Tais Helena Grechi

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.

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.

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.

Original ArticleMastication and deglutition changes in children with tonsillar hypertrophy

UNLABELLED The changes in mastication and deglutition in children with adenotonsillar hypertrophy need to be better characterized. OBJECTIVE To evaluate the frequency of parent-reported myofunctional changes and to determine if there are differences in the alteration patterns of children with adenotonsillar hypertrophy and subjects with adenoid hypertrophy. METHOD Questionnaire and assessment by a speech therapist of children aged between three and six years with tonsillar hypertrophy. The data reported by the parents were compared to the data obtained from the speech therapists evaluation; additionally, data from children with adenotonsillar hypertrophy were compared to findings from subjects with adenoid hypertrophy. STUDY DESIGN cross-sectional cohort. RESULTS The myofunctional changes observed by the speech therapist were more frequent than the alterations reported by the parents, and there was no correlation between the two findings. The children with adenoid hypertrophy and the individuals with adenotonsillar hypertrophy had the same pattern of myofunctional alteration. CONCLUSION Parents cannot clearly correlate tonsillar hypertrophy with changes in mastication and deglutition. The cause of the respiratory obstruction does not seem to interfere in the pattern of myofunctional change.

Mastication and deglutition changes in children with tonsillar hypertrophy

UNLABELLED The changes in mastication and deglutition in children with adenotonsillar hypertrophy need to be better characterized. OBJECTIVE To evaluate the frequency of parent-reported myofunctional changes and to determine if there are differences in the alteration patterns of children with adenotonsillar hypertrophy and subjects with adenoid hypertrophy. METHOD Questionnaire and assessment by a speech therapist of children aged between three and six years with tonsillar hypertrophy. The data reported by the parents were compared to the data obtained from the speech therapists evaluation; additionally, data from children with adenotonsillar hypertrophy were compared to findings from subjects with adenoid hypertrophy. STUDY DESIGN cross-sectional cohort. RESULTS The myofunctional changes observed by the speech therapist were more frequent than the alterations reported by the parents, and there was no correlation between the two findings. The children with adenoid hypertrophy and the individuals with adenotonsillar hypertrophy had the same pattern of myofunctional alteration. CONCLUSION Parents cannot clearly correlate tonsillar hypertrophy with changes in mastication and deglutition. The cause of the respiratory obstruction does not seem to interfere in the pattern of myofunctional change.

Bruxism in children with nasal obstruction: Preliminary study

Abstract Objectives: The present study investigated the occurrence of bruxism and its characteristics in children with age between 2 years 1 month and 12 years 8 months, with nasal obstruction. Methods: For this study 60 children of the Otolaryngology Clinics/Clinics Hospital of Ribeirao Preto have participated. The data were obtained through a standardized questionnaire applied to the responsible of the children and evaluation. These subjects were divided into 2 groups: with bruxism (group 1) and without bruxism (group 2). The criteria adopted was the presence on not of complaint and dental waste. The obtained results were analyzed statistically from the comparison among the groups with the aid of the Qui-square test or the Fisher Exact test. For intragroup analysis the Binomial test was achieved. Results: The obtained results showed an occurrence of 65.22% of bruxism in children with nasal obstruction. Conclusion: A relationship was observed between bruxism and gender, teething phase, presence of auditive pathologies, health condition, bad occlusion degree, and the child’s behavior. Nevertheless, a prevalence of allergic rhinitis and oral habits, involving bite and absence of sustion habits, was observed in the group with bruxism.

Cephalometric, muscular and swallowing changes in patients with OSAS

Obstructive Sleep Apnoea Syndrome (OSAS) is believed to be associated with craniofacial and neuromuscular changes, although the interplay among these variables still is poorly recognised. The objective of this study was to identify hyoid, muscular and swallowing changes associated with OSAS, and to correlate these alterations with OSAS severity. Cross-sectional study, in a tertiary referral centre. Seventy-two adult individuals participated in this study: 12 controls (without apnoea) and 60 patients with apnoea (mild, moderate and severe OSAS-20 individuals in each group). All participants were initially evaluated by otorhinolaryngologist and neurologist and underwent polysomnography for OSAS stratification. Cephalometric data, clinical myofunctional status and swallow videofluoroscopy exam were assessed. A hybrid effect model was used to analyse swallowing parameters; dependent variables were age, body mass index (BMI) and cephalometric measures. Individuals with OSAS presented lower hyoid position and narrower posterior airway distance when compared to controls. These parameters correlated to OSAS severity. Additionally, OSAS patients exhibited significantly lower myofunctional scores. Both velum and hyoid contraction times were significantly lower in the OSAS group at videofluoroscopy, regardless of its severity. Premature leakage into pharynx was more common in OSAS groups. Laryngeal penetration phenomenon occurred only in two patients (both from OSAS group). Our results suggest that hyoid bone position is associated with OSAS severity. Muscular pattern and swallowing are impaired in OSAS patients, irrespective of OSAS severity and facial profile. These findings indicate a higher predisposition of OSAS patients to present an inferior hyoid positioning, accompanied by myofunctional and swallowing disorders.

Força de mordida em crianças com mordida cruzada posterior

The bite force is influenced by the occlusal condition. In children with posterior crossbite the results are controversial. Purpose To investigate the influence of posterior crossbite in maximal isometric bite force (MIBF) in children with mixed dentition. Methods In this cross-sectional study, 32 children participated, 21 of them belonging to the posterior cross-bite group (10 girls and 11 boys, mean age 9.2 years) and 11 to the control group (6 girls, 5 boys, mean age 9.3 years). The children were evaluated by an orthodontist for occlusal diagnosis and characterization of the groups, by otorhinolaryngologists for evaluation of respiratory symptoms and by a speech therapist to identify the clinical and MIBF myofunctional orofacial condition. The dynamometer was placed in the molar region and the children were instructed to bite it as hard as possible three times alternately. For data analysis, Student’s t-test for independent samples was used. The level of significance was set at 5%. Results While comparing the groups crossbite vs. control, there was no significantly difference; also, among only children belonging to the crossbite group, there was no difference between the sides (crossed bite vs. Noncrossed one). Conclusion The presence of posterior crossbite did not influence the maximal isometric bite force in children with mixed dentition.

Força de mordida em respiradores bucais

Objetivo Investigar a influencia da respiracao bucal na forca de mordida maxima de dentes molares em criancas. Metodos Cento e cinco criancas foram divididas em dois grupos: grupo controle (GC), sem queixas respiratorias e com padrao clinico de vedamento labial e grupo de respiradores bucais (GRB), com queixas respiratorias e diagnostico otorrinolaringologico de obstrucao nasal. Todos os participantes realizaram a avaliacao da forca de mordida isometrica maxima (FMIM), de ambos os lados da arcada dentaria, por meio de um gnatodinamometro posicionado na regiao dos primeiros molares. Os testes estatisticos t de Student pareado e nao pareado foram usados nas comparacoes da FMIM entre os lados, de cada grupo, e entre os grupos (GC e GRB). O grau de obstrucao foi correlacionado a FMIM (GRB), por meio do teste de correlacao de Spearman. Foram considerados significativos resultados com p≤0,05. Resultados Nao houve diferenca nos valores de FMIM entre os lados direito e esquerdo da arcada dentaria. Quando comparados os valores de FMIM dos participantes do GC e do GRB nao foi observada diferenca, de um modo geral. Entretanto, quando correlacionada a FMIM com a idade dos participantes da pesquisa, notou-se que no GC houve aumento no valor da FMIM, de acordo com a idade. Conclusao A obstrucao nasal nao influenciou na forca de mordida isometrica maxima em criancas de 3 a 12 anos de idade. Nao houve correlacao entre o grau de obstrucao e a forca de mordida. No GC a forca de mordida foi maior em criancas mais velhas, porem, essa correlacao com a idade nao foi observada no GRB.