Pacientes com sindrome da apneia e hipopneia do sono obstrutiva avaliados pela analise cefalometrica das contra-partes de Enlow

Orientador: Darcy Flavio NouerTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A Síndrome da Apnéia e Hipopnéia do Sono Obstrutiva (SAHSO) é um distúrbio respiratório que caracteriza-se pela obstrução recorrente das vias aéreas superiores durante o sono. Uma amostra de 50 pacientes brasileiros com SAHSO leve, moderada e grave foi selecionada e dividida em dois grupos: o primeiro incluindo pacientes com síndrome leve e moderada e o segundo com síndrome grave. Foram avaliadas suas características antropométricas, polissonográficas e cefalométricas isoladamente e em conjunto, verificando-se possíveis associações entre as mesmas. O interrelacionamento das estruturas anatõmicas do complexo crânio-facial foi analisado segundo o princípio das contra-partes de Enlow, evitando comparações com normas populacionais, utilizando-se de pontos que correspondem às áreas de crescimento e remodelação, avaliando o paciente de maneira individual. Os resultados encontrados a partir das variáveis estudadas, permitiu-nos concluir que: 1.Comprometimentos dimensionais e rotacionais foram revelados pelas variáveis cefalométricas representativas da fossa craniana média e ramo mandibular, influenciando desfavoravelmente o espaço aéreo faringeano, do qual são contra-partes de crescimento, estabelecendo uma arquitetura crânio-facial que contribui para uma diminuição da dimensão ânteroposterior das vias aéreas. 2. O comportamento das variáveis cefalométricas foi semelhante nos grupos de pacientes com SAHSO leve à moderada e SAHSO grave. Os desequilíbrios crânio-faciais esqueléticos encontrados estavam presentes nos dois grupos, os quais compartilhavam das mesmas alterações intrínsecas. 3. O aumento da obesidade, o estreitamento do ramo mandibular em relação à dimensão /horizontal fossa craniana média e a diminuição da saturação oxigênio arterial durante o sono, estiveram significativamente associados à elevação dos índices de apnéia e hipopnéia. 4.Os fatores Alinhamento do ramo, Largura RalFCM, Dimensão vertical MP/Ra.FCM, Alinhamento corpo-oclusal e Curva de Spee foram predominantemente fatores agravantes da retrusão mandibular. Os fatores Efeito agregado FCM.A/Ra.B, Alinhamento da FCM, Maxi/a.A/mandíbula.B, Maxila.PrS/mandíbula.ld, foram predominantemente fatores de compensação da retrusão mandibular. 5.Nenhuma grandeza cefalométrica, quando consideradas isoladamente, teve correlação significativa com as variáveis polissonográficasAbstract: Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) is a breathing disorder characterized by repetitive obstructions of the upper airway during sleep. A sample of 50 brazilian patients with OSAHS mild, moderate and severe was selected and their antropometrics, polysonographics and cephalometrics characteristics were evaluated. The relationship between the anatomic structures of the craniofacial complex was analyzed by means of the Enlow counterpart analysis. The cephalometric analysis used evaluates the patient individually with points corresponding to areas of growthing and remodeling, avoiding comparisions to the standard population data. From the variables studied and results achieved we can conclude: 1. The dimensional and rotational compromise revealed by representative cephalometrics variables of middle cranial floor and mandibular ramus may cause unfavorable influence in the pharyngeal air space, which are counterparts of growth, establishing a craniofacial architecture that contributes for a reduction of anteroposterior airway dimension. 2. The behavior of cephalometrics variable was similar in the patient groups with middle to moderate and severe OSAHS. Craniofacial skeletal disturbs were present in both groups, which shared the same intrinsic alterations. 3. As the apnea and hypopnea index increases we observed an increase in obesity, the narrowing of mandibular ramus in relation to horizontal dimension middle cranial floor and an reduction of arterial oxygen saturation during sleep. 4. The ramus alignment, ramus/MCF horizontal skeletal dimension, PM as compared with ramus-MCF vertical relationship, alignment mandibular corpusoclusion and curve of Spee were predominantly contribuing factors to the mandibular retrusion. The aggregate cranial floor/maxila and ramus/corpus horizontal dimensions at A and B points, MCF alignment, maxillary/mandibular arches skeletal dimensions at A and B points, maxillary/mandibular arches skeletal dimensions at PrS and Id points were predominantly compensatory factors of the mandibular retrusion. 5. No cephalometric measure when evaluated alone had significant correlation with the olysomnographics variablesDoutoradoDoutor em Ortodonti

Aneurysmal Bone Cyst of the Zygomatic Arch Causing Limited Mouth Opening

The Aneurysmal Bone Cyst (ABC) is an expansive osteolytic, radiolucent, multilocular, excentric, origin-dismissed lesion consisting of spaces filled with blood in any segment of the skeleton, being most frequently encountered in the diaphysis of the long bones or spinal cord. It may occur as distinct clinic-pathologic entity or as pathophysiologic alteration of a preexisting lesion, like giant-cells lesion, fibrous dysplasia, ossifying fibroma, osteoblastoma, epiphysary chondroblastoma and even malignant lesions as osteossarcoma. This paper reports a rare case of ABC in the zygomatic arch of a young female patient who presented facial asymmetry and progressive limitant mouth opening, treated by ressective surgical procedure and discusses the clinical, imaginological, histological and treatment features of this pathology.Â

Severe obstructive sleep apnea treatment with mandibular advancement device: A case report

Mandibular advancement device (MAD) has been described as an alternative treatment to the severe obstructive sleep apnea (OSA), once it is not as effective as the continuous positive airway pressure therapy (CPAP) in reducing the apnea and hypopnea index (AHI). The objective of this study is to report a case using a MAD in a CPAP-intolerant patient suffering from severe OSA. Polysomnography exams were performed before and after treatment. Five months after fitting and titrating the MAD, the AHI was reduced from 80.5 events/hour to 14.6 events/hour and the minimum oxyhemoglobin saturation (SpO2) increased from 46% to 83%. A two-year assessment of therapy revealed an AHI of 8 events/hour and SpO2 of 85%

Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review

ABSTRACT Introduction: Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. Objective: This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. Methods: An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. Results: A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. Conclusion: The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required