Proposal for the Modification of the Method to Evaluate the Midpalatal Suture Maturation Status / Proposta de Modificação do Método para Avaliação do Status da Sutura Palatina Mediana

The objective of present research was to propose a new definition for the midpalatal suture (MPS) maturational stages through reevaluation of intermediate stages B, C and D. The sample was composed by 158 cone-beam computed tomography (CBCT) of individuals between 11 and 20 years of age (±15.4 years, 86 females and 71 males), divided into two groups: 74 individuals aged 11-15 years and 84 individuals aged 16-20 years. The CBCT scans were applied to evaluate midpalatal suture maturation status and comprised stages previously classified as B (29), C (92) and D (37). Each axial image was subdivided into six parts in the anteroposterior direction, and each portion was classified according to MPS maturational evaluation methodology. New definitions of stages were proposed. The reliability of the method was tested by two examiners and the intra- and inter-examiner concordances were defined for each evaluation through weighted kappa coefficients and 95% confidence intervals. The chi-square test was used to compare the groups. In all statistical tests, a significance level of 5% was adopted. Two new maturational stages were defined: sub-stage C- and sub-stage C+, with prevalence of 12% and 8.9%, respectively, in 11 to 20-year-olds. The redefinition and validation of the maturational stages of MPS, considering the sub-stages C- and C+, may allow to elucidate the difference in the prognosis of Rapid Maxillary Expansion among individuals aged 11 to 20 years. This data should be confirmed through a clinical study.(AU)

O objetivo da presente pesquisa foi propor uma nova definição para os estágios maturacionais da sutura palatina média (MPS) por meio da reavaliação dos estágios intermediários B, C e D. A amostra foi composta por 158 tomografias computadorizadas de feixe cônico (TCFC) de indivíduos entre 11 e 20 anos de idade (±15,4 anos, 86 do sexo feminino e 71 do sexo masculino), divididos em dois grupos: 74 indivíduos de 11 a 15 anos e 84 indivíduos de 16 a 20 anos. Os exames de TCFC foram aplicados para avaliar o estado de maturação da sutura palatina média e compreenderam os estágios previamente classificados como B (29), C (92) e D (37). Cada imagem axial foi subdividida em seis partes no sentido anteroposterior, e cada porção foi classificada de acordo com a metodologia de avaliação maturacional MPS. Novas definições de estágios foram propostas. A confiabilidade do método foi testada por dois examinadores e as concordâncias intra e interexaminadores foram definidas para cada avaliação por meio de coeficientes kappa ponderados e intervalos de confiança de 95%. O teste do qui-quadrado foi utilizado para comparar os grupos. Em todos os testes estatísticos adotou-se o nível de significância de 5%. Dois novos estágios maturacionais foram definidos: subestágio C- e subestágio C+, com prevalência de 12% e 8,9%, respectivamente, em jovens de 11 a 20 anos. A redefinição e validação dos estágios maturacionais da MPS, considerando os subestágios C- e C+, podem permitir elucidar a diferença no prognóstico da Expansão Rápida da Maxila entre indivíduos de 11 a 20 anos. Esses dados devem ser confirmados por meio de um estudo clínico.(AU)

Disseminated Nasal subtype Extranodal NK/T-cell lymphoma and its diagnostic difficulties in antemortem biopsies

ABSTRACT Extranodal NK/T- cell lymphoma (ENKTCL) is an aggressive lymphoma driven by Epstein-Barr virus (EBV) infection in genetically susceptible individuals. It was historically called a lethal midline granuloma. Due to the angio-destructive nature of ENKTCL, lymphoma cells are often accompanied and masked by necrosis and dense inflammation in the biopsy. Further, the biopsy may show vasculitis, which can mimic granulomatosis with polyangiitis. Due to these masquerades, ENKTCL is often misdiagnosed in the biopsy. Several biopsies may be required to establish the diagnosis. We describe the clinical course and autopsy findings of a young female who presented with a hard-palate ulcer. Antemortem biopsies failed to establish the diagnosis. The autopsy revealed an advanced nasal subtype of Extranodal NK/T-cell lymphoma with dissemination to the kidneys, adrenals, liver, spleen, and small intestine.

Case report on adenoid cystic carcinoma of palate with review of literature

Adenoid cystic carcinoma (ACC) is a malignant tumor of minor salivary glands of the oral cavity, particularly the palate which accounts for about 5–10%. These tumors are slow growing with a high incidence of local recurrence, perineural invasion, and distant metastasis. Here, we report the case of a 69-year-old female who presented with swelling over the hard palate. Computerized tomography shows enhancing lesion along the undersurface of the left side of the hard palate, abutting the maxillary alveolus in the region of the second premolar and first two molars. There was no erosion of the inner cortex of the maxillary alveolus and no extension into the nasal cavity. Following the biopsy, she underwent a left hard palatectomy with upper alveolar resection. The final histopathological report confirmed ACC with no perineural invasion. Following she received adjuvant radiotherapy using an intensity-modulated radiotherapy technique. Now at 6 months of follow-up, there was no evidence of recurrence. Thus, our patient requires long-term follow-up to assess the benefit and survival outcome.

Longitud del maxilar superior en relación con el biotipo facial en individuos de Cuenca, Ecuador

RESUMEN Introducción: El crecimiento y desarrollo craneofacial pueden ser evaluados mediante las radiografías cefálicas laterales, con el fin de brindar un buen diagnóstico y un plan de tratamiento efectivo. Objetivo: Identificar la relación entre la longitud del maxilar superior y el biotipo facial en individuos de 18 a 45 años de la ciudad de Cuenca, Ecuador, durante el año 2019. Método: Se realizó un estudio cuantitativo, descriptivo y relacional, la muestra fue de 160 radiografías cefálicas laterales obtenidas en un centro radiológico dental maxilofacial de la ciudad de Cuenca. Se utilizó el software AutoCAD para el trazado cefalométrico. Para el análisis estadístico se usó la prueba de Kruskal-Wallis y la prueba post hoc de Tukey con un nivel de confiabilidad del 95 % (p<0,05). Se utilizó el coeficiente de correlación Rho de Spearman para determinar la relación entre la longitud maxilar (mm) y la medición esqueletal. Resultados: Se encontró que la longitud del maxilar superior de acuerdo al biotipo facial es menor en el alto y aumenta en el bajo; el biotipo facial alto presentó la menor longitud maxilar (52,18 ±4,20 mm) y el promedio más alto fue el medio-bajo (54,37 ±4,15 mm). En el sexo masculino el promedio más alto se observó en el biotipo bajo (55,38 ±4,55 mm) y el menor valor fue en el biotipo medio alto (53,10 ±3,23 mm), en el sexo femenino el promedio más alto se encontró en el biotipo facial medio bajo (53,84 ±4,01 mm) y el promedio más bajo fue en el biotipo alto (51,64 ±3,68 mm). Conclusiones: En la medida que el biotipo facial aumenta la longitud del maxilar disminuye. No existe una relación significativa entre la longitud maxilar y edad y entre la longitud y sexo.

ABSTRACT Introduction: Craniofacial growth and development can be evaluated through lateral head radiographs, in order to provide a good diagnosis and an effective treatment plan. Objective: To identify the relationship between the length of the upper jaw and the facial biotype in individuals aged 18 to 45 years in the city of Cuenca, Ecuador, during the year 2019. Method: A quantitative, descriptive and relational study was carried out; the sample was of 160 lateral head radiographs obtained in a maxillofacial dental radiology center in the city of Cuenca. AutoCAD software was used for the cephalometric tracing. For statistical analysis, the Kruskal-Wallis test and Tukey's post hoc test were used with a reliability level of 95% (p<0.05). Spearman's Rho correlation coefficient was used to determine the relationship between maxillary length (mm) and skeletal measurement. Results: It was found that the length of the upper jaw according to facial biotype is shorter in the upper jaw and increases in the lower; the tall facial biotype presented the shortest maxillary length (52.18±4.20 mm) and the highest average was the medium-low (54.37±4.15 mm). In males, the highest average was observed in the low biotype (55.38±4.55 mm) and the lowest value was in the medium high biotype (53.10±3.23 mm); in females, the highest average was found in the medium-low facial biotype (53.84±4.01 mm) and the lowest average was in the high biotype (51.64±3.68 mm). Conclusions: As the facial biotype increases, the length of the maxillary decreases. There is no significant relationship between maxillary length and age, or between length and sex.

RESUMO Introdução: O crescimento e desenvolvimento craniofacial podem ser avaliados por meio de radiografias laterais da cabeça, a fim de fornecer um bom diagnóstico e um plano de tratamento eficaz. Objetivo: Identificar a relação entre o comprimento do maxilar superior e o biótipo facial em indivíduos de 18 a 45 anos na cidade de Cuenca, Equador, durante o ano de 2019. Método: Foi realizado um estudo quantitativo, descritivo e relacional, a amostra foi de 160 radiografias cefálicas laterais obtidas em um centro de radiologia. O software AutoCAD foi utilizado para o traçado cefalométrico. Para análise estatística, foram utilizados o teste de Kruskal-Wallis e o teste post hoc de Tukey com nível de confiabilidade de 95% (p<0,05). O coeficiente de correlação de Rho Spearman foi utilizado para determinar a relação entre o comprimento maxilar (mm) e a medida esquelética. Resultados: Verificou-se que o comprimento do maxilar superior de acordo com o biótipo facial é menor nos altos e aumenta nos baixos ; o biótipo facial alto apresentou o menor comprimento maxilar (52,18 ± 4,20 mm) e a maior média foi o médio-baixo (54,37 ± 4,15 mm). No sexo masculino, a maior média foi observada no biótipo baixo (55,38 ± 4,55 mm) e o menor valor foi no biótipo médio alto (53,10 ± 3,23 mm), no sexo feminino a maior média foi encontrada no biótipo médio. - biótipo facial baixo (53,84 ± 4,01 mm) e a menor média foi no biótipo alto (51,64 ± 3,68 mm). Conclusões: À medida que o biótipo facial aumenta, o comprimento da maxila diminui. Não há relação significativa entre comprimento maxilar e idade e entre comprimento e sexo.

Evaluation of palatal dimensions in different facial patterns by using digital dental casts

ABSTRACT Objective: To analyze the variations of hard palate volume in adults with normal occlusion and different facial types and patterns, by using a three-dimensional analysis on digital casts. Methods: The dental casts of 70 Caucasian adults (28 men, 42 women), mean age of 16.4 years (SD 1.3 years), were scanned by using a tridimensional scanner (Delcam PowerSHAPE™, 2010, Birmingham, UK). Close points were selected in the gingival and cervical regions on the lingual surface of the maxillary teeth, to analyze palatal morphology. The facial patterns and types, and the measurements (width, length, height, volume) of the space on the hard palate were compared using analysis of covariance (ANCOVA), with age as the covariate, and sex as the independent variable. The significance level of 5% (p < 0.05) was adopted. Results: This study showed that the measurements of the width and length were similar among the mesofacial, dolichofacial and brachyfacial facial types, although the height and volume of the space on the hard palate were slightly smaller in dolichofacial individuals, and both Pattern I and Pattern II individuals showed no significant changes for the four measurements. The mean values among facial patterns were: Pattern I - width 38.31±2.59 mm; length 37.44±2.42 mm; height 17.03±2.42 mm and volume 10.52±1.72 mm3; Pattern II - width 37.48±2.44 mm; length 37.48±2.44 mm; height 16.79±2.42 mm and volume 10.41±1.65 mm3 (p>0.05 for all variables). Conclusion: There were no significant differences for the facial patterns and facial types of the individuals compared in the analyzed sample.

RESUMO Objetivo: Analisar as variações do volume do palato duro em adultos com oclusão normal e diferentes tipos e padrões faciais, por meio de análise tridimensional em modelos digitais. Métodos: Os modelos das arcadas dentárias de 70 adultos caucasianos (28 homens, 42 mulheres), média de idade de 16,4 anos (DP 1,3 anos), foram digitalizados usando um scanner tridimensional (Delcam PowerSHAPE™, 2010, Birmingham, Reino Unido). Pontos próximos foram selecionados nas regiões gengival e cervical na superfície lingual dos dentes superiores, para analisar a morfologia palatina. Os padrões e tipos faciais e as medidas (largura, comprimento, altura, volume) do espaço no palato duro foram comparados por meio de análise de covariância (ANCOVA), com a idade como covariável e o sexo como variável independente, a um nível de significância de 5% (p< 0,05). Resultados: O presente estudo mostrou que as medidas de largura e comprimento foram semelhantes entre os tipos faciais mesofacial, dolicofacial e braquifacial, embora a altura e o volume do espaço no palato duro tenham sido ligeiramente menores nos indivíduos dolicofaciais, e tanto os indivíduos do Padrão I quanto do Padrão II não apresentaram alterações significativas para as quatro medidas. Os valores médios entre os padrões faciais foram: Padrão I - largura 38,31±2,59 mm, comprimento 37,44±2,42 mm, altura 17,03±2,42 mm, volume 10,52±1,72 mm3; Padrão II - largura 37,48±2,44 mm, comprimento 37,48±2,44 mm, altura 16,79±2,42 mm, volume 10,41±1,65 mm3 (p>0,05 para todas as variáveis). Conclusão: Não houve diferenças significativas para os padrões faciais e tipos faciais dos indivíduos comparados na amostra analisada.

Agreement among instruments of quantitative evaluation of the hard palate in children / Concordância entre instrumentos de avaliação quantitativa do palato duro em crianças

ABSTRACT Purpose To evaluate the agreement among instruments of the quantitative evaluation of hard palate. Methods This cross-sectional study was performed with a sample of 30 children aged 6 to 11 from Santa Maria, Southern Brazil. The instruments for palate measurements evaluated were: digital caliper, used directly in the oral cavity and in plaster casts, Korkhaus tridimensional bow, used directly in the oral cavity and in plaster casts, and Dolphin Imaging Software used for measurements in cone-beam computed tomography (CBCT). The agreement among different instruments was evaluated using the Intraclass Correlation Coefficient (ICC). Results The means of all transversal dimensions obtained by cone-beam computed tomography were lower than those of the other instruments - the agreement values in the width between the canines and in the width between the first molars were lower when comparing the cone-beam computed tomography and the other instruments. In the width between the first and second premolars, all comparisons showed acceptable agreement values. Good concordance values were obtained when comparing the palate depth at the second premolar region when using a bow divider inside the oral cavity and in the cast. Conclusion Most instruments presented satisfactory agreement in the measurements related to the transverse plane of the hard palate. However, when the vertical plane was evaluated, only the bow divider applied to both cast and oral cavity presented ideal agreement.

RESUMO Objetivo Avaliar a concordância entre instrumentos de avaliação quantitativa do palato duro. Método Este estudo transversal foi realizado com uma amostra de 30 crianças de 6 a 11 anos de Santa Maria, sul do Brasil. Os instrumentos de medidas do palato avaliados foram: paquímetro digital, utilizado diretamente na cavidade oral e em modelos de gesso, arco tridimensional Korkhaus, usado diretamente na cavidade oral e em modelos de gesso, e Dolphin Imaging Software utilizado para medições em tomografia computadorizada de feixe cônico (CBCT). A concordância entre os diferentes instrumentos foi avaliada por meio do Coeficiente de Correlação Intraclasse (ICC). Resultados As médias de todas as dimensões transversais obtidas pela tomografia computadorizada de feixe cônico foram menores do que as dos outros instrumentos - os valores de concordância na largura entre os caninos e na largura entre os primeiros molares foram baixos na comparação entre a tomografia computadorizada de feixe cônico e os demais instrumentos. Na largura entre o primeiro e o segundo pré-molar, todas as comparações apresentaram valores de concordância aceitáveis. Valores de concordância aceitáveis também foram obtidos ao comparar a profundidade do palato na região do segundo pré-molar com o uso de um divisor de arco dentro da cavidade oral e no gesso. Conclusão A maioria dos instrumentos apresentou concordância satisfatória nas medidas relacionadas ao plano transverso do palato duro. Porém, quando avaliado o plano vertical, apenas o divisor de arco aplicado tanto no gesso quanto na cavidade oral apresentou concordância ideal.

Reference parameters for normality and associated factors to hard palate during mixed dentition phase / Parâmetros de referência para normalidade e fatores associados ao palato duro durante a fase de dentição mista

ABSTRACT Purpose To evaluate the association among dimensions of the hard palate according to the sexes, skin color, and periods of the mixed dentition and present reference parameters of normality for this stage of development. Methods This cross-sectional study evaluated a representative sample of children between the ages of 7 and 13 years in Santa Maria, southern Brazil. The outcomes of the study were the dimensions of the palate: width measurements and depth. Sociodemographic characteristics and related oral measures were also assessed. Adjusted linear regression model were used to evaluate the effect of the predictor's variables on the dimensions of the hard palate in millimeters. The reference standards for the hard palate normality were presented in mean, standard deviation, and 95% confidence interval. Results A total of 569 children were evaluated. The hard palate dimensions were larger in the male sex and smaller in the first transitional period of mixed dentition. Skin color had an influence on the hard palate width at the level of the premolars, and the width measurements were smaller in white individuals. Posterior cross bite, Angle Class II and III malocclusions and non-nutritional sucking habits caused reduction in the hard palate width measurements. Conclusion Different dimensions of the hard palate are influenced by demographic variables such as sex, skin color, and mixed dentition period. Children of the female sex, white-skinned and in the first transition period of mixed dentition had smaller dimensions of the hard palate. Establishing normality reference standards in measurements of the palates guides the clinical practice.

RESUMO Objetivo Avaliar a associação entre as dimensões do palato duro de acordo com os sexos, cor da pele e períodos da dentição mista e apresentar parâmetros de normalidade de referência para esta fase de desenvolvimento. Método Este estudo transversal avaliou uma amostra representativa de crianças com idade entre 7 e 13 anos em Santa Maria, sul do Brasil. Os desfechos do estudo foram as dimensões do palato: medidas de largura e profundidade. Características sociodemográficas e medidas orais relacionadas também foram avaliadas. Modelos de regressão linear ajustados foram utilizados para avaliar o efeito das variáveis preditoras sobre as dimensões do palato duro em milímetros. Os padrões de referência para a normalidade do palato duro foram apresentados em média, desvio padrão e intervalo de confiança de 95%. Resultados Foram avaliadas 569 crianças. As dimensões do palato duro foram maiores no sexo masculino e menores no primeiro período de transição da dentição mista. A cor da pele influenciou a largura do palato duro ao nível dos pré-molares, sendo as medidas de largura menores nos brancos. Mordida cruzada posterior, más oclusões de Classe II e III de Angle e hábitos de sucção não nutricionais causaram redução nas medidas da largura do palato duro. Conclusão As diferentes dimensões do palato duro são influenciadas por variáveis demográficas como o sexo, cor da pele e período de dentição mista. Crianças do sexo feminino, de cor de pele branca e no primeiro período de transição de dentição mista apresentaram menores dimensões do palato duro. O estabelecimento de padrões de referência de normalidade nas medidas do palato orienta a prática clínica.

Diferencias morfométricas en el hueso palatino de la oveja (Ovis aries) y la cabra (Capra hircus) / Morphometric palatine differences between sheep (Ovis aries) and goat (Capra hircus)

RESUMEN: Un hueso craneal muy poco estudiado en anatomía veterinaria comparada es el palatino. En nuestro estudio, realizamos la comparación de este hueso entre la oveja (Ovis aries L., 1758) y la cabra (Capra hircus L., 1758), a partir de una muestra de 36 y 17 cráneos respectivamente, y utilizando métodos de morfometría geométrica. Se eligieron un total de 32 puntos (4 hitos y 28 semi-hitos) para analizar la lámina horizontal del hueso palatino. Se reflejaron diferencias estadísticamente significativas tanto para el tamaño como para la forma. En Capra se denota una clara expansión lateral del hueso y rostral y una contracción central, con un acercamiento relativo de los forámenes palatinos, mientras que en Ovis los forámenes están más lateralmente alejados. A nuestro parecer, esta mayor anchura y longitud de la lámina horizontal en Capra se explicaría por una mayor capacidad de frotación del alimento en relación a Ovis.

SUMMARY: Palatine is a cranial bone very less studied in comparative veterinary anatomy. In our study, we performed the comparison of this bone between sheep (Ovis aries L., 1758) and goat (Capra hircus L., 1758), from a sample of 36 and 17 skulls respectively, using methods of geometric morphology. A total of 32 points (4 landmarks and 28 semi-landmarks) were chosen to analyse the horizontal lamina of the palatine bone. Statistically significant differences were reflected for both size and shape. Capra denotes a clear lateral expansion of the bone and rostral and a central contraction, with a relative approach of palatine foramina, while in Ovis foramina are more laterally distant. In our view, this greater width of the horizontal lamina in Capra would be explained by a greater capacity to rub the food compared to Ovis.

Evaluation of oral stereognosis in completely edentulous patients with palatal tori / Evaluación de la estereognosia oral en pacientes completamente edéntulos con toros palatinos

Background: The corollary is not investigated in the completely edentulous patients with palatal tori. Objective: The aim of this study was to assess the oral stereognostic ability in completely edentulous patients with palatal tori. Material and Methods: Thirty-four completely edentulous patients aged 50 to 89 years were allocated to Group 1 (without palatal tori, n=18) and Group 2 (with palatal tori, n=16). The oral stereognostic test was conducted using 6 intraoral test pieces (circle/square/rectangle/triangle/plus/toroid) that were fabricated to standard dimensions using the light cure acrylic resin. Each test piece was placed in the patient's mouth and was asked to manipulate the test piece between the tongue and the palate. The patients identified the shapes by matching them on a shape chart. Each correct identification was assigned a score of 1. The response time taken to identify each shape was recorded. Statistical computation was done using a chi - square test and Mann-Whitney U test. Results: Significant difference was observed in the overall scoring percentages between the 2 groups (p<0.05). Group 2 had lower oral stereognostic scores compared to group 1 (p<0.05). There was no statistically significant difference in the mean response time for identifying the shapes among the groups, however group 2 patients had longer response time. Conclusion: Oral stereognostic ability of the completely edentulous patients with torus palatinus was lower when compared to completely edentulous patients without tori.

Antecedentes: el corolario no se investiga en los pacientes completamente desdentados con toros palatinos. Objetivo:El objetivo de este estudio fue evaluar la capacidad estereognóstica oral en pacientes completamente edéntulos con toros palatinos. Material y Métodos: Treinta y cuatro pacientes completamente edéntulos de 50 a 89 años fueron asignados al Grupo 1 (sin toros palatinos, n = 18) y al Grupo 2 (con toros palatinos, n = 16). La prueba estereognóstica oral se realizó utilizando 6 piezas de prueba intraorales (círculo / cuadrado / rectángulo / triángulo / cruz / aro) que se fabricaron a dimensiones estándar utilizando la resina acrílica fotopolimerizable. Cada pieza de prueba se colocó en la boca del paciente y se le pidió que manipulara la pieza de prueba entre la lengua y el paladar. Los pacientes identificaron las formas haciéndolas coincidir en un gráfico de formas. A cada identificación correcta se le asignó una puntuación de 1. Se registró el tiempo de respuesta necesario para identificar cada forma. El cálculo estadístico se realizó mediante la prueba de chi-cuadrado y la prueba U de Mann-Whitney. Resultados: Se observó una diferencia significativa en los porcentajes de puntuación generales entre los 2 grupos (p<0,05). El grupo 2 tuvo puntuaciones estereognósticas orales más bajas en comparación con el grupo 1 (p<0,05). No hubo diferencia estadísticamente significativa en el tiempo medio de respuesta para identificar las formas entre los grupos, sin embargo, los pacientes del grupo 2 tuvieron un tiempo de respuesta más largo.Conclusión: La capacidad estereognóstica oral de los pacientes completamente edéntulos con torus palatino fue menor en comparación con los pacientes completamente edéntulos sin torus.

Osteosarcoma of the hard palate in a dog - case report / [Osteossarcoma em palato duro de cão - relato de caso]

The osteosarcoma (OSA) is the most diagnosed primary bone cancer in canine patients. This work reports a case of a canine, six years old, mongrel, female, intact, with an OSA in the hard palate. Physical examination detected a firm mass in the palate. Thoracic radiographs, hematological and biochemical exams, histopathological exams and computed tomography were requested. A chondroblastic OSA was diagnosed and the tumor was characterized by immunohistochemistry. There was never evidence of metastasis in this case. The treatment consisted of the combination of conventional chemotherapy, metronomic chemotherapy, and palliative care, aiming at greater survival and well-being of the patient since surgical excision was not possible due to the location and extension of the tumor. Osteogenic sarcomas of the hard palate are rarely seen and described in the literature. In this article we present a characterization of the osteosarcoma with uncommon localization in the hard palate.(AU)

O osteossarcoma (OSA) é a neoplasia óssea primária mais diagnosticada em pacientes caninos. Este trabalho relata o caso de um canino, com seis anos de idade, sem raça definida, fêmea, não castrado, apresentando OSA em região de palato duro. Ao exame clínico, constatou-se uma massa de consistência firme em região palatina. Além do exame clínico, foram solicitadas radiografias torácicas, exames hematológicos e bioquímicos, exames histopatológicos e tomografia computadorizada. Fora então dado o diagnóstico de OSA condroblástico, e o tumor foi caracterizado pela imuno-histoquímica. Não foram observadas evidências de metástases nesse caso. O tratamento instituído consistiu na combinação de quimioterapia convencional, quimioterapia metronômica e cuidados paliativos, almejando maior sobrevida e bem-estar do paciente, uma vez que a excisão cirúrgica não foi possível devido à localização e à extensão do tumor. Neste artigo, apresentou-se uma caracterização do osteossarcoma com localização incomum no palato duro.(AU)

Exostose palatina aberrante / Exostosis palatina aberrante / Aberrant palatal exostosis

RESUMO Introdução: Exostose é um crescimento ósseo benigno que comumente acomete a mandíbula e a maxila, porém raramente apresenta grandes dimensões. Objetivo: Descrever um caso de exostose palatina de apresentação rara e discutir os principais aspectos clínicos envolvidos. Relato de caso: Paciente, gênero masculino, 66 anos, melanoderma, com história de aumento de volume no palato duro com tempo de evolução indeterminado, sem queixas álgicas, porém relatava transtornos de mastigação e fonação. O conjunto da lesão obliterava toda a profundidade do palato e ocupava grande volume na cavidade oral. A Tomografia Computadorizada de Feixe Cônico demonstrava áreas bem corticalizadas na superfície da lesão e áreas centrais menos hiperdensas, compatíveis com osso medular maduro. Após exames e pareceres pós-operatórios o paciente foi submetido a tratamento cirúrgico sob anestesia geral para remoção da massa óssea e osteoplastia subjacente, a fim de dar contornos normais ao palato, e o material colhido foi enviado para a biópsia que estabeleceu o diagnóstico de exostose. O paciente evoluiu sem complicações. Conclusão: Embora a exostose seja um crescimento ósseo benigno, ela causou problemas funcionais ao paciente, necessitando assim de um tratamento cirúrgico. Após três meses da remoção, os distúrbios foram revertidos à normalidade, e a sua reabilitação protética está em andamento(AU)

RESUMEN Introducción: La exostosis es un crecimiento óseo benigno que generalmente afecta la mandíbula y el maxilar, pero rara vez es grande. Objetivo: Describir un caso de exostosis palatina rara y discutir los principales aspectos clínicos involucrados. Presentación del caso: Paciente masculino de 66 años, melanoderma, con antecedentes de aumento de volumen del paladar duro con una evolución de tiempo indefinido, trastornos de masticación y fonación El conjunto de lesiones borró toda la profundidad del paladar y ocupó un gran volumen en la cavidad bucal. La tomografía computarizada de haz cónico mostró áreas corticalizadas en la superficie de la lesión y áreas centrales menos hiperdensas, compatibles con la médula ósea madura. Después de los exámenes y consejos preoperatorios, el paciente se sometió a un tratamiento quirúrgico con anestesia general para eliminar la masa ósea con osteoplastia subyacente a fin de obtener contornos del paladar normales, y el material recolectado fue enviado para realizar biopsia que estableció el diagnóstico de exostosis. El paciente progresó sin complicaciones. Conclusiones: Aunque la exostosis es un crecimiento óseo benigno, causó problemas funcionales al paciente, por lo que requirió tratamiento quirúrgico. Tres meses después de la extracción, los trastornos han vuelto a la normalidad y su rehabilitación protésica está en proceso(AU)

ABSTRACT Introduction: Exostosis is a benign bone growth that commonly affects the jaw and maxilla, but is rarely large. Objective: Describe a case of rare palatal exostosis and discuss the main clinical aspects involved. Case presentation: A case is presented of a male 66-year-old dark-skin patient with a history of hard palate enlargement of an indefinite time of evolution, and chewing and phonation disorders. The lesions had obliterated the entire palatal depth and occupied a large section of the oral cavity. Cone beam computed tomography revealed corticalized areas on the surface of the lesion and less hyperdense central areas compatible with mature bone marrow. After preoperative examination and advice, the patient underwent surgical treatment under general anesthesia to remove the bone mass and underlying osteoplasty to obtain normal palatal contours. The material collected was sent for biopsy testing, which established the diagnosis of exostosis. The patient recovered without any complications. Conclusions: Although exostosis is a benign bone growth, in this case it caused functional problems to the patient, thus requiring surgical treatment. Three months after removal, the disorders have been reverted to normal and prosthetic rehabilitation is underway(AU)

Extensive Basal Cell Adenocarcinoma Involving Minor Salivary Gland of the Hard Palate: A Rare Entity

@#Basal cell adenocarcinoma (BCAC) is a very rare slow-growing malignant basaloid tumour of the minor salivary gland. We reported a case of BCAC of the minor salivary gland of the hard palate occurring in a 56-year-old man. BCAC shares overlapping histopathological features with the other oral basaloid cell neoplasms which carries different prognosis and treatment modality. We emphasised on the histomorphologic features and the role of immunohistochemistry panel in the differential diagnosis of BCAC in incisional biopsies.

Anatomy of the maxillary sinus ostium: a cadaveric study

Background: Recognition of the maxillary sinus position is tedious as it is small and not easily seen. A detailedknowledge of the anatomical variations of maxillary sinus opening is required for endoscopic surgeons toperform safe surgeries. The aim of the present study is to determine the anatomical location of the maxillaryostium in a cadaveric specimen. The position of the accessory maxillary sinus, if present is also noted to furtherbenefit the surgeons.Materials and Methods: Thirty bisected halves of the formalin fixed adult head and neck specimens were obtainedfrom the Department of Anatomy. The anterior part of the skull was divided in the midline and then the nasalseptum was removed taking care not to damage the osteomeatal components. Probes were used in identifyingthe location of maxillary sinus ostium. Various other parameters like vertical diameter, transverse diameter,distance between ostium and anatomical landmarks such as inferior concha and hard palate were measured.Results: In accordance to the parameters considered in the current study, the following results were observed.The maxillary sinus ostium was present in the posterior 1/3rd of the Hiatus semilunaris in 53% of the cadavers.The most common shape of maxillary sinus ostium was oval. The mean vertical and transverse diameters ofostium were 2mm and 2.6mm respectively. The perpendicular distance of the ostium from the lower border ofinferior concha was 14.6 mm and from the upper border of the hard palate was 17.5 mm.Conclusion: The knowledge about the variations in location of the maxillary sinus Ostium and the distances ofthe ostium from the major anatomical landmarks will help the maxillofacial surgeons and otolaryngeologists toperform the surgical procedures safely.

Avaliação do padrão morfológico de rugoscopia palatal em uma população brasileira / Evaluation of the morphological pattern of palatal rugoscopy in a brazilian population

Objetivo: Este estudo teve por objetivo avaliar o perfil do padrão morfológico de rugosidade palatal de alunos de graduação da Faculdade de Odontologia de Pernambuco FOP-UPE. Metodologia: A pesquisa foi do tipo prospectiva, sendo a amostra constituída de um total de 105 (cento e cinco) indivíduos. Foi realizada a moldagem do arco superior e modelos de gesso foram confeccionados. A partir dos mesmos, a análise morfológica das rugas palatais foi realizada, por um único examinador. Os parâmetros de morfologia das rugas primárias, forma da papila incisiva, direção de alinhamento das rugas, rafe palatina mediana e força das rugas foram analisados. Os dados foram computados numa planilha do Excel, sendo posteriormente, submetidos a análise estatística. Resultados: A idade variou de 18 a 35 anos, a faixa etária mais prevalente foi 21 a 23 anos, maioria de cor branca e IMC (índice de massa corporal) normal (64,8%). A morfologia das rugas primárias mais frequente foi a curva (39,0%). Sobre a forma papila incisiva, aproximadamente metade (49,5%) foi classificada na categoria mínima seguido da cilíndrica (35,2%). Pouco mais da metade (52,4%) teve a classificação de Carrea irregular. Os dois maiores percentuais da rafe palatina foram: não bifurcada (43,8%) e bifurcada posterior (32,4%). Conclusão: pode-se concluir que, foi possível identificar um tipo morfológico específico mais prevalente dentro da população estudada. Diferenças significativas entre as classificações do IMC foram verificadas na dimensão anteroposterior, secundária esquerda e transversal. Foi observada associação significativa entre a classificação do IMC com as inicial e complementar da classificação de Santos

Objective: The purpose of this study was to evaluate the profile of the morphological pattern of palatal roughness of undergraduate students of the College of Dentistry of Pernambuco FOP-UPE, through the various proposed parameters. Methodology: The research was of the prospective type, being the sample constituted of a total of 105 (one hundred and five) individuals. Upper arch molding was performed and plaster models were made. From these, the morphological analysis of the palatal wrinkles was performed by a single examiner. The morphological parameters of the primary wrinkles, incisal papilla shape, direction of alignment of wrinkles, median raphe palatine and wrinkle strength were analyzed. The data were computed in an Excel spreadsheet, and then submitted to statistical analysis. Results: Age ranged from 18 to 35 years, the most prevalent age group was 21 to 23 years, mostly white and normal BMI (body mass index) (64.8%). The most frequent primary wrinkle morphology was the curve (39.0%). About the incisive papilla, approximately half (49.5%) was classified in the minimum category followed by the cylindrical (35.2%). Just over half (52.4%) had the classification of Carrea irregular. The two highest percentages of Rafe palatine were: non-bifurcated (43.8%) and posterior bifurcated (32.4%). Conclusion: It can be concluded that, it was possible to identify a specific morphological type most prevalent in the studied population. Significant differences between BMI classifications were found in the anteroposterior, secondary left and transverse dimensions. Significant association was observed between BMI classification with Santos' initial and supplemental classifications.

Morphometric Study Of Bony Palate Among Dry Skulls Of South India Population

Background: Hard palate forms an important area in the skull, between the oral cavity and the nasal cavity. It isformed anteriorly by the palatine process of maxillae and posteriorly by the horizontal plates of palatine bonesof both sides, forming a cruciform suture in the midline. The hard palate play a crucial role in articulation ofspeech and any significant variations in its morphology may lead to alterations in the speech of an individual.Materials and Methods: The present study was conducted on 50 dry skulls of unknown sex and age obtained fromthe department of Anatomy, K S Hegde Medical Academy, Mangaluru. Various morphometric measurments weretaken from the skull using digital vernier calipers.Results: The length, breadth and height of the hard palate was 50.45mm±2.86mm, 39.38mm±2.28mm and10.31mm±2.21mm respectively. The distance between the greater palatine foramen and middle maxillary suturewas 14.80mm±1.14mm on right and 14.83mm±1.08mm on left side. The position of greater palatine foramen in82% of the skulls was opposite 3rd molars and 18% was between 2nd and 3rd molars. The palatine index showedthat, 66% were Leptostaphyline, 18% were Mesostaphyline and 16% were Brachystaphyline The palatine heightindex showed that 56% were Chamestaphyline, and 44% were Orthostaphyline.Conclusion: The present study identifies the commonest location of greater palatine foramen to be opposite the3rd maxillary molars which is useful for clinicians to perform procedures on palate. The morphometry is usefulin comparing the skulls of various origin.

Anatomical Study On Location Of Greater Palatine Foramen In Dried Adult Human Skull: Key To Successful Maxillary Nerve Block

Background: The greater palatine foramen (GPF) conducts greater palatine nerve, responsible for the innervationof posterior part of the hard palate. Anaesthetic block for greater palatine nerve is highly recommended forsurgical practices involving upper molar, maxillary sinus and nasal region. But the practical problem associatedwith anaesthesia is difficulty in locating the exact position of greater palatine foramen, leading to deliveringinsufficient anaesthetic solution. The greater palatine neurovascular structures enter the oral cavity through thegreater palatine foramen so this foramen should be approached carefully during any surgical procedures toavoid damage to these neurovascular structure.Materials and methods: 126 dried adult skull bones of unknown sex, obtained from the department of anatomy,MVJ Medical College and Research Hospital were used to locate the exact position of greater palatine foramen inrelation to bony landmarks. On both side, the distance of greater palatine foramen from midline maxillarysuture, posterior border of hardpalate, incisive fossa and lesser palatine foramen were measured with digitalvernier caliper. Location of GPF in relation to molar or premolar tooth was also noted. The data obtained wereanalyzed statistically by calculating mean and standard deviation. The percentage was calculated for the locationof GPF in relation to molar or premolar tooth.Result: In the present study of anthropometric analysis of greater palatine foramen of 126 dried skulls, it wasobserved that the most common location of greater palatine foramen was opposite to the third molar tooth. Themean distance between greater palatine foramen to mid maxillary suture was 13.71mm on right side and13.72mm on left side and posterior border of hard palate on right side was 4.62mm and 4.49mm on left side. Themean distance between greater palatine foramen and incisive fossa was 36.73mm and 36.66mm on the right andleft side respectively. The mean distance between greater palatine foramen and lesser palatine foramen was1.47mm on right side and 1.49 mm on left side.Conclusion: Results of present study may contribute greatly to the successful outcome of maxillofacial and oralsurgeries regional anaesthesia.

Um raro diagnóstico de osteoma periférico em palato duro: relato de caso / A rare diagnosis of peripheral osteoma in the hard palate: case report

Objetivo: relatar uma biópsia excisional de um osteoma periférico no palato duro direito de uma paciente jovem, do sexo feminino e não sindrômica. Relato de caso: paciente do sexo feminino, 32 anos de idade, melanoderma e normossitêmico, buscou atendimento no ambulatório de diagnóstico estomatológico da Faculdade de Odontologia da Universidade Federal de Uberlândia com queixa quanto ao surgimento de lesão na região de palato. Após avaliação clínica e imaginológica, foi decidido realizar biópsia excisional sob anestesia local da lesão. Foram levantadas três hipóteses de diagnóstico: osteoma periférico, exostose ou osteossarcoma. O material coletado foi enviado para análise histopatológica, que confirmou a hipótese de osteoma periférico. Considerações finais: os osteomas periféricos na região de palato duro são raríssimos. Essa lesão geralmente é assintomática ­ exceto quando há impacto traumático durante a mastigação ­, de crescimento lento, podendo se desenvolver em osso cortical ou medular. O tratamento de escolha é a remoção cirúrgica e o índice de recorrência é raro. O caso enfatiza a condição rara, pois foram encontrados apenas seis casos semelhantes relacionados na literatura. (AU)

Objective: To report an excisional biopsy of a peripheral osteoma in the right hard palate in a non-syndromic young female patient. Case Report: A 32-year-old female patient, black, and normosystemic sought assistance in the stomatological diagnosis outpatient clinic of the School of Dentistry of the Federal University of Uberlândia, Brazil, complaining about the appearance of a lesion in the palate region. After clinical and imaging assessment, it was decided to perform an excisional biopsy under local anesthesia of the lesion. Three diagnostic hypotheses were raised - peripheral osteoma, exostosis, or osteosarcoma. The material collected was sent for histopathological analysis, which confirmed the hypothesis of peripheral osteoma. Final considerations: Peripheral osteomas in the hard palate region are very rare. This lesion is usually asymptomatic, except when there is a slow-growing chewing impact during mastication, which may develop in cortical or spinal bone. Surgical removal is the treatment of choice and the rate of recurrence is rare. The case emphasizes the rare condition, considering only six similar cases were found in the literature. (AU)

A Study On Hard Palate And High Arched Palate: A Morphometric Study With Associated Traits

Background: The hard palate is important for feeding, mastication and speech. Mammals with a defective hardpalate may die shortly after birth due to the inability to suckle. The interaction between tongue and hard palateis essential in the formation of certain speech sounds. In high arched palate, a proper palate-lingual contact isnot achieved, resulting in defective articulation. Surgically, the anatomy of hard palate can be modified by usingPalatal Height Index measurement, which could lead to the improvisation of palato-lingual contact andarticulation. This study aims to determine the Palatal height index.Results: After taking detail history of the subjects, the qualitative and quantitative parameters were measuredand then compared between the normal group (n=60) and high arched palate group (n=60) to know the statisticalsignificance between the two groups. The qualitative parameters measured in this study were shape of hardpalate, permanent dentition, microdontia, spacing of teeth, missing of teeth, eruption time of teeth, crowding ofteeth, malalignment, and malocclusion. The quantitative parameters measured in this study were average linearwidth, average height and palatal height index. Impressions of hard palate were taken through the prepared cast.From the prepared cast average linear width, average height and palatine height index were measured. The mean± SD value of average linear width measured between two molars was found to be 3.82 ± 0.32 in normal and 3.46± 0.17 in high arched palate subjects. The mean ± SD value of average height measured between two molars was1.58 ± 0.26 in normal and 2.06 ± 0.2 in high arched palate subjects. The mean ± SD value of palatine height indexmeasured between two molars was 41.98 ± 9.82 in normal and 59.69 ± 5.81 in high arched palate subjects.Conclusion: Palatal height index was high in the study group when compared to the normal group of similar agedcandidates and the results were found to be statistically significant. Crowding of incisors and canines,malocclusion, malalignment, absence of 2nd premolar, spacing of teeth were observed in high arched palategroup

Morphometric Study Of Pharyngeal Orifice Of Auditory Tube In South Indian Population

Auditory tube extends from the anterior wall of middle ear to the lateral wall of the nasopharynx at the level ofinferior turbinate. It plays an important role in maintaining the equilibrium of air. In the patients suffering fromchronic otitis media, the auditory tube plays an very important landmark for the endoscopic evaluation and fortransnasal approach to the infratemporal fossa. The present study was aimed to locate the pharyngeal orifice ofthe auditory tube in relation to the important anatomical landmarks. The study was carried out on 50 sagittalhead and neck sections of formalin fixed cadavers. The pharyngeal opening of auditory tube was looked for itsshape, size and position. The anatomical landmarks with reference to the pharyngeal opening of auditory tubetaken were posterior end of inferior turbinate, perpendicular distance from the clivus, from the roof of nasopharynx,from the posterior end of hard palate and from the anterior arch of atlas. The distance from these anatomicallandmarks to the pharyngeal orifice of auditory tube were measured using digital vernier calipers. The mean andstandard deviations of the distances were calculated and tabulated. The measured distances were slightlyhigher on the right than the left side. These differences were not statistically significant. The present study isuseful for otorhinolaryngologists to locate the position of pharyngeal opening of auditory tube endoscopicallyand evaluate patients with diseases of middle ear.

A Study Of Palatal Indices And Foramina In The Hard Palate Of Adult Human Skulls In Central India Region

Aim of study: Aim of study: The aim of the study is to determine morphometric indices of hard palate, positionand location of greater palatine foramen (GPF) in relation to maxillary molars and number of lesser palatineforamen (LPF).Materials and methods: 100 adult skulls (65 males and 35 females) were obtained from the Department ofAnatomy. The parameters of hard palate like length, breadth and height were measured and palatine indiceswere calculated. Observations were made on the position and relation of GPF with maxillary molar and numberof LPF. There were highly significant differences between both the sexes in Palatal length, breadth and height. Thepalatine index indicated that majority (61%)of skulls had narrow palate (Leptostaphyline).The palatine heightindex showed that majority (69%) of skulls had high arched or deep palate.(Hypsistaphyline). The greater palatineforamen was at the level of third molar in 50%, in between second and third molar in 35.5%, and at the level ofsecond molar in 14% . In majority of skulls (71%) one lesser palatine foramen was observed and about (35%) ofskulls had two LPF and (2.5%) of skulls had three LPF, and in about (5.5%) absence of LPF was observed.Conclusion: Thorough anatomical study of hard palate is useful in ethnic and racial classification of crania,anthropological studies, fabricating complete maxillary dentures for edentulous patients and performing certainsurgical procedures in hard palate and soft palate. Knowledge of palatal indices would be helpful to the anatomists,anthropologists, and forensic experts and surgeons during repair of the cleft palate and lip.