Geovana de Paula Bolzan

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.

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.

Alterações no modo respiratório, na oclusão e na fala em escolares: ocorrências e relações

PURPOSE: to check the occurrence of articulation disorders, alterations in breathing mode and malocclusion as well as the relation among theses variables in public-school children. METHODS: 308 female and male children aged between 6 and 11 years were submitted to speech pathologic and orthodontic evaluations, being selected 235. From the information collected in the evaluations, we considered: breathing mode, malocclusion by Angles classification and transverse alterations, as well as articulation disorder. RESULTS: 60.43% children had presented breathing mode alterations; 97.02% Angle malocclusion; 28.94% transverse occlusion alterations and 14.89% articulation disorder. Statistically significant relations were found between articulation disorder and transverse occlusion alterations, breathing mode and Angle malocclusion and between Angle malocclusion and transverse occlusion alterations. CONCLUSION: the malocclusions and alterations referring to breathing mode were frequent in the studied group. The found relationships reinforce the idea that there is a narrow relationship between the structure and the function of the stomatognathic system, and for that reason they deserve attention from several health professionals.

Influência do estado comportamental nos padrões de sucção de recém-nascidos pré-termo

Purpose: To verify the influence of preterm infants’ behavioral states in non-nutritive sucking, nutritive sucking and feeding performance at the moment of oral feeding release. Methods: Thirty-two preterm infants participated in the study. They were hospitalized in a Neonatal Intensive Care Unit and presented stable clinical conditions. After medical release for oral feeding, the following aspects of infants were observed by the same speech therapist: behavioral state, postural pattern, oral reflexes, phono-articulatory organs’ characteristics, non-nutritive and nutritive sucking, number of sucks per block, rate of milk transfer and oral feeding performance. Results: No relationship was found between the infants’ behavioral states and non-nutritive sucking. In nutritive sucking it was verified the influence of behavioral states on the number of sucks in the three first blocks intervals sucking/pause. This means that at the moment of oral feeding start infants in the alertness state presented a higher number of sucks than those in the sleep state. Consequently an impact on feeding performance was verified, with a higher rate of milk transfer and an increased oral feeding performance. Nonetheless no statistical significance was found in regards to these aspects. Conclusion: This research’s findings show that behavioral states did not influence on non-nutritive sucking aspects. But in nutritive sucking, infants in the alertness state presented a higher number of sucks per block than those in the sleep state.

CONCORDÂNCIA ENTRE MÉTODO ANTROPOMÉTRICO E CEFALOMÉTRICO NA CLASSIFICAÇÃO DO TIPO FACIAL

Objetivo: verificar a correspondencia entre os tipos faciais de criancas, obtidos por meio do indice morfologico da face e com o indice VERT da analise cefalometrica de Ricketts.Metodos: 57 criancas entre 7 e 12 anos foram avaliadas por meio de avaliacao antropometrica orofacial, em que foram consideradas as medidas de altura e largura facial para obtencao do indice e tipo facial, e pela cefalometria, na qual foi observada a quantidade de crescimento vertical da face. Os resultados foram analisados estatisticamente por meio do coeficiente Kappa ponderado.Resultados: houve uma concordância fraca entre os tipos faciais obtidos por meio dos dois metodos.Conclusao: a antropometria e considerada um importante recurso no exame de motricidade orofacial, entretanto o indice facial nao substitui o indice VERT da analise cefalometrica de Ricketts para determinacao do tipo facial.

Avaliação da profundidade do palato duro: correlação entre método quantitativo e qualitativo

PURPOSE: to investigate the correlation between quantitative and qualitative methods of hard palate depth evaluation. METHOD: 74 children participated in this study. They were in mixed dentition phase and were evaluated by speech therapist and dentist, who made the plaster models of maxillary dental arch used later for measure. The quantitative method was measurement of molar distance and molar depth whose values were used to calculate the Palatal Height Index. The hard palate was classified into low medium and high palate. Qualitative analysis was performed through visual inspection of the plaster models by three speech therapists with experience in Orofacial Myology. The depth of hard palate was classified as low, normal or increased. The result was the consensus of at least two evaluators. For Data analysis the frequency of ratings was investigated and the Gamma Correlation Test was applied. RESULTS: qualitative method: medium palate (55,4%) followed by low palates (39,2%) and high palate (5,4%). Quantitative method: high palates (51,4%) followed by medium palate (43,2%) and low palates (5,4%). The Gamma Correlation Test resulted in 0,6212 (p<0,05) which indicates moderate correlation. CONCLUSION: the correlation between quantitative and qualitative methods of hard palate assessment was moderate. There was a trend in the qualitative evaluation to consider the palates deeper than the quantitative method. Therefore, it is suggested that both forms of analysis to be used in clinical practice.

Contribuição da ausculta cervical para a avaliação clínica das disfagia orofaríngeas

In order to assist on the functional assessment of swallowing, most speech therapists make use of instrumental resources such as cervical auscultation. Thus, the objective of this study was to search the literature in order to find the contribution of cervical auscultation for assessing dysphagias. To this end, international and national journals were reviewed. These journals were indexed in Springer, Lilacs, Bireme, Medline and Scielo databases, comprising the period between 1992 and 2011. From the analysis of the studies, it was possible to verify that: cervical auscultation has been modernized with the technologic evolution, enabling the realization of quantitative studies of the swallowing sounds; there are still few clear evidence of the connections between the sound components of swallowing and the physiological events of the pharyngeal phase; no differences were observed between the swallowing sounds in children and adults; in some studies, cervical auscultation was positively correlated with the videofluoroscopic assessment of swallowing, and others presented positive correlation between these two assessment procedures. Hence, considering that the swallowing videofluoroscopy examination is still difficult to access, with relatively high cost, it is believed that cervical auscultation constitutes an important resource for the diagnosis and clinical monitoring in cases of oropharyngeal dysphagia.

Premature: growth and its relation to oral skills

OBJECTIVE To evaluate the influence of oral motor skills of premature infants on their oral feeding performance and growth, during neonatal hospitalization. METHODS Fifty-one newborns hospitalized in the neonatal intensive care unit of a hospital in Southern Brazil, between July 2012 and March 2013, were evaluated. The evaluation of oral feeding skills, according to Lau and Smith, was applied after prescription for starting oral feeding. The oral feeding performance was analyzed using the following variables: days taken to start independent oral feeding and hospital discharge. Growth was measured by weight, length, and head circumference, using the curves of Fenton, at birth, first and independent oral feeding, and hospital discharge. RESULTS At birth, 71% preterm infants were proper for gestational age, most of them were males (53%), with average of 33.6 (±1.5) weeks of gestational age. The gestational age in the assessment did not influence the oral feeding performance of the premature infant and did not differ between levels. Time of transition from tube feeding to oral feeding and hospital stay was shorter when the oral skills were higher. At birth, there was a tendency of low weight and low oral feeding performance. Level IV premature infants in the release of oral feeding presented higher weights. CONCLUSION The level of oral skills of the premature infant interfered positively on time of feeding transition from tube to independent oral feeding and hospital stay. Growth, represented by weight gain, was not affected by the level of oral skill.