La rhinosinusite chronique (RSC) est une maladie avec une haute prévalence au Canada et des impacts économiques et individuels importants. Une des options thérapeutiques dans l’algorithme complexe de traitement est la chirurgie endoscopique des sinus (CES), qui est préconisée chez les patients qui ont une réponse insatisfaisante à la thérapie médicale. Le présent mémoire porte sur les critères minimaux nécessaires à l’atteinte du succès en matière de CES. Dans un premier temps, une consultation d’experts en RSC Canadiens provenant de 12 institutions nous a permis d’offrir des définitions du succès acceptable ainsi que du succès optimal du point de vue des prestataires de santé. Dans un deuxième temps, une étude auprès de 22 patients souffrant de RSC nous a permis d’identifier les thèmes importants qui doivent guider le processus décisionnel collaboratif. La première étude a permis de conclure qu’une définition du succès post-opératoire en CES se doit de comporter 2 composantes : un aspect objectif (endoscopie nasale) et un aspect subjectif (test d’issues mesurées par le patient ou questionnaire spécifique). Selon les experts, pour parler de succès optimal il faut une résolution complète des symptômes ainsi qu’un résultat endoscopique parfait. La deuxième étude a permis de démontrer que les patients accordent beaucoup plus d’importance à la résolution du symptôme cardinal qui les a amenés à consulter. Cette dernière étude a également permis une exploration plus large des objectifs et attentes, ainsi que de l’expérience patient en ce qui a trait à la RSC et à la CES. En conclusion, l’évaluation des aspects subjectifs devrait être l’aspect le plus important que les cliniciens évaluent pour parler de succès. Une évaluation de la cavité nasale et des sinus devrait complémenter cette évaluation environ 3 mois après la chirurgie. Ce mémoire inclus des algorithmes pour aider les cliniciens dans l’évaluation du succès opératoire après une CES. / Chronic rhinosinusitis (CRS) is a prevalent, complex disease with important economic and individual impacts. Functional endoscopic sinus surgery (FESS) is widely used treatment for CRS, which is considered in patients with an unsatisfactory response to maximal medical therapy. This thesis examines the different ways clinicians may obtain feedback with regards to post-operative success and aims to offer definitions of acceptable success and optimal success. First, a consultation of Canadian experts in CRS from 12 institutions permitted us to construct definitions of acceptable and optimal success from healthcare providers’ viewpoint. Second, a study in collaboration with 22 patients suffering from CRS allowed us to identify key themes which will facilitate the inclusion of primary stakeholders in shared decision-making. The first study allowed us to conclude that a definition of postoperative success must be based on 2 components: an objective aspect (nasal endoscopy) and a subjective aspect (patient-reported outcome measure or specific questionnaire). According to experts, optimal success requires a complete resolution of symptoms as well as a perfect endoscopic result. With the second study, we demonstrated that patients tend to focus on the resolution of their cardinal symptom. This last study also allowed us to widely explore patients’ objectives and expectations, as well as their experience with CRS and FESS. In conclusion, subjective aspects should be the most important determinants of success after FESS. In addition, an evaluation of the nasal cavity and sinuses should complement the subjective evaluation approximately 3 months after surgery. This thesis includes algorithms to aid clinicians in evaluating the outcome of FESS for patients with CRS.

No description available.

Les lanceurs spatiaux sont soumis à un certain nombre d’excitations complexes durant les différentes phases de vie du produit. Ces excitations sont transmises à la charge utile par voie solidienne ou aérienne. Pour assurer la protection de la charge utile, l’architecture du lanceur étant figée au début du projet, l’amélioration des comportements dynamiques passe par l’introduction de systèmes secondaires. La partie essentielle des travaux de thèse est donc consacrée à l’implantation optimale de systèmes capables de diminuer les réponses vibratoires en utilisant des modèles adaptés. C’est pourquoi une méthode de double synthèse modale est mise en place, permettant ainsi de calculer la réponse vibratoire de la structure à l’aide de bases réduites et offrant des performances améliorées par rapport aux méthodes classiques. L’ajout d’un dispositif amortissant local nécessite la prise en compte d’une ou plusieurs modifications structurales dans le modèle, une méthode dédiée est alors développée. Le choix du dissipateur se porte sur un dissipateur frottant. Un prototype est conçu et réalisé. Il est dans un premier temps caractérisé seul et le modèle de comportement identifié est un modèle constitué d’un ressort en série avec un patin ; la loi de frottement adaptée est une loi de Coulomb simple. En parallèle, une maquette représentative du dernier étage d’un lanceur est dimensionnée et réalisée. Le frotteur est alors monté en pied de propulseur de la maquette et permet une diminution significative des vibrations de la charge utile au passage du mode de propulseur. / Space launchers undergo a certain amount of complex excitations during their lifecycle. These excitations are transmitted to the payload in a structure-born or air-born way. To improve the dynamic behaviour and thus ensure the protection of the payload, secondary systems must be added to the launcher – indeed, the architecture of the launcher is fixed at the beginning of the project. The essential part of this thesis work is dedicated to the optimal fitting of a system capable of reducing the vibration response of the payload, using appropriate models. Therefore a double modal synthesis method is implemented, allowing to calculate the vibrational response of the structure with reduced bases and offering improved performances over conventional methods. The addition of a local damping device requires the consideration of one or more structural modifications in the model, a dedicated method is thus developped along with a specific continuation algorithm. A friction damper is retained, a prototype is designed and built. It is first characterized alone ; the identified behaviour is that of a spring in series with a dry friction element, a simple Coulomb friction law enables to reproduce the experimental curves. A scale model of the launcher’s last stage is designed and built. The friction device is then mounted inside the scale model and leads to a significant reduction of the payload vibration levels.

Introdução: O estudo dos fatores clínicos associados ao prognóstico da rinossinusite crônica (rsc), seja associada à polipose nasossinusal (RSCcPN) ou não (RSCsPN), ainda é pouco abordado a longo prazo. Objetivo: Avaliar pacientes submetidos à ESS (cirurgia endoscópica nasal, do inglês endoscopic sinus surgery) para o tratamento de RSC no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, entre 1996 e 2006, e correlacionar a recidiva em longo prazo com parâmetros como a extensão da doença, atopia, tabagismo, asma, eosinofilia e doença respiratória exacerbada pela aspirina (DREA). Métodos: Duzentos e um pacientes foram seguidos por um período médio de 12 anos. Os dados clínicos foram levantados, assim como exames de endoscopia nasal, Tomografia Computadorizada (TC), exames séricos, prick test e prova de função pulmonar. O tempo de seguimento pós-operatório foi analisado, sendo considerado fator de mau prognóstico a indicação de novo procedimento cirúrgico. Foi realizada comparação entre os fatores pela curva de Kaplan-Meyer, e pós-teste de Log-rank. Resultados e Discussão: Pacientes com RSCcPN tiveram chance de nova cirurgia três vezes maior do que aqueles sem pólipos nasais, no período seguido. Entre os pacientes com RSCsPN, apenas a asma foi um fator de pior prognóstico significativo, levando à chance de cirurgia 5,5 vezes maior do que os não-asmáticos. Já entre os pacientes com RSCcPN, aqueles com recidiva apresentaram maior extensão da doença à TC antes da primeira cirurgia. Foram ainda considerados fatores significativamente de pior prognóstico nos pacientes com RSCcPN: asma (odds ratio [OR] de 3,2); atopia a fungos (OR de 1,9); eosinofilia periférica (considerada como >500/µL, levando a OR de 1,9); e intolerância ao Ácido Acetil Salicílico (AAS) (DREA, apresentando OR de 2,5). Conclusões: Concluiu-se que a presença de pólipos per se é fator de pior prognóstico, aumentando em três vezes a chance de recorrência cirúrgica. Entre os pacientes com RSCsPN, apenas a asma influenciou o prognóstico. Já naqueles com RSCcPN, a asma, eosinofilia periférica, atopia a fungos e DREA aumentaram significativamente a probabilidade de nova intervenção cirúrgica. / Introduction: The analysis of prognostic factors associated with the recurrence of chronic rhinosinusitis (CRS), either with nasal polyps (CRSwNP) or without (CRSsNP), is still poorly discussed in the literature. Objective: To evaluate the patients that underwent endoscopic sinus surgery (ESS) due to CRS in Clinics Hospital of Ribeirão Preto Medical School, University of São Paulo, between 1996 and 2006, and to correlate the long-term recurrence to clinical factors, such as extensiveness of the disease, atopy, smoking habits, eosinophilia, and Aspirinexacerbated respiratory disease (AERD). Methods: We collected data of 201 patients, who were followed during an average period of 12 years. Clinical data collected were: extensiveness of the disease at endoscopy and at CT scans, prick test, blood exams, and pulmonary function. The follow-up period after surgery was assessed, and the indication of a new surgical procedure was considered as a poor prognostic factor. Comparison between factors was performed by Kaplan-Meyer curve, with Log-rank post-test. Results and discussion: CRSwNP patients were 3 times more likely to need a revisional surgery than CRSsNP during the follow-up period. Only asthma was a significant prognostic factor in patients with CRSsNP, leading to 5.5 times higher chance of recurrence than non-asthmatic patients. Among patients with CRSwNP, patients with recurrence presented, prior to surgery, higher CT scan extension of the disease. Other factors that influenced the prognosis on CRSwNP were: asthma (odds ratio [OR]: 3.2); atopy for fungi (OR: 1.9); peripheral eosinophilia (considered as >500/?L, leading to an OR: 1.9); and ASA intolerance (AERD; OR: 2.5). Conclusions: The presence of polyps were related to poor prognosis per se, leading to a higher chance of surgical recurrence. Among patients with CRSsNP, only asthma influenced the prognosis. Among the patients with CRSwNP, asthma, peripheral eosinophilia, fungi atopy, and AERD significantly increased the likelihood of further surgical intervention.

Social media today is a dominant communication tool, which structures not only our social interactions but also filter the information users are getting displayed. The big social media platforms use our interaction data to analyse our behaviour and sell the data for commercial interest. But not only the pure interaction data is valuable for these platforms. Also hidden information, which can be derived from our interactive networks, about our social structures, social classifications and social status are gathered and monetised. This research attempts on the one hand to uncover some of these methods used by social media platforms, and on the other hand, also wants to show how useful these new methods can be for research on social phenomena. Therefore, this study goes beyond the confining limits of traditional sociology, where either qualitative or quantitative methods are applied. Following the idea of Critical Realism, the positivist and constructivist methods are applied in combination in order to provide thick accounts of the studied material. In this study, varying socioeconomic classification systems (like the Sinus-Milieu models) are investigated and evaluated against the background of Bourdieu’s ideas on cultural and social forms of capital. The present study uses a mixed method approach (Social Network Analysis and Sentiment Analysis) to analyse quantitative data from Twitter conversations which were collected during the Austrian EU Election 2019. In conclusion, one could say that the overall purpose of this study is to demonstrate the usefulness of Critical Realism for social media research, since this approach can create a thicker account of the studied material than other, more traditional methods. This undertaking is demonstrated by the findings of the study. These findings are the building of specific sub-clusters of EU candidates which are not related to the same political background and traditional demographics but whose relation can be detected and described using Bourdieu’s concepts of social and cultural capital. As a mean for gathering empirical data, Twitter turned out to be a useful and accessible tool for this study.

Introdução: Radiocirurgia estereotática (RCE) e radioterapia estereotática fracionada (RCEF) são inovações modernas de procedimentos radioterápicos, de alta precisão que modelam o feixe de radiação para coincidir com o contorno da lesão, por meio de um sistema de imobilização exata do paciente ao aparelho, com definição do alvo através da fusão de imagens de RM, TC, Angiografia e PET/CT; em que pelas coordenadas de referência estereotática, determina-se que a dose de radiação de alta energia prescrita pelo médico seja depositada somente no volume-alvo, com preservação dos tecidos sadios, órgãos ou estruturas localizadas em suas adjacências. Meningeomas do seio cavernoso (MSCs) representam um problema especial porque podem evoluir comprimindo ou infiltrando estruturas neurovasculares presentes no seio cavernoso. Há evidências de que a RCE e a RCEF proporcionam controle satisfatório do crescimento dos meningeomas do seio cavernoso (MSCs) com efeitos adversos reduzidos. Objetivo: Avaliar resultados da avaliação clínica e da neuroimagem de doentes sintomáticos com MSCs tratados com RCEF ou RCE exclusivamente ou de modo adjuvante à neurocirurgia. Casuística e métodos: Estudo tipo coorte e retrospectivo sobre a avaliação de 89 doentes com MSC sintomático tratados com RCE (36%) ou RCEF (64%) entre janeiro de 1994 e março de 2009 e acompanhados até o final de 2012. Haviam sido submetidos à ressecação neurocirúrgica parcial (Simpson IV) ou à biopsia (Simpson V) previamente à radioterapia 29,2% dos doentes. A dose média de RCE foi de 14Gy, e a dose total de RCEF variou entre 50,4 e 54Gy, sendo fracionada em 1,8-2Gy/dose/dia. Resultados: O período de acompanhamento variou entre 36 e 180 meses (mediana de 73 meses). A percentagem de melhora dos sintomas neuroclínicos individuais e de melhora clínica e radiológica (p > 0,05) apresentou valores semelhantes nos doentes tratados com RCE ou RCEF, sendo respectivamente de 41,6% e 48,3%. Em 37% dos doentes, houve manutenção de, pelo menos, uma queixa neurológica apresentada antes do tratamento e, em 43,8%, a imagem do MSC manteve-se inalterada. O período livre de progressão do MSC em 5, 10 e 15 anos foi de 98,8%, 92,3% e 92,3%, respectivamente. Houve progressão da doença em quatro doentes (4,5%). A melhora dos sintomas neurológicos em doentes submetidos previamente à neurocirurgia ocorreu de maneira mais lenta em relação aos não operados, em razão de manipulação de nervos cranianos. Alguns sintomas pós-operatórios, como a ptose palpebral unilateral, persistiram permanentemente. Nenhuma complicação grave foi observada. Sete doentes apresentaram neuropatia óptica transitória durante 3 meses que melhorou com o uso de corticoides, dois neuropatia trigeminal que melhorou com uso de esteroides e um doente apresentou obstrução total da artéria carótida interna sem repercussão neurológica. Letargia e cefaléia foram os sintomas temporários imediatos mais frequentes. Conclusões: A RCEF e a RCE são métodos seguros e eficazes para tratar doentes com MSC sintomático. Proporcionam melhora ou estabilização da sintomatologia na maioria dos casos, e estabilização ou regressão do tumor demonstrado pela neuroimagem em mais de 90% deles. Ocorreu recuperação dos sintomas neurológicos preexistentes mais rapidamente em doentes não submetidos previamente à neurocirurgia. Houve recorrência do tumor em 4,5% dos doentes. Em até 15 anos de acompanhamento, não se evidenciou indução tumoral com o tratamento / Introduction: Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRS) are modern innovations in radiotherapy procedures, precision shaping the radiation beam to match the contour of the lesion, through a system of accurate patient immobilization to the device, defining target through the fusion of MRI, CT, angiography and PET / CT, which is determined by reference to stereotactic coordinates. The radiation dose of high energy prescribed by the doctor to be delivery only in the target interest, with preservation of healthy tissues, organs or structures located in their vicinity. Cavernous sinus meningiomas (CSMs) pose a special problem because they can evolve compressing or infiltrating the neurovascular structures present of the cavernous sinus. There are evidences that SRS and FRS are efficient in the treatment of CSMs. Objectives: The evaluation of the long-term clinical results and neuroimaging findings in patients with symptomatic CSM treated with FSRT or SRS as single therapy or after a previous neurosurgical treatment. Patients and methods: Retrospective cohort study involving 89 patients with symptomatic CSMs treated with SRS (36%) or FSRS (64%) from January 1994 to March 2009, and followed until the end of 2012. Previous neurosurgical partial resection (Simpson IV) or biopsies (Simpson V) had been performed in 29.2% of the patients. The median dose of SRS was 14Gy and the total dose of FSRT ranged from 50.4 to 54Gy, fractionated in 1.8 to 2Gy/dose/day. Results: The follow-up period ranged from 36 to 180 months (median= 73months). There was improvement in the individual symptoms and in the clinical and radiological findings regardless the radiotherapeutic method in 41.6% and 48.3% of the patients treated with SRS or FSRT, respectively (p > 0,05). In 37% of the patients, at least one neurological complaint present before the treatment did not change and in 43.8% patients, the image of the tumor remained stable. The progression-free survival in 5, 10 and 15 years was 98.8%, 92.3% and 92.3%, respectively. The improvement of neurological symptoms in patients previously treated with neurosurgery was slower or did not occur as in nonpreviously operated patients. Lethargy and headache were the most frequent transient immediate post-radiotherapy symptoms. Seven patients presented transient optic neuropathy during 3 months and improved with corticosteroids, 2 presented trigeminal neuropathy that remitted rapidly with steroids, and one, had total occlusion of the internal carotid artery without neurological consequences. Conclusions: Both FSRT and SRS were equally safe and effective in the management of symptomatic CSMs. There was improvement or stabilization of the neurological symptoms in the majority ofthe patients and stabilization or regression of the neuroimaging of the lesion in more them 90% of them. The recovery of preexisting cranial neuropathies occurred faster and was more frequent in patients not previously treated with surgical procedure. There was recurrence in 4.5% of the patients. No radiation-induced tumor was observed term during the longest 15 years follow-up

O objetivo do autor neste trabalho foi definir critérios pré-operatórios de invasão do seio cavernoso em imagens de Ressonância Magnética (RM) de pacientes com adenomas hipofisários. Neste estudo retrospectivo, foram revisadas as imagens de RM de 103 pacientes com adenomas hipofisários tratados cirurgicamente (48 com invasão do seio cavernoso) e compararam 8 sinais de imagem com os achados cirúrgicos (critério de referência para invasão). A análise estatística foi realizada utilizando o teste de qui-quadrado (X2), e a sensibilidade, especificidade, valor preditivo positivo(VPP) e valor preditivo negativo (VPN) foram obtidos para cada grupo de sinais. Também foram calculados, por regressão logística, os valores de \"odds ratio\" dos critérios mais significativos, e realizada a regressão logística múltipla para análise conjunta desses critérios. O seio cavernoso não estava invadido com certeza quando: a glândula hipofisária normal estava interposta entre ele e o adenoma (VPP, 100%); o compartimento venoso medial foi visibilizado (VPP, 100%); a porcentagem de envolvimento carotídeo pelo tumor foi menor que 25% (VPN, 100%) e o tumor não cruzava a linha intercarotídea medial (VPN, 100%). A invasão do seio cavernoso era certa (VPP, 100%) se: a porcentagem de envolvimento carotídeo era igual ou maior que 45%; 3 ou mais compartimentos venosos não eram visibilizados e o compartimento venoso lateral não era visibilizado. A presença de invasão era altamente sugestiva quando: o compartimento venoso inferior não era visibilizado (VPP, 92,8%); o tumor cruzava a linha intercarotídea lateral (VPP, 96,1%) e quando a parede dural lateral do seio cavernoso estava abaulada (VPP, 92,3%). Na análise conjunta, o critério com maior significância estatística para invasão foi o envolvimento carotídeo pelo adenoma > 30% / The author\'s objective in this study was to define preoperative MRI criteria of cavernous sinus invasion by pituitary adenoma. In this retrospective study, the authors reviewed the MR images of 103 patients with pituitary adenomas treated surgically (48 with cavernous sinus invasion) and compared 8 groups of MR imaging signs with the surgical findings (the standard of reference criterion for invasion). Statistical analysis was performed using a qui-square test (X2), and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were obtained for each group of signs. The odds ratio of the most significant criteria was also obtained and the multiple logistic regression test was used to evaluate the criteria all together. The cavernous sinus was definitely not invaded when: normal pituitary gland was interposed between the adenoma and it (PPV, 100%); the medial venous compartment was depicted (PPV, 100%); the percentage of encasement of the intracavernous internal carotid artery (ICA) was lower than 25% (NPV, 100%) and the medial intercarotid line was not crossed (NPV, 100%). Invasion of the cavernous sinus was certain (PPV, 100%) if: the percentage of encasement of the intracavernous ICA was 45% or greater and three or more venous compartment or the lateral venous compartment was not depicted. It was highly probable invaded if: the inferior venous compartment was not depicted (PPV, 92,8%); the lateral intercarotid line was crossed (PPV, 96,1%) and the lateral dural wall of the cavernous sinus was bulged (PPV, 92,3%). The most valuable criterion of cavernous sinus invasion by statistical analysis was the percentage of encasement of intracavernous ICA >30%.

Foram poucos os estudos realizados para avaliar a capacidade da cavidade dos seios frontais para a diferenciação sexual. No entanto, a predição do sexo dos indivíduos é o passo mais importante para o desenvolvimento de um perfil biológico confiável durante a análise de restos esqueléticos. O advento da tomografia computadorizada por feixe cônico trouxe uma série de vantagens à clínica odontológica, e a quantidade de pacientes que realizam exames tomográficos para fins de diagnóstico tem aumentado cada vez mais permitindo com que estes dados sejam úteis para propósitos de identificação forense. Neste estudo, o objetivo foi propor uma nova metodologia para avaliar a capacidade de imagens em 3D da cavidade sinusal frontal, provenientes de tomografia computadorizada por feixe cônico, em determinar dimorfismo sexual entre os indivíduos. A amostra da pesquisa foi composta por 130 exames (65 do sexo masculino e 65 do sexo feminino) que foram segmentados e reconstruídos tridimensionalmente. O volume 3D foi exportado em formato Tiff nas normas frontal, lateral e basal. E as seguintes variáveis foram mensuradas em um segundo programa: área, perímetro, retângulo delimitador, elipse delimitadora, circularidade, razão de aspecto, arredondamento do objeto, solidez e diâmetro de Feret. O estudo foi capaz de demonstrar a existência de dimorfismo sexual com uma acurácia do modelo final de regressão logística igual a 80,0%. A norma basal foi a que garantiu maior poder de explicação na equação final. A metodologia foi validada e os resultados mostraram alto grau de confiabilidade. / There were few studies to assess the ability of the cavity of the frontal sinuses for sexual differentiation. However, the prediction of the sex of the individuals is the most important step in the development of a reliable biological profile during analysis of skeletal remains. The advent of cone beam computed tomography brought a number of advantages to the dental clinic, and the number of patients undergoing CT scans for diagnostic purposes has increased increasingly allowing that these data are useful for forensic identification purposes. The study aimed to propose a new methodology to assess the 3D images capacity of the frontal sinus cavity, from computed tomography cone beam, to attribute sexual dimorphism between individuals. The survey sample consisted of 130 exams (65 male and 65 female) who were reconstructed three-dimensionally. The 3D volume was exported in Tiff format in the frontal, side and basal views. In addition, the following variables were measured in a second program: area, perimeter, bounding rectangle, ellipse fit, circularity, aspect ratio, roundness, solidity and Feret\'s diameter. The study was able to demonstrate the existence of sexual dimorphism with an accuracy of the final logistic regression model equal to 80.0%. The basal view assured greater explanatory power in the final equation. The methodology has been validated and the results showed a high degree of reliability.

Introdução: O seio esfenoidal apresenta relações anatômicas extremamente importantes com estruturas neurovasculares. Estas podem apresentar diversas variações, tornando as suas relações com seio esfenoidal bastante complexas e potencialmente associadas a graves lesões durante sua abordagem. Objetivo: O objetivo deste estudo prospectivo foi descrever, através da dissecção endoscópica em cadáveres, os detalhes das variações anatômicas do SE, avaliando a concordância entre os lados e as diferenças dessas variações entre o gênero e a cor da pele. Casuística e Métodos: Quarenta e cinco cadáveres (90 fossas nasais) de ambos os sexos com idade no óbito entre 30 e 83 anos foram submetidos à dissecção endoscópica meticulosa do seio esfenoidal. A distância da parede anterior do SE à espinha nasal anterior; a localização e o formato do óstio do SE, o grau de pneumatização do SE, a presença de células de Onodi, a dominância entre os lados, a inserção de septo interssinusal e de cristas, a presença de proeminências e/ou deiscências da artéria carótida interna, do nervo óptico, do nervo maxilar e do nervo vidiano, assim como a presença de recessos óptico-carotídeo, pterigóide e lateral foram descritos. As prevalências foram comparadas entre o gênero e diferentes cor da pele. Também foi analisada a simetria entre os lados direito e esquerdo. Resultados: O óstio estava localizado medialmente à inserção póstero-inferior da concha superior em 85,6% das fossas nasais estudadas e em 50% apresentava-se com formato arredondado. A distância média do óstio do seio esfenoidal à espinha nasal anterior foi de 68 mm (+- 4,6mm) para ambos os lados. Não havia dominância dos lados direito ou esquerdo em 21 (46,7%) dos cadáveres. Em 17 cadáveres (37,8%) o seio esquerdo se apresentou mais pneumatizado e em 7 (15,6%), o seio esfenoidal direito apresentou dominância em relação ao esquerdo. O tipo selar foi o mais prevalente (53%) seguido do pré-selar (38%). O recesso mais prevalente foi o pterigóide (47,8%). As cristas estivaram presentes em 22,7% dos lados. O septo intersinusal se inseriu no trajeto da artéria carótida interna e do nervo óptico, respectivamente, em 16,7% e 2,2%. A artéria carótida interna esteve proeminente em 48,9% e deiscente em 31,1% das fossas estudadas. O nervo óptico estava proeminente e deiscente em 35,6% e 8,9%, respectivamente. O nervo vidiano foi a estrutura com proeminência mais prevalente (50%). O nervo maxilar esteve deiscente em 5,6% dos lados estudados. Uma célula de Onodi esteve presente em 23 (25,6%) dos lados dissecados. A análise da simetria mostrou concordância perfeita com relação ao grau de pneumatização e se apresentou bastante variável de acordo com a estrutura estudada. Cadáveres do sexo feminino apresentaram de forma estatisticamente significante maior prevalência de deiscência de carótida interna (p=0,002) e do nervo maxilar (p=0,02), assim como proeminência do nervo óptico (p < 0,001). Conclusão: Os dados demonstram a complexa anatomia interna do seio esfenoidal, e o conhecimento desta anatomia é de grande importância para evitar as potenciais complicações cirúrgicas nesta região. / Introduction: There are extremely important anatomic relationships between the sphenoid sinus (SS) and neurovascular structures. These structures may have several anatomic variations, which makes their relationship with the sphenoid sinus complex and carries risks of severe injuries during surgery. Objective: This prospective study used endoscopic cadaver dissection to describe details of SS anatomic variations and to evaluate agreement between sides and differences between sexes and ethnic groups. Casuistic and Methods: Fourty-five cadavers (90 nasal fossae) of both sexes ageing between 30 and 83 years underwent careful dissection of the sphenoid sinus. Distance from the SS anterior wall to the anterior nasal spine, the position and shape of the SS, the degree of SS pneumatization, the presence of Onodi cells, the dominance between sides, the insertion of the intersinus septum and crests, the presence of dehiscence and protrusions of the internal carotid artery (ICA), optic nerve (ON), maxillary and vidian nerves, and the presence of optic-carotid, pterygoid and lateral recesses were described. Data were analyzed according to sex, skin color and symmetry between nasal fossae of each cadaver. Results: Ostia were located medially to the posteroinferior insertion of the superior turbinate in 85.6% of the nasal fossae, and were circular in 50% of the cases. The mean distance from the ostium to the anterior nasal spine was 68 mm (+- 4.6 mm) for both sides. No dominance of right or left side was found in 21 (46.7%) of the cadavers. In 17 cadavers (37.8%), the left sinus was more pneumatized, and in 7 (15.6%), the right sphenoid sinus showed dominance over the left sinus. The sellar type was the most prevalent (53%), followed by the presellar type (38%). Pterygoid recesses were the most prevalent (47.8%). Crests were found in 22.7% of the sides. The intersinus septum was inserted on the course of the internal carotid artery and optic nerve in 16.7% and 2.2 % of the cases. ICA protrusions were found in 48.9% of the cases, and dehiscence in 31.1% of the fossae under study. Dehiscence and protrusion of the ON were found in 35.6% and 8.9% of the cases. The vidian nerve was the structure with the most prevalent protrusion (50%). Dehiscence over the maxillary nerve was found in 5.6% of the sides. Onodi cells were found in 23 (25.6%) of the dissected sides. The analysis of symmetry revealed perfect agreement of the degree of pneumatization and was greatly variable depending on the structure analyzed. Female cadavers had a statistically greater prevalence of dehiscence over the internal carotid artery (p = 0.002) and over the maxillary nerve (p = 0.02), as well as greater prevalence of optic nerve protrusion (p < 0.001). Conclusion: Our data showed that the SS internal anatomy is complex, and its knowledge is essential during surgical approaches to the sphenoid sinus.

Objetivos: O objetivo desse estudo foi avaliar comparativamente o potencial osteogênico in vitro de células obtidas do ramo mandibular (RM, área doadora) e do seio maxilar enxertado com uma mistura de RM e osso bovino inorgânico (OBI), previamente à instalação de implantes de titânio (SM, sítio do seio maxilar enxertado). Material e Métodos: As células foram obtidas de três pacientes submetidos a procedimentos de aumento do soalho do seio maxilar com a proporção de 1:1 de RM e OBI (GenOx Inorg®). No momento da realização dos enxertos no seio maxilar e após 08 meses, antes da inserção dos implantes de titânio, fragmentos ósseos foram colhidos do RM e do SM, respectivamente, e submetidos à digestão enzimática com tripsina e colagenase para obtenção de células primárias. As células foram subcultivadas e crescidas sob condições osteogênicas por até 21 dias, tendo sido avaliados os seguintes parâmetros: proliferação/viabilidade celular, expressão gênica de marcadores osteoblásticos, atividade de fosfatase alcalina (ALP) e conteúdo de cálcio, por extração do vermelho de Alizarina. Culturas primárias derivadas do RM foram expostas ao GenOx Inorg® por 7 dias, quando se avaliou a atividade de ALP. Os resultados foram comparados por ANOVA two-way, seguido do teste de Tukey, ou pelo teste de Mann-Whitney. Resultados: Culturas do SM exibiram uma redução significante do potencial osteogênico se comparado ao de culturas do RM, com um aumento progressivo na proliferação celular associado a uma redução da expressão dos marcadores osteoblásticos, da atividade de ALP e do conteúdo de cálcio. A exposição do GenOx Inorg® às células primárias derivadas do RM inibiram a atividade de ALP. Conclusão: Esses resultados sugerem que o uso do GenOx Inorg® em associação a fragmentos do RM para aumento do soalho do seio maxilar inibe a diferenciação de células osteoblásticas no sítio de inserção de implantes de titânio após 8 meses de enxertia. / Objectives: This study aimed to comparatively evaluate the in vitro osteogenic potential of cells obtained from the mandibular ramus (MR, autogenous bone donor site) and from the maxillary sinus bone grafted with a mixture of anorganic bovine bone (ABB) and MR prior to titanium implant placement (MS, grafted implant site). Material and methods: Cells were obtained from three patients subjected to maxillary sinus floor augmentation with a 1:1 mixture of ABB (GenOx Inorg®) and MR. At the time of the sinus lift procedure and after 8 months, prior to implant placement, bone fragments were taken from MR and MS, respectively, and subjected to trypsin-collagenase digestion for primary cell culturing. Subcultured cells were grown under osteogenic condition for up 21 days and assayed for proliferation/viability, osteoblast marker mRNA levels, alkaline phosphatase (ALP) activity and calcium content/Alizarin red staining. ALP activity was also determined in primary explant cultures exposed to GenOx Inorg® (1:1 with MR) for 7 days. Data were compared using the two-way ANOVA followed by the Tukey test; otherwise, the Mann-Whitney test was used. Results: MS cultures exhibited a significantly lower osteogenic potential compared with MR cultures, with a progressive increase in cell proliferation together with a downregulation of osteoblast markers, reduced ALP activity and calcium content. Exposure of MR-derived primary cultures to GenOx Inorg® inhibited ALP activity. Conclusion: These results suggest that the use of GenOx Inorg® in combination with MR fragments for maxillary sinus floor augmentation inhibits the osteoblast cell differentiation at the implant site in the longterm.