Influence of the palatine tonsil grade on the morphology of the maxillary and mandibular dental arches / Influencia del grado de las tonsilas palatinas en la morfología de los arcos dentales maxilar y mandibular

SUMMARY: Enlarged palatine tonsils and adenoids are thought to cause obstruction of the upper airway, triggering changes in breathing patterns, which in turn lead to dentofacial alterations, including malocclusions. The object of the present study was to correlate the size (grade) of the palatine tonsil with measurements of the maxillary and mandibular dental arches in children. This was an observational cross-sectional study carried out in 35 children aged between 6 and 11 years. The inter- and intra-arch parameters were measured (horizontal, vertical and sagittal analyses) by making plastercasts and then taking measurements with callipers. The tonsil size was classified in 5 grades from 0-4, using the Brodsky tonsil grading scale. The researcher was calibrated prior to carrying out the measurements. Pearson's chi-squared test was used and Pearson's correlation coefficient was calculated. The SPSS v.22.0 software was used, with a significance threshold of 5 %. Six patients were classified as grade 1, sixteen grade 2, eleven grade 3, two grade 4 and none of the patients presented grade 0.A low positive association was found between tonsil grade and the total length of the mandibular arch, a very low positive association between tonsil grade and maxillary inter-first premolar distance, total length of the maxillary arch and depth of the palatine recess.A very low negative association was found for tonsil grade and overjet, overbite, mandibular inter-permanent first molar distance, mandibular inter-first premolar distance, and mandibular and maxillary intercanine widths. No statistically significant correlation was observed for any of the measurements. No association was found between the tonsil grade and Angle's Classification, canine relationship, overjet and overbite. According to the results of this study there is no significant correlation between the dental arches and the tonsil grade.

RESUMEN: Se ha considerado que el grado del tamaño de las tonsilas palatinas y los adenoides pueden ser factores que generan obstrucción de la vía aérea superior, desencadenando cambios en el patrón de respiración, lo que provoca alteraciones dentofaciales, entre ellas, maloclusiones. El objetivo del presente estudio fue correlacionar el grado tonsilar palatino con medidas de los arcos dentales maxilar y mandibular en niños. Se realizó un estudio observacional de corte transversal. Fueron incluidos 35 niños entre 6 y 11 años de edad. Fueron medidos parámetros interarco e intra-arco (análisis transversal, vertical, sagital). Para eso fueron tomados modelos de yeso y luego las medidas fueron realizadas con un caliper. El grado tonsilar fue clasificado en 5 grados (0-5), de acuerdo a la escala de graduación de Brodsky. Para la realización de las mediciones el evaluador fue previamente calibrado. Se realizó la prueba Chi-cuadrado de Pearson, y coefi- ciente de correlación de Pearson. Se utilizó el software SPSS 22.0, considerándose umbral de significación de 5 %. Seis pacientes fueron clasificados en grado 1, dieciséis grado 2, once grado 3, dos grado 4 y ningún paciente presentó grado 0. Se encontró una asociación positiva baja entre grado tonsilar y la longitud total del arco mandibular, positiva muy baja entre grado tonsilar y distancia inter-primer premolar maxilar, longitud total del arco maxilar y profundidad de la bóveda palatina. Una asociación negativa muy baja fue encontrada para el grado tonsilar y overjet, overbite, distancia inter-primer molar permanente mandibular, distancia inter- primer premolar mandibular, ancho intercanino mandibular y maxilar. Se observó ausencia de correlación estadísticamente significativa para todas las medidas. No se encontró asociación entre el grado tonsilar y clase molar de Angle, relación canina, overjet y overbite. Según los resultados de este estudio no se aprecia una correlación significativa entre los arcos dentales y el grado tonsilar.

Prevalence of Snoring and High Risk of Obstructive Sleep Apnea Syndrome in Young Male Soldiers in Korea

There are little information on prevalence of obstructive sleep apnea syndrome (OSAS) and clinical features in the young military population. The purpose of this study was to estimate the prevalence of snoring and high risk of OSAS in young male soldiers in Korea and to identify the risk factors of OSAS. A total of 665 participants (aged 20-23 yr) who visited the Armed Forces Ildong Hospital for regular physical examination were enrolled. All participants completed the Berlin Questionnaire and underwent a physical examination. The participants with high risk for OSAS completed portable sleep monitoring. The prevalence of snoring and high risk of OSAS in young male soldiers in Korea was 13.5% and 8.1%, respectively. The prevalence of high arched palate, tongue indentation, long uvula, large tonsil and retrognathia was significantly higher in the high risk OSAS group. High arched palate, long uvula or low lying soft palate, tonsil size III or IV, Epworth Sleepiness Scale score > 10 and obesity (BMI > 27 kg/m2) were found to independently predict OSAS. For early identification and treatment of young soldiers with OSAS in a military environment, a precise screening by questionnaire and physical examination is needed.

Caracterização morfológica, funcional e de ocorrência das tonsilas linguais laterais / Morphology characterization, function and occurrence of the lateral lingual tonsils

Propôs-se a caracterização morfológica, funcional e de ocorrência das tonsilas linguais laterais. Compondo o Grupo experimental I, 25 espécimes de línguas humanas foram fixados em solução de formol a dez por cento e assim mantidos até o processamento. Os espécimes foram submetidos à exposição radiográfica para detecção de algum tecido mineralizado. As peças anatômicas foram examinadas a olho nu e com a utilização do estereomicroscópio. Obtiveram-se três blocos de tecido para a análise microscópica de cada espécime: um advindo da tonsila lingual e outros dois das margens laterais da região posterior do terço médio lingual, direito e esquerdo, respectivamente. Após o processamento histotécnico de rotina para coloração em hematoxilina-eosina de Harris, os espécimes foram analisados microscopicamente. Compondo-se o Grupo experimental II, procedeu-se à análise clínica dos tecidos moles bucais de 420 crianças em idade escolar, advindas da rede pública de ensino da cidade de Monte Negro, Estado de Rondônia, com o objetivo de se detectar a presença de tonsilas linguais laterais. Todas as análises, laboratoriais e clínicas, foram realizadas de forma descritiva e os dados obtidos, organizados e demonstrados comparativamente em tabelas e gráficos, com dados de freqüências absolutas e relativas. A análise clínica teve seus dados coletados correlacionados com a utilização do teste do quiquadrado. Aplicou-se a estatística kappa. Ao exame macroscópico: dos 25 espécimes de línguas humanas, nove apresentavam tonsilas linguais laterais (36%); o número de cristas nas papilas folhadas variou de um a seis. Ao microscópio óptico notou-se a presença de 16 espécimes com presença de tonsilas linguais laterais (64%, n=25); epitélio estratificado pavimentoso não queratinizado, com formação de criptas tonsilares e presença subepitelial de folículos linfóides.

Na análise clínica, Grupo experimental II, o percentual de ocorrência de tonsilas linguais laterais (3,09%, n=420) foi proporcionalmente menor do que aquele obtido nos espécimes do Grupo experimental I (36%, n=25). Conclui-se que a ocorrência de tonsilas linguais laterais é maior quando obtida por análise microscópica, em comparação com a análise clínica. A presença e a morfologia das papilas folhadas linguais são inconstantes, quer no mesmo espécime, quer de um espécime para outro e podem mascarar a presença de tonsilas linguais laterais.

This study aimed to characterize the lateral lingual tonsils as to their morphology, function and occurrence. The experimental group I was composed of 25 specimens of human tongues fixated and kept in 10% formalin until processing. The specimens were radiographed for detection of any mineralized tissue. The specimens were examined by naked eye and with aid of a stereomicroscope. Three blocks of tissue were obtained from each specimen for microscopic analysis: one from the lingual tonsil and two from the lateral borders of the posterior region of medium, right and left thirds, respectively. After routine histotechnical processing and staining with Harris hematoxylin and eosin, the specimens were microscopically analyzed. The experimental group II was achieved by clinical analysis of oral soft tissues of 420 schoolchildren attending public schools at the city of Monte Negro, State of Rondônia, to investigate the presence of lateral lingual tonsils. All laboratory and clinical analyses were performed descriptively and data were organized and comparatively demonstrated on tables and graphs, presenting absolute and relative frequencies. The results of clinical analysis were correlated by utilization of the chisquare test. The kappa statistics was applied. Macroscopic examination of 25 specimens of human tongues revealed that nine presented lateral lingual tonsils (36%); the number of crests in each foliate papilla ranged from one to six. At the microscopic analysis of 25 specimens revealed that 16 presented lateral lingual tonsils (64%, n=25); non-keratinized stratified squamous epithelium with formation of tonsillar crypts and subepithelial presence of lymphoid follicles. With regard to clinical analysis of experimental group II, the percentage of occurrence of lateral lingual tonsils (3.09%, n=420) was proportionally lower than observed on specimens in experimental group I (36%, n=25).

It was concluded that the occurrence of lateral lingual tonsils is higher when analyzed by microscopic analysis compared to clinical analysis. The presence and morphology of foliate papillae of the tongue are inconstant, both within and between specimens. They can mask lateral lingual tonsils.

Amigdalites agudas na infância / Acute amygdalities in childhood

Os autores, com base na literatura, lembram a incidência das amigdalites agudas na infância, bem como comentam alguns aspectos morfofuncionais das amígdalas palatinas e da microbiologia envolvida. Para concluir, abordam o tratamento clínico e citam algumas indicaçöes de tratamento cirúrgico