Area radiopaca mandíbulo-ptérigo-turbinal: su importancia en las telerradiografías normal lateral / Radiopaque area mandibulo-pterygo-turbinate: its importance in the teleradiographs lateral rule

La imagenología convencional es una reproducción bidimensional de una realidad anatómica tridimensional. En una radiografía convencionalse superponen imágenes radiopacas y radiolúcidas, para cuya interpretación se debe conocer en detalle la anatomía descriptivay en especial la anatomía topográfica tridimensional. De esta superposición pueden surgir imágenes que no se correspondan conelementos anatómicos ni patológicos, son las llamadas imágenes fantasmas, que pueden inducir a importantes errores de diagnóstico.Por el contrario, como las Tomografías computo asistidas (TC) y las Resonancias magnéticas nucleares (RMN) son cortes tomográficosde espesores variables y regulables, las superposiciones no se producen.En las Telerradiografías norma lateral (TRG -NL) convencionales, debido a las superposiciones se encuentra, en muchas de ellas, un árearadiopaca esferoidal que se investigó a los efectos de saber, si correspondía a un elemento anatómico, a una patología o a una imagenfantasma. Se procedió a estudiar las apófisis pterigoides, las apófisis coronoides y los cornetes inferiores, efectuando mediciones de laaltura, del ancho y del espesor de estos elementos. Sobre ellos y en un hemicráneo seco, se realizó la Técnica con alambre de cobre yen cada etapa se tomaron TRG-NL experimentales. Así mismo, se realizó una revisión bibliográfica sobre la anatomía, fisiología y patologíadel cornete inferior, llegándose a la conclusión de que el área radiopaca estudiada corresponde a la superposición bilateral de lasapófisis coronoides, de las apófisis pterigoides junto con la apófisis piramidal del palatino, de la tuberosidad del maxilar, ocasionalmentedel germen del 3er molar y de la cola del cornete inferior. A esta imagen, se le llamó área radiopaca mandíbulo-ptérigo-turbinal. De todos los elementos involucrados en la conformación de esta área se debe jerarquizar el cornete inferior y especialmente su cola...

The conventional imaging is a two-dimensional reproduction of three-dimensional anatomical reality. In a conventional X-ray images are superimposed radiopaque and radiolucent, to whose interpretation must know in detail the descriptive anatomy and especially three dimensional topographical anatomy. This overlap may arise images that do not correspond with anatomical and pathological elements, are called ghost images, which can induce significant diagnostic errors. On the contrary, such as computing assisted CT (CT) and nuclear magnetic resonances (NMR) tomographic slices thicknesses are variable and adjustable, overlaps do not occur. In lateral cephalometric standard (TRG-NL) conventional, due to overlap is found, in many of them, an area radiopaque spheroidal investigate the effects of knowing if corresponded to an anatomical element, to a pathology or a ghost image. We proceeded to study the pterygoid process, the coronoid process and inferior turbinates, taking measurements of the height, width and thickness of these elements.On them and on a dry hemicráneo, was performed technology with copper wire and at each stage were taken experimental TRG-NL.Likewise, a literature review of the anatomy, physiology and pathology of the inferior turbinate, and concluded that the radiopaque area studied corresponds to the superposition of bilateral coronoid process of the pterygoid with the pyramidal process of the palatine , the maxillary tuberosity, occasionally 3rd molar germ and tail of the inferior turbinate. This picture, was called " radiopaque area mandibulo-pterygo-turbinate ". Of all the elements involved in forming this area should prioritize the inferior turbinate and particularly its tail by the variability in shape and density, due to the presence of lymphoid follicles and arteriovenous plexus.

A turbinectomia média parcial e seus efeitos tardios em pacientes com síndrome da cefaléia do corneto médio / Partial Middle Turbinectomy and its Late Effects in Patients with Middle Turbinate Headache Syndrome

A síndrome da cefaléia do corneto médio é atribuída à compressão do cometo médio com a parede lateral do nariz ou o septo, devido a congestão da mucosa nasal ou por pneumatização do corneto médio. É caracterizada pela dor periorbitária, sendo geralmente unilateral, intermitente e associada à congestão nasal. Objetivos: Avaliar a melhora dos sintomas de cefaléia em pacientes submetidos à turbinectomia média parcial, associada ou não à septoplastia. Material e método: Foram avaliados onze pacientes, seis do sexo feminino e cinco do sexo masculino, com idade média de 30 anos (variando de 15 a 62 anos). A queixa principal era de cefaléia, em geral periorbitária (82% dos casos); associados à cefaléia, 90% dos pacientes apresentavam ainda: obstrução nasal; e 63%, rinorréia posterior. Todos os pacientes foram submetidos à turbinectomia média parcial, sendo que sete deles também foram submetidos à septoplastia. Resultados: Após um período médio de 30 meses (variando entre 10 e 52 meses) de pós-operatório, 54% dos pacientes apresentaram uma boa melhora da cefaléia (acima de 80%), 27% melhoraram moderadamente (50%), 9% melhoraram pouco (abaixo de 50%) e 9% não melhoraram. Em relação às queixas nasais, apenas 28% dos casos mantiveram rinorréia posterior e 50% melhoraram parcialmente à obstrução nasal, enquanto que 50% melhoraram totalmente da obstrução nasal. Conclusão: Pode se concluir que a turbinectomia média parcial é um método eficaz e seguro para a melhora da cefaléia e dos sintomas nasais dos pacientes, quando bem indicada.

Middle turbinate headache syndrome is mentioned as the compression of middle turbinate to the septum or to the lateral wall of nose doe to nasal oedema or middle turbinate pneumatization. It is characterised by periorbital pain, generally unilateral and intermittent, associated to nasal obstruction. Purpose: Evaluate the symptoms of headache before and after partial middle turbinectomy, associated or not to septoplasty. Material and Method: Eleven patients were analysed, five men and six women, with mean age of 30 years (varying from 15 to 62 years). The main symptom was headache, generally periorbital (82% of cases); 90% had also nasal obstruction and 63% had also posterior rhinorrea. All the patients were submitted to partial middle turbinectomy, from which seven were also submitted to septoplasty. Results: After 30 months in media (varying from 10 to 52 months) after surgery, 54% of patients had a great diminution of headache (above 80%), 27% had moderate diminution (50%), 9% had little diminution (less than 50%) and 9% had no diminution at all. Twenty eight percent of patients still had posterior rhinorrea and 50% of patients had great amelioration of nasal obstrution, whereas 50% of them had partial amelioration of it. Conclusion: It can be concluded that partial middle turbinectomy is a safe and efficient surgery to diminish headache, when well indicated.

Practice in middle turbinectomy

Middle turbinectomy is still a matter of controversy. Several years of experience had demonstrated that the middle turbinate can be removed to improve the nasal airway with no long-term sequelae. The present work was done on 30 patients at El-Minia University Hospital. Follow up was done for 4-24 months. Results were evaluated by direct clinical examination but more weight was given to the patients evaluation as to the success or failure of operation in terms of reduction of symptoms. The previously feared complications of crusting, dryness and atrophy do not occur as a result of middle turbinectomy