RESUMO
A 7-month-old boy with malignant rhabdoid tumor of the right lateral neck, status post resection and chemotherapy, underwent FDG PET/CT for restaging. The images showed diffuse increased activity in the spleen and in the bone marrow of the appendicular bones and the spine, which is related to hematopoietin administered after chemotherapy. The images also revealed intense activity in the region of sphenoid bone, which is not a common region to have elevated FDG activity. The subsequent MRI scan showed that this activity was due to not-yet-converted red marrow in the sphenoid bone in this pediatric patient.
Assuntos
Fluordesoxiglucose F18 , Osso Esfenoide/diagnóstico por imagem , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tumor Rabdoide/complicações , Tumor Rabdoide/diagnóstico por imagem , Tumor Rabdoide/patologia , Neoplasias Cranianas/complicações , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias Cranianas/patologia , Osso Esfenoide/patologiaRESUMO
OBJECTIVE: The aim of the present study was to determine the morphological differences in the base of the skull of individuals with cleft lip and palate and Class III malocclusion in comparison to control groups with Class I and Class III malocclusion. METHODS: A total of 89 individuals (males and females) aged between 5 and 27 years old (Class I, n = 32; Class III, n = 29; and Class III individuals with unilateral cleft lip and palate, n = 28) attending PUC-MG Dental Center and Cleft Lip/Palate Care Center of Baleia Hospital and PUC-MG (CENTRARE) were selected. Linear and angular measurements of the base of the skull, maxilla and mandible were performed and assessed by a single calibrated examiner by means of cephalometric radiographs. Statistical analysis involved ANCOVA and Bonferroni correction. RESULTS: No significant differences with regard to the base of the skull were found between the control group (Class I) and individuals with cleft lip and palate (P > 0.017). The cleft lip/palate group differed from the Class III group only with regard to CI.Sp.Ba (P = 0.015). Individuals with cleft lip and palate had a significantly shorter maxillary length (Co-A) in comparison to the control group (P < 0.001). No significant differences were found in the mandible (Co-Gn) of the control group and individuals with cleft lip and palate (P = 1.000). CONCLUSION: The present findings suggest that there are no significant differences in the base of the skull of individuals Class I or Class III and individuals with cleft lip and palate and Class III malocclusion.
Assuntos
Fenda Labial/patologia , Fissura Palatina/patologia , Má Oclusão Classe III de Angle/patologia , Base do Crânio/patologia , Adolescente , Adulto , Cefalometria/métodos , Criança , Pré-Escolar , Fenda Labial/complicações , Fissura Palatina/complicações , Arco Dental/patologia , Feminino , Humanos , Masculino , Má Oclusão Classe I de Angle/complicações , Má Oclusão Classe I de Angle/patologia , Má Oclusão Classe II de Angle/complicações , Má Oclusão Classe II de Angle/patologia , Má Oclusão Classe III de Angle/complicações , Mandíbula/patologia , Côndilo Mandibular/patologia , Maxila/patologia , Osso Nasal/patologia , Sela Túrcica/patologia , Osso Esfenoide/patologia , Adulto JovemAssuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Aspergilose/complicações , Pólipos Nasais/microbiologia , Rinite Alérgica/complicações , Sinusite/complicações , Osso Esfenoide/microbiologia , Doença Crônica , Rinite Alérgica/microbiologia , Sinusite/microbiologia , Osso Esfenoide/patologia , Tomografia Computadorizada por Raios XAssuntos
Aspergilose/complicações , Pólipos Nasais/microbiologia , Rinite Alérgica/complicações , Sinusite/complicações , Osso Esfenoide/microbiologia , Adolescente , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Rinite Alérgica/microbiologia , Sinusite/microbiologia , Osso Esfenoide/patologia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
The treatment of a transverse maxillary deficiency in skeletally mature individuals should include surgically assisted rapid palatal expansion. This study evaluated the distribution of stresses that affect the expander's anchor teeth using finite element analysis when the osteotomy is varied. Five virtual models were built and the surgically assisted rapid palatal expansion was simulated. Results showed tension on the lingual face of the teeth and alveolar bone, and compression on the buccal side of the alveolar bone. The subtotal Le Fort I osteotomy combined with intermaxillary suture osteotomy seemed to reduce the dissipation of tensions. Therefore, subtotal Le Fort I osteotomy without a step in the zygomaticomaxillary buttress, combined with intermaxillary suture osteotomy and pterygomaxillary disjunction may be the osteotomy of choice to reduce tensions on anchor teeth, which tend to move mesiobuccally (premolar) and distobuccally (molar).
Assuntos
Dente Pré-Molar/patologia , Análise de Elementos Finitos , Maxila/cirurgia , Dente Molar/patologia , Procedimentos de Ancoragem Ortodôntica/métodos , Técnica de Expansão Palatina , Adulto , Processo Alveolar/patologia , Fenômenos Biomecânicos , Simulação por Computador , Desenho Assistido por Computador , Suturas Cranianas/cirurgia , Humanos , Maxila/patologia , Osteotomia Maxilar/métodos , Modelos Biológicos , Osteotomia de Le Fort/métodos , Técnica de Expansão Palatina/instrumentação , Palato/patologia , Palato/cirurgia , Osso Esfenoide/patologia , Estresse Mecânico , Raiz Dentária/patologia , Interface Usuário-Computador , Zigoma/cirurgiaRESUMO
El foramen venoso es una estructura inconstante que se encuentra posterior al foramen redondo y medial al foramen oval, y da paso a una vena que anastomosa al plexo venoso pterigoideo con el seno cavernoso. La existencia de éste foramen puede ser motivo de complicaciones clínicas, entre ellas que es una potencial vía de acceso al seno cavernoso de trombos infectados y constituye una posible falsa vía durante la rizotomía percutánea del trigémino pudiendo puncionar la vena y ocasionar hematomas subdurales. Se utilizó la colección de cráneos del Departamento de Anatomía de la Facultad de Medicina UANL. Se observó la frecuencia y se midieron los siguientes parámetros del foramen: Ancho y largo; en la cara interna de la base del cráneo se midieron las distancias a: foramen redondo, foramen oval, plano sagital mediano y entre forámenes venosos; en la cara externa de la base del cráneo se midieron las distancias con: foramen oval, plano sagital medio y entre los forámenes venosos. Las medidas fueron llevadas a cabo por tres observadores distintos a través de medición directa con vernier y con microfotografías con escalas milimétricas. Se encontró una frecuencia del 20 por ciento con medidas medias de 1,66mm de largo, 1,06mm de ancho; en la cara interna de la base del cráneo: 11,31mm de distancia al foramen redondo, 4,13mm al foramen oval, 17,75mm al plano sagital medio y 31,91mm entre los forámenes; en la cara externa de la base: 2,50mm al foramen oval, 19,54mm al plano sagital medio y 36,05mm entre forámenes venoso. La distancia al foramen oval varía en la cara interna y la cara externa de la base del cráneo debido a un trayecto oblicuo del foramen que tiende a aproximarse al foramen oval y por tanto a separarse del plano sagital medio. Los forámenes derechos fueron generalmente más grandes.
Foramen venosum (foramen Vesalius) is an inconstant structure which is located posterior to the foramen rotundum and medial to the foramen ovale, and it gives pace to an emissary vein that communicates the plexus pterigoideus and the sinus cavernosus. The existence of this anatomical structure can be of interest in certain procedures like percutaneous trigeminal rhizotomy where this foramen can be the cause of a false pathway and be punctured causing a subdural hematoma. It also can be an access to the sinus cavernosus for infected thrombus coming from dental and facial infections. For this study the skull collection of the Anatomy Department, Faculty of Medicine UANL, was used. We observed the frequency and measured the following parameters: Length and width; in the basis cranii we measured: Distances to the foramen rotundum, foramen ovale, planum medianum and between two foramina venosum (one on each side). In basis cranii externa we measured: distances to foramen ovale, planum medianum, and between two foramina venosum. Three independent observers blinded among them, measured the parameters using a Vernier and microphotographs with milimetrical scales. A 20 percent frequency was found and the following median measures: Length 1.66mm, width 1.06mm; basis cranii: distance to foramen rotundum 11.31mm, distance to foramen ovale 4.13mm, distance to planum medianum 17.75mm and 31.91mm between both foramina venosum. Basis cranii externa: distance to foramen ovale 2.49mm, distance to planum medianum 19.54mm and distance between foramenina venosum 36.05. The distance to the foramen ovale varies between basis cranii and basis cranii externa because the foramen has an oblique trajectory and it approximates to the foramen ovale (from superior to inferior) and separates from the planum medianum. It was found bilaterally only in one skull. There are differences between the left and right foramens, the latter being generally larger.
Assuntos
Humanos , Masculino , Feminino , Crânio/anatomia & histologia , Crânio/irrigação sanguínea , Forame Oval/anatomia & histologia , Forame Oval/patologia , Fossa Craniana Média/anatomia & histologia , Fossa Craniana Média/crescimento & desenvolvimento , Fossa Craniana Média/patologia , Osso Esfenoide/anatomia & histologia , Osso Esfenoide/patologia , México/etnologiaRESUMO
SUMMARY: The aim of this study was to compare the electromyographic (EMG) characteristics of masticatory muscles in children with either a skeletal or dentoalveolar open bite, compared with a control group (CG). Forty-five children (31 boys and 14 girls), aged 6-11 years, were included in the study, 15 with a skeletal anterior open bite (SAOB), 15 with a dentoalveolar anterior open bite (DAOB), and 15 with a normal occlusion (CG), defined by clinical evaluation and lateral cephalograms. EMG recordings of the temporal and masseter muscles were performed under maximal voluntary clenching and during chewing. Analysis of variance was used for inter-group analysis, followed by the Tukey post hoc test. A Student's t-test for paired data was used for intra-group analysis. There were statistically significant differences among the three groups (P < 0.05), with the mean EMG being highest in the CG and lowest in children with a SAOB. The percentage EMG activity during chewing in relation to that during maximal voluntary clenching was more than 100 per cent in the SAOB group. The CG and DAOB groups presented higher EMG activity during clenching compared with chewing (P < 0.001), as well as a greater difference between tasks. In the SAOB group, the neuromuscular system appeared to have a lower capacity to produce EMG activity according to the task, while that in the DAOB group suggests that their functional capacity during growth should also be carefully observed.
Assuntos
Eletromiografia , Músculo Masseter/fisiopatologia , Mordida Aberta/fisiopatologia , Músculo Temporal/fisiopatologia , Estudos de Casos e Controles , Cefalometria , Goma de Mascar , Criança , Feminino , Alimentos , Humanos , Masculino , Mandíbula/patologia , Mastigação/fisiologia , Contração Muscular/fisiologia , Osso Nasal/patologia , Mordida Aberta/classificação , Base do Crânio/patologia , Osso Esfenoide/patologiaRESUMO
PURPOSE: The aim of this study was to highlight the challenges for early diagnosis and the difficulties observed in surgical treatment of patients with transsphenoidal meningoencephalocele associated with cleft lip and/or palate. METHOD: We evaluated six male patients treated over the course of 4 years. Five patients presented encephalic herniation with nonfunctional brain tissue; one of these presented herniation of the pituitary gland and cerebral ventricles. RESULTS: All the patients received surgical treatment for the cleft lip and/or palate. Only one patient underwent repair of the meningoencephalocele, via nasal endoscopy. There were no postprocedural clinical or surgical complications. CONCLUSION: The tendency is to avoid neurosurgery, opting for periodic follow-up with magnetic resonance imaging. In the presence of cleft palate, palatoplasty is essential to protect the meningoencephalocele.
Assuntos
Encefalocele/diagnóstico , Encefalocele/cirurgia , Meningocele/diagnóstico , Meningocele/cirurgia , Osso Esfenoide/cirurgia , Fenda Labial/diagnóstico , Fenda Labial/patologia , Fenda Labial/cirurgia , Fissura Palatina/diagnóstico , Fissura Palatina/patologia , Fissura Palatina/cirurgia , Encefalocele/patologia , Endoscopia , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningocele/patologia , Osso Esfenoide/patologia , Resultado do TratamentoRESUMO
BACKGROUND: Acromegaly is an excessive GH secretion, which in most cases, is caused by a pituitary GH-secreting adenoma. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The aim of this retrospective study is to evaluate the results of transsphenoidal endoscopic surgery in a group of patients with intrasellar GH adenoma who were operated by a pituitary specialist surgeon. We shall then argue about the economical advantages, for the NHS of a developing country, between surgical and medical treatment. METHODS: We have analyzed data from 33 patients with intrasellar GH tumor who had been referred to the neuroendocrine department of the HGF, Brazil. The patients underwent a transsphenoidal endoscopic adenomectomy for acromegaly between 2000 and 2005. Their ages were between 20 and 67 years (mean, 44 years) at the moment of surgery. No cavernous sinus invasion was present. Follow-up was a median of 2 years (range, 12 months-6 years). RESULTS: All 33 patients had intrasellar adenoma, 84.84% of patients achieved remission by surgery. One patient was operated twice and reached hormonal normalization. Five patients still had the disease and refused a second surgery. A treatment with octreotide was started for these 5 patients and resulted in an adequate control of GH and IGF-1 levels. No patients had radiotherapy. CONCLUSION: Our patients, with intrasellar GH tumor, operated by a pituitary specialist neurosurgeon had remission rates approaching those obtained by most specialized neurosurgical centers worldwide. For equal results, our study shows that the surgical treatment is the best issue for the patient and for the NHS.
Assuntos
Adenoma/cirurgia , Endoscopia/estatística & dados numéricos , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Sela Túrcica/cirurgia , Osso Esfenoide/cirurgia , Adenoma/patologia , Adenoma/fisiopatologia , Adulto , Idoso , Antineoplásicos Hormonais/uso terapêutico , Brasil , Análise Custo-Benefício , Países em Desenvolvimento , Endoscopia/economia , Endoscopia/métodos , Feminino , Adenoma Hipofisário Secretor de Hormônio do Crescimento/patologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Octreotida/uso terapêutico , Avaliação de Resultados em Cuidados de Saúde/métodos , Radiografia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/patologia , Especialização/economia , Especialização/estatística & dados numéricos , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/patologia , Falha de Tratamento , Resultado do Tratamento , Adulto JovemRESUMO
Introdução: Condroblastoma é uma rara neoplasia benigna cartilaginosa, altamente destrutiva, que caracteristicamente surge na epífise de ossos longos em pacientes jovens. Sua ocorrência é extremamente rara na base do crânio, normalmente ocorrendo no osso temporal. Objetivo: Descrever um raro caso de um paciente apresentando um condroblastoma de osso esfenóide que invadia a fossa média, submetido a ressecção cirúrgica com sucesso, sem recorrência após 2 anos. Relato do Caso: W.J.S., 37 anos, masculino, encaminhado ao ambulatório de otorrinolaringologia com otalgia persistente e de forte intensidade há 3 meses. Apresentava otoscopia normal e sem tumorações visíveis. Tomografia computadorizada evidenciou massa tumoral em fossa infra-temporal à esquerda, invadindo fossa cerebral média. Biópsia sugeria tumor de células gigantes. Realizada ressecção ampla por abordagem anterior via osteotomia orbito-zigomática. Durante a cirurgia, confirmando achados tomográficos, não foi encontrado envolvimento do osso temporal. Exame histopatológico evidenciou condroblastoma. Após 18 meses da cirurgia, não apresenta queixas, sem déficits motores, sensitivos ou de nervos cranianos e sem sinais tomográficos de recorrência. Conclusão: Destaca-se a importância do diagnóstico diferencial do condroblastoma nas lesões da base do crânio e sua abordagem terapêutica, cujo objetivo sempre deve ser a maior ressecção possível com a máxima preservação de função.
Introduction: Chondroblastoma is an uncommon cartilaginous benign neoplasm, highly destructive, which specifically appears in the epiphysis of long bones in young patients. Its occurrence is extremely rare in the cranial base, normally occurring in the temporal bone. Objective: To describe a rare case in a patient presenting with a sphenoid bone chondroblastoma that invaded the middle cranial cavity, submitted to a successful surgical resection, without recurrence after 2 years. Case Report: W.J.S, 37 years old, male, forwarded to the otorhinolaryngology service with persistent and strong otalgia for 3 months. He had normal otoscopy and without visible tumorations. The computerized tomography confirmed tumor mass in the left infra-temporal cavity, invading the middle cranial cavity. The biopsy suggested giant cells tumor. After wide resection by frontal approach via orbitozygomatic osteotomy. During the surgery, we confirmed tomographic statements and didn't find temporal bone involvement. The histopathological exam confirmed chondroblastoma. After 18 months after the surgery, he doesn't present with complaints, without motor, sensitive deficits or of cranial nerves and without recurrence tomographic signals. Conclusion: The importance of differential diagnosis of chondroblastoma is remarkable in the cranial base lesions and its therapeutic approach, whose objective must always be the major possible resection with the maximum function conservation.