Effects of minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) on the nasal cavity and upper airway: a comparative cohort study

This study was performed to evaluate the impact on the upper airway and nasal cavity of a new minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) technique for the treatment of adult patients with transverse maxillary deficiency, in comparison to surgically assisted rapid palatal expansion (SARPE). Computed tomography scans of 21 MISMARPE and 16 SARPE patients were obtained preoperatively (T0) and at the end of the activation period (T1) and analysed. Linear and volumetric measurements were performed in the dental, alveolar, nasal cavity, and oropharynx regions. Generalised estimating equations were used to consider the intervention time and surgery type, and their interaction. In both groups, measurements were increased at T1 (P < 0.001), except for oropharynx volume (P > 0.05). A greater expansion in nasal cavity floor and median palatal suture was shown for MISMARPE when compared to SARPE (P < 0.001), with the same degree of expander activation (P = 0.094). A trapezoidal (coronal plane) and 'V' shape (axial plane) expansion pattern, was observed after MISMARPE. Both surgical techniques were effective for maxillary expansion in adults. However, MISMARPE was performed without osteotomy of the pterygomaxillary suture, in an outpatient setting and with local anaesthesia.

Identification of patients with a high risk of osteoporosis. Analysis of risk factors, ultrasonography and DEXA, in a female population in the North East of Italy

AIM

The aim of this observational study is the identification of women at high risk of osteoporosis by using the phalangeal quantitative ultrasound (QUS) value for osteoporosis screening.

METHODS

The study population is composed of 1 152 women between 35 and 79 years old, both premenopausal and postmenopausal. Each woman underwent a questionnaire and phalangeal QUS. One hundred and forty-eight women also underwent dual energy X-ray absorptiometry (DEXA). Osteopenia and osteoporosis, as determined using the amplitude dependent speed of sound (AD-SoS) T-score, identified women at a high risk of fracture. Data were stored and analyzed using SPSS (Statistical Package for Social Science) for Windows.

RESULTS

AD-SoS is significantly higher in premenopausal women than in postmenopausal women without history of hormone replacement therapy (HRT) (P<0.001), if they are over 50 years old. In women 50-59 years old, AD-SoS is significantly higher in premenopausal women than in postmenopausal women with or without HRT history (P<0.001). In postmenopausal women, discriminant analysis found that HRT and years of HRT are the only significant protective factors (P<0.001). In premenopausal and postmenopausal women with no history of HRT use, discriminant analysis demonstrated that early menopause and a family history of osteoporosis are the only significant risk factors (P<0.001).

CONCLUSION

Early menopause and a family history of osteoporosis seem to be the greatest risk factors, while HRT seems to be a protective factor. The QUS technique, with DEXA as a secondary test, can be a screening test for the identification of postmenopausal women with a high risk of fracture.