Impact of CPAP treatment for a short period in moderate-to-severe OSAS patients: a randomized double-blind clinical trial / Impacto do tratamento com CPAP por um curto período em pacientes com SAOS moderada a grave: um estudo clínico duplo-cego randomizado

Abstract Introduction: Obesity is the most frequent reversible agravating factor of obstructive sleep apnea syndrome, with physical activity very important for its control. Continuous positive air pressure during sleep is the ‟gold standard" treatment for obstructive sleep apnea syndrome. Objective: we aimed to investigate if the use of continuous positive air pressure for a short period (7 days), would improve sleep quality, daytime sleepiness, and the disposition for physical activity. Methods: Eighty obstructive sleep apnea syndrome patients were randomly assigned as follows: group I - continuous positive air pressure with a steady pressure of 4cm H2O; group II - ideal therapeutic pressure. After filling out the questionnaires related to the studied variables (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index), patients underwent a baseline pulmonary function test and continuous positive air pressure titration. After continuous positive air pressure therapy for 4> hours a night for 7 consecutive days, patients returned and filled out new (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index) forms. New spirometry was carried out. Results: 39 patients completed the study. The mean age was 52 ±11 years old and 28 patients (71.79%) were obese. Both groups were similar for all variables studied at baseline. After Continuous positive air pressure use, patients of group II presented more significant improvements (p< 0.05) for sleep quality and diurnal sleepiness. Time spent with physical activities did not change. Spirometric data were at normal range at baseline. Solely the variable FEF 25%-75% was significantly enhanced (p< 0.05) in group II. Conclusion: Continuous positive air pressure therapy for 1 week, with ideal pressure, improves daytime sleepiness and sleep quality, enhances pulmonary function, but does not change the mean time spent with physical activities.

Resumo Introdução: A obesidade é o fator causal reversível mais frequente da síndrome da apneia obstrutiva do sono, a atividade física é muito importante para o seu controle. A pressão positiva contínua na via aérea, CPAP, durante o sono é o tratamento padrão ouro para essa condição clínica. Objetivo: Avaliar se o uso do CPAP na síndrome da apneia obstrutiva do sono por um curto período (7 dias) melhoraria a qualidade do sono, a sonolência diurna e a disposição para a prática de atividades físicas, além da função pulmonar. Método: Oitenta pacientes com síndrome da apneia obstrutiva do sono foram distribuídos aleatoriamente da seguinte forma: grupo I - CPAP com pressão constante de 4cm H2O; grupo II - pressão terapêutica ideal. Após o preenchimento dos questionários relacionados ao estudo das variáveis (PSQI, ESS e IPAQ-L), os pacientes foram submetidos a teste de função pulmonar basal e titulação da CPAP. Após terapia com CPAP por ≥ 4 horas por noite durante sete dias consecutivos, os pacientes retornaram e preencheram novos questionários PSQI, ESS e IPAQ-L. Nova espirometria foi feita. Resultados: Apenas 39 pacientes completaram o estudo. A média de idade foi de 52 ± 11 anos e 28 pacientes (71,79%) eram obesos. Ambos os grupos eram semelhantes quanto às variáveis avaliadas no início do estudo. Após o uso de CPAP, os pacientes do grupo II apresentaram melhorias mais significantes (p < 0,05) para qualidade do sono e sonolência diurna. O tempo gasto com atividades físicas não mudou. Os dados espirométricos estavam na faixa normal no início do estudo. Apenas a variável FEF 25%-75% aumentou significantemente (p < 0,05) no grupo II. Conclusão: A terapia com CPAP por uma semana, com pressão ideal, melhora a sonolência diurna e a qualidade do sono, melhora a função pulmonar, mas não altera o tempo médio despendido com atividades físicas.

Impact of CPAP treatment for a short period in moderate-to-severe OSAS patients: a randomized double-blind clinical trial.

INTRODUCTION: Obesity is the most frequent reversible agravating factor of obstructive sleep apnea syndrome, with physical activity very important for its control. Continuous positive air pressure during sleep is the "gold standard" treatment for obstructive sleep apnea syndrome. OBJECTIVE: we aimed to investigate if the use of continuous positive air pressure for a short period (7 days), would improve sleep quality, daytime sleepiness, and the disposition for physical activity. METHODS: Eighty obstructive sleep apnea syndrome patients were randomly assigned as follows: group I - continuous positive air pressure with a steady pressure of 4 cm H2O; group II - ideal therapeutic pressure. After filling out the questionnaires related to the studied variables (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index), patients underwent a baseline pulmonary function test and continuous positive air pressure titration. After continuous positive air pressure therapy for 4≥ hours a night for 7 consecutive days, patients returned and filled out new (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index) forms. New spirometry was carried out. RESULTS: 39 patients completed the study. The mean age was 52 ±â€¯11 years old and 28 patients (71.79%) were obese. Both groups were similar for all variables studied at baseline. After Continuous positive air pressure use, patients of group II presented more significant improvements (p <  0.05) for sleep quality and diurnal sleepiness. Time spent with physical activities did not change. Spirometric data were at normal range at baseline. Solely the variable FEF 25%-75% was significantly enhanced (p <  0.05) in group II. CONCLUSION: Continuous positive air pressure therapy for 1 week, with ideal pressure, improves daytime sleepiness and sleep quality, enhances pulmonary function, but does not change the mean time spent with physical activities.

Orthodontic-surgical treatment of a patient with Marfan Syndrome and Obstructive Sleep Apnea Syndrome: a case report with a 9-year follow-up / Tratamento ortodôntico-cirúrgico de um paciente com Síndrome de Marfan e Síndrome da Apnéia Obstrutiva do Sono: relato de caso com 9 anos de acompanhamento

ABSTRACT Marfan's (MFS) syndrome is characterized by a defect in the connective tissue, which affects multiple organic systems. Therefore, the management of these patients requires a multidisciplinary approach. This case reports the orthodontic-surgical treatment of a patient who presented both Marfan's and obstructive sleep apnea syndrome. Patient had malocclusion, TMJ clicking, vertical maxillary excess, mandibular retrognathia, severe esthetic compromise, signs and symptoms of obstructive sleep apnea syndrome, as well as alterationsin joints, cardiovascular and respiratory systems. He was treated with bimaxillary surgery aimed to enhance esthetics, occlusion and address the obstructive sleep apnea syndrome. The clinical results show that a desirable functional occlusion was achieved and both patient's facial esthetics and quality of life were significantly improved. After a 9-year follow-up period, these pleasing features were maintained. The diagnosis and management of Marfan's patients is challenging and require multidisciplinary follow-up.

RESUMO A síndrome de Marfan (SMF) é caracterizada por um defeito no tecido conjuntivo que afeta múltiplos sistemas orgânicos. Portanto, o manejo desses pacientes requer uma abordagem multidisciplinar. Este artigo relata o tratamento ortodôntico-cirúrgico de um paciente com síndrome de Marfan e síndrome da apneia obstrutiva do sono (SAOS). Ele manifestava má oclusão, estalidos na ATM, excessovertical de maxila, retrognatismo mandibular, comprometimento estético severo, sinais e sintomas de síndrome da apneia obstrutiva do sono, além de alterações nas articulações, nos sistemas cardiovascular e respiratório. O tratamento incluiu cirurgia bimaxilar com o objetivo de melhorar a estética, a oclusão e tratar sua apneia obstrutiva do sono. Os resultados clínicos mostram que uma oclusãofuncional desejável foi alcançada e tanto a estética facial quanto a qualidade de vida do paciente foram significativamente melhoradas. Após um período de 9 anos de acompanhamento, essas características agradáveis foram mantidas. O diagnóstico e tratamento de pacientes com síndrome de Marfan é desafiador e requer acompanhamento multidisciplinar.

Submental Intubation in Cases of Panfacial Fractures: A Retrospective Study.

Surgical treatment of panfacial fractures usually requires intraoperative temporary occlusion of the teeth and simultaneous access to the nasal pyramid. In such cases, the standard method of airway management is to perform a tracheostomy, but this may be associated with a significant number of perioperative and late complications. This study aimed to determine if submental endotracheal intubation (SEI) is a viable alternative to tracheostomy, especially when short-term postoperative control of the airway is foreseen. This was an observational retrospective study, carried out between 2012 and 2014, which involved 32 consecutive patients who sustained panfacial fractures and were surgically treated during a 3-year period in a level I trauma center hospital. Only those who required SEI were included in the sample. Four cases were excluded because of incomplete registries, follow-up period less than 4 months after hospital discharge, or other unrelated complications. The medical charts of all patients involved in the sample were carefully reviewed in order to qualify and quantify perioperative and postoperative complications related to anesthetic management. We hypothesized that SEI would not interfere with the surgical procedures and would present less morbidity and reduced complication rates. Twenty-eight patients, 24 male and 4 female, met all the inclusion criteria. The mean age was 29.5 ± 9.05 years (range, 18-56 years). The mean duration time of surgery was 8.07 ± 4.0 hours (range, 4-16 hours). There were no perioperative complications. Postoperatively, only 1 patient (3.57%) experienced a cutaneous infection at the submental region, which was easily treated. Additionally, only 1 case (3.57%) of hypertrophic scar was reported. SEI appears to be a safe, simple, and effective technique of immediate perioperative airway management in selected cases of panfacial fractures.

Enfisema subcutâneo abrangendo os espaços temporal, orbital, bucal, submandibular e cervical após cirurgia para extração de terceiro molar / Subcutaneous emphysema envolving temporal, orbital, buccal, submandibular and cervical spaces after third molar surgery

Enfisema subcutâneo é uma complicação bem estabelecida de trauma ou infecção com pneumonia ou tuberculose, que tem incluído o aumento da pressão intrabucal no local de uma lesão da mucosa ou a provisão de ar comprimido em uma ferida. A incidência desse tipo de complicação tem aumentado consideravelmente, desde a introdução de peças de mão em alta rotação, usadas em cirurgias de terceiro molar. Este artigo tem como objetivo apresentar um relato de caso de um paciente do gênero masculino que foi submetido à cirurgia para remover o terceiro molar superior direito, com a ajuda de peça de mão em alta rotação, desenvolvendo um enfisema subcutâneo dos espaços fasciais no pós-operatório imediato. As imagens da tomografia computadorizada revelaram a presença de enfisema com dissecção do espaço periorbitário com envolvimento das pálpebras superior e inferior, espaços temporal e bucal, estendendo-se para a região submandibular, sublingual e cervical. A partir da descrição desse caso, os autores propõem uma forma de tratamento, evidenciando os meios de diagnóstico e prevenção dessa complicação... (AU)

Subcutaneous emphysema is a well-established complication of trauma or infection pneumonia and tuberculosis, which have included increasing the intraoral pressure at a site of the mucosal lesion or compressed air supply on a wound. The incidence of this complication has increased considerably since the introduction of handpieces used in high rotation in third molar surgery. This article aims to present a case report of a male patient who underwent surgery to remove the superior right third molar, with the help of handpiece at high speed, developing a subcutaneous emphysema fascial spaces in post-operative period. The images of computed tomography revealed the presence of emphysema with dissection of the periorbital space involving the upper and lower eyelids, temporal, buccal space, extending to the submandibular, sublingual and neck. From the description of this case, the authors propose a form of treatment, showing the means of diagnosis and prevention of this complication... (AU)

Gardner Syndrome With Unusual Maxillofacial Manifestation.

Gardner syndrome is a rare autosomal-dominant condition characterized by the presence of intestinal polyposis, multiple osteomas, and tumors of the hard and soft tissues. This paper describes a patient of Gardner syndrome with unusual maxillofacial manifestation with presence of fibromyxomatous injury in jaw, coronoid hyperplasia, and multiple osteomas diffusely distributed in the craniomaxillofacial skeleton. Imaging examinations have identified craniofacial manifestations and the patient was referred to the gastroenterologist who confirmed the diagnosis of Gardner syndrome. The early diagnosis of this syndrome is important since intestinal polyps have high potential for malignant transformation. It is therefore essential that dentists are familiar with the maxillofacial features of this condition, since they precede the intestinal polyposis and encourage early diagnosis. In addition to classic maxillofacial signs of this syndrome, one must consider that, although it is rare, other injuries may be present such as those described in this clinical patient.

Kinetics of gene expression of alkaline phosphatase during healing of alveolar bone in rats.

Immunohistochemical studies and molecular biology have enabled us to identify numerous proteins that are involved in the metabolism of bone, and their encoding genes. Among these is alkaline phosphatase (ALP), an enzyme that is responsible for the initiation of mineralisation of the extracellular matrix during alveolar bone repair. To evaluate the gene expression of ALP during this process, we studied nine healthy adult male rats, which had their maxillary central incisors extracted from the right side and were randomly divided into three groups. During three experimental periods, 7 days, 14 days, and 28 days, the alveoli were curetted, the rats killed, and samples analysed by real-time reverse transcription polymerase chain reaction (qRT-PCR). The RNAm that encodes the gene for the synthesis of ALP was expressed during the three periods analysed, but its concentration was significantly increased at 14 and 28 days compared with at 7 days. There was no significant difference between 14 and 28 days (p=0.0005). We conclude that genes related to ALP are expressed throughout the healing process and more intensively during the later periods (14 and 28 days), which coincides with the increased formation of mineralised bone.

Antibiotic prophylaxis for third molar extraction in healthy patients: Current scientific evidence.

Third molar extraction is one of the most frequently performed procedures in the dental clinic, and it is associated with innumerable trans- and postoperative complications, such as pain, trismus, edema, localized alveolar osteitis, and surgical site infection. Some authors advocate the use of local or systemic antibiotics to reduce the incidence of these postoperative complications. However, several studies have revealed an insignificant gain after using antibiotics. Despite the risks of allergic reactions, toxicity, and the development of resistant microorganisms, about 50% of dentists routinely prescribe the use of prophylactic antibiotics for this purpose. The goal of this paper is to evaluate the scientific evidence that justifies antibiotic prescription to healthy patients undergoing third molar extraction.

Estudo histomorfométrico do processo de reparo de dentes reimplantados em ratos pinealectomizados / Histomorphometric study of the repair process of reimplanted teeth in pinealectomized rats

Por promover sérios danos ao ligamento periodontal e cementoblastos, a avulsão por trauma pode levar à perda do elemento dentário em consequência de reabsorção radicular. Vários fatores locais foram estudados buscando a elaboração de um protocolo de tratamento. No entanto, poucos trabalhos contemplaram a influência de alterações sistêmicas no processo de reparo. Pessoas com hábitos noturnos podem apresentar deficiência de melatonina, um hormônio produzido principalmente pela glândula pineal, que interfere no metabolismo do tecido conjuntivo fibroso e do tecido ósseo. Logo, o objetivo desse estudo foi analisar o processo de reparo de dentes reimplantados em ratos pinealectomizados. Para isso, foram utilizados 30 ratos divididos em 3 grupos de 10 animais cada. No grupo I (CON) os animais foram submetidos à extração e reimplante imediato do incisivo central superior direito. No grupo II, os animais foram submetidos à pinealectomia (PNL) e, após 30 dias, extração e reimplante dentário imediato. No grupo III (SHAM), os animais foram submetidos à exposição da glândula pineal, porém sem a sua remoção, e após 30 dias, extração e reimplante dentário imediato. Sessenta dias após o reimplante dentário, os animais sofreram eutanásia e as peças contendo os dentes foram processadas para obtenção de cortes histológicos que foram corados por hematoxilina e eosina para análise histomorfométrica. Foi avaliada e quantificada a ocorrência de reabsorção inflamatória, reabsorção por substituição e áreas de anquilose. Os dados foram convertidos em porcentagem para análise estatística. Os resultados evidenciaram maiores índices de reabsorção radicular por substituição no grupo II em comparação aos grupos I e III (Kruskal-Wallis e Teste de Dunn, p<0,05). Conclui-se que a ausência de melatonina pode induzir um comprometimento do processo de reparo de dentes reimplantados em ratos pinealectomizados

For causing serious damage to the cementoblasts and periodontal ligament, dental avulsion by trauma can lead to tooth loss as a result of root resorption. Several local factors were studied seeking the development of a treatment protocol. However, few studies have beheld the influence of systemic alterations in the repair process. People with nocturnal habits may have melatonin deficiency, a hormone produced mainly by the pineal gland, which interferes with the metabolism of fibrous connective tissue and bone tissue. Therefore, the aim of this study was to analyze the repair process of reimplanted teeth in pinealectomized rats. For this purpose 30 Wistar rats were divided into 3 groups of 10 animals each. In group I (CON) the animals were subjected to the extraction and immediate replantation of the right maxillary central incisor. In group II the animals underwent to pinealectomy and after 30 days the tooth was extracted and immediately reimplanted. In group III (SHAM), the animals were subjected to exposure of the pineal gland, but without removing it, and then to the tooth reimplantation. Sixty days after tooth replantation, the animals were euthanized and specimens containing the teeth were processed to obtain histological sections that were stained with hematoxylin and eosin for histomorphometric analysis. It was assessed and quantified the occurrence of inflammatory resorption, replacement resorption and areas of ankylosis. Data were converted into percentage for statistical analysis. The results showed higher rates of replacement root resorption in group II compared to groups I and III (Kruskal-Wallis and Dunn’s Test, p<0.05). It was concluded that the absence of melatonin may induce an impairment of reimplanted tooth repair process in pinealectomized rats

Conservative approach: using decompression procedure for management of a large unicystic ameloblastoma of the mandible.

Ameloblastoma is a relatively uncommon benign odontogenic tumor, which is locally aggressive and has a high tendency to recur, despite its benign histopathologic features. This pathology can be classified into 4 groups: unicystic, solid or multicystic, peripheral, and malignant. There are 3 variants of unicystic ameloblastoma, as luminal, intraluminal, and mural. Therefore, in mural ameloblastoma, the fibrous wall of the cyst is infiltrated with tumor nodules, and for this reason it is considered the most aggressive variant of unicystic ameloblastomas. Various treatment techniques for ameloblastomas have been proposed, which include decompression, enucleation/curettage, sclerotizing solution, cryosurgery, marginal resection, and aggressive resection. Literature shows treatment of this lesion continues to be a subject of intense interest and some controversy. Thus, the authors aimed to describe a case of a mural unicystic ameloblastoma of follicular subtype in a 19-year-old subject who was successfully treated using conservative approaches, as decompression. The patient has been followed up for 3 years, and has remained clinically and radiographically disease-free.

Procedures adopted by orthodontists for space closure and anchorage control.

OBJECTIVE: The aim of this study was to identify the procedures adopted by Brazilian orthodontists in the following situations: extraction space closure, anchorage control in case of necessary anchorage for group A and frequency of skeletal anchorage use, especially in the upper jaw. METHODS: A questionnaire was sent to the e-mail address of all dentists registered in the Brazilian Federal Council of Dentistry. RESULTS: The results showed that most Brazilian orthodontists usually perform extraction space closure by means of sliding mechanics. The use of palatal bar, inclusion of second molars in the archwire and space closure performed in two phases are the most used techniques for anchorage control in the upper jaw. The skeletal anchorage is referenced by 36.5% of specialists as a routine practice for the upper arch anchorage. CONCLUSIONS: There is a wide variety of procedures adopted by Brazilian orthodontists for orthodontic space closure and anchorage control.

Procedures adopted by orthodontists for space closure and anchorage control

OBJECTIVE: The aim of this study was to identify the procedures adopted by Brazilian orthodontists in the following situations: extraction space closure, anchorage control in case of necessary anchorage for group A and frequency of skeletal anchorage use, especially in the upper jaw. METHOD: A questionnaire was sent to the e-mail address of all dentists registered in the Brazilian Federal Council of Dentistry. RESULTS: The results showed that most Brazilian orthodontists usually perform extraction space closure by means of sliding mechanics. The use of palatal bar, inclusion of second molars in the archwire and space closure performed in two phases are the most used techniques for anchorage control in the upper jaw. The skeletal anchorage is referenced by 36.5% of specialists as a routine practice for the upper jaw anchorage. CONCLUSIONS: There is a wide variety of procedures adopted by Brazilian orthodontists for orthodontic space closure and anchorage control.

OBJETIVO: esse trabalho tem o objetivo de identificar as condutas adotadas pelos ortodontistas brasileiros para o fechamento ortodôntico de espaços de extrações, controle de ancoragem em caso de necessidade de ancoragem do grupo A, e frequência de uso de ancoragem esquelética nesses casos, especialmente na arcada superior. MÉTODOS: um questionário foi enviado para o endereço eletrônico de todos os ortodontistas inscritos no Conselho Federal de Odontologia. RESULTADOS: os resultados mostraram que a maioria dos ortodontistas brasileiros usualmente faz fechamento de espaço de extrações com mecânicas de deslizamento. O uso de barra palatina, incorporação de segundos molares no arco e fechamento de espaço em duas fases são as condutas mais utilizadas para controle de ancoragem na arcada superior. A ancoragem esquelética é referenciada por 36,5% dos especialistas como forma rotineira de ancoragem na arcada superior. CONCLUSÕES: existe uma grande variedade de condutas adotas por ortodontistas brasileiros tanto para o fechamento ortodôntico de espaço quanto para o controle de ancoragem em casos de maior necessidade de retração anterior.

Cisto dermóide em assoalho bucal: 2 casos clínicos / Dermoid cyst in floor of the mouth: 2 case reports

Cisto dermóide do assoalho bucal é uma lesão incomum que se apresenta como uma massa solitária, indolor, sem história de febre ou drenagem, geralmente na linha média, e comumente na camada superior ao nível do espaço milohióideo. Neste trabalho, os autores descrevem dois pacientes com a mesma apresentação clínica: uma grande massa no assoalho bucal que não regredia, resultando em disfagia e dispnéia. O tratamento realizado em ambos foi a remoção cirúrgica completa através de uma incisão na superfície ventral da língua... (AU)

Dermoid cyst of the floor of the mouth is an uncommon lesion that presents as a solitary mass, painless, with no history of fever or drainage, usually in the midline, and commonly in the upper level space mylohyoid. In this paper, the authors describe two patients with the same clinical presentation: a large mass in the floor of the mouth that does not regressed, resulting in dysphagia and dyspnea. The treatment was carried out in both complete surgical removal through an incision in the ventral surface of the tongue... (AU)