Dissertations / Theses: 'Palate - Surgery'

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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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Riehl, Luciane. "Etapas e condutas terapêuticas adotadas no Hospital de Reabilitação de Anomalias Craniofaciais/USP para a fissura de palato submucosa: análise de resultados." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/61/61131/tde-29052007-141224/.

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Este trabalho teve como objetivo analisar os casos com fissura de palato submucosa (FPSM) acompanhados no HRAC/USP, no período de 1984 a 2004, verificando a distribuição destes casos de acordo com a idade e conduta adotada na consulta inicial e; se a conduta inicialmente adotada manteve-se ou necessitou ser reconsiderada. Foram analisados 1.260 prontuários de pacientes FPSM, sendo excluídos 175 que apresentavam quadros sindrômicos e, portanto, a amostra final constou de 1.085 pacientes, de ambos os gêneros e procedentes das diferentes regiões do país, os quais foram distribuídos em 5 grupos etários de acordo com idade na época da consulta inicial: menores de 3 anos, de 4 a 6 anos, de 7 a 12 anos, de 13 a 17 anos e acima de 18 anos. A análise evidenciou 557 (51,33%) casos com FPSM isolada e 528 (48,67%) com FPSM associada à fissura labial, sendo os mesmos analisados de acordo com a conduta inicial adotada: acompanhamento, fonoterapia, prótese de palato ou cirurgia, respeitando-se os grupos etários definidos. Após a análise dos casos com fissura de palato submucosa acompanhados no HRAC/USP, no período de 1984 a 2004, concluiu-se que: quanto à distribuição dos casos de acordo com a conduta definida na consulta inicial, na FPSM isolada predominou a indicação para cirurgia nas idades acima de 4 anos e acompanhamento nas idades abaixo de 3 anos e, na FPSM associada à fissura labial predominou a conduta acompanhamento; Quanto à manutenção ou reconsideração da conduta inicial, dos casos indicados para acompanhamento, na FPSM isolada, a maioria dos casos alterou a conduta para cirurgia e na FPSM associada à fissura labial, a maioria manteve a conduta inicial; daqueles indicados para fonoterapia, na FPSM isolada, predominou manter a conduta inicial nas idades menores de 3 anos e de 7 a 12 anos e alterar a conduta para cirurgia nas idades de 4 a 6 anos e de 13 a 17 anos e, nos casos com FPSM associada à fissura labial, a maioria manteve a conduta inicial; dos casos indicados para prótese de palato, na FPSM isolada, a maioria dos casos entre 4 e 6 anos alterou a conduta para cirurgia, houve equilíbrio entre manter a conduta inicial e alterar para cirurgia na faixa etária de 7 a 12 anos e houve manutenção da conduta inicial na faixa etária maior de 18 anos, não ocorrendo casos com FPSM associada à fissura labial, já, dos casos indicados para cirurgia, tanto na FPSM isolada quanto na FPSM e associada à fissura labial prevaleceu à conduta inicial.
This study analyzed the patients with submucous cleft palate (SMCP) assisted at HRAC/USP during the period 1984 to 2004, checking the distribution of these cases according to age range, approach adopted at the initial consultation, and if the approach initially adopted was maintained or reconsidered. A total of 1,260 records of patients with SMCP were analyzed; 175 were excluded due to the association with syndromes, leading to a final sample of 1,085 patients, of both genders and from different regions of the country, which were distributed into 5 age groups according to the age rage upon initial consultation: younger than 3 years, 4 to 6 years, 7 to 12 years, 13 to 17 years, and older than 18 years. The analysis revealed 557 (51.33%) cases with isolated SMCP and 528 (48.67%) cases with SMCP associated with cleft lip. These cases were analyzed according to the initial approach adopted: follow-up, speech therapy, speech prosthesis, or surgery, according to the aforementioned age groups. The following could be concluded: with regard to the initial approach, for patients with isolated SMCP, there was predominance of indication for surgery at the ages above 4 years and follow-up for patients younger than 3 years, whereas in cases with SMCP associated with cleft lip there was predominance of follow-up. Concerning the maintenance or reconsideration of the initial approach, among the cases with isolated SMCP indicated for follow-up, in most cases the approach was altered to surgery, whereas the initial approach was mostly maintained for individuals with SMCP associated with cleft lip. Among individuals with isolated SMCP with indication for speech therapy, there was predominance of maintenance of the initial approach for patients younger than 3 years and aged 7 to 12 years, with maintenance of the initial approach for patients aged 4 to 6 years and 13 to 17 years, with predominance of maintenance of the initial approach for patients with SMCP. In relation to the cases with isolated SMCP with indication for speech prosthesis, the approach was altered to surgery in most cases aged 4 to 6 years; there was similar proportion between maintaining the initial approach and altering to surgery at the age range 7 to 12 years; and the initial approach was maintained for patients older than 18 years; there were no cases of SMCP with cleft lip under this indication. Contrarily, among the cases with indication for surgery, the initial approach was maintained for individuals with both isolated SMCP and SMCP with cleft lip.

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許嘉榮 and 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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Fletcher, Amy. "Mothers' experiences of surgery in babies with cleft lip and/or palate." Thesis, Cardiff University, 2011. http://orca.cf.ac.uk/9352/.

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Objectives: Cleft lip and/or palate (CLP) affects around 1 in 700 live births. Research has been conducted into the impact of the diagnosis but little research has looked at the effect of the initial surgical repair. This study aimed to discover more about the experience of surgery and its impact on mothers. The study also focused upon whether factors such as attachment, loss of control and expectations of appearance were relevant. Design: A qualitative methodology was chosen in order to allow participants to express their experiences in their own terms, rather than being bound by the researcher’s ideas or perceptions. Method: Seven semi-structured interviews were conducted with mothers of babies with CLP who had had routine lip and/or palate surgery in the last three years. Mothers were recruited from the Cleft Lip and Palate Service based at the Morriston Hospital in Swansea. Results: Interviews were analysed using Interpretative Phenomenological Analysis (IPA). The super-ordinate themes which emerged were concerned with the Context of CLP, Emotions, Coping, the Impact of Others, Information and Expectations and Considerations of Surgery. Conclusions: Implications for clinical practice included provision of reference information, more opportunities to share experiences with other parents, as well as the need to provide time for parents to spend time together. Emphasis was also placed on professionals maintaining a friendly and approachable attitude, which was highly valued. The need to spend time with families to better understand their concerns for surgery, their needs for information and their strategies for coping were also emphasised.

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Hundert, Sharon. "Velopharyngeal competence, a retrospective study of the outcome of primary cleft palate surgery." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ60439.pdf.

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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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Tan, Huann Lan, and 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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Tereso, Ana Verónica Morais Tereso. "Clínica de animais de companhia." Master's thesis, Universidade de Évora, 2018. http://hdl.handle.net/10174/23633.

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O presente relatório encontra-se dividido em duas partes. A primeira é constituída por uma descrição da casuística acompanhada durante o estágio curricular do Mestrado Integrado em Medicina Veterinária, realizado no hospital Alma Veterinária, enquanto que a segunda consiste numa revisão bibliográfica sobre as aplicações cirúrgicas do LASER de CO2 em pequenos animais, complementada com um caso clínico, referente a um cão com síndrome respiratório do braquicéfalo. A utilização do LASER de CO2, pode apresentar significativa redução na hemorragia capilar, edema e dor, durante e após o procedimento cirúrgico. A sua correta utilização facilita o trabalho do cirurgião e pode levar a uma diminuição na duração da cirurgia. A sua utilização em alguns procedimentos, torna o seu uso mais vantajoso em relação ao bisturi, sendo que o seu especial destaque são as cirurgias cutâneas e do foro otorrinolaringológico. Deste último, fazem parte os procedimentos resseção do palato mole e alaplastia nasal; ABSTRACT: Small animal veterinary surgery and clinics This report is divided into two parts. The first covers the casuistry accompanied during the Integrated Master’s degree in Veterinary Medicine internship’s, which one was held at “Hospital Alma Veterinária”. The second is composed by a bibliographic review about the applicability of a CO2 LASER in the general practice of companion animal surgery, complemented by a clinical case, referring a dog with brachycephalic respiratory syndrome. The use of CO2 LASER may show a significant reduction in surgical capillary bleeding, swelling and pain, over and after surgery. It´s proper use eases the surgeon’s job and can lead to a decrease in surgical time. Therefore, it’s use in some procedures becomes most convenient with regard to scalpel, with special highlight to cutaneous surgeries and ENT areas. Procedures that form part of ENT area are resection of the soft palate and nasal alaplasty, in which the use of LASER energy shows better results.

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Lysdahl, Michael. "Rhonchopathy : long-term clinical results after palatal surgery /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-319-8.

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Chua, Hannah Daile P. "Distraction osteogenesis versus orthognathic surgery which is better for cleft lip and palate patients? /." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41758195.

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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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Frazier, Kirsten. "Prevalence and predictors of adverse effects of medical care in patients with cleft lip and palate undergoing facial bone repairs and orthognathic surgical procedures in the United States." Thesis, University of Iowa, 2019. https://ir.uiowa.edu/etd/6735.

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BACKGROUND AND SIGNIFICANCE: Almost 15% of newborns have congenital anomalies that involve the oral and craniofacial regions, but of these congenital anomalies, cleft lip and palate and craniosynostosis are the most common. It is estimated that the incidence of cleft lip and palate is 0.664 in 1000 live births. These patients commonly have skeletal imbalances of the maxillae and mandible that require surgical and orthodontic correction. Orthodontists and oral surgeons play a critical role in identifying the necessary care and ensuring that the patient receives the best quality of care possible. OBJECTIVES: The objective of the current study is to examine the prevalence of adverse effects of medical care and infectious complications in patients with cleft lip/palate undergoing facial bone repairs/orthognathic surgeries in the United States during the years 2012 to 2014. It will also examine the association between patient/hospital related factors and surgical outcomes (including adverse affects of surgery, incidence of infection, etc.) and how these surgical outcomes impact the hospital costs and length of stay in the hospital. MATERIALS AND METHODS: The Nationwide Inpatient Sample (NIS) is a 20% stratified probability sample of hospitalizations occurring in all acute care hospitals in the United States. It is part of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ) [12]. Each hospital in this sample provides information on 20% of hospitalizations occurring during the select years. Hospital stratification is based on multiple hospital-associated variables including: hospital location, geographic region, bed size, teaching status, and ownership/control. Each hospitalization is assigned a sampling weight. Patient-related variables are also provided by the hospitals. In this study, this information is used to provide a nationally representative estimate of all hospitalizations and associated outcomes in the United States from 2012-2014. RESULTS: This study includes all 1,785 patients with cleft lip/palate undergoing facial bone repair/orthognathic surgical procedures in the United States during the study period (2012-2014). These results confirm the hypothesis that there are a combination of patient and hospital related factors that contribute to the occurrence of adverse events and that the occurrence of these events is associated with substantial increases in hospital charges and length of hospital stay. CONCLUSION: These study results are a national representative sample of patients with cleft lip/palate undergoing bony facial repair and orthognathic surgery. They reflect the practice patterns and hospitalization outcomes across the United States. These results can serve as a platform for future prospective controlled studies to examine the risk factors associated with adverse effects of medical care for a wide range of surgical procedures. This information is useful for clinicians, health policy makers, and patients so that they can make informed treatment and policy decisions as well as continue to improve surgical procedures and outcomes.

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Worrell, Emma Caroline. "The effects of surgery on facial growth in bilateral cleft lip and palate Sri Lankan subjects." Thesis, University College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.405576.

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Passos, Vivian de Agostino Biella. "Prevalência, causa e localização de fístula de palato em fissura transforame incisivo unilateral operada: estudo retrospectivo." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/61/61132/tde-31102011-144830/.

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Este trabalho objetivou avaliar a prevalência de fístula após cirurgia de palato em indivíduos com fissura transforame incisivo unilateral (FTIU) e verificar a localização e associação entre a prevalência dessas fístulas com possíveis fatores causais. Foi realizada análise retrospectiva em prontuários e fotografias pertencentes a 589 indivíduos matriculados no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP), que foram submetidos à palatoplastia com idades entre 12 e 36 meses, por meio da técnica de von Langenbeck , em tempo único, pela equipe de cirurgiões plásticos, no período de janeiro de 2003 na julho de 2007. A amplitude da fissura foi classificada em estreita (E), regular (R) e ampla (A), visualmente, por meio de fotografias iniciais pré-cirúrgicas. Para a localização das fístulas foram consideradas as regiões: palato anterior, região média do palato, área de transição (junção entre palato duro e mole) e palato mole. A prevalência de fístula foi de 27%, com um maior número de fístulas localizadas na região do palato anterior (37,11%). O teste estatístico Qui-Quadrado (2) demonstrou associação estatística significativa (p0,05) entre a presença de fístula e a amplitude inicial da fissura (p=0,0003), habilidade do cirurgião (p=0,019), intercorrências transcirúrgicas (p=0,0037) e pós-cirúrgicas mediatas (0,000002). Em vista dos resultados obtidos pode-se concluir que a alta prevalência de fístula encontrada neste estudo evidencia a necessidade de revisão dos procedimentos cirúrgicos realizados para uma possível adequação de protocolo e principalmente padronização da documentação. Desta forma contribui-se para redução de custos e melhora na qualidade do tratamento, uma vez que essas fístulas interferem na reabilitação dos pacientes, causando prejuízos funcionais relacionados à fala, deglutição e audição, bem como exigem a repetição dos procedimentos cirúrgicos que podem causar seqüelas no crescimento maxilofacial.
This study evaluated the prevalence of fistula after palate repair in individuals with complete unilateral cleft lip and palate and analyzed the location and association between the prevalence of these fistulas and possible causal factors. The prevalence of palatal fistula was retrospectively analyzed in records of 589 individuals registered at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP), who were submitted to palate repair at the age of 12 to 36 months by the von Langenbeck technique in a single stage by the plastic surgery team of the hospital, during the period January 2003 to July 2007. The study comprised analysis of patient records and photographs from the files of HRAC-USP and data were collected in a form designed for this study. The cleft width was visually classified as Narrow (N), Regular (R) and Wide (W) on the initial preoperative photographs. The following regions were considered for the location of fistulas: anterior region of the palate, medium region of the palate, transition area (between hard and soft palate) and soft palate. The prevalence of fistula was 27%, with greater number of fistulas at the anterior region of the palate (37.11%). The chi-square statistical test (2) demonstrated statistically significant association (p0.05) between the presence of fistula and the initial cleft width (p=0.0003), surgeon skill (p=0.019), transoperative problems (p=0.0037) and postoperative problems (p=0.00002). Considering these results, the high prevalence of fistula found in this study evidences the need to revise the surgical procedures to allow the adequacy of protocols and especially standardize the records. This may contribute to reduce the costs and improve the quality of treatment, because these fistulas interfere with the rehabilitation of patients, causing functional damages related to speech, swallowing and hearing, and require repetition of surgical procedures that may cause sequels to maxillofacial growth.

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Hutchinson, Deanna K. "Assessment of Parental Satisfaction with Management of a Child’s Nonsyndromic Cleft Lip and/or Cleft Palate." University of Cincinnati / OhioLINK, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1123868325.

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Silva, Thaieny Ribeiro da. "Relação oclusal em pacientes com fissura completa de lábio e palato unilateral, de acordo com a presença de bandeleta de Simonart e técnica cirúrgica." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/61/61132/tde-26072011-091543/.

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O presente estudo tem o objetivo de verificar os efeitos das cirurgias primárias sobre os arcos dentários de crianças com fissura completa de lábio e palato unilateral submetidas a dois diferentes protocolos cirúrgicos, Spina + Von Langenbeck (Grupo 1) e Millard + Von Langenbeck (Grupo 2), considerando também a presença ou ausência de bandeleta de Simonart. Para a avaliação da relação interarcos foi utilizado o Índice de Atack em uma amostra de 145 modelos de gesso obtidos aos 5 a 6 anos de idade. Nos resultados relativos aos protocolos cirúrgicos a comparação dos escores agrupados demonstrou maior ocorrência de índices 4 e 5 (42%) para ambos os grupos, com índices oclusais médios de 3,22 para o Grupo 1 e 3,12 para o Grupo 2. Houve maior prevalência de índices 4 e 5 tanto para os pacientes com bandeleta (53%) como sem bandeleta (39%), que apresentaram índices oclusais médios de 3,41 e 3,11, respectivamente. A avaliação individual do protocolo cirúrgico Spina + Von Langenbeck, considerando a presença de bandeleta, demonstrou maior porcentagem de índice 3, para os pacientes com bandeleta (42%) e índices 4 e 5 para os sem bandeleta (44%), com índices oclusais médios de 3,0 e 3,27, respectivamente. Para o protocolo de Millard + Von Langenbeck, o grupo com bandeleta apresentou acentuada maioria de índices 4 e 5 (76%) enquanto que no grupo sem bandeleta prevaleceu índices 1 e 2 (50%), com índices oclusais médios de 3,88 e 2,71, respectivamente, com diferença estatisticamente significativa entre eles (p=0,001). Na amostra estudada a avaliação dos protocolos cirúrgicos e da presença de bandeleta, de acordo com os valores dos índices oclusais, demonstrou que a maioria dos casos apresentou uma pobre relação entre os arcos, com prognóstico de tratamento ortodôntico-cirúrgico.
This study analyzed the effects of primary surgeries on the dental arches of children with complete unilateral cleft lip and palate submitted to two different surgical protocols, Spina + Von Langenbeck (Group 1) and Millard + Von Langenbeck (Group 2), also considering the presence or absence of a Simonarts band. The interarch relationship was assessed by the Atack index on a sample of 145 dental casts obtained at 5 to 6 years of age. In results related to the surgical protocols, the comparison of grouped scores revealed higher occurrence of scores 4 and 5 (42%) for both groups, with mean occlusal scores of 3.22 for Group 1 and 3.12 for Group 2. There was higher prevalence of scores 4 and 5 both for patients with band (53%) and without band (39%), who presented mean occlusal scores of 3.41 and 3.11, respectively. Individual analysis of the surgical protocol Spina + Von Langenbeck, considering the presence of a Simonarts band, demonstrated higher percentage of score 3 for patients with band (42%) and scores 4 and 5 for patients without band (44%), with mean occlusal scores of 3.0 and 3.27, respectively. Concerning the protocol Millard + Von Langenbeck, the group with band exhibited great majority of scores 4 and 5 (76%), while the group without band had predominance of scores 1 and 2 (50%), with mean occlusal scores of 3.88 and 2.71, respectively, with statistically significant difference between them (p=0.001). In the present study sample, evaluation of the surgical protocols and presence of a Simonarts band according to the values of occlusal scores demonstrated that most cases presented poor interarch relationship, thereby with prognosis for orthodontic-surgical treatment.

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Cunningham, Nina Marie Karin. "Anatomical Study of the Greater Palatine Artery: Clinical Implications for Palatal Graft Procedures." Thesis, NSUWorks, 2016. https://nsuworks.nova.edu/hpd_cdm_stuetd/71.

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Introduction: The palate is a well-established donor site for obtaining graft tissue in periodontal plastic surgery procedures. However, proximity to the adjacent teeth on the lateral aspect and the greater palatine neurovascular bundle (GPB) on the medial aspect limit the amount of graft tissue that can be obtained from the palate. Previous studies have been concerned with the location of the greater palatine foramen as well as the greater palatine artery (GPA) and have established guidelines on how to estimate the distance between the teeth and the GPB. Traditionally, clinicians follow these guidelines and choose to avoid removing graft tissue in the area close to the GPB out of fear of possible complications such as hemorrhaging and paresthesias. Objectives: The purpose of the present investigation is to locate the position of the greater palatal artery (GPA) in relation to surrounding anatomical landmarks and determine if the tissue thickness covering the GPA is sufficient to permit gingival grafts to be obtained in the area close to the GPB. Materials and methods: Cadaver dissections were performed on a total of ten (n=10) cadaver hemifaces of which 7 were partially and 3 were completely edentulous. From the greater palatine foramen to the incisive foramen, the palatal tissues of the cadavers were dissected into vertical slices of 3 mm in width perpendicular to the median palatine raphe using a double bladed scalpel. On each tissue slice, the distance from the epithelial surface to the superior border of the vessel, the diameter of the vessel, the distance from the inferiorborder of the vessel to the palatal bone, the distance from median palatine raphe to the GPA and the distance from teeth or midline of the alveolar crest to the GPA were measured using both a periodontal probe and a digital caliper. The measurements were correlated to each other, the angle of the palatal vault, an estimate of the palatal depth and the head length of the cadavers. Results: The mean thickness of the tissue above the GPA was 4.30 ± 1.61 mm with a range of 1.92 – 8.72 mm. The tissue thickness decreased consistently from the 3rd molar to the canine area with the thickest mean tissue being in the 2nd molar region with 6.25 ± 1.09 mm and shallowest mean tissue thickness in the region of the lateral incisor with 2.92 ± 0.46 mm. The mean distance of the GPA from the median palatine raphe is 10.34 ± 3.41mm ranging from 13.77 ± 1.67 mm to 6.02 ± 0.83 mm with the greatest distance being from the 3rd molar region and smallest distance being from the lateral incisor area. No statistically significant correlations were found between the angel of the palatal vault, the estimate of the palatal depth and the head length. A significant correlation (R2=0.92) was found between the total palatal tissue thickness and tissue thickness above the GPA. Discussion: There was adequate gingival tissue above the GPA to harvest tissue for free gingival grafts of 1 - 1.5 mm in thickness in the entire palate. Donor tissue for 1.5 mm thick connective tissue grafts with a 1.5 mm epithelial flap could be obtained opposing the 1st molar and posterior to it staying above the GPA. Donor site for palatal grafts can be extended in a medial and posterior direction.A Formula (Tissue Thickness above the GPA = (Total Thickness of palatal tissue - 0.967) x 0.9) has been derived, which accurately locates the GPA based on the thickness of the palatal tissue. Unique to this study were measurements from the median palatine raphe, which will provide the clinician with a new landmark to more reliably locate the GPA at various locations on the palate. Conclusion: This descriptive pilot study on human cadavers provides a formula to locate the GPA within the palate using the total palatal tissue thickness and suggests that graft tissue can be harvested from the tissue above the GPA in the entire palate for FGGs and opposing to the 1st molar and posterior to it for CTGs not exceeding 3 mm in depth.

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Loh, Ser-pheng John. "The psychological profile of cleft and non-cleft patients presenting with dento-facial deformities and its changes following surgery." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31954364.

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Lithovius, R. (Riitta). "Aspects of cleft lip and palate from Northern Finland:clefts in Northern Finland." Doctoral thesis, Oulun yliopisto, 2015. http://urn.fi/urn:isbn:9789526210629.

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Abstract Children born with a cleft lip and or palate face numerous difficulties during the course of their lives. Their families must respond to the challenge of a high level of burden of care required by these patients. The studies listed in this thesis benchmark the characteristics of cleft lip and palate in a cohort of patients living in Northern Finland. These studies strived to consider epidemiologic aspects, speech results, palatal fistula rates and hearing outcome. Records of a total of 214 patients treated between 1998-2011 at the Oulu Cleft Lip and Palate Center were assessed on a retrospective basis. Cleft palate (68.7%) was most frequent followed by cleft lip and palate (18.7%) and cleft lip with or without alveolus (12.6%). Cleft palate occurred more frequently in females (63%) and cleft lip and palate was more frequent in males (62.5%) most commonly affecting the left side (82%). The overall frequency of speech operations following primary palatoplasty was 21%. This was significantly higher for girls (27%) than for boys (13%). Patients with cleft lip and palate were more likely to require speech improvement surgery (24%) than patients with isolated soft or soft and hard palate clefts (20%). The overall frequency of postoperative fistulas following primary palatoplasty was (9.6%). Patients with cleft lip and palate were more likely to develop postoperative palatal fistulas (20%) than patients with cleft palate (6.6%). The severity of the cleft, the surgical technique used to repair the palate, hearing outcome, and the need for ventilation tube placement were determined retrospectively. At least mild hearing loss was found in 3.3% of cleft patients. Neither the surgical technique used to repair the cleft palate nor the severity of the cleft were found to be significant factors related to hearing loss or to the number of ventilation tubes required. Hearing improved significantly with increasing age over a span of 6 years
Tiivistelmä Halkiopotilaat kohtaavat elämänsä aikana monenlaisia haasteita samoin kuin heidän vanhempansa. Tämä retrospektiivinen tutkimus esittelee huuli- ja suulakihalkiopotilaisiin liittyviä näkökohtia Pohjois-Suomen alueella käsitellen epidemiologiaa, puheenparannusleikkauksen tarvetta, postoperatiivisten fisteleiden määrää sekä kuulotuloksia. Tutkimusmateriaali koostui 214 halkiopotilaasta, jotka olivat hoidossa Oulun yliopistollisessa sairaalassa vuosina 1998–2011. Tutkimusaineistossa suulakihalkio (68.7 %) oli yleisin halkiotyyppi, huulisuulakihalkio (18.7 %) oli toiseksi yleisin ja huulihalkioita oli vähiten (12.6 %). Suulakihalkio todettiin useammin tytöillä (63 %) ja huulisuulakihalkio (62.5 %) pojilla. Huulisuulakihalkio oli useimmiten vasemmalla puolella (82 %). Puheenparannusleikkauksen tarvitsi 21 % suulakihalkiopotilaista. Leikkauksen tarve oli merkittävästi yleisempi tytöillä (27 %) kuin pojilla (13 %). Huulisuulakihalkiopotilaat (24 %) tarvitsivat puheenparannusleikkausta todennäköisemmin kuin potilaat, joilla oli pehmeän tai kovan suulaen halkio (20 %). Suulaen primaarisulun jälkeen postoperatiivisten fisteleiden ilmaantuvuus oli 9.6 %. Huulisuulakihalkiopotilaille kehittyi todennäköisemmin postoperatiivinen fisteli (20 %) kuin suulakihalkiopotilaille (6.6 %). Suulakihalkion vaikeusaste, suulaen kirurginen sulkutekniikka, kuulotulos sekä välikorvan ilmastointiputkien laitto selvitettiin potilastiedoista. Vähintään vähäinen kuulonalenema todettiin 3.3 prosentilla halkiopotilaista. Sulkutekniikan eikä halkion vaikeusasteen todettu merkittävästi vaikuttavan kuulonalenemaan tai välikorvan ilmastointiputkien laittotiheyteen. Kuulon todettiin paranevan iän myötä

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Malkuch, Heidi R. "Identification of Management Practices for Infants with Pierre Robin Sequence by Recognized Craniofacial Centers." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1313754330.

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Bosi, Victor Zillo. "Ressonância de fala e complicações cirúrgicas após palatoplastia primária com veloplastia intravelar em pacientes com fissura de lábio e palato." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/61/61132/tde-12012015-160423/.

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Introdução: A correção cirúrgica primária do palato é de fundamental importância na reabilitação do indivíduo com fissura labiopalatina e visa tanto a restauração anatômica local, com o fechamento da comunicação existente entre a cavidade nasal e oral, como a restauração funcional do anel velofaríngeo por meio do reposicionamento dos músculos palatinos. Ao longo dos anos, as técnicas de fechamento de palato foram evoluindo progressivamente utilizando, cada vez mais, o procedimento de reposicionamento da musculatura responsável pelo fechamento do esfíncter velofaríngeo, denominado veloplastia intravelar. Tal procedimento favorece o funcionamento sinérgico da musculatura velar e faríngea evitando, assim, os sintomas decorrentes da insuficiência velofaríngea. No entanto, apesar de todos os esforços no sentido de conseguir o funcionamento velofaríngeo adequado, intercorrências intra-operatórias e complicações pós-operatórias imediatas e/ou tardias podem contribuir para o insucesso da palatoplastia primária e, consequentemente, levar ao aparecimento de hipernasalidade. Objetivos: Investigar o efeito da palatoplastia primária realizada com veloplastia intravelar sobre a ressonância da fala e o índice de intercorrências intra-operatórias e complicações pós-operatórias da cirurgia e, ainda, correlacionar as intercorrências e complicações pós-operatórias com os resultados de ressonância. Material e Métodos: Foram avaliados, prospectivamente, 60 pacientes com fissura labiopalatina, de ambos os sexos, submetidos à correção primária do palato aos 13 meses de idade, em média, por um único cirurgião plástico. Todos os pacientes foram submetidos à palatoplastia primária com veloplastia intravelar, utilizando amplo descolamento muscular da mucosa nasal e mínimo descolamento da mucosa oral e reposicionamento posterior do grupo muscular. Intercorrências intra-operatórias, tais como, sangramento excessivo, lasceração da mucosa, extubação e as complicações pós-operatórias imediatas e tardias, tais como febre, tosse, choro, vômito, infecção cirúrgica, infecção não cirúrgica e trauma local foram investigadas, por meio de anotações feitas no prontuário e pelo relato dos pais. A presença e localização de fístula ou deiscência do palato foi feita por meio de avaliação clínica realizada pelo mesmo cirurgião plástico, 14,8 meses, em média, após a cirurgia. Os pacientes foram submetidos, também, à gravação em áudio de amostra de fala, as quais foram analisadas por três fonoaudiólogas, que classificaram a hipernasalidade da fala em presente ou ausente. O escore final da hipernasalidade foi obtido pelo consenso entre as três avaliadoras. As intercorrências intra-operatórias e as complicações pós-operatórias foram analisadas de forma descritiva. A associação entre as intercorrências intra-operatórias e complicações imediatas e tardias com a formação de fístulas, bem como a associação entre a ocorrência de fístulas e deiscências com a presença e ausência de hipernasalidade foram analisadas por meio de Teste Exato de Fisher. Resultados: Verificou-se 5% de intercorrências intra-operatórias (sangramento excessivo e lasceração de mucosa), 20% de complicações imediatas (tosse, febre, choro, sangramento e vômito) e 13,3% de complicações tardias (tosse, sangramento e infecção não cirúrgica). O índice de ocorrência de fístulas foi de 16,67% e de deiscências foi de 5%. A proporção de hipernasalidade foi de 18,6%. Conclusão: A palatoplastia com veloplastia intravelar utilizada no presente estudo demonstrou ser uma técnica segura, de fácil execução, eficiente para a fala e com baixos índices de complicações.
Introduction: Primary surgical palate repair is fundamental for the rehabilitation of individuals with cleft lip and palate. This procedure aims at local anatomic restoration, closing the communication between nasal and oral cavities, but also at functional restoration of the velopharynx by repositioning of the palatal muscles. Along the years, the techniques for palate repair have been progressively improved, increasingly using the procedure for repositioning of velopharyngeal sphincter muscles, called intravelar veloplasty. This procedure favors the synergic functioning of the velar and pharyngeal musculature, thus avoiding the symptoms of velopharyngeal insufficiency. However, despite all efforts to achieve an adequate velopharyngeal closure, intraoperative events and immediate and/or late postoperative complications may contribute to the failure of primary palatoplasty, consequently leading to the occurrence of hypernasality. Objectives: To investigate the effect of primary palatoplasty with intravelar veloplasty on the speech resonance, the rate of intraoperative events and postoperative complications of surgery, as well as to correlate the events and postoperative complications with resonance outcomes. Material and Methods: A total of 60 individuals with cleft lip and palate were prospectively evaluated, of both genders, underwent primary palate repair at 13 months of age in the average, by a single plastic surgeon. All individuals were submitted to primary palatoplasty with intravelar veloplasty, with wide muscular dissection of the nasal mucosa, minimum dissection of the oral mucosa and posterior muscle repositioning. Intraoperative events, such as excessive bleeding, mucosal laceration and extubation; and immediate and late postoperative complications, including fever, cough, crying, vomiting, surgical infection, non-surgical infection and local trauma were assessed from the patients records and parents reports. The presence and location of palatal fistula or dehiscence were clinically analyzed by the same plastic surgeon, at 14.8 months after surgery in the average. The individuals were also submitted to audio recording of speech samples, which were analyzed by three speech-language pathologists who scored the speech hypernasality as present or absent. The final score of hypernasality was obtained by consensus among the three examiners. The intraoperative events and postoperative complications were descriptively analyzed. The Fishers exact test was applied to investigate the association between intraoperative events, immediate and late complications and the occurrence of fistulas, as well as between the occurrence of fistulas and dehiscences and the presence or absence of hypernasality. Results: The findings revealed 5% of intraoperative events (excessive bleeding and mucosal laceration), 20% of immediate complications (cough, fever, crying, bleeding and vomiting) and 13.3% of late complications (cough, bleeding and non-surgical infection). The occurrence of fistulas was 16.67%, and dehiscences were observed in 5%. The proportion of hypernasality was 18.6%. Conclusion: Palatoplasty with intravelar veloplasty used in the present study presented to be a safe technique, with easy accomplishment, effective for speech and with low rates of complications.

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Kennedy, Laura. "'Carry not a picke-tooth in your mouth' : an exploration of oral health in early-modern writings." Thesis, Loughborough University, 2012. https://dspace.lboro.ac.uk/2134/10976.

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This thesis is an exploration of various aspects of oral health in the early-modern period. It examines evidence taken from texts belonging to a range of genres including surgical manuals, botanical texts, midwifery manuals, poets and plays. Building on existing academic work relating to the history of dentistry and venereal disease, it aims to assimilate material from across science and the arts in order to gain a sense of what general social expectations were in relation to the condition of the teeth and palate, and how people suffering with a decline in oral health were advised, or what treatments were available to them either from a professional or in the home. It aims to challenge existing preconceptions that people living in this period displayed a negligent attitude towards the health of their teeth and oral hygiene. The thesis contains four chapters which each focus on a different aspect of oral health, though many themes recur across all four chapters. The first chapter investigates advice that was available in print, and therefore likely to be in public consciousness, to the early-modern individual in relation to maintaining their teeth. It then considers the portrayal of unattractive teeth and bad breath in early-modern literature. Chapter Two deals with early-modern explanations of what caused the toothache and how it could be remedied. Analysis of the depictions of toothache in various poetry and plays follows in order to explore how wider society made sense of medical thinking at the time. The palate becomes the sole focus of Chapter Three, which considers what specific health concerns posed a threat to the condition of the roof of the mouth, and what difficulties could arise for the individual whose palate has been damaged by disease or injury. The thesis concludes with a chapter which investigates the history of a congenital oral birth defect, the cleft lip and palate. The thesis was designed to allow each chapter to deal with a separate facet of oral health; they encompass in turn: oral hygiene, dental pain, the impact of disease on the palate and an exploration of an oral birth defect. An undercurrent of the thesis is to use a range of material to ascertain a realistic idea of what it was like for an individual to experience oral health difficulties in this period. It is therefore interested in how society perceived people who were experiencing problems with their oral health, and what could be done to improve their quality of life. The research presented here represents a contribution to the field of the history of oral health and aims to provoke further questions relating to the responsibility early-modern individuals took for their own oral health, and the specific situations in which intervention, either surgical or medicinal, was deemed necessary.

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Nunes, Claudia Regina Matiole [UNESP]. "Avaliação de pacientes com sequência de Robin no pós-operatório imediato após palatoplastia primário." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/96421.

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Made available in DSpace on 2014-06-11T19:28:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-16Bitstream added on 2014-06-13T18:57:20Z : No. of bitstreams: 1 nunes_crm_me_botfm.pdf: 392435 bytes, checksum: 70391dbf289d0130b47bfb5d3d2df41b (MD5)
Secretaria de Saúde do Estado de São Paulo
Dentre as malformações associadas à fissura labiopalatal, a Sequência de Robin (SR) é a que apresenta maior frequência, exigindo maiores cuidados e, dentre as síndromes associadas a SR, a mais freqüente é a Sequência de Robin Isolada (SRI). Caracteriza-se por anomalias como micrognatia, glossoptose e fissura palatina. O tratamento destes pacientes exige que se realize a palatoplastia primária a partir dos 12 meses de vida, de acordo com determinações do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). Tais pacientes apresentam maior índice de complicações na Sala de Recuperação Anestésica (SRA). Neste período crítico a enfermagem deve permanecer atenta às complicações, promovendo as intervenções mais rápidas e eficazes possíveis. Este trabalho, prospectivo não exploratório, tem como objetivo avaliar as complicações no pós-operatório imediato em pacientes com SRI após palatoplastia primária e propor um instrumento específico para aplicá-lo na SRA do HRAC-USP, bem como descrever os tipos de complicações mais frequentes e indicar as principais intervenções realizadas pela equipe de enfermagem. Para isto, propôs-se um instrumento, baseado no modelo de Biazon, o qual foi submetido à avaliação de juízes, que atestaram sua objetividade e clareza. Este instrumento contem parâmetros clínicos e sintomas indicativos de complicações e intervenções, relacionados à Respiração, Sangramento, Hipotermia e Dor. Fezse um estudo piloto com dez pacientes, calculando-se o Valor α de Cronbach para avaliar sua consistência e coerência. Depois o instrumento foi aplicado em mais 25 pacientes. Os resultados obtidos após avaliação evidenciam que a idade média dos pacientes com SRI submetidos a palatoplastia primária é superior à Resumo dos pacientes com fissura de palato...
Among all malformations associated to cleft lip and palate, the Robin Sequence (RS) is the most frequent, demanding more care than any other associated syndrome. And, among all the syndromes associated to the RS, the most common is the Isolated Robin Sequence (IRS). It is characterized by three abnormalities: Micrognathism, Glossoptosis and cleft palate. The treatment requires to perform a first plastic surgery, identified as primary palatoplasty, only after the age of 12 months, according to a determination of the Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). Such patients have a higher rate of complications at the Post-Anaesthetic Recovery Room (PARR). In this critical period, nursing must keep focus observing the possible complications in order to promote the most effective and imediate interventions. This prospective, non-exploratory research aims to evaluate the complications at the imediate post-operatory of IRS patients after a primary palatoplasty and propose a specific instrument to be applied at the HRAC-USP`s PARR, as well as describe the most frequent complications and indicate the main interventions by the nurse staff team. In order to achieve it, it was proposed an instrument, based on Biazon`s model, wich was submitted to judges evaluation, whom testified its clearness and objectivity. This instrument contains clinical parameters, indicative symptoms of complications and interventions, related to breathing, bleeding, hipothermy and pain. There has been made a pilot study with tem patients, calculating the value of the coefficient of Cronbach`s α, measuring the reliability and consistency of this study. Later the same instrument was applied to more 25 patients. The results, obtained after the evaluation, demonstrated that the average age of patients with IRS undergoing primary palatoplasty is higher Abstract than that... (Complete abstract click electronic access below)

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Nunes, Claudia Regina Matiole. "Avaliação de pacientes com sequência de Robin no pós-operatório imediato após palatoplastia primário /." Botucatu, 2009. http://hdl.handle.net/11449/96421.

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Orientador: José Eduardo Corrente
Banca: Maria Irene Bachega
Banca: Wilza Carla Spiri
Resumo: Dentre as malformações associadas à fissura labiopalatal, a Sequência de Robin (SR) é a que apresenta maior frequência, exigindo maiores cuidados e, dentre as síndromes associadas a SR, a mais freqüente é a Sequência de Robin Isolada (SRI). Caracteriza-se por anomalias como micrognatia, glossoptose e fissura palatina. O tratamento destes pacientes exige que se realize a palatoplastia primária a partir dos 12 meses de vida, de acordo com determinações do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). Tais pacientes apresentam maior índice de complicações na Sala de Recuperação Anestésica (SRA). Neste período crítico a enfermagem deve permanecer atenta às complicações, promovendo as intervenções mais rápidas e eficazes possíveis. Este trabalho, prospectivo não exploratório, tem como objetivo avaliar as complicações no pós-operatório imediato em pacientes com SRI após palatoplastia primária e propor um instrumento específico para aplicá-lo na SRA do HRAC-USP, bem como descrever os tipos de complicações mais frequentes e indicar as principais intervenções realizadas pela equipe de enfermagem. Para isto, propôs-se um instrumento, baseado no modelo de Biazon, o qual foi submetido à avaliação de juízes, que atestaram sua objetividade e clareza. Este instrumento contem parâmetros clínicos e sintomas indicativos de complicações e intervenções, relacionados à Respiração, Sangramento, Hipotermia e Dor. Fezse um estudo piloto com dez pacientes, calculando-se o Valor α de Cronbach para avaliar sua consistência e coerência. Depois o instrumento foi aplicado em mais 25 pacientes. Os resultados obtidos após avaliação evidenciam que a idade média dos pacientes com SRI submetidos a palatoplastia primária é superior à Resumo dos pacientes com fissura de palato... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Among all malformations associated to cleft lip and palate, the Robin Sequence (RS) is the most frequent, demanding more care than any other associated syndrome. And, among all the syndromes associated to the RS, the most common is the Isolated Robin Sequence (IRS). It is characterized by three abnormalities: Micrognathism, Glossoptosis and cleft palate. The treatment requires to perform a first plastic surgery, identified as primary palatoplasty, only after the age of 12 months, according to a determination of the Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). Such patients have a higher rate of complications at the Post-Anaesthetic Recovery Room (PARR). In this critical period, nursing must keep focus observing the possible complications in order to promote the most effective and imediate interventions. This prospective, non-exploratory research aims to evaluate the complications at the imediate post-operatory of IRS patients after a primary palatoplasty and propose a specific instrument to be applied at the HRAC-USP's PARR, as well as describe the most frequent complications and indicate the main interventions by the nurse staff team. In order to achieve it, it was proposed an instrument, based on Biazon's model, wich was submitted to judges evaluation, whom testified its clearness and objectivity. This instrument contains clinical parameters, indicative symptoms of complications and interventions, related to breathing, bleeding, hipothermy and pain. There has been made a pilot study with tem patients, calculating the value of the coefficient of Cronbach's α, measuring the reliability and consistency of this study. Later the same instrument was applied to more 25 patients. The results, obtained after the evaluation, demonstrated that the average age of patients with IRS undergoing primary palatoplasty is higher Abstract than that... (Complete abstract click electronic access below)
Mestre

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Alner, Kizzy. "How do individuals construct themselves following corrective facial surgery for a unilateral or bilateral cleft lip and palate : a grounded theory study." Thesis, University of East Anglia, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.327207.

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Loh, Ser-pheng John, and 盧思鵬. "The psychological profile of cleft and non-cleft patients presenting with dento-facial deformities and its changes following surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31954364.

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Mani, Maria. "Unilateral Cleft Lip and Palate : Quality of Life and Nasal Form and Function among Adults." Doctoral thesis, Uppsala universitet, Plastikkirurgi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-122574.

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Unilateral cleft lip and palate (UCLP) is a craniofacial malformation with functional and aesthetical impact on the face and the upper airways. The aims of the current thesis were to evaluate Quality of life (QoL) in adults treated for UCLP (I), to objectively evaluate nasal form and function and to search for possible differences in residual nasal deformity and impairment of function between patients operated according to one-stage and two-stage palate closure (II) as well as to evaluate the relationship between professional and lay rating and patient satisfaction with nasolabial appearance (III) and to identify factors associated with lower levels of QoL and less satisfaction with nasal appearance among adults treated for UCLP (IV). Analyses of data from a homogenous population of UCLP patients treated at Uppsala University Hospital form the basis of this thesis. The mean follow-up time after primary surgery was 35 years (20-47 years) and participation rate was 79% (n=86). An age and gender matched control group of 68 people without clefts were evaluated according to the same protocol. The evaluation protocol included the Short Form 36 questionnaire (SF-36), rhinomanometry, acoustic rhinometry, odor test, peak nasal inspiratory flow test and photographies of faces. For the SF-36 data, age- and gender-matched norm data of 1385 people from the Swedish population were used. Unilateral cleft lip and palate affected QoL differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients in several subscales. However, except for lower values in the Mental Health subscale, QoL was similar among UCLP patients and norm data. Objectively measured nasal function was extensively affected among adults treated for UCLP. No difference in impairment of nasal function was found between one-stage and two-stage palate closure protocols on the cleft side. Judgment of nasolabial appearance differed between professionals, lay people and patients. Large infant cleft width was associated with less satisfaction with nasal appearance and male gender was associated with lower levels of mental QoL. Correlation between high nasal breathing resistance and low levels of physical QoL was found. In conclusion, this thesis provides a platform for future research for optimal evaluation of cleft treatment outcome.

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Menegueti, Katia Ignacio. "Perfil da fala de pacientes submetidos à palatoplastia primária." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5170/tde-06122016-160112/.

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Diversas alterações anatômicas e funcionais são observadas como consequência da fissura labiopalatina, ocasionando alterações em relação ao crescimento do terço médio da face, à audição e a funcionalidade do esfíncter velofaríngeo. Esta última interfere diretamente nas funções de sucção, deglutição e fala. O objetivo deste estudo é caracterizar o perfil da fala de pacientes submetidos à palatoplastia primária em um hospital escola de referência da cidade de São Paulo, levando-se em consideração a idade do paciente no momento da cirurgia. Os objetivos específicos são a análise da eficácia da cirurgia; a resposta muscular em relação ao procedimento cirúrgico; e o momento mais adequado para a intervenção cirúrgica. Participaram do estudo 97 indivíduos com diagnóstico de fissura palatina não sindômica associada ou não à fissura de lábio, encaminhados para avaliação fonoaudiológica, conforme demanda do serviço. Estes foram divididos em dois grupos: o grupo precoce (GP) e grupo tardio (GT). O GP foi composto por indivíduos que realizaram a palatoplastia primária até o segundo ano de vida (43 participantes) e o GT por indivíduos que realizaram a palatoplastia primária tardiamente, após os dois anos de idade (54 participantes). Os participantes foram submetidos à rotina de avaliação fonoaudiológica na Unidade de Fonoaudiologia do ICHC-FMUSP, realizada por um fonoaudiólogo treinado e com experiência na área. Dentre os parâmetros avaliados encontram-se a presença de alterações de ressonância, o grau de alteração da ressonância, a presença de distúrbios articulatórios compensatórios, a presença de ronco nasal, a presença de fraca pressão intraoral, a presença de emissão de ar e o grau de inteligibilidade da fala, variáveis consideradas para este estudo. Essas características foram classificadas inicialmente como \"presente\" ou \"ausente\" nas diferentes amostras de fala de cada participante, e posteriormente, quando aplicável, determinado seu grau de comprometimento. Após a realização do estudo verificou-se que: 1) Em relação à caracterização geral dos participantes: 1.1) Idade média da palatoplastia: GP = 1,4 anos; GT = 11,5 anos; 1.2) Idade média da primeira avaliação fonoaudiológica no serviço: GP = 12,3 anos; GT = 19,8 anos; 1.3) Gênero: predomínio do gênero masculino para GP (55,8%) e feminino para GT (53,7%); 2) Quanto à caracterização da fala (análise geral): 2.1) Ressonância: alterada em 69,8% dos participantes do GP e em 85,2% do GT, sem diferença estatisticamente significante; 2.2) Hipernasalidade: 1) presente em 72,1% dos participantes do GP, em grau leve em 48,4%, moderado em 41,9% e grave em 9,7%; 2) presente em 85,2% do GT, em grau leve em 32,6%, moderado em 43,5% e grave em 23,9%. Não foi observada diferença estatisticamente significante entre os grupos; 2.3) Hiponasalidade: presente em 7,4% do GT, todos em grau leve; 2.4) Ronco nasal: presente em 14% dos participantes do GP e em 5,6% do GT, sem diferença estatisticamente significante; 2.5) Fraca pressão intra oral: presente em 30,2% dos participantes do GP e em 44,4% do GT, sem diferença estatisticamente significante; 2.6) Emissão de ar nasal audível: presente em 23,3% dos participantes do GP e em 31,5 do GT, sem diferença estatisticamente significante; 2.7) Inteligibilidade de fala: 1) prejudicada em 69,8% dos participantes do GP, em grau leve em 56,7%, moderado em 30% e grave em 13,3%; 2) prejudicada em em 83,3% do GT, em grau leve em 24,4%, moderado em 46,7% e grave em 28,9%. Não foi observada diferença estatisticamente significante entre os grupos; 2.8) DACs: presente em 55,8% dos participantes de GP e em 75,9% de GT, com diferença significante entre os grupos (número de fonemas alterados - p=0,020); 3) Em relação à caracterização da fala (considerando tipo de fissura): ausência de resultados estatisticamente significativos entre os grupos estudados quando se levou em consideração as variáveis citadas e os tipos de fissuras; 4) Quanto à conduta fonoaudiológica após a avaliação: a conduta mais indicada foi a fonoterapia, seguida pelo acompanhamento longitudinal (alta assistida), indicação de novo procedimento cirúrgico, e alta (propriamente dita). Diante do apresentado, foi possível caracterizar o perfil geral e de fala dos pacientes submetidos à palatoplastia primária do referido hospital escola, referência de atendimento à pacientes fissurados na cidade de São Paulo. Observa-se, de forma geral, prejuízo significativo na fala dos participantes do estudo, sendo evidenciado diferença estatisticamente significante entre os resultados do procedimento precoce e tardio somente para a presença de DACs. A variável ressonância apresentou resultados estatísticos marginais, indicando tendência à diferenciação dos grupos também em relação à essa alteração. Conclui-se que a realização da cirurgia foi benéfica para os participantes, independentemente do momento da intervenção, com melhores resultados em idade anterior aos 2 anos de vida. No entanto, a resposta muscular em relação ao procedimento pode variar, chegando a não ser satisfatória em alguns casos
Several anatomic and functional alterations are observed as consequences of cleft lip and palate, causing alterations related to the growth of the medium third of the face, hearing, and the Velopharyngeal Sphincter function. This last one interferes directly with the functions of suction, deglutition, and speech. The objective of this study is to determine the speech profile of patients submitted to primary palatoplasty, in a benchmark school-hospital in Sao Paulo city, taking into consideration the patient\'s age at the moment of surgery. The specific objectives are: the analysis of the effectiveness of surgery; the muscular response related to the surgical procedure; and the most suitable moment for surgical intervention. 97 subjects with nonsyndromic cleft palate diagnosis associated or not with cleft lip participated in this study and they were referred to a speech language evaluation on demand. They were divided into two groups: the early group (EG) and the late group (LG). The EG was composed by subjects who have undergone primary palatoplasty until the second year of life (43 subjects) and the LG was made by those who had the surgery lately, after two years old (54 subjects). The participants were submitted to a speech language routine in the Speech Language service at ICHC-FMUSP with an experienced and well-trained speech language pathologist. Among the evaluated parameters, there were: existence of abnormal nasal resonance, degrees of abnormal nasal resonance, existence of articulatory compensatory disturbs (ACD), existence of nasal snoring, existence of weak intra-oral air pressure, existence of air emission, and degrees of speech intelligibility. These parameters were initially classified as \"present\" or \"absent\" in the different speech samples of each subject, and subsequently, when applicable, her/his degree of impairment was determined. After carrying through this study, it showed that: 1) according to the subjects\' general characterization: 1.1) average palatoplasty age: EG = 1.4 years old; LG = 11.5 years old; 1.2) Average age on first speech language evaluation in the service: EG = 12.3 years old; LG = 19.8 years old; 1.3) Gender: predominance of male subjects in PG (55.8%) and female subjects in LG (53.7%); 2) concerning the characterization of speech (general analysis): 2.1) abnormal nasal resonance in 69.8% of EG subjects and 85.2% of LG subjects, without any statistical significant difference; 2.2) hypernasality: 1) present in 72.1% of PG subjects, 48.4% in mild, 41.9% in moderate and 9.7% in severe levels; 2) present in 85.2% of LG subjects, 35.6% in mild, 43.5% in moderate and 23.9% in severe levels. It was not showed any statistical significant difference between the groups; 2.3) hyponasality: present in 7.4% of EG, all mild level; 2.4) Nasal snoring: present in 14% of EG and in 5.6% of LG, without any statistical significant difference; 2.5) weak intra-oral air pressure: present in 30.2% of EG and in 44.4% of LG without any statistical significant difference; 2.6) audible air emission: present in 23.3% of EG and in 31.5% of LG, without any statistical significant difference; 2.7) speech intelligibility: 1) affected in 69.8% of EG, 56.7% in mild, 30% moderate and 13.3% severe levels; 2) affected in 83.3% of LG, 24.4% in mild, 46.7% in moderate and 28.9% in severe levels. There was not showed any statistical significant difference between groups; 2.8) ACDs: present in 55.8% of EG and in 75.9% of LG with a statistical significant difference between groups (number of phonemes errors - p=0.020); 3) concerning the speech characterization (considering cleft type): absence of statistical significant results between the studied groups when taking into consideration the cited varies and cleft types; 4) About the speech language approach after the evaluation: the most indicated one was the speech therapy followed by long-term monitoring (assisted discharge), indication of new surgical procedure, and actual discharge. It was possible to characterize the general and speech characteristics of the patients submitted to primary palatoplasty in the cited school-hospital, benchmark in cleft patients in Sao Paulo city. It was observed, all in all, significant impairment in the speech of these subjects, being evident the statistical significant difference between the results of the precocious and late groups only for the existence of ACDs. The variable nasal resonance presented minimal statistical significant results which indicated a tendency to differentiate the groups also regarding this alteration. In conclusion, the surgery was beneficial to the subjects independently of the moment of intervention, with better results in ages younger than two years old. Although, the muscular response regarding this procedure might vary, not being satisfactory in a few cases

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Conegliam, Priscila Capelato Prado. "Estudo prospectivo das complicações respiratórias da palatoplastia primária em crianças com fissura de palato." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/61/61132/tde-07012014-155327/.

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Objetivo: Investigar a incidência de complicações respiratórias trans e pós-operatórias em crianças com fissura de palato submetidas à palatoplastia primária, com vistas à identificação de sinais e sintomas de apneia obstrutiva do sono (AOS). Modelo/Local de Execução: Estudo prospectivo realizado no Hospital de Reabilitação de Anomalias Craniofaciais. Participantes: Setenta e seis crianças não-sindrômicas, de ambos os sexos, foram divididas em dois grupos: um constituído por 56 crianças com fissura de palato (FP), idade entre 11 e 15 meses, sendo 20 com fissura de lábio e palato unilateral (FLPU), 16 com fissura de lábio e palato bilateral (FLPB), 20 com fissura de palato isolada (FPi), e, outro, controle, constituído por 20 crianças com fissura de lábio (FL), idade entre 3-13 meses. As crianças do grupo FP foram submetidas à palatoplastia primária pela técnica de von Langenbeck modificada e o grupo controle, à queiloplastia pela técnica de Millard. Variáveis: Dados referentes à história clínica e sintomas respiratórios foram levantados junto aos pais no pré-operatório (PRE), i.e., no período de 1 a 2 dias que antecederam a cirurgia primária. Foram, ainda, analisadas as complicações respiratórias observadas no transoperatório (TRANS) e em três momentos do pós-operatório: imediato (POSi), i.e., na sala de recuperação anestésica, mediato (POSm), i.e., 12 a 24 horas após a cirurgia estando o paciente ainda hospitalizado, e, tardio (POSt), i.e., 1 a 2 meses após a alta hospitalar, por contato telefônico. Com base na identificação de dificuldade respiratória, ronco e apneia durante o sono foi calculado um escore clínico (índice de Brouillette) no PRE, POSi e POSt, de modo a identificar crianças com suspeita de AOS. Resultados: A análise do índice de Brouillette mostrou aumento do escore médio, sugestivo da possível presença de AOS, apenas no POSi. Nas demais abordagens, observou-se que o grupo FP, comparativamente ao grupo controle, apresentou complicações respiratórias com frequência significantemente maior (p<0,05), particularmente no POSi. Proporção significantemente maior de crianças com FP apresentou ronco. Pausas ventilatórias no sono não foram relatadas. Conclusão: O fechamento cirúrgico do palato exerce efeito obstrutivo sobre a via aérea superior a curto prazo, em decorrência da manipulação cirúrgica, levando a sintomas respiratórios transitórios, em sua maioria. Contudo, o elevado número de relatos de ronco a longo prazo, não permite descartar a ocorrência de AOS nessa população. Estudos polissonográficos devem ser realizados para investigar em maior profundidade esta relevante questão clínica
Objective/Purpose: To investigate the incidence of trans- and postoperative respiratory complications in infants with cleft palate undergoing primary palatoplasty, in order to identify signs and symptoms of obstructive sleep apnea (OSA). Study model/Setting: Prospective study, carried out at the USP Hospital for Rehabilitation of Craniofacial Anomalies. Design/Participants: Seventy-six non-syndromic infants, both genders, were divided into two groups: CP group (56 infants with cleft palate±lip, aged 11-15 months, comprising 20 with unilateral cleft lip and palate, 16 with bilateral cleft lip and palate and 20 with isolated cleft palate), and CL control group (20 infants with cleft lip, aged 3-13 months). CP infants underwent palatoplasty using a modified von Langenbeck technique, and control infants underwent cheiloplasty using the Millard technique. Main outcome measures: Data based on parent reports of clinical history and respiratory symptoms were collected 1-2 days preoperatively (PRE). Respiratory complications were assessed during surgery (TRANS) and three times postoperatively: in the recovery room (POST1); 12-24 hours after surgery, while the patient was still hospitalized (POST2) and 1-2 months after hospital discharge, by telephone parental report (POST3). Based on the identification of breathing difficulty, snoring and breathing pauses during sleep, a clinical score was calculated (Brouillette index) at PRE, POST1 and POST3, in order to identify infants with suspected OSA. Results: Brouillette index analysis showed an increase in mean score, suggestive of OSA, only at POST1. On the other approaches, the CP group showed higher frequency of respiratory complications than the control group, (p<0.05), mainly at POST1. A significantly higher number of infants with CP presented snoring. Breathing pauses during sleep were not observed/reported. Conclusion: The surgical closure of the palate has an obstructive effect on the upper airway in the short-term due to surgical manipulation, mainly leading to transitory respiratory symptoms. However, the high number of snoring reports at the long-term, does not allow to rule out the occurrence of OSA in this population. Polysomnography studies shall be carried out to further investigate this relevant clinical issue.

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Rojo, Xicart Ernest. "Soft tissue volume gain around dental implants after abutment connection surgery using autogenous subepithelial connective tissue grafts harvested from the palate or tuberosity. A randomized prospective clinical study." Doctoral thesis, Universitat Internacional de Catalunya, 2017. http://hdl.handle.net/10803/586354.

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The aim of the present study is to compare the volume gain around dental implants when a subepithelial connective tissue graft (SCTG) from palate or tuberosity is used randomly. The most studied donor area for soft tissue augmentation has been the autogenous connective tissue from the palate. However recent studies has affirmed that tuberosity tissue may possess better tissue qualities for soft tissue volume augmentation. It has been shown that tuberosity connective tissue is more dense with less fat and glandular tissue. Therefore, it could be speculated that this firmer tissue will have less shrinkage and achieve more soft tissue gain. In the present study 32 patients with 36 implants with localized volume deficiency has been included and received randomly a SCTG from palate or tuberosity. Measurements using an intraoral optical scan has been done at baseline and 3 months. Also 20 samples were obtained at baseline for immunohistochemistry and descriptive histological analysis. In conclusion both groups obtained volume gain at 3 months. No statistical significant differences were found. Even though a tendency of better results was observed for patients who received SCTG from tuberosity.
L’objectiu del present estudi es comparar el guany de volum al voltant d’implants dentals després d’haver utilitzat aleatoriament injert de teixit conectiu subepitelial de paladar o de tuberositat. L’àrea donant més utilitzada per realitzat procediments d’augment gingival ha estat sempre la zona del paladar. Tot i que estudis recents han demostrat que la zona de la tuberositat pot ser una bona alternativa degut a que pot tenir millors propietats per l’augment gingival. S’ha demostrat darrerament que el teixit conectiu de la tuberositat és més dens i conté menys teixit gras i glandular. Això pot comportar que aquest teixit no es contraigui tant i que per tant pugui aconseguir millors resultats en quant a guany de volum. En aquesta investigació 32 pacients portadors de 35 implants amb defecte de volum vestibular han rebut cirugía d’augment de teixit tou utilitzant injert de teixit conectiu de paladar o tuberositat. S’han realitzat mesures utilitzant un escáner intraoral a l’inici de l’estudi i 3 mesos després. També s’ha realitzat estudi histològic i d’immunohistoquímica de 20 mostres. Com a conclusió, els dos grups de l’estudi han aconseguit guanyar volum de teixit tou als 3 mesos. No s’han detectat diferencies estadísticament significatives entre els grups. Tot i així s’ha observat una tendencia a millors resultats en el grup de pacients que han rebut injert de teixit tou de la tuberositat.

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Niemeyer, Trixy Cristina. ""Cirurgia ortognática e produção da fala."." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/61/61131/tde-05052006-163707/.

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Objetivo: Analisar, em indivíduos com mordida cruzada total, a influência da cirurgia ortognática na produção dos diferentes fonemas da língua portuguesa, agrupados quanto ao ponto articulatório. Modelo: Estudo prospectivo, que comparou a fala de sujeitos submetidos à cirurgia ortognática, nas fases pré e pós-cirúrgica. Local: Laboratório de Fisiologia- HRAC/USP. Participantes: 19 homens e 11 mulheres (média de 21 anos) com mordida cruzada total, que apresentavam fissura labiopalatina reparada. Intervenções: Avaliação da fala, antes e, em média, 4 meses após a cirurgia ortognática. Variáveis: Ponto articulatório dos grupos de fonemas bilabiais, labiodentais, linguodentais, alveolares, palatais e velares, sendo considerada presença ou ausência de alteração. Resultados: Houve o predomínio de permanência sem alteração para os grupos de fonemas bilabiais e velares, permanência com alteração para os labiodentais e linguodentais, e melhora para os alveolares. Já, no grupo de fonemas palatais, houve uma maior distribuição entre os resultados, com equilíbrio entre permanência com e sem alteração. Apesar de raros, houveram casos de piora para esses quatro grupos. Conclusão: Em sujeitos com mordida cruzada total, a cirurgia ortognática não exerceu influência nos fonemas bilabiais e velares, corretos na fase pré-cirúrgica; influência positiva foi observada em menos de 1/3 no grupo de fonemas labiodentais, e ao redor de 50% nos linguodentais, alveolares e palatais; influência negativa ocorreu nos quatro grupos, ao redor de 5%. À exceção dos casos de adequação automática de todos os fonemas do grupo e de permanência sem alteração, os demais resultados evidenciaram a necessidade de terapia miofuncional orofacial.
Objective: To evaluate, in individuals with anterior and posterior crossbite, the influence of orthognathic surgery on the production of different Portuguese phonemes grouped as to the place of articulation. Model: Prospective study for comparison of the speech of individuals submitted to orthognathic surgery, before and after surgery. Setting: Physiology Laboratory HRAC/USP. Participants: 19 males and 11 females (mean age 21 years) with anterior and posterior crossbite with repaired cleft lip and palate. Interventions: Speech evaluation before and about four months after orthognathic surgery. Variables: Place of articulation of the groups of bilabial, labiodental, dental, alveolar, palatal and velar phonemes, considering the presence or absence of alteration. Results: There was predominance of permanence without alteration for the groups of bilabial and velar phonemes, permanence with alteration for the labiodental and dental phonemes, and improvement in the alveolar phonemes. As regards the group of palatal phonemes, there was a greater distribution among the outcomes with balance between permanence with and without alteration. Though rare, there were cases of worsening for these four groups. Conclusion: In subjects with anterior and posterior crossbite, the orthognathic surgery did not yield any influence on the bilabial and velar phonemes, which were correct in the pre-surgical phase; a positive influence was observed in less than 1/3 in the group of labiodental phonemes and close to 50% in the dental, alveolar and palatal phonemes; the negative influence in the four groups was close to 5%. Except for the cases with automatic adaptation of all phonemes in the group and permanence without alteration, the other results indicated the need of orofacial myofunctional therapy.

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Paniagua, Lauren Medeiros. "Estudo comparativo de três técnicas de palatoplastia em pacientes com fissura labiopalatina por meio das avaliações perceptivo-auditiva e instrumental." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2009. http://hdl.handle.net/10183/17371.

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Introdução: A palatoplastia é o procedimento cirúrgico que visa à reconstrução do palato duro e/ou mole. Atualmente dispomos de diferentes técnicas que buscam o maior alongamento do palato mole junto à parede nasofaríngea para contribuir no funcionamento adequado do esfíncter velofaríngeo (EVF). Falhas no seu fechamento ocasionam disfunções na fala. Objetivo: Comparar os achados das avaliações perceptivo-auditiva e instrumental em pacientes com fissura labiopalatina operados mediante três técnicas distintas de palatoplastia. Métodos: A presente pesquisa realizou duas avaliações (perceptivo-auditiva e instrumental). Os dados foram obtidos de 26 pacientes, com aproximadamente 8 anos de pós-operatório, do total de 30 participantes de um ensaio clínico randomizado, cujos métodos foram descritos por Fróes Filho (2003). Os pacientes na época da cirurgia foram divididos em três grupos distintos com 10 participantes em cada um. O presente estudo avaliou: 10 pacientes da Técnica de Furlow, 7 pacientes da Técnica de Veau-Wardill-Kilner+Braithwaite e 9 pacientes da Técnica Znasal. Todos pacientes foram submetidos à avaliação perceptivo-auditiva por meio de gravação de fala. Também foi realizada a avaliação instrumental por meio do exame de videonasoendoscopia. A interpretação de ambos os procedimentos foi realizada separadamente por três fonoaudiólogas experientes, cegadas quanto ao tipo de técnica de palatoplastia. Para o julgamento perceptivo-auditivo considerou-se a presença ou ausência de hipernasalidade; grau de hipernasalidade segundo uma escala de severidade; presença ou ausência de distúrbio articulatório compensatório; presença ou ausência de emissão de ar nasal audível. Na avaliação instrumental foi estimado clinicamente o tamanho do gap do esfíncter velofaríngeo de acordo com uma escala de severidade. Resultados: As técnicas de Furlow e V-W-K+B apresentaram aproximadamente o dobro de hipernasalidade quando comparadas com a técnica Znasal, porém sem significância estatística. Houve menor ocorrência de Distúrbio Articulatório Compensatório e Emissão de Ar nasal Audível em todas as técnicas. Na avaliação instrumental, observou-se maior ocorrência de sujeitos sem gap na técnica Znasal em relação as demais. Conclusão: não foi encontrada diferença estatisticamente significativa entre as técnicas de palatoplastia nas duas avaliações.
Introduction: The palatoplasty is a surgical procedure aimed at the reconstruction of hard palate and / or soft. Currently we have different techniques that seek the greatest sling of the soft palate near the nasopharyngeal wall to contribute to the proper velopharyngeal sphincter functioning. Failures to its closure cause speech disorders. Objective: To compare the findings of auditory perceptual and instrumental evaluations in patients with cleft lip and palate surgery by three different techniques of palatoplasty. Method: The present research made two assessments (auditory perceptual and instrumental). The data were obtained from 26 patients, after approximately 8 years of post-operative, in a total of 30 subjects of a randomized clinical trial, whose methods were described by Fróes Filho (2003). The patients at the time of surgery were divided into three groups with 10 participants in each. This study evaluated: 10 patients in the Furlow technique, 7 patients of the Veau-Kilner-Wardill + Braithwaite technique and 9 patients in the Wardill-Kilner-Veau Braithwaite + Zetaplasty technique. All of them were submitted to perceptual assessment through their recording audio speech. It was also performed the instrumental evaluation through the videonasoendoscopy. The interpretation of both procedures was performed separately by three experienced speechlanguage pathologists blind on the type of palatoplasty technique. For the perceptual-auditory judgment, it was evaluated the presence or absence of hypernasality; degree of hypernasality using a scale of severity, presence or absence of compensatory articulation disorder, presence or absence of audible nasal air emission in all the techiniques. On the instrumental evaluation, it was clinically estimated the gap size of the velopharyngeal sphincter according to a severity scale. Results: The Furlow techniques and V-W-K+B presented approximately twice more of hipernasality when compared with the technique Znasal, however without statistical significant. There was a low occurrence of compensatory articulation disorder and emission of audible nasal air. In the instrumental assessment, it was seen more often subjects without gap in the Znasal technique comparing it to the others.Conclusion: It was not found statistically significant difference between palatoplasty techniques in the two assessments.

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Batista, Júlia Fernandes. "Evolução clínica dos cães braquicéfalos após a cirurgia corretiva, na visão do proprietário." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2018. http://hdl.handle.net/10400.5/16882.

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Dissertação de Mestrado Integrado em Medicina Veterinária
As raças braquicefálicas como o Pug, Boxer, Shih Tzu, Bouledogue Francês e Bulldog Inglês têm popularidade crescente na sociedade mundial. Porém, os defeitos anatómicos como a estenose de narinas e prolongamento do palato mole, apresentados por muitos destes animais, ainda são subvalorizados pelos proprietários, pois são tidos como “características normais da raça”. Na literatura veterinária, os sinais clínicos mais frequentemente associados são dispneia, roncos, estridor, regurgitação, vómitos, cianose e colapso. Sabe-se que a obstrução crónica do trato respiratório superior traz consequências importantes a nível respiratório, digestivo e sistêmico para estes animais, podendo leva-los à morte. O médico veterinário tem um papel essencial na orientação dos criadores e proprietários com relação à reprodução, cuidados de saúde, bem-estar e à importância da correção cirúrgica de cães com alterações extremas. Este trabalho experimental sobre a Síndrome Obstrutiva das Vias Aéreas dos Braquicéfalos (BOAS), realizou inquérito online com 100 proprietários de cães braquicéfalos operados das narinas estenóticas e/ou palato mole alongado. Verificou-se uma melhora clínica evidente em 99% destes animais através do aumento no nível de atividade e da redução dos sinais clínicos respiratórios e digestivos.
ABSTRACT - Clinical evolution of brachycephalic dogs after corrective surgery in the owner’s view - Brachycephalic breeds such as Pug, Boxer, Shih Tzu, French and English Bulldog have increasing popularity in world society. However, anatomical defects such as stenotic nares and elongated soft palate, presented by many of these animals, are still underestimated by the owners, since they are considered "normal characteristics of the breed". According to the veterinary literature, the clinical signs most frequently associated are dyspnea, snoring, stridor, regurgitation, vomiting, cyanosis and collapse. It is known that chronic obstruction of the upper respiratory tract has important respiratory, digestive and systemic consequences for these animals, which can lead to death. The veterinarian has an essential role in guiding animal breeders and dog owners regarding the breeding, health care attention, welfare and the importance of surgical correction procedures for dogs with severe alterations. This Brachycephalic Airway Obstructive Syndrome (BOAS) experimental study carried out an online survey of 100 owners of brachycephalic dogs who had surgery on the stenotic and / or elongated soft palate. The results showed an evident clinical improvement of 99% of these animals through an increase in the level of activity and the reduction of respiratory and digestive clinical signs.
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François-Fiquet, Caroline. "FENTES LABIO-PALATINES : Approche étiologique génétique. Place des gènes de l’angiogenèse. Développement d’un modèle d’étude in vivo chez l’enfant." Thesis, Reims, 2013. http://www.theses.fr/2013REIMM204/document.

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Les fentes labio-palatines (FLP) sont la malformation cranio-faciale congénitale la plus fréquente. D'origine multifactorielle, elles sont la conséquence d'un défaut de fusion des bourgeons faciaux.Objectif et MéthodologieL'objectif de ce travail a été d'étudier la place des gènes de l'angiogenèse dans le cadre de la piste étiologique des FL/P. La méthodologie de ce travail comportait 3 étapes :- Une analyse systématique et exhaustive des gènes impliqués dans les FL/P comprenant les gènes identifiés mais aussi les gènes potentiellement impliqués.- Une analyse rétrospective des explorations génétiques des FL/P opérées au CHU de Reims entre 2003 et 2009.- La mise en place d'une analyse prospective (2009-2012, AOL) :- Génomique constitutionnelle par CGH Array- In situ au niveau des berges des fentes issues de déchets opératoires des chirurgies primaires des FL/P comprenant :Le développement d'un protocole de culture cellulaire de fibroblastesUne analyse anatomopathologiqueEt surtout le développement d'un modèle d'étude in vivo chez l'enfant d'analyse d'expression des gènes de l'angiogenèse.RésultatsL'analyse systématique des gènes impliqués dans les FL/P a mis en évidence 95 gènes dont plus d'une dizaine sont connus comme liés aux mécanismes d'angiogenèse (facteurs de croissance et protéases). Ces derniers sont en interaction entre eux mais aussi avec 18 autres gènes impliqués eux aussi dans les FL/P. Ainsi au total 1/3 des gènes d'intérêt sont soit des gènes de l'angiogenèse soit en lien avec eux.L'étude rétrospective nous a permis de mettre en exergue certaines formes cliniques originales qui ont été étudiées et publiées sous un angle « étiologique ».L'étude prospective nous a permis, après obtention des consentements, d'inclure 72 patients (30 FLP, 24FL, 18FP) opérés au CHU de Reims entre 2009 et 2012 d'une chirurgie primaire.Nous présentons :- nos résultats anatomopathologiques, et génétiques (CGH Array)- notre protocole de culture cellulaire- nos réflexions, notre cheminement aboutissant à la création du modèle d'étude d'analyse d'expression des gènes de l'angiogenèseDiscussionLa littérature a bien mis en avant une implication des phénomènes angiogéniques dans la constitution des FL/P par le biais des facteurs de croissance (TGFβ, PDGF C et Ra, FGF, TGFA, FGFR1, FGFR2 ; VEGF) et des protéases (MMP/TIMP2). L'ensemble de nos manipulations in situ nous permet aujourd'hui de disposer du matériel nécessaire pour l'étude de l'expression des facteurs impliqués dans l'angiogenèse sur les berges des fentes.Parallèlement, l'étude génomique constitutionnelle en CGH Array a permis de retrouver des variations non-connues comme polymorphiques chez 62% de nos patients. Des études familiales vont compléter notre travail. Elles permettront de savoir si ces CNV sont héritées ou De Novo et ainsi de préciser leur caractère bénin ou pathologique. L'identification chez un de nos patients d'une amplification, même de petite taille, du gène SKI (gène lié à la voie des TGFβ) nous encourage dans la poursuite de nos recherches d'anomalies constitutionnelles des gènes de l'angiogenèse dans les FL/PLa CGH array est une technique qui nous a paru particulièrement utile et fiable en terme de « scanning » et de dépistage.En conclusion, en pratique clinique, la découverte des anomalies préalablement certainement sous estimées par les cliniciens doit nous mener à une nouvelle réflexion sur le conseil génétique et sur l'utilité dans l'avenir d'un dépistage plus systématique
Cleft lip and palate (CLP) are the most common congenital craniofacial malformation. They have a multifactorial etiology and are the consequence of incomplete fusion of the facial buds.Objective and MethodologyThe objective of this work was to study the role of the genes of angiogenesis in the framework of studying the etiology of CL/P. Our methodological approach included 3 steps:- Systematic and thorough analysis of the genes involved in CL/P including identified genes but also genes that could be potentially involved.- A retrospective analysis of the operated clefts at the University Hospital of Reims between 2003 and 2009.- Implementation of a prospective analysis (2009-2012, AOL):- Constitutional genomic study by CGH Array- In situ with tissue specimens extracted from surgically excised cleft edges including:The development of a protocol for fibroblast cell culturesHistopathological analysisAnd above all the development of an in vivo study model in children for analyzing the expression of genes of angiogenesis.ResultsThe systemic analysis of genes involved in cleft lip palate unveiled 95 genes including about ten that are known to be related to angiogenesis mechanisms (growth factor and proteases). These genes interact between themselves but also with 18 other genes also involved in CL/P. In all, 1/3 of relevant genes are either angiogenesis-related genes or in direct relation with them.The retrospective study permitted to underline the some original clinical forms that were studied and published under an « etiological » angle.The prospective study included 72 patients (30 CLP, 24CL, 18CP), for whom we obtained informed signed consents, operated at the University Hospital of Reims between 2009 and 2012 for primary cleft surgery.We present:- Our histopathological and genetic results (CGH Array)- Our cell culture protocol (submitted for publication)- Our approaches and thought process behind the design of a study model for analyzing expression profiling of angiogenic genesDiscussionThe literature has highlighted the role of angiogenesis in the formation of cleft lip/palate via growth factors (TGFβ, PDGF C and Ra, FGF, TGFA, FGFR1, FGFR2, VEGF) and proteases (MMP/TIMP2). All our manipulations in situ have yielded the necessary material, i.e. edges of resected clefts, to study the expression of factors involved in cleft angiogenesis.In parallel, the constitutional genomic study in CGH Array enabled to uncover abnormalities in 62% of our patients. Family studies will complete our work. They will help to refine if these CNV are inherited or de novo and thus indicate their benign or pathological nature. In one of our patients, the identification of the SKI gene (related to the TGFβ pathway) encourages us to continue our research of genetic abnormalities of angiogenic genes involved in cleft lip/palate. CGH array appeared to be a very useful and reliable method in terms of scanning and screening.In conclusion, in clinical practice, the discovery of abnormalities which were probably underestimated by clinicians before, leads us to rethink the issue of genetic counseling and the relevance of a more systematic screening for these abnormalities in the future

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Mirdamadian, Pegah, and Nargi Raha Salahshour. "Grafting materials for alveolar cleft reconstruction -a systematic review." Thesis, Malmö universitet, Odontologiska fakulteten (OD), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-42795.

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Aim: The aim of this literature study was to systematically review the scientific evidence on the most effective donor sites and/or bone substitute material for secondary alveolar cleft grafting in alveolar cleft patients. Material and method: In order to acquire a systematic and transparent reporting this literature review was conducted according to the PRISMA statement. The literature search was performed in the following four databases; PubMed, CENTRAL, Web of Science and Scopus.The quality of the included studies was assessed using the revised Cochrane Risk of Bias 2 tool (RoB 2 tool). Result: The search identified 4754 studies. Five RCT studies was included in this systematic review and assessed different donor site or bone substitute materials. Two studies showed low risk of bias and three moderate risk of bias. Only one study showed a statistically significant difference when comparing iliac bone to substitute material however all studies presented substitute materials with satisfactory results. Conclusion: According to the data from this systematic review no clear conclusion can be drawn regarding what the most effective bone donor site and/or tissue engineered bone substitute material to use in secondary bone grafts. Based on the available evidence iliac bone could still be regarded as a benchmark, but more research and RCT’s of high quality are required, especially for artificial bone substitute materials.
Syfte: Syftet med denna litteraturstudie var att systematiskt granska den vetenskapliga evidensen gällande det mest effektiva bentagningsstället och/eller bensubstitutmaterialet vid sekundär bentransplantation hos patienter med käkspalt. Material och metod: För att uppnå en systematisk och transparent rapportering av denna litteraturstudie följdes PRISMA statement. Litteratursökningen gjordes i följande fyra databaser; PubMed, CENTRAL, Web of Science och Scopus. Kvaliteten av inkluderade studier granskades med hjälp av Cochrane Risk of Bias 2 tool (Rob 2 tool). Resultat: Sökningen identifierade 4754 studier. Fem RCT studier inkluderades i denna systematiska översikt vilka värderade olika bentagningsställen eller bensubstitut. Två studier bedömdes ha låg risk för bias och tre artiklar måttlig risk för bias. Endast en studie visade på en statistiskt signifikant skillnad vid jämförelse av höftben med bensubstitut däremot presenterade samtliga studier substitutmaterial med tillfredsställande resultat. Konklusion: Denna systematiska översikt visade att ingen klar slutsats kan dras gällande vilken det mest effektiva bentagningsstället eller bensubstitutsmaterialet är för sekundär bentransplantation hos patienter med käkspalt. Baserat på tillgänglig evidens kan transplantat från höftbenet fortfarande anses vara bäst lämpat men mer forskning samt RCT studier av hög kvalité erfordras, särskilt för artificiella bensubstitutmaterial.

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Alves, Trixy Cristina Niemeyer Vilela. "Análise da produção da fala nas correções cirúrgicas da deformidade dentofacial." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/61/61131/tde-18092008-092048/.

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A fala de indivíduos com mordida cruzada anteroposterior e fissura labiopalatina reparada, antes e após a cirurgia ortognática, foi investigada quanto à: alteração do ponto articulatório (presença e tipo) dos diferentes grupos de fonemas; porcentagem e severidade do comprometimento; e associação com os aspectos estrutural, motor e sensorial. Avaliou-se 20 jovens, antes e 13 após a cirurgia, analisando: a fala (após 5 juízas verificarem as alterações do ponto articulatório) obtendo a porcentagem de consoantes corretas (PCC); a sensibilidade (estesiômetro Semmes-Weinstein - SORRI) e mobilidade (escores de 6 a 18) de lábios e língua; e a audição (limiar do SRT e perda auditiva nas freqüências baixas, médias e altas). Antes da cirurgia, a mediana da PCC (n=20) era 23% (15% em palatais), com comprometimento severo na maioria, passando para 69% (n=13) após a cirurgia (31% em palatais), havendo melhora na fala (p=0,001, N=13), com redução da severidade do comprometimento (p=0,002). Quanto maior o trespasse horizontal negativo antes da cirurgia, menor a PCC (p=0,019) e menor a porcentagem de melhora após a cirurgia (p=0,002). Os indivíduos avaliados apresentaram, antes da cirurgia: comprometimento severo da fala, com alteração do ponto articulatório especialmente dos fonemas labiodentais, linguodentais, e alveolares (principalmente ponto bilabial, interdental e ceceio); após a cirurgia verificou-se modificação significante na porcentagem e severidade do comprometimento da fala, evidenciada nos linguodentais, alveolares e labiodentais e rara variação no tipo de alteração; houve associação entre o aspecto estrutural e a PCC pré-cirúrgica, e entre o aspecto estrutural e o aumento pós-cirúrgico da PCC.
The speech of individuals with anteroposterior crossbite and repaired cleft lip and palate, before and after orthognathic surgery, was evaluated as to alteration in the articulation point (presence and type) of the different groups of phonemes; percentage and severity of the disorder; and association with structural, motor and sensorial aspects. Twenty young individuals were evaluated before and 13 after surgery, for analysis of: speech (after 5 examiners analyzed alterations in the articulation point) for achievement of the percentage of correct consonants (PCC); sensitivity (esthesiometer Semmes-Weinstein - SORRI) and mobility (scores from 6 to 18) of the lips and tongue; and hearing (Speech Reception Threshold) and hearing loss at low, medium and high frequencies). Before surgery, the median of the PCC (n=20) was 23% (15% in palatal), with severe disorder in most, changing to 69% (n=13) after surgery (31% in palatal), with an improvement in speech (p=0.001, n=13) and reduction in the severity of disorder (p=0.002). The greater the negative overjet before surgery, the lower was the PCC (p=0.019) and the lower was the percentage of improvement after surgery (p=0.002). Before surgery, the evaluated subjects presented severe speech impairment with alterations in the articulation point, especially of labiodental, dental and alveolar phonemes (especially bilabial point and interdental and lisp); after surgery, there was significant improvement in the percentage and severity of speech impairment, evidenced in dental, alveolar and labiodental phonemes, with rare variation in the type of alteration; there was association between the structural aspect and the preoperative PCC, and between the structural aspect and the postoperative increase in the PCC.

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Beluci, Marli Luiz. "Qualidade de vida de indivíduos com fissura labiopalatina: avaliação pré e pós-correção cirúrgica da deformidade dentofacial." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/61/61132/tde-26052014-144355/.

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Objetivos: Avaliar a qualidade de vida (QV) e o impacto das condições de saúde oral na QV de indivíduos com fissura labiopalatina reparada, nos períodos pré e pós-correção cirúrgica da deformidade dentofacial (DDF), bem como verificar a expectativa dos indivíduos relacionada à correção cirúrgica e a satisfação com os resultados. Material e Método: Estudo quantitativo e prospectivo, realizado no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo. Participaram 50 indivíduos acima de 18 anos, de ambos os sexos, com fissura labiopalatina reparada e indicação para cirurgia de correção da DDF. Para avaliar a QV foram utilizados os instrumentos WHOQOL-Bref e OHIP-14. Para verificar a expectativa do indivíduo com a correção cirúrgica da DDF e a satisfação com os resultados, um questionário elaborado para este estudo foi aplicado, aproximadamente três dias antes e entre três e 12 meses após a cirurgia. Foram realizadas comparações entre os resultados obtidos nos dois momentos investigados, considerando-se o nível de significância de 5%. O teste t para amostras pareadas foi utilizado para analisar os resultados do WHOQOL-Bref, o teste de Wilcoxon foi utilizado na análise dos resultados do OHIP-14 e do questionário sobre a expectativa e satisfação com os resultados do tratamento. Resultados: A comparação dos resultados obtidos com o WHOQOL-Bref evidenciou diferença significativa após a cirurgia para os domínios: Físico (p=0,034), Psicológico (p<0,001), Meio Ambiente (p=0,034) e nas Questões Gerais (p=0,014). Assim como para os domínios: Desconforto Psicológico (p<0,001), Limitação Psicológica (p<0,001), Limitação Social (p=0,027), Incapacidade (p=0,001) e no Escore Geral (p<0,001) para o OHIP-14. A maior expectativa quanto à cirurgia foi a estética facial (78%) e, após tal procedimento, 96% da amostra apresentaram-se satisfeitos com os resultados alcançados para a face (p<0,001), nariz (p=0,004), dentes (p<0,001) e lábios (p<0,001). Conclusão: A correção cirúrgica da DDF propiciou melhora da QV e o impacto negativo da saúde oral na QV diminuiu; a maior expectativa antes da cirurgia era a melhora da estética facial e após a cirurgia os indivíduos se mostraram satisfeitos com os resultados relacionados aos aspectos corpo, face, nariz, dentes e lábios.
Objectives: To evaluate the quality of life (QL) and the impact of oral health conditions on the QL of individuals with repaired cleft lip and palate, in periods before and after surgical correction of the dentofacial deformity (DFD), as well as to analyze the expectations of individuals related with the surgical correction and satisfaction with the outcomes. Material and methods: Quantitative and prospective study conducted at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo. The study was conducted on 50 individuals older than 18 years, of both genders, with repaired cleft lip and palate and with indication for surgical correction of DFD. The QL was evaluated using the instruments WHOQOL-Bref and OHIP-14. To verify the expectations of individuals about the surgical correction of DFD and the satisfaction with the outcomes, a questionnaire designed for this study was applied approximately three days before and three to 12 months after surgery. The results obtained in the two moments were compared, considering a significance level of 5%. The t test for paired samples was used to analyze the outcomes of the WHOQOL-Bref, the Wilcoxon test was used for analysis of the outcomes of OHIP-14 and questionnaire about the expectation and satisfaction with the treatment outcomes. Results: Comparison of the results obtained with the WHOQOL-Bref evidenced significant difference after surgery for the following domains: Physical (p=0.034), Psychological (p<0.001), Environment (p=0.034) and in General Questions (p=0.014), as well as the domains Psychological Discomfort (p<0.001), Psychological Limitation (p<0.001), Social Limitation (p=0.027), Inability (p=0.001) and Overall Score (p<0.001) for the OHIP-14. The greatest expectation about surgery was for facial esthetics (78%) and, after the procedure, 96% of the sample was satisfied about the outcomes achieved for the face (p<0.001), nose (p=0.004), teeth (p<0.001) and lips (p<0.001). Conclusion: Surgical correction of the DFD provided improvement in the QL and the negative impact of oral health on QL was reduced; the greatest expectation before surgery was to improve the facial esthetics, and after surgery the individuals were satisfied about the outcomes related to the aspects body, face, nose, teeth and lips.

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Mondelli, Ricardo Lia. "Queiloplastia de FTB, comparação da técnica clássica de Spina com a modificada pelo HRAC." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/61/61132/tde-06022012-150523/.

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Introdução: As fissuras bilaterais de lábio e palato sempre apresentaram divergências a respeito de seu tratamento cirúrgico. Nesta pesquisa duas técnicas cirúrgicas para correção de fissuras de lábio bilaterais, a Clássica de Spina (grupo S) e a de Spina modificada pelo Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP) (grupo TD) foram comparadas. Os objetivos deste estudo foram: determinar os resultados estéticos, as complicações pós-operatórias imediatas e mediatas, a satisfação pessoal da aparência e do tratamento recebido, bem como a qualidade de vida em indivíduos com fissuras transforame bilateral, operados no HRAC-USP pelas técnicas de Spina e Spina modificada pelo HRAC-USP. Método: Após aprovação do comitê de ética e pesquisa e obtenção do consentimento informado, foram avaliados setenta e seis indivíduos, 48 do sexo masculino e 28 do sexo feminino. O grupo S apresentou-se com 44 indivíduos e o grupo TD com 32. Julgadores fizeram análises subjetivas em fotografias de sete atributos em cada indivíduo, utilisando-se de uma escala numérica de 1 a 5. Da análise de prontuários foram obtidas as complicações pós operatórias imediatas e mediatas, além do número de internações cirúrgicas e do número de retornos ambulatoriais. Os próprios indivíduos responderam a duas escalas visuais analógicas (EVA), uma de satisfação da sua aparência e outra do tratamento recebido no HRAC-USP e também a um questionário de qualidade de vida da Organização Mundial da Saúde (WHOQOL-bref). Resultados: As duas técnicas cirúrgicas utilizadas não mostraram diferença estatística nas análises fotográficas subjetivas. As complicações cirúrgicas imediatas e mediatas foram semelhantes entre os grupos. Houve diferença estatística significante quanto ao número de cirurgias (p=0,0000), o grupo S apresentou 8,06 (2,18) e o grupo TD apresentou 4,72 (1,45) internações cirúrgicas, os atendimentos ambulatoriais não apresentaram diferenças apresentando para o grupo S 27,49 (17,58) e 22,31 (15,38) vindas ao hospital. As escalas visuais analógicas (EVA) de satisfação da aparência apresentaram para o grupo S 53,80 (14,46) e TD 57,54 (14,41) e do tratamento recebido no HRAC-USP para S 68,14 (11,16) e TD 63,18 (11,39). O WHOQOL-bref também não mostrou diferença entre os grupos em nenhum dos seus domínios. Conclusão: As queiloplastias realizadas pelas técnicas de Spina e de Spina modificada pelo HRAC-USP, não mostraram diferença estatística nos resultados das avaliações fotográficas, das complicações pós operatórias imediatas e mediatas, do número de atendimentos ambulatoriais, das escalas visuais analógicas de satisfação da aparência e do atendimento recebido no HRAC-USP, e do questionário de qualidade de vida. Os indivíudos operados pela técnica de Spina modificada pelo HRAC-USP apresentaram menos internações cirúrgicas que indivíduos os operados pela técnica clássica de Spina, com resultados estatísticos significativos.
Background: The bilateral cleft lip palate ever had a divergence of its treatment. In this research two techniques to correction bilateral cleft lip, Spina classic technique (S group) and Spina modified by HRAC-USP (TD group). Aims: Determine the esthetical results, immediate and mediate postoperative complications, the number of surgeries and ambulatory attendance, the personal satisfaction with its appearance and received attendance, and the quality of life in subjects with bilateral clef lip palate, operated in the HRAC-USP by Spina and Spina modified by HRACUSP techniques of cheiloplasty. Method: After approve of the ethical committee and attainment of assent, was evaluated 74 subjects, 46 male and 28 female. The S group had 42 and the TD group with 32 subjects. Judges made facial analysis in photographs of seven attributes in each subject, using an analogical scale of 1 to 5. From the bedside assessment the immediate and mediate complications was taken. The number of surgical procedures and ambulatorial coming was tabulated. The own subjects answer two visual analogical scale (EVA) of satisfaction of appearance and the treatment received at HRAC-USP and an OMS quality of life questionnaire (WHOQOL-bref). Results: The two techniques utilized did not show statistic difference in the subjective facial analyses. The immediate and mediate complications were similar between the groups. There were significant difference in the number of surgical procedures (p=0000), S group had 8,06 (± 2,18) and TD group 4,72 (± 1,45) surgical internment. The ambulatory coming did not show differences, the S group had 27,49 (± 17,58) and TD 22,31 (± 15,38) coming to to the Hospital. The visual analogical scales (EVA) of satisfaction whit the appearance shows for S group 53,80 (± 14,46) e TD 57,54 (± 14,41) and the do treatment received at HRAC-USP for S group 68,14 (± 11,16) e TD 63,18 (± 11,39). The WHOQOL-bref did not show differences between the groups in none of their dominion. Discussion: All elements of this work were interpreted and analysis was performed whit literature correlation. Conclusion: The cheiloplasty whit the technique of Spina and Spina modified by HRAC-USP, did not show statistical difference in the results of photographs evaluation, immediate e mediate complications, the number of coming to the hospital, the visual analogical scale of satisfaction whit the appearance and the treatment received at HRAC-USP and the questionnaire of quality of life. The subjects submitted to the Spina technique modified by HRAC-USP shows less surgical procedures that those submitted to the classical Spina technique whit statistical significance difference.

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Alves, Michelly Lima Moro. "Avaliação da qualidade de vida de pacientes com fissura transforame bilateral submetidos à cirurgia ortognática comparados aos reabilitados com próteses de recobrimento no Hospital de Reabilitação de Anomalias Craniofaciais da Universidad." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/61/61132/tde-08012015-094224/.

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A preocupação em restabelecer e avaliar a qualidade de vida do paciente é um assunto que vem sendo bastante abordado na literatura atual. A fissura labiopalatina é uma das malformações mais comuns, afetando não só o aspecto funcional do paciente, mas também o psicológico, fatores esses estritamente relacionados com a qualidade de vida. Pacientes com fissura do tipo transforame bilateral sofrem mais as consequências das cirurgias primárias corretivas, levando cerca de 25-38% necessitarem de correção cirúrgica da discrepância maxilomandibular com cirurgia ortognática. Devido ao anseio de muitos em finalizar a reabilitação com um tempo mais curto, ou a vontade de terminar o caso sem procedimento cirúrgico, o setor de Prótese Dentária do Hospital de Reabilitação de Anomalias Craniofaciais, desenvolveu uma prótese removível diferenciada, chamada prótese removível de recobrimento ou overlay. Objetivo: Avaliar a qualidade de vida geral e oral dos pacientes que tiveram seus tratamentos finalizados com cirurgia ortognática (CiOr) comparados aos que finalizaram seus casos com a prótese de recobrimento (PR). Metodologia: O trabalho foi composto de 40 pacientes, sendo 20 no Grupo CiOr e 20 no Grupo PR. Foi feito um levantamento epidemiológico e aplicação de dois questionários: WHOQOL-bref e OHIP-14. Os resultados finais foram avaliados estatisticamente através do teste Mann-Whitney. Resultados: Em relação ao comparativo com o questionário WHOQOL-bref, não foi encontrado diferença estatisticamente significativa entre os grupos. Na análise do OHIP-14, apenas no campo Limitação psicológica pôde ser observado diferença, sendo que o Grupo CiOr teve impacto mais negativo quando comparado ao Grupo PR. Conclusão: Ambas as reabilitações proporcionam uma qualidade de vida satisfatória para os pacientes.
The concern for restoring and assess the quality of life has been extensively discussed in the literature. Cleft lip and palate is one of the most common birth defects, affecting not only the functional aspect of the patient, but also the psychological, these are factors closely related to the quality of life. Patients with complete bilateral cleft lip and palate suffer most the consequences of primary corrective surgeries; about 25-38% of them require surgical correction of maxilomandibular discrepancy with orthognathic surgery. Due to the desire of many to finalize the rehabilitation within a shorter time, or the desire to end the case without surgical procedure, the Prosthodontics Department of the Hospital for Rehabilitation of Craniofacial Anomalies, developed a differentiated removable prosthesis, called overlay. Objective: To evaluate the overall and oral quality of life of patients who had completed their treatment with orthognathic surgery (CiOr) compared to those who completed their cases with prosthetic rehabilitation (PR). Methodology: The study comprised 40 patients, 20 in CiOr Group and 20 in PR Group. Epidemiological survey and application of two questionnaires (WHOQOL-bref and OHIP-14) were done. The final results were evaluated statistically by the Mann-Whitney test. Results: Regarding the comparison with the WHOQOL-bref, no significant statistical differences between groups were found. In the analysis of the OHIP-14, only in \"Psychological Limitation\" field difference could be observed, where CiOr Group showed more negative impact when compared to the PR Group. Conclusion: Both rehabilitations provide a satisfactory quality of life for patients.

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Faco, Renato André de Souza. "Antibioticoterapia profilática em cirurgia bucomaxilofacial em pacientes com fissuras labiopalatinas." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/61/61132/tde-26072011-092028/.

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Objetivos: Avaliar os resultados obtidos com a utilização do protocolo de antibioticoterapia profilática do HRAC-USP em cirurgias bucomaxilofaciais. Material e Métodos: Para a realização do presente estudo foram analisados 649 prontuários de pacientes com fissura labiopalatina, devidamente matriculados no HRAC-USP submetidos à cirurgia bucomaxilofacial entre os meses de outubro de 2008 e outubro de 2009, aos quais foi ministrado cefazolina e metronidazol para os pacientes não alérgicos e clindamicina e gentamicina aos pacientes com alergia à penicilina. Resultados: 410 pacientes (63,1%) eram do sexo masculino e 239 (36,9%) eram do sexo feminino, com idade média de 18 anos. Somente 13 pacientes (2%) apresentaram infecção pós-cirúrgica. Conclusão: A utilização do protocolo de antibioticoterapia do HRAC-USP em cirurgias bucomaxilofaciais em pacientes com fissura labiopalatina demonstrou ser eficaz, resultando em baixo índice de infecção.
Objectives: To evaluate the outcomes achieved by utilization of the antibiotic prophylaxis protocol of HRAC-USP in maxillofacial surgeries. Material and methods: The study comprised analysis of 649 records of patients with cleft lip and palate, registered at HRAC-USP and submitted to maxillofacial surgery in the period October 2008 to October 2009. The prescriptions comprised cephazolin and metronidazole for non-allergic patients, and clindamycin and gentamicin for patients allergic to penicillin. Results: 410 patients (63.1%) were males and 239 (36.9%) were females, with mean age of 18 years. Only 13 patients (2%) presented postoperative infection. Conclusion: Utilization of the antibiotic prophylaxis protocol of HRAC-USP in maxillofacial surgery in patients with cleft lip and palate demonstrated to be effective, resulting in a low rate of infection.

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Jones, Timothy Edward McEvoy. "A study to determine the optimal outcome measure to assess primary surgery in cleft lip and palate patients and an analysis of five year old patients as part of the Cleft Care UK study : have standards improved since CSAG?" Thesis, University of Bristol, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.681747.

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To determine the optimal dentoalveolar measure to assess unilateral cleft lip and palate (UCLP) patient models. To analyse the study models collected of five year old children with UCLP as part of Cleft Care UK (CCUK) to see if primary surgical outcome has improved since CSAG. Method: The models of 34 patients with UCLP taken at 5, 10 and 20 years were scored by two examiners on two occasions using five indices: the 5 Year Olds' (5YO); Goslon; Modified Huddart/Bodenham (MHB), Eurocran and Overjet. Reliability, predictive validity, agreement with gold standard, ease of use and time taken were recorded for each index/examiner. CCUK study models and intraoral photographs were scored using the 5YO index by two examiners on two occasions. These results were then compared to the original CSAG results. Results: Highest overall reliability was seen with MHB, followed by Overjet, 5YO and Goslon, with the latter more reliable in the mixed dentition. Predictive validity was similar for MHB, Goslon and 5YO with a 50%-65% prediction of final outcome from 5 and 10 years. Eurocran palatal index showed no clear predictive validity (Spearman's correlation=0.20). Agreement to 5YO at the 5 year age group was almost perfect for MHB and moderate for Goslon. Agreement to Goslon at 10 years was substantial for 5YO and moderate for oveljet and MHB. Time to score 34 models per index(mean in minutes): Goslon(13.4)< Overjet(13.6) 5Y0(19.4)< Eurocran(24.8)< MHB(27.4). Good outcomes accounted for 53% of all outcomes in CCUK (up from 30% in CSAG), whereas poor outcomes accounted for 19% (down from 36% in CSAG). Conclusion: As an outcome measure of UCLP models, only MHB and 5YO indices can be recommended for use at 5 years and Goslon at 10 years. Outcomes of primary surgery for UCLP have significantly improved in the United Kingdom since the original CSAG results were collected.

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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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Zwicker, Carmen Vivian Domingues. "Sintomas respiratórios em indivíduos com sinais da Síndrome Velocardiofacial após cirurgia para correção da disfunção velofaríngea." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/61/61132/tde-25092012-093022/.

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Objetivos: Investigar a ocorrência de queixa respiratória nos pacientes com sinais clínicos da Síndrome Velocardiofacial (SVCF) submetidos à cirurgia para a correção da Disfunção Velofaríngea (DVF), comparativamente àqueles com fissura isolada de palato sem sinais da SVCF, além de verificar se a condição respiratória pré-cirúrgica interfere na escolha do tratamento cirúrgico para correção da DVF. Material e Método: Estudo retrospectivo e prospectivo com 30 indivíduos de ambos os sexos, que realizaram procedimento cirúrgico para a correção da DVF (veloplastia intravelar ou retalho faríngeo), sendo 15 com sinais clínicos da SVCF (grupo estudo) e 15 com fissura isolada de palato sem sinais clínicos da SVCF, pareado por sexo e idade (grupo controle). Um levantamento de sintomas respiratórias foi realizado utilizando-se três questionários, um aplicado antes e após a cirurgia (Caouette-Laberge et al 1992) e dois aplicados apenas após a cirurgia (Petry et al 2008, Berlin, proposto por Netzer et al 1999). As comparações foram realizadas por meio do Teste Exato de Fisher, considerando-se nível de significância de 5%. Resultados: Sintomas como respiração oral e ronco estavam presentes nos períodos pré e pós-cirúrgico em ambos os grupos estudados, não sendo detectada diferença entre esses períodos quanto à presença desses sintomas, nos dois grupos. Diferença entre os grupos não foram constatadas em relação à presença de sonolência diurna excessiva, ronco, apneia, sono/fadiga, histórico de obesidade ou hipertensão arterial e risco potencial para SAOS. No grupo estudo houve semelhante distribuição entre a realização de veloplastia intravelar e retalho faríngeo, diferentemente do grupo controle em que prevaleceu a veloplastia intravelar, não havendo relação entre a frequência de sintomas respiratórios e o tipo de cirurgia, para ambos os grupos. Conclusão: Nos pacientes com sinais clínicos da SVCF, sintomas de respiração oral e ronco estão presentes antes e após a correção cirúrgica da DVF; não há diferença quanto aos sintomas respiratórios entre indivíduos com sinais clínicos da SVCF e indivíduos com fissura isolada de palato sem sinais da SVCF; a condição respiratória antes da cirurgia não interferiu na escolha do tipo de procedimento cirúrgico para correção da DVF.
Objectives: To investigate the occurrence of respiratory complaint in individuals with clinical signs of Velocardiofacial Syndrome (VCFS) submitted to surgery for correction of Velopharyngeal Dysfunction (VPD), compared to individuals without signs of VCFS, and analyzed if the preoperative respiratory condition interferes with surgical treatment planning for correction of VPD. Material and method: Retrospective and prospective study of 30 individuals of both genders, who were submitted to surgery for correction of VPD (intravelar veloplasty or pharyngeal flap), being 15 with clinical signs of VCFS (study group) and 15 with isolated cleft palate without clinical signs of VCFS, matched for gender and age (control group). A survey of respiratory complaints was performed using three questionnaires, one applied before and after surgery (Caouette-Laberge et al 1992) and two applied only after surgery (Petry et al 2008, Berlin, proposed by Netzer et al 1999). Comparisons were performed by the exact Fisher test, at a significance level of 5%. Results: Symptoms as mouth breathing and snoring were present in pre- and postoperative periods in both groups, without difference between periods concerning the presence of these symptoms, in the two groups. No differences were observed between groups as to the presence of excessive somnolence during the day, snoring, apnea, sleep/fatigue, history of obesity or arterial hypertension and potential risk to OSA. The study group presented similar distribution of intravelar veloplasty and pharyngeal flap, different from the control group that presented predominance of intravelar veloplasty, without relationship between the frequency of respiratory symptons and type of surgery, for both groups. Conclusion: In patients with clinical signs of VCFS, complaints of mouth breathing and snoring are present before and after surgical correction of VPD; there is no difference in the complaints of respiratory symptoms between individuals with clinical signs of VCFS and individuals with isolated cleft palate without signs of VCFS; the respiratory condition before surgery did not interfere with selection of the type of surgical procedure for correction of VPD.

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Holmlund, Thorbjörn. "Evaluation of surgical methods for sleep apnea and snoring." Doctoral thesis, Umeå universitet, Institutionen för klinisk vetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-118944.

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Background: Snoring and obstructive sleep apnea (OSA) are both common disorders with a number of negative health effects. The safety and efficacy of treating snoring and OSA surgically have been questioned and there has been a lack of studies in the field. Aims: 1) To investigate the frequency of serious complications, including death, after surgery for the treatment of snoring and sleep apnea; 2) to evaluate the effect on daytime sleepiness after radiofrequency surgery of the soft palate in snoring men with mild or no OSA; 3) to evaluate the effect of tonsillectomy on sleep apnea in adults with OSA and tonsillar hypertrophy; 4) to investigate the morphology and cytoarchitecture of muscle fibers in human soft palatal muscles with immunohistochemical and morphological techniques. Methods and results: In paper 1, a retrospective database study. All Swedish adults who were treated surgically because of snoring or OSA from January 1997 to December 2005 were identified in the National Patient Register. None of the surgically treated patients died in the peri- and postoperative period. Severe complications were recorded in 37.1 of 1,000 patients treated with uvulopalatopharyngoplasty (UPPP), in 5.6 of 1,000 patients after uvulopalatoplasty (UPP) and in 8.8 of 1,000 patients after nasal surgery. In paper 2, the study was designed as a randomized, controlled trial. 35 snoring men with mild or no OSA were randomized to either radiofrequency or sham surgery of the soft palate. Radiofrequency surgery was not found to be effective since there was no significant difference between the two groups in relation to the Epworth Sleepiness Scale (ESS) or apnea-hypopnea index (AHI) at follow-up. Paper 3 was a prospective study, including 28 patients with an AHI of >10 and with large tonsils. In these patients, tonsillectomy was an effective treatment for OSA; the mean AHI was reduced from 40 units/h to 7 units/h (p<0.001), and the mean ESS was reduced from 10.1 to 6.0 (p<0.001) at the six-month follow-up after surgery. Minor and moderate swallowing dysfunction was found in seven of eight patients investigated before surgery and the swallowing function improved in 5 of them after surgery, while no one deteriorated. In paper 4, we investigated the morphology and cytoarchitecture in normal soft palate muscles. Human limb muscles were used as reference. The findings showed that the soft palate muscle fibers have a cytoskeletal architecture and cellmembrane complex that differs from that of the limb muscles. Conclusions No case of death related to surgery was found among 4,876 patients treated with UPPP, UPP or nasal surgery for snoring or OSA in Sweden between 1997 and 2005. Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring or apnea frequency in snoring men with mild or no OSA. Tonsillectomy can be an effective treatment for OSA in adults with large tonsils. A subgroup of muscle fibers in the human soft palate appears to have special biomechanical properties and their unique cytoarchitecture must be taken into account while assessing function and pathology in oropharyngeal muscles.
Snarkning och obstruktiv sömnapné (OSA) är idag en global folksjukdom. Snarkning är det ”oljud” som uppstår när luftvägen under sömn förminskas och vävnaden börjar vibrera under andning. Vid obstruktiv sömnapné faller vävnaden samman och blockerar luftflödet till lungorna. Ett andningsuppehåll, en s.k. apné inträffar. Ett andningsuppehåll kan pågå allt ifrån några sekunder till mer än en minut och kan uppstå hundratals gånger per natt. För att klassificeras som en patologisk apné enligt internationell standard måste andningsuppehållet vara längre än 10 sek. Snarksjukdomen förvärras sannolikt över tid och övergår succesivt i obstruktiv sömnapné med ökande antal andningsuppehåll under sömn. Detta leder till ett stresspåslag för kroppen med oftast uttalad dagtrötthet och en mängd negativa hälsoeffekter. Snarksjukdom och sömnapné ökar risken för bl.a. högt blodtryck och hjärt-kärlsjukdom samt också för att den drabbade ska orsaka trafikolyckor på grund av försämrad koncentrationsförmåga och trötthet. En del av den negativa utvecklingen från snarkning till sömnapné anses bero på att snarkvibrationer kan ge neuromuskulära skador i gom och svalg. Dessa vävnadsskador anses också vara orsaken till att personer som snarkat länge ofta uppvisar störd sväljningsfunktion i form av felsväljning, där maten i uttalade fall hamnar i luftstrupen istället för i matstrupen. I dagsläget är förstahandsbehandling vid sömnapné CPAP, en mask som placeras över näsa och mun och som skapar ett övertryck i luftvägen vilket förhindrar att luftvägen faller samman och att andningsstopp uppstår. CPAP har enligt flera studier den bästa effekten mot andningsuppehåll. En annan vanlig behandling är en bettskena som för underkäken nedåt och framåt så att luftvägen bli mer öppen. Bettskenan är en vanlig och effektiv behandlingsmetod för personer utan kraftig övervikt vid vanemässig snarkning eller måttlig sömnapné. För ett tjugotal år sedan var kirurgi förstahandsmetoden vid behandling av snarkning och måttlig sömnapné. Man utförde då ofta operationer i svalg och gomm, s.k. gomplastiker. Bruket av kirurgisk behandling har dock minskat med tiden, dels p.g.a. biverkningar men också för att det saknades vetenskapliga studier som bevisade att kirurgin gav önskad och långsiktig effekt. Kirurgi utgör dock fortfarande ett komplement till behandling av snarkning och sömnapné när CPAP eller bettskena av olika skäl inte fungerar eller kan tolereras av patienten. 8 Även barn kan lida av snarkning och sömnapné men behandlingsprinciperna för barn skiljer sig från dem hos vuxna och berörs inte i avhandlingen. I denna avhandling studeras: i) biverkningsfrekvenser efter olika typer av snarkkirurgi, ii) effekten av radiovågsbehandling i mjuka gommen på vuxna män med snarkning, iii) effekten av att operera bort halsmandlarna på vuxna med sömnapné och stora halsmandlar, iv) muskelvävnadens struktur och molekylära uppbyggnad i mjuka gommen hos friska personer som inte snarkar. Avhandlingen består av fyra delstudier: 1. En registerstudie med kartläggning av svåra biverkningar efter kirurgi i form av uvulopalatopharyngoplastik, uvulupalatoplastik samt näskirurgi för behandling av sömnapné och snarkning och utfört i Sverige mellan åren 1997-2005. Studien omfattade 4 876 patienter. Inga dödsfall noterades. Komplikationsrisken var störst vid operationer där man tog bort delar av mjuka gommen samt halsmandlarna, där i snitt 37 av 1000 opererade fick biverkningar, framförallt p.g.a. infektioner eller blödningar. 2. I en prospektiv, randomiserad placebostudie utvärderades effekten av radiovågsbehandling i mjuka gommen vid snarkning och lindrig sömnapne. Trettiotvå patienter lottades till att få radiovågsbehandling eller placebo behandling. Patienterna visste inte vilken grupp de tillhörde. Vid uppföljning efter 12 månader var det inga statistiska belägg för att radiovågsbehandling minskade vare sig antal andningsuppehåll eller dagtrötthet. 3. Effekten av att ta bort halsmandlarna på patienter med stora halsmandlar och olika grad av sömnapné utvärderades i denna studie. Totalt deltog 28 patienter. Vid uppföljning 6 månader efter operationen hade antalet andningsuppehåll sjunkit drastiskt, från i snitt 40 till 7 andningsuppehåll per timme nattsömn. Inga allvarliga biverkningar uppstod. Dessa fynd talar för att man som förstahandsmetod ska erbjuda patienter med sömnapné och stora halsmandlar att ta bort halsmandlarna. 4. I detta projekt undersökte vi utseendet och uppbyggnaden av cellskelettet i två normala muskler i mjuka gommen hos friska personer utan känd snarkning och sömnapné. Muskler från armar och ben användes som referens. Fynden i studien visar att de normala muskelfibrernas uppbyggnad i mjuka gomen skiljer sig från jämförade muskler i armar och ben. Detta kan vara ett uttryck för en evolutionär utveckling för att möjligöra de komplexa funktioner som krävs av svalgets muskulatur. 9 Sammanfattningsvis kan vi konstatera: Att inga dödsfall har skett i Sverige efter operationer i gom, svalg eller näsa, utförda för att behandla snarkning och sömnapné under åren 1997 till 2005. Att radiovågsbehandling av mjuka gommen hos snarkande män med lindrig sömnapné inte har någon effekt på dagtrötthet, snarkning eller andningsuppehåll vid uppföljning efter 12 månader. Metoden kan därför inte rekommenderas. Att när man opererar bort stora halsmandlar på personer med andningsuppehåll så leder detta ofta till att andningsuppehållen minskar drastiskt. Metoden kan därför oftast rekommenderas som en förstahandsbehandling för denna patientgrupp. Att mjuka gommens muskelfibrer är uppbyggda på ett unikt sätt indikerar att deras specifika biomekaniska egenskaper skiljer sig från referens muskler i armar och ben.

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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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Silva, Willian Saranholi da. "Análise de recidiva após osteotomia Le Fort I para avanço maxilar em pacientes com fissura de lábio e palato." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/61/61132/tde-19102016-154434/.

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O presente estudo observou e avaliou retrospectivamente o índice de recidiva após cirurgia ortognática para avanço maxilar em pacientes com fissura de lábio e palato. A amostra foi composta por telerradiografias laterais analisadas através de traçados cefalométricos e imagens digitais tridimensionais de modelos de estudo de 17 pacientes de ambos os sexos (10 pacientes do sexo feminino e 07 pacientes do sexo masculino), com idade entre 17 e 33 anos. Os traçados cefalométricos digitais foram avaliadas em: T1 pré-operatório; T2 pós-operatório imediato e T3 pós-operatório de seis meses a 1 ano. A análise cefalométrica digital determinou as medidas de forma linear para possíveis mudanças verticais e horizontais no pós-operatório da cirurgia ortognática para avanço maxilar. Os modelos de estudo digitalizados foram avaliados nas seguintes fases: F1 préoperatório; F2 pós-operatório de seis meses a 1 ano e F3 pós operatório de 1 até 2 anos, nos planos frontal e lateral. Verificou-se ainda nos modelos digitalizados, a linha média dentária, trespasse vertical (plano frontal) e a relação pré-molar nos lados direito e esquerdo e trespasse horizontal (plano lateral). As análises dos arcos dentários foram realizadas diretamente nas imagens escaneadas, por meio do Scanner 3Shapes R700TM e avaliadas pelo 3D Software OrthoAnalyzerTM. Um avaliador previamente calibrado e treinado fez as avaliações. A análise estatística descritiva foi realizada com valores de média, desvio-padrão e porcentagem. O teste ANOVA de medidas repetidas foi aplicado nas variáveis estudadas (movimento vertical, movimento horizontal, trespasse horizontal, trespasse vertical e linha média dentária) para comparar os três tempos determinantes. Como verificou-se significância estatística nestas diferenças, o teste Tukey foi aplicado para avaliar os grupos entre si. O nível de significância de 5% foi adotado para todas as análises. Os resultados mostraram que na cefalometria digital o movimento vertical apresentou diferença estatisticamente significativa entre T2 e T3 (p=0,002). A relação pré-molar dos lados direito e esquerdo revelou que os pacientes apresentavam em F2, ¼ classe II e classe I, 29,4% e 23,5%, e em F3 classe I, 58,8% e 70,6%, respectivamente Donde conclui-se que houve recidiva na cefalometria quanto ao movimento vertical, após cirurgia ortognática para avanço maxilar, sem recidiva nos demais parâmetros avaliado
This observational study evaluated retrospectively forms the recurrence rate after orthognathic surgery for maxillary advancement in patients with cleft lip and palate. The sample consisted of radiographs with lateral cephalometric tracing and three-dimensional digital images of 17 patients study models of both genders (10 female patients and 07 male patients), aged between 17 and 33 years. The cephalometries were evaluated: T1 preoperative; T2 - immediate postoperative period and T3 - postoperative six months to 1 year. The digital cephalometric analysis determined the measures linearly for possible vertical and horizontal changes in the postoperative period of orthognathic surgery for maxillary advancement. Study models, scanned, were evaluated in the following phases: F1 - preoperative; F2 - postoperative six months to 1 year and F3 - postoperative 1 to 2 years, in the frontal and lateral planes. It was also found on scanned models, the dental midline, overbite, overjet (frontal plane) and pre-molar relationship, on the right and left sides (lateral plane). The analysis of dental arches were made directly on the scanned images through the scanner 3Shape\'s R700TM and evaluated by 3D Software OrthoAnalyzerTM. A calibrated and trained evaluator evaluations. Descriptive statistical analysis was performed with mean values, standard deviation and percentage. The ANOVA test for repeated measures was applied to the variables (vertical movement, horizontal movement, overjet, overbite and dental midline) to compare the times. As there was statistical significance in these differences, the Tukey test was used to evaluate the groups together. The 5% significance level was adopted for all analyzes. The results showed that the cephalometry vertical movement showed a statistically significant difference between T2 and T3 (p=0.002). The premolar ratio of the right and left sides showed that patients had in F2, ¼ class II and class I, 29.4%, and 23.5%, and F3 class I 58.8% and 70.6%, respectively. It is concluded that there was recurrence in cephalometrics as the vertical movement after orthognathic surgery for maxillary advancement, without recurrence in the remaining parameters

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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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Abstract:

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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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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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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Beck, Gerald Joseph. "The effect of antenatal palatal surgery on postnatal palatal growth in sheep a thesis submitted in partial fulfillment ... in oral and maxillofacial surgery ... /." 1986. http://catalog.hathitrust.org/api/volumes/oclc/68788161.html.

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Nique, Thomas Alan. "Particulate allogeneic bone grafts into maxillary alveolar clefts in humans a thesis submitted in partial fulfillment ... oral and maxillofacial surgery ... /." 1985. http://books.google.com/books?id=lYk9AAAAMAAJ.

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Dissertations / Theses on the topic 'Palate - Surgery'

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