NIVALDO ALONSO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
- Cranial Fossa Volume and Morphology Development in Apert Syndrome(2020) LU, Xiaona; FORTE, Antonio Jorge; WILSON, Alexander; STEINBACHER, Derek M.; ALPEROVICH, Michael; ALONSO, Nivaldo; PERSING, John A.Background: Apert syndrome causes normal or enlarged intracranial volume overall as patients grow. This study aimed to trace the segmental anterior, middle, and posterior cranial fossae volume and structural morphology in these patients, to help discern a more focused and individualized surgical treatment plan for patients with Apert syndrome. Methods: This study included 82 preoperative computed tomographic scans (Apert, n = 32; control, n = 50) divided into five age-related subgroups. The scans were measured using image processing and three-dimensional modeling software. Results: The middle cranial fossa volume was increased and was the earliest change noted. It was increased by 45 percent (p = 0.023) compared with controls before 6 months of age and remained increased into adulthood (161 percent, p = 0.016), with gradually increasing severity. The anterior and posterior cranial fossae volumes also increased, by 35 percent (p = 0.032) and 39 percent (p = 0.007), respectively. Increased depth of cranial fossae contributed most to the increase in volumes of patients with Apert syndrome, with correlation coefficients of 0.799, 0.908, and 0.888 for anterior, middle, and posterior cranial fossa, respectively. The intracranial volume was increased 12 percent (p = 0.098) across the entire test age range (0 to 26 years old), but only had statistical significance during the age range of 6 to 18 years (22 percent, p = 0.001). Conclusions: Malformation of the middle cranial fossa is an early, perhaps the initial, pivotal cranial morphologic change in Apert syndrome. Increased cranial fossae depth is an inherent characteristic of the maldevelopment. Normalization of cranial volume and circumference overall may not achieve a normal skull structure, as it does not correct regional craniocerebral disproportion.
- Global Burden of Orofacial Clefts and the World Surgical Workforce(2021) MASSENBURG, Benjamin B.; HOPPER, Richard A.; CROWE, Christopher S.; MORRISON, Shane D.; ALONSO, Nivaldo; CALIS, Mert; DONKOR, Peter; KRESHANTI, Prasetyanugraheni; YUAN, JieBackground: Orofacial clefts are one of the most common congenital anomalies, but this disease burden is unevenly distributed worldwide. The authors hypothesize that this burden falls disproportionately on the countries with the smallest surgical workforce or lowest Socio-Demographic Index, rather than those with the highest prevalence of disease. Methods: The authors estimated the prevalence and disease burden of orofacial clefting from 1990 to 2017 in 195 countries using the Global Burden of Disease methodology. Prevalence and disability-adjusted life-years were compared geographically, temporally, and against the size of the national surgical workforce, Socio-Demographic Index, and income status. Linear and logarithmic regressions were performed. Results: In 2017, the prevalence of orofacial clefting was estimated to be 10.8 million people, representing a disease burden of 652,084 disability-adjusted life-years, with most of this disease burden experienced by low- and middle-income countries (94.1%). From 1990 to 2017, there was a decrease in disease burden (-70.2%) and prevalence (-4.9%). There was negative logarithmic association between surgical workforce size and disease burden, with a surgical workforce of greater than six providers per 100,000 population (3.6 disability-adjusted life-years versus 22.4 disability-adjusted life-years per 100,000 population; p < 0.0001). Conclusions: Burden of orofacial clefting has a strong negative association with the size of the surgical workforce, suggesting that strengthening the surgical workforce will help alleviate this burden. Epidemiologic data on countries and regions with inadequate surgical workforces and high disease burden should guide future research efforts and allocation of resources, and guide the treatment and educational goals of international charitable organizations.
- Pharyngoplasty Applied to Velopharyngeal Insufficiency: Efficacy versus Morbidity(2012) LIMA JUNIOR, Jonas E.; TANIKAWA, Daniela Y. S.; ROCHA, Diogenes L.; ALONSO, Nivaldo
- Reply: Myotomy of the Levator Labii Superioris Muscle and Lip Repositioning: A Combined Approach for the Correction of Gummy Smile(2011) ISHIDA, Luis Henrique; ALONSO, Nivaldo; ISHIDA, Luiz C.; FERRIERA, Marcus Castro
- What Is the Difference in Cranial Base Morphology in Isolated and Syndromic Bicoronal Synostosis?(2020) LU, Xiaona; FORTE, Antonio Jorge; WILSON, Alexander T.; PARK, Kitae Eric; ALLAM, Omar; MOZAFFARI, Mohammad Ali; ALPEROVICH, Michael; STEINBACHER, Derek M.; ALONSO, Nivaldo; PERSING, John A.Background: The association of isolated craniosynostosis and the influence of syndromic forms confound the understanding of craniofacial morphologic development. This study attempts to clarify the individual influences of isolated bicoronal synostosis, Apert syndrome, and Crouzon syndromes on skull base morphology. Methods:: One hundred seventeen computed tomographic scans were included (nonsyndromic bicoronal synostosis,n= 36; Apert syndrome with bicoronal synostosis,n= 25; Crouzon syndrome with bicoronal synostosis,n= 11; controls,n= 45). Cephalometric measurements were analyzed using Materialise software. Results: Nonsyndromic bicoronal synostosis patients developed a shortened cranial base length, with a significantly shortened distance between nasion and sella (p= 0.005). The cranial base angles of nonsyndromic bicoronal synostosis in both the cranial side (N-S-BA) and facial side (N-SO-BA) increased significantly, by 17.04 degrees (p <0.001) and 11.75 degrees (p <0.001), respectively. However, both the N-S-BA and N-SO-BA angles of Apert syndrome and Crouzon syndrome were narrowed more than that of nonsyndromic bicoronal synostosis [by 12.11 degrees (p <0.001) and 12.44 degrees (p <0.001), respectively, in Apert syndrome; and by 11.66 degrees (p= 0.007) and 13.71 degrees (p= 0.007), respectively, in Crouzon syndrome]. However, there is no statistically significant difference of these two angles between Apert syndrome and Crouzon syndrome, when they were only associated with bicoronal synostosis. Contrary to the relatively normal subcranial space of nonsyndromic bicoronal synostosis, both Apert and Crouzon syndromes developed a reduced subcranial space. Conclusions: Isolated bicoronal synostosis resulted in a flattened cranial base, whereas Apert syndrome and Crouzon syndrome developed a normal cranial base angle when only associated with bicoronal synostosis. The syndromic skulls had additional significantly reduced subcranial space.
- Reduced Three-Dimensional Nasal Airway Volume in Treacher Collins Syndrome and Its Association with Craniofacial Morphology(2015) MA, Xiaoyang; FORTE, Antonio Jorge; BERLIN, Nicholas Lee; ALONSO, Nivaldo; PERSING, John A.; STEINBACHER, Dereck MatthewBackground: Airway insufficiency decreases quality of life and may be life threatening in patients with Treacher Collins syndrome. The authors calculated the three-dimensional nasal airway volume in patients with Treacher Collins syndrome to identify correlations between nasal airway volume and craniofacial morphology and provide guidance for surgical planning. Methods: Thirty nonoperated patients with Treacher Collins syndrome were compared with 35 unaffected age-and gender-matched controls. Anatomic variables of the cranial base, the maxilla complex, and internal diameters of nasal airway were compared between patients and control subjects using three-dimensional craniometric analyses. In the Treacher Collins group, the relation of craniofacial morphology to nasal airway volume was assessed separately. Statistical analyses were performed using independent sample t tests and Pearson correlation coefficient analyses. Results: Nasal airway volume was decreased 38.6 percent in patients with Treacher Collins syndrome relative to controls (p = 0.001). A positive correlation of maxillary position and nasal airway volume was shown in Treacher Collins patients (r = +0.463, p = 0.013). Maxillary, nasal bone, and orbitale width were also positively correlated with nasal airway volume (r = +0.582, p = 0.001; r = +0.408, p = 0.035; and r = +0.677, p < 0.001, respectively). Shortened internal diameters of the nasal airway all positively correlated with nasal airway volume. Conclusions: Nasal airway volume is reduced in patients with Treacher Collins syndrome. Reduced projection of the maxilla and transverse maxillary deficiency are correlated with reduced nasal airway volume and are primarily responsible for obstruction of the nasal airway.
- Orbital and Periorbital Dysmorphology in Untreated Pfeiffer Syndrome(2022) LU, Xiaona; FORTE, Antonio Jorge; ALLAM, Omar; PARK, Kitae Eric; WILSON, Alexander; ALPEROVICH, Michael; STEINBACHER, Derek M.; TONELLO, Cristiano; ALONSO, Nivaldo; PERSING, John A.Background: Visual impairment secondary to orbital and periorbital dysmorphology is frequent in Pfeiffer syndrome patients. The etiopathogenesis of this aberrancy, however, remains unclear. Methods: Untreated Pfeiffer syndrome patients (n = 31) and normal control subjects (n = 43) were compared. Craniometric and volumetric analyses related to the orbital and periorbital anatomy were performed using Materialise (Leuven, Belgium) software. Results: Overall, orbital cavity volume of Pfeiffer patients is reduced by 28 percent (p < 0.001), compared to normal, starting before 3 months of age (p = 0.004). Globe volume was diminished by 10 percent (p = 0.041) before 3 months of age, yet tended to catch up thereafter. However, the retrobulbar soft-tissue volume remained smaller beyond 1 year of age (17 percent, p = 0.003). Globe volume projection beyond the bony orbit increased in all observed ages (82 percent, p < 0.001). The volumes of sphenoid bone, maxilla, and mandible proportionately were restricted by 24 to 25 percent (p = 0.003 to 0.035) before 3 months of age. The volume of maxilla and mandible gradually approximate normal; however, the sphenoid bone volume in Pfeiffer patients remains less than normal (p = 0.002) into childhood. The anteroposterior length of both the zygoma and the maxilla was reduced by 14 percent (p < 0.001). Anterior positioning of the zygoma is less by 23 percent (p < 0.001) in Pfeiffer patients overall, with anterior positioning of maxilla reduced similarly by 23 percent (p < 0.001). Conclusions: Pfeiffer syndrome patients develop decreased retrobulbar soft-tissue and globe volume, along with a restricted orbital cavity volume in infancy. Significant hypoplasia of the sphenoid bone is associated with more severe central facial (maxilla) retrusion, compared to lateral facial structures (zygoma).
- Respective Roles of Craniosynostosis and Syndromic Influences on Cranial Fossa Development(2021) LU, Xiaona; FORTE, Antonio Jorge; WILSON, Alexander T.; PARK, Kitae Eric; ALLAM, Omar; ALPEROVICH, Michael; STEINBACHER, Derek M.; ALONSO, Nivaldo; PERSING, John A.Background: Little is known about the detailed growth of the cranial fossae, even though they provide an important structural connection between the cranial vault and the facial skeleton. This study details the morphologic development of isolated cranial vault synostosis and associated syndromes on cranial fossa development. Methods: A total of 125 computed tomographic scans were included (nonsyndromic bicoronal synostosis, n = 36; Apert syndrome associated with bicoronal synostosis, n = 24; Crouzon syndrome associated with bicoronal synostosis, n = 11; and controls, n = 54). Three-dimensional analyses were produced using Materialise software. Results: The regional anterior and middle cranial fossae volumes of nonsyndromic bicoronal synostosis are characterized by significant increases of 43 percent (p < 0.001) and 60 percent (p < 0.001), respectively, and normal posterior cranial fossa volume. The cranial fossae depths of nonsyndromic bicoronal synostosis were increased, by 37, 42, and 21 percent (all p < 0.001) for anterior, middle, and posterior cranial fossae, respectively, accompanying the shortened cranial fossae lengths. The volume and morphology of all cranial fossae in Apert syndrome nearly paralleled nonsyndromic bicoronal synostosis. However, Crouzon syndrome had reduced depths of cranial fossae, and more restricted fossa volumes than both Apert syndrome and nonsyndromic bicoronal synostosis. Conclusions: Cranial vault suture synostosis is likely to be more influential on cranial fossae development than other associated influences (genetic, morphologic) in Apert and Crouzon syndromes. Isolated Apert syndrome pathogenesis is associated with an elongation of the anterior cranial fossa length in infants, whereas in Crouzon syndrome, there is a tendency to reduce cranial fossa depth, suggesting individual adaptability in cranial fossae development related to vault synostosis.
- Airway Analysis in Apert Syndrome(2019) FORTE, Antonio J.; LU, Xiaona; HASHIM, Peter W.; STEINBACHER, Derek M.; ALPEROVICH, Michael; PERSING, John A.; ALONSO, NivaldoBackground: Apert syndrome is frequently combined with respiratory insufficiency, because of the midfacial deformity which, in turn, is influenced by the malformation of the skull base. Respiratory impairment resulting from Apert syndrome is caused by multilevel limitations in airway space. Therefore, this study evaluated the segmented nasopharyngeal and laryngopharyngeal anatomy to clarify subcranial anatomy in children with Apert syndrome and its relevance to clinical management. Methods: Twenty-seven patients (Apert syndrome, n = 10; control, n = 17) were included. All of the computed tomographic scans were obtained from the patients preoperatively, and no patient had confounding disease comorbidity. Computed tomographic scans were analyzed using Surgicase CMF. Craniometric data relating to the midface, airway, and subcranial structures were collected. Statistical significance was determined using t test analysis. Results: Although all of the nasal measurements were consistent with those of the controls, the nasion-to-posterior nasal spine, sphenethmoid-to-posterior nasal spine, sella-to-posterior nasal spine, and basion-to-posterior nasal spine distances were decreased 20 (p < 0.001), 23 (p = 0.001), 29 (p < 0.001), and 22 percent (p < 0.001), respectively. The distance between bilateral gonions and condylions was decreased 17 (p = 0.017) and 18 percent (p = 0.004), respectively. The pharyngeal airway volume was reduced by 40 percent (p = 0.01). Conclusion: The airway compromise seen in patients with Apert syndrome is attributable more to the pharyngeal region than to the nasal cavity, with a gradually worsening trend from the anterior to the posterior airway, resulting in a significantly reduced volume in the hypopharynx.
- Orbital Dysmorphology in Untreated Children with Crouzon and Apert Syndromes(2015) FORTE, Antonio Jorge; STEINBACHER, Derek M.; PERSING, John A.; BROOKS, Eric D.; ANDREW, Tom W.; ALONSO, NivaldoBackground: Orbital dysmorphology and midface retrusion are the hallmarks of Crouzon and Apert syndromes. The precise nature of this deficiency is not known. Methods: Untreated Crouzon and Apert syndrome patients and age- and sex-matched controls were included. Computed tomographic scans were digitized and reconstructed. Craniometric and volumetric data relating to the orbit were collected. Results: Thirty-one scans were included (control, n = 12; Crouzon; n = 9; Apert, n = 10). The mean age of the Apert group was 5.31 5 years; Crouzon, 5.77 +/- 2.7 years; and control, 6.4 +/- 3.6 years. The bony orbit length was 12 percent shorter in Apert (p = 0.004) and 17 percent shorter in the Crouzon group when compared to controls (p < 0.0001). The bony orbital volume was 21 percent smaller in the Apert children (p = 0.0006) and 23 percent smaller in Crouzon when compared to controls (p = 0.003). Globe volume was 15 percent larger in Apert (p = 0.008) and 36 percent larger in the Crouzon group when compared to controls (p < 0.0001). Orbital soft-tissue volume was 19 percent less in the Apert group (p = 0.004) and 29 percent less in the Crouzon group (p = 0.001) when compared to controls. Conclusions: A shortened bony orbit, decreased orbital and orbital soft-tissue volumes, and an increased volume of the globe were found in both conditions. Despite normal volume of the overall orbital contents, the contents are altered, and the bony orbit is shorter and holds less volume.