RESUMO
El desarrollo craneofacial es un proceso complejo con diversos factores involucrados. Cuando las maloclusiones son de origen esqueletal pueden generar una relación ortognática (clase I), retrognática (clase II) o prognática (clase III) de la mandíbula respecto de la maxila. Esta configuración está estrechamente relacionada con la base del cráneo donde la silla turca ha sido estudiada con este fin debido a su origen ectomesenquimático (Dasgupta et al., 2018) y sus relaciones anatómicas. Diversos estudios se han realizado para dilucidar esta relación y este trabajo busca aportar a la discusión comparando las características de la silla turca entre las maloclusiones esqueletales a través de telerradiografías laterales. El estudio se realizó mediante 52 placas radiográficas de individuos de entre 18 a 24 años con igual número de sujetos masculinos y femeninos, 15 de clase I, 7 de clase II y 30 de clase III. Se realizó la medición digital del área radiográfica de la silla turca y se clasificó morfológicamente mediante las categorías de Axelsson et al. (2004). Se utilizó coeficiente de correlación intraclase con un 95 % de confianza arrojando un valor de 0,88 para el área de la silla turca, 0,89 para el ángulo ANB y de 0,70 para el valor Wits demostrando una excelente fiabilidad del observador. Con un 95 % de confianza la prueba exacta de Fisher evidenció una asociación significativa (p = 0,029) entre las variaciones morfológicas de la ST y la clase esqueletal siendo más frecuentes en clase III. La prueba H de Kruskal Wallis no arrojó diferencias significativas (p=0,550) en las medianas del área selar entre las clases esqueletales. Las variaciones morfológicas parecen ser más relevantes que las variaciones anatómicas en esta asociación. Se requieren nuevos estudios en población chilena con un mayor número de casos.
SUMMARY: Craniofacial development is a complex process with several factors involved. When malocclusions have a skeletal origin, they can generate an orthognathic (class I), retrognathic (class II) or prognathic (class III) relationship of the mandibular bone respect to the maxilla. This configuration is closely related to the base of the skull where the sella turcica has been studied for this purpose due to its ectomesenchymal origin (Dasgupta et al., 2018) and its anatomical relationships. Several studies have been conducted to elucidate this relationship and this work seeks to contribute to the discussion by comparing the characteristics of the sella turcica among skeletal malocclusions through lateral teleradiographies. The study was conducted using 52 radiographic plates of individuals between 18 and 24 years old with an equal number of male and female subjects, 15 class I, 7 class II and 30 class III. The radiographic area of the sella turcica was digitally measured and morphologically classified using the categories of Axelsson et al. (2004). An intraclass correlation coefficient was obtained with 95 % confidence, yielding a value of 0.88 for the sella turcica area, 0.89 for the ANB angle and 0.70 for the Wits value, demonstrating excellent observer reliability. With 95 % confidence, Fisher's exact test showed a significant association (p = 0.029) between the morphological variations of the ST and the skeletal class, being more frequent in class III. The Kruskal Wallis H test did not show significant differences (p=0.550) in median sellar area between skeletal classes. Morphological variations seem to be more relevant than anatomical variations in this association. New studies are required in the Chilean population with a greater number of cases.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Sela Túrcica/anatomia & histologia , Sela Túrcica/diagnóstico por imagem , Má Oclusão , Estudos TransversaisRESUMO
SUMMARY: This study evaluated the effects of ethnicity, sex, and age on the linear dimensions of the sella turcica (ST) and the pneumatization patterns of the sphenoid sinus (SS). In this cross-sectional retrospective study, we examined digitally standardized computed tomography scans of 100 Jordanians. These study participants comprised 50 men and 50 women, and their age ranged from 23 years to 77 years. We assessed linear ST dimensions and SS pneumatization patterns and correlated this data to age and sex. Furthermore, we compared the data with different ethnic groups from previous studies. The mean (standard deviation [SD]) length, diameter, width, and depth of the ST were 9.98 (1.89) mm, 12.45 (2) mm, 11.96 (1.76) mm, and 8.38 (1.63) mm, respectively. The mean (SD) interclinoid diameter was 8.84 (2.03) mm. These measurements were not significantly correlated with sex or age. With regards to pneumatization patterns of the sphenoid sinus, the conchal type was observed in 2 % of the study participants. Presellar involvement was observed in 30 % of the patients. The sellar and postsellar type was observed in 66 % and 2 % of patients, respectively. In our study, ST measurements did not differ significantly between the sexes. Pneumatization patterns of the SS differed from the patterns reported for other races. The findings of this study could assist neurosurgeons, orthodontists, and forensic medical investigators in diagnosing and planning treatment for pituitary gland pathologies.
Este estudio evaluó los efectos de la etnia, el sexo y la edad sobre las dimensiones lineales de la silla turca y los patrones de neumatización del seno esfenoidal (SE). En este estudio retrospectivo transversal, examinamos tomografías computarizadas estandarizadas digitalmente de 100 jordanos. Los participantes del estudio comprendían 50 hombres y 50 mujeres entre los 23 y los 77 años de edad. Evaluamos las dimensiones lineales del SE y los patrones de neumatización del SE y correlacionamos estos datos con la edad y el sexo. Además, comparamos los datos con diferentes grupos étnicos de estudios previos. La media (desviación estándar) de la longitud, el diámetro, el ancho y la profundidad del SE fueron 9,98 (1,89) mm, 12,45 (2) mm, 11,96 (1,76) mm y 8,38 (1,63) mm, respectivamente. El diámetro interclinoideo medio era de 8,84 (2,03) mm. Estas medidas no se correlacionaron significativamente con el sexo o la edad. Con respecto a los patrones de neumatización del seno esfenoidal, el tipo conchal se observó en el 2 % de los participantes del estudio. Se observó afectación preselar en el 30 % de los pacientes. El tipo selar y postsillar se observó en el 66 % y el 2 % de los pacientes, respectivamente. En nuestro estudio, las medidas del SE no difirieron significativamente entre los sexos. Los patrones de neumatización de la silla turca diferían de los patrones informados para otras razas. Los hallazgos de este estudio podrían ayudar a los neurocirujanos, ortodoncistas e investigadores médicos forenses en el diagnóstico y el tratamiento de las patologías de la hipófisis.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Sela Túrcica/anatomia & histologia , Seio Esfenoidal/anatomia & histologia , Sela Túrcica/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Estudos Transversais , Estudos RetrospectivosRESUMO
BACKGROUND: The sellar barrier concept reflects the association between the components of the roof of the pituitary fossa and the risk of intraoperative cerebrospinal fluid (CSF) leak in the surgery of pituitary adenomas. We based our concept in previous reports on the microsurgical anatomy of the pituitary fossa's superior wall. However, proof of the usefulness of this concept in endoscopic approaches is yet missing. The aim of this study was to describe the endoscopic anatomy of the sellar barrier and its subtypes in a laboratory setting and to provide evidence of its clinical usefulness. METHODS: We provided anatomical models in six fresh-frozen head and neck specimens. We performed an endoscopic endonasal approach and recreated a pathological model of each possible subtype of sellar barrier. To demonstrate the usefulness of this model in clinical practice, we conducted a prospective study including all patients with pituitary adenoma operated by an endoscopic approach between June and July 2019. RESULTS: We successfully recreated the models for each subtype of sellar barrier. When analyzing the clinical cases, we found that intraoperatively, 73.69% (14) had a strong sellar barrier; 21.05% (4) had mixed sellar barrier, and 5.26% (1) had weak sellar barrier. We recorded one case of intraoperative CSF leak in a patient with a weak sellar barrier by magnetic resonance imaging. CONCLUSION: We described the endoscopic anatomy of the sellar barrier and we recreated the three subtypes in anatomical models. We also identified these subtypes in a series of clinical cases, proving its clinical usefulness.
Assuntos
Adenoma/cirurgia , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Endoscopia , Modelos Anatômicos , Neoplasias Hipofisárias/cirurgia , Sela Túrcica/anatomia & histologia , Adulto , Idoso , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas , Estudos ProspectivosRESUMO
PURPOSES: The main purpose of this study was to assess the measurements and shape of the sella turcica by using cone beam computed tomography (CBCT) and to associate the data to skeletal class II and class III patients, including correlations with gender, age and measurements of the anterior cranial base. MATERIAL AND METHODS: A trained examiner specialist in dental radiology selected and evaluated randomly 95 CBCT images of pre-orthognathic surgery patients, 60 (63.2%) being female and 35 (36.8%) male with age between 16 and 57 years. All images were evaluated to determine the size, shape and volume of the sella turcica. The anterior cranial base, represented by the S-N line (sella-nasion), was also measured. RESULTS: Of these 95 patients, 48 (50.5%) had class III facial skeletal pattern, whereas 47 (49.5%) had class II. No statistically significant differences were found between class II and class III patients in the measurements and shape of the sella turcica (P > 0.05). The diameter and volume of the sella turcica had higher values in female patients, whereas the measurements of the anterior cranial base were higher in males (P < 0.05). CONCLUSION: Therefore, one can conclude that measurements of the sella turcica are not reliable parameters to evaluate whether a class II or class III patient will or will not need orthognathic surgery.
Assuntos
Tomada de Decisão Clínica/métodos , Má Oclusão Classe III de Angle/cirurgia , Má Oclusão Classe II de Angle/cirurgia , Cirurgia Ortognática/métodos , Sela Túrcica/anatomia & histologia , Adolescente , Adulto , Fatores Etários , Cefalometria/métodos , Tomografia Computadorizada de Feixe Cônico , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Reprodutibilidade dos Testes , Sela Túrcica/diagnóstico por imagem , Fatores Sexuais , Base do Crânio/anatomia & histologia , Base do Crânio/diagnóstico por imagem , Adulto JovemRESUMO
The ponticulus posticus (PP) is a bridge of bone sometimes found on the atlas vertebra surrounding the vertebral artery and the first cervical nerve root. Sella turcica bridging (STB) is the fusion of anterior and posterior clinoid processes. The objective of this study was to find out the association between STB and PP. For the study, 752 digital lateral cephalograms were retrieved from the archived records of Necmettin Erbakan University, Faculty of Dentistry, Konya, Turkey. There was a significant relationship between the presence of STB and PP (p=0.000, p<0.001). This study indicates that there is a significant correlation between the presence of STB and PP.
El Ponticulus Posticus (PP) es un puente de hueso que se encuentra, a veces, en el atlas y rodea la arteria vertebral y la primera raíz del nervio cervical. El puente de la silla turca (PST) es la fusión de los procesos clinoides anteriores y posteriores. El objetivo de este estudio fue conocer la asociación entre PST y PP. Para el estudio, fueron utilizados 752 cefalogramas digitales laterales, obtenidos de los registros archivados de la Facultad de Odontología de la Universidad Necmettin Erbakan, Konya, Turquía. Hubo una relación significativa entre la presencia de PST y PP (p = 0,000, p <0,001). Este estudio indica que existe una correlación significativa entre la presencia de PST y PP.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Atlas Cervical/anatomia & histologia , Atlas Cervical/diagnóstico por imagem , Sela Túrcica/anatomia & histologia , Sela Túrcica/diagnóstico por imagem , Cefalometria , Fatores SexuaisRESUMO
Anatomical variations in the shape and dimension of the dorsum sellae and posterior clinoid process are common. Most textbooks describe its shape as a median rectangular plate, a square plate, or a transverse ledge on a slope behind the sella turcica (hypophyseal fossa). This work aims to study the dorsum sellae of human skull. One hundred and twenty five dried adult human skulls, irrespective of age, were used for the study. Detailed features of the dorsum sellae were noted and classified into five types: crest like, thin plate, frail quadrilateral plate, heavy square plate, thick elongated plate. Fusion of the posterior and middle clinoid processes in one (unilateral) and all the clinoid processes (anterior, middle, and posterior) in three skulls (unilateral in one, bilateral in two) were also noticed. Findings are discussed in the light of the literature.
Son frecuentes las variaciones anatómicas de la forma y dimensión de dorsum sellae y de los procesos clinoides posteriores. La mayoría de los textos describen su forma como una placa rectangular mediana, una placa cuadrada, o un plano transversal en una pendiente detrás de la sella turcica (fosa hipofisaria). Este trabajo tiene como objetivo estudiar el dorsum sellae en cráneo humano. Para el estudio se utilizaron 125 cráneos humanos adultos secos, de diferentes edades. Se observaron características detalladas de dorsum sellae y se clasificaron en cinco tipos: cresta, al igual que la placa delgada, lámina cuadrilátera, placa cuadrada gruesa, placa alargada gruesa. En tres cráneos se observó fusión de la parte posterior y los procesos clinoides intermedios (unilateral) y los procesos clinoides (anterior, medio y posterior) (unilateral en uno de ellos, bilateral en dos). Los resultados se discuten en consideracion de la literatura.
Assuntos
Humanos , Variação Anatômica , Sela Túrcica/anormalidades , Sela Túrcica/anatomia & histologia , Cefalometria , Osso Esfenoide/anormalidades , Osso Esfenoide/anatomia & histologiaRESUMO
OBJECTIVE: The aim of this study was to determine the standards of facial height in 30 young (14-year-old) Japanese-Brazilian descendants with normal occlusion, and assess whether sexual dimorphism is evident. METHODS: The cephalometric measurements used followed the analyses by Wylie-Johnson, Siriwat-Jarabak, Gebeck, Merrifield and Horn. RESULTS: Results showed dimorphism for total anterior facial height (TAFH), lower anterior facial height (LAFH), anterior facial height (AFH), total posterior facial height (TPFH) and upper posterior facial height (UPFH) measurements. CONCLUSIONS: The standards of facial heights in young Japanese-Brazilian descendants with normal occlusion were observed. Sexual dimorphism was identified in five out of thirteen evaluated variables at this age range. .
INTRODUÇÃO: o objetivo desse estudo foi obter os valores médios de normalidade das alturas faciais anterior e posterior de 30 jovens mestiços nipo-brasileiros, descendentes de xantodermas e leucodermas, com oclusão normal, com idade média de 14 anos, e verificar a presença ou ausência de dimorfismo entre os sexos. MÉTODOS: elaborou-se um estudo cefalométrico com as mensurações advindas das análises de Wylie e Johnson, Siriwat e Jarabak, Gebeck, Merrifield e Horn. RESULTADOS: os resultados revelaram a presença de dimorfismo entre os sexos para as variáveis AFAT, AFAI, AFA, AFPT e AFPS. CONCLUSÕES: um padrão cefalométrico específico, das alturas faciais anterior e posterior, para os jovens mestiços nipo-brasileiros com oclusão normal, descendentes de xantodermas e leucodermas, foi apresentado e um dimorfismo entre os sexos para cinco das treze variáveis avaliadas foi verificado nessa faixa etária média. .
Assuntos
Adolescente , Criança , Feminino , Humanos , Masculino , Cefalometria/métodos , Oclusão Dentária , Etnicidade , Face/anatomia & histologia , Pontos de Referência Anatômicos/anatomia & histologia , Brasil , Queixo/anatomia & histologia , Japão , Mandíbula/anatomia & histologia , Côndilo Mandibular/anatomia & histologia , Maxila/anatomia & histologia , Osso Nasal/anatomia & histologia , Palato/anatomia & histologia , Caracteres Sexuais , Sela Túrcica/anatomia & histologia , Dimensão VerticalRESUMO
AIM: The purpose of this study was to verify the association between the facial type and the morphology of the upper central incisor, to potentially provide a guide for artificial tooth selection in esthetic and prosthetic rehabilitation. MATERIALS AND METHODS: The sample consisted of 51 lateral teleradiographs (lateral cephalometric radiographs) and cast models of subjects with a naturally optimal occlusion and at least four of the six keys of Andrews, for optimal occlusion. The facial type was defined by two cephalometric measurements (SN.Gn and SN.GoGn) and classified into dolichofacial, meso- facial and brachyfacial after digitizing the radiographs. The incisor morphology was classified into quadrangular, oval and triangular after 3D digitizing the models and evaluation of the images by 12 dentists. The evaluation between the examiners was performed by Kappa test. In order to test the differences between the variables, it was used a chi-square test (5%). RESULTS: No significant difference (p < 0.05) was found between the studied variables. CONCLUSION: Facial type was not associated with the morphology of the upper central incisor, considering the methodology and population included in the present study. CLINICAL SIGNIFICANCE: Using the facial type as a way to select the morphology of the upper central incisor proved to be inadequate in this study.
Assuntos
Face/anatomia & histologia , Incisivo/anatomia & histologia , Maxila/anatomia & histologia , Coroa do Dente/anatomia & histologia , Adolescente , Cefalometria/métodos , Oclusão Dentária , Planejamento de Prótese Dentária , Estética Dentária , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Masculino , Mandíbula/anatomia & histologia , Modelos Dentários , Osso Nasal/anatomia & histologia , Odontometria/métodos , Sela Túrcica/anatomia & histologia , Adulto JovemRESUMO
OBJECTIVE: The aim of this study was to determine the standards of facial height in 30 young (14-year-old) Japanese-Brazilian descendants with normal occlusion, and assess whether sexual dimorphism is evident. METHODS: The cephalometric measurements used followed the analyses by Wylie-Johnson, Siriwat-Jarabak, Gebeck, Merrifield and Horn. RESULTS: Results showed dimorphism for total anterior facial height (TAFH), lower anterior facial height (LAFH), anterior facial height (AFH), total posterior facial height (TPFH) and upper posterior facial height (UPFH) measurements. CONCLUSIONS: The standards of facial heights in young Japanese-Brazilian descendants with normal occlusion were observed. Sexual dimorphism was identified in five out of thirteen evaluated variables at this age range.
Assuntos
Cefalometria/métodos , Oclusão Dentária , Etnicidade , Face/anatomia & histologia , Adolescente , Pontos de Referência Anatômicos/anatomia & histologia , Brasil , Criança , Queixo/anatomia & histologia , Feminino , Humanos , Japão , Masculino , Mandíbula/anatomia & histologia , Côndilo Mandibular/anatomia & histologia , Maxila/anatomia & histologia , Osso Nasal/anatomia & histologia , Palato/anatomia & histologia , Sela Túrcica/anatomia & histologia , Caracteres Sexuais , Dimensão VerticalRESUMO
The cavernous sinus (CS) has one of the most complex anatomical networks of the skull base and because of the diversity of its contents is involved in many pathological processes. Nevertheless, anatomical literature concerning the CS is still controversial, so a systematic literature review was performed to find out the microanatomy of the medial wall of the CS and its clinical importance on sellar pathologies. Experimental studies from English-language literature between 1996 and 2010 were identified in MEDLINE, LILACS, and Cochrane databases. After analysis, two tables were prepared exhibiting the major points of each article. Fourteen experimental studies were included in the tables. Four studies concluded that the medial wall of the CS is composed of a loose, fibrous structure, and the remaining ten presumed that the medial wall is formed by a dural layer that constitutes the lateral wall of the sella. The lack of definition standards and of methodological criteria led to variation in the results among different studies. Thus, this hindered results comparison, possibly explaining the different observations.
Assuntos
Seio Cavernoso/anatomia & histologia , Dura-Máter/anatomia & histologia , Seio Cavernoso/patologia , Humanos , Hipófise/anatomia & histologia , Valores de Referência , Sela Túrcica/anatomia & histologiaRESUMO
INTRODUCTION: The aim of this study was to evaluate craniofacial asymmetry by using 2-dimensional (2D) posteroanterior cephalometric images, 3-dimensional cone-beam computed tomography (CBCT), and physical measurements (gold standard). METHODS: Ten dry human skulls were assessed, and radiopaque markers were placed on 17 skeletal landmarks. Twenty linear measurements were taken on each side to compare the right and left sides and to compare these measurements with the physical measurements made with a digital caliper. To acquire the 2D posteroanterior radiographs, an Extraoral Phosphor Storage Plate (Air Techniques, Chicago, Ill) was used as the image receptor with a Eureka x-ray-Duocon Machlett unit (Machlett Laboratores, Chicago, Ill). Three-dimensional imaging data were acquired from a CB MercuRay (Hitachi Medical, Tokyo, Japan). RESULTS: On average, the right side was larger than the left for most of the 20 distances evaluated in the digital 2D and the CBCT images, and there was poor agreement between the digital 2D images and the physical measurements (kappa = 0.0609) and almost perfect agreement (kappa = 0.92) between the CBCT and physical measurements when individual measurements were considered. CONCLUSIONS: Human skulls, with no apparent asymmetry, had some differences between the right and left sides, with dominance for the right side but with no clinical significance. CBCT can better evaluate craniofacial morphology when compared with digital 2D images.
Assuntos
Cefalometria/normas , Tomografia Computadorizada de Feixe Cônico/normas , Assimetria Facial/diagnóstico , Ossos Faciais/anatomia & histologia , Imageamento Tridimensional/normas , Crânio/anatomia & histologia , Queixo/anatomia & histologia , Assimetria Facial/diagnóstico por imagem , Marcadores Fiduciais , Humanos , Mandíbula/anatomia & histologia , Côndilo Mandibular/anatomia & histologia , Maxila/anatomia & histologia , Osso Nasal/anatomia & histologia , Cavidade Nasal/anatomia & histologia , Órbita/anatomia & histologia , Intensificação de Imagem Radiográfica/instrumentação , Intensificação de Imagem Radiográfica/métodos , Sela Túrcica/anatomia & histologia , Software , Ecrans Intensificadores para Raios X , Zigoma/anatomia & histologiaRESUMO
El cefalograma lateral es una radiografía que se usa rutinariamente en la ortodoncia. Este tipo de radiografía plana es la mejor opción para investigar las características morfométricas de la silla turca, determinando su tamaño y forma y sus eventuales variaciones. Taveras & Wood han descrito un método, para determinar el tamaño de la silla turca en radiografías. Midiendo el mayor diámetro anteroposterior de la silla turca y la profundidad de ella desde el punto más bajo a una línea que conecta la cima del dorso de la silla al tubérculo selar. Esto nos motivó llevar a cabo un estudio de estas características, para lo cual se registraron las correspondientes observaciones en 88 teleradiografias laterales, de las cuales correspondían a 44 individuos adultos jóvenes mapuches y 44 no mapuches, de ambos sexos, todos pertenecientes a la IX Región. El diámetro anteroposterior de la silla turca fue de 12,85 +/- 1,5 mm, con rangos entre 10,05 a 15,95 mm; la profundidad fue de 10,31 +/- 1,3 mm, con rangos de 7,20 a 13,36 mm; en individuos no mapuche el diámetro anteroposterior fue de 12,11 +/- 2,4 mm, con rangos entre 6,72 a 17,06 mm; la profundidad fue de 11,01 +/- 1,4 mm, con rangos de 7,92 a 13,67 mm. El área selar en mapuches fue de 132,4 mm²; y en no mapuches de 133,3 mm². La forma de la fosa fue circular en 36 casos, oval en 30 casos y plana en 22 casos.
The lateral cephalogram is an x-ray routinely used in orthodontics. This type of plane x-ray is the best choice to investigate the morphometric characteristics of the sella turcica, its size and shape, creating a variation. Taveras & Wood described a method to determine the size of the sella in radiography. Measuring the diameter of the anterior sella turcica and the depth of it from the lowest point to a line connecting the top of the back of the sella to the sellar tuber. This led to a study of the present characteristics , which reported observations in 88 lateral teleradiograph takes, of which 44 were young adult Mapuche individuals and 44 non Mapuche of both sexes, all native to the IX Region. The anteroposterior diameter of the sella turcica was 12.85 +/- 1.5mm, ranging from 10.05 to 15.95 mm, the depth was 10.31 +/- 1.3 mm, with ranges of 7.20 to 13.36 mm, in Mapuche individuals anteroposterior diameter was 12.11 +/- 2.4 mm, ranging from 6.72 to 17.06 mm, the depth was 11.01 +/- 1.4 mm, ranging from 7.92 to 13.67mm. Sellar area in Mapuches has been set at 132.4 mm² and non Mapuche of 133.3 mm². The shape of the fossa of the sella turcica was circular in 36 cases, oval in 30 cases and plane in 22 cases.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Cefalometria/métodos , Sela Túrcica/anatomia & histologia , Sela Túrcica , Chile/etnologia , Indígenas Sul-Americanos , Ortodontia/métodos , HipófiseRESUMO
The transnasal approach is the most utilized approach to the sellar region. This study was conducted to identify an anatomical landmark on the lateral surface of the head that corresponds to the midpoint of the sellar floor at the level of sphenoidal rostrum. This point, lined up with the nostril, simulates the surgical path and facilitates the transnasal access to the sella turcica. Four adult, formalin-fixed and silicon-injected cadaveric heads, and ten dried skulls were used for laboratory dissection. The heads and skulls were sectioned along the midline; and the spheno-sellar point, corresponding to the midpoint of the sellar floor at the level of sphenoid rostrum, was determined. The spheno-sellar point was plotted on the lateral surface of the skull, and its position measured relative to the external acoustic meatus. Linking the spheno-sellar point with the nostril created the spheno-nostril line. This line represents the surgical path to be taken for direct access to the sphenoid rostrum, and was used to align the cadaveric heads as in surgery. The endonasal transsphenoidal approach was then utilized in one hundred and two adult patients with sellar lesions, using the spheno-sellar point and the spheno-nostril line as the superficial landmarks to guide the approach. The results of this clinical experience are summarized. The spheno-sellar point was found to be located an average of 40.1 mm (SD+/-2.9 mm) anterior and 23.3 mm (SD+/-3.2 mm) superior to the external acoustic meatus. The spheno-nostril line represents the straight surgical path to the sphenoidal rostrum. This landmark was used in 102 correlative transnasal surgeries for sellar lesions of adult patients, and has allowed an easy and straightforward access to the sella. In only 3 cases with poor pneumatisation of the sphenoid sinus (presellar type), the actual location of the surgical instruments had to be confirmed by fluoroscopy. The application of the spheno-sellar point and the spheno-nostril line is a fast, reliable and very simple way to facilitate transsphenoidal surgery, and their use may avoid complications associated with misdirection of this approach. Its use may be limited in cases of poor pneumatisation of the sphenoid sinus, where fluoroscopic guidance could be necessary as a rule.
Assuntos
Cavidade Nasal/anatomia & histologia , Neoplasias Hipofisárias/cirurgia , Sela Túrcica/anatomia & histologia , Osso Esfenoide/anatomia & histologia , Seio Esfenoidal/anatomia & histologia , Adulto , Cadáver , Humanos , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Sela Túrcica/cirurgia , Osso Esfenoide/cirurgia , Seio Esfenoidal/cirurgiaRESUMO
OBJECTIVES: To compare the electromyographic (EMG) activity of the masseter and anterior portion of temporal muscles in different vertical facial types. MATERIALS AND METHODS: Clinical examination, cephalometric analysis, and electromyographic examination were performed in 44 volunteers ranging from 18 to 35 years old. The volunteers were classified on the basis of their vertical facial characteristics into three groups-brachyfacial, mesofacial, and dolicofacial-by the grouping analysis. The EMG records were obtained with three repetitions during mandibular rest, maximum voluntary contraction in intercuspidation, and simultaneous bilateral isotonic contraction. The Kolmogorov-Smirnov and Levene tests were applied to verify the normality and homogeneity of variance. Analysis of variance and the Kruskal-Wallis test identified statistical differences among groups that did not present normality and homogeneity of distribution, respectively. Significance for all statistical tests was set at P < .05. RESULTS: At rest, only the right temporal and masseter muscles presented statistically significant differences among the groups. The differences were observed between groups 1 and 2 (P = .02) and 1 and 3 (P = .038) for the right temporal muscle, and between groups 1 and 2 (P = .029) for the right masseter muscle. Generally, group 1 presented the lowest EMG values for the four muscles evaluated during rest. For isotonic evaluation, none of the groups of muscles presented statistically significant differences. CONCLUSION: Different vertical facial types do not determine distinct patterns of EMG activity for the masseter and anterior portion of temporal muscles during rest and bilateral mastication.
Assuntos
Eletromiografia , Face/anatomia & histologia , Músculo Masseter/fisiologia , Músculo Temporal/fisiologia , Adolescente , Adulto , Cefalometria , Oclusão Dentária , Meato Acústico Externo/anatomia & histologia , Feminino , Osso Frontal/anatomia & histologia , Humanos , Processamento de Imagem Assistida por Computador , Contração Isotônica/fisiologia , Masculino , Mandíbula/anatomia & histologia , Contração Muscular/fisiologia , Osso Nasal/anatomia & histologia , Órbita/anatomia & histologia , Sela Túrcica/anatomia & histologia , Dimensão Vertical , Adulto JovemRESUMO
The knowledge of the normal anatomy and variations regarding the management of tumors of the sellar region is paramount to perform safe surgical procedures. The sellar region is located in the center of the middle cranial fossa; it contains complex anatomical structures, and is the site of various pathological processes: tumor, vascular, developmental, and neuroendocrine. We review the microsurgical anatomy (microscopic and endoscopic) of this region and discuss the surgical nuances regarding this topic, based on anatomical concepts.
Assuntos
Microcirurgia/métodos , Sela Túrcica/anatomia & histologia , Sela Túrcica/cirurgia , Artérias Carótidas/anatomia & histologia , Endoscopia/métodos , Humanos , Cavidade Nasal/anatomia & histologia , Seio Esfenoidal/anatomia & histologiaRESUMO
BACKGROUND: Different techniques have already been described for reconstructing the sellar floor after transsphenoidal (TS) procedures. This paper reports on the use of fibrin glue alone without grafting or the use of implants in the reconstruction of the sellar floor after TS. METHODS: Five hundred sixty-seven patients who submitted to TS for pituitary and sellar region tumors were studied. No intraoperative cerebrospinal fluid (CSF) leak occurred in 503 patients (group 1); in the remaining 64 patients (group 2), intraoperative CSF leak was noted. In group 1 patients, closure of the sellar floor consisted of packing the surgical bed with hemostatic material only. When CSF leak was noted, the surgical bed was covered with a layer of hemostatic material and the intrasellar space was filled up with fibrin glue. An additional layer of hemostatic material was added at the topography of the preexisting sellar floor, and a second amount of fibrin glue was applied over it. At the end of surgery, a continuous lumbar CSF drainage system was installed in group 2 patients and kept for 5 days. Prophylactic antibiotics were administered during this period. RESULTS: We did not observe delayed CSF leak, meningitis, or visual loss in group 1 patients. In group 2, 2 patients presented with complications: 1 patient got meningitis but no overt CSF leak, and the other disclosed a delayed postoperative leak treated by reoperation. DISCUSSION: Our results showed that closure of the sellar floor with hemostatic material and fibrin glue without grafting or the use of implants is a safe and efficient method to prevent postoperative complications after TS. Generally speaking, there is no need for grafting or the use of implants at the end of TS.
Assuntos
Adesivo Tecidual de Fibrina/uso terapêutico , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Sela Túrcica/cirurgia , Osso Esfenoide/cirurgia , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/fisiopatologia , Rinorreia de Líquido Cefalorraquidiano/prevenção & controle , Derivações do Líquido Cefalorraquidiano/normas , Derivações do Líquido Cefalorraquidiano/estatística & dados numéricos , Seguimentos , Humanos , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/etiologia , Meningites Bacterianas/prevenção & controle , Procedimentos Neurocirúrgicos/instrumentação , Hipófise/anatomia & histologia , Hipófise/patologia , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Próteses e Implantes/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/instrumentação , Reoperação/estatística & dados numéricos , Sela Túrcica/anatomia & histologia , Sela Túrcica/patologia , Osso Esfenoide/anatomia & histologia , Osso Esfenoide/patologia , Transplantes/estatística & dados numéricos , Resultado do TratamentoRESUMO
El desarrollo de la tecnología en el diagnóstico por imagen hizo posible el análisis morfológico multiplanar de las estructuras intracraneanas, como la silla turca. Para el presente estudio fueron utilizados cien cráneos del Departamento de Anatomía Descriptiva y Topográfica de la Universidad Federal de Sao Paulo (UNIFESP), que después de clasificarlos, fueron sometidos a exámenes tomográficos en el plano sagital, donde los datos radiológicos que se obtuvieron pudieron ser correlacionados de acuerdo con el sexo de los individuos analizados, demostrando que la silla turca es una estructura anatómica constante, pero de forma variable.
Assuntos
Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Sela Túrcica/anatomia & histologia , Sela Túrcica , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X , CrânioRESUMO
Presentamos el caso de una niña de 1 año y 6 meses con baja talla, obesidad, panhipopituitarismo, diabetes insípida y trastornos visuales que en el examen postmortem mostró atrofia cerebral secundaria a una encefalopatía difusa, frecuentes neuronas calcificadas en corteza cerebral, núcleos de la base y, particularmente, en el hipotálamo, nervios ópticos con moderada atrofia, tallo hipofisario filiforme y silla turca vacía con hipófisis en el dorso de la concavidad. Se discute la probable patogenia de los hallazgos anatomopatológicos en el contexto de la literatura pertinente
Assuntos
Pré-Escolar , Humanos , Criança , Feminino , Diabetes Insípido/classificação , Sela Túrcica/anatomia & histologia , Sela Túrcica/patologia , Síndrome , Córtex Cerebral/anatomia & histologia , Córtex Cerebral/crescimento & desenvolvimento , Córtex Cerebral/patologiaRESUMO
Objetivo: O desenvolvimento da tecnologia em diagnóstico por imagem tornou possível a realização da pesquisa morfológica da sella turcica, objeto desta tese. Imagens tomográficas foram obtidas em diferentes planos de secção, focalizando sua morfometria e sua forma. Os dados radiológicos obtidos foram correlacionados com o índice crânico horizontal (ICH), a idade e o sexo dos indivíduos cujos crânios foram analisados. Métodos: Foram utilizados para este estudo 100 crânios do Museu de Ossos da UNIFESP - Escola Paulista de Medicina, que após mensurados e classificados, foram submetidos a exames tomográficos nos três planos de secção: coronal, transversal e sagital, sendo posteriormente calculadas as seguintes medidas no filme: altura, perímetro, comprimento e área da sella turcica. Estatisticamente foram utilizados os testes qui-quadrado, Mann-Whitney, Kruskal-Wallis e Correlação de Spearman. Resultados: Os valores tomográficos da sella turcica são: comprimento mais freqüente de 10,31 mm variando entre 6 a 15,1 mm; altura mais freqüente de 6,33 mm variando entre 2,9 e 11,1mm; área mais freqüente de 41,21mm` variando entre 8 e 79mm2; perímetro mais freqüente de 30,02mm variando entre 17,44 e 42,12mm. Conclusões: Conclui-se que a sella turcica é uma estrutura anatômica constante, de forma variável, e que se desenvolve independentemente da tipologia craniana nos indivíduos do sexo feminino. Há influência do sexo sobre o comprimento tomográfico da sela e sobre o perímetro tomográfico da sele nos indivíduos masculinos. Há também correlação estatística entre alguma medidas da própria sela: área e perímetro (rs=0,873); área e altura (rs=0,920) área e comprimento (rs=0,292); perímetro e a altura (rs=0,720); comprimento E perímetro (rs=0,649); distância entre os processos clinóides anteriores E posteriores direitos e esquerdos (rs=0,766)