Irene Queiroz Marchesan

Avaliação miofuncional orofacial: protocolo MBGR

PURPOSE: to present a protocol with scores on the Orofacial Myofunctional area. This protocol is called MBGR. METHODS: based on different protocols used in the Orofacial Myofunctional area, a new protocol with scores was elaborated. This protocol was applied in both, patients and non-patients during five distinct phases during the elaboration. After each phase, the results were analysed and the necessary corrections were performed in order to improve the protocol and, in this way, provide an accurate diagnosis and prognosis. It took two years to elaborate the protocol. During those two years, independent judges were responsible for testing the protocol in each phase. RESULTS: a new protocol with scores on the Orofacial Myofunctional area was elaborated and tested during two years in different phases. The new MBGR Protocol gives the possibility to obtain numeric parameters. CONCLUSION: the MBGR Protocol with scores was presented. This protocol helps the Speech-Language Pathologist to evaluate and give the diagnosis and the prognosis on the Orofacial Myology area.

Tipologia facial aplicada à Fonoaudiologia: revisão de literatura

A face humana, com suas estruturas osseas e musculares, apresenta caracteristicas proprias e peculiares. Pode ser classificada em tres tipos basicos, os quais tem relacao com a variacao do formato e da configuracao craniofacial, tanto no sentido vertical como no horizontal e influenciam diretamente a oclusao dentaria, harmonia facial, musculatura orofacial e funcoes estomatognaticas. Por essa razao, diagnosticar o tipo facial e importante para a clinica fonoaudiologica. O objetivo deste estudo foi realizar uma revisao de literatura relacionada as caracteristicas dos tipos faciais e apresentar as pesquisas e os estudos mais recentes sobre o tema. Para atingir tal meta, fez-se um levantamento bibliografico nas bases de dados LILACS, SciELO, Web of Science e Google Academico, alem de livros, dissertacoes e teses sobre o assunto dos ultimos dez anos. Varias pesquisas em campo comprovaram algumas caracteristicas dos tipos faciais encontradas, principalmente, em referencias mais antigas. Alguns aspectos, porem, foram controversos ao se comparar os tipos faciais como a atividade eletromiografica do musculo masseter, modo respiratorio e o comprimento do labio superior e do filtro. Pode-se constatar que conhecer o tipo facial e correlaciona-lo as funcoes estomatognaticas, musculatura e oclusao e um fator importante para a pratica clinica, mas o profissional deve ser flexivel ao comparar as caracteristicas do paciente com a literatura. Dessa forma, pode-se evitar determinar uma anormalidade ou atipia quando nao for o caso, e ocorrer apenas uma variabilidade ou adaptacao.

Postura, tônus e mobilidade de lábios e língua de crianças respiradoras orais

PURPOSE: to characterize lips and tongue posture, tone and mobility of mouth breathing children. METHOD: the subjects of this study, conducted in Sao Paulo, SP, Brazil, were 40 mouth breathing children, 26 (65%) male and 14 (35%) female, aging between 7 and 10-year old. MBGR protocol was used to evaluate the aforementioned aspects. RESULTS: the following results were obtained for lip posture: semi-open lips (32.5%), alternating between open and closed lips (27.5%), open lip posture (22.5%) and closed lips (17.5%). With regards to the upper lip tone: 90% showed normal muscle tone, 10% lower tone, and no subjects showed a higher muscle tone. As for the tone of the lower lip, 80.0% of the children showed lower muscle tone, and 20.0% normal muscle tone. For the lips mobility variable, 100% had their mobility close to the best scores. Regarding tongue posture, 57.5% had a low-lying resting tongue posture, 32.5% did not allow for observation of this variable, and in 10.0% of the subjects the tongue was placed in an interdental resting posture. As for tongue muscle tone, 52.5% showed lowered tone, and 47.5% were considered normal. When assessing tongue mobility, 100% had mobility close to the best scores. CONCLUSION: characteristics of posture, tone and mobility of lips in this studys mouth breathing children were: semi-opened lip posture, upper lip with normal tone, lower lip with lowered tonicity and normal mobility. Regarding tongue characteristics: low-lying resting posture, lowered muscle tone and normal mobility.

Protocolo de avaliação do frênulo lingual para bebês: relação entre aspectos anatômicos e funcionais

OBJETIVO: verificar quais caracteristicas do frenulo da lingua influenciam nas funcoes de succao e degluticao em bebes nascidos a termo, com a finalidade de propor adequacoes no protocolo proposto por Martinelli et al (2012). METODO: foi aplicado o protocolo de avaliacao do frenulo da lingua em 100 bebes saudaveis nascidos a termo. Os filmes obtidos na avaliacao foram analisados por duas fonoaudiologas especialistas em MO, com experiencia em avaliacao de frenulo lingual. Foram aplicados os testes Qui-quadrado seguido do teste exato de Fisher, alem da analise de variância, considerando os dados qualitativos e quantitativos, respectivamente. RESULTADOS: nos 16 bebes que apresentaram alteracao do frenulo lingual, verificou-se a relacao entre: a tendencia do posicionamento da lingua durante o choro e o tempo entre as mamadas; a forma da lingua quando elevada e o cansaco para mamar; bem como a fixacao do frenulo na lingua e o movimento da lingua na succao nao nutritiva. Pela analise dos dados dos bebes com alteracao de frenulo lingual, foi possivel definir as caracteristicas indicativas de alteracao, que possibilitaram a adequacao do protocolo inicial, e a atribuicao de escores. CONCLUSAO: a forma da lingua, quando elevada durante o choro, influencia o movimento da lingua durante a succao nao nutritiva, e o ponto de fixacao do frenulo na lingua influencia o ritmo da succao durante a amamentacao. O novo protocolo com escores e uma ferramenta efetiva para avaliar e diagnosticar alteracoes anatomicas do frenulo da lingua e suas possiveis interferencias na amamentacao.

Protocolo de avaliação do frênulo da língua em bebês

OBJETIVO: apresentar uma proposta de protocolo de avaliacao do frenulo da lingua em bebes com escores. METODO: inicialmente foi realizada uma revisao da literatura relacionada, consultando as bases de dados Web of Science, Pubmed, Embase, All Evidence-Based Medicine Reviews e Scielo, bem como livros textos das areas de anatomia, odontopediatria e fonoaudiologia. Todos os aspectos julgados relevantes nos trabalhos encontrados foram incluidos na versao inicial, que foi submetida a avaliacao de tres fonoaudiologas especialistas em motricidade orofacial, sendo obtida a versao consenso, que foi aplicada em 10 bebes nascidos a termo buscando verificar a exequibilidade do instrumento. RESULTADOS: com base na literatura consultada e no estudo piloto, foi elaborado o protocolo de avaliacao do frenulo da lingua em bebes. A primeira parte e composta por historia clinica contendo questoes gerais de identificacao e questoes especificas sobre antecedentes familiais e amamentacao. A segunda parte e composta pelo exame clinico, constituido de avaliacao anatomofuncional e avaliacao das funcoes orofaciais. CONCLUSOES: o protocolo de avaliacao do frenulo da lingua em bebes foi desenvolvido a partir de uma proposta teorica e depende de sua aplicabilidade para se configurar como um teste validado. Espera-se que o mesmo possa auxiliar os profissionais da saude a avaliar e diagnosticar as variacoes anatomicas do frenulo e sua possivel interferencia na amamentacao, norteando condutas eficazes e promovendo uma pratica baseada em evidencias. A segunda fase deste trabalho deve compreender a pesquisa experimental e a analise estatistica dos dados.

Avaliação clínica, endoscópica e manométrica da deglutição em pacientes com miastenia grave autoimune adquirida

Dysphagia, or difficulty swallowing, is a common problem following myasthenia gravis (MG) and may lead to aspiration of saliva, food or liquids. We herein present 22 MG patients, with complaint of dysphagia, evaluated by phonoaudiological evaluation, nasofibrolaryngoscopical analysis and manometry of upper esophageal sphincter. The main objective was to evaluate the phases of the swallowing process and anatomical and functional aspects of oropharyngeal musculature. The age of patients varied from 19 to 74 years; being 19 female and 3 male. The main data were: (1) statistically significant relation between the phonoaudiological clinical evaluation and nasofibrolaryngoscopical one; (2) stomatognatical system disorders present in 100%; (3) swallowing and chewing disorders present in 100%, when clinically evaluated, and in 81,8% when evaluated by the nasofibrolaryngoscopy; (4) statistically significant relation between penetration/aspiration and antecedents of pneumonia; (5) stomatognatical muscles very altered, difficulty controlling the bolus, collection of food in the pharynx or larynx and presence of penetration and/or aspiration showed significant correlation with weakness of a pharyngeal muscles. These findings justify the necessity to evaluate clinically the swallowing phases in MG patients, with the main purpose to prevent both aspiration and dehidration from inadequate oral intake.Dysphagia, or difficulty swallowing, is a common problem following myasthenia gravis (MG) and may lead to aspiration of saliva, food or liquids. We herein present 22 MG patients, with complaint of dysphagia, evaluated by phonoaudiological evaluation, nasofibrolaryngoscopical analysis and manometry of upper esophageal sphincter. The main objective was to evaluate the phases of the swallowing process and anatomical and functional aspects of oropharyngeal musculature. The age of patients varied from 19 to 74 years; being 19 female and 3 male. The main data were: (1) statistically significant relation between the phonoaudiological clinical evaluation and nasofibrolaryngoscopical one; (2) stomatognatical system disorders present in 100%; (3) swallowing and chewing disorders present in 100%, when clinically evaluated, and in 81,8% when evaluated by the nasofibrolaryngoscopy; (4) statistically significant relation between penetration/aspiration and antecedents of pneumonia; (5) stomatognatical muscles very altered, difficulty controlling the bolus, collection of food in the pharynx or larynx and presence of penetration and/or aspiration showed significant correlation with weakness of a pharyngeal muscles. These findings justify the necessity to evaluate clinically the swallowing phases in MG patients, with the main purpose to prevent both aspiration and dehidration from inadequate oral intake.

Lingual frenulum: changes after frenectomy

OBJETIVO: Descrever as mudancas ocorridas apos a frenectomia com relacao a mobilidade e funcoes da lingua. METODOS: Foram avaliados 53 sujeitos, os quais nunca haviam se submetido a fonoterapia ou a cirurgia do frenulo. Um protocolo com escores especificos para avaliacao do frenulo lingual foi utilizado para avaliar os sujeitos com evidencias de alteracao neste aspecto. Foi encontrada alteracao em dez sujeitos, que foram encaminhados a um otorrinolaringologista para frenectomia. Apos a cirurgia, esses sujeitos foram reavaliados pelo fonoaudiologo utilizando-se o mesmo protocolo. Fotos e videos foram usados para comparacao. RESULTADOS: Trinta dias apos a cirurgia, os sujeitos apresentaram a forma da ponta da lingua modificada, assim como os movimentos melhorados. O fechamento labial e a fala tambem melhoraram. CONCLUSAO: A frenectomia e eficiente para melhorar a mobilidade e a postura da lingua, assim como suas funcoes, incluindo a producao da fala.PURPOSE To describe the changes after frenectomy concerning mobility and functions of the tongue. METHODS Participants were 53 subjects who had never undergone speech therapy or lingual frenulum surgery. A specific lingual frenulum protocol with scores was used by speech-language pathologists when there was evidence of frenulum alteration. Ten subjects had abnormal frenulum and were referred to an otolaryngologist for frenectomy. After surgery, the subjects were re-evaluated using the same protocol. Photos and videos were taken for comparison. RESULTS Thirty days after surgery, the subjects had the shape of the tip of the tongue and its movements improved. Lip closure and speech were also improved. CONCLUSION Frenectomy is efficient to improve tongue posture, tongue mobility, oral functions, and oral communication.

ESTUDO LONGITUDINAL DAS CARACTERÍSTICAS ANATÔMICAS DO FRÊNULO LINGUAL COMPARADO COM AFIRMAÇÕES DA LITERATURA

Purpose to assess the anatomical characteristics of lingual frenulum in infants at first, sixth and twelfth months of life and compare the findings to the statements found in the literature. Methods video recordings of the lingual frenulum – normal or altered – of 71 infants, from both genders at the first, sixth and twelfth months of life were taken. The recordings were analyzed by two specialists in orofacial motricity who observed the following anatomical aspects: thickness, attachment to the tongue and attachment to the floor of the mouth. The data collected were compared to the literature. Results of the 71infants, the lingual frenulum of 51 infants was thin and 20 had thick lingual frenulum. 40 infants had the lingual frenulum attached to the middle of the tongue, 27 had the attachment between the apex and the middle of the tongue, and 4 to the apex. Concerning attachment to the floor of the mouth, the lingual frenulum of 42 infants was attached to the alveolar crest and 29 had the attachment between the sublingual caruncles. The characteristics of the lingual frenulum observed at the first, sixth and twelfth months of life remained the same. Conclusion contrary to what has been stated in the literature changes concerning lingual frenulum thickness, attachment to the tongue and to the floor of the mouth were not observed in the 71 infants during the first year of life. KEYWORDS : Lingual Frenulum; Anatomy; Tongue

Relação entre cefalometria e análise facial na determinação do tipo de face

PURPOSE: to correlate the cephalometrical findings with the ones from facial analysis performed by means of photographs to classify facial type, according to the gender. METHODS: 105 leukoderm adults took part, 34 male (32.4%) and 71 female (67.6%) with ages between 20 and 40 years old, in a private orthodontic clinic in Belo Horizonte, MG - Brazil. The cephalometrics analysis findings for determining facial type from the Ricketts VERT index were compared with the facial classification performed by means of clinical facial analysis based on observation of two photographs. For this analysis, three Speech and Language Pathologists specialized in orofacial myology were involved. RESULTS: there was no satisfactory correspondence when comparing the two forms of facial type classification presented in this study. Most of the dolichofacial males were classified as medium face by means of facial analysis, meaning four among seven subjects (57.14%). The eleven mesofacial subjects were identified as medium face (N=5; 45.45%) or short (N=4; 36.36%) and the 16 braquifacial subjects as medium face (N=9; 56.25%) or short (N=7; 43.75%). With females, it was observed that 11 among 20, meaning 55% of the dolichofacial individuals were appointed as medium face. Among the 26 mesofacial subjects, 16 (61.53%) were also classified as medium face. Regarding the 25 braquifacial subjects, 12 (48%) were identified as short face and 11 (44%), as medium. CONCLUSION: facial type classification based only on facial analysis performed by means of photographs was not considered trustworthy, if used independently, when compared with cephalometrics analysis findings.

Proposta para determinação do tipo facial a partir da antropometria

PURPOSE To describe orofacial indexes and proportions in adults, according to facial type and gender, and to verify the possibility to establish a way of classifying face based on anthropometry. METHODS Participants were 105 leukoderm adults, 34 male (32.4%) and 71 female (67.6%), with ages between 20 and 40 years old, patients in a private orthodontic clinic in Belo Horizonte, Minas Gerais, Brazil. The findings from the cephalometric analysis contained in their orthodontic records were used for determination of facial type. Subjects were divided according to gender and facial type, and were submitted to anthropometric facial measures obtained directly through a caliper rule. These measures were compared to six variables: facial index, lower face index, upper face index, chin-face height proportion, chin height proportion, and mandibular height proportion. RESULTS The average values obtained by the subjects divided into genders and facial types that presented significant differences were: facial index, lower face index, upper face index, and mandibular height proportion for males, and mandibular height proportion, for females. To predict facial types, the following parameters were considered significant: facial index, upper face index and mandibular height proportion for the dolichofacial type, for males; and mandibular height proportion for the dolichofacial and lower face index for the brachyfacial type, for females. CONCLUSION Some indexes and orofacial proportions present variations according to facial types and genders. In general, the anthropometric variables in this study are not good predictors to determine facial types.