Screening for Obstructive Sleep Apnea and Associated Risk Factors in Adolescents and Adults With Isolated Robin Sequence.

OBJECTIVE: To investigate the subjective risk for obstructive sleep apnea (OSA) in adolescents and young adults with isolated Robin sequence (IRS). Additionally, to investigate the association of OSA risk with respiratory signs/symptoms, and retrognathia. DESIGN: Prospective, observational, and cross-sectional study. SETTING: Tertiary reference hospital for the rehabilitation of craniofacial anomalies. PARTICIPANTS: Adolescents and adults (n = 30) with IRS were clinically evaluated and screened through the Berlin Questionnaire (BQ) and Respiratory Symptoms Questionnaire. The maxillomandibular relationship was assessed on lateral cephalograms of those that reached skeletal maturity (n = 13). Polysomnography (PSG) was performed in a subgroup of 4 individuals. RESULTS: The mean age of the sample was 18.2 (±3.4) years, 17 (56.7%) were adolescents (14-19 years), and 16 were (53.3%) female, all presented a repaired cleft palate. CLINICAL PARAMETERS: Systemic arterial pressure (118.0 ± 4.1/76.3 ± 4.9 mmHg), body mass index (BMI) (20.9 ± 2.8 kg/m2), neck (33.2 ± 2.3 cm), and waist circumferences (72.0 ± 5.8 cm) were within normal ranges. A skeletal class I pattern was observed in 61.5% of the participants while a class II was seen in 15.4% of them. A high risk for OSA was detected in 16.7%, and it was associated with nasal obstruction, snoring and drowsiness, and a skeletal class II pattern (P ≤ .05). One patient presented with mild OSA (apnea-hypopnea index [AHI] = 10.1 events/hour) at the PSG exam. CONCLUSIONS: A high risk for OSA can be observed with a moderate frequency among adolescents and young adults with IRS, especially among those who are concurrently suffering from nasal obstruction, snoring and retrognathia.

The role of double-step advancement genioplasty and bilateral coronoidectomy in Nager Syndrome: A case report.

AIM: To report the surgical management of bilateral mandibular coronoid processes hyperplasia and mandibular retrognathism associated with trismus and convex facial profile in an individual diagnosed with Nager syndrome (NS). CASE REPORT: A 21 years old female was referred to the Department of Oral and Maxillofacial Surgery, presenting limited mouth opening and an unpleasant convex facial profile. The tomography exhibited hyperplasia of mandibular coronoid processes with no evidence of intracapsular ankylosis of the temporomandibular joint. The treatment objectives were to increase mouth opening through a bilateral coronoidectomy and gain chin projection using the double-step advancement genioplasty technique. The 9-month postoperative follow-up revealed a 22.22% (6 mm) gain in jaw opening, improved masticatory function, and facial profile. CONCLUSIONS: The NS is a complex craniofacial anomaly due to its clinical heterogeneity. Thus, treatment planning must be done individually, considering the patients' main complaints and respecting the limitations regarding anatomy and availability of proper surgical materials. In the present case, a bilateral coronoidectomy associated with immediate physiotherapy improved the patient's mouth opening, and the double-step genioplasty promoted a much more significant chin advancement than would be obtained with the single-step traditional osteotomy.

Bite force assessment before and after orthognathic surgery in individuals with repaired cleft lip and palate.

OBJECTIVE: To evaluate the impact of orthognathic surgery on the masticatory system of individuals with repaired cleft lip and palate (CLP) by means of bite force (BF) assessment. MATERIAL AND METHODS: Forty individuals were prospectively divided into 2 groups: 1) Control group (CON): 20 individuals without CLP (10 males, 10 females, 23.7y±7.4), 2) Cleft lip and palate group (CLP): 20 individuals with complete CLP with indication for orthognathic surgery (OS) (11 males, 9 females, 23.6y±5.6; 10 unilateral CLP; 10 bilateral CLP). The BF was evaluated in the immediate preoperative period (PRE), 3 months postoperatively (POST3M) and 6 months postoperatively (POST6M), using a gnathodynamometer (IDDK Kratos, Cotia-SP, Brazil). RESULTS: The BF of the CLP group was significantly lower than that of the CON in all evaluated periods. The BF of individuals with CLP was significantly lower in POST3M compared to PRE. Also, a significant increase in BF was observed between POST3M and POST6M. Though not significant, the BF was increased in POST6M when compared to PRE. The BF of unilateral and bilateral CLP individuals were statistically similar. Males presented a BF almost twice as high as females. CONCLUSION: Cleft lip and palate negatively impacts BF. Although there was a tendency for BF values to increase 6 months after OS, it was still significantly reduced when compared to controls, not reaching normative values.

Perfil epidemiológico de los pacientes portadores de ameloblastoma sometidos a cirugía en un hospital terciario del estado de São Paulo / Epidemiological profile of ameloblastoma affected patients subjected to surgery at a tertiary hospital in the state of Sao Paulo

Resumen: El ameloblastoma es un tumor odontogénico localmente invasivo cuyo diagnóstico precoz es difícil. El tratamiento puede variar desde una enucleación simple, una enucleación asociada a curetaje y/o crioterapia hasta amplias resecciones quirúrgicas. En este presente estudio se utilizaron los datos epidemiológicos de los pacientes tales como nombre, edad, género, tipo de ameloblastoma, región y tipo de tratamiento. Éstos fueron colectados a partir de las historias clínicas de los pacientes tratados en el Conjunto Hospitalar del Mandaqui durante el periodo de 01/01/2010 al 30/08/2016. Los datos fueron transcritos para el formulario usado cotidianamente en el hospital y presentados en tablas y gráficos. De las 11 historias clínicas seleccionadas, seis pacientes pertenecían al sexo masculino y cinco al sexo femenino, con un promedio de edad de 32 años. La región mandibular fue la más comprometida según los datos recolectados (91%). Radiográficamente, la imagen visualizada en una mayor frecuencia fue la multilocular (64%), y por otro lado, la presencia del ameloblastoma uniquístico fue detectada en cuatro casos (36%). El tratamiento consistió en la descompresión seguida de curetaje en tres casos (27%), resección segmentar en un caso (9%), resección segmentar seguida de reconstrucción en dos casos (18%), enucleación seguida de curetaje en tres casos (27%), curetaje y aplicación de solución de Carnoy en dos casos (18%). El periodo máximo de acompañamiento fue de cinco años, no presentándose recidiva en este periodo; sin embargo, hubo pérdida de acompañamiento de estos pacientes. Con base en los datos obtenidos en la población estudiada, se concluyó que la edad promedio varió de 10 a 66 años con una media de 32 años; por otro lado, el sexo masculino fue el más comprometido correspondiendo al 55% de la muestra, siendo el tipo radiográfico de la lesión más encontrado el multilocular (64%). Finalmente, el área mandibular más afectada fue la región posterior de la mandíbula (73%) y el tipo de tratamiento con mayor prevalencia fue el desbridamiento (27%).

Abstract: Ameloblastoma is a locally invasive, odontogenic tumor of difficult early diagnosis. Treatment can vary from simple enucleation, enucleation associated to curettage and/or cryotherapy up to extensive surgical resections. The present study used epidemiological data of patients such as name, age, gender, type of ameloblastoma, region and type of treatment. Aforementioned data were collected from clinical histories of patients treated at the Mandaqui Hospital Compound during the period 01/01/ 2010 to 08/30/2016. Data were transcribed for the forms used every day in hospital, and were presented in tables and graphs. Out of 11 selected clinical histories, six patients were male and five female, average age was 32 years. According to collected data, mandibular region was the most compromised (91%). Radiographically, the most frequently image was multilocular (64%), presence of single-cyst ameloblastoma was detected in four cases (36%). In three cases (27%) treatment consisted on decompression followed by curettage, in one case (9%) segmented resection was performed, in two cases (18%), segmented resection followed by reconstruction was achieved, in three cases (27%) enucleation followed by curettage, in two cases (18%), curettage and application of Carnoy solution. Maximum follow up period was five years, no recurrence was observed in that period, nevertheless, there was follow up loss in these patients. Based on data obtained from studied population, it was concluded that average age varied from 10 to 66 years, mean age 32 years; on the other hand, male gender was the most compromised (55%), multilocular lesions were the most frequently found lesions (64%). Finally the most affected mandibular area was the posterior region of the lower jaw (73%), most frequent type of treatment was debridement (27%).

CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus: Importance to sagittal split osteotomy

Background: Mandibular Sagittal Split Osteotomy (MSSO) is a popular technique in orthognathic surgery used both to advance and to retreat the mandible. However, MSSO may incur in important complications, such as bad splits and sensorineural injuries. Knowing the location of the fusion between the buccal and lingual cortical (FBLC) in the mandibular ramus and the bone thickness in the region where osteotomies will be performed is determinant in MSSO planning to avoid complications. The aim of this study was to document and evaluate possible differences between sexes regarding the location of the FBLC in relation to the superior cortical of mandibular foramen (MF) and bone thickness in the region of interest for MSSO in a Brazilian population. Material and Methods: Eighty five cone-beam Computed Tomography (CBCT) scans were used to perform linear measurements to determine the location of the FBLC. Bone thickness from the mandibular canal (MC) to the cortical external surfaces and the diameter of the MC were measured at three different points: mandibular ramus (A), mandibular angle (B) and mesial of the second molar (C). Results: The FBLC was located at a mean distance of 8.3 mm from the superior cortical of the MF in males and 8.1 mm in females. There was no difference between males and females regarding the mean bone thickness from the MC to the buccal external surface at all the points investigated (p>0.05). Bone thickness from the lingual external surface to the MC was bigger among females than males in regions B and C (p < 0.05). The diameter of the MC was bigger among males in regions B and C. Conclusions: Sexual dimorphism regarding mandibular bone thickness but not regarding the location of FBLC was present. This fundamental knowledge may assist to the panning of MSSO (AU)

No disponible

Eficacia de las suturas de las bases alares y en forma de V-Y labial en pacientes sometidos a la expansión quirúrgicamente asistida de maxila / Efficacy of sutures of the ala bases and in the form of V-Y labial in patients subject to the surgically assisted expansion of maxila

El presente estudio evaluó los efectos de las suturas de base alar nasal (S.B.A.N) y V-Y labial en el mantenimiento de la distancia entre las bases alares nasales y de la espesura del bermellón del labio. Fueron evaluados 9 pacientes, de los cuales 4 recibieron las suturas descritas anteriormente y los 5 restantes recibieron suturas simples. Fueron evaluadas las medidas de las bases alares nasales (B. A. N) y la del bermellón del labio superior (E.V.L.) en las etapas del preoperatorio, del post operatorio inmediato y de 7 y450 días después. Los resultados con respecto a las medidas de las B.A.N se mostraron estables durante todo el periodo de evaluación en el grupo que recibió las suturas S.B.A.N y S.V-Y.L., mientras que en el grupo que recibió suturas simples hubo un aumento de esta medida en el post operatorio y una disminución después de 450 días. El grupo con S.V-Y.L. y S.B.A.N presentó un aumento significativo de la E.V.L en el postoperatorio inmediato, reduciendo levemente después de 7 días, con una pérdida significativa en la evaluación final, mostrando un valor menor del que obtenido en la evaluación preoperatoria. Las S.BA.N se mostraron efectivas en corto y mediano plazo en el control del alargamiento nasal no deseado en pacientes sometidos a la expansión quirúrgicamente asistida (E.M.C.A). En el post operatorio inmediato existe un aumento del E.V.L, sin embargo, a largo plazo la reducción de la E.V.L ocurre en todos los pacientes con E.M.C.A, independiente del tipo de sutura utilizada.

This study aimed to evaluate the effects of the Nasal Alar Bases suture (N.A.B.S.) and V-Ylip suture (V-Y.L.S.) in the maintenance of the distance between the nasal alar bases (N.A.B.) and the red lipsdisplay (R.L.D.) in patients operated for correction of crossbite with maxillary atresia. We evaluated 9 patients,4 who received the above mentioned sutures, and 5 who received simple sutures. It was evaluated the measuresN.A.B. and R.L.D. in the preoperative phase, postoperative, and after 7 and 450 days. Measurements of N.A.B.were stable throughout the experimental period in N.A.B.S. and V-Y.L.S. group, while the group receivingsimple sutures there was an increase of this measure in the postoperative period and a decrease after 450days. The N.A.B.S. and V-Y.L.S. group showed a significant increase in R.L.D. in immediate postoperativeperiod, reducing slightly after 7 days, and presenting a significant loss in the final assessment, showing aneven lower value than the mean preoperative. N.A.B.S. was effective in the short and medium term in controllingunwanted nasal enlargement in patients undergoing E.M.C.A. In the immediate postoperative period, there isan increased R.L.D., but long-term reduction of the R.L.D. occurs in all E.M.C.A. patients, regardless of the typeof suture used.

Estudo do risco de injúra ao canal mandibular em imagens de tomografia computadorizada por feixe cônico / Study of the injury risk to the mandibular canal bycone beam computed tomography images

O conhecimento anatômico da mandíbula, do canal mandibular e outros reparos presentes na região mandibular são essenciais para o sucesso em vários procedimentos odontológicos, variando desde o mais básico como a anestesia, até procedimentos mais complexos, tais como a instalação de implantes, cirurgias ortognáticas e até mesmo cirurgias para correções estéticas de ângulo mandibular. O objetivo deste trabalho foi analisar as distâncias presentes da cortical vestibular mandibular, até a cortical vestibular do canal mandibular em 3 regiões específicas além da avaliação da região de fusão entre o córtex vestibular e lingual em exames de TCFC. Foram selecionadas 100 imagens de exames de TCFC pertencentes ao arquivo de imagens do Departamento de Estomatologia da Faculdade de Odontologia de Bauru. Para análise das medidas foi estudado o canal mandibular sendo investigadas as distâncias em pontos específicos que seriam de grande importância durante a realização de osteotomias em ramo e corpo mandibular, bem como a possibilidade de injúria neurosensorial. A distância da cortical vestibular do canal mandibular até a cortical vestibular da mandíbula foi de 2.95 mm na região da entrada do NAI na mandíbula, 3.88 mm na região de transição do ramo mandibular para corpo mandibular e 4,72 mm para a região mesial de segundos molares. A distância média da cortical lingual do canal mandibular até a cortical lingual da mandíbula foi de 2.07 mm na região de transição de ramo mandibular para corpo mandibular e 2.22 mm na região mesial de segundos molares. A distância da cortical do soalho do canal mandibular até a base mandibular foi correspondente a 8.54 mm na área de transição de ramo mandibular para corpo mandibular e de 6.97 mm na região mesial de segundos molares. A distância média da cortical do teto do canal mandibular até a cortical óssea superior da mandíbula na região de transição de ramo mandibular para corpo mandibular foi de 16.35 mm e de 16.08 mm para a zona...

The anatomical knowledge of the jaw, the mandibular canal and other anatomical landmarks in the mandibular region are essential for success in various dental procedures, from anesthesia to implants insertions, orthognatic surgery and aesthetic corrections of mandibular angle.The aim of this paper was to locate the mandibular canal to the mandibular corticals canal in 3 specific regions and to evaluate union between the buccal and lingual cortical. We selected 100 CBCT exams of belonging to the image files of the Stomatology Department of the School of Dentistry in Bauru - Brazil.The distance of the mandibular canal cortical to the buccal plate of the mandible was 2.95 mm in the area of the entrance to the alveolar inferior nerve (AIN) into the mandibula, 3.88 mm in the transition region of the mandibular ramus to mandibular body and 4.72 mm for mesial region of second molars.The average distance of mandibular canal corticalto the lingual plate of mandible was 2.07 mm in the transition region of mandibular ramus to mandibular body and 2.22 mm in the mesial of second molars. The distance from the floor of the cortical mandibular base canal was corresponding to 8.54 mm in the area of transition of mandibular ramus to mandibular body and 6.97 mm in the mesial of second molars.The average distance from the ceiling of the cortical mandibular canal until the upper bone in mandibular cortical transition region of mandibular ramus for mandibular body was 16.35 mm and 16.08 mm for zone corresponds to the mesial area of second molars. In the mandibular foramen, place of entry of AIN in the mandibular the average obtained for the diameter of the canal was of 2.78 mm, while in the transition region between mandibular ramus and mandibular body the average for the same diameter was 3.85 mm and in the mesial of second molar this measure was 2.99 mm. In 13 of the patients surveyed had some sort of anatomical variation present in the mandibular...