Avaliação do desvio de septo nasal por meio de tomografia computadorizada do tipo Cone Beam em pacientes submetidos à expansão orto-cirúrgica da maxila

Abstract

The surgical assisted expansion of the maxilar helps solve one of the major problems of the ortodontic treatments: the transverse maxilary deficiency. This deformity occours both on young and adult pacients. However the surgical assisted expansion of the maxilar is a proceding only aplied on pacients that already achieved bone maturity. Therefore, many surgical techniques were presented through the years on the attempt to solve the problem efficiently, with good post surgical stability and low death rates. Controversy related with the surgical procedure still remain, specialy related on the conduct of the nasal septum. Many authors defend the rupture of the nasal septum and many others are against this proceeding. Studies on the post surgical behaviour of the nasal septum based on radiografic exam and tomography were takem, however the doubt still remained. The objectives of this study were to evaluate the deviation of the nasal septum and the expansion of the nasal cavity on patients submited to surgical assisted expansion of the maxilar, using the cone bean computer tomografy exam. Ten patients were submitted to the surgical procedure between october 2007 and september 2008. These patients were chosen and submitted to the cone bean computer tomography exam before the after the surgical procedure and also after the activation of the brace. The tecnique applied on the patients was based in a horizontal osteotomy of the maxilar with piriformy disjunction bilaterally and the zigomaticmaxilar process and vertical osteotomy between the central incisors. Osteoctomy and rupture of the pterygoid process and of the nasal septum were not taken. To achieve standard measures of the cumputer tomografy exams before and after surgery, some identification spots were chosen on the axis cuts to guide us. All the measures were achieved through similar axis cuts before and after the surgery. This cuts were chosen trhough correlations with the coronary and sagital cuts. The results were submitted to statistics analisys to achieve a reliable method. It was observed an increase of the nasal cavity and a deviation of the nasal septum. Therefore we concluded that despite the deviaton of the nasal septum no significant functional or static injury was observed on our patients.