Ce travail étudie les corrélats cérébraux de l’adaptation de la parole et de la motricité oro-faciale après l’exérèse chirurgicale d’une tumeur intra-orale. Une attention particulière est portée à la recherche de corrélats révélant une redéfinition des buts de la tâche, une réorganisation de la coordination motrice, et une modification des représentations internes du système moteur.Trois tâches ont été étudiées : production de mouvements oro-faciaux silencieux ; production de voyelles ; production de syllabes. Les activités cérébrales ont été mesurées par IRM fonctionnelle au cours de 4 sessions, en pré-opératoire, puis 1 mois, 3 mois et 9 mois après la chirurgie. Onze patients et onze sujets sains ont été enregistrés. Pour les patients, trois types de données informant sur leur récupération motrice ont été acquis aux mêmes périodes : données praxiques ; signal acoustique de parole ; auto-évaluation de la qualité de parole. Trois analyses statistiques ont été menées sur les données cérébrales : (1) une analyse « cerveau entier » sur les amplitudes des activations ; (2) une analyse de la localisation de l’activation principale dans le cortex moteur primaire ; (3) une analyse en régions d’intérêt dans le réseau cérébral de la parole, via un modèle linéaire général dans lequel le facteur Groupe (Patients/Sains) a été remplacé par une covariable continue, l’« Indice d’Adaptation Motrice » ou « IAM », mesurant le niveau de dégradation de la parole, puis son amélioration dans les mois suivants l’opération. Les effets et les interactions des facteurs Groupe (ou IAM), Session et Tâche sur la variable dépendante ont ainsi été mesurés. Toutes tâches et toutes sessions confondues, les patients se distinguent des sujets sains par une activité cérébrale plus faible dans les zones sensori-motrices oro-faciales. Des effets de la session sont observés pour toutes les tâches, pour les patients et les sujets sains. Seules les tâches de motricité silencieuse et de production des voyelles révèlent des effets de la session sur l’activité cérébrale significativement différents pour les patients et les sujets sains. Ainsi, pour la motricité silencieuse, 1 mois après l’opération, les patients montrent, pour la tâche linguale, une forte activité dans le Lobule Pariétal Supérieur (LPS) et dans le Cortex Pré-Frontal Dorso-Latéral (CPFDL). Pour les voyelles, 3 mois après la chirurgie, l’activité cérébrale des patients décroît dans le cervelet et croît fortement dans le Lobule Pariétal Inférieur ; de 3 à 9 mois après la chirurgie, l’activité croît dans les zones motrices (Cortex Moteur Primaire et Aire Motrice Supplémentaire) et elle décroît dans le Gyrus Temporal Supérieur. Les patients montrent aussi 1 mois après l’opération, tous articulateurs confondus, une localisation plus dorsale de l’activité dans le Cortex Moteur Primaire. Pour des tâches motrices silencieuses, nos observations suggèrent que, immédiatement après l’opération, les patients pourraient réactualiser leur modèle interne du système moteur (activité dans le LPS), devenu imprécis, tout en ré-élaborant leurs stratégies de coordination (activité dans le CPFDL). Pour la production des voyelles, tâche plus complexe et plus précise, nos résultats suggèrent que 3 mois après l’opération, les patients utiliseraient moins les modèles internes devenus trop imprécis. Le retour à une activation forte dans les zones motrices 9 mois après l’intervention suggère que l’adaptation de la production des voyelles est quasiment achevée, et la baisse concomitante de l’activation dans le cortex auditif est cohérente avec l’hypothèse qu’il existerait de nouveau une adéquation entre la copie d’efférence auditive et le feedback auditif externe. Pour la production de syllabes, les résultats sont les moins pertinents parmi les 3 tâches. Une réorganisation plus tardive, au-delà de 9 mois, due à la plus grande complexité de la tâche, pourrait en être une explication potentielle. / This thesis investigates the cerebral correlates of the adaptation of speech production and orofacial motor skills after the exeresis of a tumor in the intraoral cavity. A special focus has been given to searching for correlates associated with a redefinition of the task’s goals, a reorganization of motor coordination, or a change in the internal representations of the peripheral motor system. Three tasks were investigated: non-audible oro-facial movements, vowel production, and syllable production. Brain activity was measured using fMRI longitudinally across 4 sessions: before surgery, and at 1, 3 and 9 months after surgery. Eleven patients and eleven healthy subjects were recorded. For the patients only, 3 additional kinds of data were collected in parallel to the fMRI, in order to assess, at each stage of the clinical process, the improvement of oro-facial motor skills: scores assessing orofacial praxis, acoustic speech signal, and a self-evaluation of speech production quality. Three statistical analyses were run on the fMRI data: (1) a “whole brain” analysis, which is based on brain activity amplitudes; (2) an analysis of the localization of the strongest activity in the primary motor cortex; (3) an analysis of Regions of Interest located in the speech production/perception cerebral network, using a General Linear Model. In this third analysis, the independent “Group” factor has been replaced by a continuous covariable, called “Motor Adaptation Index” (MAI), that quantitatively measures the degradation of speech production 1 month after surgery, and then its improvement in the subsequent months. The main effects of the “Group” (or MAI), “Session” and “Task” factors have been estimated, together with their interactions.All the tasks and all the sessions taken together, patients show significantly lower activity than healthy subjects in the orofacial sensorimotor regions. Significant main effects of the “Session” factor are also observed for all the tasks, for the patients as well as for the healthy subjects. Only non-audible motor tasks and vowel production tasks show for the “Session” factor effects that are significantly different for the patients and the healthy subjects. For non-audible lingual movements, 1 month after surgery, the patients show a high level of activity in the Superior Parietal Lobule (SPL) and DorsoLateral PreFrontal Cortex (DLPFC). For patients’ vowel production, 3 months after surgery activity decreases in the cerebellum and strongly increases in the Inferior Parietal Lobule (IPL), while from 3 to 9 months after surgery, the activity increases in the motor regions (Primary Motor Cortex, Supplementary Motor Area), and decreases in the Superior Temporal Gyrus (STG). In addition, 1 month after the surgery, patients show, for all tasks, Primary Motor Cortex activity located more dorsally than in the other sessions.For non-audible oro-facial motor tasks, our results suggest that immediately after surgery patients might have to re-tune their internal model of the peripheral motor system (SPL activity), which is no longer accurate, while redefining their coordination strategies (DLPFC activity). For vowel production, a more skilled and demanding task, stronger modifications of the patients’ internal model could be necessary 3 months after surgery. Nine months after surgery, the simultaneous increase of activity in the motor regions and decrease of activity in the STG suggest for vowel production that the adaptation has almost been achieved, with regained consistency between the efferent copy and auditory feedback. Syllable production tasks show no significant patient specific changes across sessions, possibly due to the greater complexity of the task as compared to the other two.

A proposta neste estudo foi avaliar as alterações da densidade ótica do osso alveolar perimplantar cervical em controle longitudinal, por meio de radiografias periapicais digitalizadas de dez pacientes, nos quais foram instalados seis implantes na maxila submetidos à função oclusal imediata, mediante a instalação de uma prótese fixa 24 horas após a cirurgia. Todos os pacientes foram avaliados clinicamente, com exames da análise da freqüência de ressonância, além de controle radiográfico. Foi utilizada a técnica radiográfica intrabucal do parale lismo, com cone longo, sendo que o feixe de raios X incidiu perpendicularmente ao longo eixo do implante. Os controles radiográficos foram realizados na instalação da prótese, após 6 meses e após 12 meses. As radiografias obtidas foram então capturadas por uma câmera de vídeo (preto e branco) por meio de um microscópio ótico (40 vezes de aumento). Devido à ampliação utilizada, os implantes tiveram suas imagens digitalizadas em 2 etapas (metade direita e metade esquerda), sendo consideradas como amostras independentes. Após a sobreposição de um gabarito sobre a imagem, com a finalidade padronizar as áreas a serem estudadas, foram analisadas as densidades óticas na área de interesse osso + implante e na área de controle implante (onde não é esperada alteração) por meio do software ImageLab. Para a correção de possíveis variações na densidade da radiografia e projeção geométrica oriundas da metodologia empregada, foi utilizada uma equação matemática para validar a análise dos dados obtidos. Os resultados mostraram que ocorreu variação percentual da densidade ótica na área de interesse (osso + implante) nos primeiros seis meses (T2) com diminuição de aproximadamente 5% para o lado direito e diminuição de aproximadamente 6% para o lado esquerdo em relação às radiografias iniciais (T1) e após doze meses, a diminuição da densidade ótica estabilizou-se, não sendo encontradas alterações estatisticamente significantes em relação ao período correspondente entre T2 (seis meses) e T3 (doze meses). Os resultados da análise digital das radiografias periapicais demonstraram coincidência com os resultados da análise da freqüência de ressonância e exame clínico dos implantes e demonstraram um aspecto compatível com o sucesso dos implantes osteointegrados com função imediata na maxila. / The aim in this study was the evaluation of the variations of the perimplantar optical bone density at the cervical region in a longitudinal control, by the use of digitized radiographs of ten patients, who received six implants installed in the maxilla and submitted to immediate occlusion function, through fixed prosthesis installed 24 hours after the surgery. All the patients were observed in clinical control, with resonance frequency analysis and also radiographic control. It was performed a intraoral radiograph using the paralleling technique, with the long cone and the beam of x-ray aimed perpendicular to the long axis of the implant. The radiographic controls were done at the time of the installation of the prosthesis, after six months and after twelve months after the first control. The obtained radiographs were captured by a black and white video camera by an optical microscope (40 times of magnification). Due to the utilized magnification, the implants have their images digitized in two steps: half right and half left, and they were considered as independent samples. After the superimposition of a standardized pattern, to help the standardization of the areas of the study, it was analyzed the optical density at the areas of interest bone + implant and at areas of control bone (where it is not hope changes) through the software ImageLab. To correct possible variations of the effect of the absence of standardization of the geometric projection and the radiographic density, it was realized a mathematic equation and it was obtained a correction factor of density in order to compensate. The results sho wed that there were percentage variation of the optical density at the area of interest (bone + implant) at six months (T2) showed a decreased of about 5% for the right side and showed a decreased of about 6% for the left side when analyzed the first control and after twelve months no significant statistical difference was observed between the T2 period (six months) and T3 period (twelve months). The results of digital analysis from the intraoral radiographs showed as the same as the results of resonance frequency analysis and the clinic examination of the implants and showed a success of implants installed in the maxilla with immediate occlusion function.

INTRODUÇÃO: A apnéia obstrutiva do sono (AOS) é caracterizada como uma doença crônica, progressiva, incapacitante, com alta morbidade e mortalidade cardiovascular, sendo causada pela obstrução dinâmica repetitiva da via aérea superior (VAS). As repercussões geram necessidade de tratamento. Dentre os tratamentos disponíveis e com efetividade comprovada, há a opção de uso dos aparelhos intraorais. Neste estudo, avaliou-se a eficácia de um tipo de aparelho intraoral (AIO) monobloco, assim como suas complicações e intercorrências em longo prazo, em hospital de ensino. MÉTODOS: 20 pacientes participaram do presente estudo. Foram incluídos pacientes com diagnóstico polissonográfico prévio de AOS leve ou moderada (5 >IAH< 30), com idade até 60 anos, e não obesos. O critério de exclusão foi para pacientes em uso de medicamentos psicotrópicos, não condição oral para suporte do AIO e IMC e idade acima do proposto. Após 60 dias de uso do AIO realizou-se nova polissonografia (PSG), e acompanhamento pelo questionário RDC/TMD e ficha clínica EDOF/HC basal, 60 e 180 dias. RESULTADOS: Dentre os 20 pacientes, 11 eram do sexo masculino e nove do sexo feminino, com média de idade de 51 anos, e a média do IMC foi de 27,76. O índice de apnéia e hipopnéia (IAH) apresentou decréscimo de 19,23 para 7,51 eventos/hora de sono (p= 0,001). O eixo I e II do RDC/TMD não apresentou alterações significativas nos três momentos avaliados, porém o eixo II mostrou que os pacientes desta amostra apresentam maior grau de sintomas físicos e depressivos do que o padrão. CONCLUSÕES: No período estudado houve redução significativa do índice de apnéia e hipopnéia com o uso do aparelho intra-oral monobloco e foi eficaz total ou parcialmente no tratamento de 80% dos pacientes. As complicações não foram homogêneas e mostraram-se transitórias. / INTRODUCTION: Obstructive sleep apnea (OSA) is characterized as a chronic, progressive, disabling condition with high cardiovascular morbidity and mortality, and with repetitive episodes of upper airway (UA) obstruction. Its impact generates need for treatment. Among the treatments available and with demonstrated effectiveness, there is the option of using the oral appliances. In this study, we evaluated the effectiveness of a type of monoblock oral appliance (OA), as well as its complications and long-term complications in teaching hospital. METHODS: 20 patients participated in this study. We included patients with polysomnographic diagnosis of OSA prior mild or moderate (5> AHI <30), aged up to 60 years and not obese. The exclusion criteria were patients using psychotropic drugs, not oral condition to support the AIO and BMI and age above proposed. After 60 days of use of OA underwent a polysomnography (PSG) exam and follow-up by clinical record EDOF/HC and questionnaire RDC/TMD at baseline, 60 and 180 days. RESULTS: 11 male and nine female, mean age 51 years, and mean BMI was 27.76. The apnea-hypopnea index (AHI) showed a decrease of 19.23 to 7.51 events/hour of sleep (p = 0.001). Axis I and II of the RDC / TMD was not significantly changed in the three moments, but the axis II showed that patients in this sample have a higher degree of physical symptoms and depression than the standard. CONCLUSIONS: Oral appliance therapy for obstructive sleep apnea over the period reduced significantly the AHI and was totally or partially effective in treating 80% of patients. Complications were not homogeneous and were transient.

No description available.

For woodwind and brass performers, intraoral pressure is the measure of force exerted on the surface area of the oral cavity by the air transmitted from the lungs. This pressure is the combined effect of the volume of air forced into the oral cavity by the breathing apparatus and the resistance of the embouchure, reed opening, and instrument’s back pressure. Recent research by Michael Adduci shows that intraoral pressures during oboe performance can exceed capabilities for corresponding increases in sound output, suggesting a potentially hazardous situation for the development of soft tissue disorders in the throat and velopharyngeal insufficiencies. However, considering that oboe back pressure is perhaps the highest among the woodwind instruments, this problem may or may not occur in other woodwinds. There has been no research of this type for the other woodwind instruments. My study was completed to expand the current research by comparing intraoral pressure (IOP) and sound pressure when performing with a characteristic tone on oboe, clarinet, flute, bassoon, and saxophone. The expected results should show that, as sound pressure levels increase, intraoral pressure will also increase. The subjects, undergraduate and graduate music majors at the University of North Texas, performed a series of musical tasks on bassoon, clarinet, flute, oboe, and alto saxophone. The musical tasks cover the standard ranges of each instrument, differences between vibrato and straight-tone, and a variety of musical dynamics. The data was collected and examined for trends. The specific aims of this study are to (1) determine whether there is a correlation between IOP and sound pressure, (2) shed light on how well each instrument responds to rapid fluctuation, and (3) determine which instruments are most efficient when converting air pressure into sound output. Results of this study raised concerns shared by previous studies – that woodwind players are potentially causing harm to their oropharynx by inaccurately perceiving intraoral pressure needed to achieve a characteristic sound. Evidence found by this study suggests that while oboists generate high intraoral pressure for relatively little sound output (a fact corroborated by past studies), the same cannot be said for all of the woodwind instruments, particularly the flute.

No description available.

Ziel: Die Grundlage einer erfolgreichen Insertion dentaler Implantate ist neben dem klinischen Befund die adäquate radiologische Darstellung des geplanten Insertionsortes. Ziel dieser Studie war die Evaluation der Darstellbarkeit von enossalen Implantaten und benachbarten Strukturen mit der Flächendetektor- Volumencomputertomographie (fpVCT) im Vergleich zu derzeit klinisch anwendbaren radiologischen Verfahren in der Zahnmedizin. Methodik: Es wurden insgesamt 14 in Schweinekieferproben inserierte enossale Implantate und die umgebenden Strukturen mit einem Prototyp eines fpVCT untersucht. Die erhobenen Befunde wurden mit intraoralem Zahnfilm (ZF), Orthopantomographie (OPG) und Digitaler Volumentomographie (DVT) verglichen. Ergebnisse: Bei der Erhebung der Daten waren die 3D-Verfahren den 2D-Verfahren aufgrund der überlagerungsfreien Darstellung deutlich überlegen. Die Implantate und periimplantären anatomischen Strukturen, nebst Knochen- und Implantatdefekten und Fremdmaterial, ließen sich mit der fpVCT adäquat detektieren. Die Knochen- und Implantatdefekte konnten hinsichtlich ihrer genauen Lokalisation, Größendimension und Beziehung zu umliegenden Strukturen sehr detailliert beschrieben werden. Differenzierte Aussagen über Art, Anzahl und Größe verschiedener Fremdmaterialien waren möglich. Distanzmessungen ließen sich präzise ausführen. Die genaue Beurteilung von Zahnschmelz, Dentin, Pulpa und dem Parodontalspalt war möglich. Gegenüber in der Klinik etablierten DVT kann bei Verwendung von Flachbilddetekoren zur computertomographischen Bildgebung eine deutlich höhere räumliche Auflösung bis zu 200 μm (bei 10% MTF) erreicht werden. Der Zahnfilm hingegen ermöglicht durch seine hohe Ortsauflösung ebenso eine präzise Darstellung im Mikrometerbereich, stellt nachteilig jedoch wie ein OPG zweidimensionale Summationsdatenbilder dar. Sowohl Zahnfilm als auch OPG gehen vorteilig mit einer deutlich geringeren Strahlenbelastung für den Patienten bei deutlich höherer Verfügbarkeit einher. Im Vergleich von DVT und fpVCT kommt es bei der fpVCT zu geringeren Einschränkungen der Bildauswertung durch Streustrahlenartefakte. Allerdings ist derzeit aufgrund fehlender lokaler Strahlenapplikation eine klinische Anwendung noch nicht möglich. Schlussfolgerung: Die vorliegende Studie zeigt, dass die fpVCT die präzise zerstörungsfreie dreidimensionale Darstellung von Zahnimplantaten und periimplantären Strukturen ermöglicht.

Describe la frecuencia de tipo de reborde residual alveolar según la clasificación de Seibert asociado a edad e historia de uso previo o no de prótesis completa. Estudio descriptivo, observacional y transversal, la muestra está conformada por 30 pacientes. Mediante examen clínico intraoral se registra la información obtenida en una ficha de recolección de datos. Es analizado mediante estadística descriptiva, aplicando el paquete estadístico SPSS 21.0. De los resultados se concluye que el reborde alveolar residual tipo 2 de Seibert es el que más se presenta en la muestra. La reabsorción del reborde alveolar residual aumenta en pacientes de edad avanzada y un factor que influye es la prótesis dental. / Tesis