Adriana Tessitore

Aspectos neurofisiológicos da musculatura facial visando a reabilitação na paralisia facial

PURPOSE: theoretical review on the neurophysiologic aspects of the orofacial musculature, aiming at the rehabilitation of peripheral facial paralysis. METHODS: review of the literature on neuroanatomicophysiology of orofacial musculature by means of researching articles of national and international journals and in scientific books about the theme, in the period between 1995 and 2005. RESULTS: we have reviewed 50 references all along this work. Out of them, 20 on neurophysiology, and 14 on neuroanatomy. The others were on speech therapy and facial paralysis. The studied articles were divided in three groups: I. Aspects of the neuromuscular compound; II. Morphologic and histochemical characteristics of the face muscles and III. Denervation and muscular atrophy. CONCLUSION: from the findings, we managed to didactically systematize the particularities of the neuroanatomicophysiology, whose knowledge, under the authors point of view, is relevant for the success of the rehabilitation of facial paralysis.

Proposta de documentação fotográfica em motricidade oral

PURPOSE: to propose a specific protocol for photographic register of Oral Motricity patients. METHODS: a digital camera mounted on a tripod was used. Standardized photos of body and face were taken. A tele-radiography modified by using contrast with barium which was spread over the patients tongue was taken. RESULT: the pictures made easy the visualization of our therapeutic results. CONCLUSION: so far it is possible to conclude that the proposed documentation helps in the diagnosis process and prognosis analysis, and it may be used as supplementary material for guiding patients and parents on the best treatment to follow.

Efetividade da fonoterapia e proposta de intervenção breve em respiradores orais

PURPOSE: to check the effect of speech and language therapy on a group of mouth breathers, as well proposing a minimum therapy for mouth breathing treatment. METHOD: longitudinal prospective study, casuistic on 40 mouth breather subjects who were patients from the Otorhinolaryngology Ambulatory of UNICAMP Hospital. On weeks 0, 12 and 24, we proceeded photographical documentation, clinical assessment, and protocol application in order to categorize the breathing mode, posture (lips and cheeks), strength and movement (lips, cheeks and tongue). The applied therapeutic proposal consisted of practicing and awareness on nasal breathing; maneuvers to warm and vascularize the orofacial muscles; application of points and motor zones on the face; passive maneuvers; use of distal impulse; myofunctional exercises and register of patients’ perception on their olfactive conditions and nasal obstructions. A non-parametric two proportion equality test was used, p < 0.05. RESULTS: nasal breathing function was adjusted. Increase on lip, tongue and cheek strength. Improvement on the movement: lips pouted to the right and left, snap and lip vibration. Vibration and snap of tongue. Simultaneous inflation of the cheeks, inflation of left and right cheeks alternately. The highest therapeutic gain occurred on 12 weeks. From such data it was possible to come up a protocol made up of 12 structured sessions using the strategies from this study. CONCLUSION: the study has demonstrated the effectiveness of using myofunctional rehabilitation for mouth breathers, and the highest therapeutic evolution took place during the 12th week.

Ocorrência de movimentos primários de língua em crianças respiradoras oronasais

ABSTRACTPurpose: to quantify the occurrence of primary tongue movements in 130 children with oronasal breathing and in 89 with nasal breathing with ages between 5 and 12 years old, evaluated in the Section of Mouth Breathing, of the Clinical Hospital of Unicamp, within the Otorrinolaringology Clinic. Methods: during the evaluation, the children were requested to swallow saliva, close their eyes and put their tongue outside the mouth. They were supposed to stay like this for, at least, one minute, which is enough time to monitor their primary movements. Two language speech pathologists monitored each child, in order to verify the presence of movements. Results: the occurrence of the primary tongue movements was found in 44.75% of the sample (n=98), while 55.25% (n=121) did not show any such movements. It was observed that both nasal and oronasal categories showed statistically signifi cant difference as for the occurrences of primary tongue movements. Conclusion: oronasal breathing has higher frequency for maintenance of primary tongue movements, and there is statistically signifi cant difference between oronasal and nasal breathing groups as for the primary tongue movement’s variable.

Alterações de funções orais na presença de aparelhos ortodônticos fixos com recursos intraorais

ABSTRACTPurpose: to investigate possible changes in speech, chewing and swallowing in users orthodontic appliances with features (intraoral) fixed on the palate. Method: a total of 28 patients of both sexes, in the 10-24 age-group, were evaluated. These patients were being treated at the CEREO — Centro de Reabilitacao Estetica Orofacial (Aesthetic and Orofacial Rehabilitation Center) in Campinas, Sao Paulo. They were evaluated by speech therapists before they had their orthodontic appliances installed and also 30 days after they were using these appliances with feature. All subjects were previously evaluated by orthodontists from the CEREO and were candidates to the installation of intraoral features. The speech therapist’s test was composed of two parts: the first was the evaluation of chewing, swallowing and speech, according to the MBGR protocol and the second was a phonological evaluation of language. The statistical tests applied were: Two Proportions Equality Test, Chi-Square Test for Independence. We considered significant the associations with p-value <0.10.

Mensuração da evolução terapêutica com paquímetro digital na Paralisia Facial Periférica de Bell

Purpose: to assess the use of the digital caliper in the measurement of the facial mimic movements in different moments of the speech therapy. Method: prospective longitudinal study, with 20 subjects between 7 and 70 years-old, 13 females and 7 males, all diagnosed with Bell’s Palsy, attended in the Facial Paralysis Ambulatory, of the otorhinolaryngology subject of a University Public Hospital. The use of a Digimess 100,174BL digital measuring caliper was adopted for this study. The measurements were carried out in the facial mimic movement, always starting from a fixed point to a mobile point in the structures: the tragus and the labial commissure, external corner of the eye and labial commissure and also internal corner of the eye and the nasal ala. All measurements were carried out both prior and after the treatment. The quantification of the incompetence of the movement was measured by simple percentage. The Wilcoxon signed rank test was applied to check for possible differences between both moments considered (with and without movements), as the study variables. Results: the measurements had a statistically significant result (p<0.05) in all the proposed measured structures (tragus and labial commissure, external corner of the eye and labial commissure, and internal corner of the eye and nasal ala), showing that there are possibilities of measuring of movement and absence of movement using a digital caliper. Conclusion: the caliper has demonstrated to be a useful device which has permitted to objectively compare the evolution of the rehabilitation of facial mimic in Bell’s Palsy in the sample studied here.

Medida angular para aferição do tônus muscular na paralisia facial

BACKGROUND the decrease of facial movements in peripheral facial paralysis and the resulting aesthetical sequels may have important emotional repercussions as a consequence to the functional deficit, and depending on the intensity of the clinical condition. Orofacial rehabilitation has as a purpose to favor the recovery of orofacial movements and to adequate and/or adapt orofacial functions and facial mimic. However, quantifying therapeutic results in an attempt to measure the muscle tonus is a challenge. Generally, the used forms of measurement are general and subjective. AIM to propose the labial commissure angle as an anthropometric marker and to evaluate its reliability as an objective tool to evaluate the modification of the facial muscle tonus after rehabilitation. METHOD participants of the study were 20 patients presenting peripheral facial paralysis - level IV. The study was conducted using images from the photographical documentation taken fifteen days to one year post-onset of facial paralysis. The angle was measured by tracings determined by pre-established anthropometric facial points, such as the line between the glabella and the gnation and the crossing with the left and right chelion points determining an angle manually measured with a protractor on the photography. RESULTS The average Labial Commissure Angle before treatment was of 101.70 and after rehabilitation of 93.80 (standard deviation, SD = 4.3). The statistical analysis indicated a significant difference (p < 0.001). CONCLUSION the results obtained suggest that the Labial Commissure Angle allows the objective evaluation of facial muscle tonus modification.

Aplicação da escala psicossocial de aparência facial na avaliação da paralisia facial periférica: estudo piloto

Purpose To apply the Psychosocial Scale of Facial Appearance in order to verify its applicability and reproducibility in a pilot study. Methods Subjects: eight adult subjects with peripheral facial palsy were selected according to established criteria. Procedures: 1. speech-language assessment of the facial function; 2. verification of the reliability of the Psychosocial Scale of Facial Appearance; 3. verification of the scale’s reproducibility; 4. application of the Hospital Anxiety and Depression Scale. A descriptive analysis of the data was performed, and the paired t-Student test (between times 1 and 2) and the intraclass correlation coefficient (ricc) were applied. Results Assessing the applicability increased the familiarity with the data collection process and contributed to modifications in the procedures. The questionnaire proved to be reliable for all the scales analyzed: Functional, Social, and Emotional Aspects of Face, General, and Note Assigned to the Face. The intraclass correlation coefficient (ricc) demonstrated the reproducibility of the instrument by showing excellent values for all thematic groups analyzed. Conclusion This study provided subsides for the improvement and final elaboration of an instrument that aims to investigate the psychosocial aspects associated with peripheral facial palsy.

A necessidade da avaliação fonoaudiológica no protocolo de pacientes candidatos à cirurgia bariátrica

The purpose of this study is to analyze the actual need of speech therapy intervention through assessment, records and therapeutic sessions in the pre and post-surgery of the bariatric surgery candidate. This study, a cross-sectional one, describes the records, assessment and speech therapy sessions from a male patient, age 36, 51 BMI, presenting comorbidities, submitted to FobiCapella bariatric surgery. According to a pre-planned protocol, the patient underwent a three month of pre and post-surgery clinical assessment of the stomatognathic system, which was recorded through photos of the dynamic structures, orofacial system film, orofacial measurements and palpation of the masticatory muscles and temporalis. After the first evaluation, the patient received prescribed instructions on chewing and oromiofunctional exercises. The comparative analysis of pre and post-surgery assessments showed improvement in the general aspects of the stomatognathic system structures and on their functions such as chewing and breathing, however, because of some functional limitations, continuous speech therapy was made necessary to a maximum adjustment and balance. It is concluded, that the speech therapy documentation on the evaluation protocol of the bariatric surgery candidate, asserts for a specific and scientific speech therapy intervention, supporting the patient with a satisfactory oral adjustment to his new functional and morphological needs.

Avaliação de um protocolo da reabilitação orofacial na paralisia facial periférica: evaluation of an orofacial rehabilitation protocol

PURPOSE: to evaluate a proposed protocol of orofacial neuromuscular rehabilitation for peripheral facial paralysis. METHODS: clinical observation of 20 patients with fourth-degree paralysis, sent to orofacial rehabilitation in the Facial Paralysis Ambulatory from Hospital das Clinicas at UNICAMP: prospective longitudinal study. The verification of functional evolution or not, in the rehabilitation, was based on the improvement of muscular tonus, whose variation was measured by the modification in the labial commissure angle. The study was done with images from photographical documentation prior to (fifteen days after the installation of facial paralysis) and post one-year treatment. As proof of the effect concerning rehabilitation, the pre and post rehabilitation labial commissure angle was measured. The studied group was compared to a control group composed of nine subjects with fourth-degree orofacial paralysis, who did not undergo orofacial rehabilitation. The data were statistically analyzed by the two tail paired sample test (Students T test). RESULTS: the average of labial commissure angle was 7.9o after treatment, with statistically significant difference (p<0.001). For the control group the average of the angular measurement was 100.9o + 1.9. This value did no differ from the values initially measured in the studied group (p=0.723). They were significantly higher when compared to the average of the values of the final angles of the studied group with treated patients (p=0.001). CONCLUSION: the rehabilitation protocol used in the sample promoted significantly increment of muscular tonus, with functional improvement and in the facial rest.