Alterações na articulação emporomandibular (ATM) comumente geram desequilíbrios musculares que estão associados à alterações no tecido ósseo. Esta articulação pode sofrer a influência de traumas, fatores congênitos ou desordens de crescimento. Estudos sobre alterações de crescimento do complexo maxilomandibular decorrentes de problemas da ATM são escassos. O objetivo deste trabalho foi avaliar por meio da microtomografia os efeitos da remoção do disco articular e a remoção conjugada do disco e cartilagem articular no crescimento e na microarquitetura óssea da mandíbula de ratos. Trinta ratos da raça Wistar com um mês de idade foram divididos em três grupos: CTR (controle operado); RD (remoção de disco articular) e RDC (remoção conjugada do disco e cartilagem articular). Apenas o lado direito foi operado; o lado esquerdo permaneceu intacto. Após dois meses de acompanhamento, os ratos foram sacrificados e as hemimandíbulas escaneadas em microtomógrafo A remoção do disco articular e a remoção conjugada do disco e cartilagem articular alteram o volume e microestrutura do osso trabecular da mandíbula de ratos jovens. Estas duas intervenções provocaram uma queda na qualidade de parâmetros da microestrutura do trabeculado do processo angular e diminuição do crescimento da hemimandíbula do lado operado. / Changes in the temporomandibular joint (TMJ) lead to muscle dysfunctions that are associated with bone changes. This joint region can be influenced by trauma, congenital factors or growth disorders. Studies linking TMJ problems and growth alterations are scarce. The aim of this study was to evaluate the effects of the articular disc removal or articular disc and cartilage removal on the bone microarchitecture and mandibular growth of young rats. Thirty Wistar rats (one month old) were divided into three groups: CTR (sham operated); RD (disc removal) and RDC (disc and cartilage removal). Only the right side was operated, keeping the left side intact. After two months, the rats were sacrificed and the mandibles scanned on micro-CT for quantitative analysis. Some microstructural parameters were altered by the disc removal or disc and cartilage removal. The right side presented lower growth than the left side.

Alterações na articulação emporomandibular (ATM) comumente geram desequilíbrios musculares que estão associados à alterações no tecido ósseo. Esta articulação pode sofrer a influência de traumas, fatores congênitos ou desordens de crescimento. Estudos sobre alterações de crescimento do complexo maxilomandibular decorrentes de problemas da ATM são escassos. O objetivo deste trabalho foi avaliar por meio da microtomografia os efeitos da remoção do disco articular e a remoção conjugada do disco e cartilagem articular no crescimento e na microarquitetura óssea da mandíbula de ratos. Trinta ratos da raça Wistar com um mês de idade foram divididos em três grupos: CTR (controle operado); RD (remoção de disco articular) e RDC (remoção conjugada do disco e cartilagem articular). Apenas o lado direito foi operado; o lado esquerdo permaneceu intacto. Após dois meses de acompanhamento, os ratos foram sacrificados e as hemimandíbulas escaneadas em microtomógrafo A remoção do disco articular e a remoção conjugada do disco e cartilagem articular alteram o volume e microestrutura do osso trabecular da mandíbula de ratos jovens. Estas duas intervenções provocaram uma queda na qualidade de parâmetros da microestrutura do trabeculado do processo angular e diminuição do crescimento da hemimandíbula do lado operado. / Changes in the temporomandibular joint (TMJ) lead to muscle dysfunctions that are associated with bone changes. This joint region can be influenced by trauma, congenital factors or growth disorders. Studies linking TMJ problems and growth alterations are scarce. The aim of this study was to evaluate the effects of the articular disc removal or articular disc and cartilage removal on the bone microarchitecture and mandibular growth of young rats. Thirty Wistar rats (one month old) were divided into three groups: CTR (sham operated); RD (disc removal) and RDC (disc and cartilage removal). Only the right side was operated, keeping the left side intact. After two months, the rats were sacrificed and the mandibles scanned on micro-CT for quantitative analysis. Some microstructural parameters were altered by the disc removal or disc and cartilage removal. The right side presented lower growth than the left side.

Background. The treatment of patients born with cleft lip and palate has been gradually modified over the years as the surgical procedures have developed and improved. Multidisciplinary team care has evolved and provided improved care with enhanced results. Clefts in the alveolus can be reconstructed by alveolar bone grafting or by periosteoplasty. The main goal is to repair and close the alveolar cleft and create a continuous alveolar processes so that the teeth can erupt. Aims. This thesis has several aims: to investigate the impact of dental status and initial cleft width on the outcome of Secondary alveolar bone grafting (SABG) in patients born with unilateral cleft lip and palate (UCLP) at the 10-year follow-up (Studies I and II); to compare the outcomes of primary periosteoplasty (PPP) with those of SABG in patients born with unilateral cleft lip and alveolus (CLA) (Study III); to evaluate clinical and radiographic conditions and identify factors important for the final treatment outcomes after SABG ( Study IV); to evaluate two radiographic methods, i.e. occlusal radiographs and cone beam tomography (CBCT)) for assessing alveolar bone height ( study IV). Results. In UCLP patients, SABG achieved excellent results in terms of bone height; tended to reduce with time, correlated with dental status and dental restoration factors. Occlusal radiographs correspond well with the CBCT, for evaluating alveolar bone height in cleft area. The width of the initial cleft does not seem to affect the success of SABG. Finally, patients with CLA treated with PPP at the time of lip repair have inferior bone formation outcomes in the cleft area compared with patients treated with SABG at the time of mixed dentition. Conclusion.  Poor dental status and malpositioning negatively affect the long-term survival of bone in the alveolar cleft. The initial cleft width affects certain dental status factors. In adults with UCLP, the alveolar bone height in the cleft was correlated to the presence of gingival inflammation and restorations at 20 years follow-up. Specially designed maintenance therapy is beneficial, after complex dental restorations in the cleft area. SABG is preferred to PPP for the reconstruction of alveolar clefts.

Introduction : La croissance maxillo-mandibulaire des enfants avec une séquence de Pierre Robin (SPR) est controversée dans la littérature. Certains auteurs croient que la croissance mandibulaire est accélérée après la naissance, mais peu se sont penchés sur la croissance du maxillaire supérieur. Cette étude rétrospective sur dossier vise à analyser la croissance maxillo-mandibulaire des enfants atteints de la SPR. Dans un deuxième temps, nous aurions aimé évaluer la sévérité et l’évolution de l’apnée du sommeil en lien avec la croissance des maxillaires, mais un manque de données a empêché l’atteinte de cet objectif. Matériel et méthode : Les dossiers médicaux et orthodontiques de 93 patients (82 volet apnée et 40 volet croissance) du CHU Ste-Justine avec une SPR isolée ont été révisés puis comparés au groupe contrôle composé d’enfants normaux de l’Université du Michigan. L’analyse statistique de modèle mixte pour mesures répétées de même que celle de Brunner-Langer furent effectuées. Résultats : L’évaluation orthodontique a montré un changement statistiquement significatif pour la relation molaire droite, la présence de chevauchement et de diastème au maxillaire et le surplomb vertical. L’analyse des données céphalométriques nous montre que le maxillaire supérieur, la branche montante et le corps de la mandibule sont tous réduits par rapport à la normale. Ce dernier montre une diminution significative avec l’âge (p = 0,03). L’angle gonial, le SNA, SNB, ANB, l’angle de convexité faciale et l’inclinaison de l’incisive supérieure par rapport à FH sont tous normaux. Par contre, on remarque une augmentation statistiquement significative de cette dernière avec l’âge (p = 0,04). L’angle Y est augmenté tandis que les hauteurs faciales supérieure (HFS) et inférieure (HFI) sont diminuées bien que cette dernière montre une tendance à s’approcher de la normale avec l’âge (p ≤ 0,001). Discussion : Les dimensions des maxillaires sont similaires à plusieurs études. En ce qui concerne la mandibule, la croissance est soit plus lente, soit diminuée. Cette observation est plus marquée lorsque l’on s’approche du pic de croissance puisque l’écart par rapport à la normale s’agrandit. On voit une tendance à la croissance hyperdivergente qui pourrait expliquer l’augmentation de la HFI avec l’âge. Le fait que SNA et SNB soient dans la normale pourrait s’expliquer par une diminution de la longueur de la base crânienne. Conclusion : Il n’y a pas de rattrapage de croissance maxillaire et mandibulaire. Les maxillaires restent micrognathes quoique proportionnels l’un envers l’autre et le profil est convexe tout au long de la croissance. La comparaison des données céphalométriques et des traitements orthodontiques avec ceux des patients présentant une fente palatine isolée devrait se faire sous peu. Nous n’avons pas été en mesure d’atteindre nos objectifs concernant l’apnée du sommeil. Une étude prospective serait à prévoir pour y arriver. / Introduction: Maxillo-mandibular growth in children with Pierre Robin sequence (PRS) is controversial in the literature. Some authors believe that mandibular growth is accelerated after birth, but few have looked at the growth of the maxilla. This retrospective study aims to analyze the maxillo-mandibular growth in children with PRS. Secondly, we would have liked to assess the severity and evolution of sleep apnea related to the growth of the jaws, but a lack of data prevented the achievement of this objective. Materials and Methods: The medical and orthodontic records of 93 patients (82 apnea, 40 growth) of the CHU Ste-Justine with isolated PRS were reviewed and compared to the control group composed of normal children of the University of Michigan. The mixed model repeated measures statistical analysis as well as that of Brunner-Langer was performed. Results: Orthodontic evaluation showed a statistically significant change in the right molar relationship, the presence of crowding and diastema in the maxilla and the overbite. Analysis of cephalometric radiographs shows that the upper jaw, the ramus and body of the mandible are reduced compared to normal values. The latter shows a significant decrease with age (p = 0,03). The gonial angle, SNA, SNB, ANB, facial convexity angle and inclination of the upper incisor compared with FH are all normal. However, the latter is significantly increased with age (p = 0,04). The Y axis is increased while the upper and lower facial heights (UFH, LFH) are reduced although the latter shows a tendency to normalize with age (p ≤ 0,001). Discussion: Maxillary dimensions are similar to several studies. With regard to the mandible, the growth is either slower or decreased. This observation was more pronounced when approaching the peak of growth since the deviation from the normal enlarges. We see a growth trend hyperdivergent, which could explain the normalization of the LFH. The fact that SNA and SNB are in normal limits could be explained by a decrease in the length of the cranial base. Conclusion: There is no catch up growth either for the maxilla or the mandible. Both jaws remain smaller than normal and the profile stays convexe throughout growth. Comparison of cephalometric data and orthodontic treatments with patients presenting an isolated cleft palate should be done shortly. We have not been able to achieve our goals for sleep apnea. A prospective study would be expected to get there.

Indivíduos com fissura labiopalatina apresentam características craniofaciais que os diferenciam da população em geral. A proposta desta pesquisa foi, por meio de radiografias cefalométricas póstero-anteriores, estudar as dimensões transversais totais da face e as assimetrias esqueléticas faciais horizontais em indivíduos portadores de fissura labiopalatina unilateral completa. Utilizou-se neste estudo 34 radiografias cefalométricas póstero-anteriores, de indivíduos com fissura labiopalatina unilateral completa, já submetidos às cirurgias primárias e sem tratamento ortodôntico prévio. A amostra foi composta de 14 do gênero feminino e 20 do masculino, divididos igualmente pela lateralidade da fissura, com média de idade de 9 anos e 8 meses. As mensurações transversais totais e as hemifaciais foram realizadas por meio da demarcação de 5 pares de pontos bilaterais, correspondendo às mensurações em largura facial superior (Lo-Lo’), bizigomática (ZZ’), nasal (Cn-Cn’), maxilar (J-J’) e mandibular (Ag-Ag’). Para a análise das dimensões transversais totais da face suas mensurações foram comparadas aos valores normativos existentes na literatura especializada. A assimetria facial foi verificada tomando-se o lado sem fissura como controle e comparado-o com o lado fissurado. Ambas as análises consideraram a lateralidade da fissura e o gênero, Pode-se concluir que , as dimensões transversais totais da face destes indivíduos apresentaram-se maiores em relação às normas clínicas correspondentes, independente da lateralidade da fissura. Não existiram diferenças significantes nas mensurações entre os grupos com fissura à direita e à esquerda. O gênero masculino apresentou, em média, mensurações maiores que o feminino. Houve tendência do lado fissurado ser maior que o não fissurado, particularmente quanto à largura nasal. O gênero masculino apresentou menor tendência de assimetria, independente da lateralidade da fissura. O melhor entendimento das alterações do padrão de crescimento facial e das suas particularidades torna-se imprescindível para que o indivíduo com fissura labiopalatina alcance os melhores resultados estéticos, funcionais e psíquicos. / Individuals with cleft lip and palate present craniofacial characteristics that differentiate them from the general population. The aim of this research was to study, through frontal cephalometric radiographies, total facial transverse dimensions and the skeletal horizontal asymmetries in complete cleft lip and palate individuals. Thirty four frontal cephalometric radiographies obtained from complete cleft lip and palate individuals were used in this study and individuals were previously submitted toprimary surgery but not submitted to previous orthodontic treatment. The sample was constituted by 14 female and 20 male individuals, equally divided according to the cleft laterality, mean age of 9 years-old and 8 months. Total transverse and hemifacial measures were accomplished demarcating five pairs of bilateral points, corresponding to superior facial width (Lo-Lo'), bizygomatic (Z-Z'), nasal (Cn-Cn'), maxillary (J-J') and mandibular (Ag-Ag') measures. Total transverse dimensions were analyzed by comparison to existent normative values in the specialized literature. The facial asymmetry was verified by comparison with the non-cleft side used as control side. Both analyses considered cleft laterality and gender. In conclusion, the total transverse facial dimensions of these individuals were larger in relation to the corresponding clinical norms, independent of the cleft laterality. There were no significant statistical differences in the measurements between groups with right or left cleft. Measurements in male individuals were larger than the ones verified in females. There was tendency cleft side larger than control side, in particular for the nasal width. Male individuals presented smaller asymmetry tendency, independent on cleft laterality. A better understanding of the alterations in facial growth pattern and about their particularities it becomes indispensable to better aesthetic, functional and psychic results in cleft lip and palate individuals.

Indivíduos com fissura labiopalatina apresentam características craniofaciais que os diferenciam da população em geral. A proposta desta pesquisa foi, por meio de radiografias cefalométricas póstero-anteriores, estudar as dimensões transversais totais da face e as assimetrias esqueléticas faciais horizontais em indivíduos portadores de fissura labiopalatina unilateral completa. Utilizou-se neste estudo 34 radiografias cefalométricas póstero-anteriores, de indivíduos com fissura labiopalatina unilateral completa, já submetidos às cirurgias primárias e sem tratamento ortodôntico prévio. A amostra foi composta de 14 do gênero feminino e 20 do masculino, divididos igualmente pela lateralidade da fissura, com média de idade de 9 anos e 8 meses. As mensurações transversais totais e as hemifaciais foram realizadas por meio da demarcação de 5 pares de pontos bilaterais, correspondendo às mensurações em largura facial superior (Lo-Lo’), bizigomática (ZZ’), nasal (Cn-Cn’), maxilar (J-J’) e mandibular (Ag-Ag’). Para a análise das dimensões transversais totais da face suas mensurações foram comparadas aos valores normativos existentes na literatura especializada. A assimetria facial foi verificada tomando-se o lado sem fissura como controle e comparado-o com o lado fissurado. Ambas as análises consideraram a lateralidade da fissura e o gênero, Pode-se concluir que , as dimensões transversais totais da face destes indivíduos apresentaram-se maiores em relação às normas clínicas correspondentes, independente da lateralidade da fissura. Não existiram diferenças significantes nas mensurações entre os grupos com fissura à direita e à esquerda. O gênero masculino apresentou, em média, mensurações maiores que o feminino. Houve tendência do lado fissurado ser maior que o não fissurado, particularmente quanto à largura nasal. O gênero masculino apresentou menor tendência de assimetria, independente da lateralidade da fissura. O melhor entendimento das alterações do padrão de crescimento facial e das suas particularidades torna-se imprescindível para que o indivíduo com fissura labiopalatina alcance os melhores resultados estéticos, funcionais e psíquicos. / Individuals with cleft lip and palate present craniofacial characteristics that differentiate them from the general population. The aim of this research was to study, through frontal cephalometric radiographies, total facial transverse dimensions and the skeletal horizontal asymmetries in complete cleft lip and palate individuals. Thirty four frontal cephalometric radiographies obtained from complete cleft lip and palate individuals were used in this study and individuals were previously submitted toprimary surgery but not submitted to previous orthodontic treatment. The sample was constituted by 14 female and 20 male individuals, equally divided according to the cleft laterality, mean age of 9 years-old and 8 months. Total transverse and hemifacial measures were accomplished demarcating five pairs of bilateral points, corresponding to superior facial width (Lo-Lo'), bizygomatic (Z-Z'), nasal (Cn-Cn'), maxillary (J-J') and mandibular (Ag-Ag') measures. Total transverse dimensions were analyzed by comparison to existent normative values in the specialized literature. The facial asymmetry was verified by comparison with the non-cleft side used as control side. Both analyses considered cleft laterality and gender. In conclusion, the total transverse facial dimensions of these individuals were larger in relation to the corresponding clinical norms, independent of the cleft laterality. There were no significant statistical differences in the measurements between groups with right or left cleft. Measurements in male individuals were larger than the ones verified in females. There was tendency cleft side larger than control side, in particular for the nasal width. Male individuals presented smaller asymmetry tendency, independent on cleft laterality. A better understanding of the alterations in facial growth pattern and about their particularities it becomes indispensable to better aesthetic, functional and psychic results in cleft lip and palate individuals.

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