ª de Angle, associada a retrognatismo mandibular, tratados durante 12 meses com o aparelho ortopédico de Herbst. A amostra constou de 20 adolescentes brasileiros (40 ATMs), leucodermas, de ambos sexos (7 do sexo masculino e 13 do feminino), em fase de crescimento, com idade média de 12 anos e oito meses, desvio padrão de um ano e um mês e, ausência de deslocamento do disco articular. As imagens de RM foram adquiridas em três tempos do tratamento: T1 –antes do início, T2 – após oito semanas até 10 semanas da colocação do aparelho, e T3 –após 12 meses, no final do período de avaliação. Foi realizada uma avaliação qualitativa da posição do côndilo na fossa mandibular, com boca fechada (BF) e máxima intercuspição habitual (MIH). Na avaliação foi observado que 33(82,5%) côndilos de 40 ATMs estavam concêntricos (BF) e retroposicionados (MIH) em T1, ficaram anteriorizados (BF e MIH) em T2, retornando à posição original (BF e MIH) em T3. Em sete (17,5%) articulações o comportamento foi diferente, porém não caracterizando uma condição patológica. Com base nos resultados obtidos pode-se afirmar que este método de tratamento não alterou a posição do côndilo na fossa mandibular entre os tempos inicial e final do período de avaliação.

The purpose of this prospective study was to evaluate the condyle and the temporomandibular joint disk position (TMJ’s) by means of magnet resonance (MR), in adolescents with Class II, division 1 Angle malocclusion and mandibular retrognatism following Herbst treatment during twelve months. The sample was compoused by 20 white Brazilian adolescents (40 TMJ’s), from both sexes (seven male and 13 female individuals), average age of 12 years and eight months, standard deviation of one year and one month, and absence of articular disk displacement. The MR images were taken during three different stages of treatment: T1 – before the beginning of treatment, T2- between eight and 10 weeks after set-up, and T3- after 12 months, in the evaluation period. A qualitative evaluation of the condyle position in the mandibular fossa was carried out with closed mouth (CM) and in habitual maximum intercuspation (HMI). The results showed that 33 (82,5%) condyles of 40 TMJ’s presented concentric position (CM) and were retropositioned (HMI) at T1, displaced forward (CM and HMI) at T2 and returning to its original position (CM and HMI) at T3. In seven (17,5%) TMJ’s the behavior was different, but did not characterize a pathologic condition. Based an the results achieved, it can be conclude that this method of treatment has not changed the condyle position in the mandibular fossa between the initial and final stages of the evaluation period.

Tomografia computadorizada no diagnóstico da otosclerose retrofenestral / Computed tomography in the diagnosis of retrofenestral otosclerosis

OBJETIVO: Identificar os principais achados tomográficos da otosclerose retrofenestral. MÉTODO: Estudo prospectivo multicêntrico com tomografia computadorizada (TC) de ossos temporais em 54 pacientes com diagnóstico clínico e cirúrgico de otosclerose. Foi realizada uma análise tomográfica, em que foi avaliada a utilidade da TC no diagnóstico radiológico da otosclerose retrofenestral, sendo verificados os principais sítios de lesões dessa doença. Foram incluídos neste estudo 22 pacientes submetidos à TC de ossos temporais para investigação de outras afecções otológicas, que constituíram o grupo controle. RESULTADOS: Os achados tomográficos foram bilaterais na maioria dos casos e o foco retrofenestral mais prevalente foi o foco pericoclear. CONCLUSÕES: A TC monstrou-se útil na identificação dos focos retrofenestrais. A evidência tomográfica desses focos juntamente com o envolvimento endosteal da cóclea podem sugerir uma maior atividade da doença.

Tomografia computadorizada no diagnóstico da otosclerose fenestral / Computed tomography in the diagnosis of fenestral otosclerosis

OBJETIVO: Identificar os principais achados tomográficos da otosclerose fenestral e avaliar a utilidade da tomografia computadorizada de alta resolução (TCAR), como método diagnóstico dessa osteodistrofia. FORMA DE ESTUDO: Estudo prospectivo multicêntrico com tomografia computadorizada (TC) de ossos temporais. MATERIAL E MÉTODO: 54 pacientes com diagnóstico clínico e cirúrgico de otosclerose. Foi realizada uma análise tomográfica, em que foi avaliada a sensibilidade da TC no diagnóstico radiológico da otosclerose fenestral, sendo verificados os principais sítios de lesões dessa doença, como também a sua bilateralidade e simetria. Foram incluídos neste estudo 22 pacientes submetidos à TC de ossos temporais para investigação de outras afecções otológicas, que constituíram o grupo controle. RESULTADOS: A TC foi positiva em 87 por cento dos pacientes (77 por cento das orelhas). Os achados tomográficos foram bilaterais na maioria dos casos (78,7 por cento), e o foco fenestral mais prevalente foi o foco anterior à janela oval (FAJO). CONCLUSÕES: A TC apresentou um alto índice de positividade e o FAJO foi o foco mais prevalente nessa população, podendo ser considerado um achado tomográfico altamente sugestivo de otosclerose.

Variaçöes anatômicas e sinusopatias: estudo por tomografia computadorizada / Anatomical variations and sinusitis: a computed tomographic study

Introduçäo: A tomografia computadorizada tem sido cada vez mais utilizada para a identificaçäo e avaliaçäo das variaçöes anatômicas das cavidades nasais que podem levar às sinusites. Objetivo: Avaliar, por meio da tomografia computadorizada, a incidência de espessamento mucoso nos seios paranasais de pacientes com sintomas de sinusite e a correlaçäo entre sinusopatias e presença de célula de Haller, concha média bolhosa e desvio de septo nasal localizado no meato médio. Forma de Estudo: Clínico retrospectivo. Material e Método: Foram avaliadas retrospectivamente 150 tomografias computadorizadas de seios paranasais de pacientes com idade igual ou superior a 13 anos, realizadas no Departamento de Diagnóstico por Imagem da Universidade Federal de Säo Paulo - Escola Paulista de Medicina, no período de julho de 1999 a outubro de 2001. Foram excluídos os exames de pacientes com pós-operatório de cirurgias de seios paranasais e de base de crânio, além dos portadores de lesöes tumorais envolvendo estas regiöes. Resultados: 70 por cento dos pacientes apresentavam espessamento mucoso em pelo menos um dos seios paranasais. Observou-se a freqüência de 52,7 por cento de sinusopatia maxilar, 28,0 por cento de etmoidal, 13,0 por cento de esfenoidal e 8,3 por cento de frontal. Concha média bolhosa foi encontrada em 33,3 por cento das cavidades nasais, desvio de septo nasal localizado no meato médio em 23,3 por cento e célula de Haller em 9,3 por cento. Conclusöes: Os seios paranasais mais freqüentemente acometidos foram, em ordem decrescente: maxilar, etmoidal, esfenoidal e frontal. Näo foi observado correlaçäo entre sinusopatias e presença de célula de Haller, concha média bolhosa e desvio de septo nasal localizado no meato médio

Temporomandibular joint and masticatory muscle involvement in myotonic dystrophy: a study by magnetic resonance imaging.

OBJECTIVE: The purpose of this study was to evaluate the masticatory muscles and the temporomandibular joint (TMJ) by magnetic resonance imaging (MRI) in myotonic dystrophy (MD) patients. STUDY DESIGN: MRI of the masticatory muscles and TMJ was performed in 15 MD patients, 11 male and 4 female, aged 16 to 53 years (mean, 31 years). Many of them had dental malocclusion, especially Angle class III and anterior open bite, and 3 complained of recurrent TMJ dislocation. TMJ and masticatory muscle pain was not observed, and joint sounds were noted in only 1 patient. RESULTS: The analysis of MRI scans showed masticatory muscle involvement in 13 patients (86.6%). In 11, the involvement was moderate to intense. The main abnormalities observed were increased intramuscular tissue signal on T1 (fatty infiltration) and volumetric reduction of muscles. Regarding the TMJ, articular disk displacement was seen in only 1 patient, but abnormalities of disk shape were common. Mild bone abnormalities were frequently observed, including changes of shape and contour of bone surface, and sclerosis of bone marrow. In 4 patients the condyle moved anterior to the eminence with the mouth opened fully (condylar hyperexcursion). CONCLUSIONS: This study shows that masticatory muscles are frequently and intensively affected in MD patients. Bone changes are the most consistent abnormalities observed in the TMJ. It is possible that remodeling is caused by biomechanical changes in the jaw as a result of masticatory muscle involvement.

Fränkel appliance therapy and the temporomandibular disc: a prospective magnetic resonance imaging study.

This prospective clinical study assessed the effect of the Fränkel Functional Regulator-II (FR-II) treatment on the position and shape of the articular disc of the temporomandibular joint. The sample included magnetic resonance images of 112 temporomandibular joints taken initially (T1) and after 18 +/- 1 months (T2). The subjects were 56 white Brazilian children who were beginning their pubertal growth spurt. They had Class II Division 1 malocclusions and were selected from 800 children in neighborhood schools. They were randomly dichotomized into either the treated group (treated with the FR-II for 18 months) or the control group (not treated during the observation period). Our findings showed a low prevalence (3.57%) of disc displacement in the 112 temporomandibular joints. Mandibular propulsion with the FR-II had no unfavorable effect on the temporomandibular joints of the treated group; 100% of the patients kept an upper and interposed disc position (closed and open mouth, respectively) at T1 and T2. The control group had 7.1% partial anterior medial disc displacement, both at T1 and T2. Regarding disc morphology, the control group showed biconcave-shaped discs in 82.1% of the joints, statistically similar to the treated group (89.3%) at the beginning of the observation period. At T2, the articular disc morphology of the control group was unchanged, but that of the treated group was significantly more normal (P =.016), progressing from nonbiconcave at T1 (10.7%) to biconcave at T2 (100%). Our results showed that disc displacement is not a complication of functional appliance therapy; in fact, such treatment might help some children with incipient temporomandibular disorders.

Angiographic study of the arterial supply to the palatine mucoperiosteum.

Studies on the arterial supply of dog palatal mucoperiosteum have contributed to the success of surgical procedures on the hard palate of humans. We decided to undertake a more detailed anatomical study of the arterial supply of the canine palate. 15 male dogs of the species Canis familiaris were used. Contrast solution (barium sulfate) was injected into the palatal arterial system, followed by the removal of the dog's palate together with its mucoperiosteum. To obtain good radiographic imaging of the arterial network of the palatal mucoperiosteum, decalcification of the palatal bone was carried out. X-ray images were taken by a mammography X-ray machine set for 23 kV and 10 mA. The X-ray images showed that the mucoperiosteal arterial network is composed of a left and a right major artery which enters the mucoperiosteum through the left and right foramen, respectively. Anastomoses were observed between these two major arteries along their path from the posterior to the anterior regions of the mucoperiosteum. These anastomoses always occurred at the palatal transversal crests. The statistical study of the collected data showed that, for the posterior third of the palate, there is a proportionality between the number of the arterial derivations from the two major arteries and the mucoperiosteal area. The X-ray images also showed that the middle third of the palate is the least supplied with arterial derivations.