published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

published_or_final_version / Dentistry / Master / Master of Dental Surgery

published_or_final_version / Dentistry / Master / Master of Dental Surgery

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Este trabalho teve como objetivo analisar os casos com fissura de palato submucosa (FPSM) acompanhados no HRAC/USP, no período de 1984 a 2004, verificando a distribuição destes casos de acordo com a idade e conduta adotada na consulta inicial e; se a conduta inicialmente adotada manteve-se ou necessitou ser reconsiderada. Foram analisados 1.260 prontuários de pacientes FPSM, sendo excluídos 175 que apresentavam quadros sindrômicos e, portanto, a amostra final constou de 1.085 pacientes, de ambos os gêneros e procedentes das diferentes regiões do país, os quais foram distribuídos em 5 grupos etários de acordo com idade na época da consulta inicial: menores de 3 anos, de 4 a 6 anos, de 7 a 12 anos, de 13 a 17 anos e acima de 18 anos. A análise evidenciou 557 (51,33%) casos com FPSM isolada e 528 (48,67%) com FPSM associada à fissura labial, sendo os mesmos analisados de acordo com a conduta inicial adotada: acompanhamento, fonoterapia, prótese de palato ou cirurgia, respeitando-se os grupos etários definidos. Após a análise dos casos com fissura de palato submucosa acompanhados no HRAC/USP, no período de 1984 a 2004, concluiu-se que: quanto à distribuição dos casos de acordo com a conduta definida na consulta inicial, na FPSM isolada predominou a indicação para cirurgia nas idades acima de 4 anos e acompanhamento nas idades abaixo de 3 anos e, na FPSM associada à fissura labial predominou a conduta acompanhamento; Quanto à manutenção ou reconsideração da conduta inicial, dos casos indicados para acompanhamento, na FPSM isolada, a maioria dos casos alterou a conduta para cirurgia e na FPSM associada à fissura labial, a maioria manteve a conduta inicial; daqueles indicados para fonoterapia, na FPSM isolada, predominou manter a conduta inicial nas idades menores de 3 anos e de 7 a 12 anos e alterar a conduta para cirurgia nas idades de 4 a 6 anos e de 13 a 17 anos e, nos casos com FPSM associada à fissura labial, a maioria manteve a conduta inicial; dos casos indicados para prótese de palato, na FPSM isolada, a maioria dos casos entre 4 e 6 anos alterou a conduta para cirurgia, houve equilíbrio entre manter a conduta inicial e alterar para cirurgia na faixa etária de 7 a 12 anos e houve manutenção da conduta inicial na faixa etária maior de 18 anos, não ocorrendo casos com FPSM associada à fissura labial, já, dos casos indicados para cirurgia, tanto na FPSM isolada quanto na FPSM e associada à fissura labial prevaleceu à conduta inicial. / This study analyzed the patients with submucous cleft palate (SMCP) assisted at HRAC/USP during the period 1984 to 2004, checking the distribution of these cases according to age range, approach adopted at the initial consultation, and if the approach initially adopted was maintained or reconsidered. A total of 1,260 records of patients with SMCP were analyzed; 175 were excluded due to the association with syndromes, leading to a final sample of 1,085 patients, of both genders and from different regions of the country, which were distributed into 5 age groups according to the age rage upon initial consultation: younger than 3 years, 4 to 6 years, 7 to 12 years, 13 to 17 years, and older than 18 years. The analysis revealed 557 (51.33%) cases with isolated SMCP and 528 (48.67%) cases with SMCP associated with cleft lip. These cases were analyzed according to the initial approach adopted: follow-up, speech therapy, speech prosthesis, or surgery, according to the aforementioned age groups. The following could be concluded: with regard to the initial approach, for patients with isolated SMCP, there was predominance of indication for surgery at the ages above 4 years and follow-up for patients younger than 3 years, whereas in cases with SMCP associated with cleft lip there was predominance of follow-up. Concerning the maintenance or reconsideration of the initial approach, among the cases with isolated SMCP indicated for follow-up, in most cases the approach was altered to surgery, whereas the initial approach was mostly maintained for individuals with SMCP associated with cleft lip. Among individuals with isolated SMCP with indication for speech therapy, there was predominance of maintenance of the initial approach for patients younger than 3 years and aged 7 to 12 years, with maintenance of the initial approach for patients aged 4 to 6 years and 13 to 17 years, with predominance of maintenance of the initial approach for patients with SMCP. In relation to the cases with isolated SMCP with indication for speech prosthesis, the approach was altered to surgery in most cases aged 4 to 6 years; there was similar proportion between maintaining the initial approach and altering to surgery at the age range 7 to 12 years; and the initial approach was maintained for patients older than 18 years; there were no cases of SMCP with cleft lip under this indication. Contrarily, among the cases with indication for surgery, the initial approach was maintained for individuals with both isolated SMCP and SMCP with cleft lip.

Made available in DSpace on 2014-06-11T19:28:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-16Bitstream added on 2014-06-13T18:57:20Z : No. of bitstreams: 1 nunes_crm_me_botfm.pdf: 392435 bytes, checksum: 70391dbf289d0130b47bfb5d3d2df41b (MD5) / Secretaria de Saúde do Estado de São Paulo / Dentre as malformações associadas à fissura labiopalatal, a Sequência de Robin (SR) é a que apresenta maior frequência, exigindo maiores cuidados e, dentre as síndromes associadas a SR, a mais freqüente é a Sequência de Robin Isolada (SRI). Caracteriza-se por anomalias como micrognatia, glossoptose e fissura palatina. O tratamento destes pacientes exige que se realize a palatoplastia primária a partir dos 12 meses de vida, de acordo com determinações do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). Tais pacientes apresentam maior índice de complicações na Sala de Recuperação Anestésica (SRA). Neste período crítico a enfermagem deve permanecer atenta às complicações, promovendo as intervenções mais rápidas e eficazes possíveis. Este trabalho, prospectivo não exploratório, tem como objetivo avaliar as complicações no pós-operatório imediato em pacientes com SRI após palatoplastia primária e propor um instrumento específico para aplicá-lo na SRA do HRAC-USP, bem como descrever os tipos de complicações mais frequentes e indicar as principais intervenções realizadas pela equipe de enfermagem. Para isto, propôs-se um instrumento, baseado no modelo de Biazon, o qual foi submetido à avaliação de juízes, que atestaram sua objetividade e clareza. Este instrumento contem parâmetros clínicos e sintomas indicativos de complicações e intervenções, relacionados à Respiração, Sangramento, Hipotermia e Dor. Fezse um estudo piloto com dez pacientes, calculando-se o Valor α de Cronbach para avaliar sua consistência e coerência. Depois o instrumento foi aplicado em mais 25 pacientes. Os resultados obtidos após avaliação evidenciam que a idade média dos pacientes com SRI submetidos a palatoplastia primária é superior à Resumo dos pacientes com fissura de palato... / Among all malformations associated to cleft lip and palate, the Robin Sequence (RS) is the most frequent, demanding more care than any other associated syndrome. And, among all the syndromes associated to the RS, the most common is the Isolated Robin Sequence (IRS). It is characterized by three abnormalities: Micrognathism, Glossoptosis and cleft palate. The treatment requires to perform a first plastic surgery, identified as primary palatoplasty, only after the age of 12 months, according to a determination of the Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). Such patients have a higher rate of complications at the Post-Anaesthetic Recovery Room (PARR). In this critical period, nursing must keep focus observing the possible complications in order to promote the most effective and imediate interventions. This prospective, non-exploratory research aims to evaluate the complications at the imediate post-operatory of IRS patients after a primary palatoplasty and propose a specific instrument to be applied at the HRAC-USP`s PARR, as well as describe the most frequent complications and indicate the main interventions by the nurse staff team. In order to achieve it, it was proposed an instrument, based on Biazon`s model, wich was submitted to judges evaluation, whom testified its clearness and objectivity. This instrument contains clinical parameters, indicative symptoms of complications and interventions, related to breathing, bleeding, hipothermy and pain. There has been made a pilot study with tem patients, calculating the value of the coefficient of Cronbach`s α, measuring the reliability and consistency of this study. Later the same instrument was applied to more 25 patients. The results, obtained after the evaluation, demonstrated that the average age of patients with IRS undergoing primary palatoplasty is higher Abstract than that... (Complete abstract click electronic access below)

Orientador: José Eduardo Corrente / Banca: Maria Irene Bachega / Banca: Wilza Carla Spiri / Resumo: Dentre as malformações associadas à fissura labiopalatal, a Sequência de Robin (SR) é a que apresenta maior frequência, exigindo maiores cuidados e, dentre as síndromes associadas a SR, a mais freqüente é a Sequência de Robin Isolada (SRI). Caracteriza-se por anomalias como micrognatia, glossoptose e fissura palatina. O tratamento destes pacientes exige que se realize a palatoplastia primária a partir dos 12 meses de vida, de acordo com determinações do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). Tais pacientes apresentam maior índice de complicações na Sala de Recuperação Anestésica (SRA). Neste período crítico a enfermagem deve permanecer atenta às complicações, promovendo as intervenções mais rápidas e eficazes possíveis. Este trabalho, prospectivo não exploratório, tem como objetivo avaliar as complicações no pós-operatório imediato em pacientes com SRI após palatoplastia primária e propor um instrumento específico para aplicá-lo na SRA do HRAC-USP, bem como descrever os tipos de complicações mais frequentes e indicar as principais intervenções realizadas pela equipe de enfermagem. Para isto, propôs-se um instrumento, baseado no modelo de Biazon, o qual foi submetido à avaliação de juízes, que atestaram sua objetividade e clareza. Este instrumento contem parâmetros clínicos e sintomas indicativos de complicações e intervenções, relacionados à Respiração, Sangramento, Hipotermia e Dor. Fezse um estudo piloto com dez pacientes, calculando-se o Valor α de Cronbach para avaliar sua consistência e coerência. Depois o instrumento foi aplicado em mais 25 pacientes. Os resultados obtidos após avaliação evidenciam que a idade média dos pacientes com SRI submetidos a palatoplastia primária é superior à Resumo dos pacientes com fissura de palato... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Among all malformations associated to cleft lip and palate, the Robin Sequence (RS) is the most frequent, demanding more care than any other associated syndrome. And, among all the syndromes associated to the RS, the most common is the Isolated Robin Sequence (IRS). It is characterized by three abnormalities: Micrognathism, Glossoptosis and cleft palate. The treatment requires to perform a first plastic surgery, identified as primary palatoplasty, only after the age of 12 months, according to a determination of the Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). Such patients have a higher rate of complications at the Post-Anaesthetic Recovery Room (PARR). In this critical period, nursing must keep focus observing the possible complications in order to promote the most effective and imediate interventions. This prospective, non-exploratory research aims to evaluate the complications at the imediate post-operatory of IRS patients after a primary palatoplasty and propose a specific instrument to be applied at the HRAC-USP's PARR, as well as describe the most frequent complications and indicate the main interventions by the nurse staff team. In order to achieve it, it was proposed an instrument, based on Biazon's model, wich was submitted to judges evaluation, whom testified its clearness and objectivity. This instrument contains clinical parameters, indicative symptoms of complications and interventions, related to breathing, bleeding, hipothermy and pain. There has been made a pilot study with tem patients, calculating the value of the coefficient of Cronbach's α, measuring the reliability and consistency of this study. Later the same instrument was applied to more 25 patients. The results, obtained after the evaluation, demonstrated that the average age of patients with IRS undergoing primary palatoplasty is higher Abstract than that... (Complete abstract click electronic access below) / Mestre

Este trabalho teve como objetivo analisar os casos com fissura de palato submucosa (FPSM) acompanhados no HRAC/USP, no período de 1984 a 2004, verificando a distribuição destes casos de acordo com a idade e conduta adotada na consulta inicial e; se a conduta inicialmente adotada manteve-se ou necessitou ser reconsiderada. Foram analisados 1.260 prontuários de pacientes FPSM, sendo excluídos 175 que apresentavam quadros sindrômicos e, portanto, a amostra final constou de 1.085 pacientes, de ambos os gêneros e procedentes das diferentes regiões do país, os quais foram distribuídos em 5 grupos etários de acordo com idade na época da consulta inicial: menores de 3 anos, de 4 a 6 anos, de 7 a 12 anos, de 13 a 17 anos e acima de 18 anos. A análise evidenciou 557 (51,33%) casos com FPSM isolada e 528 (48,67%) com FPSM associada à fissura labial, sendo os mesmos analisados de acordo com a conduta inicial adotada: acompanhamento, fonoterapia, prótese de palato ou cirurgia, respeitando-se os grupos etários definidos. Após a análise dos casos com fissura de palato submucosa acompanhados no HRAC/USP, no período de 1984 a 2004, concluiu-se que: quanto à distribuição dos casos de acordo com a conduta definida na consulta inicial, na FPSM isolada predominou a indicação para cirurgia nas idades acima de 4 anos e acompanhamento nas idades abaixo de 3 anos e, na FPSM associada à fissura labial predominou a conduta acompanhamento; Quanto à manutenção ou reconsideração da conduta inicial, dos casos indicados para acompanhamento, na FPSM isolada, a maioria dos casos alterou a conduta para cirurgia e na FPSM associada à fissura labial, a maioria manteve a conduta inicial; daqueles indicados para fonoterapia, na FPSM isolada, predominou manter a conduta inicial nas idades menores de 3 anos e de 7 a 12 anos e alterar a conduta para cirurgia nas idades de 4 a 6 anos e de 13 a 17 anos e, nos casos com FPSM associada à fissura labial, a maioria manteve a conduta inicial; dos casos indicados para prótese de palato, na FPSM isolada, a maioria dos casos entre 4 e 6 anos alterou a conduta para cirurgia, houve equilíbrio entre manter a conduta inicial e alterar para cirurgia na faixa etária de 7 a 12 anos e houve manutenção da conduta inicial na faixa etária maior de 18 anos, não ocorrendo casos com FPSM associada à fissura labial, já, dos casos indicados para cirurgia, tanto na FPSM isolada quanto na FPSM e associada à fissura labial prevaleceu à conduta inicial. / This study analyzed the patients with submucous cleft palate (SMCP) assisted at HRAC/USP during the period 1984 to 2004, checking the distribution of these cases according to age range, approach adopted at the initial consultation, and if the approach initially adopted was maintained or reconsidered. A total of 1,260 records of patients with SMCP were analyzed; 175 were excluded due to the association with syndromes, leading to a final sample of 1,085 patients, of both genders and from different regions of the country, which were distributed into 5 age groups according to the age rage upon initial consultation: younger than 3 years, 4 to 6 years, 7 to 12 years, 13 to 17 years, and older than 18 years. The analysis revealed 557 (51.33%) cases with isolated SMCP and 528 (48.67%) cases with SMCP associated with cleft lip. These cases were analyzed according to the initial approach adopted: follow-up, speech therapy, speech prosthesis, or surgery, according to the aforementioned age groups. The following could be concluded: with regard to the initial approach, for patients with isolated SMCP, there was predominance of indication for surgery at the ages above 4 years and follow-up for patients younger than 3 years, whereas in cases with SMCP associated with cleft lip there was predominance of follow-up. Concerning the maintenance or reconsideration of the initial approach, among the cases with isolated SMCP indicated for follow-up, in most cases the approach was altered to surgery, whereas the initial approach was mostly maintained for individuals with SMCP associated with cleft lip. Among individuals with isolated SMCP with indication for speech therapy, there was predominance of maintenance of the initial approach for patients younger than 3 years and aged 7 to 12 years, with maintenance of the initial approach for patients aged 4 to 6 years and 13 to 17 years, with predominance of maintenance of the initial approach for patients with SMCP. In relation to the cases with isolated SMCP with indication for speech prosthesis, the approach was altered to surgery in most cases aged 4 to 6 years; there was similar proportion between maintaining the initial approach and altering to surgery at the age range 7 to 12 years; and the initial approach was maintained for patients older than 18 years; there were no cases of SMCP with cleft lip under this indication. Contrarily, among the cases with indication for surgery, the initial approach was maintained for individuals with both isolated SMCP and SMCP with cleft lip.

Indiana University-Purdue University Indianapolis (IUPUI) / The Riley Children's Hospital Craniofacial Anomalies Team rigorously follows a treatment protocol developed by Dr. Sheldon Rosenstein for the treatment of cleft lip and palate patients. Rosenstein's protocol incorporates primary bone grafting and alveolar molding appliances for cleft lip and palate patients. While other cleft lip and palate treatment centers utilize alveolar molding appliances, there remains debate concerning the efficacy of primary bone grafting. The principal detraction of primary bone grafting is the concern that such early surgical treatment affects maxillary and craniofacial growth and development. The purpose of this retrospective study was to analyze post-treatment lateral head plates and dental casts of cleft lip and palate circumpubertal patients treated in infancy at Riley Hospital in Indianapolis by the Craniofacial Team following Rosenstein's protocol. The hypothesis was that primary alveolar bone grafting in conjunction with the use of alveolar molding appliances contributes to the early stabilization of the alveolar segments, and produces no statistically significant difference in craniofacial development among primary bone grafted patients and nongrafted patients. The dental arch dimensions of the nongrafted patients (control group) consisted of the same data utilized by Moorrees in his study of the dentition of the growing child. The dental arch dimensions of nongrafted cleft patients consisted of the same data utilized by Athanasiou in his study of the dentition of cleft patients treated surgically without bone grafting. Of the eight measurements made by the three examiners, six demonstrated excellent interexaminer agreement, one demonstrated moderate interexaminer agreement, and one demonstrated poor interexaminer agreement. The arch width and length for the grafted group was significantly smaller (p < .05, Student's t-test) than the normal group in all measures except for the mandibular canine width. The arch width and length for the grafted group was not significantly different (p < .05, Student's t-test) than the nongrafted group, except for the maxillary molar width where the grafted group was smaller than the nongrafted group. The cephalometric values of the Riley group were compared against a nongrafted group, an early primary grafted group, and the Bolton standard values cited in Rosenstein's study. The Bolton standard values were used as the control group. This study found the cephalometric values of the Riley experimental group (treated following Rosenstein's protocol) to be of no statistically significant difference (p < .05, Students t-test) when compared with cephalometric values of the nongrafted and primary alveolar grafted groups cited in Rosenstein's 1982 study. The cephalometric values of the Riley experimental group were less than the cephalometric values of the nonclefted patients (Bolton standard control group) cited in Rosenstein's 1982 study. Interexaminer agreement ranged from poor to good with the poorest agreement among the linear values of ANS/PNS and GO/ME. The intraclass correlation coefficient values for SNA,m ANB, and SNB ranged from fair to moderate. The Riley cephalometric values were equal or slightly better than Rosenstein's grafted and nongrafted groups. Though smaller than the control group, the Riley cephalometric values were of no statistical significance (p < .05, Students t-test) when compared with the same parameters cited in Rosenstein's study. Although these findings infer that the patients treated following Rosenstein's protocol demonstrate some degree of craniofacial growth attenuation when compared with nonclefted patients (Bolton standard control group), the Riley patients showed no worse growth attenuation than similar patients treated without Rosenstein's protocol for primary alveolar grafting. The hypothesis of this thesis was that Rosenstein's protocol was viable and non-detrimental when compared with other treatment regimens. The results of this study support the hypothesis that Rosenstein's surgical protocol is not a contributing factor in craniofacial growth attenuation among cleft lip and palate patients.

O presente estudo tem o objetivo de verificar os efeitos das cirurgias primárias sobre os arcos dentários de crianças com fissura completa de lábio e palato unilateral submetidas a dois diferentes protocolos cirúrgicos, Spina + Von Langenbeck (Grupo 1) e Millard + Von Langenbeck (Grupo 2), considerando também a presença ou ausência de bandeleta de Simonart. Para a avaliação da relação interarcos foi utilizado o Índice de Atack em uma amostra de 145 modelos de gesso obtidos aos 5 a 6 anos de idade. Nos resultados relativos aos protocolos cirúrgicos a comparação dos escores agrupados demonstrou maior ocorrência de índices 4 e 5 (42%) para ambos os grupos, com índices oclusais médios de 3,22 para o Grupo 1 e 3,12 para o Grupo 2. Houve maior prevalência de índices 4 e 5 tanto para os pacientes com bandeleta (53%) como sem bandeleta (39%), que apresentaram índices oclusais médios de 3,41 e 3,11, respectivamente. A avaliação individual do protocolo cirúrgico Spina + Von Langenbeck, considerando a presença de bandeleta, demonstrou maior porcentagem de índice 3, para os pacientes com bandeleta (42%) e índices 4 e 5 para os sem bandeleta (44%), com índices oclusais médios de 3,0 e 3,27, respectivamente. Para o protocolo de Millard + Von Langenbeck, o grupo com bandeleta apresentou acentuada maioria de índices 4 e 5 (76%) enquanto que no grupo sem bandeleta prevaleceu índices 1 e 2 (50%), com índices oclusais médios de 3,88 e 2,71, respectivamente, com diferença estatisticamente significativa entre eles (p=0,001). Na amostra estudada a avaliação dos protocolos cirúrgicos e da presença de bandeleta, de acordo com os valores dos índices oclusais, demonstrou que a maioria dos casos apresentou uma pobre relação entre os arcos, com prognóstico de tratamento ortodôntico-cirúrgico. / This study analyzed the effects of primary surgeries on the dental arches of children with complete unilateral cleft lip and palate submitted to two different surgical protocols, Spina + Von Langenbeck (Group 1) and Millard + Von Langenbeck (Group 2), also considering the presence or absence of a Simonarts band. The interarch relationship was assessed by the Atack index on a sample of 145 dental casts obtained at 5 to 6 years of age. In results related to the surgical protocols, the comparison of grouped scores revealed higher occurrence of scores 4 and 5 (42%) for both groups, with mean occlusal scores of 3.22 for Group 1 and 3.12 for Group 2. There was higher prevalence of scores 4 and 5 both for patients with band (53%) and without band (39%), who presented mean occlusal scores of 3.41 and 3.11, respectively. Individual analysis of the surgical protocol Spina + Von Langenbeck, considering the presence of a Simonarts band, demonstrated higher percentage of score 3 for patients with band (42%) and scores 4 and 5 for patients without band (44%), with mean occlusal scores of 3.0 and 3.27, respectively. Concerning the protocol Millard + Von Langenbeck, the group with band exhibited great majority of scores 4 and 5 (76%), while the group without band had predominance of scores 1 and 2 (50%), with mean occlusal scores of 3.88 and 2.71, respectively, with statistically significant difference between them (p=0.001). In the present study sample, evaluation of the surgical protocols and presence of a Simonarts band according to the values of occlusal scores demonstrated that most cases presented poor interarch relationship, thereby with prognosis for orthodontic-surgical treatment.