Study on static parameters of internal nasal valve in 3-dimensional model of nasal cavity space / 中华耳鼻咽喉头颈外科杂志

Objective: To identify the internal nasal valve (INV) and to evaluate its key parameters in the established 3D models of nasal cavity space via Mimics from CT images, in order to provide evidence for quantitative diagnosis of nasal valve compromise. Methods: A total of 32 Han adults without nasal diseases who underwent maxillofacial CT test in Shanghai Ninth People's Hospital from January 2015 to December 2018 were retrospectively recruited, including 16 males and 16 females, with the age ranged from 20 to 80 years (50% age<50 years old). Maxillofacial CT images were used to create 3D model of nasal cavity space. The INV was identified and the following parameters were measured: the angle between the INV and the nasal bone (θINV-B), unilateral cross-sectional area of the INV (AINV-R, AINV-L), total cross-sectional area of the INV (AINV), unilateral height of the INV (HINV-R, HINV-L), unilateral nasal valve angle (αINV-R, αINV-L), and the sum of nasal valve angle (αINV). The AINV in our study was compared with the results of the previously adopted planes (PlaneC, perpendicular to the hard palate and PlaneB, plane perpendicular to the nasal bone). The parameters above were compared among genders, age and race groups. SPSS 26 and GraphPad Prism 9 software were used for statistical analysis and mapping of data. Results: The AINV in our study was (214.87±52.94) mm², which was significantly less than that of PlaneC (254.97±47.80) mm² and PlaneB (226.07±57.36) mm². The measured parameters were as follows: θINV-B was (82.07±7.06)°; AINV-R was (112.66±31.39) mm²; AINV-L was (102.21±27.14) mm²; AINV was (214.87±52.94) mm²; HINV-R was (24.87±4.62) mm; HINV-L was (24.35±4.86) mm; αINV-R was (20.48±2.99)°; αINV-L was (19.65±3.82)°; αINV was (40.13±6.24)°. The AINV-R was larger than AINV-L (t=2.33, P<0.05); The HINV, AINV-R, AINV-L and AINV of males were more than those of females (t value was 5.77, 3.21, 2.91 and 3.52, respectively, all P<0.01). The AINV of the young group (<50 years) was larger than that of the old group (t=2.83, P<0.01); The θINV-B was different between the Han people and the Caucasian (t=2.92,P<0.01). The αINV of the Han people was larger than that of Caucasians (Z=-6.92, P<0.01), but the HINV was smaller (Z=-3.89, P<0.01). Conclusion: The AINV carried out in 3D models of nasal cavity space is significantly smaller than that obtained by the previous methods of CT evaluation. INV static parameters differ among genders, age and race groups.

Changes in nasal septum morphology after rapid maxillary expansion: a Cone-Beam Computed Tomography study in pre-pubertal patient

ABSTRACT Introduction: Nasal septum deviation (NSD) is the most common structural cause of nasal obstruction, affecting around 65-80% of the adult population. Rapid maxillary expansion (RME) is currently used for treatment of maxillary transverse deficiency, but can also influence nasal cavity geometry. Objective: The present study aimed at evaluating the changes in NSD by using Cone-Beam Computed Tomography (CBCT) scans in pre-pubertal patients treated with RME. Methods: This retrospective exploratory study evaluated 20 pre-pubertal patients (mean age 10 ± 2 years) who were treated for transverse maxillary constriction with RME and presented mild/moderate NSD as an incidental finding. The outcome measures were NSD tortuosity and area. These measures were obtained from transverse and coronal views of records taken before and after RME treatment. Intra-rater reliability was also assessed with intraclass correlation coefficient. Results: NSD was mild in thirteen patients (65%) and moderate in seven (35%). NSD tortuosity index did not significantly change over time (mean difference 0.002 mm/year, 95% CI; p = 0.58). NSD area did not significantly change over time (mean difference 2.103 mm2/year, 95% CI; p = 0.38). Intraclass correlation coefficient was 0.73 (95% CI) for NSD tortuosity and 0.84 (95% CI) for NSD area. Conclusions: NSD tortuosity and area suggested potential changes in NSD with small clinical relevance in pre-pubertal patients who were treated with RME. Additional studies using CBCT scans in larger samples are required to clarify the role of RME in NSD treatment.

RESUMO Introdução: O desvio de septo nasal (DSN) é a causa estrutural mais frequente de obstrução nasal, afetando de 65% a 80% da população adulta. A expansão rápida da maxila (ERM), atualmente utilizada para o tratamento da deficiência transversa da maxila, também pode influenciar na geometria da cavidade nasal. Objetivos: O presente estudo teve como objetivo avaliar, usando tomografia computadorizada de feixe cônico (TCFC), as mudanças no DSN após o tratamento com ERM em pacientes pré-púberes. Métodos: Esse estudo exploratório retrospectivo avaliou 20 pacientes pré-púberes (idade média de 10 ± 2 anos) com deficiência transversa da maxila tratados com ERM, e que apresentavam DSN de leve a moderado, como um achado incidental. Foram realizadas medições da tortuosidade e área do DSN. Essas medições foram feitas em cortes transversais e coronais das TCFCs pré- e pós-tratamento com ERM. A confiabilidade intraexaminador também foi aferida por meio do coeficiente de correlação intraclasse. Resultados: O DSN era leve em 13 pacientes (65%) e moderado em 7 (35%). O índice de tortuosidade do DSN não mudou significativamente ao longo do tempo (diferença média = 0,002 mm/ano, IC 95%; p= 0,58). A área do DSN não mudou significativamente ao longo do tempo (diferença média = 2,103 mm2/ano, IC 95%; p= 0,38). O coeficiente de correlação intraclasse foi igual a 0,73 (IC 95%) para a tortuosidade do DSN e 0,84 (IC 95%) para a área do DSN. Conclusões: Os valores de tortuosidade e da área do DSN sugeriram potenciais mudanças no DSN, mas com pequena relevância clínica, nos pacientes pré-púberes tratados com ERM. Estudos adicionais utilizando TCFC em amostras maiores são necessários para esclarecer o papel da ERM no tratamento do DSN.

The determination of the piriform aperture morphometry and golden ratio in healthy Turkish subjects: a CT study / Determinación de la morfometría de la apertura piriforme y la proporción áurea en sujetos turcos sanos: un estudio con TC

This study was undertaken to determine the morphometry of the piriform aperture width and height in Turkish population aged between 18-60 years. It was a retrospective study in which 200 subjects were included 106 males and 94 females, ranging from 18 up to 60 years. Subjects having brain CT in the Radiology Department. Statistical analysis were evaluated with SPSS 21.00 programme. ANOVA Test were used to determine the significance between measurements and age group. The p<0.05 value was considered as significant. The groups were divided into four groups according to age. The overall means and standard deviations of the measurements were: piriform aperture height, 45.19±2.91 mm; piriform aperture width, 24.98±2.85 mm; the golden ratio, 1.84±0.19 in males, respectively whereas, the same measurements were 42.84±2.88; 23.46±2.15 mm; 1.83±0.19 in females, respectively. Also there were an increase in piriform aperture width measurement as the age increased. These anatomical values provides more important knowledge to determine the dimensions of these structures in clinic, surgical processes.

El estudio se realizó para determinar la morfometría del ancho y la altura de la abertura piriforme en la población turca de entre 18 y 60 años. Se llevó a cabo un análisis retrospectivo en el que se incluyeron 200 sujetos 106 hombres y 94 mujeres, entre los 18 y 60 años. Sujetos con TC cerebral en el Departamento de Radiología. El análisis estadístico se evaluó con el programa SPSS 21.00. La prueba ANOVA se utilizó para determinar la importancia entre las mediciones y el grupo de edad. El valor p <0,05 se consideró significativo. La muestra se dividió en cuatro grupos según la edad. Las medias generales y las desviaciones estándar de las mediciones fueron: altura de apertura piriforme, 45,19 ± 2,91 mm; ancho de apertura piriforme, 24,98 ± 2,85 mm; la proporción áurea, 1,84 ± 0,19 en varones, mientras que las mismas medidas fueron 42,84 ± 2,88; 23,46 ± 2,15 mm; 1,83 ± 0,19 en mujeres. También hubo un aumento en la medición del ancho de apertura piriforme a medida que la edad aumentó. Estos valores anatómicos proporcionan un conocimiento más importante para determinar las dimensiones de estas estructuras en procesos clínicos y quirúrgicos.

Avaliação do volume das vias aéreas superiores conforme o padrão facial / Upperairway volume assessment accordingto facial pattern

Objetivo: analisar o volume da via aérea superior (VAS) em pacientes adultos saudáveis, a partir de exames de tomografia computadorizada de feixe cônico, comparando os padrões faciais esqueléticos I, II e III, considerando a idade e o sexo. Método: um estudo retrospectivo de análise do banco de dados de uma clínica radiológica, com uma amostra de 129 exames de face total em formato DICOM, datados de 2015 a 2018. Após a divisão da amostra em três grupos, conforme o padrão esquelético, as medidas volumétricas foram obtidas através do aplicativo ITK-SNAP versão 3.6.0, um processador gratuito de segmentação anatômica 3D. Resultados: a amostra foi separada em padrão I com 60 exames, padrão II com 48 exames e padrão III com 21 exames. O sexo feminino foi o mais frequente, com 69,8% (n = 90), e a média de idade foi definida em 35 anos. O volume médio geral foi de 22.774,2 mm³ e a média entre os padrões esqueléticos não apresentou diferença significante (p = 0,251), segundo o teste não paramétrico de Kruskal-Wallis (p < 0,05). Na análise do dimorfismo sexual, os homens apresentaram maior volume, com diferença estatística (p = 0,033) através do teste de Mann-Whitney. Conclusão: o volume médio da VAS entre indivíduos saudáveis com padrões faciais I, II e III não apresentou diferença significativa, apenas uma discreta variação, sendo o padrão III maior em 14,8% do que o padrão I. O sexo masculino se destacou com maior volume, e a variação da idade não teve correlação com o volume do espaço aéreo faríngeo.(AU)

Aims: Analyze upper airway volume in healthy adult patients from CBCT examinations, comparing skeletal facial patterns I, II and III, considering age and gender. Methods: A retrospective study of a radiological clinic database analysis, with a sample of 129 full-face DICOM exams, dated between 2015 and 2018. After dividing the sample into three groups, according to skeletal pattern, volumetric measurements were obtained through the application ITK-SNAP version 3.6.0, a free 3D anatomical segmentation process. Results: The sample was separated into pattern I with 60 exams, pattern II with 48 and pattern III with 21 exams. Females were the most frequent with 69.8% (n = 90) and the mean age was defined as 35 years. The overall mean volume was 22,774.2 mm³ and the mean between skeletal patterns showed no significant difference (p = 0,251), according to the nonparametric Kruskal-Wallis test (p < 0,05). In the analysis of sexual dimorphism, men presented higher volume, with statistical difference (p = 0,033) through the Mann-Whitney test. Conclusion: The mean upper airway volume among healthy individuals with facial patterns I, II and III showed no significant difference, only a slight variation, pattern III being 14.8% higher than pattern I. The male gender stood out with greater volume and the age variation had no correlation with the pharyngeal space volume.(AU)

Leiomiosarcoma primario de cornete nasal inferior: reporte de caso clínico y revisión de la literatura / Primary leiomyosarcoma of inferior nasal turbinate: clinical case report and literature review

Los leiomiosarcomas de la cavidad nasal y senos paranasales son neoplasias malignas de baja frecuencia, localmente agresivas. Presentan una alta tendencia a la recurrencia de aproximadamente 55% en nariz y senos paranasales. Están conformados por células musculares lisas. Según diversos autores, aproximadamente el 50% de los pacientes mueren antes del primer año y la supervivencia a los 5 años es del 20%. Anteriormente se pensaba que no poseían potencial metastásico, sin embargo, en series actuales se ha visto que presentan un alto poder metastásico de hasta el 50%. Las metástasis se presentan de forma tardía. El tratamiento recomendado consiste en la resección radical del tumor primario con un amplio margen de tejido normal y la radioterapia es de uso controversial en el manejo.

Leiomyosarcoma of the nasal cavity and paranasal sinuses are malignant, low frequency, locally aggressive neoplasm. They present a high tendency to recurrence of approximately 55% in the nose and paranasal sinuses. They are made up of smooth muscle cells. According to different authors, approximately 50% of patients die before the first year and survival at 5 years is 20%. Previously it was thought that they did not possess metastatic potential, however in current series it has been seen that they have a high metastatic power of up to 50%. Metastases present late. The recommended treatment consists of radical resection of the primary tumor with a wide margin of normal tissue.

Are computed tomography 3D measurements of the upper airways in mouth-breathing children in agreement with the ENT clinical diagnosis of obstruction? / Medidas obtidas por tomografia computadorizada em 3D das vias aéreas superiores em crianças com respiração bucal estão de acordo com o diagnóstico clínico-otorrinolaringológico de obstrução?

Abstract Introduction: Imaging studies have hystorically been used to support the clinical otorhinolaryngological evaluation of the upper respiratory tract for the diagnosis of obstructive causes of oral breathing. Objective: The objective of this study was to compare 3D volumetric measurements of nasal cavity, nasopharynx and oropharynx of obstructed mouth-breathing children with measurements of non-obstructed mouth-breathing children. Methods: This retrospective study included 25 mouth-breathing children aged 5-9 years evaluated by otorhinolaryngological clinical examination, flexible nasoendoscopy and full-head multi-slice computed tomography. Tomographic volumetric measurements and dichotomic otorhinolaryngological diagnosis (obstructed vs. non-obstructed) in three anatomical regions (the nasal cavity, nasopharynx and oropharynx) were compared and correlated. An independent sample t-test was used to assess the association between the 3D measurements of the upper airways and the otorhinolaryngological diagnosis of obstruction in the three anatomical regions. Inter- and intra-observer intraclass correlation coefficients were used to evaluate the reliability of the 3D measurements. Results: The intra-class correlation coefficients ranged from 0.97 to 0.99. An association was found between turbinate hypertrophy and nasal cavity volume reduction (p < 0.05) and between adenoid hyperplasia and nasopharynx volume reduction (p < 0.001). No association was found between palatine tonsil hyperplasia and oropharynx volume reduction. Conclusions: (1) The nasal cavity volume was reduced when hypertrophic turbinates were diagnosed; (2) the nasopharynx was reduced when adenoid hyperplasia was diagnosed; and (3) the oropharynx volume of mouth-breathing children with tonsil hyperplasia was similar to that of non-obstructed mouth-breathing children. The adoption of the actual anatomy of the various compartments of the upper airway is an improvement to the evaluation method.

Resumo Introdução: O exame clínico otorrinolaringológico da via aérea superior tem sido historicamente feito com a ajuda de imagens radiográficas para diagnosticar causas obstrutivas da respiração bucal. Objetivo: O objetivo deste estudo foi comparar as medidas volumétricas em 3D da cavidade nasal, nasofaringe e orofaringe entre crianças com respiração bucal e obstrução respiratória e crianças respiradoras bucais sem obstrução respiratória. Método: Estudo retrospectivo que inclui 25 crianças respiradoras bucais de 5 a 9 anos. As crianças foram avaliadas por exame clínico otorrinolaringológico, nasofibroscopia flexível e tomografia computadorizada multi-slice. Medidas volumétricas obtidas tomograficamente de três regiões anatômicas (cavidade nasal, nasofaringe e orofaringe) foram correlacionadas e comparadas com diagnóstico dicotômico otorrinolaringológico (obstruído vs. não obstruído). Um teste t de amostra independente foi usado para avaliar a associação entre as medidas em 3D das vias aéreas superiores e o diagnóstico otorrinolaringológico de obstrução nas três regiões anatômicas. Os coeficientes de correlação intraclasse inter e intraobservador foram usados para avaliar a confiabilidade das medidas em 3D. Resultados: O coeficiente de correlação intraclasse variou de 0,97 a 0,99. Uma associação foi encontrada entre a hipertrofia de conchas e a redução do volume da cavidade nasal (p < 0,05) e entre a hiperplasia de tonsila faríngea e a redução do volume da nasofaringe (p < 0,001). Não foi encontrada associação entre a hiperplasia da tonsila palatina e a redução do volume da orofaringe. Conclusões: 1) O volume da cavidade nasal estava reduzido nas crianças com diagnóstico de hipertrofia de conchas; 2) O volume da nasofaringe estava reduzido nas crianças com diagnóstico de hiperplasia de tonsila faríngea; e 3) O volume da orofaringe de crianças com respiração bucal e hiperplasia de tonsila palatina foi semelhante ao de crianças respiradoras bucais sem aumento da tonsila palatina. A adoção da mensuração anatômica dos vários compartimentos da via aérea superior complementa o método de avaliação.

Rapid maxillary expansion in mouth breathers: a short-term skeletal and soft-tissue effect on the nose / Expansão rápida da maxila em respiradores orais: efeitos esqueléticos e tegumentares do nariz em curto prazo

Abstract Introduction Rapid maxillary expansion can change the form and function of the nose. The skeletal and soft tissue changes can influence the esthetics and the stability of the results obtained by the procedure. Objective The aim of this retrospective study was to evaluate the short-term effects of rapid maxillary expansion on the skeletal and soft tissue structures of the nose, in mouth-breathing patients, using a reliable and reproducible, but simple methodology, with the aid of computed tomography. Methods A total of 55 mouth-breathing patients with maxillary hypoplasia were assessed and were divided into an experimental group treated with rapid maxillary expansion(39 patients, 23 of which were male and 16 female, with an average age of 9.7 years and a standard deviation of 2.28, ranging from 6.5 to 14.7 years) and a control group (16 patients, 9 of which were male and 7 female, with an average age of 8.8 years, standard deviation of 2.17, ranging from 5.11 to 13.7 years). The patients of the experimental group were submitted to multislice computed tomography examinations at two different points in time: (T1) pre-rapid maxillary expansion and (T2) three months after the procedure. The control group underwent to the same exams at the same intervals of time. Four skeletal and soft tissue variables were assessed, comparing the results of T1 and T2. Results There was in the experimental group a significant increases in all the skeletal and soft tissue variables (p < 0.05) but no significant alteration was found in the control group. When comparing the experimental group and the control group, the most important change occurred in the width of the pyriform aperture (p < 0.001). Conclusion Rapid maxillary expansion is capable of altering the shape and function of the nose, promoting alterations in skeletal and soft tissue structures. This kind of study may, in the future, permit the proper planning of esthetic procedures at the tip and base of the nose and also the performance of objective measurements in early or late surgical outcomes.

Resumo Introdução A expansão rápida da maxila pode alterar a forma e a função do nariz. As alterações do esqueleto e dos tecidos moles podem influenciar a estética e a estabilidade dos resultados obtidos através deste procedimento. Objetivo Avaliar, em curto prazo, os efeitos da expansão rápida da maxila sobre as estruturas esqueléticas e tegumentares do nariz em pacientes respiradores orais por meio de uma metodologia confiável e reprodutível, porém simples, com a ajuda da tomografia computadorizada. Método Foram avaliados 55 pacientes respiradores orais com hipoplasia maxilar que foram divididos em grupo experimental tratado com expansão rápida da maxila (39, 23 do sexo masculino e 16 do feminino, com média de 9,7 anos e desvio padrão de 2,28, variação de 6,5 a 14,7 anos) e um grupo controle (16 pacientes, nove do sexo masculino e sete do feminino, com média de 8,8 anos, desvio padrão de 2,17, variação de 5,11-13,7 anos). Os pacientes do grupo experimental foram submetidos a exames de tomografia computadorizada multislice em dois tempos distintos: (T1) pré-expansão rápida da maxila e (T2) três meses após o procedimento. O grupo controle foi submetido aos mesmos exames nos mesmos intervalos de tempo. Foram avaliadas quatro variáveis esqueléticas e quatro tegumentares comparando-se os resultados de T1 e T2. Resultados O grupo experimental apresentou aumentos significativos em todas as variáveis esqueléticas e tegumentares (p < 0,05), mas não houve alterações significativas no grupo controle. Ao compararem-se o grupo experimental e o grupo controle, foi observado que a alteração mais importante ocorreu na largura da abertura piriforme (p < 0,001). Conclusão A expansão rápida da maxila é capaz de alterar a forma e a função do nariz, promove alterações nas estruturas esqueléticas e dos tecidos moles. Esse tipo de estudo pode, no futuro, permitir o planejamento adequado de procedimentos estéticos na ponta e base do nariz e também a feitura de medidas objetivas em resultados cirúrgicos iniciais ou tardios.

Carcinoma adenoide quístico de cavidad nasal y senos paranasales: experiencia de 5 años en Clínica Las Condes de Santiago de Chile / Adenoid cystic carcinoma of nasal cavity and paranasal sinuses: 5 years experience in las Condes Clinic of Santiago of Chile

RESUMEN Introducción: El carcinoma adenoide quístico es una neoplasia originada en glándulas exocrinas de todo el cuerpo, principalmente en glándulas salivales mayores. En cavidad nasal y senos paranasales es poco frecuente y se caracteriza por presentar una alta frecuencia de recurrencia y de metástasis a distancia posterior a su remisión y a pesar de su tratamiento. Objetivo: Describir características de una serie de casos de pacientes con carcinoma adenoide quístico de cavidad nasal y senos paranasales operados. Material y método: Estudio descriptivo-retrospectivo. Período enero de 2012 y enero de 2017. La información se obtuvo a partir de las fichas electrónicas de la Clínica Las Condes. Se describen procedencia, edad y sexo, características clínicas, hallazgos anatomopatológicos, métodos diagnósticos, tratamiento, evolución. Resultados: Total de 5 pacientes operados, 3 mujeres y 2 hombres. La edad promedio fue de 63 años, con rango de 33 años a 90 años de edad. 100% de los casos sin factores asociados. La presentación clínica más frecuente fue la obstrucción nasal unilateral, seguida por el dolor facial. Dos pacientes se presentaron con diagnóstico inicial, dos por recurrencia y uno por persistencia. En tres casos el tumor se origina de seno maxilar y en dos en seno etmoidal. Todos presentaron enfermedad avanzada, etapa IV y III. Tres pacientes histológicamente fueron de bajo grado y dos de alto grado. En los cinco casos el tratamiento primario fue quirúrgico, en el 60% endoscópico, 20% abierto y 20% combinado. En cuatro casos se usó radioterapia posoperatoria y en tres de éstos, quimioterapia concomitante. Todos se encuentran sin signos de recidiva tumoral en último control. Conclusiones: El carcinoma adenoide quístico de cavidad nasal y senos paranasales es bastante infrecuente, su incidencia es menor a 1/100.000 casos por año. Es más frecuente en mujeres entre 40 y 50 años. Se identifica más con su origen en el seno maxilar (50%) y de patrón cribiforme. Clínicamente se presenta en estadíos avanzados ya que en etapa precoz es asintomático o presenta clínica inespecífica inflamatoria. El diagnóstico se realiza con biopsia complementada con imagenología. El tratamiento más utilizado es la cirugía endoscópica o abierta asociado a radioterapia posoperatoria, a pesar de la cual, se presentan con alta recurrencia a largo plazo.

ABSTRACT Introduction: Adenoid Cystic Carcinoma is a neoplasm originating in exocrine glands throughout the body, mainly in the major salivary glands. In the nasal cavity and paranasal sinuses is rare and characterized by a high frequency of recurrence and distant metastasis after remission and despite its treatment. Aim: To describe characteristics of a series of patients with operated adenoid cystic carcinoma of the nasal cavity and paranasal sinuses. Material and method: Descriptive-retrospective study. Period January 2012 and January 2017. The information was obtained from the electronic tabs of the Las Condes Clinic. It describes origin, age and sex, clinical characteristics, anatomopathological findings, diagnostic methods, treatment, evolution. Results: Total 5 patients operated, 3 women and 2 men. The average age was 63 years, ranging from 33 years to 90 years of age. 100% of the cases without associated factors. The most frequent clinical presentation was unilateral nasal obstruction, followed by facial pain. 2 patients presented with initial diagnosis, 2 due to recurrence and 1 due to persistence. In 3 cases the tumor originates from the maxillary sinus and in 2 in the ethmoidal sinus. All had advanced disease, stage IV and III. 3 patients were histologically low grade and 2 high grade. In all 5 cases, the primary treatment was surgical, 60% endoscopic, 20% open and 20% combined. In 4 cases, postoperative radiotherapy was used and in 3 of this concomitant chemotherapy. All are without signs of tumor recurrence in the last control. Conclusion: Adenoid Cystic Carcinoma of the nasal cavity and paranasal sinuses is quite infrequent; its incidence is less than 1/100,000 cases per year. It is more common in women between 40 and 50 years. It is identified more with its origin in the maxillary sinus (50%) and cribriform pattern. Clinically it presents in advanced stages since at an early stage, it is asymptomatic or it presents nonspecific inflammatory clinic. Diagnosis is performed with biopsy supplemented with imaging. The most commonly used treatment is endoscopic or open surgery associated with postoperative radiotherapy, despite which, they present with high recurrence in the long term.

Maxillary sinus floor pneumatization and alveolar ridge resorption after tooth loss: a cross-sectional study

Abstract This is a cross-sectional study that aimed to estimate maxillary sinus floor (MSF) pneumatization in single missing tooth of posterior maxilla, by using cone-beam computed tomography (CBCT). CBCT images were analyzed bilaterally and divided into 2 groups: edentulous site (EdS) - edentulous single region of upper second premolar, first or second molars; Tooth site (TS) - contralateral region homologous to the EdS region, with tooth present. Variables evaluated were: sinus height (SH), estimated sinus pneumatization (eSP: ∆ EdS - TS), healed ridge height (HR) and presence of localized sinus pneumatization (LSP) in molars teeth at TS. HR were categorized according to therapeutic option for posterior maxilla. 183 CBCT scans were included and it was observed that EdS presented a higher SH than the TS (p < 0.001) showing an eSP of 0.9 ± 2.93 mm. First molars presented the highest SH for both sides, although significant differences were detected when compared to second molars. First molars were mostly affected by LSP at TS (36 out of 43). Individuals with LSP at TS presented lower HR than the ones without LSP (p < 0.05). 54% of the cases presenting LSP obtained HR < 5 mm, which indicates sinus lift surgery. The present study showed that tooth loss in posterior maxilla favors sinus pneumatization and the identification of LSP at molar roots seems to indicate a greater necessity for sinus lift surgeries.

Nasal polyposis in cystic fibrosis: follow-up of children and adolescents for a 3-year period / Polipose nasal em fibrose cística: seguimento em crianças e adolescentes durante um período de 3 anos

Abstract Introduction: Nasal polyposis is often found in patients with cystic fibrosis. Objective: To assess the incidence of nasal polyposis, the response to medical treatment, recurrence and the need for surgical intervention in children and adolescents with cystic fibrosis during a three-year follow-up. Methods: Clinical symptoms (pulmonary, pancreatic insufficiency, malnutrition, nasal obstruction), two positive sweat chloride tests, and genotype findings in 23 patients with cystic fibrosis were analyzed. All patients underwent nasal endoscopy every 12 months from January 2005 to December 2007, to assess the presence and grade of Nasal Polyps. Nasal polyposis, when present, were treated with topical corticosteroids for 6-12 months, with progress being evaluated within the 3 years of follow-up. Results: In the first evaluation, nasal polyposis was diagnosed in 30.43% of patients (3 bilateral and 4 unilateral), recurrent pneumonia in 82.6%, pancreatic insufficiency in 87%, and malnutrition in 74%. The presence of nasal polyposis was not associated with chloride values in the sweat, genotype, clinical signs of severity of cystic fibrosis, or nasal symptoms. In the three-year period of follow up, 13 patients (56.52%) had at least one event of polyposis, with the youngest being diagnosed at 32 months of age. Only one patient underwent surgery (polypectomy), and there was one diagnosis of nasopharyngeal carcinoma. Conclusion: The study showed a high incidence of nasal polyposis. Monitoring through routine endoscopy in patients with cystic fibrosis, even in the absence of nasal symptoms, is highly recommended. The therapy with topical corticosteroids achieved good results. Thus, an interaction between pediatricians and otolaryngologists is necessary.

Resumo Introdução: A polipose nasal é frequentemente encontrada em pacientes portadores de fibrose cística. Objetivo: Avaliar a incidência de polipose nasal, a resposta ao tratamento clínico, a recorrência e a necessidade de intervenção cirúrgica em crianças e adolescentes com fibrose cística durante um seguimento de 3 anos. Método: Os sintomas clínicos (pulmonar, insuficiência pancreática, desnutrição, obstrução nasal), duas pesquisas de cloro no suor positivas e genótipo de 23 pacientes com fibrose cística foram descritos. Todos os pacientes foram submetidos à endoscopia nasal a cada 12 meses de janeiro de 2005 a dezembro de 2007, para avaliação de presença e grau de polipose nasal. A polipose nasal, quando presente, foi tratada com corticosteroide tópico de 6 a 12 meses e avaliada a evolução nos 3 anos de seguimento. Resultados: Na primeira avaliação, a polipose nasal foi diagnosticada em 30,43% dos pacientes (três bilaterais e quatro unilaterais), pneumonia recorrente em 82,6%, insuficiência pancreática em 87% e a desnutrição em 74%. A presença de polipose nasal não se associou aos valores de cloro no suor, genótipo, sinais clínicos de gravidade da fibrose cística ou sintomas nasais. Nos três anos de seguimento, 13 pacientes (56,52%) apresentaram pelo menos um evento de polipose, o mais jovem foi diagnosticado aos 32 meses. Apenas um paciente foi submetido à cirurgia (polipectomia) e houve um diagnóstico de carcinoma da nasofaringe. Conclusão: O estudo mostrou alta incidência de polipose nasal. O acompanhamento por meio de exames endoscópicos de rotina em pacientes fibrocisticos, mesmo na ausência de sintomas nasais, é altamente recomendado. A terapia com corticoide tópico mostrou bons resultados. Assim, faz-se necessária a interação entre pediatras e otorrinolaringologistas.

Trifid nasopalatine canal: case report of a rare anatomical variation and its surgical implications / Conducto nasopalatino Trifid: presentación de caso de una variación anatómica rara y sus implicaciones quirúrgicas

The nasopalatine canal is a long slender structure present in the midline of the anterior maxilla that connects the palate to the floor of the nasal cavity. The nasopalatine canal contains the nasopalatine nerve, the terminal branch of the nasopalatine artery, fibrous connective tissue, adipose tissue, and minor salivary glands. The purpose of this article was to report a case of a trifid nasopalatine canal detected by cone beam computed tomography prior to dental implant placement. A 47-year-old female patient was submitted to cone beam computed tomography. Axial and sagittal sections revealed a trifurcation of the nasopalatine canal. Each canal was separated from the other by bony septa and extended independently from the floor of the nasal cavity to the incisive foramen in the remnant of the alveolar process in the anterior region of the maxilla. Cone beam computed tomography has permitted better visualization of the details and anatomical variations of the nasopalatine canal. Detailed knowledge of variations in the shape, number and size of the nasopalatine canal is fundamental for surgical procedures, such as local anesthesia in the anterior maxillary region and placement of dental implants, in order to prevent damage to important arteries and nerves(AU)

El canal nasopalatino es una larga estructura delgada presente en la línea media del maxilar anterior que conecta el palato al suelo de la cavidad nasal. El canal nasopalatino contiene el nervio nasopalatino, la rama terminal de la arteria nasopalatina, el tejido conectivo fibroso, el tejido adiposo y las glándulas salivales menores. El propósito de este artículo es presentar el caso de un canal nasopalatino trifid detectado a través de tomografía computarizada de haz cónico anterior a la colocación de implantes dentales, en una paciente de femenino 47 años de edad. Secciones axiales y sagitales revelaron la trifurcación del canal nasopalatino. Cada canal se apartó del otro por tabiques ósea y extendida independientemente del suelo de la cavidad nasal para el agujero incisivo en el remanente del proceso alveolar en la región anterior del maxilar. La tomografía computarizada de haz cónico ha permitido una mejor visualización de los detalles y variaciones anatómicas del canal nasopalatino. El conocimiento detallado de las variaciones en su forma, el número y el tamaño del canal nasopalatino es fundamental para los procedimientos cirúrgicos, así como la anestesia local en la región anterior del maxilar superior y la colocación de los implantes dentales, con el fin de prevenir el daño a las arterias y a los nervios importantes(AU)

Investigation on the nasal airflow characteristics of anterior nasal cavity stenosis

We used a computational fluid dynamics (CFD) model to study the inspiratory airflow profiles of patients with anterior nasal cavity stenosis who underwent curative surgery, by comparing pre- and postoperative airflow characteristics. Twenty patients with severe anterior nasal cavity stenosis, including one case of bilateral stenosis, underwent computed tomography (CT) scans for CFD modelling. The pre- and postoperative airflow characteristics of the nasal cavity were simulated and analyzed. The narrowest area of the nasal cavity in all 20 patients was located within the nasal valve area, and the mean cross-sectional area increased from 0.39 cm2 preoperative to 0.78 cm2 postoperative (P<0.01). Meanwhile, the mean airflow velocity in the nasal valve area decreased from 6.19 m/s to 2.88 m/s (P<0.01). Surgical restoration of the nasal symmetry in the bilateral nasal cavity reduced nasal resistance in the narrow sides from 0.24 Pa.s/mL to 0.11 Pa.s/mL (P<0.01). Numerical simulation of the nasal cavity in patients with anterior nasal cavity stenosis revealed structural changes and the resultant patterns of nasal airflow. Surgery achieved balanced bilateral nasal ventilation and decreased nasal resistance in the narrow region of the nasal cavity. The correction of nasal valve stenosis is not only indispensable for reducing nasal resistance, but also the key to obtain satisfactory curative effect.

Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers

OBJECTIVE: To assess short-term tomographic changes in the upper airway dimensions and quality of life of mouth breathers after rapid maxillary expansion (RME). METHODS: A total of 25 mouth breathers with maxillary atresia and a mean age of 10.5 years old were assessed by means of cone-beam computed tomography (CBCT) and a standardized quality of life questionnaire answered by patients' parents/legal guardians before and immediately after rapid maxillary expansion. RESULTS: Rapid maxillary expansion resulted in similar and significant expansion in the width of anterior (2.8 mm, p < 0.001) and posterior nasal floor (2.8 mm, p < 0.001). Although nasopharynx and nasal cavities airway volumes significantly increased (+1646.1 mm3, p < 0.001), oropharynx volume increase was not statistically significant (+1450.6 mm3, p = 0.066). The results of the quality of life questionnaire indicated that soon after rapid maxillary expansion, patients' respiratory symptoms significantly decreased in relation to their initial respiratory conditions. CONCLUSIONS: It is suggested that RME produces significant dimensional increase in the nasal cavity and nasopharynx. Additionally, it also positively impacts the quality of life of mouth-breathing patients with maxillary atresia. .

OBJETIVO: avaliar, por meio de tomografias, as mudanças em curto prazo nas vias aéreas superiores e na qualidade de vida em pacientes respiradores bucais, após expansão rápida da maxila (ERM). MÉTODOS: foram avaliados 25 pacientes respiradores bucais com atresia maxilar, com idade média de 10,5 anos, por meio de tomografia computadorizada de feixe cônico (TCFC) e questionário padronizado de qualidade de vida submetido aos pais/responsáveis, antes e imediatamente após a ERM. RESULTADOS: a ERM promoveu uma expansão, de forma semelhante e significativa, tanto na largura do soalho nasal anterior (2,8mm, p < 0,001) quanto na largura do soalho nasal posterior (2,8mm, p < 0,001). No volume aéreo da nasofaringe e fossas nasais, houve aumento significativo (+1646,1mm3 p < 0,001); entretanto, no volume aéreo da orofaringe, houve aumento não significativo (+1450,6 mm3 p = 0,066). Os resultados do questionário de qualidade de vida indicaram melhora significativa na qualidade de vida dos pacientes após a ERM, em comparação ao questionário inicial. CONCLUSÕES: a ERM promoveu aumento dimensional significativo nas fossas nasais e na nasofaringe, bem como melhorou significativamente a qualidade de vida dos pacientes. .

Computed Tomography and Magnetic Resonance Imaging Findings of Nasal Cavity Hemangiomas According to Histological Type

OBJECTIVE: To compare computed tomography (CT) and magnetic resonance imaging (MRI) findings between two histological types of nasal hemangiomas (cavernous hemangioma and capillary or lobular capillary hemangioma). MATERIALS AND METHODS: CT (n = 20; six pre-contrast; 20 post-enhancement) and MRI (n = 7) images from 23 patients (16 men and seven women; mean age, 43 years; range, 13-73 years) with a pathologically diagnosed nasal cavity hemangioma (17 capillary and lobular capillary hemangiomas and six cavernous hemangiomas) were reviewed, focusing on lesion location, size, origin, contour, enhancement pattern, attenuation or signal intensity (SI), and bony changes. RESULTS: The 17 capillary and lobular hemangiomas averaged 13 mm (range, 4-37 mm) in size, and most (n = 13) were round. Fourteen capillary hemangiomas had marked or moderate early phase enhancement on CT, which dissipated during the delayed phase. Four capillary hemangiomas on MRI showed marked enhancement. Bony changes were usually not seen on CT or MRI (seen on five cases, 29.4%). Half of the lesions (2/4) had low SI on T1-weighted MRI images and heterogeneously high SI with signal voids on T2-weighted images. The six cavernous hemangiomas were larger than the capillary type (mean, 20.5 mm; range, 10-39 mm) and most had lobulating contours (n = 4), with characteristic enhancement patterns (three centripetal and three multifocal nodular), bony remodeling (n = 4, 66.7%), and mild to moderate heterogeneous enhancement during the early and delayed phases. CONCLUSION: CT and MRI findings are different between the two histological types of nasal hemangiomas, particularly in the enhancement pattern and size, which can assist in preoperative diagnosis and planning of surgical tumor excision.

A nodular growth on maxillary gingiva.

A case of angiosarcoma of maxilla is presented. The occurrence of angiosarcoma in the oral cavity is a rare incidence and maxilla is one of the rarest sites to be involved. The purpose of this article is also to emphasize the fact that sometimes small, innocent-looking masses in the oral cavity might actually turn out to be a highly destructive malignant tumor. Hence, a complete radiographic and histopathologic examination is mandatory.

Piriform Aperture Morphometry and Nasal Bones Morphology in Brazilian Population by Postero-Anterior Caldwell Radiographys / Morfometría de la Apertura Piriforme y Morfología de los Huesos Nasales en la Población Brasileña por la Radiografía Postero-Anterior de Caldwell

Piriform aperture and nasal bone contribute to the formation of the nose. Its morphology varies according to ethnic group and gender. The piriform apertures and nasal bones of 97 individuals were examined radiographically through Caldwell radiographic technique and the types of nasal bones were classified according to Hwang et al. (2005). The width, height and area of piriform aperture were measured to demonstrate the difference according to gender. Statistical analysis was performed from the Student t test and analysis of variance (ANOVA). The most frequent type of nasal bone was A, and D was the most uncommon in both genders. In the Student t test significant differences between genders, height, width and area of the piriform aperture were obtained and were larger in males when compared to females. The dimensions of the piriform aperture were higher in males when compared to females, and therefore may be used as parameter for the distinction of gender in Brazilian population. The type A of nasal bone was the most frequent in the Brazilian population, contributing to ethnic differentiation in human identification.

La apertura piriforme y el hueso nasal contribuyen a la formación de la nariz. Su morfología varía de acuerdo a los grupos étnicos y al sexo. Este estudio evaluó la morfología de la apertura piriforme y el hueso nasal y su relación con el sexo. Las aperturas piriformes y los huesos nasales de 97 personas fueron examinados radiográficamente mediante la técnica radiográfica de Caldwell, y los tipos de huesos nasales se clasificaron de acuerdo con Hwang et al. (2005). Se midió el ancho, la altura y el área de la apertura piriforme para demostrar las diferencias por sexo. El análisis estadístico se realizó a partir de la prueba t de Student y análisis de varianza (ANOVA). El tipo más frecuente de hueso nasal fue la A, y la D fue la menos común, en ambos sexos. En la prueba t de Student se obtuvo diferencias significativas entre los sexos, altura, ancho y área de la apertura piriforme, las que fueron mayores en hombres en comparación a las mujeres. Las dimensiones de la apertura piriforme fueron mayores en los hombres que en las mujeres, por lo que se puede utilizar como parámetro para la distinción de sexo en la población brasileña. En la población brasileña el tipo A de hueso nasal fue el más frecuente, lo que contribuye para la diferenciación étnica en la identificación humana.

Rhinolith.

Rhinoliths are rare entities encountered in clinical practice. They are calcified masses found within the nasal cavity. Which lesions can be encountered incidentally upon a routine dental radiograph. This article reports a case of such an incidental finding of rhinolith on a dental radiograph.

Obstrução nasal unilateral: relato de caso e revisão da literatura / Unilateral nasal obstruction: case report and literature review

Obstrução nasal apresenta diversas etiologias, sendo a mais freqüente a que acompanha os processos virais de vias aéreas superiores. Quando o sintoma é unilateral e persistente, deve ser sempre descartada a presença de corpo estranho, principalmente se acompanhado de secreção nasal fétida. Também pode representar um tumor intranasal ou outras alterações estruturais (ex.: desvio de septo e/ou hipertrofia de conchas nasais). Rinólitos são massas calcáreas devido à incrustação parcial ou completa de um corpo estranho intranasal. O objetivo deste trabalho é revisar o diagnóstico e o tratamento da obstrução nasal unilateral a partir do relato de um caso clínico de rinólito em paciente adulto. Conclui-se que obstrução nasal unilateral, persistente e resistente a tratamento clínico convencional, é sinônimo de rinoscopia e que esta deva ser realizada, preferencialmente, por meio de endoscopia (AU)

Nasal obstruction has several causes being the upper respiratory viral infections the most frequent one. The presence of a foreign body has to be ruled out when the symptom is persistent and unilateral, and is associated to malodorous discharge. It might also be a symptom of an intranasal tumor or other anatomic abnormalities (eg: septal deviation or turbinate hypertrophy). Rhinoliths are calcareous masses from the deposition of calcium and magnesium over a long lasting intranasal foreign body. The purpose of this paper is to review the diagnosis and treatment of unilateral nasal obstruction from a case report of an adult patient with a rhinolith. We conclude that unilateral nasal obstruction, persistent and resistant to conventional clinical treatment is synonymous of a nasal rhinoscopy and that the rhinoscopy should be performed with endoscopic guidance (AU)

Maxillary sinus floor in edentulous and dentate patients.

To compare the depth of the maxillary sinus floor on panoramic radiographs between the edentulous and dentate patients. Thirty panoramic radiographs of edentulous female patients and 47 panoramic radiographs of female dentate patients were used for the sample. To measure the depth of the maxillary sinus floor, the outline of the maxillary sinus on the panoramic radiograph was traced on transparent paper. An apparent difference in depth of the maxillary sinus floor was recognized only in comparing the left sides of the edentulous and dentate jaws(P < 0.05). However, there was no statistical difference in the depth of the maxillary sinus floor between the right and left sides in the edentulous and dentate jaws. In this study there seems to be no difference in the depth of maxillary sinus floor between the right and left sides of either the edentulous or dentate jaws. It is not clear as to why, on the other hand, there is a statistical difference in between only the left maxillary sinus floor of the edentulous and dentate jaws, this apparent contradiction might be further investigated statistically.