No abstract

No abstract

The main purpose was to assess and compare nasal cavity (NC) volumes among adults with unilateral (UCLP) and bilateral cleft lip and palate (BCLP) and in noncleft controls (CON), by means of cone-beam computed tomography (CBCT) three-dimensional reconstructions. Forty-five scans of individuals with class III skeletal pattern, matched by age, were gathered in 3 groups: UCLP (n = 15), BCLP (n = 15) and (CON) (n = 15). The NC volume was assessed three-dimensionally, using Dolphin 11.8 software. Descriptive normally distributed data was presented as mean (±SD). Comparisons of NC volume among groups was performed using ANOVA test (P ≤ 0.05). The NC mean volumes corresponded to 14.7(±2.2) cm3 (UCLP), 17.1(±2.2) cm3 (BCLP) and 18.1(±3.8) cm3 (CON), respectively. UCLP individuals presented a significantly reduced NC volume when compared to controls (P = 0.006). No differences were observed between UCLP versus BCLP or BCLP versus CON. The intraclass correlation coefficient suggested a high intra- and inter-examiners agreement (>.075). Individuals with unilateral cleft lip and palate presented reduced NC when compared to individuals without cleft lip and palate. CBCT scans can be considered a highly accurate tool for morphometric assessments of craniofacial structures.

RESUMO Objetivo Comparar a geometria da cavidade nasal de crianças e adolescentes com fissura labiopalatina e deficiência maxilar por meio de dois métodos: a tomografia computadorizada de feixe cônico, considerada padrão-ouro, e a rinometria acústica. Método Foram avaliados, de maneira transversal, os exames de tomografia computadorizada de feixe cônico e de rinometria acústica, previamente obtidos para fins de planejamento ortodôntico, de 17 crianças e adolescentes com fissura labiopalatina e atresia maxilar. Por meio do programa Dolphin Imaging 11.8, a cavidade nasal das imagens tomográficas foi reconstruída por dois avaliadores e foram obtidos os volumes internos nasais. Por meio da rinometria, os volumes nasais foram aferidos para as regiões V1 e V2. Os valores de cada exame foram, então, comparados, a um nível de significância de 5%. Resultados A análise estatística mostrou alta reprodutibilidade intra e interavaliadores na análise da tomografia computadorizada de feixe cônico. Os volumes internos nasais médios (± desvio-padrão), utilizando a rinometria acústica e a tomografia computadorizada de feixe cônico corresponderam a 6,6 ± 1,9 cm3 e 8,1 ± 1,5 cm3, respectivamente. A diferença entre os exames foi de 17,7%, considerada estatisticamente significante (p = 0,006). Conclusão Os volumes nasais aferidos pelos dois métodos são diferentes, ou seja, apresentam discrepâncias nas medidas. A técnica considerada padrão-ouro identificou volumes maiores na cavidade nasal. A determinação de qual exame reflete a realidade clínica constitui passo futuro importante.

Objectives: Studies have suggested that upper airway (UAW) dysmorphologies in Syndromic Craniosynostosis (SCS) are mainly related to midface hypoplasia and consequently with obstructive sleep apnea (OSA). The aim of this study was to characterize the morphophysiology of UAW in SCS individuals as compared to controls (CON) by means of computed tomography (CT) and computational fluid dynamics (CFD). We hypothesized that UAW was reduced and physiologically impaired in SCS. Methods: The sample was composed by two groups: 1) CON: 19 scans of individuals without any syndrome or upper airway infections (25,2±6,6 years of age), and 2) SCS 10 CT scans of individuals with SCS (21,0±4,8 years of age); volume (cm 3) (V) and minimal cross-sectional area (mm 2) (mCSA) were assessed using Mimics software; UAW was divided into total UAW (tUAW), nasal cavity (NC), and pharynx (Phrx). Cephalometric analysis was also performed using Dolphin software. Seven individuals of each group, age and gender matched, were considered for CFD simulation. Measurements were done twice by the same evaluator at two different time points. Differences between groups were assessed at a 5% significance level. Results: Mean values of V (±Sd) for groups CON and SCS corresponded to: tUAW 34,3±5,9 and 24,5±9,5; NC 17,9±3,0 and 14,1±4,3; Phrx 16,4±4,6 and 10,4±5,6 respectively. Mean mCSA (±Sd) for groups CON and SCS corresponded to 67,3±54,2 and 28,6±17,1. Cephalometric findings showed significant differences between CON and SCS respectively: a smaller maxillomandibular length in SCS, represented by Co-A (mm) 84,1±5,8 and 67,3±11,3, Go-Me (mm) 71,1±6,0 and 58,3±9,5; midface retrusion in relation to the skull base, showed by SNA 82,8°±3,8 and 76,4°±8,5; anterior position of hyoid illustrated by SNH 56,42°±4,50 and 62,24°±5,7; greater flexure of skull base angle, from the magnitude of Ba-S-N 131,1°±6,2 and 121,8°±7,6. There was a positive correlation between the cephalometric variables Co-A/Go-Me and V Phrx. The mCSA showed a positive correlation with V Phrx. On CFD analysis, pressure boundary condition on outlet (Pout), expressed in Pascals, on CON and SCS corresponded to-45,6±24,2 and-107,7±63,0. The UAW resistance (Res), expressed in Pa/(L/min), corresponded to-2,7±1,7 and-6,8±3,7, on CON and SCS respectively. The actual simulated flow rate (Flw), expressed in L/min, was from 17,2±2,39 and 15,8±1,88, for CON and SCS respectively. Conclusion: The initial hypothesis was confirmed, since the UAW dimensions were significantly reduced in SCS. The same significance was found in CFD variables. Therefore, the results suggested these individuals with SCS are at great risk for OSA.