Tesi: "Maxilla Surgery"

1

Lee, Chee-wei, e 李志維. "Clinical outcomes of transpalatal distraction for transverse maxillaryhypoplasia: a retrospective study". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B50639602.

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Aim of study The aim of this clinical retrospective study is to evaluate the clinical outcomes of patients with transverse maxillary hypoplasia who underwent surgical assisted maxillary expansion (SARME) using a bone borne distractor in 2 different surgical centers. Patients and Methods This is a clinical retrospective cross‐sectional study of adult patients diagnosed with maxillary transverse hypoplasia and having had transpalatal distraction by SARME done in two surgical centers (Oral and Maxillofacial Surgery, The University of Hong Kong, Hong Kong and The Baruch Padeh Medical Center, Poriya, Israel) from January 2004 to December 2011. A total of 37 patients were identified. The mean age was 27.1. Each patient underwent a standard Le Fort I osteotomy with midline split with no mobilization under general anesthesia. A bone‐borne palatal distractor was fitted on the hard palate. The distractor was activated at a rate of 0.6mm per day following 5 ‐ 7 days of latency until the amount of expansion was reached according to plan. Occlusal radiographs and lateral cephalographs were obtained at pre‐expansion phase and regular postoperative intervals during the activation and consolidation period. Among the 37 patients, only 15 patients could be contacted by phone, mail or e‐mail and has agreed to participate in the cross‐sectional analysis. Clinical examination was performed and included the following: tooth vitality, tooth mobility, periodontal status and occlusion. Questionnaire was also given to patients to grade their experiences toward the treatment outcome. Results The mean transverse expansion achieved was 9.58mm. The TPD was removed from the patients in the ranged of 2 months to the longest 8 months (mean: 5.2 months). The distraction gap was gradually ossified by bone and then the teeth were aligned into the space achieving stable dental occlusion. No intra‐operative complications were recorded. Post‐operatively, 2 patients had to be re‐operated due to failure to activate the distractor. Others post‐operative complications encountered were pain, fixation screw loosening, insufficient distractor length, infection, asymmetric expansion and tooth migration into the distraction gap. These complications were well managed accordingly. Majority of the patients were satisfied with the treatment and will recommend it to others. Conclusions Correction of maxillary transverse hypoplasia using a transpalatal distractor can reliably achieve large bony expansion of the maxillary arch with few postoperative complications.
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Dental Surgery
Master
Master of Dental Surgery

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2

Thongdee, Pornpaka. "Stability of surgical movement of the maxilla in cleft lip and palate". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B38628119.

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3

Yip, Hok-siu Ian, e 葉學韶. "Stability and morbidities of Le Fort I osteotomies with bioresorbable fixation: a randomized controlled trial". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B45007780.

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4

Dance, Geoffrey Mark. "The long term stability of the Le Fort I Osteotomy". Title page, contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09DM/09dmd173.pdf.

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Bibliography: leaves 342-392. I: Introduction. Ch. 1. The Le Fort I osteotomy for the correction of maxillary position in three dimensions -- II: Review of the literature. Ch. 2. Dentofacial discrepancies involving the maxilla -- Ch. 3. Cephalometry -- Ch. 4. Relapse following Le Fort I osteotomy -- Ch. 5. Factors associated with post surgical relapse following Le Fort I osteotomy -- Ch. 6. Biomechanics of fixation -- III: Materials and method. Ch. 7. Evaluation of post surgical relapse -- Ch. 8. Errors of method -- IV: Results. Ch. 9. Early, intermediate and long term dentoskeletal effect following Le Fort I osteotomy -- Ch. 10. Results: Errors of the method -- V: Discussion. Ch. 11. Discussion of experimental design -- Ch. 12. Discussion of factors in the relapse of Le Fort I osteotomy -- VI: Conclusion. Ch. 13. Conclusion. -- VII: Appendix. i. Bone grafts ; ii. Le Fort I osteotomy surgical technique ; iii. Bone plate removal protocol statement.

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5

Mah, Michelle Clare. "Functional outcomes and long term complications following distraction osteogenesis of the maxilla and mandible: asystematic review". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B50639626.

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Background Distraction osteogenesis (DO) was first applied on the human craniofacial skeleton in 1992 by McCarthy et al.1 who performed lengthening of the mandible in patients with hemifacial microsomia and Nager’s syndrome. Further advances in this field have since then led to the widespread use of this modality for the treatment of numerous congenital and acquired craniofacial skeletal anomalies. In 2001, a review by Swennen et al2 concluded that up to year 1999, this form of treatment was gaining intense popularity but that the main drawbacks included insufficient data on long term results and relapse. A systematic review of the last decade on functional outcomes and long term complications following distraction osteogenesis of the facial skeleton is presented. Methods A structured systematic literature search, with predefined inclusion and exclusion criteria from relevant computer databases and journals were performed. The journals were evaluated and critically appraised by 2 reviewers separately in 3 rounds. Papers were categorized according to the level of evidence, the quality of methodology and the specific field of functional outcomes and long term complications. Results were then categorized according to the type of distraction movements, ie maxillary advancement and mandibular lengthening. Results A total of 42 papers comprising of 16 studies for maxillary advancement and 26 studies for mandibular lengthening were included in this review. Maxillary advancement was found to be beneficial in patients with cleft maxillary hypoplasia in terms of achieving aesthetic outcome but the risk for velopharyngeal insufficiency remains uncertain. The achieved maxillary advancement was stable if performed on adult patients while a recurrence of midface retrusion was noted if DO was performed on growing patients. Overcorrection was recommended in these cases to an estimated value of 20-50%. Mandibular lengthening was 99% successful in relieving respiratory obstruction in patients with isolated Pierre Robin Sequence (PRS) or syndromic micrognathic infants preventing the need for tracheostomy in the long term, and in 89% successfully decannulating infants with pre-existing tracheostomy. However, feeding and growth outcomes after airway obstruction was relieved remain unknown due to lack of sufficient evidence. Unilateral mandibular DO was successful in achieving aesthetic symmetrical facial balance in patients with hemifacial microsomia however a total loss of corrected distraction length was noted by the end of growth period if DO was performed during growth. Conclusions DO achieved stable results in terms of lengthening the maxilla and mandible but was also noted to cause restricted growth potential of the distracted bone. Hence, the benefits of performing DO during active growth should be weighed against the likely need for a second surgery due to a growth deficit of distracted bone and future surrounding bone growth. However DO in adults remains an alternative to conventional orthognathic surgery and choice of treatment should be patient centred.
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Dental Surgery
Master
Master of Dental Surgery

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許嘉榮 e Edward Hui. "Soft tissue changes following maxillary osteotomies in cleft lip and palate and non-cleft patients". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1992. http://hub.hku.hk/bib/B38628338.

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7

Tan, Su-keng, e 陳舒卿. "Perioperative antibiotic prophylaxis in orthognathic surgery". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B4466140X.

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8

Loo, Sun Din, e 羅山定. "Functional outcomes after myocutaneous free flap and osteocutaneous free flap for maxillary reconstruction: across sectional comparison". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48541941.

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Background Maxillary defects subsequent to hemimaxillectomy have long been restored with a pedicled temporalis flap. Recently,the trend towards maxillary reconstruction using vascularized bone free flaps and soft tissue free flaps has been gaining popularity. However, the value in terms of functional rehabilitation of these surgical modalities remains unconclusive. Objective To ascertain and compare masticatory performance and quality-of-life in patients with surgically reconstructed maxillectomy Class 2 (subtype A) defects by vascularized bone free flaps, vascularized soft tissue free flaps and pedicled soft tissue flaps. Methods Eighteen patients divided into 3 groups (4 vascularized bone flap, 5 vascularized soft tissue flap, 9 pedicled soft tissue flaps) were evaluated for functional outcome and qualityof-life (QoL). All patients were objectively assessed using masticatory comminution test. Subjective evaluation was conducted using functional outcomes questionnaire and patient reported speech perception. Self image and body perception were assessed using Body Esteem Scale. Overall quality-of-life was assessed using University of Washington QoL questionnaires. Results Patients reconstructed with vascularized bone flaps and vascularized soft tissue flaps showed superior masticatory performance compared to patients reconstructed with pedicled soft tissue flaps. Speech, facial attractiveness and overall QoL were similar for all three groups. Conclusions Maxillectomy class 2 (subtype A) patients show comparable speech, facial attractiveness and quality-of-life levels after reconstruction with vascularized bone flaps, vascularized soft tissue flaps and pedicled soft tissue flaps. However, those reconstructed with pedicled soft tissue flaps achieved lowest masticatory performances amongst the three surgical reconstruction modalities. Thus, the choice of recontruction for maxillectomy class 2 (subtype A) defects should be guided by minimizing surgical time and long term morbidity given the apparent similarity in functional outcomes.
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Dental Surgery
Master
Master of Dental Surgery

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9

Vijayakumar, Charanya. "Bioactive glasses in cranio-maxillofacial and oral surgery". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48542118.

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10

Lau, Sze-lok Alfred. "Evidence-based practice in oral and maxillofacial surgery /". View the Table of Contents & Abstract, 2005. http://sunzi.lib.hku.hk/hkuto/record/B32222154.

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Xia, Jiong James. "Three-dimensional surgical planning and simulation system for orthognathic surgery in virtual reality environment /". Hong Kong : University of Hong Kong, 1998. http://sunzi.lib.hku.hk/hkuto/record.jsp?B20377824.

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12

許顯名 e Hin-ming Hui. "The morbidity of anterior iliac bone harvesting for maxillofacial grafting procedures". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1998. http://hub.hku.hk/bib/B38628211.

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13

Tan, Huann Lan, e 陳喚男. "One stage versus two stage cleft palate repair: implications for maxillary growth". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46600140.

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14

Lau, Sze-lok Alfred, e 劉思樂. "Evidence-based practice in oral and maxillofacial surgery". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B45007755.

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15

Johansson, Björn. "Bone grafts and dental implants in the reconstruction of the severely atrophied, edentulous maxilla". Doctoral thesis, Uppsala University, Department of Surgical Sciences, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-614.

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In two prospective, clinical studies the stability of implants and prosthetic constructions were evaluated after three years of loading. In the first study, the implant and the bridge stability of 39 patients with 1-stage bone grafts, were compared to a reference-group of 37 patients who did not need bone grafts. In the second study, 40 patients were randomised to have either 1-stage sinus inlay bloc grafts or 2-stage sinus inlay particulated grafts.

Implant success in Paper 1, was 75.3% in the study group and 93.1% in the reference group. In Paper 2 implant survival in the 1-stage group was 77.7% and 86.5% in the 2-stage group. Bruxism and post-operative complications, such as unexpected pain, dehiscence and infection were found to be associated with the later loss of implants.

The volumes of onlay block and inlay particulated bone grafts, after 6 months as evaluated by computed tomography showed the decrease of 49.5% and 47% respectively, although there was a wide range in both groups.

Using of cutting torque measurements during the placement of implants in grafted and non-grafted jaw bone, showed a significant inverse correlation to the commonly used clinical estimation of jaw bone quality, acc. to Lekholm & Zarb. Significantly lower torque values were recorded in grafted regions when compared to non-grafted.

It was shown that autogenous bone grafts and implants to the edentulous maxilla, after early high failure rates, showed stable and predictable results after three years. Bruxism was found to be significantly associated with implant failures and initially reduced biomechanical properties was seen in the grafted bone.

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16

Lui, Wai-kay Wilkie, e 雷偉基. "A cephalometric study of stability after maxillary impaction". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1996. http://hub.hku.hk/bib/B31954030.

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17

Silva, Carolina Ávila Varginha de Moraes e. "Resultados da expansão de maxila cirurgicamente assistida sem disjunção ptérigomaxilar: uma avaliação tridimensional". Universidade do Estado do Rio de Janeiro, 2010. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=2581.

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A expansão rápida da maxila cirurgicamente assistida tornou-se amplamente utilizada e muito aceitável no tratamento da deficiência maxilar de pacientes adolescentes e adultos. Diversas técnicas cirúrgicas foram propostas ao longo dos anos com o objetivo de solucionar este problema de forma eficiente, com estabilidade dos resultados e baixa morbidade. Controvérsias em relação ao procedimento cirúrgico persistem, principalmente relacionadas a quais osteotomias devem ser realizadas para se obter bons resultados. O objetivo deste trabalho foi avaliar os resultados da expansão ortocirúrgica da maxila realizando osteotomias nas paredes laterais da maxila e na sutura palatina mediana. Foram selecionados dezessete pacientes adultos portadores de deficiência transversa maxilar, com média de idade de 24 anos e 8 meses; todos foram submetidos a exames de tomografia computadorizada convencional e moldagens maxilares previamente ao procedimento cirúrgico e após três meses, no mínimo, do término de ativação e estabilização do aparelho expansor. As medidas do pós-cirúrgico foram confrontadas com as do pré-cirúrgico e os resultados foram comparados e analisados estatisticamente. Foi obtida a expansão desejada clinicamente em todos os pacientes. No entanto, a quantidade de expansão na região de molares foi estatisticamente maior nas áreas referentes aos dentes, enquanto que os resultados obtidos referentes aos caninos se mostraram similares nas três regiões maxilares avaliadas. Quando comparadas às regiões de caninos e molares entre si, a expansão intercaninos foi maior na altura dos forames palatinos e o inverso ocorreu nas regiões de processo alveolar e dentária, nas quais a expansão intermolar foi maior.
Several surgical techniques have been proposed over the years for the treatment of maxillary deficiency aiming at correcting it efficiently, with long-lasting results and low morbidity. Surgically assisted rapid maxillary expansion has found wide acceptance for the treatment of maxillary deficiency in both adolescents and adults. Controversy still remains regarding particularly to which osteotomies are to be done in order to achieve satisfactory outcomes. The author reports on the results of the ortho-surgical maxillary expansion with osteotomies of the maxillary lateral walls and midpalatal suture. Seventeen adults with transverse maxillary deficiency had conventional CT scans and maxillary dental models prior to the operation and also after at least three months from the complete activation and stabilization of the expansion device. The measurements made before and after the operation as well as the final results were assessed and statistical analysis performed. All nineteen patients had the amount of expansion which had been planned. However, the amount of expansion in the molar region was shown to be statistically larger at the teeth while the results at the canines was similar in the three maxillary regions. When comparing the canine and molar regions, the intercanine expansion was greater at the palate foramina region and the opposite was observed with greater intermolar expansion within the regions of the alveolar process and dental.

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夏炯 e Jiong James Xia. "Three-dimensional surgical planning and simulation system for orthognathic surgery in virtual reality environment". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1998. http://hub.hku.hk/bib/B3123950X.

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19

Scattaregi, Pedro Luis. "AVALIAÇÃO CEFALOMÉTRICA DA ESTABILIDADE PÓS-EXPANSÃO RÁPIDA DA MAXILA ASSISTIDA CIRURGICAMENTE". Universidade Metodista de São Paulo, 2008. http://tede.metodista.br/jspui/handle/tede/1252.

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Made available in DSpace on 2016-08-03T16:31:10Z (GMT). No. of bitstreams: 1 02 - Revisao da Literatura.pdf: 52833 bytes, checksum: d0497a36eff0b91592a9fdc38ed827b8 (MD5) Previous issue date: 2008-02-20
This study evaluated the stability of the dental and skeletal changes produced by Rapid Maxillary Expansion Surgically Assisted (RMESA), in transversal and vertical dimensions. The sample selected for this retrospective study comprised 60 posteroanterior cephalograms, of 15 patients, being 6 males and 9 females, with mean age of 23,3 years old. An Hyrax appliance was used and the surgical procedure was caractherized by median sagitall osteotomy and non approach of pterygopalatine suture. The beginning of activation occurred in the third post-operatory day, being that, the limits for the expansion were determined by criteria eminently clinical. All the patients were radiografied in periods preexpansion (T1), immediate post-expansion (T2), three months post-expansion (with the Hyrax appliance as retention) (T3) and six months post-expansion (with the removable acrylic plate as retention) (T4). Linear measurments were obtained from the cephalograms tracings generated by a computerized program (Radiocef Studio 2) and statistically analized by the test of variance (ANOVA) and Tukey at the level of 5% of significance. It was concluded that RMESA produced a statistically significant increase , of nasal cavity, maxillary width , upper intermolars distance, from T1 to T2, and were mantained in T3 and T4. The facial width and the lower intermolars distance did not presented changes after the RMESA. Evaluating the vertical behavior of the face, it was observed an increase of anterior inferior facial heigh in periods T1 to T2 that decreased after retention of three months (T3) and mantained stable in T4, although increased if compared with T1.(AU)
Este estudo avaliou a estabilidade das alterações dentárias e esqueléticas produzidas pela Expansão Rápida da Maxila Assistida Cirurgicamente (ERMAC), no sentido transversal e vertical. A amostra selecionada para este estudo retrospectivo foi composta de 60 telerradiografias em norma frontal, de 15 pacientes, sendo 6 do sexo masculino e 9 do sexo feminino, com média de idade de 23 anos e 3 meses. Utilizou-se o disjuntor tipo Hyrax e o procedimento cirúrgico foi caracterizado pela osteotomia sagital mediana da maxila e não abordagem da sutura pterigopalatina. O início da ativação ocorreu no terceiro dia pós-operatório, sendo que, os limites para a expansão foram determinados por critérios eminentemente clínicos. Todos os pacientes foram radiografados nas fases pré-expansão (T1), pós-expansão imediata (T2), 3 meses pós- expansão (com o próprio disjuntor como contenção) (T3) e 6 meses pós-expansão (com a placa de acrílico removível como contenção) (T4). Medidas lineares foram obtidas a partir dos traçados cefalométricos gerados por um programa computadorizado (Radiocef Studio 2) e analisadas estatisticamente pelo teste de variância (ANOVA) e Tukey ao nível de 5% de significância. Concluiu-se que a ERMAC produziu um aumento estatisticamente significante, da cavidade nasal, largura maxilar, distância intermolares superiores, de T1 para T2, e que se mantiveram em T3 e T4. A largura facial e as distâncias intermolares inferiores não apresentaram alterações após a ERMAC. Avaliando o comportamento vertical da face, notou-se um aumento da AFAI nos tempos T1 para T2 que, diminuiu após a contenção de 3 meses (T3) e permaneceu estável em T4, embora aumentada se comparada com T1.(AU)

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Doan, Nghiem Van Trong. "An evaluation of clinical procedures used in dental implant treatment in posterior maxilla using flapless technique". Thesis, Queensland University of Technology, 2014. https://eprints.qut.edu.au/67447/4/Nghiem_Doan_Thesis.pdf.

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This study was a measure forward in cultivating the scientific basis for an approach to examine clinical procedure in Flapless dental implant surgery. The thesis is based on: the systematic review, retrospective study of flapless implants, and in vivo study on the osseo-integration in osteoporotic rats. Dr Doan investigated "clinical procedures used in dental implant treatment in posterior maxilla using flapless technique". The work has yielded significant contributions to the area of implant flapless surgery and its effects on osteoporotic patients having implants in the posterior maxilla.

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21

Martins, Teresinha Luiza. "Estudo comparativo do emprego de tramadol, codeína e cetoprofeno no controle da dor pós-operatória e nos níveis de glicose, cortisol e interleucina-6 em cães submetidos à maxilectomia ou mandibulectomia". Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5152/tde-09122009-173304/.

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Embora existam muitos estudos clínicos avaliando analgésicos e o controle da dor em cães, poucos são realizados em animais com dor do câncer e submetidos a procedimento cirúrgico para ressecção da neoplasia como a maxilectomia e mandibulectomia. Este estudo clínico foi realizado de forma prospectiva, comparativa, aleatória e de maneira simples cego com o propósito de avaliar a eficácia analgésica de diferentes tratamentos no período pós-operatório em cães submetidos à maxilectomia ou mandibulectomia. Foram utilizados no estudo 42 cães com neoplasia oral. Todos os animais foram prémedicados com acepromazina (0,05mg/kg) associado à meperidina (2mg/kg) por via intramuscular e a anestesia foi induzida com propofol por via iv na dose suficiente realizar a intubação (2.3-6.5mg/kg). O isoflurano foi utilizado para a manutenção da anestesia. Trinta minutos antes do fim do procedimento cirúrgico, os cães foram distribuídos aleatoriamente em um dos 5 diferentes grupos para analgesia pósoperatória: tramadol 2mg/kg (Tra), codeína 2mg/kg (Co), cetoprofeno 2mg/kg (Ce), tramadol 2mg/kg associado ao cetoprofeno 2mg/kg (TraCe) ou codeína 2mg/kg associado ao cetoprofeno 2mg/kg (CoCe), por via subcutânea. A freqüência cardíaca (FC) e respiratória (FR), pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e pressão arterial média (PAM), glicose sanguínea, cortisol e interleucina-6 (IL- 6) e grau de sedação foram verificados até 24 horas, e grau de analgesia foi verificado por até 120 horas do início da administração do analgésico, ou seja, os respectivos tratamentos foram mantidos por 5 dias da seguinte forma: tramadol ou codeína a cada 8 horas e cetoprofeno a cada 24 horas por via oral (MBL, M1, M2, M3, M4, M5, M24, M48, M72, M96 e M120). O resgate analgésico foi realizado nos animais que apresentaram escore de dor 4 em qualquer momento do estudo (dipirona 25mg/kg e morfina 0,1mg/kg). A análise estatística foi realizada por meio do Kruskal-Wallis, Friedman para mensurações repetidas, ANOVA e teste 2. Os gráficos em boxplot ou diagrama em caixas representam a distribuição dos dados. Os valores com p<0,05 foram considerados significantes. Não houve diferença entre os grupos de tratamento com relação ao peso, tempo de cirurgia, tempo para extubação, FC, FR, PAS, PAD e PAM, cortisol e IL-6 séricos, e escore de dor pela escala de análise descritiva. A concentração da glicose sanguínea aumentou de forma significante com relação aos valores basais no grupo Tra (M5= 96±14), Co (M1= 120±66 e M3=96±21), Ce (M5= 105±22) e CoCe (M3=104±16). Aumento do escore de dor foi observado no M2 do grupo Tra em relação a MBL e M1 a M5 do grupo Co em relação a M120 (p<0,05), contudo a média do escore não foi maior que 2,7. Baixo grau de sedação ainda foi observado no grupo CoCe no M24 (0,1±0,4 p<0,001) com relação ao M1. O número de resgate foi baixo, totalizando 19 administrações. No grupo Ce houve maior necessidade de resgate analgésico. Com base nos resultados obtidos, pôde-se concluir que os grupos de tratamento analgésico promoveram controle da dor pós-operatória de boa qualidade na maioria dos cães do estudo e com baixa incidência de efeitos adversos, podendo ser indicados no controle da dor em procedimentos de maxilectomia e mandibulectomia.
Although there are many clinical studies evaluating analgesics and pain control in dogs, very few were carried out in animals with cancer pain, and submitted to oncologic surgery with tumor resections such as maxillectomy and mandibulectomy. This clinical, prospective, randomized, simple blinded study was performed with the purpose of evaluating analgesic efficacy of different treatments in the postoperative period in dogs submitted to maxillectomy or mandibulectomy. Forty-two client-owned dogs with oral tumor were used in the study. Dogs were premedicated with acepromazine (0.05mg kg-1) and meperidine (2mg kg-1) by the intramuscular route and anesthesia was induced with intravenous propofol in a dose sufficient to allow intubation (2.3-6.5mg-1). Isoflurane was used for maintenance of anesthesia. Thirty minutes prior to the end of surgery, dogs were randomly allocated in one of 5 different groups for postoperative analgesia: tramadol 2mg kg-1 (Tra), codeine 2mg kg-1 (Co), ketoprofen 2mg kg-1 (Ke), tramadol 2mg kg-1 + ketoprofen 2mg kg-1 (TraKe) or codeine 2mg kg-1 + ketoprofen 2mg kg-1 (CoKe), subcutaneously. Heart (HR) and respiratory (RR) rates, systolic (SBP), median (MBP) and diastolic (DBP) blood pressures, blood glucose, serum cortisol and interleukin-6 (IL-6) and degree of sedation were recorded for 24 hours, and degree of analgesia were evaluated until 120 hours of the start of analgesic administration (MBL, M1, M2, M3, M4, M5, M24, M48, M72, M96 and M120), being that treatments were maintained for 5 days as follows: codeine or tramadol every 8 hours and the ketoprofen every 24 hours orally. Analgesic rescue was delivered to animals with pain scores equal or superior to 4 at any time of the study (dypirone 25mg -1 and morphine 0,1mg-1). Statistical analyses were performed by means of the Kruskal-Wallis, Friedmann for repeated measures, ANOVA and 2 tests. Graphics boxplot or box diagrams represents dates of distribution. Values of p<0.05 were considered significant. There were no differences between groups related to weight, surgical time, extubation time, HR, RR, SBP, MBP, DBP, serum cortisol and IL-6, and pain score by Descriptive Scale (DS). Blood glucose concentrations were significantly increased in relation to baseline, in groups Tra (M5= 96±14), Co (M1= 120±66 e M3=96±21), Ke (M5= 105±22) and CoKe (M3=104±16). Increase of pain score was observed in M2 of group Tra in relation to baseline, and M1 to M5 of group Co in relation to M120 (p<0,05), however the average score was not higher than 2.7. Low level of sedation was also observed in group CoKe in M24 (0.1 ± 0.4 - p <0.001) compared to M1.. The number of rescue was low, totaling 19 administrations. Ke group required more analgesic rescue. So, it can be conclude that treatment analgesic groups promoted a good quality pain control of postoperative in most of the dogs in the study and with low incidence of side effects, could be indicated in the control of the pain in procedures of maxillectomy and mandibulectomy.

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Abrahão, Tatiana Sumie Kawahara. "AVALIAÇÃO CEFALOMÉTRICA DAS ALTERAÇÕES SAGITAIS E VERTICAIS EM PACIENTES SUBMETIDOS À EXPANSÃO RÁPIDA DA MAXILA ASSISTIDA CIRURGICAMENTE". Universidade Metodista de São Paulo, 2006. http://tede.metodista.br/jspui/handle/tede/1228.

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Made available in DSpace on 2016-08-03T16:31:05Z (GMT). No. of bitstreams: 1 Tatiana Sumie.pdf: 1948093 bytes, checksum: 4f13df329a1650a660e7ff88dd133508 (MD5) Previous issue date: 2006-03-08
This current study aims at cephalometrically evaluating the skeletal,dental, and soft tissues sagittal and vertical alterations in patients who underwent surgically assisted rapid maxilla expansion. The sample comprised 17 teleradiographs in lateral norm of 17 Brazilian adult subjects, being 6 male subjects and 11 female subjects, with average age of 24 years and 1 month, presenting a severe transverse deficiency of the maxilla. Teleradiographs were taken at the beginning of treatment (T1), after SARME (T2), and after three months in retention with the disjunctive appliance (T3). According to the analysis and discussion of the results achieved, it was seen a clock-wise rotation of both the maxilla and mandible, presenting, as consequence, an increase of the AFAI. After three months in retention therapy, there was a relapse of this behavior. It was also seen an extrusion of the upper incisors, in which was kept during the retention period. During retention, there was also a retrusion of the upper incisors. As for the upper molars, there was an extrusion after expansion, followed by a minor relapse when compared to the effect of the expansion achieved. There was no alteration of the soft tissues regarding the nasal thickness. And, there was a retrusion of the upper and lower lips, and the soft pogonion, following the skeletal part. There was an increase of the nasolabial angle.
O presente estudo teve como objetivos avaliar cefalometricamente as alterações esqueléticas, dentárias e de tecidos moles, no sentido sagital e vertical em pacientes submetidos à expansão rápida da maxila assistida cirurgicamente. A amostra constituiu-se de 51 telerradiografias em norma lateral de 17 pacientes adultos, brasileiros, sendo 6 do sexo masculino e 11 do sexo feminino, com idade média de 24 anos e 1 mês e severa deficiência transversa da maxila. As telerradiografias foram obtidas no início do tratamento (T1), após o procedimento de ERMAC (T2), e após três meses de contenção com o próprio aparelho disjuntor (T3). A partir da análise e discussão dos resultados, observouse rotação da maxila e da mandíbula no sentido horário, havendo, como conseqüência, aumento da AFAI. Após 3 meses de contenção, houve recidiva considerando-se o aumento da AFAI. Houve extrusão dos incisivos superiores, na qual foi mantida no período de contenção. Durante a contenção, houve também retrusão dos incisivos superiores. Considerando-se aos molares superiores, houve extrusão após a expansão, acompanhada de uma recidiva com menor magnitude quando comparada ao efeito da expansão obtida. Não houve alteração dos tecidos moles quanto a espessura nasal e houve retrusão do lábio superior, lábio inferior e pogônio mole, acompanhando a parte esquelética. Houve aumento do ângulo nasolabial.

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Chehade, Antoine Jean-Marc. "A study comparing pterygomaxillary separation, with and without the use of an osteotome, during Le Fort I osteotomy". Thesis, McGill University, 1995. http://catalog.hathitrust.org/api/volumes/oclc/48117640.html.

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24

Pereira, Rui Manuel Rodrigues. "Avaliação do crescimento facial em dois protocolos para cirurgias primárias em pacientes com fissura labiopalatina unilateral: ensaio clínico randomizado". Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5132/tde-20062017-102804/.

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Introdução e Objetivo: Nos pacientes com fissura labiopalatina unilateral (FLPU) as cirurgias primárias afetam, em graus variados, o crescimento da face, comprometendo a estética facial e a oclusão dentária. Diversos estudos enfatizam a necessidade de se estabelecer protocolos cirúrgicos que apresentem repercussões positivas no crescimento facial e no desempenho fonoarticulatório dos pacientes, visando a diminuição do custo biológico, social e financeiro do tratamento integral. Este estudo objetivou comparar os efeitos de dois protocolos cirúrgicos para palatoplastia primária, em um e em dois tempos cirúrgicos, este com o fechamento tardio do palato duro (FTPD) sobre o complexo maxilo-mandibular de pacientes com FLPU completa. A hipótese do autor é que o protocolo com FTPD propicie um melhor crescimento dentofacial. Métodos: Foi realizado um ensaio clínico randomizado no qual 64 pacientes, atendidos em um centro de referência no nordeste do Brasil, foram divididos em dois grupos que receberam tratamentos cirúrgicos distintos. O grupo de intervenção (GI) foi constituído por 32 pacientes submetidas à palatoplastia em dois tempos cirúrgicos: veloplastia realizada entre os 6 e 9 meses de idade e FTPD realizado entre 36 e 48 meses de vida. O grupo controle (GC) foi constituído por 30 pacientes submetidos a palatoplastia completa entre os 9 e 15 meses. A relação entre os arcos dentários foi avaliada, de maneira cega, por três ortodontistas calibrados usando o índice FYOI (Atack,1997). Também foram investigadas as alterações dimensionais na maxila, a gravidade da fissura e as complicações pós-cirúrgicas em relação aos dois protocolos cirúrgicos. Resultados: Os modelos de gesso para avaliação pelo FYOI foram obtidos dos pacientes de ambos os grupos com idade média de 55,5 meses. O grau de concordância foi excelente (Kappa = 0,76-0,90) entre os examinadores e bom intra-examinadores (Kappa = 0,67-0,87). Os escores médios do índice FYOI variaram de 2,04 no GI a 2,76 no GC, com diferença estatisticamente significante (p = 0,007). Quando os scores foram agrupados em três categorias, bom (escores 1 e 2), Regular (escore 3) e ruim (escores 4 e 5) verificou-se diferença significativa (p < 0,006) na categoria bom (escores 1 e 2) entre os grupos GI (74%) e GC (52%). Ao serem comparadas as distribuições pela mediana, foi encontrada diferença significativa (p = 0,024) entre os escores 1 dos grupos GI (31,2%) e GC (3,3%). A correlação entre a largura da fissura e a relação maxilo-mandibular avaliada pelo FYOI não foi evidenciada pelo método de Spearman. A ocorrência de fístulas oronasais foi de 9,4% no GI e 6,7% no GC, sem diferença significativa entre eles. Conclusões: a palatoplastia realizada em dois tempos cirúrgicos com FTPD, apresenta melhores desfechos relativos ao crescimento dentofacial em crianças com FLPU. Não foi encontrada associação entre a gravidade da fissura e os desfechos relacionados ao crescimento maxilar. Não há diferenças estatisticamente significantes entre os dois protocolos cirúrgicos em relação à ocorrência de fístulas e à diminuição da distância intercaninos e diminuição do comprimento do arco maxilar
Background and Objective: An adequate growth of dentofacial structures is one of the most important goals of unilateral cleft lip and palate(UCLP) treatment and has a definitive role in getting good aesthetic and dental occlusion outcomes. To the present date several papers highlight the need of evidence-based studies to find surgical protocols that can improve facial growth and speech results aiming to reduce the burden of care of overall treatment. This study has evaluated and compared the dental arch relationship at 5 years of age after two treatment protocols, one submitted to one stage cleft palate repair (CPR) and the other to a two stage CPR with delayed hard palate closure (DHPC). The author\'s hypothesis is that the DCHP protocol provides a better dentofacial growth. Methods: A randomized clinical trial was held to evaluate the maxilo-mandibular relations in two groups of initially 32 patients each, randomly chosen. The GI group (n=32) was submitted to veloplasty between 6-9 months of age and a DCHP palatoplasty between three and four years of of age. The immediate complications were evaluated, oronasal fistulas, and cleft severity and their relationships to the surgical protocols. The dental arch relationships were assessed by a blind panel of three independent orthodontists using the FYOI index. The Kappa statistics were calculated to ensure the level of confidence. The results were statistically tested by t and Q-squared tests. Results: The GI group consisted of 32 patients while the GC group consisted of 30 patients. The oronasal fistulas incidence rate was 9.4% (GI) and 6.7% (GC), and there was no association to surgical techniques. Study models of 62 patients at the average age of 55.5 months were available for assessment. Good to very good levels of intra- and interrater reliability were obtained (0.67-0.87 and 0.76-0.90). The mean index scores varied between 2.04 (GI) and 2.76 (GC) with a statistically significant difference (p=0.007). When all evaluations were distributed between indexes good (1 and 2), regular (3) and bad (4 and 5); a statistically significant difference was observed between the GI and GC groups (p = 0.006),. The GI Group presented a 74% rate of good scores, while the GC Group rated 52% in good scores. When comparing the distributions by median, a difference (p = 0.024) was found between scores 1 of the GI (31.2%) and GC (3.3%) groups. The correlation between the cleft severity and the dental arch relationships assessed by the FYOI was not evidenced by the Spearman method. Conclusions: The ECR results provide statistical evidence that the DCHP protocol delivers better outcomes related to dentofacial growth. There was no correlation found between the cleft severity, palatal width and the results related to maxilar growth. The prevalence of oronasal fistules is similar in both surgical protocols

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Sjöström, Mats. "On healing of titanium implants in iliac crest bone grafts". Doctoral thesis, Umeå universitet, Odontologi, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-914.

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Bone grafts and titanium implants are commonly used for surgical/prosthetic rehabilitation of the atrophic edentulous maxilla. The factors which influence bone graft healing and implant integration are not sufficiently understood. The aim of this dissertation was to evaluate autogenous bone grafting and delayed placement of titanium endosteal implants for reconstruction of the atrophic maxilla, including the effects of different patient factors on bone graft healing and integration of titanium implants into grafted bone. A total of 46 patients with severe maxillary atrophy received onlay- (n=35) or interpositional bone grafts (n=11) and 6 mo. later received 341 titanium endosteal implants. All bone grafts were harvested from the iliac crest. All patients received fixed dental bridges and were followed clinically and with radiographical examinations for 3 yr. In Papers I and II, a total of 68 titanium microimplants were placed and retrieved from the bone grafts at various time points for histological analysis of the bone graft-implant interface. Integration was better after 6 mo. healing than placement in conjunction with bone grafting. Implant integration was similar for the two bone-grafting techniques. In Papers III and IV, originally including 29 patients and 222 implants, implant stability was measured with resonance frequency analysis (RFA) at placement, abutment connection, after 6 mo. of loading (III) and after 3 yr. of loading (IV). Ten non-grafted patients measured at the same time points were used as controls (III). RFA showed equal implant stability in grafted bone vs. non-grafted bone (III). Stability did not change from the 6-mo. to the 3-yr. control. Cumulative survival was 90% after 3 yr. (21 implants failed). Thirteen implants were lost prior to loading and 8 during functional loading. The group of failed implants showed a lower primary RFA stability than those that remained stable for 3 yr. All patients received and maintained a fixed dental bridge throughout the study. In Paper V, the graft volume changes (GVC) during the 6-mo. healing period prior to implant placement were studied in 30 patients using computerized tomography. Blood samples were taken from 25 patients in conjunction with bone grafting and were analysed for 13 haematological factors. Bone mineral density (BMD) was measured in 21 patients. Biopsies of the bone grafts were analysed for bone volume fraction (BVF). GVC (loss) was correlated with decreased BMD of the lumbar vertebrae L2-L4. There was no correlation between the haematological factors and GVC. Implant failure was not correlated with BMD, BVF or GVC. This dissertation shows that surgical/prosthetic rehabilitation of the atrophic edentulous maxilla with autogenous iliac crest bone grafts and delayed placement of titanium implants after 6 mo. of graft healing is effective, reproducible and functional. RFA at placement may be able to predict later implant failure.

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Stagnaro, Gonzalo Borgia. "Osseointegração de implantes após levantamento de assoalho do seio maxilar com osso bovino inorgânico : estudo clínico, radiográfico e histológico". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/87613.

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Introdução: os fenômenos envolvidos durante o processo de reparo após elevação do assoalho do seio maxilar, relacionados ao uso de enxertos e biomateriais, não são completamente conhecidos. Objetivos: avaliar clínica, radiológica e histomorfometricamente os resultados de neoformação óssea e desempenho de implantes inseridos em sítios previamente reconstruídos por meio de cirurgia de elevação do assoalho do seio maxilar utilizando osso bovino inorgânico, verificando se há correlação entre os mesmos. Metodologia: a amostra consistiu em 20 implantes inseridos após 7 a 11 meses, em 20 sítios de 10 pacientes adultos, consecutivamente, submetidos à cirurgia de levantamento do assoalho do seio maxilar e enxerto de osso bovino inorgânico. No momento da inserção do implante foi coletada uma amostra de tecido ósseo no sitio da perfuração, para a realização da histomorfometria. O sucesso dos implantes foi avaliado por critérios clínicos decorridos quatro meses de sua inserção. A densidade radiográfica das radiografias periapicais prévias à instalação de 13 dos implantes foi medida e correlacionada aos dados histomorfométricos e de sucesso. Resultados: um implante foi perdido. A porcentagem media de osso vital foi de 50.06%, a de não vital de 40.17%, e de tecido mole de 9,44%. Houve correlação positiva entre a densidade radiográfica e a quantidade de osso vital, e negativa entre esta e a quantidade de tecido mole. Não houve correlação entre o sucesso dos implantes e os demais achados. Conclusões: a cirurgia de elevação do seio maxilar mostrou-se segura a eficaz, permitindo inserção de implantes nos períodos citados. A radiografia periapical digitalizada apresentou potencial para estimar o percentual de osso vital após este tipo de procedimento.
Introduction: healing process after sinus floor elevation using biomaterials is not fully understood. Objectives: clinical, radiological and histomorphometric evaluation of healing, as well as implant results on previously sinus lift implant sites using inorganic bovine graft, testing for correlation between variables. Methods: 20 implants inserted after 7 to11 months, on 20 sitesof 10 adult consecutive patients,indicated for sinus floor elevation using inorganic bovine graft composed the study sample. On implant insertion a bone sample was trefined from implant site, for histomorphometry. Implant success was evaluated by clinical criteria 4 months after insertion. Radiographic density was measured before implant insertion on 13 sites and correlated to success and histomorphometric data. Results: one implant was lost. Vital bone was present on 50.06% of the sample areas, non vital on 40.17% and soft tissue one 9,44%. There was positive correlation between radiographic density and vital bone area, as weel as negative correlation with soft tissue area. There was not correlation between implant success and the other data. Conclusions: sinus lift presented as a safe and efficient treatmenta alternative for implant placement, on the healing periods described. Periapical radiography showed potential to estimate the vital bone and soft tissue formation after sinus lift using this kind of graft.

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Souza, Ramiro Beato. "Avaliação da fidelidade da referência externa em tecidos moles na cirurgia ortognática da maxila". Universidade do Estado do Rio de Janeiro, 2009. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=2602.

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Esse trabalho teve o objetivo de analisar a fidelidade da referência externa em tecidos moles no auxílio do posicionamento vertical da maxila. Foram selecionados 40 pacientes portadores de deformidade dentofacial e submetidos à osteotomia total da maxila. Os indivíduos foram divididos em 2 grupos no intuíto de avaliar duas técnicas de referência externa: a utilização da sutura em tecidos moles e o uso do fio de Kirschner. Esta última foi utilizada como a técnica do grupo-controle. Os dados foram colhidos em duas fases. Na primeira delas, foi realizada a mensuração da posição vertical da maxila antes da osteotomia Le Fort I e após a fixação da maxila, utilizando a referência externa. A partir desses números, foi obtida a alteração vertical de cada caso, colhida durante a cirurgia. Na segunda fase da coleta de dados, foram realizadas mensurações verticais da maxila baseadas nas radiografias cefalométricas pré e pós-operatórias. Assim, foi obtido o valor da alteração vertical de cada caso, baseado na documentação radiográfica. Após esta etapa, foi calculada a diferença entre a alteração vertical obtida durante a cirurgia e a alteração vertical colhida a partir das radiografias. Dessa forma, foram obtidos valores que correspondem às imperfeições no posicionamento vertical da maxila de cada paciente, tendo como base a posição do incisivo central superior. Os resultados foram comparados e analisados estatisticamente. A média aritmética da precisão no posicionamento vertical da maxila no grupo-controle foi de 0,52mm e do grupo da referência em tecidos moles foi de 0,65mm. A aplicação do teste t de Student a 5% revelou que não houve diferença estatística significativa entre o grau de precisão das duas técnicas de referência externa (P=0,429). Como conclusão, observou-se que as duas técnicas foram eficazes no auxílio ao posicionamento vertical da maxila e que a referência externa em tecidos moles apresentou um grau de precisão semelhante ao valor obtido com a técnica do fio de Kirschner.
The aim of this study was to analyze the accuracy of external reference placed in soft tissue nasion for vertical maxillary repositioning. Forty patients with dentofacial deformities who were to undergo Le Fort I maxillary osteotomy were separated into two groups to evaluate two different external reference measurement techniques: soft tissue nasion (study group) and Kirschner pins (control group). Data were collected in two phases. Initially the vertical position of the maxilla was assessed during surgery before Le Fort I osteotomy and after maxillary fixation, in relation to the external reference point, evaluating the intra-operative vertical alteration of each case. In the second phase, maxillary vertical measurements were done using the pre and pos-operative cephalometric radiographs to assess their radiographic vertical alteration. Differences among radiographic and intra-operative vertical variations of the maxilla were calculated to acquire values corresponding to discrepancies in maxillary positioning in relation to upper central incisor. Results were statistically compared and analyzed. The average of accuracy of vertical maxillary positioning was 0.525 mm for the control group and 0.650 mm for the study group. Student t test indicated no significant difference between both methods (P=0.429). In conclusion it was noted that both techniques were efficient for vertical maxillary repositioning and soft tissue nasion method showed a similar accuracy of that obtained with Kirschner pins.

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Petersson, Frida, e Charlotte Åkerlund. "Haptic Force Feedback Interaction for Planning in Maxillo-Facial Surgery". Thesis, Linköping University, Department of Science and Technology, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-2036.

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New Virtual Reality technologies provide the possibility of widening access to information in data. Haptics, the technology of touch, could be an interesting future aid and have large impact on medical applications. The use of haptic devices allows computer users to use their sense of touch, in order to feel virtual objects with a high degree of realism.

The aim of the thesis is to investigate the potential deployment and the benefits of using haptic force feedback instruments in maxillo-facial surgery. Based on a produced test application, the thesis includes suggested recommendations for future haptic implementations.

At the Department of Maxillo-Facial Surgery, at the Karolinska Hospital in Stockholm, Virtual Reality technologies are used as an aid to a limited extent during the production of physical medical models. The physical medical models are produced with Rapid Prototyping techniques. This process is examined and described in the thesis. Moreover, the future of the physical medical models is outlined, and a future alternative visualizing patient data in 3D and use haptics as an interaction tool, is described. Furthermore, we have examined the present use of haptic technology in medicine, and the benefits of using the technology as an aid for diagnostic and treatment planning.

Based on a presented literature study and an international outlook, we found that haptics could improve the management of medical models. The technology could be an aid, both for physical models as well as for virtual models. We found three different ways of implementing haptics in maxillo-facial surgery. A haptic system could be developed in order to only manage virtual medical models and be an alternative solution to the complete Rapid Prototyping process. A haptic system could serve as a software, handling the image processing and interfacing from a medical scanner to an Rapid Prototyping system. A haptic system could be developed as an alternative interaction tool, which could be implemented as an additional function in currently used image processing software, in order to improve the management of virtual medical models before the Rapid Prototyping process.

An implementation for planning and examination in maxillo-facial surgery, using haptic force feedback interaction, is developed and evaluated. The test implementation is underlying our aim of investigating the potential deployment and the benefits of using haptic force feedback instruments in maxillo-facial surgery.

After discussing the possible future of our implementation and the future of haptic force feedback in maxillo-facial surgery, a recommendation is given as a conclusion of our total work.

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Piersanti, Luigi <1973&gt. "New Application of Piezoelectric Ultrasounds in Maxillo-facial bone surgery". Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2015. http://amsdottorato.unibo.it/7118/1/New_Application_Definitivo.pdf.

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Background: Piezoelectric instrumentation seems to offer 3 important advantages for cutting bone structures. Be more precise because it is produced by micro-vibrations from the cutting insert. Be safer because the ultrasonic frequency used does not affect soft tissue. Thirdly, the less invasive cutting action produces minor tissue damage and consequently probably a better healing Aim of the Study: The aim of this study is to evaluate the effectiveness of piezoelectric device capability in maxillo-facial surgery, in order to take advantage of these favourable capacity. Material and Methods: Considering the several potential application of the piezoelectric technology in Orthognathic, Oncologic and Extractive surgery, we would like to design protocols in order to verify how this new device can modify the surgical technique, the surgical time, the patients healing and its quality of life. Results: Due to the precise Piezosurgery cut, we can manage the Cad-Cam-Custom Made plates protocol in Oncologic Surgery and in Orthognatic Surgery increasing our percentage of comparison between the 3D preoperative plan and the surgical execution. We also found a better quality of life impaction in Patient who underwent and extractive surgery Conclusion: Piezosurgery device seems to be a strong surgical aid were safe and precise cut are needed and its capability to reduce the discomfort Patients need to be study in deep also in major surgery like Orthognatic and Oncologic surgery.

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Piersanti, Luigi <1973&gt. "New Application of Piezoelectric Ultrasounds in Maxillo-facial bone surgery". Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2015. http://amsdottorato.unibo.it/7118/.

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Background: Piezoelectric instrumentation seems to offer 3 important advantages for cutting bone structures. Be more precise because it is produced by micro-vibrations from the cutting insert. Be safer because the ultrasonic frequency used does not affect soft tissue. Thirdly, the less invasive cutting action produces minor tissue damage and consequently probably a better healing Aim of the Study: The aim of this study is to evaluate the effectiveness of piezoelectric device capability in maxillo-facial surgery, in order to take advantage of these favourable capacity. Material and Methods: Considering the several potential application of the piezoelectric technology in Orthognathic, Oncologic and Extractive surgery, we would like to design protocols in order to verify how this new device can modify the surgical technique, the surgical time, the patients healing and its quality of life. Results: Due to the precise Piezosurgery cut, we can manage the Cad-Cam-Custom Made plates protocol in Oncologic Surgery and in Orthognatic Surgery increasing our percentage of comparison between the 3D preoperative plan and the surgical execution. We also found a better quality of life impaction in Patient who underwent and extractive surgery Conclusion: Piezosurgery device seems to be a strong surgical aid were safe and precise cut are needed and its capability to reduce the discomfort Patients need to be study in deep also in major surgery like Orthognatic and Oncologic surgery.

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Salmen, Fued Samir [UNESP]. "Comparação entre iniciar a cirurgia pela mandíbula ou pela maxila na correção do excesso maxilar vertical: estudo retrospectivo". Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/148865.

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O objetivo deste estudo retrospectivo foi avaliar a precisão de procedimentos bimaxilares realizados para correção de excesso maxilar vertical, quando a cirurgia é iniciada pelo reposicionamento mandibular ou pelo reposicionamento maxilar. Foram incluídos no estudo 32 prontuários de pacientes, divididos em dois grupos de dezesseis. O primeiro grupo (Grupo 1) de pacientes foi submetido a cirurgia bimaxilar com a sequência clássica do procedimento, no qual a maxila foi reposicionada primeiro que a mandíbula. O segundo grupo (Grupo 2) de pacientes sofreu alteração desta sequência, na qual a mandíbula foi reposicionada primeiro que a maxila. A mensuração para determinar a precisão do reposicionamento dos maxilares foi realizada por sobreposição, pela base do crânio, os traçados obtidos de uma telerradiografia lateral realizada com, no máximo, 30 dias de pós-operatório e os traçados de planejamento. A análise estatística foi realizada utilizando o teste t pareado para verificar a diferença entre os valores previstos e os obtidos em cada grupo. O teste t de Student para amostras independentes foi utilizado para comparar o erro de previsão entre os dois grupos. Na amostra estudada, ambas as sequências operatórias permitiram precisão satisfatória. O erro de previsão para as variáveis incisal do incisivo superior (IIS), Ponto A e cúspide mesiovestibular do molar inferior (6i Oclusal), no sentido vertical, foi maior para o Grupo 2, quando comparado ao Grupo 1. O erro de previsão no sentido vertical para o Pogônio (P) foi menor quando a cirurgia foi iniciada pela mandíbula. Em conclusão, embora ambas as sequências cirúrgicas possam ser utilizadas, iniciar a cirurgia pela mandíbula provocou maior imprecisão em relação ao traçado preditivo do que iniciar a cirurgia pela maxila. A sequência clássica, reposicionando a maxila primeiro, resultou em maior precisão no reposicionamento vertical do ponto A, bem como da incisal do incisivo superior e, portanto, da maxila, do ponto de vista estético. Iniciar a cirurgia pela mandíbula permitiu maior precisão na posição vertical do pogônio.
This study aims to evaluate the precision of bimaxillary surgery performed to correct vertical maxillary excess, when the procedure is sequenced by mandibular surgery first or maxillary surgery first. Thirty-two patients were included in this retrospective study, divided into two groups. The first group was composed by patients who received bimaxillary surgery following the classic sequence of repositioning the maxilla first. In the second group patients received bimaxillary surgery by operating the mandible first. The data were tabulated and statistically analyzed. Precision of the maxillo-mandibular repositioning was measured by superimposing, through the cranial base, digital postoperative tracings taken at a maximum of 30 days after surgery to the prediction tracings. The paired t test was used to determine the difference between predicted and obtained values for each group. The Student’s t test for independent samples was applied to compare the prediction error between groups. In this sample, both surgical sequences provided adequate clinical accuracy. The classical sequence, repositioning the maxilla first, resulted in greater accuracy of A point, lower first molar and incisor edge vertical position. Repositioning the mandible first allowed greater precision in the vertical position of pogonion. In conclusion, although both surgical sequences may be used, repositioning the mandible first will result in greater imprecision in relation to the predictive tracing, than repositioning the maxilla first. The classical sequence resulted in greater accuracy in the vertical position of the maxilla, which is key for esthetics. Repositioning the mandible first allowed greater accuracy for the vertical position of pogonion.

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Salmen, Fued Samir. "Comparação entre iniciar a cirurgia pela mandíbula ou pela maxila na correção do excesso maxilar vertical : estudo retrospectivo /". Araraquara, 2017. http://hdl.handle.net/11449/148865.

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Orientador: Mario Francisco Real [UNESP] Gabrielli
Resumo: O objetivo deste estudo retrospectivo foi avaliar a precisão de procedimentos bimaxilares realizados para correção de excesso maxilar vertical, quando a cirurgia é iniciada pelo reposicionamento mandibular ou pelo reposicionamento maxilar. Foram incluídos no estudo 32 prontuários de pacientes, divididos em dois grupos de dezesseis. O primeiro grupo (Grupo 1) de pacientes foi submetido a cirurgia bimaxilar com a sequência clássica do procedimento, no qual a maxila foi reposicionada primeiro que a mandíbula. O segundo grupo (Grupo 2) de pacientes sofreu alteração desta sequência, na qual a mandíbula foi reposicionada primeiro que a maxila. A mensuração para determinar a precisão do reposicionamento dos maxilares foi realizada por sobreposição, pela base do crânio, os traçados obtidos de uma telerradiografia lateral realizada com, no máximo, 30 dias de pós-operatório e os traçados de planejamento. A análise estatística foi realizada utilizando o teste t pareado para verificar a diferença entre os valores previstos e os obtidos em cada grupo. O teste t de Student para amostras independentes foi utilizado para comparar o erro de previsão entre os dois grupos. Na amostra estudada, ambas as sequências operatórias permitiram precisão satisfatória. O erro de previsão para as variáveis incisal do incisivo superior (IIS), Ponto A e cúspide mesiovestibular do molar inferior (6i Oclusal), no sentido vertical, foi maior para o Grupo 2, quando comparado ao Grupo 1. O erro de previsão no sen... (Resumo completo, clicar acesso eletrônico abaixo)
This study aims to evaluate the precision of bimaxillary surgery performed to correct vertical maxillary excess, when the procedure is sequenced by mandibular surgery first or maxillary surgery first. Thirty-two patients were included in this retrospective study, divided into two groups. The first group was composed by patients who received bimaxillary surgery following the classic sequence of repositioning the maxilla first. In the second group patients received bimaxillary surgery by operating the mandible first. The data were tabulated and statistically analyzed. Precision of the maxillo-mandibular repositioning was measured by superimposing, through the cranial base, digital postoperative tracings taken at a maximum of 30 days after surgery to the prediction tracings. The paired t test was used to determine the difference between predicted and obtained values for each group. The Student's t test for independent samples was applied to compare the prediction error between groups. In this sample, both surgical sequences provided adequate clinical accuracy. The classical sequence, repositioning the maxilla first, resulted in greater accuracy of A point, lower first molar and incisor edge vertical position. Repositioning the mandible first allowed greater precision in the vertical position of pogonion. In conclusion, although both surgical sequences may be used, repositioning the mandible first will result in greater imprecision in relation to the predictive tracing, than repositioning the maxilla first. The classical sequence resulted in greater accuracy in the vertical position of the maxilla, which is key for esthetics. Repositioning the mandible first allowed...(Complete abstract electronic access below)
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33

Vieira, Jefferson Moura. "A utilização do software Nemoceph 3D na predição do posicionamento do ângulo nasolabial e posição do lábio superior após avanço de maxila". Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/25/25151/tde-01102018-172457/.

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Abstract (sommario):

A cirurgia ortognática (CO) tem se tornado cada vez mais previsível devido ao avanço do diagnóstico e planejamento cirúrgico. A tomografia computadorizada possibilitou o aperfeiçoamento dos softwares que propiciam a realização do planejamento cirúrgico virtual, promovem melhor acurácia e menor tempo comparado ao planejamento manual tradicional. Com o surgimento de novos programas e novas versões, se torna necessária a avaliação da acurácia dos mesmos. O presente estudo tem como objetivo avaliar a acurácia do software Nemoceph 3D-OS, para determinar se o mesmo prevê com fidedignidade a posição do lábio superior e ângulo nasolabial após a realização da CO de avanço maxilar. Foram sobrepostos os traçados cefalométricos das reformatações de tomografias computadorizadas de feixe cônico em norma lateral, preditivos e pós-operatórios de 20 pacientes submetidos a cirurgia ortognática de avanço maxilar. Foram realizadas comparações das distâncias lineares em incisal do Incisivo Central Superior (IS), cervical do IS, e lábio superior, tanto no sentido vertical quanto horizontal, como também o ângulo nasolabial, inclinação do IS, exposição do IS e comprimento efetivo do lábio (LS). Após análise estatística, pôde-se notar que dentre as medidas lineares houve diferença estatística na incisal do IS e cervical do IS no sentido horizontal, lábio superior no sentido vertical e no ângulo nasolabial, entretanto podemos observar dentre os valores das diferenças, que de modo geral não houveram grandes discrepâncias: Incisal IS (horizontal 0,77 ± 0,94; 0,11 ± 1,08); Cervical IS (horizontal 0,42 ± 1,08; vertical 0,08 ± 1,05); LS (horizontal -0,15 ± 1,33; vertical 0,53 ± 0,99); Comprimento Efetivo do LS (0,68 ± 1,24); Exposição do IS (0,09 ± 1,15); Ângulo Nasolabial (2,41 ± 2,68); e Inclinação do IS (0,93 ± 2,97). Tanto o tecido duro quanto o tecido mole do lábio superior e ângulo nasolabial tiveram acurácia favorável quando comparados os traçados cefalométricos preditivos e pós-op.
Orthognathic surgery (OC) has become increasingly predictable due to advances in diagnosis and surgical planning. Computed tomography enabled the improvement of the software that allows the accomplishment of the virtual surgical planning and promote better predictability and less time compared to traditional manual planning. With the appearance of new programs and new versions, it becomes necessary to evaluate their accuracy. The present study aims to evaluate the accuracy of Nemoceph 3D-OS software, to determine if it accurately predicts the position of the upper lip and nasolabial angle after maxillary advancement OC. Cephalometric tracing of reformatting of cone beam computed tomography in lateral norm, predictive and post operative, of 20 patients submitted to maxillary advancement orthognathic surgery, were overlaid. Comparisons of linear distances were performed in incisal of the Upper Central Incisor (UI), UI cervical, and upper lip, both vertically and horizontally, as well as the nasolabial angle, UI slope, UI exposure and lip length. After statistical analysis, it was noted that among the linear measurements there was a statistical difference in the UI incisal and cervical UI in the horizontal direction, upper lip in the vertical direction and in the nasolabial angle, however we can observe among the values of the differences, that there were no major discrepancies. Based on the current literature and the results observed in this study, it can be concluded that the software has a high degree of predictability, which makes it clinically feasible to carry out the planning with safety and precision. The software showed a high degree of predictability, although the upper lip presented a statistically significant difference in its vertical measurements, it is clinically irrelevant and clinically correct.

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34

Bianchi, Alberto <1962&gt. "Simulation Guided Navigation in cranio-maxillo-facial surgery: a new approach to improve intraoperative three-dimensional accuracy and reproducibility during surgery". Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2014. http://amsdottorato.unibo.it/6528/1/Tesi_Dottorato_Alberto_Bianchi.pdf.

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The aim of this PhD thesis " Simulation Guided Navigation in cranio- maxillo- facial surgery : a new approach to Improve intraoperative three-dimensional accuracy and reproducibility during surgery ." was at the center of its attention the various applications of a method introduced by our School in 2010 and has as its theme the increase of interest of reproducibility of surgical programs through methods that in whole or in part are using intraoperative navigation. It was introduced in Orthognathic Surgery Validation a new method for the interventions carried out according to the method Simulation Guided Navigation in facial deformities ; was then analyzed the method of three-dimensional control of the osteotomies through the use of templates and cutting of plates using the method precontoured CAD -CAM and laser sintering . It was finally proceeded to introduce the method of piezonavigated surgery in the various branches of maxillofacial surgery . These studies have been subjected to validation processes and the results are presented .
Obiettivo di questa tesi di Dottorato “Simulation Guided Navigation in cranio-maxillo-facial surgery: a new approach to improve intraoperative three-dimensional accuracy and reproducibility during surgery.” ha avuto al centro delle proprie attenzioni le varie applicazioni di una metodica introdotta dalla ns. Scuola nel 2010 e che ha come tema di interesse l’aumento delle riproducibilità dei programmi chirurgici mediante metodiche che in toto o in parte utilizzano il navigatore intraoperatorio. Si è introdotto in Chirurgia Ortognatica un nuovo Metodo di Validazione per gli interventi effettuati secondo la metodica Simulation Guided Navigation nelle malformazioni facciali ; si è poi analizzata la metodica di controllo tridimensionale delle osteotomie mediante l’utilizzo delle dime di taglio e delle placche premodellate mediante metodica CAD-CAM e sinterizzazione laser. Si è infine proceduto ad introdurre la metodica di chirurgia piezonavigata alle varie branche di chirurgia maxillo-facciale. Tali studi sono stati sottoposti a processi di validazione ed i risultati vengono presentati.

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35

Bianchi, Alberto <1962&gt. "Simulation Guided Navigation in cranio-maxillo-facial surgery: a new approach to improve intraoperative three-dimensional accuracy and reproducibility during surgery". Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2014. http://amsdottorato.unibo.it/6528/.

Testo completo

Abstract (sommario):

The aim of this PhD thesis " Simulation Guided Navigation in cranio- maxillo- facial surgery : a new approach to Improve intraoperative three-dimensional accuracy and reproducibility during surgery ." was at the center of its attention the various applications of a method introduced by our School in 2010 and has as its theme the increase of interest of reproducibility of surgical programs through methods that in whole or in part are using intraoperative navigation. It was introduced in Orthognathic Surgery Validation a new method for the interventions carried out according to the method Simulation Guided Navigation in facial deformities ; was then analyzed the method of three-dimensional control of the osteotomies through the use of templates and cutting of plates using the method precontoured CAD -CAM and laser sintering . It was finally proceeded to introduce the method of piezonavigated surgery in the various branches of maxillofacial surgery . These studies have been subjected to validation processes and the results are presented .
Obiettivo di questa tesi di Dottorato “Simulation Guided Navigation in cranio-maxillo-facial surgery: a new approach to improve intraoperative three-dimensional accuracy and reproducibility during surgery.” ha avuto al centro delle proprie attenzioni le varie applicazioni di una metodica introdotta dalla ns. Scuola nel 2010 e che ha come tema di interesse l’aumento delle riproducibilità dei programmi chirurgici mediante metodiche che in toto o in parte utilizzano il navigatore intraoperatorio. Si è introdotto in Chirurgia Ortognatica un nuovo Metodo di Validazione per gli interventi effettuati secondo la metodica Simulation Guided Navigation nelle malformazioni facciali ; si è poi analizzata la metodica di controllo tridimensionale delle osteotomie mediante l’utilizzo delle dime di taglio e delle placche premodellate mediante metodica CAD-CAM e sinterizzazione laser. Si è infine proceduto ad introdurre la metodica di chirurgia piezonavigata alle varie branche di chirurgia maxillo-facciale. Tali studi sono stati sottoposti a processi di validazione ed i risultati vengono presentati.

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36

Chua, Hannah Daile P. "Cleft maxillary distraction versus orthognathic surgery clinical morbidities and surgical relapse /". Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31954352.

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37

Goldenberg, Dov Charles. ""Estudo das alterações esqueléticas da região maxilar em pacientes submetidos à expansão rápida da maxila assistida cirurgicamente avaliadas por tomografia computadorizada"". Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5158/tde-04102006-151756/.

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Abstract (sommario):

A expansão rápida da maxila assistida cirurgicamente (ERMAC) é o procedimento de eleição para o tratamento da deficiência transversa de maxila em pacientes esqueleticamente maduros. Controvérsias em relação ao procedimento ainda persistem principalmente relacionadas aos métodos de avaliação, técnica cirúrgica utilizada, morbidade, eficácia clínica e estabilidade de resultados. A utilização da tomografia computadorizada para a avaliação da eficiência da ERMAC é uma opção atual e ainda pouco divulgada. Consequentemente, os parâmetros anatômicos para a utilização deste método ainda não foram totalmente estabelecidos. Os objetivos do presente estudo foram avaliar a confiabilidade da metodologia proposta e as alterações esqueléticas maxilares decorrentes da ERMAC com a utilização do método de avaliação por tomografia computadorizada. No período de junho de 2004 a maio de 2005, 15 pacientes, sendo 10 do sexo feminino, foram submetidos a ERMAC. A técnica cirúrgica utilizada constou de osteotomia maxilar do tipo Le Fort I, sem osteotomia da sutura ptérigo-maxilar, associada a osteotomia sagital mediana do palato. O aparelho expansor utilizado foi do tipo Hyrax. Os pacientes foram submetidos a exames de tomografia computadorizada, em tomógrafos de múltiplos detectores, no pré-operatório e após 6 meses, utilizando-se metodologia idealizada para a avaliação específica deste procedimento cirúrgico. Para a determinação do padrão das alterações transversais e ântero-posteriores, medidas lineares e angulares foram realizadas diretamente na estação de trabalho dos aparelhos de tomografia. Através de imagens obtidas nas aquisições tomográficas axiais e em reconstruções coronais, as regiões anterior, média e posterior da maxila foram avaliadas separadamente. A área de secção transversa da maxila foi também calculada. Após a avaliação dos resultados observou-se que a confiabilidade do método foi estatisticamente comprovada. Um significativo aumento da área de secção transversa da maxila foi observado (p<0.05). Entretanto, o padrão de expansão transversa não se mostrou uniforme. O aumento das dimensões transversas nas regiões anterior e média foi estatisticamente comprovado. Não foi observada expansão transversa significativa na região posterior da maxila. Ao se avaliar a relação entre a abertura do parafuso expansor e a efetiva expansão esquelética da maxila, observou-se que esta foi menor que a abertura do parafuso, em termos absolutos. O aumento transverso relativo à expansão do parafuso foi estatisticamente maior nas regiões anterior e média da maxila do que em sua região posterior. Em conclusão, a avaliação por tomografia computadorizada para a análise das alterações esqueléticas da região maxilar, em pacientes submetidos à ERMAC é metodologia confiável e reprodutível. A expansão transversa da maxila decorrente do procedimento de ERMAC utilizado no presente estudo acarretou uma expansão não uniforme da maxila, com predomínio da expansão transversa nas regiões anterior e média.
Surgically assisted rapid palatal expansion is the procedure of choice for treating transverse maxillary deficiency in mature patients. Some controversies regarding surgically assisted rapid palatal expansion remain, mainly concerning technical aspects such as type and location of osteotomy sites, as well as surgical morbidity, clinical efficiency, and stability. The evaluation of transverse expansion is still a theme of discussion. On conventional anteroposterior radiographs, anatomical structures are superimposed, resulting in a high number of image artifacts, as well as hindering the tracing and evaluation. The use of computed tomography as a method of evaluating the efficiency of this procedure has not been widely reported. Consequently, few landmarks for use in evaluating maxillary expansion have been defined. The goals of the present study were to define parameters to assess skeletal changes after surgically assisted palatal expansion, to evaluate the reliability of the proposed method and to use computed tomography to assess those parameters. From June of 2004 to May of 2005, 15 patients underwent surgically assisted rapid palatal expansion (a modified Le Fort I maxillary osteotomy without pterygomaxillary separation, together with a sagital palatal osteotomy) according to a defined protocol, using a Hyrax appliance. To determine the pattern of transversal and anteroposterior expansion, linear and angular measurements were performed on multislice computed tomography, using computed software directly on the workstation. The anterior, intermediate and posterior portions of the maxilla were evaluated separately, using a specific method, in axial acquisition and coronal reconstructed views. The cross-sectional area of the maxilla was calculated to obtain general information about maxillary expansion. The reliability of the method was statistically confirmed. Significant maxillary overall expansion was observed. However, different patterns of expansion were seen in the three regions analyzed. In the anterior and intermediate portions of the maxilla, the increase in maxillary width was significantly greater than that observed in the posterior portion. The opening of the jackscrew was greater than skeletal expansion. Comparing jackscrew opening and transverse expansion, the same pattern of asymmetric expansion was verified. No change was observed in anteroposterior dimensions. The method of computed tomography evaluation is a useful tool for evaluation of surgically assisted rapid palatal expansion changes. The accurate evaluation of the postoperative changes was heavily dependent upon images acquired through computed tomography. An overall maxillary expansion was confirmed. However, transverse expansion of the maxilla achieved through surgically assisted rapid palatal expansion without pterygoid plate separation was less than uniform.

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38

Trevisan, Daniela. "Design, implementation and evaluation for continuous interaction in image-guided surgery". Université catholique de Louvain, 2006. http://edoc.bib.ucl.ac.be:81/ETD-db/collection/available/BelnUcetd-03142006-161703/.

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Recent progress in the overlay and registration of digital information on the users workspace in a spatially meaningful way has allowed mixed reality (MR) to become a more effective operational medium. In the area of medical surgery, surgeons are conveyed with information such as the incisions location, regions to be avoided, diseased tissues, etc, while staying in and keeping their original working environment. The main objective of this Thesis is identifying theoretical and practical basis for how mixed reality interfaces might provide support and augmentation maximizing the continuity of interaction. We start proposing a set of design principles organized in a design space which allows to identify continuity interaction properties at an early stage of the development system. Once the abstract design possibilities have been identified and a concrete design decision has been taken, an implementational strategy can be developed. Two approaches were investigated: markerless and marker-based. The last one is used to provide surgeons with guidance on an osteotomy task in the maxillo-facial surgery. The evaluation process applies usability tests with users to validate the augmented guidance in different scenarios and to study the influence of different design variables in the final user interaction. As a result we have found a model to describe the contribution factors of each variable for the continuity of the user interaction. We suggest that this methodology can be applied mainly to those applications in which smooth connections and interactions, with virtual and real environments, are critical for the system; i.e. surgery, drivers applications or pilot simulations.

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39

Stevenson, Alastair Rowan Louis. "Surgical augmentation of the atrophic anterior maxillary alveolar ridge using hydroxylapatite : an analysis of treatment results". Thesis, The University of Sydney, 1988. http://hdl.handle.net/2123/4708.

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40

Gaetti-Jardim, Ellen Cristina [UNESP]. "Análise da perda volêmica em pacientes submetidos a expansão rápida de maxila assistida cirurgicamente". Universidade Estadual Paulista (UNESP), 2011. http://hdl.handle.net/11449/88933.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
As cirurgias ortognáticas são procedimentos executados com frequência e complicações como lesões arteriovenosas ou mesmo pelo tempo cirúrgico, podem ocasionar hipovolemia. A necessidade de reposição do volume sanguíneo por meio da infusão de soluções cristalóides, colóides ou até a transfusão de sangue é sempre considerada. Assim, propôs-se neste estudo quantificar a perda sanguínea, bem como avaliar a necessidade da transfusão sanguínea em 19 pacientes submetidos à expansão rápida de maxila assistida cirurgicamente. Foram avaliados os valores de pressão arterial média, tempo de procedimento cirúrgico, gênero, perda volêmica intra-operatória e classificação ASA. Pode-se concluir que a hipovolemia e a requisição de transfusão de sangue nestas cirurgias foram pequenas, entretanto, os profissionais devem sempre estar atentos quanto ao tempo cirúrgico e ao aprimoramento da técnica cirúrgica
Orthognathic surgeries are procedures performed at a frequency quite considerable and now, at the expense of complexity with regard to the complications inherent in the technique, such as arteriovenous injuries or even the time of surgery, can cause a severe hypovolemia. The need for replacement of blood by infusion of crystalloid solutions, colloids or by blood transfusion is always considered. Thus, we proposed this study to quantify the blood loss, and assess the need for blood transfusion in 19 patients undergoing to surgical assisted rapid maxillary expansion. The values of mean arterial pressure, duration of surgery, gender, ASA classification and volume loss. It can be concluded that hypovolemia and the request for blood transfusion in these surgeries were small, however, professionals should always be alert as to the time of surgical procedure and the development of a meticulous surgical technique

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41

Lima, Júnior Sergio Monteiro. "Avaliação fotoelastica da expansão rapida de maxila cirurgicamente assistida usando diferentes metodos de ancoragem ortodontica". [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289617.

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Orientadores: Luciana Asprino, Marcio de Moraes
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: O objetivo deste estudo foi avaliar por meio de modelos fotoelásticos de um crânio humano a expansão da maxila cirurgicamente assistida, comparando diferentes aparelhos e ancoragens ortodônticas para expansão e sua distribuição de forças, com e sem disjunção ptérigomaxilar. Foram utilizados nos testes seis aparelhos diferentes. Três Hyrax, um com ancoragem em primeiros pré-molares e primeiros molares (H1), um com ancoragem em caninos e primeiros molares (H2) e um com ancoragem em caninos e segundos molares (H3) e três aparelhos Haas (A1, A2, A3) com as três ancoragens citadas acima. Estes aparelhos foram submetidos a um teste de carga previamente a análise fotoelástica. Os testes de carga mostraram que todos os aparelhos avaliados produziram forças ortopédicas (> 500 gramas). A análise fotoelástica revelou que os aparelhos Haas apresentam distribuição de tensões mais homogêneas pela maxila; Os aparelhos com ancoragem em primeiros pré-molares e primeiros molares geram maior concentração de tensões na região posterior da maxila; A separação dos processos pterigóideos, em todos os seis crânios avaliados, mostrou diminuição das tensões com menor concentração das tensões por todo o esqueleto facial. Em conclusão, os aparelhos Haas apresentaram melhor distribuição das tensões com menor concentração das mesmas nos dentes e adjacências do que o aparelho Hyrax; as variações de ancoragem ortodôntica não apresentaram diferenças significativas; e todos os pilares de resistência, inclusive os processos pterigóideos, devem ser separados da maxila para evitar efeitos indesejáveis de acúmulo de tensões no restante das estruturas do crânio.
Abstract: The aim of this study was to evaluate how variations in the design of the orthodontic appliances and their anchorages would influence the distribution of forces along the cranial bones through a photoelastic skull model during the surgically assisted maxillary expansion with and without pterygoid splitting. It was used six different expanders in the tests. Three of them were Hyrax aplliances, with anchorage at first bicuspids and first molars (H1), canines and first molars (H2) and canines and second molars (H3). The three Haas appliances had the same anchorage patterns described above (A1, A2, A3). The three Haas appliances were submitted to a load peak test to evaluate the forces in the orthopedic range (> 500 grams). The photoelastic analysis revealed that Haas expanders generated similar anterior and posterior fringe patterns, while anchorage at first bicuspids and first molars created stress at the posterior region of the maxilla. The splitting of the pterygoid plates lowered the tension necessary for SARME. In conclusion, Haas expanders showed better distribution of tension lines in the maxilla, without higher concentration of tension in and around the teeth; variation on the anchorage does not influence the final result and release of all anatomic resistance, including pterygoid plates splitting facilitates the expansion movement.
Mestrado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Mestre em Clínica Odontológica

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42

Oliveira, Neto Patrício José de 1980. "Avaliação mecânica e fotoelástica do uso de placas 2,0 mm com sistema de travamento na reconstrução de defeitos mandibulares pós-ressecção". [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289614.

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Abstract (sommario):

Orientador: Luciana Asprino
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Atualmente os defeitos de continuidade mandibular são convencionalmente tratados com o emprego de placas de reconstrução de titânio do sistema 2,4mm. Entretanto, os sistemas de reconstrução têm se tornado menores e com um perfil mais delgado e o sistema de reconstrução 2,0mm com travamento tem sido utilizado nas reconstruções mandibulares. O propósito deste estudo foi avaliar comparativamente, in vitro, a resistência e a distribuição de tensões promovidas pela fixação por placas e parafusos dos sistemas 2,0mm com travamento (locking) e 2,4mm convencional (não-locking), na reconstrução de defeitos mandibulares com perda de continuidade, e seu uso associado a enxertos. Para a avaliação mecânica, 20 réplicas de mandíbula humana de poliuretano foram submetidas a uma ressecção em região de corpo mandibular, produzindo um defeito de continuidade de 5cm de extensão, e divididas em quatro grupos. Nos grupos 1 e 3 as mandíbulas foram fixadas com placas 2,0mm locking e 2,4mm convencional respectivamente. Nos grupos 2 e 4, as mandíbulas foram fixadas com placas 2,0mm locking e 2,4mm convencional respectivamente, estando associadas a enxertos de poliuretano em bloco. As cinco mandíbulas de cada grupo foram submetidas ao teste de carregamento no primeiro molar contralateral ao defeito até se atingir 5mm de deslocamento, quando os valores de carga foram registrados. Para os testes fotoelásticos, quatro mandíbulas em resina fotoelástica foram submetidas ao mesmo defeito de continuidade, e cada uma fixada como nos quatro grupos descritos anteriormente e submetidas ao mesmo teste de carregamento que as mandíbulas de poliuretano. A análise estatística revelou que a placa 2,4mm apresentou resistência mecânica estatisticamente superior à placa 2,0mm locking, independente da presença ou não do enxerto, provavelmente em virtude da maior espessura da placa e diâmetro dos parafusos. Em relação ao enxerto, observou-se que sua presença não aumentou de forma significativa a resistência mecânica do sistema placa - enxerto - mandíbula, para ambos os tipos de placa. No entanto, na análise fotoelástica, verificou-se que a associação de enxerto resultou em uma menor concentração de tensões ao redor de placas e parafusos, havendo uma distribuição mais equilibrada das tensões, o que pode favorecer o uso das placas 2,0mm locking quando associado à reconstrução óssea imediata. Pode-se concluir que: o sistema de fixação interna para reconstrução mandibular 2,0mm locking apresentou resistência mecânica insatisfatória para reconstrução de defeitos de continuidade mandibular; a associação de enxerto ósseo favoreceu a distribuição das tensões, mas não promoveu aumento na resistência mecânica dos sistemas avaliados na reconstrução de defeitos de continuidade mandibular
Abstract: Currently mandibular continuity defects are conventionally treated with 2.4mm titanium reconstruction plates. However, the reconstruction systems have become progressively slimmer and more malleable and the 2.0mm locking reconstruction plate system has been introduced as the next generation system to improve on current reconstruction plate designs. The purpose of the present investigation was comparatively evaluate the mechanical behaviour and the stress distribution promoted by 2.4mm reconstruction plate system and 2.0mm locking reconstruction plate system in mandibular continuity defects, with or without block grafts. Twenty polyurethane mandibles (Synbone®) were underwent to a 5-cm mandibular body ressection and equally divided among 4 groups. In groups 1 and 3, the mandibles were bridged with a 2.0mm locking reconstruction plate system and with a 2.4mm reconstruction plate system respectively. In groups 2 and 4 the mandibles were fixated with a 2.0mm locking and 2.4mm reconstruction plates, being associated with block grafts. The mandibles from each group were subjected to contralateral molar load until 5-mm displacement, and the values were recorded. Mandibular photoelastic models simulating the type of mandibular defect and plate fixation with or without block grafts were subjected to the same contralateral molar load. Statistical analysis showed that the 2.4 mm plate showed statistically superior mechanical strength to the locking plate 2.0 mm, regardless of the presence or absence of graft, probably due to the greater plate thickness and diameter of the screws. In relationship to the graft, it was observed for both types of fixation systems that its presence did not increase the mechanical strength of the plate - graft - mandible set when compared to the without graft situation. However, the photoelastic analysis found that the combination of graft resulted in a lower stress concentration around screw and plate, with a more balanced distribution of tension, which may favor the use of locking plates 2.0 mm when associated with immediate bone reconstruction. It can be concluded that: the 2.0mm locking reconstruction plate system had an unsatisfactory mechanical strength for reconstruction of mandibular continuity defects; the association of bone graft provided a better stress distribution, but did not increase the mechanical strength of the systems evaluated in the reconstruction of mandibular continuity defects
Doutorado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Doutor em Clínica Odontológica

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43

Noel, Colin Byron. "The interaction between exercise induced muscle damage and fatigue on neural regulation and exercise performance during submaximal and maximal running". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29702.

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Aim: To study the effects of muscle damage and fatigue on neuromuscular preactivation and performance during submaximal and maximal running. Setting: University of Cape Town, Sports Science Institute of South Africa. Methods: 12 male distance runners (19 - 39 years of age) with a minimum weekly training distance of 40 kilometers per week were randomly assigned to either control (n = 6) or experimental (n = 6) groups. Subjects’ visited the laboratory over an 11 day period during which testing included a submaximal and maximal run (5 km time trial) on the first and last day of testing. Neuromuscular preactivation, rating of perceived exertion, heart rate and performance times were recorded during the performance trials. The intervention between performance trials included two 40 minute bouts on a treadmill at 70 % peak treadmill running speed at –10 º elevation (experimental) or horizontal (control). Results: Running performance in the 5 km time trial (5K) improved in the experimental group alone by an average of 40 seconds over 5 km (P < 0.04) in the presence of muscle damage and without altered neuromuscular preactivation. There was no evidence any interaction between altered neuromuscular activity with regard to fatigue and muscle damage during submaximal and maximal running. Evidence of muscle damage in the experimental group was supported by a significant group versus time interaction effect in subjective pain score for daily living and increased plasma creatinine kinase levels in the experimental group (P<0.03). A significant decrease in rating of perceived exertion (RPE) was observed in both groups during both the submaximal (P<0.04) and 5 km time trial (P<0.03) post intervention. There was an interaction effect for group versus pre-post 5K (P<0.06), with the post 5K RPE in the experimental group showing an average decreased RPE score of 2.6 for each kilometer and the control group an average decrease in RPE score of only 0.03. Conclusion: The research design of this study was appropriate to study the interaction between fatigue and muscle damage during submaximal and maximal running. This study suggests that there is no neuromuscular compensation after muscle damage and that EMG is regulated similarly for both fatigue and muscle damage during submaximal and maximal running. Improvement in running performance and decreased rating of perceived exertion after muscle damage is due to some unknown variable.

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Gilardino, Miroslav S. "Prevention of maxillary collapse during sutural distraction osteogenesis for cleft palate closure". Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=84034.

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Sutural distraction osteogenesis (SDO) has been proposed as a novel approach for cleft palate closure in an effort to avoid the shortcomings of traditional surgical repair. In this thesis, we present data that confirms that attempted distraction of the palatomaxillary suture (PMS) achieves cleft closure preferentially by alveolar arch collapse, and not by intended SDO. To that end, we have designed a novel custom-fit intraoral splint that successfully prevents maxillary collapse while facilitating cleft defect approximation via sutural distraction. Preservation of maxillary dimensions was confirmed via intraoral measurements and craniometrics. New bone deposition secondary to SDO was quantified with histomorphometry and microCT, while the effects of distraction on the PMS and palatal bone were assessed with histology and Dual-energy Xray Absorptiometry (DXA). In summary, approximation of palatal defects via SDO in a canine model without maxillary collapse is possible, and may be a promising therapeutic approach for the repair of cleft palates in human infants.

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Margoni, Neto Octavio. "OSTEOTOMIA SEGMENTAR DE MAXILA CASO CLÍNICO". Universidade Metodista de São Paulo, 2012. http://tede.metodista.br/jspui/handle/tede/1211.

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Segmental osteotomy of Maxilla Osteotomy Le Fort I or Segmented is a procedure that has become increasingly common for dentofacial deformities surgeries, known as Orthognathic Surgery. This procedure is very well indicated for the correction of discrepancies in the different plans and jaw in a single surgical time, optimizing the time of the processing treatment for which the patient is submitted. Transversal skeletal stability and the occlusal of patients, who are subjected to this type of osteotomy, has been studied in the literature, as well as, potential risks and complications associated with this procedure, the dental tissues, oro-nasal fistula, tooth loss, necrosis of some segment of the jaw or even across the jaw. The aim of this study is to present the clinical case of a patient underwent to segmental maxillary osteotomy, and to do a review of literature covering the past 10 years, with articles that discuss the stability of this procedure, as well as the potential risks and complications . Using a few key words in the electronic data base PUBMED, 12 articles were selected for this work, during the period from 2002 to 2012. Segmental osteotomy of the maxilla is a stable and safe procedure, with low complication rate, when given correctly and with the proper care in pre, trans and post-operatory.
A Osteotomia Segmentar de Maxila ou Osteotomia Le Fort I Segmentada é um procedimento que tem se tornado, cada vez mais comum, nas cirugias para as correções das deformidades dentofaciais, conhecidas como Cirurgias Ortognáticas. Este procedimento é muito bem indicado para a correção das discrepâncias maxilares, nos diferentes planos e num único tempo cirúrgico, otimizando assim, o tempo de tratamento a que o paciente é submetido. A estabilidade esquelética transversal e a oclusal dos pacientes, que são submetidos a este tipo de osteotomia, tem sido objeto de estudo na literatura , assim como também, os potenciais riscos e complicações inerentes a este procedimento como, a desvitalização dentária, fístula oro-nasal, perda dentária, necrose de algum segmento da maxila ou até mesmo, de toda a maxila. O objetivo deste trabalho é apresentar o caso clínico de um paciente submetido à osteotomia segmentar de maxila, e fazer uma revisão da literatura abrangendo os últimos 10 anos, com artigos que abordam a estabilidade deste tipo de procedimento, assim como também os potenciais riscos e complicações aos pacientes submetidos a este procedimento. Utilizando algumas palavras chave na base de dados eletrônica PUBMED, 12 artigos foram selecionados para este trabalho, no período de 2002 a 2012. A Osteotomia Segmentar de Maxila é um procedimento estável e seguro, com baixo índice de complicação, quando indicado corretamente e com os devidos cuidados no pré, trans e pós operatórios.

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CANTARELLA, DANIELE. "MINIMALLY INVASIVE SURGERY TO FACILITATE MICRO-IMPLANT SUPPORTED MAXILLARY SKELETAL EXPANSION IN ADULT PATIENTS". Doctoral thesis, Università degli Studi di Milano, 2022. http://hdl.handle.net/2434/914517.

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Introduction The aim of the present study is to evaluate the skeletal modifications induced by maxillary expansion supported by palatal micro-implants and localized osteotomies produced with minimally invasive surgical technique in young-adult and adult patients. In the present investigation, osteotomies had a lower extension than the ones used in conventional surgically assisted rapid palatal expansion (SARPE), to adopt a minimally invasive surgical technique that can be performed with greater comfort for the patient and less post-operative sequelae. More in detail, the localized osteotomies were executed only in the anterior part of the midpalatal suture and bilaterally at the basis of the zygomatic process of the maxilla without involvement of the piriform rim. These areas represent a great resistance to the lateral maxillary movement. Furthermore, they are of simple surgical access and don’t present important arterial plexuses. Patients requiring micro-implant supported maxillary expansion and/or SARPE routinely undergo a pre-treatment cone-beam computed tomography (CBCT) of the skull, to plan the surgical operation and, one month after treatment a secondary CBCT for a surgical and orthodontic control. CBCT is a low radiation tomography, extensively used in maxillofacial surgery and in dentistry. For the implementation of this study, that aims at evaluating the efficacy of micro-implant-supported maxillary expansion in combination with localized osteotomies, only radiologic exams that are anyway needed for the planning and post-treatment evaluation were used. Aim The aim of the present study is to evaluate the advantages introduced in the treatment of maxillary constriction by the therapy with micro-implant supported Maxillary Skeletal Expander (MSE) and localized osteotomies in young-adult and adult patients. The main objective is to evaluate the efficacy of the technique, by measuring the movement of skeletal landmarks in the midface, particularly on the maxillary and zygomatic bones, and on the lateral wall of the nose, by comparing the pre-treatment and post-treatment CBCT. For this particular technique, a new methodology for digital planning of position of MSE and miniscrews on patient CBCT was developed. Furthermore, incorporation of 2 additional miniscrews to the original MSE design, which conventionally features only 4 miniscrews, was developed with the aid of computer aided design – computer aided manufactured (CAD-CAM) technology. Methods The study presented the following steps: ▪ Development of a digital planning methodology for positioning the miniscrews and MSE appliance on pre-treatment CBCT ▪ Development of a CAD-CAM methodology for incorporating 2 additional miniscrews to the original MSE design with 4 miniscrews ▪ Selection of patients with age above 17 years, without congenital craniofacial syndromes, who require intervention of maxillary skeletal expansion ▪ Acquisition of initial CBCT with 17 x 13.5 cm field of view (FOV) ▪ Intervention of maxillary expansion supported by palatal micro-implants and localized osteotomies executed with minimally invasive surgical technique ▪ One month after treatment, acquisition of post-treatment CBCT with 17 x 13.5 cm FOV ▪ Analysis of skeletal modifications in the midface (maxillary bone, sphenoid bone, zygomatic arch, nasal cavity, etc.), by comparing the pre- and post- treatment CBCT with a 3D software (OnDemand software by Cybermed) Results The new methodology allowed the digital planning of MSE and miniscrews positioning on patients’ CBCTs, and the incorporation of two additional miniscrews to the original MSE design through CAD-CAM technology. In the clinical trial, a total of four patients had an average age of 27.6 years (range 22.1 – 39.9 years). MSE appliance was activated by an average of 6.0 mm and generated a parallel split of the midpalatal suture of 3.4 mm, 3.0 mm and 3.6 mm at anterior nasal spine (ANS), nasopalatine foramen (NPF) and posterior nasal spine (PNS), respectively. Skeletal modifications were found in all CBCT sections evaluated in the study (axial palatal, upper nasal, coronal zygomatic, axial zygomatic), indicating that all midfacial bones are affected by maxillary expansion with MSE and localized osteotomies. Particularly, skeletal changes were noticed also in CBCT sections above the lateral maxillary osteotomies (LMOs), in the maxilla, zygomatic bone, zygomatic arches, and nasal cavity. In the upper nasal section (UNS) the maxilla was laterally displaced by 2.4 mm and 0.9 mm, at its anterior and posterior extremities, respectively. The frontozygomatic angle (FZA) increased by 1.9° (average of right and left side), while the lower interzygomatic distance increased by 2.9 mm, indicating a rotation of the zygomatic bone in a lateral direction. The zygomatic arch was affected by bone bending phenomena and was deflected in an outward direction, with increase in the anterior intermaxillary distance by 1.7 mm and in the posterior inter-zygomatic distance by 1.6 mm. The nasal width (NW) parameter increased by 2.9 mm with treatment: this anatomical finding is the basis for a potential improvement in nasal breathing for patients suffering from increased nasal airway resistance. The cited modifications in skeletal structures above lateral maxillary osteotomies (LMOs) are most likely due to the fact that LMOs didn’t involve the piriform rim of the maxilla, and this point needs further investigations. Regarding dentoalveolar modifications, the inter-molar distance increased by 7.4 mm, and molars underwent a small dentoalveolar tipping in a buccal direction by 1.1° (average of right and left side), as evidenced by the change in molar basal bone angle (MBBA). No intra-operatory hemorrhage nor post-operatory bleeding was reported in treated patients, probably due to the lack of pterygopalatine suture surgical disjunction. A limitation of the study is its small sample size, represented by 4 patients. A larger number of patients is required to confirm the above results.

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Gaetti-Jardim, Ellen Cristina. "Análise da perda volêmica em pacientes submetidos a expansão rápida de maxila assistida cirurgicamente /". Araçatuba : [s.n.], 2011. http://hdl.handle.net/11449/88933.

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Orientador: Elio Hitoshi Shinohara
Banca: Jéssica Lemos Gulinelli
Banca: Roberta Okamoto
Resumo: As cirurgias ortognáticas são procedimentos executados com frequência e complicações como lesões arteriovenosas ou mesmo pelo tempo cirúrgico, podem ocasionar hipovolemia. A necessidade de reposição do volume sanguíneo por meio da infusão de soluções cristalóides, colóides ou até a transfusão de sangue é sempre considerada. Assim, propôs-se neste estudo quantificar a perda sanguínea, bem como avaliar a necessidade da transfusão sanguínea em 19 pacientes submetidos à expansão rápida de maxila assistida cirurgicamente. Foram avaliados os valores de pressão arterial média, tempo de procedimento cirúrgico, gênero, perda volêmica intra-operatória e classificação ASA. Pode-se concluir que a hipovolemia e a requisição de transfusão de sangue nestas cirurgias foram pequenas, entretanto, os profissionais devem sempre estar atentos quanto ao tempo cirúrgico e ao aprimoramento da técnica cirúrgica
Abstract: Orthognathic surgeries are procedures performed at a frequency quite considerable and now, at the expense of complexity with regard to the complications inherent in the technique, such as arteriovenous injuries or even the time of surgery, can cause a severe hypovolemia. The need for replacement of blood by infusion of crystalloid solutions, colloids or by blood transfusion is always considered. Thus, we proposed this study to quantify the blood loss, and assess the need for blood transfusion in 19 patients undergoing to surgical assisted rapid maxillary expansion. The values of mean arterial pressure, duration of surgery, gender, ASA classification and volume loss. It can be concluded that hypovolemia and the request for blood transfusion in these surgeries were small, however, professionals should always be alert as to the time of surgical procedure and the development of a meticulous surgical technique
Mestre

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Tavares, Rodrygo Nunes. "Alterações em tecido mole associadas com avanço total de maxila por meio de radiografias cefalometricas". [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289661.

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Orientador: Luis Augusto Passeri
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: O presente estudo avaliou as alterações em tecido mole associadas com avanço total de maxila em uma população brasileira por meio de radiografias cefalométricas. Vinte seis pacientes foram submetidos a tratamento orto-cirúrgico, com a utilização de fixação interna rígida. Nenhum dos pacientes realizou qualquer tipo de procedimento associado ou combinado, tais como osteotomia mandibular ou mentoplastia. Foram utilizadas telerradiografias, em norma lateral, pré-operatória e pós-operatória com intervalo mínimo de 6 meses. Os pacientes foram submetidos a avanços de maxila que variaram de 2 a 9 mm, com movimento no sentido vertical não maior que 3 mm. Foram analisados deslocamentos horizontais e verticais em pontos de tecido ósseo e do tecido mole. Proporções entre as mudanças do tecido ósseo e o tecido mole, assim como as análises de correlação significativas, foram calculadas. Os resultados demonstraram várias correlações significativas. A resposta do tecido mole ao avanço da maxila pareceu ser previsível: (1) o lábio superior acompanhou o movimento do incisivo central superior no plano horizontal, com o ponto labrale superius acompanhando em 65,2% e stomion superius, em 50,1%; (2) o ponto A foi relacionado com três pontos do tecido mole, subnasale, labrale superius e stomion superius, por 60,2%, 58,2% e 58,1%, respectivamente
Abstract: The present study evaluated the soft tissue changes associated with total maxillary advancement in a brazilian population through cephalometric radiographs. Twentysix patients were submitted to presurgical orthodontic maxillary surgery stabilized with a rigid fixation. None of them were submitted to any other adjunctive procedure, such as mandibular osteotomy or genioplasty. Presurgical and late postsurgical radiographs taken apart with a minimum of 6 months interval had been used. All the patients were submitted to advancement of the maxilla between 2 and 9,5 mm, with no more than 3 mm of vertical displacement. The horizontal and vertical displacement of skeletal and soft tissue profile points were analyzed. Soft-tissue change to hard tissue change ratios, as well as correlations analyses, were calculated. The results demonstrated many statistical significant correlations. The soft tissue response to maxillary advancement appeared to be predictable: (1) the upper lip followed the movement of maxillary central incisor in the horizontal plane, with the point labrale superius following by 65.2% and stomion superius, 50.1%; (2) the point A was related to three points at the soft tissue, subnasale, labrale superius and stomion superius, by 60.2%, 58.2% and 58.1%, respectively
Doutorado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Doutor em Clínica Odontológica

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Pádua, Francini Grecco de Melo. "Estudo da anatomia da região do forame esfenopalatino na parede lateral do nariz através da dissecção endoscópica em cadáveres". Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5143/tde-12022008-150115/.

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INTRODUÇÃO: Apesar do índice de sucesso da cirurgia da ligadura ou cauterização da artéria esfenopalatina, para o tratamento da epistaxe severa, ser maior que 95%, a falha pode variar de 2% a 10%. Algumas variações anatômicas na parede lateral do nariz são relatadas, sendo referentes à localização do forame esfenopalatino (FEP), à presença de um forame acessório, à ramificação das artérias e à dimensão e morfologia do FEP. A variação anatômica dessa região assim como a escassez de estudos endoscópicos mostrando pontos de reparo para o encontro da artéria esfenopalatina e seus ramos podem justificar a falha cirúrgica em alguns casos, assim como a dificuldade técnica encontrada por alguns autores. OBJETIVO: Descrever a anatomia da região do FEP na parede lateral do nariz e as possíveis variações anatômicas, durante a dissecção endoscópica em cadáveres, e observar as possíveis diferenças entre os achados anatômicos, o gênero (masculino/feminino) e o grupo étnico/racial, assim como a simetria entre as fossas nasais. CASUÍSTICA E MÉTODOS: Estudo anatômico prospectivo realizado de setembro de 2006 a janeiro de 2007. A região do FEP de 61 cadáveres frescos (122 fossas nasais) foi cuidadosamente dissecada, sob visibilização endoscópica. Prevaleceram os cadáveres do sexo masculino (75%) e grupo étnico/racial pardo, seguidos de negros e brancos. Foram observados a presença da crista etmoidal da lâmina perpendicular do osso palatino, a localização dos forames esfenopalatino e acessório, o número de ramos arteriais emergentes pelos forames e a distância dos mesmos à espinha nasal anterior. Os dados foram analisados em relação ao gênero, grupo étnico/racial e simetria entre as fossas nasais do mesmo cadáver. Foi, ainda, avaliada a predição da presença do forame acessório em relação ao número de ramos arteriais emergentes através do FEP, à localização do FEP e à distância do FEP à espinha nasal anterior. RESULTADOS: A crista etmoidal esteve presente em 100% dos cadáveres, sendo anterior ao mesmo em 98,4% das vezes. A localização mais freqüente do FEP foi a região de transição do meato médio e meato superior (86,9%). A distância média do FEP e do forame acessório à espinha nasal anterior foi respectivamente de 66mm e 67mm, com desvio padrão de 5,3 e 4,7mm. O forame acessório esteve presente em 9,83% dos casos. Um único tronco arterial emergia através do FEP em 67,2% das vezes e em 100% dos forames acessórios. A análise da prevalência das variáveis estudadas em relação ao gênero e grupo étnico/racial não mostrou diferenças estatisticamente significantes (p<0,05). A análise da simetria mostrou concordância boa a excelente em relação à localização do FEP (índice Kappa 0,71/ p<0,001); concordância pobre em relação ao número de ramos arteriais emergentes através do FEP (índice Kappa 0,22/p=0,03) e ausência de concordância estatisticamente significante em relação à presença de forame acessório (p=0,53). Nenhuma das variáveis de interesse apresentou associação estatisticamente significante (p>0,05) que permita predizer a presença do forame acessório. CONCLUSÕES: Existem variações anatômicas na parede lateral do nariz que devem ser levadas em consideração para o sucesso do tratamento cirúrgico endoscópico da epistaxe severa.
INTRODUCTION: Even though the success rate of sphenopalatine ligation is greater than 95%, some authors have reported some difficulties in isolating those arteries during endoscopic surgical procedure. The failure rate of the sphenopalatine artery ligation or cauterization may vary from 2% to 10%. Some anatomical variations on the nose lateral wall are reported, with reference to the sphenopalatine foramen (SPF) location, the presence of an accessory foramen, arteries ramification and SPF dimension and morphology. Anatomical variation of the region, as well as scarcity of endoscopic studies showing landmarks to find the sphenopalatine artery and its branches may justify surgical failure. OBJECTIVE: The purpose of this study was to describe the anatomy of SPF region and possible anatomical variations, during the endoscopic cadaver dissection and to observe the symmetry between nasal sides and the relationship to gender and racial group. CASUISTICS AND METHODS: It is a prospective anatomical study developed from September, 2006 to January, 2007. The SPF of 61 fresh cadavers (122 nasal fossae) was carefully endoscopic dissected. Male (75%) and mixed race cadavers prevailed. Presence of ethmoidal crest, location of sphenopalatine and accessory foramens, number of arterial branches emerging through foramens and distances from the foramens to anterior nasal spine were observed. Data were analyzed in relation to gender, racial group and symmetry of the same cadaver. Prediction of the presence of accessory foramen was evaluated in relation to number of arterial branches emerging through SPF, SPF location and distance from the SPF to the anterior nasal spine. RESULTS: Ethmoidal crest was present in 100% of cadavers, being anterior to the SPF in 98.4% of times. The most frequent SPF location was the transition region of middle and superior meatus (86.9%). Mean distance from SPF and accessory foramen to anterior nasal spine was 6.6cm and 6.7cm, respectively. Accessory foramen was present in 9.83% of cases. A single arterial stem emerged through the SPF in 67.2% of times, and 100% through accessory foramens. The prevalence analyses showed no differences statistically significant (p>0,05) between gender and racial group. The symmetry analyses showed a strong conformity (Kappa index 0,71/p<0,01) between nasal fossae in relation to the SPF location; and a poor conformity (Kappa index 0,22/p=0,03) in relation to the number of arterial branches emerging through the SPF. There was no statistically significant conformity between nasal fossae and the presence of accessory foramen (p = 0,53). None of the variables of interest presents any statistically significant (p>0,05) association with the presence of the accessory foramen. CONCLUSIONS: Anatomical variations in the lateral nose wall exist, and should be taken into account, for a well-succeeded endoscopic surgical treatment of severe epistaxis.

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Peiró, Ibañez Jose Luis. "Reparación intrauterina del labio leporino en el feto ovino". Doctoral thesis, Universitat Autònoma de Barcelona, 2014. http://hdl.handle.net/10803/283942.

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