Análise da fossa pterigopalatina em pacientes submetidos à expansão maxilar rápida assistida cirurgicamente: um estudo morfométrico utilizando a tomografia computadorizada de feixe cônico

Autores

DOI:

https://doi.org/10.33448/rsd-v10i12.20388

Palavras-chave:

Fossa pterigopalatina; Radiologia; Tomografia computadorizada de feixe cônico; Técnica de expansão palatina.

Resumo

Este estudo retrospectivo, observacional e longitudinal realizou uma análise morfométrica da fossa pterigopalatina (PPF) em pacientes submetidos à expansão maxilar rápida assistida cirurgicamente (SARME) utilizando TCFC (TCFC). Foram avaliadas tomografias CBCT de 41 pacientes consecutivos e foram realizadas as seguintes medições: Volume de PPF (PPFV), altura (PPFH), comprimento (PPFL) e ângulo (PPFA). A amostra foi dividida em grupos D (pacientes submetidos à SARME; n=26) e controle (n=15). O grupo D foi subdividido em D+ (com disjunção pterigomaxilar - PMD) e D- (sem PMD). As diferenças entre o período pré e pós-operatório foram testadas usando o U Mann-Whitney ou o teste t. Os grupos D+ e D- foram comparados usando os testes ANOVA ou Kruskal-Wallis unidirecionais (nível de significância fixado em 5%). Em geral, houve variações morfométricas no PPF, com valores mais baixos após a SARME. As diferenças para PPFH, PPFL e PPFA não foram significativas (p>0,05). No lado direito, houve diferenças no PPFV, com valores mais baixos em pacientes do grupo D+ (p<0,05). Estes achados indicam uma redução morfométrica de PPF após a SARME, com diferenças quando a disjunção é realizada ou não. O cirurgião maxilofacial deve estar ciente destas mudanças ao realizar a SARME com ou sem disjunção.

Biografia do Autor

Isabella Maria Zanutto, State University of Maringa

Master student in integrated dentistry, Department of Dentistry, State University of Maringá, Maringá, PR, Brazil

Liogi Iwaki Filho, State University of Maringa

Titular Professor of Oral and Maxillofacial Surgery, Department of Dentistry, State University of Maringá, Maringá, PR, Brazil

Breno Gabriel da Silva, University of São Paulo

PhD Student in Statistics and Agricultural Experimentation, Department of Exact Sciences, “Luiz de Queiroz” College of Agriculture, University of São Paulo (ESALQ/USP), Piracicaba, SP, Brazil.

Mariliani Chicarelli da Silva, State University of Maringa

Adjunct Professor of Dental Radiology and Imaging, Department of Dentistry, State University of Maringá, Maringá, PR, Brazil

Elen de Souza Tolentino, State University of Maringa

Assistant Professor of Dental Radiology and Imaging, Department of Dentistry, State University of Maringá, Maringá, PR, Brazil

Eder Alberto Sigua-Rodriguez , University Institution Colleges of Colombia

Resident of Oral and Maxillofacial Surgery, Department of Dentistry, State University of Maringá, Maringá, PR, Brazil.  

Lilian Cristina Vessoni Iwaki, State University of Maringa

Titular Professor of Dental Radiology and Imaging, Department of Dentistry, State University of Maringá, Maringá, PR, Brazil.  

Referências

Alfieri, A., Jho, H. D., Schettino, R., & Tschabitscher, M. (2003). Endoscopic endonasal approach to the pterygopalatine fossa: anatomic study. Neurosurgery, 52(2), 374–380.

Alhammadi, M. S., Halboub, E., Fayed, M. S., Labib, A., & El-Saaidi, C. (2018). Global distribution of malocclusion traits: A systematic review. Dental press journal of orthodontics, 23(6), 40.e1–40.e10.

Ali Hasan, H., Khursheed Alam, M., Yusof, A., Matsuda, S., Shoumura, M., & Osuga, N. (2016). Accuracy of Three Dimensional CT Craniofacial Measurements Using Mimics and InVesalius Software Programs. Journal of Hard Tissue Biology, 25(2), 219–224. doi:10.2485/jhtb.25.219

Alves, N. et al. (2017). Nasolabial changes after two different approaches for surgically assisted rapid maxillary expansion. International Journal of Oral and Maxillofacial Surgery, v. 46, n. 9, p. 1088-1093.

Aoun, G., Nasseh, I., & Sokhn, S. (2016). Radio-anatomical Study of the Greater Palatine Canal and the Pterygopalatine Fossa in a Lebanese Population: A Consideration for Maxillary Nerve Block. Journal of clinical imaging science, 6, 35.

Bailey, L. J., Haltiwanger, L. H., Blakey, G. H., & Proffit, W. R. (2001). Who seeks surgical-orthodontic treatment: a current review. The International journal of adult orthodontics and orthognathic surgery, 16(4), 280–292.

Carvalho, P. H. A., Moura, L. B., Trento, G. S., Holzinger, D., Gabrielli, M. A. C., Gabrielli, M. F. R., & Pereira Filho, V. A. (2019). Surgically assisted rapid maxillary expansion: a systematic review of complications. International Journal of Oral and Maxillofacial Surgery.

Codari, M., Zago, M., Guidugli, G. A., Pucciarelli, V., Tartaglia, G. M., Ottaviani, F., Righini, S., & Sforza, C. (2016). The nasal septum deviation index (NSDI) based on CBCT data. Dento maxillo facial radiology, 45(2), 20150327.

Derinkuyu, B. E., Boyunaga, O., Oztunali, C., Alimli, A. G., & Ucar, M. (2017). Pterygopalatine Fossa: Not a Mystery!. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes, 68(2), 122–130.

Elhadi, A. M., Zaidi, H. A., Yagmurlu, K., Ahmed, S., Rhoton, A. L., Jr, Nakaji, P., Preul, M. C., & Little, A. S. (2016). Infraorbital nerve: a surgically relevant landmark for the pterygopalatine fossa, cavernous sinus, and anterolateral skull base in endoscopic transmaxillary approaches. Journal of neurosurgery, 125(6), 1460–1468.

Evans BT. (2016) Infratemporal and pterygopalatine fossae and temporomandibular joint. In: Standring S (ed). Gray’s Anatomy: the anatomical basis of clinical practice, 41st edn, Elsevier, Amsterdam, pp 534-555.

Fındık, Y., Baykul, T., & Yazıcı, T. (2019). Nasal soft tissue changes after two different approaches for surgically assisted rapid maxillary expansion. International journal of oral and maxillofacial surgery, 48(7), 957–961.

Fortes FS, Sennes LU, Carrau RL, Brito R, Ribas GC, Yasuda A, Rodrigues AJ Jr, Snyderman CH, Kassam AB. (2008) Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach: Development of a surgical instruction model. Laryngoscope;118(1):44-49. PMID: 17989582.

Gamer M. (2010). irr: Various coefficients of interrater reliability and agreement. http://cran. r-project. org/web/packages/irr/irr. pdf.

Gibelli, D., Cellina, M., Gibelli, S., Cappella, A., Panzeri, M. M., Oliva, A. G., Termine, G., Dolci, C., & Sforza, C. (2019). Anatomy of the pterygopalatine fossa: an innovative metrical assessment based on 3D segmentation on head CT-scan. Surgical and radiologic anatomy : SRA, 41(5), 523–528.

Gurler, G. et al. (2018) Skeletal changes following surgically assisted rapid maxillary expansion (SARME). Eur Oral Res, Turkey, v.52, n.2, p.94-8.

Han, U. A., Kim, Y., & Park, J. U. (2009). Three-dimensional finite element analysis of stress distribution and displacement of the maxilla following surgically assisted rapid maxillary expansion. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 37(3), 145–154.

Hegde S, Ajila V, Kamath JS, Babu S, Pillai DS, Nair SM. (2018) Importance of cone-beam computed tomography in dentistry: An update SRM jornal of research in dental sciences. Vol 9; 4 ;186-190. DOI: 10.4103/srmjrds.srmjrds_26_18

Hernandez-Alfaro, F., Mareque Bueno, J., Diaz, A., & Pagés, C. M. (2010). Minimally invasive surgically assisted rapid palatal expansion with limited approach under sedation: a report of 283 consecutive cases. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 68(9), 2154–2158.

Hitotsumatsu T, Matsushima T, Rhoton AL. (1999). Surgical anatomy of the midface and the midline skull base. Oper Tech Neurosurg ;2(4):160-180.

Icen, M., & Orhan, K. (2019). Cone-beam computed tomography evaluation of the pterygomaxillary fissure and pterygopalatine fossa using 3D rendering programs. Surgical and radiologic anatomy : SRA, 41(5), 513–522.

Kayalar, E., Schauseil, M., Hellak, A., Emekli, U., Fıratlı, S., & Korbmacher-Steiner, H. (2019). Nasal soft- and hard-tissue changes following tooth-borne and hybrid surgically assisted rapid maxillary expansion: A randomized clinical cone-beam computed tomography study. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 47(8), 1190–1197.

Khonsary, S. A., Ma, Q., Villablanca, P., Emerson, J., & Malkasian, D. (2013). Clinical functional anatomy of the pterygopalatine ganglion, cephalgia and related dysautonomias: A review. Surgical neurology international, 4(Suppl 6), S422–S428.

Kish, L. (1995). Survey Sampling. New York: John Wiley and Sons.

Landis JR, & Koch GG. (1977). The measurement of observer agreement for categorical data. biometrics, 159-174.

Liu, M. C., Yin, X. R., Zhang, Y. S., Yang, W., Zhang, H. W., Duan, H. B., Liu, J. M., Cheng, K. L., & Li, Y. Q. (2017). Computed Tomography Research: Relative Anatomy of Caldwell-Luc Approach in Pterygopalatine Fossa Surgery. The Journal of craniofacial surgery, 28(6), 1537–1540.

Medeiros JR, Ferraro Bezerra M, Costa FWG, Bezerra TPP, de Araújo Alencar CR, Studart Soares EC. (2017) Does pterygomaxillary disjunction in surgically assisted rapid maxillary expansion influence upper airway volume? A prospective study using Dolphin Imaging 3D. Int J Oral Maxillofac Surg. Sep;46(9):1094-1101. doi: 10.1016/j.ijom.2017.04.010. Epub 2017 May 15. PMID: 28521967.

Pereira, M. D., Koga, A. F., Prado, G., & Ferreira, L. M. (2018). Complications From Surgically Assisted Rapid Maxillary Expansion With HAAS and HYRAX Expanders. The Journal of craniofacial surgery, 29(2), 275–278.

R Core Team. (2020). R: a language and environment for statistical computing. Vienna, AT: R Foundation for Statistical Computing.

Sokucu, O., Kosger, H. H., Bicakci, A. A., & Babacan, H. (2009). Stability in dental changes in RME and SARME: a 2-year follow-up. The Angle orthodontist, 79(2), 207–213. https://doi.org/10.2319/031808-155.1

Tashi, S., Purohit, B. S., Becker, M., & Mundada, P. (2016). The pterygopalatine fossa: imaging anatomy, communications, and pathology revisited. Insights into imaging, 7(4), 589–599.

Tomaszewska, I.M., Kmiotek, E.K., Pena, I.Z. et al. (2015) Computed tomography morphometric analysis of the greater palatine canal: a study of 1,500 head CT scans and a systematic review of literature. Anat Sci Int 90, 287–297.

Uehara M, Tominaga K, Asahina I. (2013) Surgical approach to the pterygopalatine fossa -comparison between anterior approach and lateral approach. J Craniofac Surg;24(2);536-539.

Verlinden, C. R., Gooris, P. G., & Becking, A. G. (2011). Complications in transpalatal distraction osteogenesis: a retrospective clinical study. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, 69(3), 899–905.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. (2008) STROBE initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol:61:344-349.

Vuksanovic-Bozaric A, Vukcevic B, Abramovic M, Vukcevic N, Popovic N, Radunovic M. (2019) The pterygopalatine fossa: morphometric CT study with clinical implications. Surg Radiol Anat. Feb;41(2):161-168. doi: 10.1007/s00276-018-2136-8. Epub 2018 Nov 23. PMID: 30470877.

Wickham H. (2016). ggplot2: elegant graphics for data analysis. springer.

Williams, B. J., Currimbhoy, S., Silva, A., & O'Ryan, F. S. (2012). Complications following surgically assisted rapid palatal expansion: a retrospective cohort study. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 70(10), 2394–2402.

Yushkevich, P. A., Piven, J., Hazlett, H. C., Smith, R. G., Ho, S., Gee, J. C., & Gerig, G. (2006). User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. NeuroImage, 31(3), 1116–1128.

Zandi, M., Miresmaeili, A., Heidari, A., & Lamei, A. (2016). The necessity of pterygomaxillary disjunction in surgically assisted rapid maxillary expansion: A short-term, double-blind, historical controlled clinical trial. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 44(9), 1181–1186. https://doi.org/10.1016/j.jcms.2016.04.026

Downloads

Publicado

16/09/2021

Como Citar

ZANUTTO, I. M.; IWAKI FILHO, L. .; SILVA, B. G. da .; SILVA, M. C. da .; TOLENTINO, E. de S.; SIGUA-RODRIGUEZ , E. A. .; IWAKI, L. C. V. . Análise da fossa pterigopalatina em pacientes submetidos à expansão maxilar rápida assistida cirurgicamente: um estudo morfométrico utilizando a tomografia computadorizada de feixe cônico. Research, Society and Development, [S. l.], v. 10, n. 12, p. e158101220388, 2021. DOI: 10.33448/rsd-v10i12.20388. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/20388. Acesso em: 3 jul. 2024.

Edição

v. 10 n. 12

Seção

Ciências da Saúde

Licença

Copyright (c) 2021 Isabella Maria Zanutto; Liogi Iwaki Filho; Breno Gabriel da Silva; Mariliani Chicarelli da Silva; Elen de Souza Tolentino; Eder Alberto Sigua-Rodriguez ; Lilian Cristina Vessoni Iwaki

Creative Commons License
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.

Autores que publicam nesta revista concordam com os seguintes termos:

1) Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.

2) Autores têm autorização para assumir contratos adicionais separadamente, para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.

3) Autores têm permissão e são estimulados a publicar e distribuir seu trabalho online (ex.: em repositórios institucionais ou na sua página pessoal) a qualquer ponto antes ou durante o processo editorial, já que isso pode gerar alterações produtivas, bem como aumentar o impacto e a citação do trabalho publicado.