Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Introduction : Le bruxisme du sommeil est un désordre du mouvement décrit comme un mouvement involontaire de la mastication durant le sommeil. Cette parafonction est observée dans 14-38% de la population pédiatrique. Un lien a été trouvé entre les événements respiratoires et les épisodes de bruxisme. L’expansion palatine rapide (EPR) est un traitement orthopédique effectué chez les enfants en croissance pour régler un manque transverse squelettique du maxillaire supérieur. Quelques études ont observé que l’apnée obstructive du sommeil a été diminuée par un traitement d’expansion palatine rapide. Objectifs : Étant donné que le bruxisme est en lien avec des événements respiratoires et que l’expansion palatine rapide augmente la dimension des cavités nasales, l’objectif de la présente étude est d’évaluer la possible réduction du bruxisme après le traitement d’expansion rapide. Méthodes : Ce projet pilote est une étude clinique randomisée contrôlée de patients consécutifs qui a inclus 27 enfants (8-14 ans, 8 garçons et 19 filles) avec ou sans bruxisme du sommeil. Tous ces patients sont venus à la clinique d’orthodontie de l’Université de Montréal et présentaient un manque transverse du maxillaire supérieur (au moins 5 mm). Dans le cadre de l’étude, les patients devaient passer un enregistrement polysomnographique ambulatoire avant le traitement d’expansion palatine (T0) et après l’activation de l’appareil d’expansion (T1). Résultats : Les résultats démontrent une diminution du bruxisme chez 60% (9 patients) de nos patients bruxeurs. L’interaction entre le traitement et les groupes (Br et Ctl) s’est avérée significative (p=0,05 ANOVA mesures répétées), et démontre une diminution du bruxisme chez les bruxeurs (p=0,04, t-test paire). Les médianes (min, max) du groupe avec bruxisme sont passées de 3,11 (2,06; 7,68) à 2,85 (0,00; 9,51). Les paramètres de sommeil sont restés stables (Stade N1/N2/N3, REM, efficacité du sommeil), ainsi que les paramètres respiratoires et le ronflement. Conclusion : Une réduction du bruxisme a été observée lors de cette étude, mais un échantillonnage plus grand est nécessaire pour conclure. / Introduction: Sleep bruxism (SB) is a movement disorder described as an involuntary mastication movement during sleep. This parafunction is observed in 14-38% of the child population. A link was found between respiratory events and episodes of bruxism. Rapid palatal expansion (RPE) in children is an orthopedic treatment that is effective in correcting maxillary transverse deficiency and in reducing obstructive apnea syndrome (OAS) by increasing airway capacity. Objectives : Since bruxism is related to respiratory events and RPE increases respiratory capacity, the objective of this study is to evaluate the possible reduction of bruxism after RPE therapy. Material and Methods : This prospective randomized controlled clinical pilot study recruited 27 children (8-14 years old, 8 boys, 19 girls) with or without sleep bruxism. These patients were seeking treatment for transverse maxillary deficiency (5 mm or more) at the orthodontics department of the University of Montreal. Patients underwent an ambulatory polysomnography before (T0) and after expansion (T1). Sleep parameters, rhythmic muscular masticatory activity index were evaluated. Results : The results show a reduction of bruxism in 60% of bruxer patients (9 participants). The interaction between the treatment and the groups (Br and ctl) was significant (p=0,05, repeated measures ANOVA). A reduction of bruxism is shown for bruxers (p=0,04, paired t-test). The sleep parameters stayed stable after RPE (Stage N1/N2/N3, REM, sleep efficiency) as well as the breathing parameters and snoring data. The medians (min, max) of bruxism group went from 3,11 (2,06; 7,68) to 2,85 (0,00; 9,51). Conclusion : During this study, a reduction of bruxism was observed but a larger sample size is needed to conclude on the subject.

Introdução: Dentre as alterações da má-oclusão dentária na primeira dentição, destaca-se a mordida cruzada posterior, a qual consiste numa relação de sobressaliência vestibular inversa dos dentes superiores com seus antagonistas inferiores. O crescimento das estruturas faciais é composto de múltiplas atividades funcionais inter-relacionadas por diferentes componentes da cabeça e pescoço. A respiração nasal é um dos elementos de atividade funcional. Se houver obstrução nas vias aéreas superiores, haverá adaptações funcionais na direção de crescimento das estruturas do esqueleto da face. A hiperplasia das tonsilas faríngeas e/ou palatinas associadas são uma das causas mais comuns de obstrução respiratória. Objetivos: investigar a prevalência da mordida cruzada posterior em crianças de 3 a 6 anos de idade e associá-la ao padrão respiratório; verificar se houve associação desta má-oclusão com o tipo da hiperplasia das tonsilas palatinas associadas ou não com tonsilas faríngeas; realizar uma análise comparativa em crianças respiradoras orais e respiradoras nasais na idade categorizada 3-4 anos e 5-6 anos nos seguintes aspectos: distâncias da largura dos arcos por meio das distâncias intercaninos e intermolares da maxila e mandíbula. Casuística e Métodos: Participaram deste estudo 53 crianças, meninos e meninas com hiperplasia das tonsilas faríngea e/ou palatinas provenientes do ambulatório da Divisão da Clínica Otorrinolaringológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HCFMUSP, com indicação de adenoamigdalectomia ou adenoidectomia. Os pacientes foram submetidos a exame físico otorrinolaringológico, além de fibronasofaringoscopia ou Raios- X de Cavum. O grupo controle foi de 41 crianças sem queixas de obstrução respiratória levantada por questionários dirigidos aos pais, oriundas de escolas do município de Itapetininga-SP. Todas as crianças foram avaliadas por um cirurgião dentista que mensurou a largura dos arcos dentários diretamente na boca por meio de um paquímetro digital. Resultados: A mordida cruzada posterior esteve presente em 9,57% do total da amostra. A prevalência do cruzamento posterior no grupo de estudo foi de 15,09% e, no grupo controle, 2,13%. Foram encontradas nos diferentes tipos de hiperplasia linfoide as seguintes frequências de cruzamento posterior: palatina isolada (16,67%); faríngea isolada (25%); e palatina e faríngea associada (7,41%). A largura dos arcos dentais no grupo de estudo, apesar de não apresentar relevância estatística quando comparado com o grupo controle na idade de 3-4 anos, mostrou-se com as maiores médias. Já na idade de 5-6 anos, mostrou-se com as menores médias. Conclusões: A prevalência de mordida cruzada em respiradores orais é 15,09%. Observou-se uma tendência associativa da mordida cruzada posterior nas crianças do grupo de estudo. Na associação do tipo de obstrução respiratória com a presença do cruzamento posterior, não houve diferença estatística. Quanto à análise da largura dos arcos dentais em relação à idade categorizada, verificou-se, no grupo controle, uma diferença estatisticamente significante da idade de 5-6 anos em relação à idade 3-4 anos. Esta diferença, porém, não foi encontrada no grupo de estudo / Introduction: Among the alterations of dental malocclusion in the first dentition, the posterior crossbite stands out, which consists of a relation of vestibular reverse overjet of superior teeth with their inferior antagonists. The growth of facial structures consists of multiple functional activities interrelated by different components of the head and the neck. Breathing through the nose is one of the elements of functional activity. If there is obstruction in the superior airway, there will be functional adaptations in the growth direction of face skeleton structures. The hyperplasia of the adenoids and/or associate palatine tonsils is one of the most common causes of airway obstruction. Objectives: Probe the prevalence of posterior crossbite in children from 3 to 6 years old and associate it to the respiratory pattern; verify if there is association of such malocclusion with the etiology of hyperplasia of palatine tonsils associate or not with hyperplasia of the adenoids; carry out a comparative analysis in children who breathe through their mouth and nose at the categorized age of 3-4 years old and 5-6 years old in the following aspects: arch width distances by means of maxillary and mandibular intercanine and intermolar distances. Casuistry and Methods: A total of 53 children took part in the study herein, boys and girls with hyperplasia of the adenoids and/or associate palatine tonsils coming from the ambulatory of the Division of Otorhinolaryngology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - HCFMUSP, with indication of tonsillectomy or adenoidectomy. The patients have been submitted to an otorhinolaryngological physical examination, in addition to nasal fiber pharyngoscopy or Cavum x-ray. The control group consisted of 41 children with no complaints of airway obstruction surveyed by questionnaires forwarded to their parents, children coming from schools of the municipality of Itapetininga, State of São Paulo. All children have been evaluated by a dental surgeon who has measured their dental arch width directly in the mouth by means of a digital calliper. Results: The posterior crossbite was present in 9.57% out of the total of the sample. The prevalence of posterior cross in the study group was 15.09% and, in the control group, 2.13%. The following frequencies of posterior cross have been found in different etiologies of lymphoid hyperplasia: isolated palatine (16.67%); isolated pharynx (25%); and associated palatine and pharynx (7.41%). The dental arch width in the study group, in spite of not presenting statistical relevance when compared to the control group at the age of 3-4 years old, was shown with the highest averages. On the other hand, at the age of 5-6 years old, lowest averages were shown. Conclusions: The prevalence of crossbite in children who breathe through their mouth is of 15.09%. An associated trend of posterior crossbite in children of the study group has been observed. In the association of the type of airway obstruction with the presence of posterior cross, there was no statistical difference. As per the dental arch width analysis in regards to the categorized age, in the control group, a statistically significant difference was verified at the age of 5-6 years old regarding the age of 3-4 years old. Such difference, however, was not found in the study group

Introduction : L’expansion palatine rapide assistée chirurgicalement (EPRAC) est une option de traitement privilégiée chez les patients ayant atteint la maturité squelettique et présentant une déficience transverse du maxillaire. L’effet bénéfique de l’EPRAC sur la fonction respiratoire est régulièrement mentionné, toutefois, encore peu d’études ont évalué son impact sur les voies aériennes supérieures. L’objectif de cette étude clinique prospective comparative consistait à évaluer les effets tridimensionnels de l’EPRAC sur la cavité nasale, le nasopharynx et l’oropharynx à l’aide de la tomodensitométrie. Méthodologie : L’échantillon était constitué de 14 patients (5 hommes, 9 femmes) dont l’âge moyen était de 23,0 ± 1,9 ans (16 ans 4 mois à 39 ans 7 mois). Tous ont été traités avec un appareil d’expansion de type Hyrax collé et l’expansion moyenne a été de 9,82 mm (7,5 - 12,0 mm). Tous ont eu une période de contention d’une année avant le début de tout autre traitement orthodontique. Une évaluation par tomodensitométrie volumique à faisceau conique a été réalisée aux temps T0 (initial), T1 (6 mois post-expansion) et T2 (1an post-expansion) et le volume des fosses nasales, du nasopharynx et de l’oropharynx ainsi que les dimensions de la zone de constriction maximale de l’oropharynx ont été mesurés sur les volumes tridimensionnels obtenus. Résultats : Les résultats radiologiques ont démontré une augmentation significative du volume des fosses nasales et du nasopharynx ainsi qu’une augmentation de la zone de constriction maximale de l’oropharynx à 6 mois post-expansion. Par la suite, une portion du gain enregistré pour ces trois paramètres était perdue à un an post-EPRAC sans toutefois retourner aux valeurs initiales. Aucun effet significatif sur le volume de l’oropharynx n’a été observé. De plus, aucune corrélation significative entre la quantité d’expansion réalisée et l’ensemble des données radiologiques n’a été observée. L’analyse de la corrélation intra-classe a démontré une excellente fiabilité intra-examinateur. Conclusions : L’EPRAC entraîne un changement significatif du volume de la cavité nasale et du nasopharynx. L’EPRAC ne modifie pas le volume de l’oropharynx, par contre, un effet significatif sur la zone de constriction maximale de l’oropharynx est noté. Les effets observés n’ont pas de corrélation avec le montant d’activation de la vis d’expansion. / Introduction: Surgically assisted rapid palatal expansion (SARPE) is a treatment of choice for patients who have reached skeletal maturity and present a maxillary transverse deficiency. It is often mentioned that SARPE has the benefit to improve respiratory function, however, only a few research projects have investigated the effects of SARPE on the upper airways. The objective of this clinical prospective comparative study was to evaluate the three-dimensional effects of SARPE on the nasal cavity, the nasopharynx and the oropharynx using computed tomography. Materials and Methods: The sample consisted of 14 subjects (5 males, 9 females) whose mean age was 23.0 ± 1.9 years (range: 16 y. 4 mo. to 39 y. 7 mo.). All patients were treated using a bonded Hyrax expander and the mean expansion was 9.82 mm (7.5-12.0 mm). A one-year retention period was undertaken before the beginning of any other orthodontic treatment. A cone-beam computed tomography (CBCT) evaluation was performed at T0 (initial), T1 (6 months post-expansion) and T2 (1 year post-expansion), and then the nasal cavity, nasopharyngeal and oropharyngeal volumes and the oropharyngeal minimal cross-sectional area were measured on the three-dimensional volumes that were obtained. Results: Radiological results have demonstrated a significant increase of the nasal and nasopharyngeal volumes and also an increase of the oropharyngeal minimal cross-sectional area at 6 months post-expansion. At one year post-SARPE, for these three parameters, a part of the gain was lost but did not return to the initial values. No significant effect on oropharyngeal volume was found. No significant correlation between expansion screw activation and radiological parameters were noted. Intra-class correlation analysis showed excellent intra-examiner reliability. Conclusions: SARPE causes significant changes of the nasal cavity and nasopharyngeal volumes. SARPE does not modify the oropharyngeal volume, but induces significant changes of the oropharyngeal minimal cross-sectional area. The observed effects do not have a correlation with the amount of expansion screw activation.

Introduction : Le bruxisme du sommeil est un désordre du mouvement décrit comme un mouvement involontaire de la mastication durant le sommeil. Cette parafonction est observée dans 14-38% de la population pédiatrique. Un lien a été trouvé entre les événements respiratoires et les épisodes de bruxisme. L’expansion palatine rapide (EPR) est un traitement orthopédique effectué chez les enfants en croissance pour régler un manque transverse squelettique du maxillaire supérieur. Quelques études ont observé que l’apnée obstructive du sommeil a été diminuée par un traitement d’expansion palatine rapide. Objectifs : Étant donné que le bruxisme est en lien avec des événements respiratoires et que l’expansion palatine rapide augmente la dimension des cavités nasales, l’objectif de la présente étude est d’évaluer la possible réduction du bruxisme après le traitement d’expansion rapide. Méthodes : Ce projet pilote est une étude clinique randomisée contrôlée de patients consécutifs qui a inclus 27 enfants (8-14 ans, 8 garçons et 19 filles) avec ou sans bruxisme du sommeil. Tous ces patients sont venus à la clinique d’orthodontie de l’Université de Montréal et présentaient un manque transverse du maxillaire supérieur (au moins 5 mm). Dans le cadre de l’étude, les patients devaient passer un enregistrement polysomnographique ambulatoire avant le traitement d’expansion palatine (T0) et après l’activation de l’appareil d’expansion (T1). Résultats : Les résultats démontrent une diminution du bruxisme chez 60% (9 patients) de nos patients bruxeurs. L’interaction entre le traitement et les groupes (Br et Ctl) s’est avérée significative (p=0,05 ANOVA mesures répétées), et démontre une diminution du bruxisme chez les bruxeurs (p=0,04, t-test paire). Les médianes (min, max) du groupe avec bruxisme sont passées de 3,11 (2,06; 7,68) à 2,85 (0,00; 9,51). Les paramètres de sommeil sont restés stables (Stade N1/N2/N3, REM, efficacité du sommeil), ainsi que les paramètres respiratoires et le ronflement. Conclusion : Une réduction du bruxisme a été observée lors de cette étude, mais un échantillonnage plus grand est nécessaire pour conclure. / Introduction: Sleep bruxism (SB) is a movement disorder described as an involuntary mastication movement during sleep. This parafunction is observed in 14-38% of the child population. A link was found between respiratory events and episodes of bruxism. Rapid palatal expansion (RPE) in children is an orthopedic treatment that is effective in correcting maxillary transverse deficiency and in reducing obstructive apnea syndrome (OAS) by increasing airway capacity. Objectives : Since bruxism is related to respiratory events and RPE increases respiratory capacity, the objective of this study is to evaluate the possible reduction of bruxism after RPE therapy. Material and Methods : This prospective randomized controlled clinical pilot study recruited 27 children (8-14 years old, 8 boys, 19 girls) with or without sleep bruxism. These patients were seeking treatment for transverse maxillary deficiency (5 mm or more) at the orthodontics department of the University of Montreal. Patients underwent an ambulatory polysomnography before (T0) and after expansion (T1). Sleep parameters, rhythmic muscular masticatory activity index were evaluated. Results : The results show a reduction of bruxism in 60% of bruxer patients (9 participants). The interaction between the treatment and the groups (Br and ctl) was significant (p=0,05, repeated measures ANOVA). A reduction of bruxism is shown for bruxers (p=0,04, paired t-test). The sleep parameters stayed stable after RPE (Stage N1/N2/N3, REM, sleep efficiency) as well as the breathing parameters and snoring data. The medians (min, max) of bruxism group went from 3,11 (2,06; 7,68) to 2,85 (0,00; 9,51). Conclusion : During this study, a reduction of bruxism was observed but a larger sample size is needed to conclude on the subject.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Introdução: Dentre as alterações da má-oclusão dentária na primeira dentição, destaca-se a mordida cruzada posterior, a qual consiste numa relação de sobressaliência vestibular inversa dos dentes superiores com seus antagonistas inferiores. O crescimento das estruturas faciais é composto de múltiplas atividades funcionais inter-relacionadas por diferentes componentes da cabeça e pescoço. A respiração nasal é um dos elementos de atividade funcional. Se houver obstrução nas vias aéreas superiores, haverá adaptações funcionais na direção de crescimento das estruturas do esqueleto da face. A hiperplasia das tonsilas faríngeas e/ou palatinas associadas são uma das causas mais comuns de obstrução respiratória. Objetivos: investigar a prevalência da mordida cruzada posterior em crianças de 3 a 6 anos de idade e associá-la ao padrão respiratório; verificar se houve associação desta má-oclusão com o tipo da hiperplasia das tonsilas palatinas associadas ou não com tonsilas faríngeas; realizar uma análise comparativa em crianças respiradoras orais e respiradoras nasais na idade categorizada 3-4 anos e 5-6 anos nos seguintes aspectos: distâncias da largura dos arcos por meio das distâncias intercaninos e intermolares da maxila e mandíbula. Casuística e Métodos: Participaram deste estudo 53 crianças, meninos e meninas com hiperplasia das tonsilas faríngea e/ou palatinas provenientes do ambulatório da Divisão da Clínica Otorrinolaringológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HCFMUSP, com indicação de adenoamigdalectomia ou adenoidectomia. Os pacientes foram submetidos a exame físico otorrinolaringológico, além de fibronasofaringoscopia ou Raios- X de Cavum. O grupo controle foi de 41 crianças sem queixas de obstrução respiratória levantada por questionários dirigidos aos pais, oriundas de escolas do município de Itapetininga-SP. Todas as crianças foram avaliadas por um cirurgião dentista que mensurou a largura dos arcos dentários diretamente na boca por meio de um paquímetro digital. Resultados: A mordida cruzada posterior esteve presente em 9,57% do total da amostra. A prevalência do cruzamento posterior no grupo de estudo foi de 15,09% e, no grupo controle, 2,13%. Foram encontradas nos diferentes tipos de hiperplasia linfoide as seguintes frequências de cruzamento posterior: palatina isolada (16,67%); faríngea isolada (25%); e palatina e faríngea associada (7,41%). A largura dos arcos dentais no grupo de estudo, apesar de não apresentar relevância estatística quando comparado com o grupo controle na idade de 3-4 anos, mostrou-se com as maiores médias. Já na idade de 5-6 anos, mostrou-se com as menores médias. Conclusões: A prevalência de mordida cruzada em respiradores orais é 15,09%. Observou-se uma tendência associativa da mordida cruzada posterior nas crianças do grupo de estudo. Na associação do tipo de obstrução respiratória com a presença do cruzamento posterior, não houve diferença estatística. Quanto à análise da largura dos arcos dentais em relação à idade categorizada, verificou-se, no grupo controle, uma diferença estatisticamente significante da idade de 5-6 anos em relação à idade 3-4 anos. Esta diferença, porém, não foi encontrada no grupo de estudo / Introduction: Among the alterations of dental malocclusion in the first dentition, the posterior crossbite stands out, which consists of a relation of vestibular reverse overjet of superior teeth with their inferior antagonists. The growth of facial structures consists of multiple functional activities interrelated by different components of the head and the neck. Breathing through the nose is one of the elements of functional activity. If there is obstruction in the superior airway, there will be functional adaptations in the growth direction of face skeleton structures. The hyperplasia of the adenoids and/or associate palatine tonsils is one of the most common causes of airway obstruction. Objectives: Probe the prevalence of posterior crossbite in children from 3 to 6 years old and associate it to the respiratory pattern; verify if there is association of such malocclusion with the etiology of hyperplasia of palatine tonsils associate or not with hyperplasia of the adenoids; carry out a comparative analysis in children who breathe through their mouth and nose at the categorized age of 3-4 years old and 5-6 years old in the following aspects: arch width distances by means of maxillary and mandibular intercanine and intermolar distances. Casuistry and Methods: A total of 53 children took part in the study herein, boys and girls with hyperplasia of the adenoids and/or associate palatine tonsils coming from the ambulatory of the Division of Otorhinolaryngology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - HCFMUSP, with indication of tonsillectomy or adenoidectomy. The patients have been submitted to an otorhinolaryngological physical examination, in addition to nasal fiber pharyngoscopy or Cavum x-ray. The control group consisted of 41 children with no complaints of airway obstruction surveyed by questionnaires forwarded to their parents, children coming from schools of the municipality of Itapetininga, State of São Paulo. All children have been evaluated by a dental surgeon who has measured their dental arch width directly in the mouth by means of a digital calliper. Results: The posterior crossbite was present in 9.57% out of the total of the sample. The prevalence of posterior cross in the study group was 15.09% and, in the control group, 2.13%. The following frequencies of posterior cross have been found in different etiologies of lymphoid hyperplasia: isolated palatine (16.67%); isolated pharynx (25%); and associated palatine and pharynx (7.41%). The dental arch width in the study group, in spite of not presenting statistical relevance when compared to the control group at the age of 3-4 years old, was shown with the highest averages. On the other hand, at the age of 5-6 years old, lowest averages were shown. Conclusions: The prevalence of crossbite in children who breathe through their mouth is of 15.09%. An associated trend of posterior crossbite in children of the study group has been observed. In the association of the type of airway obstruction with the presence of posterior cross, there was no statistical difference. As per the dental arch width analysis in regards to the categorized age, in the control group, a statistically significant difference was verified at the age of 5-6 years old regarding the age of 3-4 years old. Such difference, however, was not found in the study group

Historique & Objectifs: Les effets de l’avancement maxillaire (AM) sur l’anatomie velopharyngée ont déjà été étudiés en utilisant la céphalométrie. Cette modalité ne permet toutefois pas de bien caractériser les tissus mous. Le but de cette étude est de comparer la configuration de l’espace vélopharyngé en pré- et post-opératoire, telle que mesurée par tomodensitométrie (TDM). De plus, notre objectif est d’analyser et de comparer les différences dans ces mesures chez les patients avec et sans fente palatine (FP). Méthodologie: Ceci est une étude rétrospective portant sur 44 patients avec et sans FP, traités avec AM pour une hypoplasie maxillaire et une malocclusion dento-squelettique. Les TDM pré- et post-opératoires ont été comparés en se basant sur des repères préétablis. Des distances linéaires, des aires de sections transversales et des mesures volumétriques ont été mesurées en utilisant des reconstructions tridimensionnelles des TDM. Résultats: Pour les distances linéaires mesurées, une différence statistiquement significative a été notée pour les mesures linéaires du nasopharynx et du palais mou (25.1 vs 28.5 mm p=0.001 et 6.5 vs 7.6 mm p=0.026, respectivement). Les aires des sections transversales au niveau du nasopharynx et du palais mou ainsi que l'évaluation volumétrique de l'espace vélopharyngé n'ont pas démontrées une différence statistiquement significative en comparant les mesures en pré- et post-opératoire (p>0,05). En comparant les patients avec et sans FP, une différence statistiquement significative n’a été notée que pour la distance linéaire et l’aire de la section transversale du nasopharynx (p=0.045 et p=0.04, respectivement). Un antécédent de réparation de FP n’était pas prédictif de différences de mesures pré- et post-opératoire. Conclusion: Nos résultats confirment que, bien que certaines modifications structurelles de l’espace vélopharyngé soient inhérentes à l’AM chez les patients avec FP, leurs aires et volumes ne semblent pas changer de façon significative. Ces changements sont indépendants d’une histoire de FP réparée. / Background & Purpose: The effects of maxillary advancement (MA) on velopharyngeal anatomy have primarily been studied using lateral cephalometric radiographs. However, with recent advances in orthognathic surgery, there is an increased need for more detailed and precise imaging such as computerized tomographic (CT) scan reconstructions, to help in surgical planning and to measure outcomes. The purpose of this study is to compare the pre-and post-operative velopharyngeal space configuration modifications as measured on CT scans. The aim is also to assess differences in these airway measures between patients with and without history of prior repaired cleft palate (CP). Methods: This is a retrospective cohort study of 44 patients with and without CP who were treated with MA for midface hypoplasia and secondary malocclusion at skeletal maturity. The pre-and post-operative CT scans were compared with respect to pre-established landmarks. Linear distances, cross-sectional areas, and volumes were measured using 3-dimensional (3D) CT scan reconstructions. Results: For the linear distances measured, a statistically significant difference was found when comparing the pre-and post-operative measures of the narrowest part of the nasopharynx and the narrowest part of the retropalatal airway space (25.1 vs 28.5 mm p=0.001 and 6.5 vs 7.6 mm p=0.026, respectively). Retropalatal cross-sectional areas, nasopharyngeal cross-sectional areas and the volumetric assessment of the nasopharyngeal space showed no statistically significant differences when comparing pre-and post-operative scans (p>0.05). The main effect of palatal repair (CP vs. Non-CP) showed that there was only a statistically significant difference for the measures of the narrowest part of the nasopharynx and the nasopharyngeal cross-sectional area (p=0.045 and p=0.04, respectively). Mean changes in the measures did not differ over time (pre-and post-op) depending on whether there was prior history of CP repair. Conclusion: Our results support the hypothesis that although structural modifications of the pharyngeal space are inherent to MA in patients with CP, its surface area and volume do not change significantly. These changes are also independent of history of previous CP repair.

Les fentes labio-palatines (FLP) sont la malformation cranio-faciale congénitale la plus fréquente. D'origine multifactorielle, elles sont la conséquence d'un défaut de fusion des bourgeons faciaux.Objectif et MéthodologieL'objectif de ce travail a été d'étudier la place des gènes de l'angiogenèse dans le cadre de la piste étiologique des FL/P. La méthodologie de ce travail comportait 3 étapes :- Une analyse systématique et exhaustive des gènes impliqués dans les FL/P comprenant les gènes identifiés mais aussi les gènes potentiellement impliqués.- Une analyse rétrospective des explorations génétiques des FL/P opérées au CHU de Reims entre 2003 et 2009.- La mise en place d'une analyse prospective (2009-2012, AOL) :- Génomique constitutionnelle par CGH Array- In situ au niveau des berges des fentes issues de déchets opératoires des chirurgies primaires des FL/P comprenant :Le développement d'un protocole de culture cellulaire de fibroblastesUne analyse anatomopathologiqueEt surtout le développement d'un modèle d'étude in vivo chez l'enfant d'analyse d'expression des gènes de l'angiogenèse.RésultatsL'analyse systématique des gènes impliqués dans les FL/P a mis en évidence 95 gènes dont plus d'une dizaine sont connus comme liés aux mécanismes d'angiogenèse (facteurs de croissance et protéases). Ces derniers sont en interaction entre eux mais aussi avec 18 autres gènes impliqués eux aussi dans les FL/P. Ainsi au total 1/3 des gènes d'intérêt sont soit des gènes de l'angiogenèse soit en lien avec eux.L'étude rétrospective nous a permis de mettre en exergue certaines formes cliniques originales qui ont été étudiées et publiées sous un angle « étiologique ».L'étude prospective nous a permis, après obtention des consentements, d'inclure 72 patients (30 FLP, 24FL, 18FP) opérés au CHU de Reims entre 2009 et 2012 d'une chirurgie primaire.Nous présentons :- nos résultats anatomopathologiques, et génétiques (CGH Array)- notre protocole de culture cellulaire- nos réflexions, notre cheminement aboutissant à la création du modèle d'étude d'analyse d'expression des gènes de l'angiogenèseDiscussionLa littérature a bien mis en avant une implication des phénomènes angiogéniques dans la constitution des FL/P par le biais des facteurs de croissance (TGFβ, PDGF C et Ra, FGF, TGFA, FGFR1, FGFR2 ; VEGF) et des protéases (MMP/TIMP2). L'ensemble de nos manipulations in situ nous permet aujourd'hui de disposer du matériel nécessaire pour l'étude de l'expression des facteurs impliqués dans l'angiogenèse sur les berges des fentes.Parallèlement, l'étude génomique constitutionnelle en CGH Array a permis de retrouver des variations non-connues comme polymorphiques chez 62% de nos patients. Des études familiales vont compléter notre travail. Elles permettront de savoir si ces CNV sont héritées ou De Novo et ainsi de préciser leur caractère bénin ou pathologique. L'identification chez un de nos patients d'une amplification, même de petite taille, du gène SKI (gène lié à la voie des TGFβ) nous encourage dans la poursuite de nos recherches d'anomalies constitutionnelles des gènes de l'angiogenèse dans les FL/PLa CGH array est une technique qui nous a paru particulièrement utile et fiable en terme de « scanning » et de dépistage.En conclusion, en pratique clinique, la découverte des anomalies préalablement certainement sous estimées par les cliniciens doit nous mener à une nouvelle réflexion sur le conseil génétique et sur l'utilité dans l'avenir d'un dépistage plus systématique. / Cleft lip and palate (CLP) are the most common congenital craniofacial malformation. They have a multifactorial etiology and are the consequence of incomplete fusion of the facial buds.Objective and MethodologyThe objective of this work was to study the role of the genes of angiogenesis in the framework of studying the etiology of CL/P. Our methodological approach included 3 steps:- Systematic and thorough analysis of the genes involved in CL/P including identified genes but also genes that could be potentially involved.- A retrospective analysis of the operated clefts at the University Hospital of Reims between 2003 and 2009.- Implementation of a prospective analysis (2009-2012, AOL):- Constitutional genomic study by CGH Array- In situ with tissue specimens extracted from surgically excised cleft edges including:The development of a protocol for fibroblast cell culturesHistopathological analysisAnd above all the development of an in vivo study model in children for analyzing the expression of genes of angiogenesis.ResultsThe systemic analysis of genes involved in cleft lip palate unveiled 95 genes including about ten that are known to be related to angiogenesis mechanisms (growth factor and proteases). These genes interact between themselves but also with 18 other genes also involved in CL/P. In all, 1/3 of relevant genes are either angiogenesis-related genes or in direct relation with them.The retrospective study permitted to underline the some original clinical forms that were studied and published under an « etiological » angle.The prospective study included 72 patients (30 CLP, 24CL, 18CP), for whom we obtained informed signed consents, operated at the University Hospital of Reims between 2009 and 2012 for primary cleft surgery.We present:- Our histopathological and genetic results (CGH Array)- Our cell culture protocol (submitted for publication)- Our approaches and thought process behind the design of a study model for analyzing expression profiling of angiogenic genesDiscussionThe literature has highlighted the role of angiogenesis in the formation of cleft lip/palate via growth factors (TGFβ, PDGF C and Ra, FGF, TGFA, FGFR1, FGFR2, VEGF) and proteases (MMP/TIMP2). All our manipulations in situ have yielded the necessary material, i.e. edges of resected clefts, to study the expression of factors involved in cleft angiogenesis.In parallel, the constitutional genomic study in CGH Array enabled to uncover abnormalities in 62% of our patients. Family studies will complete our work. They will help to refine if these CNV are inherited or de novo and thus indicate their benign or pathological nature. In one of our patients, the identification of the SKI gene (related to the TGFβ pathway) encourages us to continue our research of genetic abnormalities of angiogenic genes involved in cleft lip/palate. CGH array appeared to be a very useful and reliable method in terms of scanning and screening.In conclusion, in clinical practice, the discovery of abnormalities which were probably underestimated by clinicians before, leads us to rethink the issue of genetic counseling and the relevance of a more systematic screening for these abnormalities in the future.

La période entre 338 et 290 av. J.-C. fut un tournant pour Rome, car elle vit la soumission des Latins et la défaite des Samnites, ce qui permit à l’Urbs de devenir la première puissance italique. On assista donc à l’avènement d’un impérialisme romain. Se pose alors la question de l’idéologie d’État de cette Rome en transition. Comme cette expansion fut accompagnée par la construction, à Rome, de dix nouveaux temples, souvent dédiés à des divinités nouvelles, et que toute divinité exprimait une idéologie, il nous a semblé possible de reconstituer, dans ses grands traits, cette idéologie d’État grâce aux nouvelles divinités et leurs sanctuaires. Nous avons donc choisi d’analyser deux nouveaux temples : celui de Quirinus et celui de Victoria. Le choix de Quirinus s’explique par le fait que ce dieu avait, on l’a montré, déjà été assimilé à Romulus ; quant à Victoria, on l’a choisie pour trois raisons : elle était une déesse de la victoire ; son temple fut élevé au-Dessus du Lupercal, au cœur même de la « Rome de Romulus » ; grâce aux fouilles de P. Pensabene, on peut reconstituer son sanctuaire. Puis, on a analysé les deux temples et leurs divinités à travers les concepts (cadre social de la mémoire, mémoire collective) issus de la sociologie de M. Halbwachs. On a ainsi constaté qu’à travers ces temples, l’élite dirigeante avait diffusé auprès du peuple une nouvelle identité collective affirmant le caractère exceptionnel de Rome et contenant l’idée d’une expansion illimitée de l’Urbs. Cette création d’une identité romaine impérialiste se fondant sur Romulus et la religion en général, on peut l’interpréter comme la construction d’un destin collectif pour Rome. / The period between 338 and 290 B.C. saw a sea change for Rome, because the subjugation of the Latins and the defeat of the Samnites allowed her to become the main italic power, and witnessed the advent of a roman imperialism. In this context arises the problem of the state ideology of this Rome in transition. As this expansion was accompanied by the construction of ten new temples in Rome, frequently consecrated to new deities, each of them expressing a specific ideology, we thought it possible to reconstruct the new state ideology through an analysis of the deities and shrines in question. So, for our study, we chose two new temples, those of Quirinus and of Victoria. Quirinus because of his assimilation to Romulus, Victoria because she was a deity of victory; her shrine was built above the Lupercal, at the heart of the “Rome of Romulus”; and because her temple can be reconstructed thanks to the excavations of P. Pensabene. Then we analyzed the two temples and their godheads through concepts (social frame of memory; collective memory) taken from the sociology of M. Halbwachs. In this way we came to the conclusion that, through these two shrines, the ruling élite had tried to communicate to the common people a new collective identity promoting the exceptionality of Rome and her unlimited powers of expansion. This construction of an imperialistic roman identity being based on Romulus and the religion in general, one can interpret it as construction of a collective destiny for Rome.