Is the difference in the volume of the pharyngeal space, as measured by acoustic pharyngometry, before and after tonsillectomy proportional to the volume of the excised tonsils?

OBJECTIVE: Adenotonsillectomy is recognized as an effective therapy for snoring and sleep disorders in children. It is important to understand whether adenotonsillectomy significantly increases the volume of the pharyngeal space. The goal of this study was to evaluate the change in oropharyngeal volume after adenotonsillectomy and the correlation of this change with the objective volume of the tonsils and body mass index. METHODS: We included 27 subjects (14 males) with snoring caused by tonsil and adenoid hypertrophy. The mean age of the subjects was 7.92 (±2.52) years. Children with craniofacial malformations or neuromuscular diseases or syndromes were excluded. The parents/caregivers answered an adapted questionnaire regarding sleep-disordered breathing. All patients were subjected to weight and height measurements and body mass index was calculated. The subjects underwent pharyngometry before and after adenotonsillectomy and the volume of both excised tonsils together was measured in cm3 in the operating room. RESULTS: Pharyngometric analysis showed that the mean pharyngeal volume was 28.63 (±5.57) cm3 before surgery and 31.23 (±6.76) cm3 after surgery; the volume of the oropharynx was significantly increased post-surgery (p=0.015, Wilcoxon test). No correlation was found between the objective tonsil volume and the post-surgical volume increase (p=0.6885). There was a fair correlation between the oropharyngeal volume and body mass index (p=0.0224). CONCLUSION: Adenotonsillectomy increases the volume of the pharyngeal space, but this increase does not correlate with the objective tonsil size. Furthermore, greater BMI was associated with a smaller increase in the pharyngeal volume. Oropharyngeal structures and craniofacial morphology may also play a role in the increase in oropharyngeal volume.

Fechamento de comunicação buco-antral com a bola adiposa de bichat: relato de caso / Closure of oroantral communication using buccal fat pad graft: case report

Introdução: Existem muitas causas de fístulas que envolvem a cavidade nasal, sinusal ou ambas, podendo estas ser resultado de uma entidade patológica ou secundárias à remoção de lesões tumorais ou císticas dos maxilares. Contudo, as fístulas buco-antrais são freqüentes pós-extrações de dentes molares e prémolares superiores. Isso é favorecido pela íntima relação entre os ápices desses dentes e os seios maxilares associados à diminuta espessura do assoalho destes seios. Quando ocorre uma falha no fechamento primário dessas fístulas durante as primeiras três semanas pode ser indicada uma reparação secundária. No tratamento dessas comunicações estão presentes manobras que visam o fechamento de forma direta ou com o deslizamento de retalhos mucosos, todos com um mesmo alto índice de insucesso. Objetivo: O presente artigo tem a intenção de relatar um caso clínico de fechamento secundário de fístula bucoantral. Relato do Caso: Tratamento cirúrgico de fístula buco-antral presente há 6 meses, pós exodontia de molar, pelo uso da técnica da bola adiposa da bochecha como enxerto pediculado associado ao uso de retalho mucoso. Conclusão: O tratamento mencionado é um método cientemente simples, completo e permite uma extensa aplicabilidade na maioria dos casos.

Introduction: There are many causes of fistulas that involve the nasal and antral cavities or both. They may result from pathological entities or secondary to removal of tumors or maxillary cysts. However, the extraction of a maxillary molar or premolar is the most common cause of oroantral fistula. This is explained by the close relationship between the apex of these teeth and the thinness of the antral floor. When the primary fistula repair fails to heal spontaneously during the first three weeks after surgery, a secondary repair may be indicated. During treatment process of the fistulas, there are procedures to make a direct close or the use of a sliding mucosal flap, all techniques own an equal and high degree of failure. Objective: To show a case report of oroantral fistula and its closure. Case Report: A 6-month-Surgical treatment of oroantral fistula, after a tooth removal, using the buccal fat pad method as a pedicled graft associated with a sliding mucosal flap. Conclusion: The mentioned treatment is simple, complete and allows an extensive applicability in most of cases.

Fibroma ossificante periférico maxilar: relato de caso clínico / Peripheral ossifying fibroma of the maxilla: case report

O fibroma ossificante periférico é um tumor benigno de crescimento lento, que pode produzir recidiva após exérese. Possui origem fibro-óssea e é encontrado na maioria das vezes no osso maxilar. Clinicamente, caracteriza-se por um aumento volumétrico assintomático, que pode determinar, com o tempo, assimetria facial. Objetivo: Descrever um caso de fibroma ossificante de grandes dimensões em maxila. Relato do Caso: Paciente de 32 anos, sexo feminino, com um tumor de crescimento lento na maxila, atípico por suas grandes dimensões e aspecto clínico, levando à assimetria facial, dificuldade mastigatória, da fala e disfagia. Foi submetida à cirurgia de remoção da lesão juntamente com os prováveis fatores irritantes, sendo o diagnóstico histológico de fibroma ossificante periférico. Conclusão: É importante que se remova completamente a lesão para minimizar a tendência à recidiva, incluindo o periósteo subjacente e o ligamento periodontal, além dos prováveis fatores causais.

The peripheral ossifying fibroma is a slow growth benign tumor that may induce recurrence after removal. It is of fibro-osseous origin and it is commonly found on maxillary bone. It is of asymptomatic growth that may induce facial asymmetry. Objective: This article presents a clinical case of peripheral ossifying fibroma. Case Report: A-32-year-old female patient presented a slow growth tumor in the maxilla; atypical for its dimensions and appearance; leading to facial asymmetry, masticatory, deglution and dysphagia problems. She underwent surgery for lesion excision and likely irritating factors, and was diagnosed with Peripheral Ossifying Fibroma. Conclusion: It is important to completely remove the lesion to reduce the possible recurrences; the periosteum, the periodontal ligament and other factors should be included.