Efeito da expansão rápida da maxila na dimensão da cavidade nasal e morfologia facial pela rinometria acústica e rinomanometria

OBJECTIVE: To assess the effects of rapid maxillary expansion on facial morphology and on nasal cavity dimensions of mouth breathing children by acoustic rhinometry and computed rhinomanometry. METHODS: Cohort; 29 mouth breathing children with posterior crossbite were evaluated. Orthodontic and otorhinolaryngologic documentation were performed at three different times, i.e., before expansion, immediately after and 90 days following expansion. RESULTS: The expansion was accompanied by an increase of the maxillary and nasal bone transversal width. However, there were no significant differences in relation to mucosal area of the nose. Acoustic rhinometry showed no difference in the minimal cross-sectional area at the level of the valve and inferior turbinate between the periods analyzed, although rhinomanometry showed a statistically significant reduction in nasal resistance right after expansion, but were similar to pre-treatment values 90 days after expansion. CONCLUSION: The maxillary expansion increased the maxilla and nasal bony area, but was inefficient to increase the nasal mucosal area, and may lessen the nasal resistance, although there was no difference in nasal geometry. Significance: Nasal bony expansion is followed by a mucosal compensation

Suppression of Inflammatory Cytokine Secretion by an NF-kappa B Inhibitor DHMEQ in Nasal Polyps Fibroblasts

Background: NF-kappa B is an essential transcription factor strongly associated to inflammatory response in chronic rhinosinusitis with nasal polyps (CRSwNP). DHMEQ is a NF-kappa B inhibitor that has been previously described with a greatpotential indecreasing inflammation in diseases other than CRSwNP. The aim of study isto evaluate the ability of DHMEQ to reducethe inflammatory recruiters on CRSwNP and to compare its anti-inflammatory profile as a single-agent or in association with fluticasone propionate (FP). Methods: nasal polyp fibroblasts were cultured in TNF-alpha enriched media. Cells were submitted to three different concentrations (1, 10 and 100nM) of either FP, DHMEQ or both. Inflammatory response was accessed by VCAM-1, ICAM-1 and RANTES expression (by RTQ-PCR) and protein levels by ELISA. Nuclear translocation of NF-kappa B was also evaluated. Results: both FP and DHMEQ inhibited inflammatory recruiters' production and NF-kappa B nuclear translocation. Interestingly, the anti-inflammatory effect from the association steroids plus DHMEQ was more intense than of each drug in separate. Conclusion: DHMEQ seems efficient in modulating the inflammatory process in CRSwNP. The synergic anti-inflammatory effect of DHMEQ and steroids may be a promising strategy to be explored, particularly in the setting of steroid-resistant NP. Copyright (c) 2012 S. Karger AG, BaselFAPESP [07/50359-4]FAPESPIRBIRB [4374/2007

Mechanism of action of glucocorticoids in nasal polyposis

SummaryGlucocorticoids (GC) are the drugs of choice for the clinical treatment of nasal polyposis, according to the medical literature. Its mechanism of action in the regression of clinical symptoms and polyps, however, is not fully understood. The topical and/or systemic use of glucocorticoids lead to variable expression of cytokines, chemokines and lymphokines, as well as changes in cells. It is known that GC suppresses the expression of pro-inflammatory cytokines, chemokines and adhesion molecules such as ICAM-1 and E-selectin; GC also stimulate the transcription of anti-inflammatory cytokines such as TGF-β. GC suppress pro-fibrotic cytokines related to polyp growth, such as IL-11, the basic fibroblast growth factor (b-FGF), and the vascular endotelial growth factor (VEGF). The action of GC depends fundamentally on their interaction with receptors (GR); certain subjects have a degree of resistance to its effect, which appears to be related with the presence of a β isoform of GR. GC also act variably on the genes involved in immunoglobulin production, presentation, and antigen processing.AimWe present a review of the literature on the mechanisms of GC action in nasal polyosis.ConclusionUnderstanding the mechanism of action of GC in nasal polyposis will aid in the development of new, more efficient, drugs

O impacto da septoplastia Metzembaum sobre o crescimento nasal e facial em crianças

Há vários estudos que investigaram os efeitos da septoplastia no crescimento facial em crianças, com resultados conflitantes. No entanto, poucos empregaram medidas objetivas ou avaliaram os pacientes após o término do crescimento facial. OBJETIVO: Este estudo avalia os efeitos da septoplastia Metzenbaum, que preserva o pericôndrio e áreas relacionadas com o crescimento, sobre o crescimento nasal e facial em crianças. MÉTODO: Crianças que foram operadas antes dos 14 anos e que apresentavam 16 anos ou mais na avaliação foram incluídas. Dezesseis pacientes foram selecionados. Os seguintes parâmetros foram avaliados: satisfação clínica (patência e estética nasal); medidas antropométricas; cefalometria. Desenho científico: estudo de coorte histórica com corte transversal. RESULTADOS: A idade média na cirurgia foi de 13 anos; as crianças foram avaliadas em média 4,3 anos após a cirurgia. Apenas um paciente apresentou medidas antropométricas e cefalométricas abaixo da normalidade, porém, sem queixas quanto à estética ou à patência. Outros quatro pacientes apresentaram queixa quanto à estética nasal e três quanto à patência nasal. CONCLUSÃO: A septoplastia Metzenbaum parece ser uma técnica segura na correção de desvios caudais. Esta técnica não apresentou impacto significativo no crescimento facial dos pacientes avaliados

Relation between chronic rhinosinusitis and gastroesophageal reflux in adults: systematic review

Abstract Introduction: The relationship between gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) is still a controversial issue in literature. Objective: A systematic review of the association between these two diseases in adult patients. Methods: Systematic review in PubMed and Cochrane Database with articles published between 1951 and 2015. We included all articles that specifically studied the relationship between CRS and GERD. Results: Of the 436 articles found, only 12 met the inclusion criteria. Eight cross-sectional articles suggest a relation between CRS and GERD, especially on CRS that is refractory to clinical or surgical treatment. However, the groups are small and methodologies are different. Four other longitudinal studies have assessed the effect of treatment with proton pump inhibitors (PPIs) on the improvement of symptoms of CRS, but the results were conflicting. Conclusions: There seems to be relative prevalence of reflux with intractable CRS. There is still a lack of controlled studies with a significant number of patients to confirm this hypothesis. Few studies specifically assess the impact of treatment of reflux on symptom improvement in patients with CRS