Wilma Terezinha Anselmo Lima

Influência do padrão respiratório na morfologia craniofacial

OBJETIVO: este estudo teve como objetivo avaliar por meio de analise cefalometrica as diferencas nas proporcoes faciais de criancas respiradoras bucais e nasais. FORMA DE ESTUDO: coorte transversal. MATERIAL E METODO: Foram selecionadas 60 criancas entre 6 e 10 anos que, apos avaliacao otorrinolaringologica para o diagnostico do tipo de respiracao, foram divididas em dois grupos: grupo I, constituido de criancas respiradoras bucais, com elevado grau de obstrucao das vias aereas e grupo II, composto de criancas respiradoras nasais. Os pacientes foram submetidos a avaliacao ortodontica por meio de radiografias cefalometricas em norma lateral, a fim de avaliar as proporcoes faciais, atraves das seguintes medidas cefalometricas: SN.GoGn, ArGo.GoMe, N-Me, N-ENA, ENA-Me, S-Go, S-Ar, Ar-Go; e os seguintes indices: iAF=S-Go / N-Me, iAFA=ENA-Me / N-Me e iPFA=N-ENA / ENA-Me. RESULTADO: Foi constatada que a inclinacao do plano mandibular (SN.GoGn) nos pacientes respiradores bucais foi estatisticamente maior que nos respiradores nasais, enquanto que a proporcao da altura facial posterior e anterior (iAF), e da altura facial anterior superior e inferior (iPFA) foram estatisticamente menores nos pacientes bucais, indicando altura facial posterior menor que a anterior e altura facial anterior inferior aumentada nesses pacientes. CONCLUSAO: Pode-se concluir, entao, que os respiradores bucais tendem a apresentar maior inclinacao mandibular e padrao de crescimento vertical, evidenciando a influencia da funcao respiratoria no desenvolvimento craniofacial.

Breathing mode influence in craniofacial development

AIM The aim of this study was to evaluate the differences in facial proportions of nose and mouth breathing children using cephalometric analysis. STUDY DESIGN Transversal cohort. MATERIAL AND METHOD Sixty cephalometric radiographs from pediatric patients aged 6 to 10 years were used. After otorhinolaryngological evaluation, patients were divided into two groups: Group I, with mouth breathing children and group II, with nose breathers. Standard lateral cephalometric radiographs were obtained to evaluate facial proportions using the following measures: SN.GoGn, ArGo.GoMe, N-Me, N-ANS, ANS-Me and S-Go; and the following indexes: PFH-AFH ratio: S-Go/N-Me; LFH-AFH ratio: ANS-Me/N-Me and UFH-LFH ratio: N-ANS/ANS-Me. RESULTS It was observed that the measurements for the inclination of the mandibular plane (SN.GoGn) in mouth breathing children were statistically higher than those in nasal breathing children. The posterior facial height was statistically smaller than the anterior one in mouth breathing children (PFH-AFH ratio). Thus, the upper anterior facial height was statistically smaller than the lower facial height (UFH-LFH ratio). CONCLUSION We concluded that mouth breathing children tend to have higher mandibular inclination and more vertical growth. These findings support the influence of the breathing mode in craniofacial development.

Uso da rinometria acústica como método diagnóstico

A avaliacao da patencia nasal de forma clara e objetiva tem sido motivo de investigacao ha mais de 100 anos. O desenvolvimento de metodos objetivos de medida confiaveis tem sido lento, e mesmo com varias tentativas, nenhum tem sido aceito de forma geral, permanecendo pela maioria do rinologistas o diagnostico baseado em dados da historia clinica e a rinoscopia. Rinometria acustica e uma tecnica que permite a medida da relacao entre a area transversal com a distância da cavidade nasal. OBJETIVO: Estudar a patencia nasal atraves da rinometria acustica em pacientes brasileiros normais. FORMA DE ESTUDO: Clinico-prospectivo. MATERIAL E METODO: Avaliamos vinte pacientes, com idade variando entre 21 e 60 anos. Todos foram submetidos ao exame de rinometria acustica antes e apos teste de vasoconstricao nasal e as medidas de ATM (area transversal minima) e distância foram analisadas. RESULTADOS: Foram encontrados os valores medios de ATM 0.59 antes e 0.60 pos-vaso. CONCLUSOES: Concluimos ser a rinometria acustica um metodo diagnostico objetivo, simples, rapido, reprodutivel, confiavel, nao-invasivo para avaliacao da patencia nasal. Ela permitiu evidenciar diferencas numericas na amostra analisada, transformando-se em um parâmetro objetivo de comparacao.

Efeitos do cigarro sobre o epitélio respiratório e sua participação na rinossinusite crônica

O crescente consumo de cigarro tem despertado preocupacoes com o desenvolvimento e agravamento de doencas, em especial as relacionadas ao trato respiratorio. OBJETIVO: Neste artigo revisamos as evidencias que apontam os efeitos da fumaca de cigarro sobre o epitelio respiratorio bem como o seu papel na fisiopatogenia na rinossinusite cronica. CONCLUSAO: Embora existam dados que fortalecam um vinculo entre o habito de fumar e a RSC, em seu conjunto, os estudos demonstram que deve haver grande dependencia da susceptibilidade individual na resposta a fumaca de cigarro para o desenvolvimento ou manutencao da RSC. Uma adequada orientacao a esses pacientes para interrupcao do consumo de cigarro, assim como o reforco de campanhas de combate ao tabagismo, sao de extrema importância para o controle dessa doenca de grande impacto socio-economico.

Effects of cigarette smoking on the respiratory epithelium and its role in the pathogenesis of chronic rhinosinusitis

UNLABELLED The increasing consumption of cigarettes has aroused concerns about the development and worsening of diseases, particularly those related to the respiratory tract. AIM In this paper we review the evidence suggesting the effects of cigarette smoking on the respiratory epithelium and its role in the pathogenesis in chronic rhinosinusitis. CONCLUSIONS Although there is evidence supporting a link between smoking and CRS, studies suggest that there might be individual susceptibility to cigarette smoking causing the development and/or maintenance of CRS. Proper patient education to quit smoking as well as reinforcement of antismoking campaigns are extremely important to control this disease of major socio-economic impact.

Surgical treatment of nasal packing refractory epistaxis

UNLABELLED Epistaxis is the main otorhinolaryngology emergency and, in severe cases, it can lead to hemodynamic instability and be life threatening. AIM To evaluate factors involved in epistaxis resistant to nasal packing that needed surgical treatment, as well as post-surgical results. MATERIAL AND METHODS Retrospective study from January 2002 to August 2007. 40 consecutive patients that underwent surgical treatment for refractory epistaxis were analyzed. Predisposing factors, procedures performed, need of blood transfusion, and recurrence were evaluated. RESULTS Otorhinolaryngology post operative complications (37.5%), high blood pressure (30%), and coagulopathy (15%) were the main factors related to epistaxis. 50% of the patients (n=20) presented with hemodynamic instability and 90% of them (n=18) needed blood transfusion. Eletrocauterization of the bleeding site was enough in 35% of these patients (n=14), while in 65% (n=26) was necessary cauterization and/or arterial ligation. Five patients (12.5%) had bleeding recurrence, which needed re-operation. CONCLUSION Earlier indications of surgical treatment to control severe and refractory epistaxis to conventional treatment, especially in a population with high risk such as post operative bleeding and coagulopathies, may decrease the need of blood transfusion.

Leiomyoma of the nasal cavity: case report

CASEM.AH, female, 54 years, born and raised in Sao Paulo, with repetition epis-taxis, nasal obstruction and hyposmia for two years. A solid tumor was found in her nose, coming from the middle meatus and partially obstructing her left nasal cavity.We performed a contrasted CT scan of her paranasal sinuses and a nasofibros-copy with biopsy. The material was then sent for a pathology exam and immunohis-tochemistry, which confirmed the diagnosis of a mesenchymal neoplasia originating from the smooth muscle.Surgery was performed under endoscopic view, with a 30

Descompressão endoscópica orbitária na oftalmopatia de Graves

orbitopatia de Graves pode levar a exoftalmia significa-tiva com alteracoes cosmeticas ate a propria perda visual. O tratamento cirurgico desta doenca era entao realizado atra-ves de descompressao orbitaria por via externa. Entretanto, tecnicas minimamente invasivas atraves da descompressao orbitaria por via endoscopica agora sao possiveis, possibili-tando a remocao da parede medial e inferior da orbita sem a realizacao de incisoes cutâneas ou gengivais, permitindo a reducao media da proptose comparavel com as tecnicas externas. Este artigo de revisao tem por objetivo descrever os passos tecnicos em detalhe, enfocando suas vantagens e desvantagens. A descompressao orbitaria por via endoscopica e um procedimento seguro e efetivo para o tratamento da exoftalmia tireoideana.Wilma Terezinha Anselmo Lima

Bone defect repair on the alveolar wall of the maxillary sinus using collagen membranes and temporal fascia: an experimental study in monkeys

UNLABELLED Few studies has been done using guided bone regeneration in maxillary sinus defects. AIM To assess the bone repair process in surgical defects on the alveolar wall of the monkey maxillary sinus, which communicates with the sinus cavity, by using collagen membranes: Gen-derm--Genius Baumer, Pro-tape--Proline and autologous temporal fascia. MATERIALS AND METHODS In this prospective and experimental study, orosinusal communications were performed in four tufted capuchin monkeys (Cebus apella) and histologic analysis was carried out 180 days after. RESULTS In the defects without a cover (control), bone proliferation predominated in two animals and fibrous connective tissue predominated in the other two. In defects repaired with a temporal fascia flap, fibrous connective tissue predominated in three animals and bone proliferation predominated in one. In the defects repaired with Gen-derm or Pro-tape collagen membranes there was complete bone proliferation in three animals and fibrous connective tissue in one. CONCLUSIONS Surgical defect can be repaired with both bone tissue and fibrous connective tissue in all study groups; collagen membranes was more beneficial in the bone repair process than temporal fascia or absence of a barrier.

Comparação das técnicas de turbinectomia com laser de CO2 e laser a diodo

We describe an evaluation of the techniques aiming to reduce the bulk of inferior turbinates with the diode laser and the CO2 laser, as well as a comparison between the techniques. STUDY DESIGN: Longitudinal Cohort. MATERIAL AND METHOD: Sixty patients with turbinate hypertrophy were submitted to the submucous diode laser reduction and CO2 with a follow up period of 6 months following a established protocol concerning pain, bleeding and subjective evaluation of the nasal obstruction preoperatively and postoperatively. RESULTS: The procedures showed a low level of bleeding and no packing was necessary in all patients. We observed that the patients were very pleased concerning the nasal obstruction postoperatively. CONCLUSION: The primary goal of the inferior turbinectomy is to reduce the patient complain of nasal obstruction with less discomfort, morbidity and complications during and after the procedure. The laser reduction showed in this study good results in a 6-month follow up. Further studies must be done to evaluate the results in a longer follow up.