Análise tridimensional do espaço aéreo faríngeo e posição do osso hioide em crianças com e sem indicação para adenotonsilectomia
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2018-06-23
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Universidade Federal de Goiás
Resumo
The pharynx is an organ that participates in the respiratory and digestive systems. Its
peculiar tubular anatomy may be mechanically obstructed, especially due to
adenotonsillar hyperplasia. This hyperplasia, when chronic, results in changes in
craniofacial growth and development. The present study aimed to perform the threedimensional
evaluation, using cone beam computed tomography (CBCT), of 4- to 9-
year-old children, with and without indication for adenotonsillectomy (AT) and with
maxillary atresia, comparing the measurements and the location of the minimum area
of the pharynx, as well as the total pharyngeal volume and the volume of the
subregions of the palatine tonsils and adenoids and, additionally, locating the position
of the hyoid bone (H) and correlating it with the total pharynx volume and the volume
of the subregions of the palatine tonsils and adenoids. For the selection of the nonprobabilistic
consecutive sampling, 487 children were screened at the
Otorhinolaryngology Outpatient Clinic of the Hospital das Clínicas, School of Medicine
of the Universidade Federal de Goiás, from March to December 2017. Inclusion criteria
were: age group between 4 and 9 years, presence of maxillary atresia, and balanced
face (evaluated by the S line) using facial analysis. Exclusion criteria were: obesity,
extensive caries, previous AT, presence of craniofacial syndromes or congenital
anomalies, history of traumas or surgeries in the region of head, neck, or face, previous
orthopedic/orthodontic treatment, early tooth loss, and dental Class II or III. The
diagnosis of maxillary atresia and the other oral conditions were performed by two
orthodontists. After selection, the patients were evaluated by an otorhinolaryngologist,
who conducted anamnesis, physical examination and flexible nasal endoscopy to
diagnose the obstruction due to adenotonsillar hyperplasia. The sample size
calculation, considering the minimum area of the pharynx as the primary variable,
defined 30 patients in each of the two study groups, the surgical and the non-surgical
groups, who underwent the Prick test. Posteriorly, they underwent CBCT exams to
evaluate the airflow and position of H. CBCTs were analyzed using the Invivo Dental
software to obtain the three-dimensional and two-dimensional measurements of the
pharyngeal airway space and the position of H. The age did not show statistical
difference between groups (p = 0.111). The surgical group had a higher frequency of
male participants. The measurements of total pharyngeal volume (p = 0.038), volume
of the adenoid region (p = 0.001), and minimum area of the pharynx (p = 0.011) showed
significant statistical differences between the grupos. In the surgical group, the highest
frequency of the minimum area of the pharynx was in the adenoid region (60.0%), while
in the non-surgical group the highest frequency was in the palatine tonsil region
(73.3%). The correlation coefficient between H-Tweed mandibular plane (MP) and the
volume of the palatine tonsil region was moderate in the surgical group (r = 0.408; p =
0.025). In conclusion, in this study: the pharyngeal volumes and the volume in the
adenoid region were signifcantly reduced in the patients of the surgical group
compared to the non-surgical group; the volume corresponding to the palatine tonsil
region was similar in both groups; the narrowest pharynx area was located at a higher
frequency in the region near the adenoid hyperplasia in the surgical group, whereas in
the non-surgical group it was located at a higher frequency in the palatine tonsil region;
no significant statistical difference was found for the position of H between the groups,
and the correlation between its position and the sagital and vertical cephalometric
patterns was weak.
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Citação
SANTOS, C. B. Análise tridimensional do espaço aéreo faríngeo e posição do osso hioide em crianças com e sem indicação para adenotonsilectomia. 2018. 80 f. Dissertação (Mestrado em Odontologia) - Universidade Federal de Goiás, Goiânia, 2018.