Nasomaxillary effects of miniscrew-assisted rapid palatal expansion and two surgically assisted rapid palatal expansion approaches.

This retrospective study was performed to evaluate nasomaxillary changes in 36 patients at an advanced stage of skeletal maturity who underwent miniscrew-assisted rapid palatal expansion (MARPE) or surgically assisted rapid palatal expansion (SARPE) with/without an alar base cinch. Cone beam computed tomography images taken before and after expansion were analysed. Changes in the width of the dental arch (D66S, D66I), maxillary base (MxMol), and nasal floor and nasal cavity in the molar and canine regions (NaFMol, NaFCan, NaCMol, NaCCan) were compared, as well as changes in the choanal aperture (CA) and nasal soft tissue (NW). The MARPE technique produced smaller dental changes (D66S; P=0.025) and greater nasomaxillary expansion (MxMol, P=0.010; NaCMol, P=0.016; NaCCan, P=0.017; NaFMol, P=0.001; CA, P=0.002) than both SARPE techniques. Changes in NW did not differ significantly between the groups (P=0.200). MARPE uniformly increased the anterior and posterior widths of the nasal cavity. SARPE expanded the nasal cavity in a 'V-shape' pattern. Changes in the nasal cavity and choanal aperture related to the amount of dental arch expansion were greater for MARPE than for SARPE. All three approaches increased the width of the nasal soft tissue, although the cinch in SARPE limited this increase.

Factores relacionados con una respuesta inmediata a los síntomas en pacientes con ictus o accidente isquémico transitorio / Factors related to immediate response to symptoms in patients with stroke or transient ischaemic attack

INTRODUCCIÓN: Pese a los recientes avances en el manejo agudo del ictus, se aplican terapias de reperfusión a menos de un 10% de los pacientes. Una de las causas es el retraso en la búsqueda de atención médica por el paciente y sus familiares, que analizaremos a continuación. MÉTODOS: Se realizó un estudio observacional, prospectivo, en pacientes consecutivos con ictus o accidente isquémico transitorio. Se recogieron parámetros sociodemográficos y clínicos, y datos sobre el retraso en la decisión, retraso prehospitalario y el tipo de contacto médico seleccionado. Se realizaron análisis descriptivo, bivariante y multivariante para determinar los factores relacionados con la búsqueda de atención médica en los primeros 15minutos. RESULTADOS: Se recogieron 382 pacientes. Un 24,9% decidió solicitar atención médica en los primeros 15 minutos. Lo favorecieron la severidad del evento (OR: 1,08; IC 95%: 1,04-1,13; p < 0,001), estar acompañado de un hijo (OR: 3,44; IC 95%: 1,88-6,27; p < 0,001) y el tratamiento con insulina (OR: 2,89; IC 95%: 1,35-6,20; p = 0,006). Los infartos lacunares (OR: 0,41; IC 95%: 0,17-0,97; p = 0,042), los infartos parciales de circulación anterior (OR: 0,43; IC 95%: 0,22-0,85; p = 0,015) y los cuadros monosintomáticos sin afasia o paresia de miembros (OR: 0,15; IC 95%: 0,033-0,724; p = 0,018) se relacionaron con retrasos mayores de 15 minutos. CONCLUSIONES: La severidad y estar acompañado de un hijo fueron los principales determinantes de una reacción inmediata. Futuras intervenciones deben promocionar una consulta inmediata independientemente de la severidad, así como incidir en un mayor abanico de síntomas

INTRODUCTION: Despite recent advances in the management of acute stroke, fewer than 10% of patients receive reperfusion therapy. One of the main reasons for such a low rate of administration is the delay on the part of patients and their families in seeking medical attention. This study aimed to analyse this delay. METHODS: A prospective observational study was conducted on consecutive stroke or transient ischaemic attack. Data on sociodemographic and clinical parameters, decision delay, pre-hospital delay, and first medical contact were collected. Descriptive, bivariate, and multivariate logistic regression analyses were performed to determine factors associated with seeking medical attention within the first 15minutes of stroke or TIA occurrence. RESULTS: A total of 382 patients were included, 24.9% of whom had a decision delay of 15 minutes or less. Stroke severity (OR 1.08; 95% CI, 1.04-1.13; P < .001), patient's son/daughter witnessing the event (OR 3.44; 95% CI, 1.88-6.27; P < .001), and insulin treatment (OR 2.89; 95% CI, 1.35-6.20; P = .006) were related to an immediate reaction. Lacunar infarcts (OR 0.41; 95% CI, 0.17-0.97; P=.042), partial anterior circulation infarcts (OR 0.43; 95% CI, 0.22-0.85; P = .015), and monosymptomatic events not involving limb paresis or aphasia (OR 0.15; 95% CI, 0.033-0.724; P = .018) favoured delays longer than 15 minutes. CONCLUSIONS: Severity of the event and presence of a son/daughter are the factors most frequently associated with an immediate response to stroke. Future interventions should emphasise the need for an immediate response irrespective of severity and include a wider spectrum of symptoms

Factors related to immediate response to symptoms in patients with stroke or transient ischaemic attack. / Factores relacionados con una respuesta inmediata a los síntomas en pacientes con ictus o accidente isquémico transitorio.

INTRODUCTION: Despite recent advances in the management of acute stroke, fewer than 10% of patients receive reperfusion therapy. One of the main reasons for such a low rate of administration is the delay on the part of patients and their families in seeking medical attention. This study aimed to analyse this delay. METHODS: A prospective observational study was conducted on consecutive stroke or transient ischaemic attack. Data on sociodemographic and clinical parameters, decision delay, pre-hospital delay, and first medical contact were collected. Descriptive, bivariate, and multivariate logistic regression analyses were performed to determine factors associated with seeking medical attention within the first 15minutes of stroke or TIA occurrence. RESULTS: A total of 382 patients were included, 24.9% of whom had a decision delay of 15minutes or less. Stroke severity (OR 1.08; 95% CI, 1.04-1.13; P<.001), patient's son/daughter witnessing the event (OR 3.44; 95% CI, 1.88-6.27; P<.001), and insulin treatment (OR 2.89; 95% CI, 1.35-6.20; P=.006) were related to an immediate reaction. Lacunar infarcts (OR 0.41; 95% CI, 0.17-0.97; P=.042), partial anterior circulation infarcts (OR 0.43; 95% CI, 0.22-0.85; P=.015), and monosymptomatic events not involving limb paresis or aphasia (OR 0.15; 95% CI, 0.033-0.724; P=.018) favoured delays longer than 15minutes. CONCLUSIONS: Severity of the event and presence of a son/daughter are the factors most frequently associated with an immediate response to stroke. Future interventions should emphasise the need for an immediate response irrespective of severity and include a wider spectrum of symptoms.

Effects of lateral osteotomy on surgically assisted rapid maxillary expansion.

This study aimed to assess the potential effects of two different osteotomy designs of the maxillary lateral wall on dental and skeletal changes after surgically assisted rapid maxillary expansion (SARME). Thirty adult patients were divided into two groups according to the lateral osteotomy design: group 1 (n=16) underwent lateral osteotomy performed in a horizontal straight fashion, and group 2 (n=14) underwent lateral osteotomy performed in parallel to the occlusal plane with a step at the zygomatic buttress. Cone beam computed tomography scans were obtained preoperatively (T1), immediately after expansion (T2), and 6 months after expansion (T3). Mixed analysis of variance (ANOVA) was used for the statistical analysis. The results showed no significant interaction effect between groups and time points. Therefore, maxillary expansion was effective in both groups. Statistically significant increases in all dental and skeletal measurements were observed immediately after expansion (P<0.001). Relapse of the nasal floor width, tipping of the supporting teeth, and an increase in root distance in molars occurred at T3 (P<0.05). In summary, the maxillary lateral osteotomy design did not influence the results of SARME, which occurred mainly through the inclination of maxillary segments.

Volumetric upper airway assessment in patients with transverse maxillary deficiency after surgically assisted rapid maxillary expansion.

Transverse maxillary deficiency is commonly found in patients with sleep apnea and is also related to abnormal breathing patterns. Maxillary expansion procedures promote widening of the nasal floor and reduce the resistance to airflow, and have a positive influence on nasopharynx function. In order to evaluate volume changes in the upper airway, 15 adult patients with transverse maxillary deficiency underwent surgically assisted rapid maxillary expansion (RME) until a slight overcorrection of the crossbite was obtained. Cone beam computed tomography (CBCT) volumetric images were obtained at three predefined time points. The mean age of the patients was 30.2 (±7.4) years; nine were females and six were males. The area, volume, and the smallest transverse section area of the airway were assessed using Dolphin Imaging 3D software. Statistical comparisons were made of the changes between time periods. No statistically significant differences were found for volume or area. However a significant difference was found between the preoperative and immediate postoperative smallest transverse section area (P<0.05). Maxillary expansion, as an isolated procedure, does not result in a statistically significant improvement in the airway dimensions and results in an inferior relocation of the smallest transverse section area.

Pseudo-Class III treatment with reverse traction: case report.

The pseudo-Class III can be defined as a functional reflex of an anterior positioning of the mandible, an acquired muscular position that simulates a mesiocclusion. The diagnosis and treatment plan of this condition must be based on a cephalometric evaluation that provides information about the relative contributions of the skeletal and dental components to the malocclusion. There is still great controversies about when is the best moment to start the Class III treatment. The purpose of this article is to describe a case report in which a Class III patient was successfully treated with reverse traction.

Influência do uso de ortopedia funcional sobre a profundidade de sondagem do sulco gengival / Effect of orthopedic treatment on sulcus depth

Os autores avaliaram o efeito do tratamento ortopédico para correçäo de maloclusäo Classe II divisäo 1ª de Angle, e os resultados dessa correçäo, sobre a profundidade de sondagem do sulco gengival. Foram estudadas 26 crianças de 7 a 9 anos de idade de ambos os sexos, portadores desse tipo de maloclusäo, tratadas (13) e näo tratadas ortopedicamente (13), avaliadas quanto à profundidade de sondagem do sulco gengival na regiäo de incisivos superiores e inferiores, a intervalos de 3 meses por um período de 1 ano. Os dados obtidos submetidos à análise de variância, demostraram que o uso de ortopedia funcional influenciou na mensuraçäo da profundidade de sondagem com maiores valores para o grupo tratado, mantendo essa diferença mesmo após a correçäo da maloclusäo. Estes resultados levaram à conclusäo que a terapia com aparelhos ortopédicos contribui para maiores valores de profundidade de sondagem, provavelmente pelo efeito da movimentaçäo dentária, e que a correçäo da maloclusäo apesar de proporcionar melhor posicionamento de dentes e arcos, näo resultou em menores valores comparado ao grupo controle. Este efeito pode ser transitório, podendo ser minimizado ou desaparecer com a estabilizaçäo da posiçäo dentária e a instituiçäo de medidas efetivas de higiene e controle da placa bacteriana

Incremental growth charts for condylar growth between 6 and 16 years of age.

This study provides sex specific reference data for the incremental growth of the mandibular condyle. The results pertain to a mixed-longitudinal sample of 113 males and 108 females followed annually between 6 and 16 years of age (total of 1647 observations). Growth of condylion was evaluated using naturally stable mandibular reference structures. The mean growth curves were estimated by multilevel models using iterative least squares procedures; between subject variation was estimated based on the sample's percentile distributions. Mean yearly velocities of condylar growth for males ranged between 2.1 and 3.1 mm/year. Growth rates decreased during childhood, increased during adolescence, and attained a maximum of 3.1 mm/year at approximately 14.3 years of age. Females showed a more constant rate of condylar growth during childhood (2.0-2.7 mm/year), a smaller adolescent peak (2.3 mm/year) at approximately 12.2 years and rapid deceleration after the peak. These reference data offer orthodontists an objective means of evaluating growth potential and treatment outcome in individual patients. Charts are provided for evaluating condylar growth of individual patients.

Condylar growth and glenoid fossa displacement during childhood and adolescence.

This study evaluated age and gender differences in the growth of the mandibular condyle and displacement of the glenoid fossa. The results pertain to longitudinal samples of untreated French Canadians, including 118 children and 155 adolescents. Childhood and adolescent growth were described for girls aged between 6 and 10 years and 9 and 13 years, respectively, and for boys aged between 8 and 12 years and 11 and 15 years, respectively. Four-year growth changes of the cephalometric landmarks condylion and articulare were evaluated. Mandibular and cranial/cranial base structural superimpositions were used to assess condylar growth and fossa displacement, respectively. The results showed that the condyle grew between 0.8 and 1.3 mm posteriorly and between 9.0 and 10.7 mm superiorly over the 4-year periods; the articulare landmark showed significantly more posterior and less superior growth than the condylion landmark. Relative to the cranial base reference structures, the fossa was displaced between 1.8 and 2.1 mm posteriorly and between 1.0 and 1.8 mm inferiorly. The articulare showed significantly more inferior movement than the condylion. Boys showed significantly greater superior condylar growth during adolescence than during childhood. The glenoid fossa demonstrated greater posterior and inferior displacement during adolescence than during childhood.