RESUMO
Introdução: além de amplamente utilizada na área odontológica Recebido em: 06/01/2018 para avaliação de tratamentos ortodônticos e para planejamento de cirurgias, a Tomografia Computadorizada de Feixe Cônico tem ganhado espaço também na literatura médica para avaliação das vias aéreas superiores. Isto porque as imagens tridimensionais da TCFC permitem a avaliação das áreas seccionais e volumes do espaço aéreo faríngeo. Objetivo: demonstrar, por meio de revisão da literatura, os efeitos da cirurgia ortognática sobre as vias aéreas superiores, avaliados por meio de tomografia computadorizada de feixe cônico (TCFC) e sua relação com a AOS. Material e Método: foi realizada uma busca nas bases de dados Lilacs e Pubmed utilizando como palavras-chave: tomografia computadorizada de feixe cônico, apneia do sono e cirurgia ortognática. Foram incluídos artigos nos idiomas português e inglês, sem limitação temporal, que tinham como principal foco avaliar as mudanças na via aérea superior após a cirurgia ortognática por meio de TCFC. Resultados: ao todo foram encontrados 11 artigos, dos quais 5 atenderam os critérios de inclusão e foram, portanto, analisados. Observou-se que: 3 artigos realizaram cirurgia bimaxilar e, neles, os resultados mostraram que não houve alteração da via aérea total após a cirurgia; 1 utilizou a técnica de retroposicionamento mandibular e observou que, após a cirurgia, houve diminuição significativa do volume total da via aérea e do seu segmento hipofaríngeo, bem como redução da área seccional faríngea mínima; 2 realizaram cirurgia de avanço maxilar que levou ao aumento significativo do volume da via aérea superior em ambos; 1 realizou cirurgia de avanço maxilomandibular que levou ao aumento significativo do espaço aéreo posterior. Conclusão: os resultados da presente revisão de literatura mostraram que a cirurgia ortognática levou a alterações da dimensão da via aérea superior na maior parte dos estudos analisados, a depender da técnica utilizada, que não se relacionou com a ocorrência de sintomas respiratórios ou AOS.
Introduction: in addition to being widely used in the dental area, for the evaluation of orthodontic treatments and for the planning of surgeries, Cone-Beam Computed Tomography has also gained space in the medical literature for evaluation of the upper airways. This is because the three-dimensional images of the CBCT allow the evaluation of the sectional areas and volumes of the pharyngeal space. Objective: to demonstrate, through a literature review, the effects of orthognathic surgery on the upper airways, by means of cone-beam computed tomography (CBCT), and its relationship with OSA. Material and Method: a search was carried out at Bireme and Pubmed databases using the following keywords: CBCT, sleep apnea and orthognathic surgery. Articles with the main focus of evaluating changes in the upper airway after an orthognathic surgery by means of CBCT was included in the study. Results: A total of 11 articles were found, of which 5 met the inclusion criteria and were, therefore, analyzed. It was observed that: in 3 studies bimaxillary surgery was performed and the results showed that there was no alteration of the total airway after surgery; 1 used the mandibular setback technique and observed that, after surgery, there was a significant decrease in the total volume of the airway and its hypopharyngeal segment, as well as reduction of the minimal pharyngeal cross-sectional area; in 2 maxillary advancement surgery was performed, which led to a significant increase in upper airway volume; 1 performed maxillomandibular advancement surgery, which led to a significant increase in posterior airway space. Conclusion: the results of the present literature review showed that orthognathic surgery led to alterations in the size of the upper airway in most of the studies analyzed, depending on the technique used. These alterations were not related to the occurrence of respiratory symptoms or OSA.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Apneia Obstrutiva do SonoRESUMO
BACKGROUND: Pythium insidiosum is the etiological agent of pythiosis, an emerging life-threatening infectious disease in tropical and subtropical regions. The pathogen is a fungus-like organism resistant to antifungal therapy, for this reason, most cases need extensive surgical debridments as treatment, but depending on the size and anatomical region of the lesion, such approach is unfeasible. We investigate the fungicidal effect and toxicity of crude bark extract of Stryphnodendron adstringens and commercially available tannin on Pythium insidiosum both in vitro and in vivo. METHODS: Standardized fragments of mycelia of fifteen isolates of P. insidiosum were tested with different concentrations of bark extract (10 to 30% v/v) and tannin (0.5, 1.0 and 1.5 mg/mL). For in vivo study, fifteen rabbits were experimentally infected with zoospores of P. insidiosum and treated by oral and intralesional applications of bark extract and tannin. Acute toxicity tests with both substances were also performed in rats. RESULTS: In vitro studies showed fungicidal effect for both substances at different concentrations and the SEM showed alteration on the cell wall surface of the pathogen. All infected rabbits developed a firm nodular mass that reached around 90 mm2 ninety days after inoculation, but neither the intralesional inoculation of tannin, nor the oral administration of crude extract and tannin were able to promote remission of the lesions. CONCLUSIONS: Lesions developed by rabbits presented an encapsulated abscess being quite different of naturally acquired pythiosis, which is characterized by ulcerated lesions. Since no toxicity was observed in rats or rabbits inoculated with these products, while in vitro experiments showed direct antifungal effect, therapeutic activity of S. adstringens and tannin should be clinically tested as an alternative for healing wounds in naturally acquired pythiosis.
