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Doctoral Thesis
DOI
https://doi.org/10.11606/T.61.2019.tde-18032020-093824
Document
Author
Full name
Michele Garcia-Usó
Institute/School/College
Knowledge Area
Date of Defense
Published
Bauru, 2019
Supervisor
Committee
Suedam, Ivy Kiemle Trindade (President)
Ioshida, Marília Sayako Yatabe
Oliveira, Rodrigo Cardoso de
Santos, Carlos Ferreira dos
Title in Portuguese
Vias aéreas superiores nas craniossinostoses sindrômicas: análise por tomografia computadorizada e fluido dinâmica computacional
Keywords in Portuguese
Acrocefalosindactilia
Imagem tridimensional
Obstrução das vias aéreas
Tomografia
Abstract in Portuguese
Objetivos: Estudos sugerem que as dismorfologias das vias aéreas superiores (VAS) nas Craniossinostoses Sindrômicas (CSS) são decorrentes da hipoplasia de terço médio da face e possuem estreita relação com a Síndrome da Apneia Obstrutiva do Sono (SAOS). O objetivo do presente estudo foi caracterizar a morfo-fisiologia das VAS nos indivíduos com CSS comparados a um grupo controle (CON), por meio de tomografia computadorizada (CT) e fluidodinâmica computacional (CFD). A hipótese inicial foi de que as UAW estão reduzidas e fisiologicamente impactadas nos CSS. Métodos: a amostra foi composta por dois grupos: 1) CON: 19 tomografias de indivíduos sem síndromes ou infecções das VAS (25±7 anos de idade); 2) SCS 10 tomografias de indivíduos com CSS (21±5 anos de idade); O volume (cm3) (V) e área seccional mínima (mm2) (ASm) foram aferidos por meio do software Mimics. As VAS foram divididas em VAS total (VASt), cavidade nasal (CN) e faringe (FAR). A análise cefalométrica foi realizada por meio do software Dolphin. Sete indivíduos de cada grupo foram selecionados, pareados por gênero e idade, para as simulações de CFD. As medidas foram feitas duas vezes pelo mesmo avaliador em dois momentos distintos. Valores de p<0,05 foram considerados significantes. Resultados: Valores médios de V (±Dp) para os grupos CON e CSS corresponderam a: VASt 34,3±5,9 e 24,5±9,5; CN 17,90±3,0 e 14,1±4,3; FAR 16,4±4,0 e 10,4±5,6 respectivamente. Os valores médios de ASm (±Dp) para os grupos CON e SCC corresponderam a 67,3±54,2 e 28,6±17,1, respectivamente. Dentre os principais resultados cefalométricos observou-se que as dimensões maxilomandibulares estavam significantemente reduzidas em relação ao grupo CON (Co-A (mm) 84,1±5,8 vs. 67,3±11,3; Go-Me (mm) 71,1±6,0 vs. 58,3±9,5; SNA (°) 82,8±3,8 vs. 76,4±8,5). Foi observada uma correlação positiva entre as dimensões maxilomandibulares (Co-A e Go-Me) e V. Na análise por CFD, pressões mais negativas (Pa) foram observadas no grupo CSS (-107,7±63,0) em relação ao grupo Com (-45,6±24,2). Da mesma forma, maiores valores de resistência (Pa/(cm2/min)) ao fluxo inspiratório foram observadas no grupo CSS (-6,8±3,7) em relação ao grupo CON (-2,7±1,7) .2021 Conclusão: As dimensões das VAS dos indivíduos com CSS estão reduzidas em relação à indivíduos não sindrômicos. Esta redução pode ser justificada pela discrepância maxilo-mandibular observada. As dimensões reduzidas impactam negativamente a função das VAS. Infere-se, assim, que esta população está mais predisposta ao desenvolvimento de obstrutiva do sono e desordens relacionadas
Title in English
The upper airways in syndromic craniosynostosis: tomographic and computational fluid dynamics assessment
Keywords in English
Acrocephalosyndactylia
Airway obstruction
Imaging threedimensional
Tomography
Abstract in English
Objectives: Studies have suggested that upper airway (UAW) dysmorphologies in Syndromic Craniosynostosis (SCS) are mainly related to midface hypoplasia and consequently with obstructive sleep apnea (OSA). The aim of this study was to characterize the morphophysiology of UAW in SCS individuals as compared to controls (CON) by means of computed tomography (CT) and computational fluid dynamics (CFD). We hypothesized that UAW was reduced and physiologically impaired in SCS. Methods: The sample was composed by two groups: 1) CON: 19 scans of individuals without any syndrome or upper airway infections (25,26±6,67 years of age), and 2) SCS 10 CT scans of individuals with SCS (21,05±4,89 years of age); volume (cm3) (V) and minimal cross-sectional area (mm2) (mCSA) were assessed using Mimics software; UAW was divided into total UAW (tUAW), nasal cavity (NC), and pharynx (Phrx). Cephalometric analysis was also performed using Dolphin software. Seven individuals of each group, age and gender matched, were considered for CFD simulation. Measurements were done twice by the same evaluator at two different time points. Differences between groups were assessed at a 5% significance level. Results: Mean values of V (±Sd) for groups CON and SCS corresponded to: tUAW 34,31±5,97 and 24,52±9,55; NC 17,90±3,07 and 14,10±4,30; Phrx 16,46±4,60 and 10,42±5,63 respectively. Mean mCSA (±Sd) for groups CON and SCS corresponded to 67,32±54,20 and 28,66±17,14. Cephalometric findings showed significant differences between CON and SCS respectively: a smaller maxillomandibular length in SCS, represented by Co-A (mm) 84,13±5,80 and 67,36±11,30, Go-Me (mm) 71,14±6,00 and 58,37±9,50; midface retrusion in relation to the skull base, showed by SNA 82,87°±3,80 and 76,44°±8,50; greater flexure of skull base angle, from the magnitude of Ba-S-N 131,16°±6,2 and 121,85°±7,60. There was a positive correlation between the cephalometric2425 variables Co-A/Go-Me and V Phrx. The mCSA showed a positive correlation with V Phrx. On CFD analysis, pressure boundary condition on outlet (Pout), expressed in Pascals, on CON and SCS corresponded to -45,6±24,26 and -107,78±63,06. The UAW resistance (Res), expressed in Pa/(L/min), corresponded to -2,74±1,77 and - 6,88±3,78, on CON and SCS respectively. The actual simulated flow rate (Flw), expressed in L/min, was from 17.2±2.39 and 15.8±1.88, for CON and SCS respectively. Conclusion: The initial hypothesis was confirmed, since the UAW dimensions were significantly reduced in SCS. The same significance was found in CFD variables. Therefore, the results suggested these individuals with SCS are at great risk for OSA
 
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Publishing Date
2020-10-14
 
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