Luciana Vitaliano Voi Trawitzki

Masticatory muscle function three years after surgical correction of class III dentofacial deformity

Individuals with dentofacial deformities have masticatory muscle changes. The objective of the present study was to determine the effect of interdisciplinary treatment in patients with dentofacial deformities regarding electromyographic activity (EMG) of masticatory muscles three years after surgical correction. Thirteen patients with class III dentofacial deformities were studied, considered as group P1 (before surgery) and group P3 (3 years to 3 years and 8 months after surgery). Fifteen individuals with no changes in facial morphology or dental occlusion were studied as controls. The participants underwent EMG examination of the temporal and masseter muscles during mastication and biting. Evaluation of the amplitude interval of EMG activity revealed a difference between P1 and P3 and no difference between P3 and the control group. In contrast, evaluation of root mean square revealed that, in general, P3 values were higher only when compared with P1 and differed from the control group. There was an improvement in the EMG activity of the masticatory muscles, mainly observed in the masseter muscle, with values close to those of the control group in one of the analyses.

Tongue strength of healthy young adults

The measurement of tongue strength contributes to the study of oro-facial physiology. The objective of this study was to investigate the influence of gender on tongue strength in young adults and to determine the differences in this strength between tongue regions. This study was conducted on 50 healthy volunteers (17 men and 33 women) with a mean age of 23 years, with no oro-facial myofunctional alterations. The strength of the anterior portion and of the dorsum of the tongue was analysed with a calibrated electronic dynamometer. The subjects were asked to apply maximum force. Men showed higher tongue strength values than women both in the anterior portion and in the dorsum of the tongue (P<0·05), and the strength of the anterior portion of the tongue was lower than that of the dorsum in both genders (P<0·05). We conclude that gender and region influenced tongue strength.

Aleitamento e hábitos orais deletérios em respiradores orais e nasais

OBJETIVO: A amamentacao promove varios beneficios na crianca, entre eles o favorecimento da respiracao nasal. Neste estudo verificou-se a relacao do padrao respiratorio com o historico de aleitamento e habitos orais deleterios. FORMA DE ESTUDO: clinico com coorte transversal. MATERIAL E METODO: A populacao foi constituida por 62 criancas, de 3 anos e 3 meses a 6 anos e 11 meses, as quais foram submetidas a avaliacao otorrinolaringologica, para definicao dos grupos respiradores nasais e orais e entrevista fonoaudiologica. A avaliacao otorrinolaringologica constituiu-se dos seguintes exames: rinoscopia anterior, oroscopia e exame radiologico. Os pais das criancas foram questionados em relacao a forma (natural e/ou artificial), e ao periodo de aleitamento, alem da presenca de habitos orais deleterios (succao e mordida). O teste Exato de Fisher foi utilizado para comparar os grupos em relacao a presenca ou ausencia de habitos e diferentes periodos de aleitamento. RESULTADOS: O periodo de aleitamento materno foi maior nos respiradores nasais concentrando-se no periodo de 3 a 6 meses de idade. Quanto ao uso de mamadeira, os resultados mostraram que a maioria das criancas de ambos os grupos utilizou-se deste tipo de aleitamento nos primeiros anos de vida, nao apresentando diferenca estatistica entre os grupos (p=0.58). A presenca de habitos orais deleterios ocorreu de maneira marcante nos respiradores orais, evidenciando diferenca estatisticamente significativa, entre os grupos, para os habitos de succao (p=0.004) e habitos de mordida (p=0.0002). CONCLUSAO: As criancas respiradoras orais apresentaram um menor periodo de aleitamento materno e um historico de habitos orais presentes comparadas as criancas respiradoras nasais.

Deglutição em crianças com alterações neurológicas: avaliação clínica e videofluoroscópica

BACKGROUND: swallowing in children with neurologic disorders. AIM: to relate the data obtained in the clinical and in the videofluoroscopic evaluations of swallowing in children with neurologic disorders. METHODS: a retrospective analysis of 24 protocols of speech-language evaluation and of medical records of children, of both genders, referred to clinical and videofluoroscopic evaluations of swallowing at the School of Medicine of Ribeirao Preto -University of Sao Paulo, from January 2001 to June 2005. The following aspects were analyzed in the clinical evaluation: diet consistency, functional aspects of the swallowing mechanism and results of the cervical auscultation. Videofluoroscopic evaluation was performed to determine the dynamic aspects of the oral and pharyngeal phases. RESULTS: during the clinical evaluation of the oral phase, for both liquid and pasty consistencies, a greater occurrence of inadequate bolus control was observed (n = 15 e n = 14, respectively). In the pharyngeal phase, also for both consistencies, an adequate cervical auscultate was more frequntly observed before swallowing (n = 16 e n = 13) followed by the inadequate cervical auscultation during swallowing (n = 15 e n = 12). In the videofluoroscopic evaluation, during the oral phase, for both consistencies, the presence of inadequate food propulsion was the most frequent finding (n = 13 e n = 13) and, in the pharyngeal phase, the most frequent finding was the absence of laryngotracheal aspiration (n = 12 e n = 17). There was a statistically significant correlation between the cervical auscultate and the excursion of the hyoid and the larynx, and between the cervical auscultate and laryngotracheal aspiration of liquid and pasty consistencies. CONCLUSION: both procedures are important and complementary in the diagnosis of dysphagia.

Bruxism in children with nasal obstruction

INTRODUCTION Bruxism is characterized by repeated tooth grinding or clenching. The condition can occur in all age ranges and in both genders, being related or not to other oral habits. OBJECTIVE The objective of the present study was to investigate the occurrence of bruxism in children with nasal obstruction and to determine its association with other factors. METHODS Sixty children with nasal obstruction seen at the Otorhinolaryngology Outpatient Clinic of the University Hospital of Ribeirão Preto participated in the study. The data were obtained using a pre-established questionnaire applied to the person responsible and by orofacial evaluation of the patient. The participants were divided into two groups: group with bruxism (GB) as reported by the relatives and with the presence of tooth wear detected by clinical evaluation, and group without bruxism (GWB), consisting of children with none of the two symptoms of bruxism mentioned above. RESULTS The presence of bruxism exceeded its absence in the sample studied (65.22%). There was no significant difference (P<0.05) between groups regarding gender, phase of dentition, presence of hearing diseases, degree of malocclusion, or child behavior. CONCLUSION Bruxism and deleterious oral habits such as biting behavior (objects, lips and nails) were significantly present, together with the absence of suction habits, in the children with nasal obstruction.

Breast-feeding and deleterious oral habits in mouth and nose breathers

AIM Breast-feeding promotes several benefits in childhood, among them favoring the nasal breathing. In the present study, the relationship between breathing pattern and the history of breast-feeding and of deleterious oral habits was determined. STUDY DESIGN clinical with transversal cohort. MATERIAL AND METHOD The study population consisted of 62 children ranging in age from 3 years and 3 months to 6 years and 11 months who were submitted to otorhinolaryngologic evaluation to determine nasal and mouth breathers and to a speech language pathologic interview. The otorhinolaryngologic evaluation involved the following exams: anterior rhinoscopy, oroscopy and radiologic examination. The parents of the children were questioned about the form of feeding (natural and/or artificial), the duration of breast-feeding and the presence of deleterious oral habits (suction and biting). The Fisher exact test was used to compare groups regarding the presence and absence of habits and the different periods of breast-feeding. RESULTS The breast-feeding period was longer among nasal breathers and was concentrated in the period between 3 and 6 months of age. Regarding the use of bottle, the results showed that most of the children in both groups used this type of feeding during the first years of life, with no significant difference between groups (p=0.58). There was a marked presence of deleterious oral habits among mouth breathers, with a statistically significant difference between groups regarding suction (p=0.004) and biting habits (p=0.0002). CONCLUSION Mouth breathing children were breast-fed for a shorter period of time and had a history of deleterious oral habits compared to nose breathers.

Masticatory efficiency in class II and class III dentofacial deformities

Masticatory efficiency may be impaired in individuals with dentofacial deformities. The objective of the present study was to determine the condition of masticatory efficiency in individuals with dentofacial deformities. 30 patients with class II (DG-II) and 35 patients with class III (DG-III) dentofacial deformity participated in the study, all had an indication for orthognathic surgery. 30 volunteers (CG) with no alterations of facial morphology or dental occlusion and with no signs or symptoms of temporomandibular joint dysfunction also participated. Masticatory efficiency was analysed using a bead system (colorimetric method). Each individual chewed 4 beads, one at a time, over 20s measured with a chronometer. The groups were compared in terms of masticatory efficiency using analysis of variance (ANOVA), with the level of significance set at P<0.05. Masticatory efficiency was significantly greater in CG (P<0.05) than in DG-II and DG-III in all chewing tasks tested, with no significant difference between DG-II and DG-III (P>0.05). It was observed that the presence of class II and class III dentofacial deformity affected masticatory efficiency compared to CG, although there was no difference between DG-II and DG-III.

Masseter muscle thickness three years after surgical correction of class III dentofacial deformity

OBJECTIVE To analyse the effect of integrated orthodontic treatment, orthognathic surgery and orofacial myofunctional therapy on masseter muscle thickness in patients with class III dentofacial deformity three years after orthognathic surgery. DESIGN A longitudinal study was conducted on 13 patients with class III dentofacial deformities, denoted here as group P1 (before surgery) and group P3 (same patients 3 years to 3 years and 8 months after surgery). Fifteen individuals with no changes in facial morphology or dental occlusion were assigned to the control group (CG). Masseter muscle ultrasonography was performed in the resting and biting situations in the three groups. Data were analysed statistically by a mixed-effects linear model considering a level of significance of P < 0.05. RESULTS Significantly higher values (P < 0.01) of masseter muscle thickness (cm) were detected in group P3 (right rest: 0.82 ± 0.16, left rest: 0.87 ± 0.21, right bite: 1 ± 0.22, left bite: 1.04 ± 0.28) compared to group P1 (right rest: 0.63 ± 0.19, left rest: 0.64 ± 0.15, right bite: 0.87 ± 0.16, left bite: 0.88 ± 0.14). Between P3 and CG (right rest: 1.02 ± 0.19, left rest: 1 ± 0.19, right bite: 1.18 ± 0.22, left bite: 1.16 ± 0.22) there was a significant difference on the right side of the muscle (P < 0.05) in both situations and on the left side at rest. CONCLUSION The proposed treatment resulted in improved masseter muscle thickness in patients with class III dentofacial deformity.

Predictors of uvulopalatopharyngoplasty success in the treatment of obstructive sleep apnea syndrome.

OBJECTIVE Uvulopalatopharyngoplasty (UPPP) has been described as an option for treating obstructive sleep apnea syndrome (OSAS), with variable success rates. The main purpose of our study was to correlate UPPP success to craniofacial bony structure and orofacial muscles function. METHODS Clinical variables, including body mass index (BMI), age, and preoperative apnea-hypopnea index (AHI); cephalometric measurements of the craniofacial region and hyoid bone position; and muscle function variables including clinical protocol and tongue strength measures were evaluated in 54 patients who underwent UPPP in the last 7years. The measurements were related to the success or failure of UPPP based on the results of preoperative and postoperative polysomnography (PSG). RESULTS The variables BMI, preoperative AHI, and cephalometric measurements showed no influence on surgical success. The clinical muscle protocol also was similar between groups. However, the muscle strength of the anterior portion of the tongue was significantly greater in the group that showed surgical success compared to those with surgical failure. CONCLUSION OSAS is a multifactorial disease and diagnostic symptom assessments should be individualized. In addition, special attention should be given to functional muscle alterations of the airways, as they might influence the evolution of the disease.

Chewing time and chewing strokes in different dentofacial deformities

PURPOSE To verify whether the number of chewing strokes and the chewing time are influenced by dentofacial deformities in habitual free mastication. METHODS Participants were 15 patients with diagnosis of class II dentofacial deformity (GII), 15 with class III (GIII), and 15 healthy control individuals with no deformity (CG). Free habitual mastication of a cornstarch cookie was analyzed, considering the number of chewing strokes and the time needed to complete two mastications. Strokes were counted by considering the opening and closing movements of the mandible. The time needed to consume each bite was determined using a digital chronometer, started after the placement of the food in the oral cavity and stopped when each portion was swallowed. RESULTS There were no differences between groups regarding both the number of strokes and the chewing time. However, with regards to the number of strokes, CG and GII presented a significant concordance between the first and the second chewing situation, which was not observed in GIII. The analysis of time showed significant concordance between the first and second chewing situation in CG, reasonable concordance in GII, and discordance in GIII. CONCLUSION Dentofacial deformities do not influence the number of chewing strokes or the chewing time. However, class III individuals do not show uniformity regarding these aspects.