RESUMO
Resumen Los condrosarcomas son cánceres realmente infrecuentes en cabeza y cuello, y más aún en el hueso hioides. Por lo general, son neoplasias que debutan como una masa cervical sin otra sintomatología. Su diagnóstico requiere de estudios de imagen y su tratamiento es fundamentalmente quirúrgico. Comentamos el caso de un paciente de 57 años, desde el diagnóstico de la lesión hasta su tratamiento y seguimiento, y una revisión bibliográfica de esta patología.
Abstract Chondrosarcomas are a rare type of head and neck cancer, especially in the hyoid bone. They usually make their debut through a cervical mass, without other symptoms. The diagnosis requires image studies, and the treatment is fundamentally surgical. We report the case of a 57 years old patient, from the lesion diagnosis, its treatment and follow up, and a bibliographic review of this pathology.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Ósseas/cirurgia , Neoplasias Ósseas/diagnóstico por imagem , Condrossarcoma/cirurgia , Condrossarcoma/diagnóstico por imagem , Osso Hioide/cirurgia , Osso Hioide/diagnóstico por imagem , Neoplasias Ósseas/patologia , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Condrossarcoma/patologia , Osso Hioide/patologiaRESUMO
OBJECTIVES: Temporomandibular disorders (TMD) are frequently observed in various populations. They affect both the temporomandibular joints and several associated structures such as the cervical spine. In this observational, descriptive, cross-sectional study, the authors assessed possible relationships between various cranio-cervical parameters and TMD. METHOD: The study group consisted of 102 patients who were diagnosed with TMD and were treated at the Faculty of Dentistry of the University of Concepción, Chile. The control group was composed of 99 subjects without TMD, treated at other clinics of the University of Concepción. RESULTS: The following relationships between TMD and cranio-cervical parameters were found to be statistically significant: TMD and inversion of the hyoid triangle (p = 0.0060); TMD and depth of cervical curvature (p = 0.0302); TMD and deformity of the cervical vertebrae (p = 0.0001). DISCUSSION: The findings suggest a significant relationship between TMD findings and both cephalometric and morphometric parameters of the cervical spine.
Assuntos
Vértebras Cervicais/patologia , Transtornos da Articulação Temporomandibular/etiologia , Adolescente , Adulto , Idoso , Cefalometria , Criança , Estudos Transversais , Feminino , Humanos , Osso Hioide/patologia , Masculino , Pessoa de Meia-Idade , Transtornos da Articulação Temporomandibular/patologia , Adulto JovemRESUMO
There are limited studies about the effects of occlusal appliance (OA) after three months of use. This study aimed to compare myofascial pain (MP) according to RDC/TMD, craniocervical relationships (CR) and masseter and temporalis bilateral electromyographic (EMG) activity, before and after three months of occlusal appliance use. Nineteen patients participated in this study. Cephalometric and RDC/TMD diagnostics were performed previously (baseline) and at the end of the study period (three months). EMG recordings at clinical mandibular rest position (MRP), during swallowing of saliva (SW) and during maximum voluntary clenching (MVC) were performed as follows: after one hour of use of an OA; after three months of using the OA for a minimum of 16 hours each day; and immediately after removal from the mouth. MP was relieved in all patients at the end of the study period. CR did not change significantly between baseline and after removal of the OA at the end of the study period. EMG activity during MRP, SW, and MVC decreased in both muscles after one hour using the OA and maintained the same level for the three-month period. When comparing baseline versus final EMG activity without OA, a significant decrease was only observed in the masseter muscle. The results observed in the present study are relevant to clinicians because they imply that the therapeutic effect of OA does not significantly affect the homeostasis of the craniocervical system.
Assuntos
Placas Oclusais , Síndrome da Disfunção da Articulação Temporomandibular/terapia , Adolescente , Adulto , Vértebra Cervical Áxis/patologia , Cefalometria/métodos , Vértebras Cervicais/patologia , Deglutição/fisiologia , Eletromiografia/métodos , Feminino , Seguimentos , Humanos , Osso Hioide/patologia , Masculino , Músculo Masseter/fisiopatologia , Contração Muscular/fisiologia , Osso Nasal/patologia , Processo Odontoide/patologia , Sela Túrcica/patologia , Músculo Temporal/fisiopatologia , Fatores de Tempo , Dimensão Vertical , Adulto JovemRESUMO
This study investigated the existence of association between the angulation of the styloid process on the anterior and medial directions with the intensity of temporomandibular dysfunction (TMD) symptoms. Fifty patients (8 men and 42 women) aged 25 to 70 years, with relevant TMD symptoms were evaluated. Clinical examinations were performed to determine the severity of TMD symptoms (orofacial pain, headache, tinnitus and dizziness) based on the RDC/TMD criteria and the visual analogue scale (VAS), and digital radiographic images of the styloid process were obtained: lateral cephalometric skull radiograph (analysis of anterior angulation) and posteroanterior skull radiograph (reverse Towne's projection) (analysis of medial angulation). The anterior angulation average of the styloid process was 20.89° while the medial angulation average was 19.1° in the right side and 19.04° in the left side. There was no statistically significant difference among the patient groups (severe, moderate and mild symptoms) associating the TMD symptoms and the anterior or medial angulation of the styloid process (p>0.05). There was no correlation between the intensity of the TMD symptoms and the measurements of anterior and medial angulation of the styloid process using either lateral cephalometric or posteroanterior radiographs (reverse Towne's projection).
Assuntos
Osso Hioide/diagnóstico por imagem , Osso Hioide/patologia , Transtornos da Articulação Temporomandibular/patologia , Adulto , Idoso , Cefalometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/patologia , Medição da Dor , Radiografia , Base do Crânio/diagnóstico por imagem , Osso Temporal/anormalidades , Osso Temporal/diagnóstico por imagem , Osso Temporal/patologia , Transtornos da Articulação Temporomandibular/diagnóstico por imagemRESUMO
Cephalometry has been used to measure hard and soft facial tissues, as well as the pharyngeal air space for the diagnosis of obstructive sleep apnea (OSA). The changes occurring in the pharynx due to maxillo-mandibular advancement (MMA) have not been established or quantified. The objective of this study was to identify the anatomical changes of the pharynx and of hard tissues that occur in patients with OSA after MMA. 19 patients with a polysomnographic diagnosis of OSA were submitted to cephalometric analysis before and 6 months after surgery in order to evaluate the changes produced by MMA in the pharynx and soft tissues. Cephalometry was standardized in order to obtain descriptive measurements of the dimensions of the airways, the position of the hyoid bone, and maxilla-mandibular relations. The modifications of the pharynx due to MMA showed a significant relation obtained by cephalometry. For each millimeter of maxillary and mandibular bone advancement there was a 0.76mm increase in the retropalatal region and a 1.2mm increase in the pharynx in the retrolingual region. In addition, MMA promoted a significant repositioning of the hyoid bone in the cranial direction.
Assuntos
Cefalometria/métodos , Avanço Mandibular/métodos , Maxila/cirurgia , Faringe/patologia , Apneia Obstrutiva do Sono/cirurgia , Queixo/patologia , Feminino , Seguimentos , Humanos , Osso Hioide/patologia , Masculino , Mandíbula/patologia , Mandíbula/cirurgia , Maxila/patologia , Osso Nasal/patologia , Osteotomia de Le Fort/métodos , Osteotomia Sagital do Ramo Mandibular/métodos , Palato/patologia , Polissonografia , Sela Túrcica/patologia , Base do Crânio/patologiaRESUMO
OBJECTIVE: This study analyses the different parts of the upper airway space and the changes in hyoid position. The results provide a clinical reference for developing timely and effective treatment programmes for patients with mandibular fractures caused by maxillofacial trauma. METHODS: Standard X-cephalometric measurements of the lateral skull of 210 subjects were taken. The subjects were divided into four fracture groups: condylar, mandibular angle, mandibular body, and parasymphyseal. RESULTS: The radiographs of the mandibular fracture groups were compared with the normal occlusion group to analyse the upper airway space and the changes in hyoid position. Different types of fractures have different effects on the upper airway space. Bilateral mandibular body fracture and the parasymphyseal fracture have a significant influence on the lower oropharyngeal and laryngopharyngeal airway spaces, with serious obstructions severely restricting the ventilatory function of patients. CONCLUSIONS: Fractures at different parts of the mandibular structure are closely related to the upper airway and hyoid position.
Assuntos
Osso Hioide/patologia , Côndilo Mandibular/lesões , Fraturas Mandibulares/patologia , Adolescente , Adulto , Cefalometria , Humanos , Osso Hioide/diagnóstico por imagem , Masculino , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/patologia , Fraturas Mandibulares/diagnóstico por imagem , Palato Mole/patologia , Radiografia , Adulto JovemRESUMO
OBJECTIVES: The aim of this study was to observe the influence of orthodontic treatment on the hyoid position of patients with different vertical skeletal craniofacial patterns of mandibular deviations. METHODS: A total of 60 patients with mandibular deviations, including 30 males and 30 females with a mean age of 15.4 years, were recruited. They were equally divided into average angle, high angle, and low angle groups, with a 1:1 gender ratio. Their hyoid position was measured before and after orthodontic treatment. The data were analysed using paired t-tests and analysis of variance (ANOVA). RESULTS: After treatment, the hyoid body in the high angle group presented significant forward and upward movements (p = 0.012 and p = 0.005). The hyoid body in the low angle group exhibited significant forward movement (p = 0.048) and a significant increase in the hyoid inclination (p = 0.00). In the average angle group, the hyoid body significantly moved downward (p = 0.031) and the thyrohyoid moved upward (p = 0.046). The ANOVA showed that orthodontic treatment significantly influenced the vertical position and inclination degree of the hyoid (F = 6.37, p = 0.003; F = 6.204, p = 0.004; and F = 3.393, p = 0.025). The average angle group displayed significant differences in these indices compared with the high angle and low angle groups. Orthodontic treatment significantly influenced the mandibular plane angle in the high angle group (p = 0.012). CONCLUSION: Orthodontic treatment influences the hyoid position of patients with different vertical skeletal craniofacial patterns of mandibular deviations by varying degrees.
Assuntos
Osso Hioide/patologia , Má Oclusão/terapia , Ortodontia Corretiva/métodos , Adolescente , Cefalometria , Criança , Feminino , Humanos , Masculino , Má Oclusão/patologia , Resultado do TratamentoRESUMO
This study investigated the existence of association between the angulation of the styloid process on the anterior and medial directions with the intensity of temporomandibular dysfunction (TMD) symptoms. Fifty patients (8 men and 42 women) aged 25 to 70 years, with relevant TMD symptoms were evaluated. Clinical examinations were performed to determine the severity of TMD symptoms (orofacial pain, headache, tinnitus and dizziness) based on the RDC/TMD criteria and the visual analogue scale (VAS), and digital radiographic images of the styloid process were obtained: lateral cephalometric skull radiograph (analysis of anterior angulation) and posteroanterior skull radiograph (reverse Towne's projection) (analysis of medial angulation). The anterior angulation average of the styloid process was 20.89° while the medial angulation average was 19.1° in the right side and 19.04° in the left side. There was no statistically significant difference among the patient groups (severe, moderate and mild symptoms) associating the TMD symptoms and the anterior or medial angulation of the styloid process (p>0.05). There was no correlation between the intensity of the TMD symptoms and the measurements of anterior and medial angulation of the styloid process using either lateral cephalometric or posteroanterior radiographs (reverse Towne's projection).
Este estudo investigou a existência de associação entre a angulação do processo estiloide nas direções anterior e medial e a intensidade dos sintomas de disfunção temporomandibular. Cinquenta pacientes (8 homens e 42 mulheres) com idade entre 25 a 70 anos, com sintomas relevantes de DTM foram avaliados. Os exames clínicos foram realizados para determinar a severidade dos sintomas da DTM (dor orofacial, cefaleia, zumbido e tontura) com base nos critérios do RDC / DTM e na escala visual analógica (EVA), e imagens de radiografias digitais do processo estiloide foram obtidas: cefalométrica lateral com incidência reversa (análise de angulação anterior), e póstero-anterior do crânio (projeção reversa de Towne) (análise de angulação medial). A média de angulação anterior do processo estilóide foi 20,89°, enquanto a média da angulação medial foi 19,1° no lado direito e 19,04° no lado esquerdo. Não houve diferença estatisticamente significativa entre os grupos de pacientes (sintomas severos, moderados ou leves) em associação com os sintomas de DTM e as angulações anterior ou medial do processo estiloide (p>0,05). Não houve correlação entre a intensidade dos sintomas de DTM e as medidas das angulações anterior e medial do processo estiloide utilizando a radiografia cefalométrica lateral ou a póstero-anterior (projeção reversa de Towne).
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osso Hioide/patologia , Osso Hioide , Transtornos da Articulação Temporomandibular/patologia , Cefalometria , Ossificação Heterotópica/patologia , Ossificação Heterotópica , Medição da Dor , Base do Crânio , Osso Temporal/anormalidades , Osso Temporal/patologia , Osso Temporal , Transtornos da Articulação TemporomandibularRESUMO
OBJECTIVES: To assess the development of face and hyoid bone in children with obstructive sleep apnea syndrome (OSAS) through lateral cephalometries. MATERIALS AND METHODS: Children aged 7-10 years with mixed dentition and with no previous otorhinolaryngologic, orthodontic or speech therapy treatments were studied. Twenty nasal breathers were compared to 20 mouth breathing children diagnosed as OSAS patients. All children underwent otorhinolaryngologic evaluation and cephalometries; children with OSAS also underwent nocturnal polysomnography in a sleep laboratory. RESULTS: Children with OSAS presented increase in total and lower anterior heights of the face when compared to nasal breathers. In addition, children with OSAS presented a significantly more anterior and inferior position of the hyoid bone than nasal breathers. No significant differences in upper, anterior or posterior heights of the face were observed between groups. CONCLUSION: The results suggest that there are evident and early changes in facial growth and development among children with OSAS, characterized by increased total and inferior anterior heights of the face, as well as more anterior and inferior position of the hyoid bone.
Assuntos
Cefalometria , Ossos Faciais/patologia , Osso Hioide/patologia , Apneia Obstrutiva do Sono/patologia , Estudos de Casos e Controles , Criança , HumanosRESUMO
Considering that orthognathic surgery promotes changes in orofacial structures constituting the resonating system, functional changes secondary to surgery are expected to affect speech, leading to the need for further speech and voice adjustments. Thus, understanding the possible relationships of these structures with voice production is important. Therefore, this study aimed to describe the changes in voice fundamental frequency of a patient submitted to orthognathic surgery and observe if there is a relationship with hyoid bone positioning at the different treatment periods. The results revealed that voice fundamental frequency increased after surgery, returning to values close to the preoperative condition, which corresponded to vertical movement of the hyoid bone.
Assuntos
Má Oclusão Classe III de Angle/cirurgia , Ortodontia Corretiva , Voz/fisiologia , Adulto , Cefalometria , Queixo/cirurgia , Feminino , Humanos , Osso Hioide/patologia , Maxila/anormalidades , Maxila/cirurgia , Osteotomia/métodos , Osteotomia de Le Fort/métodos , Prognatismo/cirurgia , Espectrografia do Som , Fala/fisiologia , Dimensão Vertical , Qualidade da Voz/fisiologiaRESUMO
The relationships between temporomandibular joint (TMJ) disorders and cervical structure dysfunctions have already been demonstrated. The aim of the present study was to investigate functional and structural alterations of the head and neck of 17 individuals with TMJ disorders (TMD group), compared with a control group of 17 asymptomatic subjects in a cross-sectional design. The outcome variables included pain on palpation of the sternocleidomastoideus, superior trapezius and subocciptal muscles, as well as radiographic measures of alignment of the cervical spine and positioning of the hyoid bone. Cervical alignment, determined by measures of the cervical curvature angle, was investigated by the Cobb method. Independent Student t-tests were used to investigate differences between groups for all outcome variables (alpha < 0.05). The results demonstrated that individuals with TMJ disorders, when compared with asymptomatic subjects, presented higher levels of perception of pain in all cervical muscles (P < 0.0001). No significant differences were found between groups for the cervical alignment measures. In the TMD group, the position of the hyoid bone in relation to the cervical spine did not appear to be different from the control group.
Assuntos
Vértebras Cervicais/fisiopatologia , Osso Hioide/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto , Índice de Massa Corporal , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Estudos Transversais , Feminino , Humanos , Osso Hioide/diagnóstico por imagem , Osso Hioide/patologia , Hiperalgesia/etiologia , Masculino , Músculos do Pescoço/fisiopatologia , Palpação , Radiografia , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/patologiaRESUMO
Introdução: o tratamento do pescoço no carcinoma espinocelular (CEC) de língua oral e soalho de boca sem metástase detectadas clinicamente permance controverso. Objetivo: analisar o resultado após esvaziamento cervical supraomo-hióideo(ECSOH) estendido ao nível IV. Método: analisamos, restrospectivamente, 40 pacientes com estadiamento cl[inico NO e N1 de 1996 a 2002. Havia 29 homenzs e 11 mulheres, cujas idades variaram de 46 a 83 anos (mediana, 63). Foram estadiados como T1 (2), T2(24), T3(13) e T4(1). Todos foram submetidos a ECSOH estendido ao nível IV. Resultados: dentre os 34 pacientes estadiados como N0, os achados histológicos foram confirmados em 29 (85,3%), enquanto que cinco foram estadiados como pN positivo. Assim, havia seis pacientes pN1 e cinco pN2a. Dos seis pacientes estadiados clinicamente como N positivo, não houve falso-positivos. Todos os pacientes com linfonodos positivos foram tratados com radioterapia adjuvante. Recidiva cervical ocorreu em 6,9% dos pacientes N) (2/29), 28,6% pN1(2/7) e 50% dos pN2a (2/4). Foram encontradas metástases ocultas em cadeia IV em dois casos (5%) entre aqueles estadiados como pN2a e nenhuma metástase em cadeia V. Tdoas as recidivas ocorreram nos níveis II e III. Conclusão: uma taxa de 14,7% dos pacientes estadiados como N) clinicamente apresentaram metástases ocultas. Todas as metástases pN1 ocorreram nso níveis I ou II. Cinco por cento dos pN2a apresentaram metástases ocultas em cadeia IV. Recidiva cervical ocorreu em 6,9% dos pacientes pN), 28,6% dos pN1 e 50% dos pN2a. Todas as recidivas ocorreram nos níveis I e II.
Introduction: the neck treatment in the squamous cell carcinoma (SCC) of the oral tongue and floor of the mouth without clinical metastasis remains controversial. Objective: to analyze the outcomeafter supraomohyoid neck dissection (SOHND) extended for level IV for those patients. Methods: we retrospectively analyzed 40 patients with clinically N0 and N1 stage SCC from 1996 to 2002. There were 29 men and 11 women whose ages varied from 46 to 82 (median, 63). They were staged as T1(2), T2(24), T3(13), and T4(1). They underwnt SOHND extended for level IV. Results: camong the 34 patients staged as N0, the histologic findings confirmed that in 29 (85.3%), whereas 5 were staged as pN positive. Thus, there were 6 patients staged a pN1 and 5 patients were pN2a. Among the 6 patients staged as clinical N positive, there was no false-positive case. All patients with node positivity received adjuvant radiation therapy. Neck failure occurred in 6.9% of the pN0 patients (2/29), 28.6% of the pN1 patients (2/7), and 50% of the pN2a group (2/4). Occult metastasis in level IV occurred in 2 cases (5%) among those sateged as pN2a and no one had it at leval V. All recurrences occurred in levels II and III. Conclusion: a rate of14.7% of patients clinically staged as N0 necks showed occult metastasis. All the pN1 metastasis occurred in level I or II. Occult metastasis in level IV occurred in 5% of the pN2a cases. Neck failure occurred in 6.9% of the pNO patients, 28.6% of the pN1 patients, and 50% of the pN2a. All recurrences occurred in levels II and III.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Esvaziamento Cervical/métodos , Neoplasias Bucais/cirurgia , Neoplasias Bucais/patologia , Carcinoma de Células Escamosas/radioterapia , Estadiamento de Neoplasias , Estudos Retrospectivos , Metástase Linfática , Neoplasias Bucais/radioterapia , Osso Hioide/cirurgia , Osso Hioide/patologia , Reações Falso-Positivas , Recidiva Local de Neoplasia , Resultado do Tratamento , SeguimentosRESUMO
Discutir o planejamento cirúrgico, os diferentes fatores da técnica cirúrgica que influenciam nos resultados e as complicações do uso do músculo esterno-hióideo como retalho na cirurgia reparadora da laringe. Material e método: Sessenta e sete pacientes com tumor glótico ou transglótico, no período de 29 anos (grupo 1) e três pacientes com estenose cicatricial do segmento laringotraqueal, nos últimos cinco anos (grupo 2) receberam ressecção parcial vertical de extensão variável e reparo com retalho, bipediculado ou de pedículo superior, do músculo esterno-hióideo. Resultados: Grupo 1: o retalho reparou a anatomia da laringe e o volume do músculo contribuiu para o fechamento glótico adequado em 88% dos pacientes; grupo 2: o retalho forneceu suporte dinâmico e forro laringotraqueal, em um único tempo cirúrgico. Conclusão: A utilização do músculo estemo-hióideo como retalho mostrou ser um procedimento seguro, versátil e de resultados consistentes na cirurgia reparadora da laringe.
To discuss the surgical planning, the influence of different surgical technique variables in the results and the complications of using the sternohyoid muscle as a flap on reconstruction of the larynx. Material and methods: Sixty - seven patients with glottic or transglottic tumors in a 29 year period (group 1) and three patients with cicatricial laryngotracheal stenosis in the past five years (group 2) had varying vertical partial resection and a bipedicled or pedicled superiorly sternohyoid muscle flap reconstruction. Results: Group 1: the flap restored the anatomy of the larynx and the muscle bulk contributed for an adequate glottic closure in 88% of the patients; group 2: the flap provided one-stage dynamic luminal support and epithelial resurfacing of the laryngotracheal segment. Conclusion: The use of the sternohyoid muscle as a flap demonstrated to be a safe, versatile, with consistent results on reconstruction of the larynx.
Assuntos
Humanos , Masculino , Feminino , Osso Hioide/patologia , Laringe/anatomia & histologia , Laringe/cirurgia , Laringe/fisiologiaRESUMO
Introducción. El quiste tirogloso es una anomalía congénita debida a la persistencia de un conducto fibroepitelial ubicado entre la tiroides y su origen, el foramen de la lengua y el piso de la boca. La operación de Sistrunk es la de elección para eliminar el quiste. Material y métodos. En un estudio retrospectivo se analizaron los expedientes de 30 años con diagnóstico de quiste tirogloso operados en un periodo de tres años. Conclusiones. Probablemente el quiste tirogloso es más frecuente en México que en otros países. Predomina en el sexo masculino y entre los cinco y diez años de edad. La operación de Sistrunk fue efectuada en 100 por ciento de los casos. Hubo recurrencia en todos los niños que no se operaron con este procedimiento
Assuntos
Humanos , Masculino , Lactente , Pré-Escolar , Criança , Adolescente , Anormalidades Congênitas/patologia , Anormalidades Congênitas/cirurgia , Procedimentos Cirúrgicos Operatórios , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Cisto Tireoglosso/patologia , Cisto Tireoglosso/cirurgia , Glândula Tireoide/cirurgia , Glândula Tireoide/patologia , Osso Hioide/patologia , Osso Hioide/cirurgia , México , Língua/patologia , Língua/cirurgiaRESUMO
Em 50 cadáveres humanos evidenciou-se o lobo piramidal em 27; sua configuraçäo mais frequente é a piramidal (51,85%), implantado sobre o istmo da gl. tireóide mais a esquerda e com inserçäo na face posterior do corpo do osso hióide, onde se fixa por intermédio de um filamento de tecido froxo. Os lobos piramidais foram processados histologicamente, sendo constituído por tecido glandular com maior freqüência, de sua base para a porçiao média e também por fibras musuclares estriadas esqueléticas; ocorrendo o inverso no que diz respeito ao tecido conjuntivo frouxo que aumenta da base para o ápice