Comparative cephalometric study of the airways between different ethnic groups with normal occlusion

ABSTRACT Objective: This study aimed to compare the nasopharynx and oropharynx airway dimensions of Caucasians, Blacks, Japanese, Japanese Brazilians, and Black Caucasians. Methods: A sample of 216 lateral radiographs of untreated young Brazilian subjects (mean age of 12.94 years; SD 0.88) were divided into five groups: Black Caucasian, Black, Caucasian, Japanese, and Japanese Brazilian. Lateral radiographs were used to measure the oropharynx (from the midpoint on the soft palate to the closest point on the anterior pharyngeal wall) and the nasopharynx (from the intersection of the posterior border of the tongue and the inferior border of the mandible to the closest point on the posterior pharyngeal wall). Analyses of variance (ANOVA) and Tukey's test were performed (p< 0.05). Results: The linear dimension of the oropharynx was similar among the different ethnic groups. Caucasian individuals presented a significantly greater linear dimension of the nasopharynx than Black Caucasian and Black individuals. Conclusions: All the groups had similar buccopharyngeal values. However, Caucasian individuals had significantly higher values when compared to Black Caucasians and Black individuals.

RESUMO Objetivo: Este estudo teve como objetivo comparar as dimensões das vias aéreas da nasofaringe e da bucofaringe de leucodermas, melanodermas, xantodermas, feodermas e nipo-brasileiros. Material e métodos: Uma amostra de 216 telerradiografias laterais de jovens brasileiros não tratados (idade média de 12,94 anos; DP 0,88) foi dividida em cinco grupos: melanodermas, leucodermas, xantodermas, feodermas e nipo-brasileiros. As telerradiografias foram utilizadas para medir a bucofaringe (do ponto médio do palato mole até o ponto mais próximo da parede anterior da faringe) e a nasofaringe (da intersecção da borda posterior da língua e da borda inferior da mandíbula até o ponto mais próximo). Foram realizadas análises de variância (ANOVA) e teste de Tukey (p < 0,05). Resultados: A dimensão linear da bucofaringe foi semelhante entre os diferentes grupos étnicos. Indivíduos leucodermas apresentaram dimensão linear da nasofaringe significativamente maior do que indivíduos feodermas e melanodermas. Conclusões: Todos os grupos apresentaram valores da bucofaringe semelhantes. No entanto, os indivíduos leucodermas apresentaram valores significantemente maiores, quando comparados aos feodermas e melanodermas.

Rinoscopia como auxiliar no diagnóstico de criptococose felina: Relato de caso / Rhinoscopy as aid in the diagnosis of feline cryptococosis: case report

Criptococose é uma micose sistêmica não contagiosa que acomete, principalmente, felinos. O agente etiológico é uma levedura do gênero Cryptococcus sp., e a sua transmissão ocorre por via aerógena, com a inalação dos esporos que se alojam, principalmente, na cavidade nasal e pulmão. A forma nasal é a mais comum em felinos e as suas manifestações clínicas incluem edema nasofacial, eritema e secreção nasal. O diagnóstico pode ser realizado por meio de cultivo micológico, citologia, histologia e reação em cadeia polimerase. Neste artigo, é apresentado o relato de caso de um felino diagnosticado com criptococose, no qual o diagnóstico de triagem foi realizado por meio de rinoscopia. No atendimento inicial, o animal apresentava hiporexia, reflexo de deglutição constante, engasgos, odor acentuado em região nasal e crepitações pulmonares com evolução de três meses. O diagnóstico foi realizado com o emprego de rinoscopia, que identificou massa interna na região da mucosa nasofaríngea, com posterior biópsia e exame anatomopatológico. Após a confirmação diagnóstica, o paciente foi medicado com itraconazol 10 mg/kg SID, por 5 meses, e teve a resolução de todos os sinais clínicos apresentados. A criptococose deve ser considerada como diagnóstico, diferencial de alterações do sistema respiratório em felinos e a rinoscopia pode ser um recurso diagnóstico importante para auxiliar na conclusão e reconhecimento da enfermidade.(AU)

Cryptococcosis is a non-contagious systemic mycosis that primarily affects felines. Its etiological agent is a yeast of the genus Cryptococcus sp., and its transmission occurs through the air, by inhalation of spores that primarily lodge in the nasal cavity and lungs. The nasal form is the most common in felines and clinical manifestations include nasofacial edema, erythema and nasal discharge. Diagnosis can be made by means of mycological culture, cytology, histology and polymerase chain reaction. This article presents a case of a feline diagnosed with cryptococcosis, in which the screening diagnosis was performed by means of rhinoscopy. In the initial care, the animal presented hyporexia, constant swallowing reflex, choking, accentuated odor in the nasal region and pulmonary crackles with evolution of three months. The diagnosis was made using rhinoscopy, which identified an internal mass in the nasopharyngeal mucosa, and subsequent biopsy and anatomopathological examination. After diagnostic confirmation, the patient was medicated with itraconazole 10 mg/kg SID for 5 months and had resolution of all clinical signs presented. Cryptococcosis should be considered as a differential diagnosis of alterations in the respiratory system in cats and rhinoscopy can be an important diagnostic tool to assist in the conclusion and recognition of this disease.(AU)

Colonization by Streptococcus pneumoniae among children in Porto Velho, Rondônia, Western Brazilian Amazon / Colonização por Streptococcus pneumoniae em crianças na Amazônia Ocidental Brasileira, Porto Velho, Rondônia

Streptococcus pneumoniae is one of the primary pathogens that are associated with acute respiratory infections (ARI) that cause high rates of morbidity and mortality among children under five years of age in developed and developing countries. This study aimed to determine the prevalence of nasopharyngeal colonization, the antimicrobial resistance profile, and the capacity for biofilm formation by S. pneumoniae isolated from children aged 0-6 years with ARI throughout the Porto Velho-RO. A total of 660 swabs were collected from children with ARI. Molecular and biochemical tests were performed to characterize the isolates. The disk-difusion method and the E-test were used for antimicrobial sensitivity testing (TSA). Biofilm formation capacity was assessed using microtiter plate assays, and serotype detection was acheived using polymerase chain reaction (PCR) analyses. The colonization rate for S. pneumoniae was 8.9% (59/660) and exhibited a high prevalence in children under 23 months of age 64.4% (38/59). The observed serotypes were 9V and 19F with frequencies of 1.7% (1/59) and 13.6% (8/59), respectively. The antimicrobial susceptibility test revealed 100% (59/59) sensitivity to vancomycin. In contrast, trimethoprim and oxacillin exhibited high resistance rates of 76.3% (45/59) and 52.5% (31/59), respectively. Of the biofilm-forming isolates, 54.8% (23/42) possessed resistance to some antimicrobials. In this study, S. pneumoniae showed high rates of antimicrobial resistance and the ability to form biofilms, as these are factors that favor bacterial persistence and can cause serious damage to the host.(AU)

Streptococcus pneumoniae é um dos principais patógenos associados a infecções respiratórias agudas (IRAs) que causam altas taxas de morbidade e mortalidade entre crianças menores de cinco anos de idade em países desenvolvidos e em desenvolvimento. Este estudo teve como objetivo determinar a prevalência de colonização da nasofaringe, o perfil de resistência antimicrobiana e a capacidade de formação de biofilme dos S. pneumoniae isolados de crianças de 0 a 6 anos com IRA na cidade de Porto Velho-Rondônia. Um total de 660 swabs foi coletado de crianças com IRA. Testes moleculares e bioquímicos foram realizados para identificar os isolados bacterianos. O método de disco-difusão e o E-test foram utilizados para o teste de sensibilidade antimicrobiana (TSA). A capacidade de formação de biofilme foi avaliada por meio de ensaios em placas de microtitulação e a detecção de sorotipos foi obtida por meio de análises de Reação em Cadeia da Polimerase (PCR). A taxa de colonização por S. pneumoniae foi de 8,9% (59/660) e apresentou alta prevalência em menores de 23 meses de idade 64,4% (38/59). Os sorotipos identificados foram 9V e 19F com frequências de 1,7% (1/59) e 13,6% (8/59) respectivamente. O teste de sensibilidade aos antimicrobianos revelou 100% (59/59) de sensibilidade à vancomicina. Em contraste, trimetoprima e oxacilina apresentaram altas taxas de resistência de 76,3% (45/59) e 52,5% (31/59) respectivamente. Dos isolados formadores de biofilme 54,8% (23/42) possuíam resistência a alguns dos antimicrobianos. Neste estudo, S. pneumoniae apresentou altas taxas de resistência antimicrobiana e capacidade de formar biofilmes, pois são fatores que favorecem a persistência bacteriana e podem causar sérios danos ao hospedeiro.(AU)

Cáncer de nasofaringe, una revisión de la literatura / Nasopharyngeal Cancer, a literature review

Resumen Introducción: El cáncer de nasofaringe es una patología poco común que tiene gran impacto en la calidad de vida de los pacientes. Con el advenimiento de nuevos esquemas de tratamiento se ha logrado mejorar el pronóstico con un menor índice de morbilidad. Esta revisión describe la perspectiva actual del cáncer de nasofaringe, basado en la literatura reciente y la disponibilidad de recursos para su tratamiento en una institución médica de Medellín, Colombia. Materiales y Método: Se realizó una búsqueda bibliográfica que incluyó artículos desde 1986 hasta 2018 en diferentes bases de datos como MEDLINE, EBSCO y LILACS. Se incluyó literatura escrita en inglés o español, utilizando como términos MESH neoplasias de nasofaringe, diagnóstico y terapéutica. Resultados: La evaluación diagnóstica oportuna del cáncer de nasofaringe es de vital importancia al proporcionar una estrategia de tratamiento efectiva con menor morbimortalidad. Según la experiencia institucional de los autores, en las etapas clínicas tempranas, se sugiere la radioterapia radical como modalidad única y en etapas intermedias-avanzadas los tratamientos combinados con quimioterapia-radioterapia concomitante o secuencial dependiendo de cada paciente y quimioterapia única en pacientes metastásicos a distancia. Conclusiones: Acorde con el análisis de la literatura y evidencia existente, las estrategias utilizadas son adaptadas a los alcances de la institución como ente de alto nivel en el sector salud. La cirugía representa un papel relevante en la enfermedad recurrente resecable ya sea con técnica endoscópica o abierta. Es importante recordar que la morbilidad postoperatoria no es inocua, y en ocasiones sobrepasa el beneficio obtenido.

Introduction: Nasopharyngeal cáncer is a rare disease that has a huge impact on the quality of life. Survival rates are steadily improving due to new treatments with a lower morbidity index. This review describes the current perspective of nasopharyngeal cancer, based on recent literature and the availability of resources for treatment in the different specialties of an institution in Medellin, Colombia. Materials and Method: A literature review was carried out, including articles from 1986 to 2017 in different databases such as MEDLINE, EBSCO and LILACS. Written literature in English or Spanish was included, using MESH terms as Nasopharyngeal, diagnostic and therapeutic neoplasms. Results: Nasopharyngeal cancer timely diagnostic is of vital importance. According to the institutional experience, in early clinical stage radiotherapy is suggested as a single modality. Intermediate stages treatments options are concurrent chemo radiotherapy or sequential radiotherapy according to each patient case. In distant metastatic stage single chemotherapy is used. Conclusions: According to existing evidence strategies used are adapted to the scope of the institution as a high-level entity in health sector. Surgery represents a relevant role in recurrent resecable disease with either endoscopic or open technique. It is important to remember that postoperative morbidity is not harmless, and sometimes exceeds the benefit obtained.

Pólipo piloso nasofaríngeo en un recién nacido con obstrucción intermitente de la vía aérea. Presentación de un caso / Nasopharyngeal hairy polyp in a newborn with intermittent airway obstruction. Case report

Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente

Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient

Caracterización clínica y epidemiológica del carcinoma nasofaríngeo y su relación con el virus Epstein-Barr / Nasopharyngeal carcinoma and its relationship with the Epstein-Barr virus, clinical and epidemiological description

RESUMEN Fundamento: El carcinoma nasofaríngeo es el tumor maligno más frecuente del cavum. Estos tumores se diferencian de otros carcinomas epidermoide de la cabeza y cuello por su histología característica y su relación con el virus de Epstein-Barr. Objetivo: Caracterizar clínica y epidemiológicamente el carcinoma de nasofaringe y su relación con el virus Epstein-Barr, en el Instituto Nacional de Oncología y Radiobiología, Ciudad de la Habana, en el período de enero a diciembre de 2012. Metodología: Se realizó un estudio retrospectivo; se trabajó con un total de 16 historias clínicas. Se observaron variables como edad, sexo, tipo histológico, estadiamiento clínico, presencia del virus Epstein-Barr en el tumor, tratamiento aplicado, respuesta al tratamiento, recaída y estado del paciente. Resultados: El 50 % tenían entre 45-55 años de edad, 75 % eran hombres, el 50 % diagnosticados con tipo 3, 100 % negativo a la inmunohistoquímica para virus Epstein-Barr, predominó la etapa III con 43.75 %, el 56.25 % de los casos se trataron con radio-quimioterapia más quimioterapia, el 50 % tuvo respuesta completa, la recaída fue de 37.50 % y el 68.75 % de los pacientes estaba vivo a los 60 meses. Conclusiones: En esta pequeña población con carcinoma nasofaríngeo, la totalidad de la población fue negativa a la presencia de virus Epstein-Barr por técnicas de inmunohistoquímica, por lo que su negatividad se hizo representativa en los tipo 3 y etapas avanzadas y no tuvo impacto en la respuesta al tratamiento y la supervivencia global.

ABSTRACT Background: Nasopharyngeal carcinoma is the most common malignant tumor of the cavum. These tumors differ from some other epidermoid carcinomas of the head and neck by their histology features and their Epstein-Barr virus relationship. Objective: To describe clinically and epidemiologically the nasopharyngeal carcinoma and its relationship with the Epstein-Barr virus, at the National Institute of Oncology and Radiobiology, Havana City, from January to December 2012. Methodology: A retrospective study was conducted; with a total of 16 medical records. Variables such as age, sex, histological type, clinical staging, and presence of Epstein - Barr virus in the tumor, applied treatment, response to treatment, relapse and patient status were observed. Results: 50 % were between 45-55 years old, 75 % were men, 50 % diagnosed with type 3, 100 % negative to Epstein-Barr virus immunohistochemistry, stage III predominated with 43.75 %, 56.25 % of the cases were treated with radio-chemotherapy plus chemotherapy, 50 % had a complete response, relapse was 37.50 % and at 60 months 68.75 % of the patients were still alive. Conclusions: In this small population with nasopharyngeal carcinoma, the entire population was negative to the presence of Epstein-Barr virus applying immunohistochemical techniques, so its negativity became representative in type 3 and advanced stages and had no impact on the treatment response and overall survival.

The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases / O papel do exame clínico e da biópsia de nasofaringe no diagnóstico de doenças malignas

Abstract Introduction: In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated. Objectives: The aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated. Methods: The study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology. Results: The examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p < 0.001). Conclusion: In comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.

Resumo Introdução: Em proporção direta à taxa crescente de exames de nasofaringe que são feitos, o diagnóstico precoce e o tratamento de lesões nessa região têm sido possíveis. Nem sempre os achados clínicos e os resultados da primeira biópsia são consistentes, levando à necessidade de biópsias repetidas. Objetivos: Avaliar a distribuição dos resultados dos testes histopatológicos obtidos pela biópsia de nasofaringe, determinar quais métodos foram mais frequentemente usados na identificação e investigar os casos nos quais a biópsia precisou ser repetida. Método: O estudo incluiu 1.074 pacientes (500 mulheres, 574 homens) submetidos a biópsia de nasofaringe em nossa clínica entre junho de 2011 e junho de 2017. Os dados foram obtidos dos prontuários dos pacientes e incluíram idade, sexo, achados clínicos, achados de imagem e diagnóstico histopatológico. Os diagnósticos histopatológicos foram separados em três grupos principais como nasofaringite crônica, citologia benigna e citologia maligna. Resultados: Os exames resultaram em 996 casos laudados como nasofaringite crônica, 47 como citologia benigna e 31 como citologia maligna. Das 31 lesões malignas, o diagnóstico foi feito em 15 (48,4%) com uma única biópsia e em 16 (51,6%), quando duas ou mais biópsias foram feitas. Na comparação das lesões benignas e malignas em relação à necessidade de biópsias repetidas, os casos determinados como malignos mostraram uma taxa estatisticamente maior de biópsia repetida (p < 0,001). Conclusão: Em comparação com os casos de tumores benignos, um número estatisticamente maior de biópsias repetidas foi necessário em casos diagnosticados como tumores malignos, para confirmação do diagnóstico histopatológico ou na suspeita continuada de malignidade. Portanto, quando há suspeita clínica, mesmo que não haja achados de malignidade na primeira biópsia, ela deve ser repetida tão logo seja possível.

Assessment of nasopharyngeal airway volume in pediatric patients with adenoid hypertrophy by cone-beam computerized tomography / Volumen de la vía aérea nasofaríngea en pacientes pediátricos con hipertrofia adenoidea: evaluación por tomografía computarizada de haz cónico

Objective: Adenoid hypertrophy is a disease whose most serious effect is the obstruction of the nasopharyngeal airway, leading to severe dentoskeletal deformities. The aim of this study was to determine the volume of the nasopharynx in patients with different grades of adenoid hypertrophy. Materials and methods: A retrospective study was conducted. One hundred and twenty-five cone beam computed tomographies of 8 to 12-year-old pediatric patients, obtained from the 2014-2017 database of the School of Dentistry of Universidad de San Martin de Porres, were selected. Romexis 3.6.0 software (PlanMeca®, Finland) was used. In order to make a diagnosis and determine the grade of hypertrophy (Grade 1= healthy, Grade 2= mild, Grade 3= moderate and Grade 4= severe) quantitative and qualitative methods were used; grades 2, 3 and 4 were considered pathological. The same software was used to determine the volume of the nasopharynx. Results: Grade 1 hypertrophy was 44%, mild 36,8%, moderate 13,6% and severe 5,6%, accounting for a pathological adenoid hypertrophy prevalence of 56%. The mean volume of the nasopharynx was 4.985, 3.375, 2.154 and 0.944cm3 for grades 1, 2, 3 and 4, respectively. Conclusions: There is a high prevalence of pathological adenoid hypertrophy (56%). The volume of the nasopharynx decreases according to the severity of the adenoid hypertrophy.

Objetivo: La hipertrofia adenoidea es una patología cuya repercusión más severa es la obstrucción de la vía aérea nasofaríngea, con graves consecuencias de malformaciones dento-esqueléticas. El objetivo del estudio fue determinar el volumen de la vía aérea nasofaríngea en pacientes con diferentes grados de hipertrofia adenoidea. Material y método: Se realizó un estudio retrospectivo, se seleccionaron 125 tomografías computarizadas de haz cónico de pacientes pediátricos de 8 a 12 años de edad obtenidas en la base de datos del 2014 al 2017 de la Facultad de Odontología de la Universidad de San Martín de Porres. Se utilizó el software Romexis 3.6.0 (PlanMeca®, Finlandia); para realizar el diagnóstico y determinar el grado de hipertrofia (Grado 1= sano, Grado 2=leve, Grado 3=moderado y Grado 4= severo) se utilizaron dos métodos, uno de evaluación cualitativa y otra cuantitativa; los grados 2, 3 y 4 fueron considerados como patológicos; para determinar el volumen de la vía aérea nasofaríngea se utilizaron las herramientas del mismo software. Resultados: La hipertrofia grado 1 estuvo constituida por el 44%, leve en el 36.8%, moderado en el 13.6% y severo en el 5.6%; constituyendo finalmente una prevalencia de hipertrofia adenoidea patológica del 56%. Las medias de los volúmenes de la vía aérea nasofaríngea fueron de 4.985, 3.375, 2.154 y 0.944 cm3 para los grados 1, 2, 3 y 4 respectivamente. Conclusión: Existe una alta prevalencia de hipertrofia adenoidea patológica (56%), el volumen de la vía aérea nasofaríngea tiende a disminuir conforme a la severidad de la hipertrofia adenoidea.

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.

The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases.

INTRODUCTION: In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated. OBJECTIVES: The aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated. METHODS: The study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology. RESULTS: The examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p<0.001). CONCLUSION: In comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.

Are computed tomography 3D measurements of the upper airways in mouth-breathing children in agreement with the ENT clinical diagnosis of obstruction?

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.

Glossopharyngeal and vagus neuropathy associated to stylopharyngeus muscle compression in horse guttural pouch ­ case report / Neuropatia do glossofaringeo e vago associada à compressão pelo musculo estilofaringeo em bolsa gutural de equino ­ relato de caso

Neuropathies of pharyngeal branches of glossopharyngeal and vagus are often associated with guttural pouches diseases; however, these branches of injury due to stylopharyngeus muscle compression are not reported. A case was reported of a quarter horse mare, 8 years old, 450 kg, presenting dyspnea and respiratory noise associated with weight loss. Clinical examination observed mixed dyspnea, tachycardia, dysphagia, sialorrhea, lung crackles and submandibular and parotid lymphadenopathy. Endoscopic exam showed right arytenoid chondritis, nasopharyngeal collapse, generalized larynx edema and dorsal displacement of the soft palate. Right guttural pouch evaluation showed swelling in the origin of stylopharyngeus muscle with consequent compression of the XII, X and IX cranial nerves. Tracheotomy, systemic treatment with corticosteroids, beta lactams and aminoglycosides antibiotics were performed. No resolution was observed and, after 16 days, the animal showed clinical worsening, developed pleuropneumonia, uveitis, severe sepsis, acute renal failure and was euthanized. The mixed neuropathy resulted in rapid clinical deterioration of the animal, due to the difficulty in swallowing and consequent associated respiratory processes. This report emphasizes the importance of evaluating stylopharyngeus muscle origin in cases of nasopharyngeal collapse associated with dysphagia in horses, given the possibility that structural changes in this muscle can result in laryngeal neuropathy.(AU)

As neuropatias do glossofaríngeo e vago são frequentemente associadas com enfermidade das bolsas guturais. A ocorrência desta lesão secundária a compressão pelo músculo estilofaríngeo não é reportada. Relata-se o caso de uma égua quarto de milha, 8 anos de idade, 450 kg, apresentando dispneia, ruído respiratório e perda de peso. No exame clínico observou-se dispnéia mista, taquicardia, disfagia, sialorréia, crepitação pulmonar e linfadenopatia submandibular e parotídea. Ao exame endoscópico identificou-se condrite aritenóide direita, colapso nasofaríngeo, edema generalizado da laringe e deslocamento dorsal do palato mole. Na avaliação da bolsa gutural direita identificou-se aumento de volume na origem do músculo estilofaríngeo com consequente compressão dos nervos cranianos XII, X e IX. Foi realizada traqueotomia, tratamento sistêmico com corticosteróides e antibióticos. Nenhuma resolução foi observada, após 16 dias o animal apresentou piora clínica, pleuropneumonia, uveíte, sepse grave, insuficiência renal aguda e foi submetido à eutanásia. A neuropatia mista resultou em rápida deterioração clínica do animal, devido à dificuldade de deglutição e processos respiratórios associados. Salienta-se a importância de se avaliar a origem do músculo estilofaríngeo em casos de colapso nasofaríngeo associado a disfagia em cavalos, dada a possibilidade de que alterações estruturais nesse músculo possam resultar em neuropatia laríngea.(AU)

Glossopharyngeal and vagus neuropathy associated to stylopharyngeus muscle compression in horse guttural pouch case report / Neuropatia do glossofaringeo e vago associada à compressão pelo musculo estilofaringeo em bolsa gutural de equino relato de caso

Neuropathies of pharyngeal branches of glossopharyngeal and vagus are often associated with guttural pouches diseases; however, these branches of injury due to stylopharyngeus muscle compression are not reported. A case was reported of a quarter horse mare, 8 years old, 450 kg, presenting dyspnea and respiratory noise associated with weight loss. Clinical examination observed mixed dyspnea, tachycardia, dysphagia, sialorrhea, lung crackles and submandibular and parotid lymphadenopathy. Endoscopic exam showed right arytenoid chondritis, nasopharyngeal collapse, generalized larynx edema and dorsal displacement of the soft palate. Right guttural pouch evaluation showed swelling in the origin of stylopharyngeus muscle with consequent compression of the XII, X and IX cranial nerves. Tracheotomy, systemic treatment with corticosteroids, beta lactams and aminoglycosides antibiotics were performed. No resolution was observed and, after 16 days, the animal showed clinical worsening, developed pleuropneumonia, uveitis, severe sepsis, acute renal failure and was euthanized. The mixed neuropathy resulted in rapid clinical deterioration of the animal, due to the difficulty in swallowing and consequent associated respiratory processes. This report emphasizes the importance of evaluating stylopharyngeus muscle origin in cases of nasopharyngeal collapse associated with dysphagia in horses, giv

As neuropatias do glossofaríngeo e vago são frequentemente associadas com enfermidade das bolsas guturais. A ocorrência desta lesão secundária a compressão pelo músculo estilofaríngeo não é reportada. Relata-se o caso de uma égua quarto de milha, 8 anos de idade, 450 kg, apresentando dispneia, ruído respiratório e perda de peso. No exame clínico observou-se dispnéia mista, taquicardia, disfagia, sialorréia, crepitação pulmonar e linfadenopatia submandibular e parotídea. Ao exame endoscópico identificou-se condrite aritenóide direita, colapso nasofaríngeo, edema generalizado da laringe e deslocamento dorsal do palato mole. Na avaliação da bolsa gutural direita identificou-se aumento de volume na origem do músculo estilofaríngeo com consequente compressão dos nervos cranianos XII, X e IX. Foi realizada traqueotomia, tratamento sistêmico com corticosteróides e antibióticos. Nenhuma resolução foi observada, após 16 dias o animal apresentou piora clínica, pleuropneumonia, uveíte, sepse grave, insuficiência renal aguda e foi submetido à eutanásia. A neuropatia mista resultou em rápida deterioração clínica do animal, devido à dificuldade de deglutição e processos respiratórios associados. Salienta-se a importância de se avaliar a origem do músculo estilofaríngeo em casos de colapso nasofaríngeo associado a disfagia em cavalos, dada a possibilidade de que alterações estruturais nesse m

Glossopharyngeal and vagus neuropathy associated to stylopharyngeus muscle compression in horse guttural pouch ­ case report / Neuropatia do glossofaringeo e vago associada à compressão pelo musculo estilofaringeo em bolsa gutural de equino ­ relato de caso

Neuropathies of pharyngeal branches of glossopharyngeal and vagus are often associated with guttural pouches diseases; however, these branches of injury due to stylopharyngeus muscle compression are not reported. A case was reported of a quarter horse mare, 8 years old, 450 kg, presenting dyspnea and respiratory noise associated with weight loss. Clinical examination observed mixed dyspnea, tachycardia, dysphagia, sialorrhea, lung crackles and submandibular and parotid lymphadenopathy. Endoscopic exam showed right arytenoid chondritis, nasopharyngeal collapse, generalized larynx edema and dorsal displacement of the soft palate. Right guttural pouch evaluation showed swelling in the origin of stylopharyngeus muscle with consequent compression of the XII, X and IX cranial nerves. Tracheotomy, systemic treatment with corticosteroids, beta lactams and aminoglycosides antibiotics were performed. No resolution was observed and, after 16 days, the animal showed clinical worsening, developed pleuropneumonia, uveitis, severe sepsis, acute renal failure and was euthanized. The mixed neuropathy resulted in rapid clinical deterioration of the animal, due to the difficulty in swallowing and consequent associated respiratory processes. This report emphasizes the importance of evaluating stylopharyngeus muscle origin in cases of nasopharyngeal collapse associated with dysphagia in horses, given the possibility that structural changes in this muscle can result in laryngeal neuropathy.(AU)

As neuropatias do glossofaríngeo e vago são frequentemente associadas com enfermidade das bolsas guturais. A ocorrência desta lesão secundária a compressão pelo músculo estilofaríngeo não é reportada. Relata-se o caso de uma égua quarto de milha, 8 anos de idade, 450 kg, apresentando dispneia, ruído respiratório e perda de peso. No exame clínico observou-se dispnéia mista, taquicardia, disfagia, sialorréia, crepitação pulmonar e linfadenopatia submandibular e parotídea. Ao exame endoscópico identificou-se condrite aritenóide direita, colapso nasofaríngeo, edema generalizado da laringe e deslocamento dorsal do palato mole. Na avaliação da bolsa gutural direita identificou-se aumento de volume na origem do músculo estilofaríngeo com consequente compressão dos nervos cranianos XII, X e IX. Foi realizada traqueotomia, tratamento sistêmico com corticosteróides e antibióticos. Nenhuma resolução foi observada, após 16 dias o animal apresentou piora clínica, pleuropneumonia, uveíte, sepse grave, insuficiência renal aguda e foi submetido à eutanásia. A neuropatia mista resultou em rápida deterioração clínica do animal, devido à dificuldade de deglutição e processos respiratórios associados. Salienta-se a importância de se avaliar a origem do músculo estilofaríngeo em casos de colapso nasofaríngeo associado a disfagia em cavalos, dada a possibilidade de que alterações estruturais nesse músculo possam resultar em neuropatia laríngea.(AU)

Neutrophil-lymphocyte ratios in the prognostication of primary non-metastatic nasopharyngeal carcinoma / Neutrophil-lymphocyte ratios in the prognostication of primary non-metastatic nasopharyngeal carcinoma

Abstract Introduction: Nasopharyngeal carcinoma is a geographically and racially variable disease which has a high incidence in Malaysia. Based on current concepts in tumour related inflammation the inflammatory marker, neutrophil-lymphocyte ratio was tested to find its relationship with prognosis in nasopharyngeal carcinoma. Objective: To investigate the effect of the neutrophil-lymphocyte ratio on prognosis in non-metastatic primary nasopharyngeal carcinoma patients and to further refine the cut off between high and low neutrophil-lymphocyte ratio values. Methods: The medical charts of patients with histologically confirmed nasopharyngeal carcinoma from 1st January 2005 until 31st December 2009 were reviewed retrospectively and theneutrophil-lymphocyte ratio was calculated to see if there was any association between their higher values with higher failure rates. Results: Records of 98 patients (n = 98) were retrieved and reviewed. Only neutrophil-lymphocyte ratio (p = 0.004) and tumor node metastasis staging (p = 0.002) were significantly different between recurrent and non-recurrent groups, with the neutrophil-lymphocyte ratio being independent of tumor node metastasis staging (p = 0.007). Treatment failure was significantly higher in the high neutrophil-lymphocyte ratio group (p = 0.001). Disease free survival was also significantly higher in this group (p = 0.000077). Conclusion: High neutrophil-lymphocyte ratio values are associated with higher rates of recurrence and worse disease free survival in non-metastatic nasopharyngeal carcinoma patients undergoing primary curative treatment.

Resumo: Introdução: O carcinoma de nasofaringe é uma doença variável geográfica e etnicamente, com alta incidência na Malásia. Baseado em conceitos atuais sobre inflamação relacionada a tumores, o marcador inflamatório relação neutrófilos/linfócitos foi testado para verificar sua relação com o prognóstico dessa condição clínica. Objetivo: Investigar o efeito do marcador neutrófilos/linfócitos no prognóstico de pacientes com primários não metastáticos de nasofaringe e refinar o ponto de corte entre valores altos e baixos da relação neutrófilos/linfócitos. Método: Os prontuários médicos dos pacientes com carcinoma de nasofaringe confirmado histologicamente de 1º de janeiro de 2005 até 31 de dezembro de 2009 foram revisados retrospectivamente e a relação neutrófilos/linfócitos foi calculada para verificar se havia alguma associação entre valores maiores e aumento na taxa de falha de tratamento. Resultados: Os dados de 98 pacientes (n = 98) foram revisados. Apenas a relação neutrófilos/linfócitos (p = 0,004) e o estadiamento TNM (p = 0,002) foram significantemente diferentes entre os grupos recorrentes e os não recorrentes, a relação neutrófilos/linfócitos foi independente do estadiamento TNM (p = 0,007). A falha de tratamento foi significantemente maior no grupo com relação neutrófilos/linfócitos alta (p = 0,001). A sobrevida livre de doença também foi significantemente maior nesse grupo (p = 0,000077). Conclusão: Os altos valores da relação neutrófilos/linfócitos estão associados a maiores taxas de recorrência e menor tempo de sobrevida livre de doença em pacientes com carcinomas não metastáticos de nasofaringe submetidos a tratamento curativo primário.

Nasoangiofibroma Juvenil vs Hemangioma Arteriovenoso, Reto diagnóstico / Nasal Juvenile Angiofibroma vs Arteriovenous Hemangioma, Diagnosis Challenge. Case report

El nasoangiofibroma juvenil es un tumor vascular benigno, localmente agresivo pero poco común, representa tan solo el 0,05% de todos los tumores de cabeza y cuello, con una incidencia de aproximadamente 1:150.000. Por otra parte los hemangiomas son neoplasias benignas de las células endoteliales, representa el 7% de los tumores vasculares y son lesiones poco común de cabeza y cuello, pero ¿Son una misma entidad?, ¿Se puede trazar una línea clara para diferenciarlos?. El objetivo del presente articulo es proporcionar información acerca de estas dos entidades clínicas y responder las preguntas previamente formuladas. Este es el caso clínico de un paciente del género masculino de 19 años de edad, quien consultó por cefalea hemicraneana izquierda, otalgia y sensación de opresión ocular ipsilateral de 7 días de evolución. La tomografía axial computarizada de cráneo mostró una masa de densidad de tejidos blandos que ocupa la coana izquierda, infiltra parcialmente la región posterior de la fosa nasal izquierda, erosiona la apófisis pterigoides y el suelo de la celda esfenoidal izquierda. Se realizó biopsia por medio de nasofibrolaringoscopia en el consultorio, previa a infiltración con lidocaína, se toman dos muestras de lesión en coana izquierda sin sangrado significativo; el reporte patológico informa hemangioma arteriovenoso, por lo que se decidió realizar embolización pre quirúrgica; posteriormente es llevado a procedimiento quirúrgico sin complicaciones, finalmente la biopsia excisional reporta nasoangiofibroma juvenil con estudio de inmunohistoquimica CD31 y CD34 reactivo en pared de estructurasvasculares. El nasoangiofibroma juvenil es el tumor más común de la nasofaringe en hombres adolescente, la ausencia de epistaxis recurrente unilateral no debe descartar el diagnostico..(AU)

Nasal Juvenile angiofibroma is a benign vascular tumor, locally aggressive but uncommon, it only represents 0,05% of all head and neck tumors, with an approximate incidence of 1:150-000. On the other hand hemangiomas are benign neoplasms of endothelial cells, they represent 7% of vascular tumors and they are uncommon lesions of the head and neck but Are they the same entity?, Can a clear line be drawn to differentiate them?. The objective of this article is to provide information about these two clinical entities and answer the questions previously asked. This is the clinical case of a 19 year old male, that consulted for left headache, left earache and left ocular oppression of 7 days of evolution. Brain axial constrast computed tomography showed a mass of soft tissue density that occupies the left coana, partially infiltrates the posterior region left nasal fossa, erodes the pterygoid process and the floor of left the sphenoid cell. Biopsy was performed by means of nasofibrolaryngoscopy in the office, previos to infiltration with lidocaine, two samples of lesion were taken in the left choana without significant bleeding; the pathological report informs arteriovenous hemangioma. it was decided to perform a pre-surgical embolization. After this, the surgical procedure was carried out without complications. Finally, the excisional biopsy reported a juvenil nasoangiofibroma with immunohistochemical study of CD31 and CD34 reactive in wall of vascular structures. Nasal Juvenile Nasoangiofibroma is the most common tumor of the nasopharynx in adolescent males, the absence of recurrent unilateral epistaxis should not rule out the diagnosis..(AU)

Osteotomia Le Fort I para tratamento cirúrgico do angiofibroma juvenil nasofaríngeo: relato de três casos / Le Fort I osteotomy for surgical treatment of juvenile nasopharyngeal angiofibroma: report of three cases

O angiofibroma juvenil nasofaríngeo é um tumor benigno altamente vascularizado, de crescimento lento, mas localmente invasivo e destrutivo. De baixa prevalência, geralmente se localiza na nasofaringe de indivíduos jovens do gênero masculino. As características clínicas mais comuns são obstrução nasal e epistaxe. Possui diagnóstico baseado, principalmente, nos achados clínicos e imaginológicos, já que a biópsia é dificultada pelas características vasculares da lesão. Seu tratamento de escolha é a excisão cirúrgica, que pode ser realizada por diversas técnicas: via endoscópica, degloving médio-facial, via transpalatina, rinotomia lateral ou através da Osteotomia Le Fort I. O objetivo deste trabalho é relatar a utilização da Osteotomia Le Fort I como acesso para o tratamento cirúrgico de três pacientes do gênero masculino portadores de extensos angiofibromas localizados na nasofaringe que procuraram atendimento no ambulatório de cirurgia buco-maxilo facial do Hospital Universitário Presidente Dutra (HUUFMA)... (AU)

Juvenile nasopharyngeal angiofibroma is a slow-growing, highly invasive and vascularized benign tumor. With low prevalence rate, it is usually located in the nasopharynx of young men. The most common clinical characteristics are nasal obstruction and epistaxis. Its diagnosis is based mainly on the clinical and imaging findings, for the biopsy is hindered due to the vascular characteristics of the lesion. Thus, the treatment of choice is its surgical excision, which can be performed by many techniques: endoscopic, medial-facial degloving, transpalatine, lateral rhinotomy or through the Le Fort I Osteotomy. This paper aims to depict the use of Le Fort I Osteotomy approach for the surgical treatment of three male patients with extensive angiofibroma located in nasopharynx who sought care at the Oral and Maxillofacial Surgery Department of Presidente Dutra University Hospital.... (AU)

Neutrophil-lymphocyte ratios in the prognostication of primary non-metastatic nasopharyngeal carcinoma.

INTRODUCTION: Nasopharyngeal carcinoma is a geographically and racially variable disease which has a high incidence in Malaysia. Based on current concepts in tumour related inflammation the inflammatory marker, neutrophil-lymphocyte ratio was tested to find its relationship with prognosis in nasopharyngeal carcinoma. OBJECTIVE: To investigate the effect of the neutrophil-lymphocyte ratio on prognosis in non-metastatic primary nasopharyngeal carcinoma patients and to further refine the cut off between high and low neutrophil-lymphocyte ratio values. METHODS: The medical charts of patients with histologically confirmed nasopharyngeal carcinoma from 1st January 2005 until 31st December 2009 were reviewed retrospectively and theneutrophil-lymphocyte ratio was calculated to see if there was any association between their higher values with higher failure rates. RESULTS: Records of 98 patients (n=98) were retrieved and reviewed. Only neutrophil-lymphocyte ratio (p=0.004) and tumor node metastasis staging (p=0.002) were significantly different between recurrent and non-recurrent groups, with the neutrophil-lymphocyte ratio being independent of tumor node metastasis staging (p=0.007). Treatment failure was significantly higher in the high neutrophil-lymphocyte ratio group (p=0.001). Disease free survival was also significantly higher in this group (p=0.000077). CONCLUSION: High neutrophil-lymphocyte ratio values are associated with higher rates of recurrence and worse disease free survival in non-metastatic nasopharyngeal carcinoma patients undergoing primary curative treatment.

Extrações ortodônticas de pré-molares e seus efeitos nas vias aéreas respiratórias superiores ­ revisão da literatura / Orthodontic premolar extractions and their effects on oropharyngeal airway ­ literature review

Extrações de pré-molares por indicação ortodôntica e seus efeitos nas vias aéreas respiratórias superiores (VARS) têm sido objeto de constante investigação e controvérsia nos últimos anos. O objetivo deste estudo é identificar, através de uma busca literária, as referências mais relevantes sobre o assunto. Utilizando as bases de dados PubMed (http://www.ncbi.nlm.nih.gov/pubmed), de Janeiro de 1966 a Junho e 2016, e Google Acadêmico (http://scholar.google.com), foi conduzida uma revisão de literatura. Seis indexadores (airway, pharynx, bicuspid, premolar, incisor retraction, e sleep apnea) foram utilizados. Somente os estudos clínicos em seres humanos que não apresentavam nenhum tipo de síndrome ou deficiência física foram incluídos. Uma pesquisa manual sobre a lista de referência bibliográfica de cada artigo selecionado foi adicionada. Potencialmente, vinte e oito artigos foram identificados e somente nove artigos atingiram os critérios propostos. Quatro artigos selecionados avaliaram as alterações em imagens 2D e cinco artigos em imagens 3D. Nenhum estudo clínico selecionado utilizou randomização. A quantidade de retração dos incisivos, bem como o tipo de avaliação (2D ou 3D), tiveram influências diferentes sobre as VARS. Pouca retração dos incisivos apresenta pouca ou nenhuma influência nas VARS. Concluiu-se que a extração de pré-molares não afeta as dimensões das VARS quando pequena retração dos incisivos é realizada. A falta de estudos clínicos randomizados e de avaliação da função respiratória como indicador de apneia obstrutiva do sono ­ AOS - (por exemplo, polissonografia) justificam inconsistências da literatura sobre possível relação entre extrações ortodônticas de pré-molares e VARS/AOS.(AU)

Premolar extractions, due to orthodontic treatment, and their effect on airways have been investigated frequently in the last few years and have shown inconsistencies. The current literature review aimed to show the best articles about the topic intending to clarify such inconsistencies. Two data base, PubMed (http://www.ncbi.nlm.nih.gov/pubmed), from January of 1966 to June of 2016, and Google Scholar (http://scholar.google.com) were used to access the literature. Six key words (airway, pharynx, bicuspid, premolar, incisor retraction, and sleep apnea) were used. Only clinical studies were selected. Studies with subjects presenting syndromes or physical deficiency were excluded. Checking the references from the potential studies also targeted to find articles of interest. Initially, 28 articles were selected but only nine met the stablished criteria. Four articles evaluated the changes using 2D images and five used 3D images. None of the studies was randomized. The amount of incisor retraction and the type of evaluation (2D or 3D) showed different influences on airway. Small retraction of the incisors had none or minor influence on airway. It was concluded that premolar extractions do not cause changes on airway dimensions when the incisors were slightly retracted. Lack of randomized clinical trials and the evaluation of breathing function as indicator of obstructive sleep apnea (i.e. polysomnography) justify inconsistencies in the literature relating orthodontic premolar extractions and airway. (AU)