Eliane Castilhos Rodrigues Corrêa

Mouth Breathing Syndrome: Cervical muscles recruitment during nasal inspiration before and after respiratory and postural exercises on Swiss Ball

OBJECTIVE This study aimed to evaluate the recruitment of cervical muscles during nasal inspiration before and after breathing and postural exercises on the Swiss Ball in children with Mouth Breathing Syndrome (MBS). METHOD Surface electromyography from the sternocleidomastoid (SCM), sub-occipitals and upper Trapezius muscles was recorded during nasal inspiration, before and at the end of three months of the treatment. A physical therapy program consisting in muscular stretching and strengthening exercises along with naso-diaphragmatic breathing on the Swiss Ball were carried out for body posture realignment and respiratory training. Nineteen mouth breathing children, mean age of 10.6 years, both genres, were the subjects of this study. In order to establish a comparison between the eletromyographic results (normalized values) obtained from pre and post-physical therapy program it was used the Wilcoxon non-parametric test for dependent data. RESULTS It was found a significant decrease (p<0.01) in the electromyographic activity during nasal inspiration in all tested muscles after treatment (11.3-3.6% in the SCM, 22.4-11.7% in the sub-occipitals and 8.9-3.1% in the upper Trapezius). At the end of the treatment, the assessed muscles reached lower activity electromyographic levels during nasal inspiration and they became closer of those in the quiet position. CONCLUSION The lower activity after the physical therapy program in these muscles indicates a less effort of the accessory inspiratory muscles, probably due to a better performance of diaphragm muscle with the improvement of the body posture.

Electrical Activity of the Anterior Temporal and Masseter Muscles in Mouth and Nasal Breathing Children

UNLABELLED Mouth breathing has been associated with severe impact on the development of the stomatognathic system. AIM This paper aims to analyze the electromyographical findings and patterns of electrical activity of the anterior temporal and masseter muscles in mouth and nasal breathing children. MATERIAL AND METHOD The patients were divided into two groups: mouth breathers (n=17) and nasal breathers (n=12). The children underwent bilateral electromyographic examination of the anterior temporal and masseter muscles at maximal intercuspal position and during usual mastication. A Myosystem Br-1 electromyograph with 12 acquisition channels, amplification with total gain of 5938, rate of acquisition of 4000 Hz, and band-pass filter of 20-1000Hz, was used in the examination. The signal was processed in Root Mean Square(RMS), measured in microV, analyzed and expressed as a normalized percentage. The data set was statistically treated with the T-test (Student). RESULTS The observed level of electrical activity in the mouth breathing (MB) group was lower in all analyzed muscles, with statistical significance found only in the left temporal muscle; during mastication, mouth breathers also presented increased electrical activity on the right side and on the temporal muscle. CONCLUSION Mouth breathing impacts the electrical activity of the muscles studied at maximal intercuspal position and during usual mastication.

Impact of the mouth breathing occurred during childhood in the adult age: Biophotogrammetric postural analysis

OBJECTIVE This study aims to evaluate the impact of the mouth breathing occurred during childhood on the body posture in the adult age. METHODS 24 adults, of both genders, aged from 18 to 30 years old with report of clinical manifestations of mouth breathing during the childhood composed the study group (SG). The control group (CG) was composed by 20 adults in the same age, without any respiratory problem since the childhood up to the present time. All the volunteers underwent a physiotherapeutic evaluation consisted of anamnesis and postural biophotogrammetry (SAPo v 0.68(®)). The comparison between the data of the SG and CG was accomplished by Students t-test. RESULTS The biophotogrammetric analysis demonstrated that the SG showed more forward head posture confirmed by the angles A9 (p = 0.0000) and CL (p = 0.0414) and also by the cervical distance (p = 0.0079). Additionally, this group presented a larger angular measure of the lumbar lordosis (p = 0.0141) compared to the CG. CONCLUSION The results indicate that adults with mouth-breathing childhood have postural alterations, mainly in the head and lumbar column, which keeps for the whole life.

Cervical spine dysfunction signs and symptoms in individuals with temporomandibular disorder

PURPOSE To study the frequency of cervical spine dysfunction (CCD) signs and symptoms in subjects with and without temporomandibular disorder (TMD) and to assess the craniocervical posture influence on TMD and CCD coexistence. METHODS Participants were 71 women (19 to 35 years), assessed about TMD presence; 34 constituted the TMD group (G1) and 37 comprised the group without TMD (G2). The CCD was evaluated through the Craniocervical Dysfunction Index and the Cervical Mobility Index. Subjects were also questioned about cervical pain. Craniocervical posture was assessed by cephalometric analysis. RESULTS There was no difference in the craniocervical posture between groups. G2 presented more mild CCD frequency and less moderate and severe CCD frequency (p=0.01). G1 presented higher percentage of pain during movements (p=0.03) and pain during cervical muscles palpation (p=0.01) compared to G2. Most of the TMD patients (88.24%) related cervical pain with significant difference when compared to G2 (p=0.00). CONCLUSION Craniocervical posture assessment showed no difference between groups, suggesting that postural alterations could be more related to the CCD. Presence of TMD resulted in higher frequency of cervical pain symptom. Thus the coexistence of CCD and TMD signs and symptoms appear to be more related to the common innervations of the trigeminocervical complex and hyperalgesia of the TMD patients than to craniocervical posture deviations.

Tipo facial e postura de cabeça de crianças respiradoras nasais e orais

PURPOSE: To verify the facial type and the head posture of nasal and mouth-breathing children from habitual and obstructive etiologies, as well as to correlate the morphological facial index to the head angulation position in the sagittal plane. METHODS: Participants were59 children with ages between 8 years and 11 years and 10 months. All subjects were undergone to speech-language pathology screening, otorhynolaryngologic evaluation, and nasopharyngoscopy, allowing the constitution of three groups: nasal breathers - 15 children; mouth breathers from obstructive etiology - 22 children; and habitual mouth breathers - 22 children. In order to determine facial type and morphological facial index, the height and the width of the face were measured using a digital caliper. The head posture was assessed through physical examination and computerized photogrammetry. RESULTS: It was verified the predominance of short face in nasal breathers, and long face in mouth breathers. There was an association among facial type and breathing mode/mouth breathing etiology: the brachyfacial type was more frequent among nasal breathers, and less frequent in subjects with obstructive nasal breathing. Head posture was similar in all three groups. No correlation was found between morphological facial index and head posture. CONCLUSION: The brachyfacial type favors the nasal-breathing mode and the head posture is not influenced by breathing mode and by the etiology of mouth breathing, as well as it is not related to facial type.

Global body posture and plantar pressure distribution in individuals with and without temporomandibular disorder: a preliminary study.

OBJECTIVE The aim of this study was to evaluate body posture and the distribution of plantar pressure at physiologic rest of the mandible and during maximal intercuspal positions in subjects with and without temporomandibular disorder (TMD). METHODS Fifty-one subjects were assessed by the Diagnostic Criteria for Research on Temporomandibular Disorders and divided into a symptomatic group (21) and an asymptomatic group (30). Postural analysis for both groups was conducted using photogrammetry (SAPo version 0.68; University of São Paulo, São Paulo, Brazil). The distribution of plantar pressures was evaluated by means of baropodometry (Footwork software), at physiologic rest and maximal intercuspal positions. RESULTS Of 18 angular measurements, 3 (17%) were statistically different between the groups in photogrammetric evaluation. The symptomatic group showed more pronounced cervical distance (P = .0002), valgus of the right calcaneus (P = .0122), and lower pelvic tilt (P = .0124). The baropodometry results showed the TMD subjects presented significantly higher rearfoot and lower forefoot distribution than those in the asymptomatic group. No differences were verified in maximal intercuspal position in the between-group analysis and between the 2 mandibular positions in the within-group analysis. CONCLUSIONS Subjects with and without TMD presented with global body posture misalignment. Postural changes were more pronounced in the subjects with TMD. In addition, symptomatic subjects presented with abnormal plantar pressure distribution, suggesting that TMD may have an influence on the postural system.

Mastigação e deglutição em mulheres jovens com desordem temporomandibular

PURPOSE To evaluate chewing and swallowing functions in women with and without temporomandibular disorder (TMD) and investigate the position of the mandible and the hyoid bone as they are important structures in the development of these functions. METHODS Seventy women were evaluated in relation to TMD diagnosis according to the Research Diagnostic Criteria, among them, 34 composed the study group (SG) with TMD and 36 took part in the control group (CG). Evaluation of the masticatory and swallowing functions was performed according to the Protocol of Orofacial Myofunctional Evaluation with Scores. Mandibular and hyoid bone position variables were measured by cephalometric analysis. RESULTS TMD subjects showed a significant difference on tongue (p=0.03) and lip (p=0.04) posture during swallowing function, and a more frequent adoption of a chronic unilateral chewing pattern as well (p=0.03). Moreover, they presented a lower position of the hyoid bone in relation to the mandible (p=0,00). CONCLUSION TMD presence resulted on a higher frequency of myofunctional alterations during masticatory and swallowing functions. A greater distance from hyoid bone to the mandible in addition with the presence of painful symptom can justify, partly, the atypical behaviors of the tongue and lips observed on TMD group. The TMD repercussion on alimentaires functions in a young age group justifies the importance of an earlier diagnosis and therapeutic intervention in these individuals.

Estudo das medidas antropométricas e das proporções orofaciais em crianças respiradoras nasais e orais de diferentes etiologias

PURPOSE: To verify and compare the orofacial measurements and proportions of children with nasal breathing, obstructive mouth breathing and habitual mouth breathing, with mixed dentition. METHODS: Fifty-seven children, 32 girls and 25 boys, caucasian, with ages varying from seven years and five months to 11 years and ten months, participated in this study. The participants carried out a Speech-Language Pathology screening and an otolaryngological evaluation, in order to diagnose the breathing mode and the mouth breathing etiology. Based on the evaluations, the children were classified into three groups: 15 nasal breathers; 22 obstructive mouth breathers; and 20 habitual mouth breathers. The orofacial anthropometric evaluation was carried out using a digital caliper. The measurements and orofacial proportions of each group were described and then statistically compared, with a significance level of 5%. RESULTS: No differences were observed between anthropometric measurements and orofacial proportions of nasal and mouth breathers (of both obstructive and habitual etiologies). CONCLUSION: The results obtained suggest that breathing mode and the different etiologies of mouth breathing do not determine differences in the orofacial measurements and proportions in children during the mixed dentition period.

Análise quantitativa do palato duro em diferentes tipologias faciais de respiradores nasais e orais

PURPOSE: to compare the hard palate dimensions in nasal and mouth breathing children of different facial typologies. METHOD: the sample comprised 54 children between seven and 11 year old, divided in two groups according to the facial type and breathing mode. The facial type was obtained through the Ricketts cephalometric analysis, and the breathing mode was determined from speech-language evaluation and otorhynolaryngologic diagnosis. In order to measure the transverse, vertical and anteroposterior length of the hard palate, plaster cast models of the children superior dental arch were obtained. To get the hard palate dimensions among the groups, parametric and nonparametric tests were used under a significance level of 5%. RESULTS: no statistically significant difference was found in hard palate measures among brachyfacial, mesofacial and dolichofacial children. A significant statistical difference in the distance among the second premolars was identified when compared with the different facial types of nasal and mouth breathing children, and such a difference was not detected in multiple comparisons. CONCLUSION: the dimensions of the hard palate did not show any difference when analyzed in different facial types regardless of the breathing mode. However, when analyzing the facial type in nasal and mouth breathers, we found a difference in the distance among the second premolars.

Efeito da reeducação postural global no alinhamento corporal e nas condições clínicas de indivíduos com disfunção temporomandibular associada a desvios posturais

Este estudo visou verificar o efeito da tecnica de reeducacao postural global (RPG) nas condicoes fisicas, psicologicas e psicossociais, assim como no alinhamento corporal, de individuos com disfuncao temporomandibular (DTM) associada a desvio postural. Participaram 20 individuos com DTM e com desvio postural confirmado por exame fisico, avaliados, antes e depois do tratamento de RPG, pelos criterios diagnosticos de desordens temporomandibulares (RDC/TMD, na sigla em ingles) e quanto as medidas angulares, por fotogrametria digital. O tratamento consistiu em 10 sessoes semanais de RPG. Os resultados apos o tratamento mostram, na classificacao da disfuncao, maior predominio de desordens apenas musculares (em detrimento das articulares e por deslocamento de disco) e reducao da intensidade da dor orofacial; o percentual de individuos sem depressao aumentou de 10% para 35%; o percentual de individuos com classificacao normal de sintomas fisicos (excluindo itens de dor) passou de 30% para 55%. Foi encontrada melhora estatisticamente significante na maioria das medidas angulares, exceto nos ângulos frontais dos membros inferiores e ângulo perna/retrope direito. O alinhamento horizontal da cabeca e as medidas de lordose cervical e lombar, com valores normais antes da RPG, nao se modificaram. Conclui-se que, com o tratamento de RPG, os individuos apresentaram importantes melhoras dos sintomas fisicos e psicologicos da DTM, assim como melhora do alinhamento e simetria corporais.