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INTRODUCCION. La fistula palatina es la persistencia de comunicación anormal entre la cavidad nasal y oral post palatoplastia, es la complicación frecuente con: alta morbilidad, problemas para la alimentación, articulación de las palabras inapropiada, halitosis hasta problemas psicosociales como baja autoestima y rechazo social. OBJETIVO. Determinar los factores asociados al desarrollo de fístula palatina. MATERIALES Y MÉTODOS. Estudio observacional, analítico de casos y controles. De una población de 334 Historias Clínicas se tomó muestra de 89 en la Unidad de Plástica y Reconstructiva del Hospital de Especialidades Carlos Andrade Marín de enero 2010 a julio 2019. Criterios de inclusión: datos de pacientes con paladar fisurado reparado por palatoplastia. Criterios de Exclusión: pacientes sin buen seguimiento postquirúrgico y con paladar hendido sin reparación quirúrgica. Los datos fueron obtenidos del sistema AS400, el análisis se realizó mediante el programa estadístico International Business Machines Statistical Package for the Social Sciences. RESULTADOS. El uso de ortopedia prequirúrgica (OR: 0,014; p<0,000) y la alimentación con leche materna (OR: 0,033; p<0,003) fueron factores protectores. DISCUSIÓN. La ortopedia prequirúrgica fue la mejor opción de moldeamiento en pacientes con hendiduras amplias para la aproximación de los segmentos óseos hendidos, como factor protector significativo se encontró a la lactancia materna exclusiva dato que coincide con el estudio de López YD., donde mencionó que produjo mayor estimulación para la fusión de las crestas palatinas a pesar de que no fue estadísticamente significativa. CONCLUSION. Los factores asociados al desarrollo de fístula palatina estadísticamente significativos fueron el uso de ortopedia prequirúrgica y la alimentación con leche materna, catalogados como protectores.

INTRODUCTION. Palatal fistula is the persistence of abnormal communication between the nasal and oral cavity post palatoplasty, it ́s the frequent complication with: high morbidity, feeding problems, inappropriate articulation of words, halitosis and psychosocial problems such as low self-esteem and social rejection. OBJECTIVE. Determine the factors associated with the development of palatal fistula. MATERIALS AND METHODS. Observational, analytical case-control study. From a population of 334 Clinical Histories, a sample of 89 was taken in the Plastic and Reconstructive Unit of the Carlos Andrade Marín Specialty Hospital from january 2010 to july 2019. Inclusion criteria: data from patients with cleft palate repaired by palatoplasty. Exclusion Criteria: patients without good postsurgical follow-up and with a cleft palate without surgical repair. The data were obtained from the AS400 system, the analysis was performed using the International Business Machines Statistical Package for the Social Sciences statistical program. RESULTS. The use of presurgical orthopedics (OR: 0,014; p<0,000) and feeding with breast milk (OR: 0,033; p<0,003) were protective factors. DISCUSSION. Presurgical orthopedics was the best molding option in patients with wide clefts for the approximation of the cleft bone segments, as a significant protective factor, exclusive breastfeeding was found, data that coincides with the study by López YD., where he mentioned that it produced greater stimulation for palatine ridge fusion although it was not statistically significant. CONCLUSION. Statistically significant factors associated with the development of palatal fistula were the use of pre-surgical orthopedics and feeding with breast milk, classified as protective.

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Introdução: A palatoplastia com elevação de retalhos mucoperiostais bipediculados pela técnica de Von Langenbeck associada a veloplastia intravelar é técnica mais utilizadas na atualidade apresentando na literatura baixa taxa de fístula oronasal e de insuficiência velofaríngea. O objetivo é apresentar a experiência acumulada do autor e avaliar a incidência de fístula oronasal após 278 casos de palatoplastia primária, pela técnica de Von Langenbeck associada a veloplastia intravelar. Métodos: Estudo retrospectivo de 278 prontuários de pacientes submetidos à palatoplastia primária no Centro de Tratamento de Malformações Craniofaciais Mário Covas - Hospital Guilherme Álvaro - Santos/SP, entre de maio de 2010 a maio de 2018. Resultados: 278 procedimentos de palatoplastia primária pela técnica relatada, 225 (80,9%) em duas etapas cirúrgicas e 53 (19,1%) em única etapa. Masculino 182 (65,5%) e feminino 96 (34,5%). Fissuras labiopalatais esquerda e bilaterais (26,3% e 27%, respetivamente). As fissuras palatais completas corresponderam a 37,4% e a fissura labiopalatal direita com 7,6%. 61 pacientes apresentaram fístula oronasal (21,94%) observando-se uma diminuição progressiva da incidência em cada período. Conclusão: A palatoplastia primária pela técnica de Von Langenbeck associada à veloplastia intravelar é uma técnica reprodutível em uma ou duas etapas cirúrgicas e pode ser considerada segura quando alcançada uma adequada curva de aprendizado apresentando um índice de complicações acorde com a literatura mundial.

Introduction: Palatoplasty with elevated bilateral mucoperiosteal flaps using the von Langenbeck technique associated with intravelar veloplasty is a common procedure with low rates of oronasal fistula (ONF) and velopharyngeal insufficiency. The objective is to present the author's surgical experience and the incidence of ONF among 278 patients who underwent primary palatoplasty using the von Langenbeck technique associated with intravelar veloplasty. Methods: This retrospective study analyzed the medical records of 278 patients who underwent primary palatoplasty at the Mário Covas Treatment Center for Craniofacial Malformations of the Guilherme Álvaro Hospital located in the municipality of Santos, São Paulo, Brazil, between May 2010 and May 2018. Results: A total of 278 primary palatoplasty procedures were performed; of them, 225 (80.9%) were performed in two surgical stages and 53 (19.1%) in one surgical stage. The study population included 182 men (65.5%) and 96 women (34.5%). The prevalence of left and bilateral cleft lip and palate was 26.3% and 27%, respectively, and the prevalence of bilateral cleft palate, and right cleft lip and palate was 37.4% and 7.6%, respectively. Sixty-one patients had ONF (21.94%), the incidence of which decreased progressively throughout the study period. Conclusion: Primary palatoplasty, using the von Langenbeck technique associated with intravelar veloplasty, is reproducible when performed in one or two surgical stages, and considered safe when the learning curve is reached with a complication rate similar to those in the literature.

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Abstract: Benign migratory glossitis or geographic tongue is a benign condition that usually manifests as asymptomatic erythematous and migratory circinate patches, involving the lateral and dorsal aspects of the tongue. Extra-lingual lesions uncommonly occur and are mainly located on labial and buccal mucosae, lips and floor of the mouth. The present report describes one patient with a geographic lesion on the hard palate associated with lingual lesions and another patient who had multiple geographic lesions both in the hard and soft palate without lingual lesions. We found 64 cases in the English literature of ectopic locations with 22 palate involvement. No case of simultaneous involvement of the hard and the soft palate was found.

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AIM: To evaluate changes in pharyngeal airway space (nasopharynx and oropharynx), soft palate and lingual vallecula after maxillary advancement surgery and maxillary advancement and mandibular setback surgery (bimaxillary surgery). METHODS: Twenty Class III adult patients were included in the study. Ten patients were treated with maxillary advancement and ten with bimaxillary surgery (maxillary advancement and mandibular setback). Cephalometric landmark measurements were recorded at 3 different time intervals: pre-surgical, post-surgical and six months after surgery. Data collected were subjected to one-way ANOVA (p<0.05). RESULTS: Nasopharyngeal airway space increased after maxillary advancement and decreased after bimaxillary surgery. There was increase in oropharyngeal dimensions in the region around the uvula and loss of space for lingual vallecula, while in Group 2 there was diminished space for both uvula and vallecula. The uvula and vallecula were moved forward in Group 1, whereas these structures were moved in the posterior direction in Group 2. CONCLUSIONS: After maxillary advancement surgery there was an increased in space in the nasopharyngeal region. The oropharyngeal region related to the uvula presented an increase in space, whereas there was a reduction in relation to the lingual vallecula. The uvula and lingual vallecula were moved forward. Bimaxillary surgery promoted a reduction in the nasopharyngeal and oropharyngeal regions as regards both the uvula and lingual vallecula. The uvula and lingual vallecula were moved in the posterior direction...

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OBJETIVO: Caracterizar o padrão de fechamento velofaríngeo de pacientes operados de fissura palatina e sua relação com gênero, faixa etária, tipo de fissura e diagnóstico da função velofaríngea. MÉTODOS: Estudo retrospectivo realizado a partir de 89 exames de nasofaringoscopia de pacientes operados de fissura palatina, entre 4 e 47 anos (média=17,32±10,50). Os dados foram analisados quanto ao gênero; faixa etária (4 a 8, 9 a 12 anos, 13 a 18 e acima de 18 anos); tipo de fissura (pós-forame e transforame); diagnóstico da função velofaríngea (adequada, marginal e inadequada) e padrão de fechamento velofaríngeo (coronal, circular, circular com prega de Passavant e sagital). Os resultados foram analisados estatisticamente. RESULTADOS: Na amostra estudada, 59,55% eram do gênero feminino; 39,33% tinham mais de 18 anos de idade; 44,94% apresentavam fissura pós-forame e 55,06% transforame; 14,61% fechamento adequado, 53,93% marginal e 31,46% inadequado. Quanto ao padrão de fechamento, 37,08% apresentaram fechamento coronal, 33,71% circular, 15,73% circular com Passavant e 13,48% sagital. Houve relação do padrão de fechamento com o diagnóstico da função velofaríngea (p=0,05). CONCLUSÃO: A maior parte da amostra apresentou fechamento velofaríngeo coronal, seguido pelo circular, circular com Passavant e sagital. Não houve relação entre o padrão de fechamento e as variáveis gênero, faixa etária e tipo de fissura, mas observou-se influência relacionada ao diagnóstico da função velofaríngea.

PURPOSE: To characterize the velopharyngeal closure pattern in patients submitted to cleft palate surgery and its relation with gender, age, cleft type, and diagnosis of velopharyngeal function. METHODS: Retrospective study based on 89 nasopharyngoscopy studies of operated cleft palate patients with ages between 4 and 47 years (mean=17.32±10.50). Data were analyzed regarding gender, age range (4 to 8, 9 to 12, 13 to 18 and >18 years), cleft type (postforamen or transforamen), diagnosis of velopharyngeal function (adequate, borderline, and inadequate), and velopharyngeal closure patterns (coronal, circular, circular with Passavant's ridge, and sagittal). Results were statistically analyzed. RESULTS: In the study sample, 59.55% of the patients were women; 39.33% were above 18 years of age; 44.94% had post-foramen cleft and 55.06%, transforamen cleft; 14.61% showed adequate, 53.93% borderline, and 31.46% inadequate velopharyngeal closure. With regards to the velopharyngeal closure pattern, 37.08% of the subjects presented coronal closure; 33.71%, circular closure, 15.73% circular with Passavant's ridge; and 13.48%, sagittal closure pattern. There was a relation between pattern of closure and diagnosis of velopharyngeal function (p=0.05). CONCLUSION: Most of the sample presented coronal pattern of velopharyngeal closure, followed by circular, circular with Passavant's ridge and sagittal patterns. There was no relationship between closure pattern and the variables gender, age, and cleft type, but there was a related influence to the diagnosis of velopharyngeal function.

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OBJETIVO: Avaliar o efeito da veloplastia intravelar sobre o fechamento velofaríngeo de pacientes com fissura de palato reparada e insuficiência velofaríngea (IVF), por meio de avaliação aerodinâmica (técnica fluxo-pressão). MÉTODOS: Quarenta e sete indivíduos de ambos os gêneros, com idade entre seis e 48 anos, que apresentavam fissura de palato±lábio reparada e IVF, submetidos à veloplastia intravelar. Os pacientes foram avaliados, por meio da técnica fluxo-pressão, aferindo a medida da área do orifício velofaríngeo antes e, em média, 12 meses após a cirurgia, durante a produção do fonema /p/ inserido na palavra rampa. O fechamento velofaríngeo foi classificado como adequado (0 a 0,049 cm²), marginal (0,050 a 0,199 cm²) ou inadequado (>0,200 cm²). RESULTADOS: Após a cirurgia, verificou-se melhora considerável no grau de fechamento velofaríngeo em 66 por cento dos casos. Do total de pacientes analisados, 47 por cento passaram a apresentar fechamento adequado, 23 por cento, fechamento marginal e 30 por cento permaneceram com fechamento inadequado. CONCLUSÃO: Estes resultados mostraram que a veloplastia intravelar levou à melhora do fechamento velofaríngeo na maioria dos pacientes analisados repercutindo na redução dos sintomas de fala da IVF.

PURPOSE: To evaluate the effect of intravelar veloplasty on velopharyngeal closure of patients with repaired cleft palate and velopharyngeal insufficiency (VPI), using the pressure-flow technique. METHODS: Forty-seven individuals of both genders, with ages between six and 48 years, with repaired cleft palate±lip and residual VPI, submitted to intravelar veloplasty. The pressure-flow technique was used to measure the velopharyngeal orifice area during the production of the phoneme /p/ in the word rampa, before and, in average, 12 months after surgery. Velopharyngeal closure was classified as adequate (0 to 0.049 cm²), borderline (0.050 to 0.199 cm²) or inadequate (>0.200 cm²). RESULTS: After surgery, there was considerable improvement in the velopharyngeal closure degree in 66 percent of the cases. From the patients analyzed, 47 percent presented adequate closure, 23 percent, borderline closure and 30 percent remained with inadequate closure. CONCLUSION: These results showed that intravelar veloplasty led to improvement in velopharyngeal closure in most of the patients studied, consequently decreasing the speech symptoms of VPI.

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Objetivo: Demonstrar a eficácia do reposicionamento do músculo elevador do véu palatinoem pacientes portadores de fissura lábio-palatina anteriormente submetidos a palatoplastiapor outras técnicas. Método: Foram realizadas, 16 cirurgias de repalatoplastia posterior comdissecção radical da musculatura do véu palatino. A nasofibroscopia foi o instrumento demensuração da voz no período pré e pós-operatório, 3, 9 e 15 meses após a cirurgia. Duasfonoaudiólogas com experiência no tratamento do fissurado participaram na avaliação davoz nos períodos pré e pós-operatórios, sendo a hipernasalidade classificada em equilíbriooronasal, hipernasalidade leve, moderada e importante. O índice de Kappa foi utilizado paraavaliar o grau de concordância entre os observadores. O teste de igualdade proporcional foiutilizado com o objetivo de comparar as diferenças de voz no pré e pós-operatórios de 3,9 e 15 meses. O valor de p < 0,05 foi adotado para a significância estatística. Resultados:Seis pacientes eram do sexo masculino, com idade média de 17,93 anos. Houve uma boaconcordância entre as avaliadoras, sendo a menor de 76,6% (índice de Kappa). Com o retroposicionamentoda musculatura houve melhora no índice da hipernasalidade (p < 0,05),principalmente na hipernasalidade leve e moderada. Conclusão: Houve grande melhorado quadro da insuficiência velofaríngea após a dissecção radical, o que evidencia que talprocedimento é necessário e deve ser incluído no algoritmo dos protocolos em casos secundáriose preconiza-se que seja usado, também, em casos primários.

Objective: To demonstrate the efficacy of the muscular set back in secondary cases. Method:16 soft palate re-repair were performed with muscular set back. To evaluate the results of thesurgeries through the voice, nasal endoscopies were done pre and post operative (3, 9 and15 months). The results were evaluated by two speech pathologists specialized in cleft lipand palate patients. And the hypernasality was graded as equilibrium, mild, moderate andsevere. The Kappa index was used to evaluate the agreement between the two observers andthe equality of two proportion test gave the statistics significance, as p < 0.05. Results: Sixpatients were males. The mean age was 17.93 years. There was a good concordance betweenthe two evaluators. The least was 76.6% according to the Kappa index. With the retropositioningof the muscles` bundle there was an improvement in the velopharingeal insufficiency (p< 0.05) mainly in the mild and moderate cases. Conclusion: There was a great improvementin velopharingeal incompetence after radical muscle dissection, showing that this procedureis necessary and must be part of secondary palatoplasty protocols. And also must be usedduring primary soft palate repair.

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Introdução: Câncer de orofaringe tem incidência mundial de 8,3 casos por 100.000 habitantes. Carcinoma espinocelular representa 95% do total de tumores malignos da orofaringe. O palato mole representa 5-12% do total destes tumores. Fatores etiológicos incluem álcool e tabaco. Os tumores são freqüentemente assintomáticos e apresentam-se em estádios avançados ao diagnóstico. Métodos: Trata-se de estudo retrospectivo baseado na análise de prontuários de pacientes com diagnóstico de carcinoma espinocelular de palato mole. Resultados: Dentre 15 pacientes, 13 eram do sexo masculino e 2 do sexo feminino. Idade variou entre 54 a 76, média 63,6 anos. Sintomas mais freqüentes foram odinofagia, disfagia, nódulo cervical e emagrecimento. Pacientes no estádio IV tem prognóstico reservado, demonstrando a importância do diagnóstico precoce que permita tratamentos curativos.

Introduction: The world incidende of oropharyngeal cancer is 8.3 cases/100,000 inhabitants. The squamous cell carcinoma represents 95% of all malign tumors of oropharynx and the soft palate represents 5-12% of those tumors. Etiologic factors include alcohol and tobacco. The tumors are frequently asymptomatic and the diagnosis is usually made in advanced stages of the disease. Methods: This is a retrospective study based on charter review of cases diagnosed as squamous cell carcinoma of the soft palate. Results: From 15 pacients, 13 were men and 2 were women. The ages varied from 54 to 76, average, 63.6 years old. All patients had previous history of alcohol and tobacco use. The most frequent symptoms found were odinophagia, dysphagia, cervical nodule and weight loss. Patients in stage IV have a reserved prognosis, showing the importance of early diagnosis in order to allow healing treatment.

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Se estudiaron 100 pacientes desdentados totales maxilares y portadores de prótesis desajustadas que acudieron al Servicio de Prótesis de la Facultad de Estomatología del ISCM-H. Los pacientes fueron examinados, y por observación directa de la mucosa palatina se constató si esta mostraba macroscópicamente los signos de estomatitis subprótesis, la cual se clasificó según los criterios de Newton. Se determinó la zona de ubicación de la lesión y por medio del interrogatorio se conoció el hábito de uso de las prótesis en estos pacientes. El 70 % de los pacientes estudiados presentaron una mucosa alterada, con un predominio de estomatitis subprótesis grado II en el 44,3 % y de grado III con menor frecuencia (21,4 %). La lesión se ubicó preferentemente en la zona media y posterior de la bóveda palatina, para el 44,3 y 34,3 %, respectivamente. Presentaban la lesión en la zona media 31 pacientes, para el 44,4 % y en esta zona prevaleció la estomatitis subprótesis grado II, para el 58 %, seguido por 24 pacientes con lesión en la zona posterior (34,2 %) con una prevalencia en esta zona del grado I de la lesión (58,3 %). Con respecto al hábito de uso de las prótesis, de los 100 pacientes estudiados 75 presentaban uso continuo de estas, mientras que solo 25 tenían hábito de uso discontinuo. De los que usaban la prótesis constantemente, 62 presentaron la mucosa alterada, en los que predominó la estomatitis grado II, con el 96,8 % y las lesiones se observaron con mayor frecuencia en las zonas media y posterior, con el 80,6 y 91,6 %, respectivamente. Al relacionar el hábito de uso continuo, las zonas de ubicación de la lesión y el grado de estomatitis subprótesis, se apreció que en la zona media la frecuencia de aparición de la lesión es mayor, con el 35,8 % y mucho menor en la zona anterior, para el 8,5 %. El grado II de la lesión prevaleció en la zona media, para el 38,8 % y en la zona posterior prevaleció el grado I de la lesión, para el 50 %.

100 total maxillary edentelous patients and carriers of maladjusted dentures that received attention at the Prosthesis Service of the Faculty of Stomatology of the Higher Institute of Medical Sciences of Havana City were studied. The patients were examined and the palatal mucosa was directly observed in order to find macroscopic signs of denture stomatitis. Denture stomatitis was classified according to Newton’s criteria. The zone of location of the injury was determined and information about the denture-wearing habit was obtained by interviewing the patients. 70% of the studied patients had an altered mucosa with a predominance of degree II denture stomatitis in 44.3 % and degree III, with less frequency, in 21.4 %. The injury was preferably located in the middle and posterior zone of the palatine vault, for 44.3 and 34.3 %, respectively. 31 patients had the injury in the middle zone for 44.4 %. Degree II denture stomatitis prevailed in this zone for 58 %, followed by 24 patients with injury in the posterior zone (34.2 %), where the degree I predominated (58.3 %). As to the denture-wearing habit, 70 of the 100 studied patients wore thew denture continuously, whereas 25 wore it discontinuously. 62 of those who wore the prosthesis all the time had altered mucosa and among them there was a predominance of degree II stomatitis (96.8 %) and the injuries were more frequent in the middle and posterior zones, for 80.6 and 91.6 %, respectively. On relating the continuous denture-wearing habit, the zone of location of the injuries and the degreee of denture stomatitis, it was observed that in the middle zone the frequency of appareance of the injury was higher (35.8 %) and much lower in the anterior zone (8.5 %). The degree II injury prevailed in the middle zone, for 38.8 %, while the degree I injury predominated in the posterior zone, for 50 %.

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Se evaluó la efectividad del aceite ozonizado en el tratamiento de la estomatitis subprótesis grados I y II. Se seleccionaron 64 pacientes del Servicio de Prótesis Estomatológica de la Facultad de Estomatología, que requerían nuevo tratamiento protésico y presentaban estomatitis subprótesis. A 32 pacientes se les aplicó el oleozón y otros 32 se tomaron como grupo control, a los cuales se les aplicó la nistatina en crema. Ambos grupos (estudio y control) se subdividieron en 2 subgrupos, según el grado de estomatitis I y II, con 16 pacientes en cada uno. Se confeccionaron tablas que muestran los resultados generales alcanzados según el número de aplicaciones diarias. Según los resultados obtenidos podemos inferir que el tratamiento con ambos medicamentos ha sido efectivo, pero con la aplicación del oleozón los resultados alcanzados en la curva de la estomatitis subprótesis fueron más rápidos y se necesitó un menor número de aplicaciones.

The effectivenes of ozonized oil in the treatment of degree I and II denture stomatitis was evaluated. 64 patients patients from the Dental Prosthesis Service of the Faculty of Stomatology that required new prosthetic treatment and had denture stomatitis were selected. Oleozón was applied to 32 patients, whereas nystatin cream was used in the other 32 considered as controls. Both groups (study and control) were subdivided into 2 subgroups, according to degree I and II stomatitis, with 16 patients each. Tables showing the general results attained in accordance with the number of daily applications were included. We can conclude that the treatment with both drugs has been effective, but with the application of oleozón the results obtained in the curve of denture stomatitis were faster and less applications were needed.