Almiro José Machado Júnior

Radiographic position of the hyoid bone in children with atypical deglutition.

The persistence of childlike deglutition after the replacement of deciduous teeth is described as atypical deglutition. This condition has been attributed to sucking action without nutritive purposes, use of a feeding bottle, oral respiration, and anatomical abnormalities. Among the possible anatomical alterations, the hyoid bone, as a result of being the origin or the insertion of several muscles involved in swallowing, may have its position altered in cases of atypical deglutition. The aim of the present study was to evaluate the position of the hyoid bone using lateral teleradiographs, among patients with atypical deglutition during the stage of mixed dentition. Using cephalometric analysis on lateral teleradiographs, the distances of H-MP (hyoid to mandibular plane) and H-T (hyoid to tuber) were measured in two groups: the experimental group with atypical deglutition and the control group normal deglutition. Both groups included subjects in mixed dentition stage. Measurements from the groups were compared using Mann-Whitney U-test and a P-value <0.05 was considered as an indication of statistical significance. The average distance of the H-MP variable was 11.69 mm for the control group and 16.14 mm for the experimental group, with a statistically significant difference (P = 0.016). The average distance of the H-T variable was 2.26 mm for the control group and -5.89 mm for the experimental group, with significant difference (P < 0.001). There was no correlation among the variables studied. Cephalometric analysis of the H-MP distance revealed a mean difference of approximately 5 mm between the two groups, and the difference was more than 7 mm for H-T distance. Distances of H-MP and H-T based on radiographic measurements were greater in individuals with atypical deglutition than in control group and there was no correlation between these two parameters.

Cephalometric evaluation of the oropharyngeal space in children with atypical deglutition

For several factors, not yet fully explained until now, infant deglutition may persist after changing the primary teeth and such swallowing is classified as atypical swallowing. Possible causes: finger sucking, bottle feeding, sucking the tongue and mouth breathing. There is no consensus about the etiology of atypical deglutition. OBJECTIVE: The aim of this study was to compare the oropharyngeal space in side-view radiographs of children with atypical deglutition and normal deglutition. METHODS: Retrospective study, by means of cephalometric analysis of side-view radiographs, measuring the anteroposterior distance of the lumen of the airway in two groups: 55 cephalograms from the experimental group (with atypical deglutition) and 55 side-view radiographs from the control group (normal deglutition). Measurements from the groups were compared using Mann-Whitney U test and a p value <0.05 was considered as an indication of statistical significance. RESULTS: The median in the control group was 10 mm and in the experimental group it was 7 mm, with a statistically significant difference (p <0.001). CONCLUSION: The oropharyngeal space is reduced in the group with atypical deglutition.

Cephalometric evaluation of the airway space and hyoid bone in children with normal and atypical deglutition: correlation study

CONTEXT AND OBJECTIVE Although there is a close relationship between swallowing and breathing, there are no studies evaluating the radiographic anatomy of the airway and its possible correlation with the radiographic position of the hyoid bone. The aim of this study was to evaluate the possible correlation of the radiographic position of the hyoid bone and airway space (PAS) in lateral radiographs on children with atypical deglutition, in comparison with those with normal swallowing. DESIGN AND SETTING Cross-sectional analytical study with control group in a public university. METHODS Using cephalometric analysis on lateral teleradiographs, the distance from the hyoid bone to the mandibular plane (MP-H) and the distance from the hyoid bone to the tuber (T-H) were correlated with the PAS measurement (airway) in two groups: 55 teleradiographs in the experimental group (with atypical deglutition) and 55 teleradiographs in the control group (normal deglutition). Both groups included subjects at the mixed dentition stage. RESULTS The variable T-H presented a statistically significant correlation with PAS (0.0286) and the variable MP-H had a significant correlation with the variable PAS (0.0053). This positive correlation was significant only in the control group and not in the group with atypical swallowing. CONCLUSIONS There was a positive correlation between the MP-H and PAS measurements and between the T-H and PAS measurements only in the group with normal swallowing. These correlations were not observed in the group with atypical swallowing.

Evaluation of the lacrimal recess of the maxillary sinus: an anatomical study

UNLABELLED The anatomical relation between the maxillary sinus and the nasolacrimal duct has gained greater importance with the advent of microsurgeries and endoscopic-assisted sinonasal procedures, and the growing use of endonasal surgery to perform middle meatus procedures and transnasal dacryocystorhinostomy. We did not find reports on maxillary sinus classification concerning its lacrimal recess, nor how often it is found. OBJECTIVE To assess how frequent the lacrimal recess can be found in the maxillary sinuses of dissected anatomical specimens. METHOD We assessed 31 half-heads from cadavers. We dissected the area corresponding to the middle third of the face, by lateral access so as to be able to observe the most lateral portion of the nasolacrimal duct vis-à-vis the maxillary sinus.The maxillary sinuses were assessed by two examiners simultaneously, getting to a consensus in relation to the type of nasolacrimal duct. RESULTS We assessed 18 maxillary sinuses of the lateral type (58.1%) and 13 anterior sinuses (41.9%). The difference in frequency of the anterior type of maxillary type of the right side (35.7%) and left (47.1%) did not have statistical significance (p = 0.524). CONCLUSION We found a frequency of 41.9% of lacrimal recesses in the maxillary sinuses.

Anatomical study of minor alterations in neonate vocal folds

INTRODUCTION Minor structural alterations of the vocal fold cover are frequent causes of voice abnormalities. They may be difficult to diagnose, and are expressed in different manners. Cases of intracordal cysts, sulcus vocalis, mucosal bridge, and laryngeal micro-diaphragm form the group of minor structural alterations of the vocal fold cover investigated in the present study. The etiopathogenesis and epidemiology of these alterations are poorly known. OBJECTIVE To evaluate the existence and anatomical characterization of minor structural alterations in the vocal folds of newborns. METHODS 56 larynxes excised from neonates of both genders were studied. They were examined fresh, or defrosted after conservation via freezing, under a microscope at magnifications of 25× and 40×. The vocal folds were inspected and palpated by two examiners, with the aim of finding minor structural alterations similar to those described classically, and other undetermined minor structural alterations. Larynges presenting abnormalities were submitted to histological examination. RESULTS Six cases of abnormalities were found in different larynges: one (1.79%) compatible with a sulcus vocalis and five (8.93%) compatible with a laryngeal micro-diaphragm. No cases of cysts or mucosal bridges were found. The observed abnormalities had characteristics similar to those described in other age groups. CONCLUSION Abnormalities similar to sulcus vocalis or micro-diaphragm may be present at birth.

Postural evaluation in children with atypical swallowing: radiographic study

PURPOSE To evaluate the cranial posture on lateral teleradiographs of children with atypical swallowing in mixed dentition. METHODS By using cephalometric analysis on lateral teleradiographs, the angles between the odontoid process and cranial base (CC1) and the odontoid process and Frankfurt plane (CC2) were measured in two groups: 55 teleradiographs from the experimental group (with atypical swallowing), and 55 lateral teleradiographs from the control group (normal swallowing). These angular measurements were subjected to statistical analysis. RESULTS The means of the variable CC1 were 99.95 degrees in the experimental group and 96.42 degrees in the control group, with significant difference between them. The means of the variable CC2 were 90.60 degrees in the experimental group and 86.35 degrees in the control group, which was also statistically significant. CONCLUSION The angles CC1 and CC2 are increased in the group with atypical swallowing.

Cephalometric Evaluation of the Airway Space and Hyoid Bone in Children with Atypical Deglutition: Correlations Study

Aunque existe una estrecha relacion entre la deglucion y la respiracion, no se dispone de estudios que relacionen la anatomia radiografica atipica de deglucion del espacio de la via aerea y su posible correlacion con la posicion radiologica del hueso hioides. El objetivo fue evaluar la posible correlacion de la posicion radiologica del hueso hioides y las vias aereas en radiografias laterales de ninos con deglucion atipica. Utilizando el analisis cefalometrico sobre telerradiografias laterales, fueron analizadas las correlaciones entre las distancias H-MP (hueso hioides al plano mandibular) y HT (hioides al tuberculo) y el PAS (espacio de la via aerea) en dos grupos: el grupo experimental con la deglucion atipica y el grupo control con deglucion normal. Ambos grupos estaban en etapa de denticion mixta. Las variables HT y MP-H tuvieron una correlacion estadisticamente significativa con la variable PAS, 0,0286 y 0,0053 respectivamente. Nuestros resultados muestran que la correlacion positiva de la situacion radiologica avanzada del hueso hioides al espacio de las vias respiratorias solo se observa en el grupo de deglucion normal. La via respiratoria inferior en los pacientes con deglucion atipica provoca cambios en la postura de la lengua, lo que conduce a un cambio en la posicion del hueso hioides.

EVALUATION OF SLEEPING POSITION AMONG RETROGNATHIC CHILDREN WITH OBSTRUCTIVE SLEEP APNEA

(IAH), interferindo na qualidade do sono e de vida. O uso do Aparelho Oral (AO) é uma opção de tratamento bem aceita pelos pacientes, envolvendo profissionais da Medicina e Odontologia do Sono. Os AOs são classificados de acordo com a funcionalidade: Dispositivo Retentor Lingual, Aparelhos Elevadores do Palato Mole e Aparelho de Avanço Mandibular. A ação primária dos AOs é aumentar e estabilizar o espaço aéreo orofaríngeo e hipofaríngeo durante o sono. Foi conduzido um estudo retrospectivo com base na análise das polissonografias (PSG) dos prontuários de 37 mulheres e 39 homens com média (desvio padrão) de idade 51,56 (11,39) e índice de massa corporal 27,47 (3,99) tratados de ronco e apneia com AO. O AO utilizado modificou a via aérea superior, alterando tanto a postura da mandíbula como da língua. Sua construtiva é embasada nos conceitos da Ortopedia Funcional dos Maxilares. Nesta amostra, pretendeu-se demonstrar se houve melhora do ronco e da apneia seguindo o critério Academia Americana de Medicina do Sono (IAHo5) e o critério liberal (IAH o10); se o efeito sobre a respiração refletiu na melhora da sonolência diurna e qualidade do sono; e se houve aderência ao tratamento. Foram aplicadas estatísticas comparando resultados antes e depois do tratamento com nível de significância de 5%. O estudo revelou melhora no ronco (p:0,0061); no IAH, de 11,29 (11,79) para 4,81 (5,31) (po0,0003); no IMD de 17,19 (13,37) para 6,14 (4,51) (p:0,0001) com diminuições significativamente consideráveis. Apesar do IMC ter aumentado de 27,47 (3,99) para 27,98 (4,22) (po0,03), de 42 pacientes apneicos com PSG de controle, 32 alcançaram IAHo5; 3, IAHo10 e 7, IAH410. Consequentemente, a SED, analisada pela Escala de Sonolência de Epworth, indicou a existência de diferença entre as médias observadas de 10,10 (4,68) para 8,55 (10,20) (po0,01) evidenciando uma melhora consistente na qualidade do sono, confirmada com IMD de 17,19 (13,37) para 6,14 (4,51) (po0,0001). Os pacientes relataram desconforto tolerável e considerável aderência (p:0,0001). Os dados revelaram a eficácia do AO utilizado. Novos estudos serão necessários para avaliar a eficácia/eficiência comparando-o com outras terapias no tratamento de ronco e apneia.