Obesity and craniofacial variables in subjects with obstructive sleep apnea syndrome: comparisons of cephalometric values

<p>Abstract</p> <p>Background</p> <p>The aim of this paper was to determine the most common craniofacial changes in patients suffering Obstructive Sleep Apnea Syndrome (OSAS) with regards to the degree of obesity. Accordingly, cephalometric data reported in the literature was searched and analyzed.</p> <p>Methods</p> <p>After a careful analysis of the literature from 1990 to 2006, 5 papers with similar procedural criteria were selected. Inclusion criteria were: recruitment of Caucasian patients with an apnea-hypopnea index (AHI) >10 as grouped in non-obese (Body Mass Index – [BMI] < 30) <it>vs</it>. obese (BMI ≥ 30).</p> <p>Results</p> <p>A low position of the hyoid bone was present in both groups. In non-obese patients, an increased value of the ANB angle and a reduced dimension of the cranial base (S-N) were found to be the most common finding, whereas major skeletal divergence (ANS-PNS ^Go-Me) was evident among obese patients. No strict association was found between OSAS and length of the soft palate.</p> <p>Conclusion</p> <p>In both non-obese and obese OSAS patients, skeletal changes were often evident; with special emphasis of intermaxillary divergence in obese patients. Unexpectedly, in obese OSAS patients, alterations of oropharyngeal soft tissue were not always present and did not prevail.</p

Avaliação cefalométrica radiográfica da posição craniocervical de pacientes orientados em posição natural da cabeça pré e pós-expansão rápida da maxila Cephalometric radiographic evaluation of the craniocervical position of patients oriented in natural head position before and after the rapid maxillary expansion

O objetivo deste estudo foi avaliar a eventual alteração na posição craniocervical de pacientes orientados na Posição Natural da Cabeça (PNC), após o procedimento de expansão rápida da maxila (ERM). Utilizaram-se telerradiografias em norma lateral, selecionadas do acervo de documentação da Clínica de Ortodontia Preventiva da Faculdade de Odontologia da Universidade de São Paulo, de 20 pacientes, com idades entre 5 a 11 anos (média de 9,0 anos), sendo 7 do gênero masculino e 13 do feminino, obtidas no início do tratamento e imediatamente após a fase ativa da expansão da maxila. Os pacientes eram portadores de atresia da maxila e foram tratados com aparelho disjuntor tipo Biederman modificado. A partir dos cefalogramas pré e pós-ERM foram obtidas as grandezas angulares craniovertical (SN.VER), craniocervical (OPT.SN e CVT.SN), cervicohorizontal (OPT.HOR, CVT.HOR) e o ângulo da curvatura cervical (OPT.CVT). Após análise estatística e interpretação dos resultados obtidos concluímos que a posição da cabeça não apresentou alteração estatisticamente significativa. Não foram observadas diferenças estatisticamente significativas entre os gêneros quando comparadas as fases pré e pós-ERM para as grandezas estudadas. O método de obtenção de telerradiografias laterais em Orientação Natural da Cabeça mostrou-se confiável e reproduzível na amostra estudada, mesmo na presença de intervenção ortodôntica-ortopédica entre as séries de radiografias.<br>The aim of this study was to evaluate the eventual alteration in the craniocervical position of patients, oriented in the Natural Head Position (NHP), after the rapid maxillary expansion (RME) procedure. We have used lateral radiographs, selected from the documentation file of the Preventive Orthodontics Clinic, School of Dentistry, University of São Paulo. Our sample consisted of 20 patients (7M:13F), with ages ranging from 5.08 up to 11.08 years (mean of 9,0). The cephalometric radiographs were obtained in the beginning of the treatment and immediately after the active phase of the maxilla expansion. All patients showed constrictions of the maxilla, and were treated with modified Biederman appliance. Craniocervical cephalometric analysis was carried out by evaluating the craniovertical (SN.VER), craniocervical (OPT.SN e CVT.SN), cervicohorizontal (OPT.HOR e CVT.HOR) and the cervical curve (OPT. CVT) angles. On the basis of the statistical analysis of the data, we conclude that the head position did not show significant alteration. Statistically significant differences were not detected between the sexes, when the phases pre and post RME were compared for the measurements studied. In the sample studied, the method of obtaining cephalometric radiographs in the Natural Head Orientation showed to be trustworthy and reproducible, even in the presence of orthodontic-orthopedic intervention between the series of radiographs

O efeito da alteração da posição natural da cabeça (PNC) sobre as medidas cefalométricas The effect of the alteration the natural head position (NHP) on the cephalometric measurements

Este trabalho objetivou estudar as alterações das grandezas cefalométricas utilizadas em cefalometria, quando a posição natural da cabeça (PNC) modifica-se durante a tomada da telerradiografia, sua influência no diagnóstico ortodôntico, sua precisão e reprodutibilidade em tomadas radiográficas sucessivas. Analisou-se 180 telerradiografias, tomadas em norma lateral, de 30 pacientes do gênero feminino com idade média de 21,3 anos obtidas em duas séries de tomadas radiográficas com intervalo de 15 dias entre as séries. Registrou-se em cada série a PNC, a PNC acrescida de 5 graus e a PNC com flexão de 5 graus de cada paciente. Os resultados obtidos demonstraram que as grandezas lineares S-N, ENA-ENP, Co-Gn, Go-Gn, e as angulares SNA, ANB, PP.GoGn, 1.PP, IMPA, 1.1, SN.VER e HF.VER não apresentaram alterações estatisticamente significantes entre as posições estudadas e entre as séries de tomadas radiográficas, mas as de SNB, SN.GoGn, FMA, SN.PP, Ângulo Z e Co-Go apresentaram alterações estatisticamente significantes. Concluiu-se que as medidas angulares e lineares avaliadas não apresentaram alterações significantes quando a PNC modificou-se dentro da faixa de variação angular estudada, o que não conduziu a diagnósticos ou interpretações duvidosas. Devido à baixa variação das angulações dos ângulos SN.VER e HF.VER demonstrou-se que a utilização da Unidade Orientadora de Posicionamento, apresentada neste trabalho, permite a reprodutibilidade da posição natural da cabeça com grande confiabilidade dentro de uma faixa de variação da PNC em + 5º.<br>This work aimed to study the alterations of angular and linear cephalometrics measurements used in cephalometry, when the natural head position (NHP) is modified during the taking of cephalometric radiography, its influence in the orthodontic diagnosis, and the reliability and reproducibility of NHP for successive radiographs. One hundred and eighty cephalometrics radiographs were taken in lateral norm of 30 female patients with age range of 21,3 years old. The X-ray were obtained in two series within 15 days interval among them. In each of the series, the natural head position (NHP), the NHP added of 5 degrees (NHP+5º) and NHP with 5 degrees of flexion (NHP-5º) were registered from each patient. The obtained results demonstrated that the linear measurements S-N, ENA-ENP, Co-Gn, Go-Gn, and the angular measurements SNA, ANB, PP.GoGn, 1.PP, IMPA, 1.1, SN.VER and HF.VER did not present statistically significant alterations among the studied positions and the two series of radiographic taken as well. The angular measurements of SNB, SN.GoGn, FMA, SN.PP, Z Angle, Co-Go presented statistically significant alterations. It was concluded that the angular and linear measurements appraised did not present significant alterations when the NHP modified within of the angular variation strip studied, which did not lead to doubtful diagnosis or interpretations. Due to low variation of the angulations of the SN.VER and HF.VER angles, it was demonstrated that the employment of the Guiding Unit of Positioning presented in this work, allows the reproducibility of the natural head position with great reliability within a + 5º variation strip of NHP