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.

Introdução: As patologias que afetam a articulação temporomandibular (ATM) compõem um grupo heterogêneo e são genericamente conhecidas como desordens temporomandibulares (DTM). Nos casos de patologias proliferativas ou ablativas nesta articulação, há indicação de intervenção cirúrgica. As técnicas de reconstrução da articulação temporomandibular são indicadas quando há destruição parcial ou completa dos tecidos articulares. A técnica de artroplastia biconvexa de Puricelli propõe a reconstrução da ATM por meio da instalação de duas superfícies convexas de polimetilmetacrilato, manipuladas durante o ato cirúrgico. Uma das superfícies é localizada na parede posterior e superior da fossa mandibular e a outra no segmento mandibular, ficando as duas superfícies convexas em contato entre si em um ponto. A técnica proposta por Puricelli em 1995 tem sido aplicada em pacientes desde o ano de 1978, apresentando sucesso clínico nos casos operados. Objetivos: Os autores buscam avaliar a técnica do ponto de vista de seu controle radiográfico, desempenho funcional, e do efeito de sua realização sobre o peso corpóreo, por meio de sua aplicação em um modelo animal. A amplitude máxima dos movimentos de abertura bucal e a lateralidade bilateral da mandíbula foram medidas e comparadas entre os diferentes tempos e grupos do estudo. A avaliação macroscópica e radiográfica da estabilidade das superfícies convexas de polimetilmetacrilato na ATM reconstruída foi verificada nos diferentes períodos pós-operatórios. A avaliação do peso dos animais foi realizada por meio da comparação entre o peso corpóreo pré-operatório e nos diferentes períodos pós-operatórios. Metodologia: Foi realizado um estudo experimental em modelo animal, controlado e parcialmente cego. A técnica de artroplastia biconvexa de Puricelli foi realizada na ATM esquerda de ovelhas. O grupo controle foi composto por quatro animais, dois para cada tempo do estudo. O grupo teste, o qual foi submetido à técnica, foi composto por dez animais, cinco para cada tempo do estudo. O projeto utilizou quatorze animais. Foram realizadas análises de estabilidade da reconstrução, da funcionalidade articular e do peso em dois tempos pós-operatórios, 45 e 90 dias. Resultados: Em todos os animais submetidos à técnica de artroplastia biconvexa de Puricelli, a reconstrução da ATM apresentou estabilidade macroscópica e radiográfica nos períodos pós-operatórios avaliados. Nos grupos teste (T45 e T90) e controle (C45) não se observou diferença estatística quanto à amplitude da abertura bucal máxima e lateralidade esquerda quando comparado nos três tempos avaliados (T0= pré-operatório, T1= pós-operatório imediato e T2= pós-operatório mediato previamente à morte). Na avaliação da amplitude do movimento de lateralidade direita, nos grupos teste (T45 e T90) houve diferença estatística entre os tempos T0 (33,6 ± 6,3) e T2 (23,0 ± 3,2), bem como entre os tempos T1 (37,2 ± 3,7) e T2 (23,0 ± 3,2), observando-se um p<0,001. Não houve diferença estatística entre os grupos T45, C45, T90 e C90, quanto à amplitude de abertura bucal e lateralidade esquerda nos diferentes deltas avaliados (T1-T0 e T2-T0). A variável amplitude de lateralidade direita apresentou diferença estatística no delta (pós-operatório mediato previamente à morte – préoperatório) entre os grupos T45 (-10,60 ± 4,67) e C45 (2,50 ± 2,12), bem como entre T90 (-13,00 ± 3,56) e C45(2,50 ± 2,12). O delta T1-T0 não apresentou diferenças significativas entre os grupos na variável analisada. Não houve diferença significativa na comparação entre a média do peso no período pré-operatório (T0) e a média do peso no período pós-operatório (T2) nos grupos T45, C45 e T90, bem como quando calculado o delta da subtração T2-T0, na comparação intragrupo. Conclusões: A reconstrução da articulação temporomandibular por meio da técnica de artroplastia biconvexa de Puricelli apresenta estabilidade macroscópica e radiográfica, não interfere na manutenção da amplitude dos movimentos de abertura bucal e lateralidade esquerda, reduz a amplitude dos movimentos de lateralidade direita sem interferência na função alimentar, e não interfere na manutenção do peso corpóreo nos períodos pós-operatórios avaliados. / Introduction: The diseases that affect the temporomandibular joint (TMJ) are a heterogeneous group and are generically known as temporomandibular disorders (TMD). In cases of proliferative or ablative articular diseases, there is indication for surgical treatment. The techniques for reconstruction of the temporomandibular joint are indicated when there is partial or complete destruction of articular tissues. The Puricelli’s biconvenx arthroplasty technique proposes the reconstruction of the TMJ through the installation of two convex surfaces of polymethylmethacrylate manipulated during surgery. One of the surfaces is located in the posterior face and above the mandibular fossa and the other in the mandibular segment, being the two convex surfaces in contact with each other at one point. The technique proposed by Puricelli in 1995 has been applied in patients since the year 1978, with clinical success in the operated cases. Objectives: The authors intent to evaluate the technique by the point of view of their imaging control features, performance, and the effect of its implementation on body weight, through its application in animal model. The maximum amplitude of the movements of mouth opening and lateral jaw bilaterally were measured and compared between different periods and study groups. The macroscopic stability and imaging of the convex surfaces of polymethylmethacrylate reconstructed TMJ was evaluated at different postoperative periods. The evaluation of the animals' body weight was performed by comparing the preoperative measure and in different postoperative periods. Methodology: We conducted an experimental study in animal model, controlled, partially blinded. The Puricelli’s biconvenx arthroplasty technique was performed in the left TMJ of the sheep. The control group consisted of four animals, two for each study period. The test group, which underwent the technique consisted of ten animals, five for each study period. The project used fourteen animals. Analyses of reconstruction stability, articular functionality, and body weight were conducted in two days postoperatively, 45 and 90 days. Results: In all test animals, TMJ reconstruction was stable in macroscopic and radiographic postoperative periods evaluated. In the test (T45 and T90) and control groups (C45) was not observed statistical difference in the extent of mouth opening and maximum left lateral movement when compared in the three evaluated times (T0 = preoperative, T1 = immediate postoperative period and T2 = mediate post-surgery prior to death). In assessing the extent of the right lateral movement in the test group (T45 and T90) there was statistical difference betweenT0 (33.6 ± 6.3) and T2 (23.0 ± 3.2), and between T1 (37.2 ± 3.7) and T2 (23.0 ± 3.2), observing a p <0.001. There was no statistical difference between groups T45, C45, C90 and T90, as to the extent of mouth opening and left laterality assessed in different deltas (T1-T0 and T0-T2). The variable amplitude of right lateral presented a statistical difference in the delta (postoperative mediate prior to death - preoperative) between the T45 (-10.60 ± 4.67) and C45 and between T90 (-13.00 ± 3.56) and C45 (2.50 ± 2.12). The delta (T1-T0) showed no significant differences between groups on the analyzed variable. There was no significant difference between the average weight in the preoperative period (T0) and average weight in the postoperative period (T2) in groups T45, T90 and C45, as well as when calculated the variation of the delta T2-T0 in intragroup comparison. Conclusions: The temporomandibular joint reconstruction by using the Puricelli`s biconvex arthroplasty technique has macroscopic and radiographic stability, does not interfere with maintenance of range of motion to open the mouth and left lateral movement, reduces the amplitude of the right lateral movements without interfering with the feeding function and not interfere with the maintenance of body weight in the postoperative periods evaluated, when performed in the left TMJ of the sheep.

Introdução: As patologias que afetam a articulação temporomandibular (ATM) compõem um grupo heterogêneo e são genericamente conhecidas como desordens temporomandibulares (DTM). Nos casos de patologias proliferativas ou ablativas nesta articulação, há indicação de intervenção cirúrgica. As técnicas de reconstrução da articulação temporomandibular são indicadas quando há destruição parcial ou completa dos tecidos articulares. A técnica de artroplastia biconvexa de Puricelli propõe a reconstrução da ATM por meio da instalação de duas superfícies convexas de polimetilmetacrilato, manipuladas durante o ato cirúrgico. Uma das superfícies é localizada na parede posterior e superior da fossa mandibular e a outra no segmento mandibular, ficando as duas superfícies convexas em contato entre si em um ponto. A técnica proposta por Puricelli em 1995 tem sido aplicada em pacientes desde o ano de 1978, apresentando sucesso clínico nos casos operados. Objetivos: Os autores buscam avaliar a técnica do ponto de vista de seu controle radiográfico, desempenho funcional, e do efeito de sua realização sobre o peso corpóreo, por meio de sua aplicação em um modelo animal. A amplitude máxima dos movimentos de abertura bucal e a lateralidade bilateral da mandíbula foram medidas e comparadas entre os diferentes tempos e grupos do estudo. A avaliação macroscópica e radiográfica da estabilidade das superfícies convexas de polimetilmetacrilato na ATM reconstruída foi verificada nos diferentes períodos pós-operatórios. A avaliação do peso dos animais foi realizada por meio da comparação entre o peso corpóreo pré-operatório e nos diferentes períodos pós-operatórios. Metodologia: Foi realizado um estudo experimental em modelo animal, controlado e parcialmente cego. A técnica de artroplastia biconvexa de Puricelli foi realizada na ATM esquerda de ovelhas. O grupo controle foi composto por quatro animais, dois para cada tempo do estudo. O grupo teste, o qual foi submetido à técnica, foi composto por dez animais, cinco para cada tempo do estudo. O projeto utilizou quatorze animais. Foram realizadas análises de estabilidade da reconstrução, da funcionalidade articular e do peso em dois tempos pós-operatórios, 45 e 90 dias. Resultados: Em todos os animais submetidos à técnica de artroplastia biconvexa de Puricelli, a reconstrução da ATM apresentou estabilidade macroscópica e radiográfica nos períodos pós-operatórios avaliados. Nos grupos teste (T45 e T90) e controle (C45) não se observou diferença estatística quanto à amplitude da abertura bucal máxima e lateralidade esquerda quando comparado nos três tempos avaliados (T0= pré-operatório, T1= pós-operatório imediato e T2= pós-operatório mediato previamente à morte). Na avaliação da amplitude do movimento de lateralidade direita, nos grupos teste (T45 e T90) houve diferença estatística entre os tempos T0 (33,6 ± 6,3) e T2 (23,0 ± 3,2), bem como entre os tempos T1 (37,2 ± 3,7) e T2 (23,0 ± 3,2), observando-se um p<0,001. Não houve diferença estatística entre os grupos T45, C45, T90 e C90, quanto à amplitude de abertura bucal e lateralidade esquerda nos diferentes deltas avaliados (T1-T0 e T2-T0). A variável amplitude de lateralidade direita apresentou diferença estatística no delta (pós-operatório mediato previamente à morte – préoperatório) entre os grupos T45 (-10,60 ± 4,67) e C45 (2,50 ± 2,12), bem como entre T90 (-13,00 ± 3,56) e C45(2,50 ± 2,12). O delta T1-T0 não apresentou diferenças significativas entre os grupos na variável analisada. Não houve diferença significativa na comparação entre a média do peso no período pré-operatório (T0) e a média do peso no período pós-operatório (T2) nos grupos T45, C45 e T90, bem como quando calculado o delta da subtração T2-T0, na comparação intragrupo. Conclusões: A reconstrução da articulação temporomandibular por meio da técnica de artroplastia biconvexa de Puricelli apresenta estabilidade macroscópica e radiográfica, não interfere na manutenção da amplitude dos movimentos de abertura bucal e lateralidade esquerda, reduz a amplitude dos movimentos de lateralidade direita sem interferência na função alimentar, e não interfere na manutenção do peso corpóreo nos períodos pós-operatórios avaliados. / Introduction: The diseases that affect the temporomandibular joint (TMJ) are a heterogeneous group and are generically known as temporomandibular disorders (TMD). In cases of proliferative or ablative articular diseases, there is indication for surgical treatment. The techniques for reconstruction of the temporomandibular joint are indicated when there is partial or complete destruction of articular tissues. The Puricelli’s biconvenx arthroplasty technique proposes the reconstruction of the TMJ through the installation of two convex surfaces of polymethylmethacrylate manipulated during surgery. One of the surfaces is located in the posterior face and above the mandibular fossa and the other in the mandibular segment, being the two convex surfaces in contact with each other at one point. The technique proposed by Puricelli in 1995 has been applied in patients since the year 1978, with clinical success in the operated cases. Objectives: The authors intent to evaluate the technique by the point of view of their imaging control features, performance, and the effect of its implementation on body weight, through its application in animal model. The maximum amplitude of the movements of mouth opening and lateral jaw bilaterally were measured and compared between different periods and study groups. The macroscopic stability and imaging of the convex surfaces of polymethylmethacrylate reconstructed TMJ was evaluated at different postoperative periods. The evaluation of the animals' body weight was performed by comparing the preoperative measure and in different postoperative periods. Methodology: We conducted an experimental study in animal model, controlled, partially blinded. The Puricelli’s biconvenx arthroplasty technique was performed in the left TMJ of the sheep. The control group consisted of four animals, two for each study period. The test group, which underwent the technique consisted of ten animals, five for each study period. The project used fourteen animals. Analyses of reconstruction stability, articular functionality, and body weight were conducted in two days postoperatively, 45 and 90 days. Results: In all test animals, TMJ reconstruction was stable in macroscopic and radiographic postoperative periods evaluated. In the test (T45 and T90) and control groups (C45) was not observed statistical difference in the extent of mouth opening and maximum left lateral movement when compared in the three evaluated times (T0 = preoperative, T1 = immediate postoperative period and T2 = mediate post-surgery prior to death). In assessing the extent of the right lateral movement in the test group (T45 and T90) there was statistical difference betweenT0 (33.6 ± 6.3) and T2 (23.0 ± 3.2), and between T1 (37.2 ± 3.7) and T2 (23.0 ± 3.2), observing a p <0.001. There was no statistical difference between groups T45, C45, C90 and T90, as to the extent of mouth opening and left laterality assessed in different deltas (T1-T0 and T0-T2). The variable amplitude of right lateral presented a statistical difference in the delta (postoperative mediate prior to death - preoperative) between the T45 (-10.60 ± 4.67) and C45 and between T90 (-13.00 ± 3.56) and C45 (2.50 ± 2.12). The delta (T1-T0) showed no significant differences between groups on the analyzed variable. There was no significant difference between the average weight in the preoperative period (T0) and average weight in the postoperative period (T2) in groups T45, T90 and C45, as well as when calculated the variation of the delta T2-T0 in intragroup comparison. Conclusions: The temporomandibular joint reconstruction by using the Puricelli`s biconvex arthroplasty technique has macroscopic and radiographic stability, does not interfere with maintenance of range of motion to open the mouth and left lateral movement, reduces the amplitude of the right lateral movements without interfering with the feeding function and not interfere with the maintenance of body weight in the postoperative periods evaluated, when performed in the left TMJ of the sheep.

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.

Introdução: As patologias que afetam a articulação temporomandibular (ATM) compõem um grupo heterogêneo e são genericamente conhecidas como desordens temporomandibulares (DTM). Nos casos de patologias proliferativas ou ablativas nesta articulação, há indicação de intervenção cirúrgica. As técnicas de reconstrução da articulação temporomandibular são indicadas quando há destruição parcial ou completa dos tecidos articulares. A técnica de artroplastia biconvexa de Puricelli propõe a reconstrução da ATM por meio da instalação de duas superfícies convexas de polimetilmetacrilato, manipuladas durante o ato cirúrgico. Uma das superfícies é localizada na parede posterior e superior da fossa mandibular e a outra no segmento mandibular, ficando as duas superfícies convexas em contato entre si em um ponto. A técnica proposta por Puricelli em 1995 tem sido aplicada em pacientes desde o ano de 1978, apresentando sucesso clínico nos casos operados. Objetivos: Os autores buscam avaliar a técnica do ponto de vista de seu controle radiográfico, desempenho funcional, e do efeito de sua realização sobre o peso corpóreo, por meio de sua aplicação em um modelo animal. A amplitude máxima dos movimentos de abertura bucal e a lateralidade bilateral da mandíbula foram medidas e comparadas entre os diferentes tempos e grupos do estudo. A avaliação macroscópica e radiográfica da estabilidade das superfícies convexas de polimetilmetacrilato na ATM reconstruída foi verificada nos diferentes períodos pós-operatórios. A avaliação do peso dos animais foi realizada por meio da comparação entre o peso corpóreo pré-operatório e nos diferentes períodos pós-operatórios. Metodologia: Foi realizado um estudo experimental em modelo animal, controlado e parcialmente cego. A técnica de artroplastia biconvexa de Puricelli foi realizada na ATM esquerda de ovelhas. O grupo controle foi composto por quatro animais, dois para cada tempo do estudo. O grupo teste, o qual foi submetido à técnica, foi composto por dez animais, cinco para cada tempo do estudo. O projeto utilizou quatorze animais. Foram realizadas análises de estabilidade da reconstrução, da funcionalidade articular e do peso em dois tempos pós-operatórios, 45 e 90 dias. Resultados: Em todos os animais submetidos à técnica de artroplastia biconvexa de Puricelli, a reconstrução da ATM apresentou estabilidade macroscópica e radiográfica nos períodos pós-operatórios avaliados. Nos grupos teste (T45 e T90) e controle (C45) não se observou diferença estatística quanto à amplitude da abertura bucal máxima e lateralidade esquerda quando comparado nos três tempos avaliados (T0= pré-operatório, T1= pós-operatório imediato e T2= pós-operatório mediato previamente à morte). Na avaliação da amplitude do movimento de lateralidade direita, nos grupos teste (T45 e T90) houve diferença estatística entre os tempos T0 (33,6 ± 6,3) e T2 (23,0 ± 3,2), bem como entre os tempos T1 (37,2 ± 3,7) e T2 (23,0 ± 3,2), observando-se um p<0,001. Não houve diferença estatística entre os grupos T45, C45, T90 e C90, quanto à amplitude de abertura bucal e lateralidade esquerda nos diferentes deltas avaliados (T1-T0 e T2-T0). A variável amplitude de lateralidade direita apresentou diferença estatística no delta (pós-operatório mediato previamente à morte – préoperatório) entre os grupos T45 (-10,60 ± 4,67) e C45 (2,50 ± 2,12), bem como entre T90 (-13,00 ± 3,56) e C45(2,50 ± 2,12). O delta T1-T0 não apresentou diferenças significativas entre os grupos na variável analisada. Não houve diferença significativa na comparação entre a média do peso no período pré-operatório (T0) e a média do peso no período pós-operatório (T2) nos grupos T45, C45 e T90, bem como quando calculado o delta da subtração T2-T0, na comparação intragrupo. Conclusões: A reconstrução da articulação temporomandibular por meio da técnica de artroplastia biconvexa de Puricelli apresenta estabilidade macroscópica e radiográfica, não interfere na manutenção da amplitude dos movimentos de abertura bucal e lateralidade esquerda, reduz a amplitude dos movimentos de lateralidade direita sem interferência na função alimentar, e não interfere na manutenção do peso corpóreo nos períodos pós-operatórios avaliados. / Introduction: The diseases that affect the temporomandibular joint (TMJ) are a heterogeneous group and are generically known as temporomandibular disorders (TMD). In cases of proliferative or ablative articular diseases, there is indication for surgical treatment. The techniques for reconstruction of the temporomandibular joint are indicated when there is partial or complete destruction of articular tissues. The Puricelli’s biconvenx arthroplasty technique proposes the reconstruction of the TMJ through the installation of two convex surfaces of polymethylmethacrylate manipulated during surgery. One of the surfaces is located in the posterior face and above the mandibular fossa and the other in the mandibular segment, being the two convex surfaces in contact with each other at one point. The technique proposed by Puricelli in 1995 has been applied in patients since the year 1978, with clinical success in the operated cases. Objectives: The authors intent to evaluate the technique by the point of view of their imaging control features, performance, and the effect of its implementation on body weight, through its application in animal model. The maximum amplitude of the movements of mouth opening and lateral jaw bilaterally were measured and compared between different periods and study groups. The macroscopic stability and imaging of the convex surfaces of polymethylmethacrylate reconstructed TMJ was evaluated at different postoperative periods. The evaluation of the animals' body weight was performed by comparing the preoperative measure and in different postoperative periods. Methodology: We conducted an experimental study in animal model, controlled, partially blinded. The Puricelli’s biconvenx arthroplasty technique was performed in the left TMJ of the sheep. The control group consisted of four animals, two for each study period. The test group, which underwent the technique consisted of ten animals, five for each study period. The project used fourteen animals. Analyses of reconstruction stability, articular functionality, and body weight were conducted in two days postoperatively, 45 and 90 days. Results: In all test animals, TMJ reconstruction was stable in macroscopic and radiographic postoperative periods evaluated. In the test (T45 and T90) and control groups (C45) was not observed statistical difference in the extent of mouth opening and maximum left lateral movement when compared in the three evaluated times (T0 = preoperative, T1 = immediate postoperative period and T2 = mediate post-surgery prior to death). In assessing the extent of the right lateral movement in the test group (T45 and T90) there was statistical difference betweenT0 (33.6 ± 6.3) and T2 (23.0 ± 3.2), and between T1 (37.2 ± 3.7) and T2 (23.0 ± 3.2), observing a p <0.001. There was no statistical difference between groups T45, C45, C90 and T90, as to the extent of mouth opening and left laterality assessed in different deltas (T1-T0 and T0-T2). The variable amplitude of right lateral presented a statistical difference in the delta (postoperative mediate prior to death - preoperative) between the T45 (-10.60 ± 4.67) and C45 and between T90 (-13.00 ± 3.56) and C45 (2.50 ± 2.12). The delta (T1-T0) showed no significant differences between groups on the analyzed variable. There was no significant difference between the average weight in the preoperative period (T0) and average weight in the postoperative period (T2) in groups T45, T90 and C45, as well as when calculated the variation of the delta T2-T0 in intragroup comparison. Conclusions: The temporomandibular joint reconstruction by using the Puricelli`s biconvex arthroplasty technique has macroscopic and radiographic stability, does not interfere with maintenance of range of motion to open the mouth and left lateral movement, reduces the amplitude of the right lateral movements without interfering with the feeding function and not interfere with the maintenance of body weight in the postoperative periods evaluated, when performed in the left TMJ of the sheep.

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.

Past studies evaluating the esthetics of orthodontic treatment have been done using 2-D images. New 3-D imaging offers an improved, real-life representation of a subject. The purpose of this study was to determine how laypeople perceived differences in lip position (flat versus ideal lip fullness) in 2-D compared to 3-D. 3dMD images of 8 Caucasian subjects were adjusted to an ideal and flat lip position in 3-D and then in 2-D from the profile view. 2 surveys were created with paired ideal and flat images on the screen, either in 2-D or 3-D, and evaluators were asked to choose which image they preferred and by how much. Evaluators were more likely to be neutral, and were less decisive of their preference in 3-D compared to 2-D. People might be less sensitive to small differences in facial soft tissue and esthetics than previous research in 2-D has led orthodontists to believe.

Les chirurgies de l'os mandibulaire peuvent modifier la position anatomique des disques et des condyles de l'articulation temporo-mandibulaire (ATM). Les modifications de contraintes qui en résultent peuvent être à l'origine d'une dislocation temporaire ou permanente du disque et peuvent provoquer des dysfonctionnements s'exprimant par des douleurs buccales et faciales. L'objectif de ce travail était de prévoir les modifications de contraintes dans l'articulation temporo-mandibulaire (ATM) après un protocole de distraction symphysaire mandibulaire (DS). Ce traitement chirurgical sert à traiter les encombrements dentaires de la mandibule.De manière à étudier l'impact d'une telle intervention au niveau de l'ATM, nous avons fait le choix de réaliser un modèle d'approche numérique de mastication par éléments finis. Les données géométriques ont été obtenues à partir de l'imagerie scanner et IRM d'un patient dont les composants de l'ATM ont été maillés. La chirurgie de distraction symphysaire a été réalisée sur le modèle avec un élargissement de 10 mm dans la région médiane de la mandibule. La géométrie et le maillage du cal osseux ont été reconstruits. Le cal osseux a été caractérisé par un module d'élasticité correspondant à l'os consolidé pour prédire l'effet biomécanique à long terme de la DS. Pour simuler une fermeture de la mâchoire, les conditions aux limites ont été appliquées au modèle sous la forme de vecteurs de force. Les champs de contraintes de von Mises dans les deux disques et condyles ont été analysés et comparés avant et après la DS. Contrairement aux approches habituellement menées, le modèle proposé est complet et ne contient pas de symétrie, de manière à mettre en évidence d'éventuelles asymétries dans la répartition des contraintes. La répartition des contraintes était proche dans les disques et sur les surfaces condyliennes dans les modèles avant et après distraction. Les résultats de cette étude suggèrent que les changements anatomiques des structures de l'ATM ne prédisposent pas à une fatigue des tissus. La DS n'exposerait donc pas au risque de dysfonction des ATM et de symptômes cliniques. / Mandibular surgery such as distraction osteogenesis can generate anatomical modifications in the temporomandibular joint (TMJ) discs. The resulting stress modifications can be at the origin of a temporary or permanent disc dislocation with degeneration and may cause severe oral and facial pain or masticatory dysfunctions. The aim of this work was to predict stress modification in the temporomandibular joint (TMJ) after mandibular symphyseal distraction (SD). This surgical procedure is used to resolve dental crowding on the mandibular dental arch.In order to study the potential impact of such a surgery on TMJ discs a three-dimensional finite element analysis of a complete mastication model was performed. Geometric data were obtained from MRI and CT scans of a healthy male patient and each component was meshed individually. The distraction was performed on the model with a 10 mm expansion after simulation of a surgical vertical osteotomy line in the mandibular midline region. The geometry and mesh of the bone callus were generated. The bone callus was modeled as a strengthened region characterized by a Young's modulus corresponding to consolidated bone to predict the long-term biomechanical effect of SD. Boundary conditions for jaw closing simulations were represented by different jaw muscle load directions. The von Mises stress distributions in both joint discs and condyles during closing conditions were analyzed and compared before and after SD. Contrary to usual analyses, no symmetry was used, and the whole mandible was analyzed in order to exhibit potential asymmetries. Stress distribution was similar in discs and on condylar surfaces in the pre- and post-distraction models. The outcomes of this study suggest that anatomical changes in TMJ structures should not predispose to long-term tissue fatigue and demonstrate the absence of clinical permanent TMJ symptoms after SD.

Virtual surgery planning systems have demonstrated great potential to help surgeons achieve a better functional and aesthetic outcome for the patient, and at the same time reduce time in the operating room resulting in considerable cost savings. However, the two-dimensional tools employed in these systems today, such as a mouse and a conventional graphical display, are difficult to use for interaction with three-dimensional anatomical images. Therefore surgeons often outsource virtual planning which increases cost and lead time to surgery. Haptics relates to the sense of touch and haptic technology encompasses algorithms, software, and hardware designed to engage the sense of touch. To demonstrate how haptic technology in combination with stereo visualization can make cranio-maxillofacial surgery planning more efficient and easier to use, we describe our haptics-assisted surgery planning (HASP) system. HASP supports in-house virtual planning of reconstructions in complex trauma cases, and reconstructions with a fibula osteocutaneous free flap including bone, vessels, and soft-tissue in oncology cases. An integrated stable six degrees-of-freedom haptic attraction force model, snap-to-fit, supports semi-automatic alignment of virtual bone fragments in trauma cases. HASP has potential beyond this thesis as a teaching tool and also as a development platform for future research. In addition to HASP, we describe a surgical bone saw simulator with a novel hybrid haptic interface that combines kinesthetic and vibrotactile feedback to display both low frequency contact forces and realistic high frequency vibrations when a virtual saw blade comes in contact with a virtual bone model.  We also show that visuo-haptic co-location shortens the completion time, but does not improve the accuracy, in interaction tasks performed on two different visuo-haptic displays: one based on a holographic optical element and one based on a half-transparent mirror.  Finally, we describe two prototype hand-worn haptic interfaces that potentially may expand the interaction capabilities of the HASP system. In particular we evaluate two different types of piezo-electric motors, one walking quasi-static motor and one traveling-wave ultrasonic motor for actuating the interfaces.

Les techniques de chirurgie assistée par ordinateur suscitent depuis quelques années un vif intérêt, depuis l’aide au diagnostic jusqu’à l’intervention chirurgicale elle-même, en passant pas les prises de décision. Dans ce but, l’Analyse par Éléments Finis (AEF) du comportement de modèles biomécaniques tridimensionnels est une des méthodes numériques les plus utilisées et les plus efficaces. Cependant, la fiabilité des solutions de l’AEF dépend fortement de la qualité et de la finesse de la représentation des organes sous la forme de maillages d'éléments finis (MEF). Or la génération de tels maillages peut être extrêmement longue et exigeante en ressources computationnelles, car il est nécessaire de procéder à l’extraction précise de la géométrie de l’organe-cible à partir d’images médicales avant de recourir à des algorithmes sophistiqués de maillage. Confrontés à ces enjeux, certains travaux se sont attachés à éviter la procédure de maillage en exploitant des méthodes fondées pour chaque patient sur la déformation géométrique d’un maillage défini sur un sujet de référence, dit « Atlas ». Mais ces méthodes nécessitent toujours une description géométrique précise de l’organe-cible du patient, sous la forme de contours, de modèles surfaciques tridimensionnels ou d’un ensemble de points de référence. Dans ce contexte, le but de la thèse est de développer une méthodologie de conception automatique de maillages « patient-spécifiques », basée sur un Atlas, mais évitant cette étape de segmentation de la géométrie de l’organe-cible du patient. Dans une première partie de la thèse, nous proposons une méthode automatique qui, dans une première phase, procède au recalage volumétrique de l'image anatomique de l’Atlas sur celle du patient, afin d’extraire la transformation géométrique permettant de passer de l’Atlas au patient, puis, dans une seconde phase, déforme le maillage de l’Atlas et l’adapte au patient en lui appliquant cette transformation. Le processus de recalage est conçu de telle manière que la transformation géométrique préserve la régularité et la haute qualité du maillage. L’évaluation de notre méthode, à savoir l'exactitude du processus de recalage inter-sujets, s’est faite en deux étapes. Nous avons d’abord utilisé un ensemble d’images CT de la cage thoracique, en accès libre. Puis nous avons exploité des données IRM de la langue que nous avons recueillies pour deux sujets sains et deux patients souffrant de cancer de la langue, en condition pré- et post-opératoire.Dans une seconde partie, nous développons une nouvelle méthode, toujours basée sur un Atlas, qui exploite à la fois l'information fournie par les images anatomiques et celle relative à la disposition des fibres musculaires telles qu’elle est décrite par imagerie par résonance magnétique du tenseur de diffusion (RM-DT). Cette nouvelle démarche s’appuie ainsi, d’abord sur le recalage anatomique proposé dans notre première méthode, puis sur l’identification et le recalage d’un ensemble de faisceaux de fibres musculaires qui seront ensuite intégrés aux maillages « patient-spécifiques ». Contrairement aux techniques usuelles de recalage d’images RM-DT, qui impliquent pour chaque image la réorientation des tenseurs de diffusion soit au cours de l'estimation de la transformation géométrique, soit après celle-ci, notre technique ne nécessite pas cette réorientation et recale directement les faisceaux de fibres de l’Atlas sur ceux du patient. Notre démarche est très importante, car la détermination et l’identification précises de toutes les sous-structures musculaires nécessiteraient une intervention manuelle pour analyser des milliers, voire des millions, de fibres, qui sont grandement influencées par les limitations et aux distorsions inhérentes aux images RM-DT et aux techniques de tractographie des fibres. L’efficacité de notre méthodologie est démontrée par son évaluation sur un ensemble d’images IRM et RM-DT de la langue d’un sujet. / During the last years, there has been considerable interest in using computer-aided medical design, diagnosis, and decision-making techniques that are rapidly entering the treatment mainstreams. Finite Element Analysis (FEA) of 3D models is one of the most popular and efficient numerical methods that can be utilized for solving complex problems like deformation of soft tissues or orthopedic implant designs/configurations. However, the accuracy of solutions highly depends upon the quality and accuracy of designed Finite Element Meshes (FEMs). The generation of such high-quality subject/patient-specific meshes can be extremely time consuming and labor intensive as the process includes geometry extraction of the target organ and meshing algorithms. In clinical applications where the patient specifiity has to be taken into account via the generation of adapted meshes these problems become methodological bottlenecks. In this context, various studies have addressed these challenges by bypassing the meshing phase by employing atlas-based frameworks using the deformation of an atlas FE mesh. However, these methods still rely on the geometrical description of the target organ, such as contours, 3D surface models, or a set of land-marks.In this context, the aim of this thesis is to investigate how registration techniques can overcome these bottlenecks of atlas-based approaches.We first propose an automatic atlas-based method that includes the volumetric anatomical image registration and the morphing of an atlas FE mesh. The method extracts a 3D transformation by registering the atlas' volumetric image to the subject's one. The subject-specific mesh is then generated by deforming a high-quality atlas FE mesh using the derived transformation. The registration process is designed is such a way to preserve the regularity and the quality of meshes for subsequent FEAs. A first step towards the evaluation of our approach, namely the accuracy of the inter-subject registration process, is provided using a data set of CT ribcage. Then, subject-specific tongue meshes are generated for two healthy subjects and two patients suffering from tongue cancer, in pre- and post-surgery conditions. In order to illustrate a tentative fully automatic process compatible with the clinical constraints, some functional consequences of a tongue surgery are simulated for one of the patients, where the removal of the tumor and the replacement of the corresponding tissues with a passive flap are modeled. With the extraction of any formal priorknowledge on the shape of the target organ and any meshing algorithm, high-quality subject-specific FE meshes are generated while subject’s geometrical properties are successfully captured.Following this method, we develop an original atlas-based approach that employs the information provided by the anatomical images and diffusion tensor imaging (DTI) based muscle fibers for the recognition and registration of fiber-bundles that can be integrated in the subject-specific FE meshes. In contrast to the DT MR images registration techniques that include reorientation of tensors within or after the transformation estimation, our methodology avoids this issue and directly aligns fiber-bundles. This also enables one to handel limited or distorted DTIs by deformation of an atlas fibers’ structure according to the most reliable and non-distorted subject’s ones. Such a manner becomes very important, since the classification and the determination of muscular sub-structures need manual intervention of thousands or millions of fibers for each subject, which are influenced by the limitations associated with the DTI image acquisition process and fiber tractography techniques. To evaluate the performance of our method in the recognition of subject’s fiber-bundles and accordingly in the deformation of the atlas ones, a simulated data set is utilized. In addition, feasibility of our method is demonstrated on acquired human tongue data set.