Disyunción Maxilar / Maxillar disjunction

RESUMEN La disyunción maxilar rápida es un procedimiento ortopédico en el que se realizan una serie de activaciones diarias a un tornillo de expansión que actúa sobre la sutura palatina media y provoca la apertura de la misma en un breve período de tiempo, puede acompañarse de excesiva sintomatología en los pacientes. El objetivo de este trabajo es mostrar los beneficios aportados por la disyunción palatina del maxilar al aplicar solamente una activación diaria (1/4 de vuelta). Para ello se empleó un tornillo tipo Hyrax en un paciente masculino de 14 años de edad que presentaba una maloclusión dental de Clase III de Angle (Sindrómica Clase I), acompañada de un micrognatismo transversal superior mayor de 4 mm, una mordida cruzada posterior bilateral y presencia de curva de Monzón, que indica endognasia del maxilar. En un período de tiempo de siete semanas se logró la apertura de la sutura palatina media y por consiguiente, el incremento de la longitud del arco dentario, la eliminación del apiñamiento además de la corrección de la mordida cruzada anterior y posterior bilateral, con escasa sintomatología referida por el paciente (AU).

ABSTRACT The rapid maxillary disjunction is an orthopedic procedure in which an expansion screw acting upon the medial palatal suture, is activated every day and causes its aperture in a short period of time, accompanied by an excessive symptomatology in the patients. The aim of this paper is showing the benefits provided by the maxillary palatal disjunction when activated only once a day (1/4 turn). A Hyrax type screw was used in a 14 years-old male patient who had an Angle´s Class III malocclusion (Syndromic Class I) together with a transversal superior micrognathism larger than 4 mm and a posterior bilateral cross bite with a Monzon´s curve indicating maxillary endognathia. The results showed the expansion of the medial palatal suture in seven weeks and as a consequence the expansion of the dental arch, the alleviation of dental crowding, and the correction of the anterior and posterior bilateral cross bite and what is most important, the distress caused to the patient was minimal AU).

Tratamento ortodôntico e ortopédico da mordida cruzada posterior / Orthodontic and orthopedic treatment of posterior crossbite

O presente estudo teve como objetivo revisar os trabalhos no que se diz respeito ao tratamento da mordida cruzada posterior e apresentar um caso clínico de uma paciente com mordida cruzada posterior e anterior tratada com disjuntor de Haas e máscara facial. Com uma estimativa de 8% a 23,5%, a mordida cruzada posterior é a má oclusão de maior frequência na clínica, sendo que estes números são similares tanto na dentição decídua quanto na permanente. Os fatores etiológicos podem ser hábitos viciosos, problemas respiratórios, interferências oclusais, más formações congênitas, entre outros, podendo agir isolados ou em conjunto. O tratamento deste tipo de má oclusão exige, além de um conhecimento do profissional para definir qual a melhor terapêutica de acordo com a idade do paciente, um diagnóstico minucioso por diversos meios preconizados como análise clínica, modelos de estudo, telerradiografias em norma lateral e frontal, auxiliando o clínico na elaboração de um plano de tratamento adequado e, como consequência, levando a um prognóstico mais favorável desta má oclusão. A expansão rápida da maxila ou disjunção, além de corrigir a deficiência transversa da maxila, proporciona diversas mudanças na oclusão como expansão indireta do arco inferior, melhora na estética do sorriso e auxílio no tratamento de Classe II. O tratamento deve ser realizado, preferencialmente, na dentadura decídua...

This study aimed to perform a literature review on the treatment of posterior crossbite and present the clinical case of a patient with posterior and anterior crossbite treated with breaker Haas and facemask. The posterior crossbite is the most frequent malocclusion, an estimative of 8% and 23.5%, in both deciduous and permanent dentitions. The etiological factors may include vicious habits, respiratory problems, occlusal interference, and congenital malformations, among others. These factors may act alone as well as combined. Beside a proper knowledge of the professional that will determine the best approach based on the age of the patient, the treatment of this malocclusion also requires an accurate diagnosis obtained through clinical analysis, study models, frontal and lateral teleradiographs. Thereby, a detailed diagnosis may assist the clinician on the development of a treatment plan that may lead to a more favorable prognosis. The fast maxillary expansion, or disjunction, in addition to correct the transverse maxillary deficiency also provides several changes in the occlusion such as indirect expansion of the lower arch, improvement of dental aesthetics, and assistance on the treatment of Class II. This kind of treatment should be conducted in patients with deciduous dentition...

As dores do parto. Reflexões psicopatológicas em torno da angústia e do narcisismo primitivo / The pains of childbirth. Psychopathological reflections around anxiety and primitive narcissism / Los dolores del parto. Reflexiones psicopatológicas en torno de la angustia y del narcisismo primitivo

Este trabalho tem como ponto de partida os enigmas suscitados pelo discurso de duas pacientes para refletir sobre as dores do parto e o pathos nele implicado. O trabalho visa aprofundar a dimensão dolorosa do nascimento, posto que nele opera um processo de disjunção. Analisa-se como a dor e o sofrimento vivenciados por Tânia e Luíza no momento do parto configuram a angústia atrelada ao inquietante e ao narcisismo primitivo. O texto também ressalta a "lavagem das dores" como possibilidade terapêutica, a qual viabiliza a passagem da angústia provocada pela disjunção para a emergência do amor materno...

This work has as starting point the enigmas raised by the speech of two patients in order to reflect about the pain of childbirth and the pathos involved in it. The paper seeks to deepen the painful dimension of childbirth, as it operates a process of disjunction. It analyzes how the pain experienced by Tânia and Luíza at the time of childbirth configures the anxiety related with the uncanny and the primitive narcissism. The text also highlights the "washing of the pains" as a therapeutic option that eases the passage of the anxiety caused by the disjunction towards the emergence of maternal love...

Este trabajo tiene como punto de partida los enigmas suscitados por el discurso de dos pacientes para reflexionar en torno de los dolores del parto y el "pathos" en el implicado. El trabajo busca profundizar en la dimensión dolorosa del nacimiento puesto que en este opera un proceso de disyunción. Se analiza como el dolor vivenciado por Tânia e Luíza en el momento del parto configura la angustia relacionada con lo inquietante y el narcisismo primitivo. El texto también resalta la "limpieza de los dolores" como posibilidad terapéutica que viabiliza el pasaje de la angustia provocada por la disyunción hacia la emergencia del amor materno...

Mosaic double aneuploidy: Down syndrome and XYY.

Chromosomal abnormalities are seen in nearly 1% of live born infants. We report a 5‑year‑old boy with the clinical features of Down syndrome, which is the most common human aneuploidy. Cytogenetic analysis showed a mosaicism for a double aneuploidy, Down syndrome and XYY. The karyotype was 47, XY,+21[19]/48, XYY,+21[6]. ish XYY (DXZ1 × 1, DYZ1 × 2). Mosaic double aneuploidies are very rare and features of only one of the aneuploidies may predominate in childhood. Cytogenetic analysis is recommended even if the typical features of a recognized aneuploidy are present so that any associated abnormality may be detected. This will enable early intervention to provide the adequate supportive care and management.

Estudio anatómico de la región pterigopalatina en cráneos macerados de brasileños con el objetivo de contribuir al desarrollo de la técnica de disyunción de la sutura esfenomaxilar / Anatomical study of the pterigopalatine region in macerated skulls of brazilians aiming to contribute to the improvement of spheno-maxillary suture disjunction technique

Una de las técnicas utilizadas en cirugía ortognática es la osteotomía Le Fort I en la cual un paso quirúrgico importante es la disyunción de la sutura esfenomaxilar. Durante este procedimiento a veces ocurren complicaciones quirúrgicas, tales como lesiones neurovasculares, debido principalmente a la falta de conocimiento de la anatomía de la región y posicionamiento inadecuado de los cinceles. El objetivo de este estudio fue contribuir para que esta técnica sea más predecible, ofreciendo datos morfométricos de los principales reparos anatómicos de la región pterigopalatina. El valor promedio de la altura de la sutura esfenomaxilar fue 13,22mm en hombres y 12,47mm en mujeres; el valor promedio del ancho de la sutura esfenomaxilar fue 11,40mm en hombres y 11,02mm en mujeres; el valor promedio de la distancia del punto de mayor concavidad de la cresta cigomatoalveolar hasta la sutura esfenomaxilar fue 25,12mm en hombres y 23,80mm en mujeres; el valor promedio de la distancia desde el punto más inferior de la sutura esfenomaxilar hasta la fisura orbitaria inferior fue 31,12mm en hombres y 29,61mm en mujeres. Los valores obtenidos en nuestra investigación pueden ser utilizados como parámetros para la realización de la técnica de disyunción de la sutura esfenomaxilar, haciéndola más predecible y con menor riesgo de complicaciones.

Among the techniques used in orthognathic surgery is the Le Fort I osteotomy in which a important surgical step is the disjunction of the spheno-maxillary suture. During this procedure surgical complications, such as neurovascular injuries sometimes occur, mainly due to lack of knowledge of regional anatomy and poor positioning of chisels. The aim of this work is to contribute for this surgical technique to become more predictable, offering morphometric data of the main anatomical landmarks of the pterygopalatine region. The height of the spheno-maxillary suture was on average 13.22mm in men and 12.47mm in women; the width of the spheno-maxillary suture was on average 11.40mm in men and 11.02mm in women, the distance from the point of greatest concavity of zigomaticoalveolar crest until spheno-maxillary suture was on average 25.12mm in men and 23.80mm in women; the distance between the lowest portion of the spheno-maxillary suture and the inferior orbital fissure was on average 31.12mm in men and 29.61mm in women. The values obtained in our study may be used as a parameter in performing the technique of spheno-maxillary suture disjunction, making it more predictable and with less risk of complications.

Discerning non-disjunction in down syndrome patients by means of GluK1-(AGAT) n and D21S2055-(GATA) n microsatellites on chromosome 21.

Introduction: Down syndrome (DS), the leading genetic cause of mental retardation, stems from non-disjunction of chromosome 21. Aim: Our aim was to discern non-disjunction in DS patients by genotyping GluK1-(AGAT) n and D21S2055-(GATA) n microsatellites on chromosome 21 using a family-based study design. Materials and Methods: We have used a PCR and automated DNA sequencing followed by appropriate statistical analysis of genotype data for the present study Results and Discussion: We show that a high power of discrimination and a low probability of matching indicate that both markers may be used to distinguish between two unrelated individuals. That the D21S2055-(GATA) n allele distribution is evenly balanced, is indicated by a high power of exclusion [PE=0.280]. The estimated values of observed heterozygosity and polymorphism information content reveal that relative to GluK1-(AGAT) n [H obs =0.286], the D21S2055- (GATA) n [H obs =0.791] marker, is more informative. Though allele frequencies for both polymorphisms do not conform to Hardy-Weinberg equilibrium proportions, we were able to discern the parental origin of non-disjunction and also garnered evidence for triallelic (1:1:1) inheritance. The estimated proportion of meiosis-I to meiosis-II errors is 2:1 in maternal and 4:1 in paternal cases for GluK1-(AGAT) n , whereas for D21S2055-(GATA) n , the ratio is 2:1 in both maternal and paternal cases. Results underscore a need to systematically evaluate additional chromosome 21-specific markers in the context of non-disjunction DS.

Estudio genómico de la región crítica del cromosoma 21 asociada con el síndrome de Down / Genomic study of the critical region of chromosome 21 associated to Down syndrome

Introduction: Previous reports have identified a region of chromosome 21 known as Down syndrome critical region (DSCR) in which the expression of some genes would modulate the main clinical characteristics of this pathology. In this sense, there is currently limited information on the architecture of the DSCR associated. Objective: To obtain in silico a detailed vision of the chromatin structure associated with the evaluation of genomic covariables contained in public data bases. Methods: Taking as reference the information consigned in the National Center for Biotechnology Information, the Genome Browser from the University of California at Santa Cruz and from the HapMap project, a chromosome walk along 21 Mb of the distal portion of chromosome 21q arm was performed. In this distal portion, the number of single nucleotide polymorphisms (SNP), number of CpG islands, repetitive elements, recombination frequencies, and topographical state of that chromatin were recorded. Results: The frequency of CpG islands and Ref genes increased in the more distal 1.2 Mb DSCR that contrast with those localized near to the centromere. The highest level of recombination calculated for women was registered in the 21q22.12 to 22.3 bands. DSCR 6 and 9 genes showed a high percentage of methylation in CpG islands in DNA from normal and trisomic fibroblasts. The DSCR2 gene exhibited high levels of open chromatin and also methylation in some lysine residues of the histone H3 as relevant characteristics. Conclusion: The existence of a genomic environment characterized by high values of recombination frequencies and CpG methylation in DSCR 6 and 9 and also DSCR2 genes led us to postulate that in non-disjunction detected in Down syndrome, complex genomic, epigenetic and environmental relationships regulate some processes of meiosis.

Introducción: Análisis previos han identificado una región del cromosoma 21, conocida como región crítica del síndrome de Down (DSCR) en donde se localizan algunos genes cuya expresión modularía las principales características clínicas de este síndrome. En este sentido, existe poca información detallada sobre la arquitectura de la cromatina asociada con la DSCR. Objetivo: Obtener in silico, a partir de la evaluación de covariables genómicas contenidas en bases de datos públicas, una visión detallada de la estructura cromatina asociada con la DSCR. Métodos: Tomando como referencia la información consignada en el National Center for Biotechnology Information, el Genome Browser de la Universidad de California en Santa Clara y el proyecto internacional HapMap, se efectuó un paseo cromosómico a lo largo de 21Mb de la porción distal del brazo q del cromosoma 21, para registrar el número de polimorfismos de nucleótido único, el de islas CpG, de secuencias repetidas, las tasas de recombinación y el estado topológico de la cromatina asociada. Resultados: La frecuencia de islas CpG y de genes referenciados se incrementó en los últimos 1,2 Mb de la región distal en contraste con su distribución pericentromérica. La mayor tasa de recombinación calculada en este estudio para mujeres se registró en las bandas 21q22.13 y 21q22.3. Los genes DSCR 6 y 9 presentaron un elevado grado de metilación en islas CpG tanto en fibroblastos normales como en trisómicos. En el gen DSCR2 se observó un alto grado de descondensación cromatínica, además de metilación de diferentes residuos de lisina de la histona H3. Conclusiones: La existencia de un ambiente genómico caracterizado por tener elevadas tasas de recombinación y de metilación de genes DSCR 6 y 9, permite postular que en la no disyunción asociada con el SD, operarían complejas interacciones genómicas, epigenéticas y ambientales que actuarían en algunos procesos meióticos.

Avaliação e mensuração da sutura palatina mediana por meio da radiografia oclusal total digitalizada em pacientes submetidos à expansão rápida maxilar / Evaluation and measurement of midpalatal suture through the digitalized occlusal radiography in patients submitted to rapid maxillary expansion

OBJETIVOS: avaliar e mensurar a sutura palatina mediana por meio de radiografias oclusais totais de maxila digitalizadas, antes e depois da sua disjunção. MÉTODOS: a amostra constou de 17 pacientes, com idades entre 7 e 22 anos. Radiografias oclusais totais da maxila foram executadas antes e depois da abertura da sutura palatina mediana, e digitalizadas em scanner HP Scanjet 6110 C com adaptador de transparências HPC 6261 6100 C, utilizando-se o programa Deskscan II. Para a avaliação e medição, foi utilizado o programa Radioimp® (Radiomemory, MG/Brasil). Na análise estatística, foram utilizados a média, o desvio-padrão, o coeficiente de variação e os testes "t" e ANOVA. CONCLUSÕES: após os resultados, foi possível concluir que (1) na região dos incisivos, houve uma abertura palatina mediana estatisticamente significativa; (2) houve abertura de diastema entre os incisivos centrais superiores em torno de 69,37 por cento dos casos; (3) houve uma maior abertura da sutura palatina mediana na região a 10mm a partir da crista para posterior, em comparação com a região a 3mm para posterior do parafuso expansor; (4) na região a 3mm para posterior do parafuso expansor houve uma abertura de 35,97 por cento, e na região a 10mm para posterior da crista uma abertura de 69,37 por cento.

AIM: to evaluate and to measure the midpalatal suture through digitalized occlusal radiographies before and after its disjunction. METHODS: The sample was comprised by 17 patients, with ages from 7 to 22 years. Occlusal radiographies of these patients were obtained before and after the suture's opening. The occlusal radiographies were digitalized in a HP Scanjet 6100 C scanner with the HPC 6261 6100 C transparencies adaptor and the Deskscan II software. The statistical analysis used average, standard deviation, variation coefficient, "t" test and ANOVA. CONCLUSIONS: After the results, it was possible to conclude that: (1) statistically, there was a significant midpalatal opening in the incisors area; (2) there was an opening in the diastema between upper central incisors in about 69.37 percent of the cases; (3) there was a bigger midpalatal suture opening in the 10mm area from the crest to posterior than in the 3mm area to posterior from the screw; (4) in the 3mm area to posterior from the screw there was an opening of 35.97 percent and in the 10mm area to posterior of the crest there was an opening of 69.37 percent.

Má oclusão de Classe I de Angle, com tendência à classe III esquelética, tratada com controle de crescimento / Angle Class I malocclusion, with class III skeletal tendency, treated with growth control

A má oclusão de Classe III de Angle é caracterizada por uma relação dentária anteroposterior inadequada, que pode ou não estar acompanhada de alterações esqueléticas. Em geral, o aspecto facial fica bastante comprometido, principalmente quando associada à deficiência no terço médio da face, sendo esse, na maioria das vezes, o principal fator que motiva o paciente a procurar tratamento. Este caso foi apresentado à Diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO), representando a categoria livre, como parte dos requisitos para a obtenção do título de Diplomado pelo BBO.

Angle Class III malocclusion is characterized by an anteroposterior dental alteration, which might be accompanied by skeletal deformities. Usually, the facial aspect becomes aesthetically compromised, mostly when the middle third of the face is affected (this is the main reason why patients seek for treatment).This case was presented to the directorship of the Brazilian Board of Orthodontics and Facial Orthopedics (BBO), standing for the free category, as a part of the requirements to obtain the Board's Certificate.

Applying a Smaller Incision to Treat Fresh Closed Heel Tendon Disjunction / 昆明医科大学学报

Objective To study the effects of emergency operation with 2~5 cm incision to treat fresh closed heel tendon disjunction.Method 23 cases of fresh closed heel tendon disjunction were operated in post-injury 3~12 hours and the incisions were 2~5 cm long. Results None of these cases was complicated with wound infection or cutaneous necrosis.The follow-up was from 6 months to 6 years,averaging 2.2 years;in which,according to the Arner-Lindholm standards,20 were excellent,3 were good.Conclusion A satisfactory effect can be obtained through the smaller incision to treat the fresh closed heel tendon disjunction.