RESUMEN
This study was performed to evaluate the impact on the upper airway and nasal cavity of a new minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) technique for the treatment of adult patients with transverse maxillary deficiency, in comparison to surgically assisted rapid palatal expansion (SARPE). Computed tomography scans of 21 MISMARPE and 16 SARPE patients were obtained preoperatively (T0) and at the end of the activation period (T1) and analysed. Linear and volumetric measurements were performed in the dental, alveolar, nasal cavity, and oropharynx regions. Generalised estimating equations were used to consider the intervention time and surgery type, and their interaction. In both groups, measurements were increased at T1 (P < 0.001), except for oropharynx volume (P > 0.05). A greater expansion in nasal cavity floor and median palatal suture was shown for MISMARPE when compared to SARPE (P < 0.001), with the same degree of expander activation (P = 0.094). A trapezoidal (coronal plane) and 'V' shape (axial plane) expansion pattern, was observed after MISMARPE. Both surgical techniques were effective for maxillary expansion in adults. However, MISMARPE was performed without osteotomy of the pterygomaxillary suture, in an outpatient setting and with local anaesthesia.
Asunto(s)
Tornillos Óseos , Procedimientos Quirúrgicos Mínimamente Invasivos , Cavidad Nasal , Técnica de Expansión Palatina , Tomografía Computarizada por Rayos X , Humanos , Técnica de Expansión Palatina/instrumentación , Femenino , Cavidad Nasal/diagnóstico por imagen , Cavidad Nasal/cirugía , Masculino , Adulto , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del Tratamiento , Maxilar/cirugía , Maxilar/diagnóstico por imagen , AdolescenteRESUMEN
PURPOSE: The aim of this study is to suggest a feasible method to find the ostium of the Wirsung's duct during sphincteroplasty of the Vater's papilla, in order to avoid post-operative complications such as acute pancreatitis. PATIENTS AND METHODS: A total of 27 patients were submitted to sphincteroplasty for choledocolithiasis with or without Odditis. After therapeutic papillotomy and sphincterotomy through the duodenun, the location of the ostium of the Wirsung's duct was determined and studied. After papillotomy, the Vater's papilla becomes an isosceles triangle and its measurements were made with a compass. Thereby the ostium of Wirsung's duct was easily detected and a catheter was inserted before the suture of the mucosa of the papilla. RESULTS: The ostium was generally found medially, on the left side of the triangle, 0.19 cm to 0.25 cm on average above its base whether there was inflammation or not, respectively. CONCLUSION: The transoperative determination of the dimensions as proposed in this study, allows a safety detection and cannulation of the Wirsung's duct with or without inflammation of the Oddi's sphincter.