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Pediatric obstructive sleep apnea (OSA), a relatively common sleep-related breathing disorder (SRBD) affecting approximately 1-5% of children, is often caused by anatomical obstruction and/or collapse of the nasal and/or pharyngeal airways. The resulting sleep disruption and intermittent hypoxia lead to various systemic morbidities. Predicting the development of OSA from craniofacial features alone is currently not possible and a controversy remains if upper airway obstruction facilitates reduced midfacial growth or vice-versa. Currently, there is no rodent model that recapitulates both the development of craniofacial abnormalities and upper airway obstruction to address these questions. Here, we describe that mice with a neural crest-specific deletion of Bmp7 (Bmp7ncko) present with shorter, more acute angled cranial base, midfacial hypoplasia, nasal septum deviation, turbinate swelling and branching defects, and nasal airway obstruction. Interestingly, several of these craniofacial features develop after birth during periods of rapid midfacial growth and precede the development of an upper airway obstruction. We identified that in this rodent model, no single feature appeared to predict upper airway obstruction, but the sum of those features resulted in a reduced breathing frequency, apneas and overall reduced oxygen consumption. Metabolomics analysis of serum from peripheral blood identified increased levels of hydroxyproline, a metabolite upregulated under hypoxic conditions. As this model recapitulates many features observed in OSA, it offers unique opportunities for studying how upper airway obstruction affects breathing physiology and leads to systemic morbidities.

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Background: The exploration of tridimensional (3D) technology of computational tomography and the development of valid 3D printed models may improve the assessment of adenoid obstruction. The identification of an enlarged adenoid in childhood would streamline the referral of appropriately selected cases to an otolaryngologist, leading to early treatment of affected children when indicated. The objective of this study is to validate the use of a 3D printed model depicting adenoid hypertrophy based on the pediatric otolaryngologist, head and neck surgeon (OHNS) participants assessment. Methods: A cross-sectional study was performed to develop and validate 3D depictions, including print-outs, of the nasopharynx including different degrees of Adenoidal Hypertrophy (AH). The print-outs were obtained from 14 Cone-beam computed tomography (CBCT) scans of 14 children (12 boys, 2 girls; mean age of 10.61 years) representing grades 1, 2, 3, and 4 nasopharyngeal adenoidal obstructions, according to a previously Nasoendoscopy-graded (NE) classification by a licensed OHNS. The prevalence of AH in this study was 36%. Two OHNS were recruited to assess the print-outs representing two different representations of the nasopharyngeal airway, the lumen (LU) and adenoid mass (AD). LU and AD were visualized in 2D -pictures-and in 3Dprinted prototypes. Intraclass correlation was used to assess intra-and inter-reliability. The validity of our depictions was analyzed through comparison (accuracy and correlation) to the reference standard (NE). The data were clustered to calculate the sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV). Cross-tab and Pearson's T-test were performed. Results: Overall, the 3D depiction tools showed different diagnostic capabilities. AD representations showed strong (AD 2D, 75%) to almost perfect (AD 3D, 88%) accuracy compared to NE. Excellent sensitivity and specificity were observed for the AD 3D (100, 70%), as well as adequate PPV and NPV (66 and 97% respectively), with only 5% of false-negative cases. Conclusion: The use of Dolphin software for the acquisition of a 3D printed prototype of the nasopharyngeal adenoidal region seems promising. These prototypes may be a practical and readily available alternative for the assessment of the nasopharyngeal obstructed area. CBCT in children must be taken under strong solid indications. Early referral to an OHNS for a full assessment remains the main objective in children with unclear symptoms.

Background Active learning is a well-established educational methodology in medical school worldwide. Although its implementation in Brazilian clinical settings is quite challenging. The objective of this study is to review the literature in a systematic manner to find and conduct a reflective analysis of how PBL has been applied in clinical teaching in Brazilian medicine schools. Material & methods A systematic literature search was conducted in three databases. A total of 250 papers related to PBL in Brazilian medical school were identified thought the databases search. Four studies were finally selected for the review. Results Four fields of medicine were explored on the four selected papers: gynecology/family medicine, medical semiology, psychiatry, and pediatrics. Overall, all the papers reported some level of strategic adaptability of the original PBL methodology to better applied in the Brazilian medical schools curricula and country peculiar characteristics. Conclusion PBL application in Brazilian medical school suffers some level of alteration from the original format, to better adapted to the peculiarities of Brazilian students maturity, health system priorities and medical labor market.

Introduction: Accordingly to the latest edition of the World Health Organization (WHO) the previously known Keratocyst Odontogenic Tumour (KCOT) has now returned to the simple odontogenic cyst (OKC) classification. We present a case successfully treated by a combination of minimal-invasive approaches. Case Presentation: A large OKC was identified extending from tooth 3.8 through the condylar process in the mandible and staged surgical conservative approaches were performed. Total healing was achieved and followed -up over 8 years. The case was well documented via panoramic radiographs, CBCTs, and a 3D image tool illustrates the cortical bone destruction (before treatment) and the cortical bone healing after treatment. Discussion: Agreement regarding terminology and treatment of OKC has been reached. In this case, a complete healing of a recurrent OKC was achieved by decompression, enucleation, and blurring of the bone walls. Rigorous follow-up enriched by a 3D reconstruction imaging allows an educational view of the healing. Conclusion: This case suggests that a staged surgery approaches concurrent to rigorous patient follow-up could be a feasible alternative to extensive OKT treatment.And, reinforces the importance of collaboration between orthodontist, pathologist, OMS, and the patient have crucial importance in the conservative management of the lesion.

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