Ana Célia Faria

Comparison of the area of the pharynx during wakefulness and induced sleep in patients with Obstructive Sleep Apnea (OSA)

UNLABELLED The study of obstructive sleep apnea (OSA) has received growing attention over the past years since various aspects have not been sufficiently established. AIM To evaluate, with the use of magnetic resonance imaging (MRI), changes in the area of the pharynx during wakefulness and induced sleep in patients with OSA. MATERIALS AND METHODS A prospective study of thirty-two patients with a polysomnographic diagnosis of OSA. All patients were submitted to MR imaging in order to obtain high-definition anatomical sagittal sequences during wakefulness and during sleep induced with Propofol. An area was defined on the sagittal plane in the midline of the pharynx. This region was called pharyngeal midplane (PMP) area. RESULTS A significant difference in PMP area (mm²) was observed between wakefulness and induced sleep in each patient (p < 0.000001). CONCLUSION The patients with OSA suffer a significant reduction of 75.5 % in the area of the pharynx during induced sleep compared to wakefulness.

Enlargement of the Pharynx Resulting From Surgically Assisted Rapid Maxillary Expansion

PURPOSE Given that transverse maxillary deficiency is an etiologic factor of obstructive sleep apnea and is intimately connected to pharyngeal size, the objective of this study was to determine whether surgically assisted rapid maxillary expansion (SARME) would promote pharyngeal enlargement in adults. MATERIALS AND METHODS This prospective study was conducted in patients with uni- or bilateral posterior crossbite who underwent SARME. Participants were recruited from the Integrated Center for the Study of Face Defects, School of Medicine of Ribeirão Preto, University of São Paulo (São Paulo, Brazil). All patients underwent computed tomography of the pharynx before and after surgery (171.5 days on average), and the sagittal and transverse planes and the total area across 3 levels of the pharynx, including the upper (posterior nasal spine), middle (first cervical vertebra), and lower (second cervical vertebra) levels, were measured on the images. A paired-samples t test was used to evaluate changes in the pharynx before and after surgery. RESULTS The studied sample consisted of 18 adult patients (10 women and 8 men) with an average age of 37.11 years (standard deviation, 11.73 yr); all patients resided in the region of Ribeirão Preto, São Paulo, Brazil. No statistical changes were observed in the upper level. An enlargement of 17.82% (P = .0107) was observed in the sagittal plane of the middle level. The cross-sectional and area values of this same portion were enlarged (16.96 and 37.38%, respectively), with a trend toward statistical significance (P = .067 and .051, respectively). The airway enlargements in the lower level were 26.41, 24.87, and 53.87% in the sagittal and transverse planes and total area, respectively; these differences were statistically significant (P = .0003, .0033, and .0016, respectively) for all 3 measurements. CONCLUSIONS SARME promotes pharyngeal enlargement, especially in the lower levels of the pharynx.

Correlation between cephalometric data and severity of sleep apnea

Introduction Obstructive sleep apnea syndrome has a high prevalence among adults. Cephalo- metric variables can be a valuable method for evaluating patients with this syndrome.

Original articleCorrelation between cephalometric data and severity of sleep apneaCorrelação entre dados cefalométricos e gravidade da apneia do sono

Introduction Obstructive sleep apnea syndrome has a high prevalence among adults. Cephalo- metric variables can be a valuable method for evaluating patients with this syndrome.

Two-Stage Treatment of Facial Asymmetry Caused by Unilateral Condylar Hyperplasia

Condylar hyperplasia (CH) is a rare, self-limiting process manifesting between the first and third decades of life. CH causes facial asymmetry and derangement of the occlusion. Management involves resection of the condylar head and orthognathic surgery. This paper describes the case of a 37-year-old woman with spontaneous onset of CH over a span of approximately 25 years. The condition was managed with resection of the condyle alone, which dramatically improved facial asymmetry and altered the occlusion within a few months of follow up. Orthodontic treatment was then carried out and the patient underwent orthognathic surgery after 3 years. The patient is currently satisfied with her appearance and function and there are no signs of recurrence.

Resection of a juvenile nasoangiofibroma by Le Fort I osteotomy: Experience with 40 cases.

PURPOSE The aim of this study was to determine the rate of success and complications of juvenile nasoangiofibroma resection by Le Fort I osteotomy. MATERIAL AND METHODS Data were obtained from the medical records of 40 patients with a diagnosis of juvenile nasoangiofibroma confirmed by anatomopathological examination. All tumors were resected by Le Fort I osteotomy between 1983 and 2010. The data obtained were gender, age, symptoms, sites of invasion, preoperative embolization, routes of surgical access, duration of surgery, complications, need for transfusion, relapses, and follow-up time. RESULTS All patients were male, ranging in age from 7 to 27 years. The most common symptom was nasal obstruction, and central nervous system (CNS) invasion was present in 27.5% of cases. Craniotomy was associated with Le Fort I osteotomy in only one case. The mean duration of surgery was 216 min. Complications occurred in 15% of cases, with intraoperative bleeding being the most frequent one. Relapses occurred in 5% of cases. The mean follow-up was 48.8 months. CONCLUSION Exclusively surgical treatment by Le Fort I access proved to be a safe and effective method for the treatment of nasoangiofibromas, permitting the removal of tumors even in patients with extension to the CNS, with a low rate of complications and relapses.

Changes of the retrolingual pharynx during the Muller manoeuvre and during sleep in sleep apnoea

OBJECTIVE To determine whether the retrolingual pharynx shows the same morphometric modifications during the Muller manoeuvre and during drug-induced sleep endoscopy (DISE) with propofol in patients submitted for maxillomandibular advancement surgery. SUBJECTS AND METHODS Eighteen patients submitted for maxillomandibular advancement surgery (MMAS) were evaluated endoscopically before and 6 month after surgery in the region of the retrolingual pharynx while seated and lying in dorsal decubitus (supine) while performing the Muller manoeuvre and during DISE with propofol, to verify and measure if the same morphometric changes occur in the retrolingual pharynx during the Muller manoeuvre and during DISE with propofol. The area, anteroposterior, and laterolateral retrolingual pharynx images were acquired using the Sony Vegas 8.0 software and recorded on a DVD. The Image J software was used to measure and compare these images. RESULTS An increase in the pharyngeal aperture was observed in all measurements after surgery, specifically in area retrolingual pharynx images. When the Muller manoeuvre was performed, a greater gain (113%) in area retrolingual pharynx measurement was observed when the patient was awake and seated. With the patient was in dorsal decubitus during DISE with propofol there was a greater gain in area retrolingual pharynx measurement (201.33%) in the smaller aperture. CONCLUSION The Muller manoeuvre after MMAS does not simulate the dimensions of the pharynx that occur during sleep.

Morphometric endoscopic study of the pharynx in patients with sleep apnea.

PURPOSE The aims of the study were to measure endoscopically the retrolingual pharynx during wakefulness and sleep before and after maxillomandibular advancement surgery and to quantify the changes observed. MATERIALS AND METHODS Eighteen patients with mild to severe grade obstructive sleep apnea hypopnea were evaluated during wakefulness while sitting and lying down and during induced sleep in dorsal decubitus while breathing naturally. Images of the retrolingual region of the pharynx were captured with a nasofibroscope and recorded on a DVD using the Sony Vegas 8.0 software (Sony Creative Software, Madison, WI). The images captured in greater and smaller aperture were measured with the Image J software (produced by Wayne Rasband, United States National Institutes of Health, Bethesda, MD) in linear anteroposterior and linear laterolateral areas. A correction factor was then applied to equalize the size of the images and thus compare them to one another. RESULTS The postoperative dimensions of the pharynx always increased significantly in all measurements compared with the preoperative ones. During induced sleep in dorsal decubitus, there was a greater gain in the area of smaller aperture (201.33%). CONCLUSIONS The proposed method showed that the dimensions of the pharynx always increased significantly after surgery for maxillomandibular advancement, although the gain was not homogeneous in all dimensions and also varied according to state of consciousness. The greatest gain was observed in the area of smaller aperture with the patient in induced sleep, thus reducing the collapse of the pharynx.

A Cephalometric Analysis for Evaluation of Changes in Soft Tissues in the Regions of the Upper and Lower Lips and Chin due to Orthognathic Maxillary Advancement Surgery

Introduction There is currently no consensus regarding the best method for predicting the changes in soft tissues due to the modification of hard tissues in orthognathic surgery. Objective To measure the changes in soft tissues of the upper lip, lower lip, and chin regions due to the modifications of hard tissues caused by orthognathic maxillary advancement surgery using a cephalometric methodology. Methods The study was conducted on 35 patients with dentoskeletal and facial deformities submitted to orthognathic maxillary advancement surgery. Two teleradiographs were taken: one during the preoperative period and the other 1 year after the surgery, on which the cephalometric tracing was drawn. Results A strong correlation (r = 0.747) was demonstrated in the horizontal analysis between the hard A (Ah) point (located in the deepest point of the anterior curvature of the maxilla) and the soft A (As) point in the advancement of the maxilla, with a mean variation of 0.859% occurring in As with each 1% variation of the Ah point. A mean variation of 0.698% occurred in the superior soft prostion point (prolongation of the superior hard prostion point to its corresponding point on soft tissue) for each 1% variation in the superior hard prostion point (bone point located at the junction of the alveolar process with the crown of the upper incisors). Conclusion The cephalometric methodology applied here revealed that the soft tissues of the upper lip accompanied 70 to 80% of the movement of hard tissues in maxillary advancement and that the soft tissues of the lower lip did not change or showed no significant changes.

Multiple Supernumerary Teeth in a Nonsyndromic 12-Year-Old Female Patient - A Case Report

Supernumerary teeth (ST) are uncommon alterations of development that may appear in either of the dental arches and that are frequently associated with syndromes such as cleidocranial dysplasia and Gardner syndrome. Multiple ST in individuals with no other disease or syndrome are very rare. In view of this situation, correct diagnosis, treatment and evaluation of ST with the use of appropriate imaging techniques are highly important. This case report presents radiographic images of a nonsyndromic 12-year-old female patient who presented with 14 supernumerary teeth and was treated under general anesthesia, with the extraction of all ST in a single surgical intervention. During the postoperative period, the patient did not complain of pain nor did she present any signs or symptoms of infection. During late follow-up period, due to difficulty in traction of the maxillary right canine and mandibular left first premolar towards the dental arch, it was necessary to extract these teeth under local anesthesia. Radiographic examination 3 years after surgery revealed the absence of ST and of diseases related to the existence of these teeth.