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

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

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

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

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

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

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

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

Dentofacial characteristics of oral breathers in different ages: a retrospective case-control study.

BACKGROUND: This study aimed to investigate the dental and skeletal variables associated with disturbances of craniofacial development in oral-breathing (OB) individuals and the probability that these variables are related to this condition. METHODS: This is an observational retrospective case-control study of 1596 patients divided into three groups of age n1 5-12, n2 13-18, and n3 19-57 years. Radiographic, clinical, and models data were analyzed. The control group was consisted of nasal breathing (NB) individuals. Statistical analyses of the qualitative data were performed with x (2) test to identify associations, and odds ratio (OR) tests were performed for the variables that the chi-square test (x (2)) identified an association. RESULTS: In the descriptive analysis of the data, we observed that the class II malocclusion was the most frequent in the total sample, but when divided by age group and mode of breathing, there is a random division of these variables. In n1 group, class II, (OR = 2.02) short and retruded mandible (SM and RM) (OR = 1.65 and1.89) were associated with OB and it was considered a risk factor. In n2 group, class II (OR = 1.73), SM (OR = 1.87) and increased lower anterior height (ILAFH) (OR = 1.84) seemed to be associated and to be risk factors for OB. In the n1 group, decreased lower anterior facial height (DLAFH) and brachycephalic facial pattern (BP) seemed to be associated with NB and a protective factor against oral breathing. CONCLUSIONS: This study showed that dental and skeletal factors are associated with OB in children, and it seems that it becomes more severe until adolescence. But adults showed no associations between OB and skeletal factors, only in dental variables, indicating that there is no cause-effect relationship between the dental and skeletal factors and OB. The treatment of nose breathing patient should be multidisciplinary, since OB remains even when dental and skeletal factors slow down.

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

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

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

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

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

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

Estudo comparativo dos mecanorreceptores dos discos intervertebrais normais e degenerados da coluna lombar de humanos pela radiografia, ressonância magnética e estudo anatomopatológico / Comparative study of normal and degenerated intervertebral discs' mechanoreceptors of human lumar spine X-ray, magnetic resonance and anatomopathologic study

Os autores fizeram um estudo da coluna lombar de humanos, objetivando avaliar e determinar os diferentes tipos de fibras nervosas no disco intervertebral normal e no degenerado. Foram usadas dez colunas lombares de cadáveres com aproximadamente 48 a 72 horas de óbito. As peças foram submetidas a exames de radiografia simples e ressonância magnética. Após os exames, os discos foram classificados em normais e degenerados. Em seguida, foram dissecados, divididos em regiões anterior e posterior, incluídos em parafina e realizado estudo de imuno-histoquímica com a proteína S100. Com o auxílio de um programa de computador Image-Pro Plus (media cybernetics®), as fibras nervosas tiveram seu diâmetro medidos em micrômetros e classificadas em quatro tipos de fibras. Foram encontrados quatro tipos de fibras nervosas nas diferentes regiões discais. O número e o tipo de fibras variaram de acordo com a região e grau de degeneração do disco intervertebral. Concluíram que as fibras do tipo III são mais freqüentes na região anterior; as fibras dos tipos II e IV são mais freqüentes na região posterior, e as fibras do tipo I não apresentaram diferenças entre a região anterior e a posterior; além disso, o disco degenerado tem mais fibras nervosas que o disco normal.

The authors conducted a study on human lumbar spine, aiming to assess and determine the different kinds of nervous fibers in normal and degenerated intervertebral discs. Ten cadavers lumbar spines with approximately 48 - 72 of death have been used. The pieces were submitted to simple X-ray and magnetic resonance tests. Subsequently to the tests, discs were divided into normal and degenerated. Then, they were dissected, divided into anterior and posterior according to the region, included in paraffin and an immunohistochemical study with S100 protein was performed. With the aid of Image-Pro Plus computer software (media cybernetics) ®, nervous fibers diameters were measured as micrometers and classified into four kinds of fibers. Four types of nervous fibers were found on different disc regions. The number and kind of fibers varied according to the region and degree of intervertebral disc degeneration. It was concluded that type-III fibers are more common at the anterior region; type-II and type-IV fibers are more common at the posterior region, and type-I fibers do not show any differences regarding anterior and posterior regions; in addition, a degenerated disc has a higher number of nervous fibers than a normal one.

Sistematização do estudo anatômico do aqueduto vestibular por tomografia computadorizada de alta resolução em pacientes com doenças de Ménière unilateral / Systematization of vestibular aqueduct anatomical study by high-resolution computed tomography in patients with unilateral Ménière's disease

OBJETIVO: Sistematizar a avaliação do aqueduto vestibular por tomografia computadorizada de alta resolução (TCAR) em pacientes com doença de Ménière unilateral e comparar com um grupo-controle. MATERIAIS E MÉTODOS: Selecionamos 20 pacientes com doença de Ménière unilateral, segundo critérios da Academia Americana de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço, e um grupo-controle composto por dez indivíduos com avaliação auditiva normal, totalizando 60 orelhas, distribuídas igualmente em três grupos: grupo I - doença de Ménière, orelha comprometida; grupo II - doença de Ménière, orelha não-comprometida; grupo III - controle. Submetemos os pacientes à TCAR de ossos temporais. O estudo das imagens foi feito de modo cego, procurando avaliar a visibilidade da porção descendente do aqueduto vestibular. Os dados obtidos foram correlacionados com os respectivos grupos. RESULTADOS: A visualização do aqueduto vestibular foi de 95 por cento no grupo I, 90 por cento no grupo II e 100 por cento no grupo III. CONCLUSÃO: É possível sistematizar a avaliação por TCAR do aqueduto vestibular, com aquisição axial, usando a mesma técnica radiológica, conhecimento anatômico e seguimento seqüencial das estruturas da orelha interna. Com esta sistematização houve alta taxa de visualização do aqueduto vestibular, sem diferença estatisticamente significante entre os grupos.

OBJECTIVE: To systematize the assessment of vestibular aqueduct by high-resolution computed tomography (HRCT) in patients with unilateral Ménière's disease as compared with a control group. MATERIALS AND METHODS: We have selected 20 patients with unilateral Ménière's disease, according to the guidelines proposed by the American Academy of Otolaryngology - Head and Neck Surgery. The control group consisted of ten individuals with normal audiometric tests. Overall, we have studied 60 ears, equally divided into three groups: group I - Ménière's disease, affected ear; group II - Ménière's disease, non-affected ear; group III - control. All the individuals have undergone temporal bones HRCT. Images were blindly reviewed, trying to evaluate the visibility of the descendent portion of the ventricular aqueduct. Afterwards data were correlated with their respective groups. RESULTS: We have identified the vestibular aqueduct in 95 percent of ears in group I, 90 percent in group II, and 100 percent in group III. CONCLUSION: It is possible to perform a systematic evaluation of the vestibular aqueduct by axial HRCT, using the same radiological technique, anatomical knowledge and sequential images of inner ear structures. With this systematic approach we have obtained a high rate of vestibular aqueduct visualization, with no statistically significant difference between the groups.

Análise por tomografia computadorizada do enxerto autógeno na cirurgia de "sinus lift" / Computed tomography evaluation of autogenous graft in sinus lift surgery

OBJETIVO: Quantificar a formação óssea nos enxertos com e sem plasma rico em plaquetas, obtido pelos métodos de centrifugação e aférese, comparando os três tipos de enxertos realizados por meio de análise tomográfica. MATERIAIS E MÉTODOS: Este estudo prospectivo, duplo cego, utilizou uma amostra composta de 34 pacientes adultos, de ambos os sexos, com idade média de 48 anos e 8 meses, portadores de pneumatização unilateral ou bilateral dos seios maxilares, que necessitavam de enxertos ósseos, com a finalidade de melhorar as condições locais para a colocação dos implantes dentários. Todos os pacientes realizaram tomografia computadorizada antes da cirurgia. Foram operados 53 seios maxilares, divididos em três grupos: enxerto de plasma rico em plaquetas obtido pelos métodos de aférese, centrifugação e enxerto apenas de osso autógeno. Após seis meses do procedimento cirúrgico foram realizados novos exames de imagem. RESULTADOS: Pela avaliação tomográfica, houve crescimento em altura e em largura nos três grupos quando foram comparados os momentos inicial e final, entretanto, não houve diferença estatística para a altura e para a largura. CONCLUSÃO: Evidências clínicas demonstram a eficácia dos enxertos autógenos, principalmente os associados a fatores indutores de crescimento ósseo, como o plasma rico em plaquetas, recuperando o arcabouço maxilofacial, necessário para a reconstrução protética e funcional por meio de implantes dentários.

OBJECTIVE: To quantify bone formation within autogenous bone grafts and autogenous bone grafts in combination with platelet-rich plasma obtained either from aphaeresis or centrifugation using computed tomography. MATERIALS AND METHODS: This prospective, double-blind study was conducted in 34 male and female adult patients (mean age of 28 years and 8 months), with either unilateral or bilateral pneumatization of the maxillary sinuses, requiring bone graft for dental implant. All patients were submitted to computed tomography examinations prior and six months after sinus lift surgery. Fifty-three maxillary sinuses were operated and divided into three distinct groups: autogenous bone graft, autogenous bone graft in combination with platelet-rich plasma obtained by centrifugation, and autogenous bone graft in combination with platelet-rich plasma obtained by aphaeresis. RESULTS: Computed tomography demonstrated bone growth in height and width between the initial and the follow-up computed tomography scans in all three groups. However, no statistical difference was found either for bone height or width. CONCLUSION: Clinical evidence demonstrates the effectiveness of autogenous bone grafts, particularly when used in combination with bone growth factors such as platelet-rich plasma, which allow prosthetic and functional restoration of maxillofacial structures through fixation of dental implants.

Mycetoma caused by Fusarium solani with osteolytic lesions on the hand: case report.

Eumycetoma is a mycotic disease caused by saprophytic soil fungi that are usually inoculated through minor injuries. A case of mycetoma in a Brazilian farmer aged 71 years is reported. This patient presented erythema and edema on the dorsal surface of the left hand with multiple crusted and cicatricial lesions. No macroscopic grains were observed. The histopathological findings showed grains consisted of numerous hyphae which stained well with Gomori-Grocott method. This material obtained by cutaneous biopsy was submitted to culture on Sabouraud's medium and the colonies were identified as Fusarium solani. The radiological studies revealed bone osteolytic lesions and the ultrasound showed pseudocysts and fistulae at the site of this infection. The patient was treated with oral ketoconazole with a good clinical response.

Calcificações orbitárias incidentais na tomografia computadorizada / Incidental orbital calcifications on computed tomography scans

Estudamos, retrospectivamente, tomografias computadorizadas de órbita de 75 pacientes, de maneira a identificar a presença de calcificações incidentais (esclerais e do aparato troclear). Estes achados devem ser incluídos no vasto diagnóstico diferencial das calcificações orbitárias. A familiaridade com seus achados de imagem pode ajudar o radiologista a diferenciá-las do diagnóstico de corpo estranho orbitário.

Influência dos acessórios ortodônticos na aquisiçäo da imagem por ressonância madnética / Influence of orthodontic accessories im magnetic resonance imaging

Um paciente de 27 anos, portador de aparelho ortodôntico fixo, marca Forestadent, tamanho standart, foi submetido a dois campos de 1,5 T para a imagem por ressonância magnética (IRM) das articulaçöes temporomandibulares (ATMS). Os objetivos foram quantificar a formaçäo de artefato, descrever os sinais do mesmo em RM, identificar e conceituar os dispositivos ortodônticos ferromagnéticos e orientar o ortodontista previamente à solicitaçäo do exame. O aparelho ortodôntico apesar de ser constituído por uma liga, mostrou-se ser um potencial causador de artefatos sobre a imagem. Os materiais considerados com grandes propriedades ferromagnéticas foram aqueles construídos a partir do aço inoxidável, como é o caso da PLAi, arco transpalatino, arcos de nivelamento de aço, jones jig (corpo principal) etc, Do ponto de vista físico, os artefatos foram maiores no equipamento de 1,5 T e apareceram como áreas de deformaçöes em hiposinal com bandas de hipersinal, comprometendo as estruturas anatômicas vizinhas ao aparelho ortodôntico; em toda a extensäo da imagem foi possível notar um ruído decorrente do fenômeno de suceptibilidade magnética, porém o diagnóstico das ATMs näo foi inviabilizado. Recomenda-se acompanhamento psicológico aos pacientes e que recursos de ancoragem e outros dispositivos para ajuste ântero-posterior dos arcos dentários tais como "Jones Jig, Jasper Jumper, magneto, etc" sejam removidos previamente ao exame

Toxocaríase ocular: relato de um caso por ressonância magnética e revisäo da literatura / Ocular toxocariasis: radiological findings a case report and review of the literature

Os autores relatam um caso de paciente do sexo feminino, com quatro anos de idade, apresentando leucocoria no olho direito há 15 dias. O exame oftalmoscópico foi impossibilitado pela presença de catarata total no referido olho. Foi, entäo, realizada ressonância magnética, que evidenciou câmara vítrea com sinal alterado e imagem nodular no fundo de olho com realce anômalo, sugestivo de granuloma infeccioso. Esses achados de imagem, em conjunto com os exames laboratoriais, fizeram o diagnóstico presuntivo de toxocaríase ocular. A criança vem sendo acompanhada ambulatorialmente com corticoterapia, com boa evoluçäo