Rapid maxillary expansion and obstructive sleep apnea: a review and meta-analysis

Background: OSAS during childhood leads to significant physical and neuropsychomotor impairment. Thus, it needs to be recognized and treated early in order to avoid or attenuate the chronic problems associated with OSAS, which are deleterious to a child’s development. Adenotonsillectomy and, in select cases, continuous positive airwaypressure (CPAP) have been the preferred treatments for OSAS in children, and yet they are ineffective at fully ameliorating the disease. Minimally invasive treatments have recently been proposed, comprising intra-oral and extra-oral devices as well as speech therapy. Objetive: to conduct a meta-analysis on studies from around the world that used rapid maxillary expansion (RME) to treat OSAS in children. Material and Methods: We performed a meta-analysis of studies using RME for OSA treatment in children. A literature survey was conductedusing PubMed and Medline for English articles published up to December 2014 with the following descriptors: Sleep Apnea, Obstructive, Children, Treatment, Orthodontic, Othopaedic, Maxillaryexpansion. Studies were included in the meta-analysisif they were case-controlled studies, randomized, and involved non-syndromic children aged 0 to 12years old diagnosed with OSA by the polysomnography apneahypopnea index (AHI) before and after the intervention, submitted RME only. Results: In all, 10 articles conformed to the inclusion criteria and were included in this meta-analysis. The total sample size across all these articles was 215 children, having a mean age of 6.7 years,of whom58.6%were male. The mean AHI during the follow-up was -6.86 (p <0.0001). Conclusions: We concluded that rapid maxillary expansion (RME) in children with OSAS appears to be an effective treatment for this syndrome. Further randomized clinical studies are needed to determine the effectiveness of RME in adults

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

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.Arelação anatômica entre seio maxilar e ducto lacrimonasal adquiriu maior importância com o advento das microcirugias e cirurgias nasossinusais assistidas por endoscopia e pelo crescente uso da endoscopia nasal na realização das meatotomias médias e dacriocistorrinostomiastransnasais. Não foram encontrados relatos de classificação do seio maxilar quanto ao seu recesso lacrimal, tampouco sua frequência. OBJETIVO: Avaliar a frequência do recesso lacrimal do seio maxilar em peças anatômicas dissecadas. MÉTODO: Foram avaliadas 31 partes de hemicabeças de cadáveres. Procedeu-se à dissecção da área correspondente ao terço médio da face, por acesso lateral, para que se pudesse observar a posição da porção mais lateral do ducto lacrimonasal em relação ao seio maxilar. Os seios maxilares foram avaliados, por dois examinadores simultaneamente, chegando ao consenso do tipo de ducto lacrimonasal. RESULTADOS: Foram encontrados 18 seios maxilares do tipo lateral (58,1%) e 13 do tipo anterior (41,9%). A diferença entre a frequência de seios maxilares do tipo anterior nos lados direito (35,7%) e esquerdo (47,1%) não mostrou significância estatística (p = 0,524). CONCLUSÃO: Observou-se frequência de 41,9% de recessos lacrimais nos seios maxilares.353

Randomized controlled study of a mandibular advancement appliance for the treatment of obstructive sleep apnea in children: a pilot study

Background: The current limited evidence may be suggestive that mandibular advancement appliance (MAAs) result in improvements in AHI scores, but it is not possible to conclude that MAAs are effective to treat paediatric OSA. There are significant weaknesses in the existing evidence due primarily to absence of control groups, small sample sizes, lack of randomization and short-term results. Aim: the objective of the present study was to evaluate MAAs in children with OSA. Material and Methods: Children presenting an apnea-hypopnea index (AHI) greater than or equal to one event per hour were considered to be apneic. This group of children with AHI greater than or equal to one was randomly divided through a draw into two subgroups: half of them in an experimental subgroup and half of them in a control subgroup. In the experimental subgroup, molds of each of these children’s maxillary and mandibular arches were taken using standard molds and molding material. The control group did not use any intraoral device and did not undergo any type of treatment for OSAS. The MAAs used in this study had the aim of achieving mandibular advancement, thereby correcting the mandibular position and dental occlusion, and perhaps increasing the airway and treating OSAS. After 12 consecutive months of use of the mandibular advancement devices, polysomnography examinations using the same parameters as in the initial examinations were requested for both the experimental and the control subgroup. Results: There was a decrease in AHI in the experimental group and an increase in the control group, with statistical significance. These data were used to calculate the sample size, which was 28 children in total in the groups. Conclusions: There was a decrease in AHI one year after implementing use of mandibular advancement devices, in comparison with the group that did not use these devices

Evaluation Of The Lacrimal Recess Of The Maxillary Sinus: An Anatomical Study.

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. To assess how frequent the lacrimal recess can be found in the maxillary sinuses of dissected anatomical specimens. 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. 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). We found a frequency of 41.9% of lacrimal recesses in the maxillary sinuses.7935-

Ewing's sarcoma of the head and neck

CONTEXT: Ewing's sarcoma is a rare neoplasm, which usually arises in long bones of the limbs and in flat bones of the pelvis, with the involvement of head and neck bones being very unusual. CASE REPORT: a case of Ewing's sarcoma occurring in the mandible of a 35-year-old female. Pain and swelling of the tumor were the main complaints. The early hypothesis was an undifferentiated malignant neoplasm, possibly a sarcoma. The CT scan depicted an expansive lesion, encapsulated, with septa and characteristics of soft tissue, involving the left side of the mandible and extending to the surrounding tissues. The patient underwent surgical excision of the lesion, the definitive diagnosis of Ewing's sarcoma was established, and the patient commenced on radiotherapy.CONTEXTO: O Sarcoma de Ewing é uma doença que geralmente acomete os ossos longos e a pelve, sendo rara a ocorrência em cabeça e pescoço. RELATO DE CASO: Caso de Sarcoma de Ewing começando na mandíbula em uma paciente de 35 anos, sendo a tumoração e a dor local os principais sintomas referidos. O diagnóstico inicial foi de neoplasia maligna indiferenciada, sugestivo de sarcoma e a tomografia computadorizada mostrou lesão expansiva com características de tumor de partes moles, septada e encapsulada, acometendo a mandíbula esquerda e apresentando extensão para as partes moles adjacentes. O tratamento realizado foi a remoção cirúrgica da lesão, complementado com radioterapia pós-operatória. O diagnóstico definitivo foi de Sarcoma de Ewing.19820

Laryngeal trauma

BACKGROUND: Evaluate the procedures and results in the treatment of the traumatic lesions of larynx. METHODS: Descriptive study on 35 patients with laryngeal trauma treated between January 1990 and April 2003. RESULTS: Predominant mechanism was the penetrant trauma (85.7%), the majority by gunshot wounds (48.6%). Ten patients (28.6%) required endotracheal intubation at the emergency room and mean RTS value was 7.28. The most frequent finding were exposition of laringeal cartilages (30%). In patients sustaining blunt trauma, the most frequent finding was subcutaneous emphysema. Optic fiber laringoscopy was perfomed in four cases. Surgical treatment was required in 34 patients (97.1%) and one was treated nonoperatively. The suture was performed in 33 patients associated with tracheostomy in 24 cases. The thyroid cartilage was the most frequently injured (57.1%). Cervical lesions associated occurred in 20 cases (57.1%). The mean ISS and TRISS values were, respectively, 16.3 and 0.93. The morbidity after laryngeal trauma was 34.3%. Reoperation was required in two patients, one due to cervical abscess and another, lately, by supraglottic stenosis, this last treated with a prothesis. Postoperative mortality was 5.7%. CONCLUSION: The standard management patients with laringeal trauma results in minor incidence of definitive sequels.OBJETIVO: O trauma da laringe é pouco freqüente. O objetivo do presente trabalho é avaliar os procedimentos e resultados no tratamento destas lesões. MÉTODO: Este trabalho baseou-se em estudo prospectivo de 35 de pacientes com trauma de laringe atendidos no período de janeiro de 1990 a abril de 2003. RESULTADOS: A média de idade foi de 31,4 anos, sendo 30 pacientes (85,7%) do sexo masculino. O mecanismo predominante foi o trauma penetrante (30 casos - 85,7%), a maioria causada por ferimento por projétil de arma de fogo (17 casos - 48,6%). Dez pacientes (28,6%) necessitaram de intubação traqueal na admissão hospitalar e o valor médio do RTS foi de 7,28. As observações mais freqüentes no exame clínico das vítimas de trauma penetrante foram exposição de cartilagens da laringe (30%) e saída de ar pelo orifício do ferimento cervical (30%). Nos cinco pacientes (14,3%) com trauma contuso o achado mais freqüente foi enfisema subcutâneo (80%).O tratamento foi cirúrgico em 34 pacientes (97,1%), através de cervicotomia em colar na maioria dos casos (91,2%). A cartilagem tireóide foi a mais lesada (20 casos - 57,1%). Em 33 pacientes operados a lesão foi tratada com sutura, associada a traqueostomia em 24 casos (72,7%). Lesões cervicais associadas ocorreram em 20 casos (57,1%), sendo mais comum as de veia jugular (10 casos). A média do ISS e do TRISS foram, respectivamente, 16,3 e 0,93. A morbidade relacionada diretamente à lesão laríngea foi de 34,3% (12 casos), sendo mais freqüente a disfonia (seis casos). Foi necessária a reexploração cervical em dois pacientes, um devido a abscesso cervical e outro, tardiamente, por estenose supra-glótica, este último tratado com molde. Dois pacientes apresentaram complicações tardias, um com disfagia e outro com disfonia. A mortalidade pós-operatória foi de 5,7% (dois casos), decorrente de complicações não relacionadas ao trauma laríngeo. CONCLUSÕES: A utilização de condutas padronizadas na abordagem do paciente com trauma de laringe, tanto no diagnóstico como no tratamento definitivo, resulta em menor taxa de seqüelas definitivas.38038

Correlation between cephalometric data and severity of sleep apnea

AbstractIntroductionObstructive sleep apnea syndrome has a high prevalence among adults. Cephalo- metric variables can be a valuable method for evaluating patients with this syndrome.ObjectiveTo correlate cephalometric data with the apnea-hypopnea sleep index.MethodsWe performed a retrospective and cross-sectional study that analyzed the cephalo- metric data of patients followed in the Sleep Disorders Outpatient Clinic of the Discipline of Otorhinolaryngology of a university hospital, from June 2007 to May 2012.ResultsNinety-six patients were included, 45 men, and 51 women, with a mean age of 50.3 years. A total of 11 patients had snoring, 20 had mild apnea, 26 had moderate apnea, and 39 had severe apnea. The distance from the hyoid bone to the mandibular plane was the only variable that showed a statistically significant correlation with the apnea-hypopnea index.ConclusionCephalometric variables are useful tools for the understanding of obstructive sleep apnea syndrome. The distance from the hyoid bone to the mandibular plane showed a statisti- cally significant correlation with the apnea-hypopnea index

Brazilian tracheotomy speech valve: diaphragm pressure standardization

Tracheotomy is performed in cases of upper airway obstruction or chronic pulmonary disorders. The Tracheotomy Speech Valves (TSV) improve communication and airway hygiene and humidification of tracheotomized patients. AIM: To show the low cost Brazilian TSV and its use in speech rehabilitation of tracheotomized patients, to evaluate diaphragm opening resistance and comfort to the patient. Study Design: Experimental, contemporary cohort. MATERIALS AND METHODS: The TSV was used in 32 patients. The valve has a diaphragm within a stainless steel body with plastic fittings. We studied the level of respiratory comfort according to the degree of valve diaphragm resistance, 40, 50 and 60 shores. RESULTS: All the patients used the TSV coupled to the cannula in a regular basis, 26 of them did it for more than 12 hours daily and from these, 14 used it for 24h daily. The diaphragm pressure obtained was that of 40 shores for 13 patients and 50 shores for 19 patients. 60 shores was never used. CONCLUSION: the metal TSV helps with speech without the need for closing the cannula with one's finger, and breathing was comfortable. We achieved standard diaphragm resistance. Currently all the patients from this study use this TSV with speech and 43.75% use it full time.A traqueotomia está indicada em condições com obstrução respiratória alta ou doença pulmonar obstrutiva crônica. As Válvulas Fonatórias (VF) melhoram a comunicação, higienização e umidificação das vias aéreas dos pacientes traqueotomizados. OBJETIVO: Demonstrar a VF nacional, de menor custo, e sua utilização na reabilitação fonatória desses pacientes, avaliar resistência de abertura pelo diafragma, o que confere melhor conforto ao paciente. Forma de Estudo: Experimental, coorte contemporâneo. MATERIAL E MÉTODO: A VF foi utilizada em 32 pacientes. A válvula tem diafragma dentro de um corpo em aço inox com encaixes de plástico. Estudou-se grau de conforto respiratório de acordo com a resistência do diafragma da válvula, 40, 50 e 60 shores. RESULTADOS: Obteve-se uso regular da VF acoplada à cânula por todos os pacientes, 26 o fizeram por mais de 12h diárias e destes 14 por 24h diárias. A pressão do diafragma obtida foi de 40 shores para 13 pacientes e 50 shores para 19 pacientes, sem utilização de 60 shores. CONCLUSÃO: A VF metálica permite fonação, sem a oclusão digital da cânula, e respiração sob conforto. Obteve-se resistência padronizada do diafragma. Atualmente todos os pacientes do estudo utilizam estas VF com fonação e 43,75% período integral.10711