GILBERTO GUANAES SIMOES FORMIGONI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
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bookPart Ronco primário(2018) SENNES, Luiz Ubirajara; NAKASATO, Alexandre; FORMIGONI, Gilberto Guanaes S.; CAHALI, Michel Burihan- Tonsil volume, tonsil grade and obstructive sleep apnea: is there any meaningful correlation?(2011) CAHALI, Michel Burihan; SOARES, Carolina Ferraz de Paula; DANTAS, Danielle Andrade da Silva; FORMIGONI, Gilberto Guanaes SimoesOBJECTIVES: The aims of this study were to evaluate the correlation between oropharyngeal examination and objective palatine tonsil volume in snoring adults and verify the influence of the oropharyngeal anatomy, body mass index, age, and severity of obstructive sleep apnea on actual tonsil volume. In addition, we aimed to assess the influence of tonsil size on obstructive sleep apnea in adults. INTRODUCTION: Pharyngeal wall geometry is often altered in adults who have obstructive sleep apnea, and this might influence the findings of the oropharyngeal examination that, in turn, are the key factors when considering surgical management for this condition. Furthermore, the correlation between the actual tonsil volume and the severity of obstructive sleep apnea in adults is currently unknown. METHODS: We prospectively studied 130 patients with obstructive sleep apnea or primary snoring who underwent pharyngeal surgery with intraoperative measurement of tonsil volume. We compared tonsil volume with preoperative polysomnography, oropharyngeal examination, and anthropometric data. RESULTS: We found a significant correlation between actual tonsil volume and subjective tonsil grade. We also found a significant correlation between tonsil volume and the apnea-hypopnea index. Using a multivariate linear regression model, tonsil volume was found to be significantly correlated with age, body mass index, and oropharyngeal examination, but not with polysomnography. Clinically, only the rare tonsil grade IV was indicative of more severe obstructive sleep apnea. CONCLUSIONS: There is a strong correlation between clinical tonsil grade and objective tonsil volume in snoring adults, and this correlation exists regardless of the presence or severity of obstructive sleep apnea. Pharyngeal tissue volume likely reflects the body mass index rather than obstructive sleep apnea severity.
bookPart Cefaleias Primárias(2019) ANDRADE, Daniel Ciampi Araujo de; FORTINI, Ida; SIQUEIRA, Silvia Regina Dowgan Tesseroli de; SIQUEIRA, José Tadeu Tesseroli de; PINTO, Lauro Figueira; TEIXEIRA, Manoel Jacobsen; MONTEIRO, Mário Luis; FORMIGONI, Gilberto- The Extracellular Matrix of the Lateral Pharyngeal Wall in Obstructive Sleep Apnea(2012) DANTAS, Danielle Andrade da Silva; MAUAD, Thais; SILVA, Luiz F. F.; LORENZI-FILHO, Geraldo; FORMIGONI, Gilberto G. S.; CAHALI, Michel B.Study Objectives: To compare the components of the extracellular matrix in the lateral pharyngeal muscular wall in patients with and without obstructive sleep apnea (OSA). This may help to explain the origin of the increased collapsibility of the pharynx in patients with OSA. Design: Specimens from the superior pharyngeal constrictor muscle, obtained during pharyngeal surgeries, were evaluated using histochemical and immunohistochemical analyses to determine the fractional area of collagen types I and II, elastic fibers, versican, fibronectin, and matrix metalloproteinases 1 and 2 in the endomysium. Setting: Academic tertiary center. Patiens: A total of 51 nonobese adult patients, divided into 38 patients with OSA and 13 nonsnoring control subjects without OSA. Interventions: Postintervention study performed on tissues from patients after elective surgery. Measurements and Results: Pharyngeal muscles of patients with OSA had significantly more collagen type I than pharyngeal muscles in control subjects. Collagen type I was correlated positively and independently with age. The other tested components of the extracellular matrix did not differ significantly between groups. In a logistic regression, an additive effect of both the increase of collagen type I and the increase in age with the presence of OSA was observed (odds ratio (OR), 2.06; 95% confidence interval (CI), 1.17-3.63), when compared with the effect of increased age alone (OR, 1.11; 95% CI, 1.03-1.20). Conclusion: Collagen type I in the superior pharyngeal constrictor muscle was more prevalent in patients with OSA and also increased with age. It was hypothesized that this increase could delay contractile-relaxant responses in the superior pharyngeal constrictor muscle at the expiratory-inspiratory phase transition, thus increasing pharyngeal collapsibility.
bookPart Síndrome da apneia obstrutiva do sono(2018) SENNES, Luiz Ubirajara; FORMIGONI, Gilberto Guanaes S.; CAHALI, Michel Burihan- Characteristics and prevalence of orofacial pain as an initial symptom of oral and oropharyngeal cancer and its impact on the patient?s functionality and quality of life(2022) VILARIM, Rita de Cassia Bonato; TAVARES, Marcos Roberto; SIQUEIRA, Silvia Regina Dowgan Tesseroli de; JALES, Sumatra Melo da Costa Pereira; FORMIGONI, Gilberto Guanaes Simoes; TEIXEIRA, Manoel Jacobsen; SIQUEIRA, Jose Tadeu Tesseroli deObjective. To evaluate the prevalence and characteristics of orofacial pain in oral and oropharyngeal cancer (OOC), at diagnosis.Material and Methods. a) Study group (SG; n = 74) patients with cancer were divided into 2 subgroups: oral cancer (OC) and oro-pharyngeal cancer (OPC); b) control group (CG; n = 74) patients within dental care.Study Design. An Orofacial Pain Assessment, verbal descriptive scale, Helkimo dysfunction index, Quality of Life questionnaire, and Karnofsky performance status (KPS) was used for evaluation.Results. The mean age was 58.46 years (79.7% male) in SG, 58.61 years (20.3% male) in CG. The pain within the SG was indi-cated by the following: prevalence = 91.9% (21.6% in stages 0, I, or II; 70.3% in III or IV); reason for seeking care = 50.1%; main complaint = 55.4%; most important issue in the past 7 days = 74.3%; breakthrough-like pain = 64.9%; main features: chewing or swallowing as triggering factors, wake up patient, variable duration, independent of daytime, multiple descriptors, and earache. The following indexes were worse within the SG: clinical dysfunction, quality of life, and KPS. In addition, the OC subgroup reported toothache-like pain and burning; whereas the OPC subgroup reported heavy swallowing as triggering factor, throat as location, and a bilateral earache.Conclusion. At diagnosis, orofacial pain, including breakthrough-like pain, was prevalent in patients with OOC, and the pattern was heterogeneous. Predominantly, the pain was moderate to severe, related to stage of cancer, and already compromising the patients' quality of life and functionality.