Effect of lingual frenotomy on tongue and lip rest position: a nonrandomized clinical trial

Introduction: The tongue plays an important role in the development of craniofacial structures. At rest, the light and constant pressure of the tongue against the hard palate, counterbalanced by the pressure provided by proper lip sealing, serves as a guide for maxillary growth. Ankyloglossia makes tongue coupling against the hard palate difficult, impacting maxillary development, which may lead to breathing disorders. Objective: To verify the effect of lingual frenotomy on the resting position of the tongue and lips in infants with ankyloglossia. Methods: The sample consisted of 334infants aged between 1 and 60 days old diagnosed with ankyloglossia. The groups were divided in: a) experimental group (EG), which consisted of infants whose mothers agreed with lingual frenotomy; b) control group (CG), which consisted of infants whose mothers either refused lingual frenotomy or were waiting for surgery. Both the position of the lips and of the tongue at rest were assessed while the infants were sleeping during the quiet sleep phase. Formothers who refused their infants to undergo the surgical procedure, a follow-up of the infants was proposed to verify possible interference of the frenulum with the resting position of the tongue and lips. Infants whose mothers agreed with surgery were referred for lingual frenotomy. Results: Regarding the position of the tongue and lips at rest at the initial and final assessments, the statistical analysis demonstrated significant differences between both groups. Conclusion: Lingual frenotomy enabled infants diagnosed with ankyloglossia to maintain both tongue coupling against the hard palate and closed lips at rest.info:eu-repo/semantics/publishedVersio

Swallowing disorders in patients with obstructive sleep apnea: a critical literature review

Patients with obstructive sleep apnea (OSA) may show signs and symptoms of altered swallowing function since repetitive episodes of OSA may cause hypoxia (decreased oxygen concentration in the blood) and hypercapnia (increased carbon dioxide concentration in the blood), as well as neuromuscular changes in the tissues involved, including the pharynx. This study aims to analyze whether patients with OSA show signs and symptoms of altered swallowing function. A literature search was performed in the PubMed, LILACS, Medline, Scopus, and SciELO databases by using the following search strategy: (“dysphagia”) or (“deglutition disorders”) and (“obstructive sleep apnea”) or (“obstructive sleep apnea syndrome”). The included articles were sorted by authors, year, country, journal of publication, and type of study, as well as analyzed according to the objectives, case series, OSA and swallowing assessment methods, results and conclusions. After applying the inclusion and exclusion criteria, ten articles published in medicine, dentistry and physiology journals between 1999 and 2018 were selected. The analysis of the selected articles showed that the number of participants and group structuring vary according to the study and instrumental and objective exams are used to assess swallowing and sleep in most articles. Also, the results show that groups of patients with OSA can present altered swallowing reflex, altered latency time and inspiratory suppression time, and presence of premature posterior escape, residues, penetration and aspiration. Premature posterior escape was the most frequent sign found. In conclusion, patients with OSA may show signs and symptoms of altered swallowing function

The Virtual Man Project's CD-ROM "Voice Assessment: Speech-Language Pathology and Audiology & Medicine", Vol.1

The CD-ROM "Voice Assessment: Speech-Language Pathology and Audiology & Medicine" was developed as a teaching tool for people interested in the production of the spoken or sung human voice. Its content comprises several subjects concerning the anatomy and physiology of spoken and sung voice. A careful assessment becomes necessary in order to ensure the effectiveness of teaching and learning educational materials, whether related to education or health, within the proposal of education mediated by technology. OBJECTIVE: This study aimed to evaluate the efficacy of the Virtual Man Project's CD-ROM "Voice Assessment: Speech-Language Pathology and Audiology & Medicine", as a self-learning material, in two different populations: Speech-Language Pathology and Audiology students and Lyrical Singing students. The participants were instructed to study the CD-ROM during 1 month and answer two questionnaires: one before and another one after studying the CD-ROM. The quantitative results were compared statistically by the Student's t-test at a significance level of 5%. RESULTS: Seventeen out of the 28 students who completed the study, were Speech-Language Pathology and Audiology students, while 11 were Lyrical Singing students (dropout rate of 44%). Comparison of the answers to the questionnaires before and after studying the CD-ROM showed a statistically significant increase of the scores for the questionnaire applied after studying the CD-ROM for both Speech-Language Pathology and Audiology and Lyrical Singing students, with p<0.001 and p<0.004, respectively. There was also a statistically significant difference in all topics of this questionnaire for both groups of students. CONCLUSION: The results concerning the evaluation of the Speech-Language Pathology and Audiology and Lyrical Singing students' knowledge before and after learning from the CD-ROM allowed concluding that the participants made significant improvement in their knowledge of the proposed contents after studying the CD-ROM. Based on this, it is assumed that this didactic material is an effective instrument for self-learning of this population

Por que no papel é mais fácil? O que fazemos e o que falamos que fazemos no Projeto Político-Pedagógico de um Curso de Graduação – Reflexões sobre o Curso de Fonoaudiologia da FOB-USP

Introduction: the undergraduation courses in Brazil requires a Political-Pedagogical Project (PPP) as collective construction of an institutional project that is pedagogical, for addressing the professional formation process, and political, for addressing purposes and values regarding the role of the university in the critical analysis and social transformation. Specific analyzes of institutions that developed or modified such project assist not only the institution analyzed, but also other educational institutions as well as the entire professional field by providing reflections and actions on professional formation. Aim: To analyze the process of elaboration and implementation of the PPP of the Speech Language Pathology and Audiology Course (SLPA) of the Bauru School of Dentistry, University of São Paulo (FOB-USP). Methods: Qualitative research conducted by means of semi-structured interviews with members of the SLPA Course Coordinating Committee (CoC-Fono), the head of the SLPA Department and Undergraduate Commission regarding the PPP´s preparation and implementation. The twelve interviews conducted were recorded, transcribed and analyzed for intercoder reliability. The content categorical-thematic analysis was performed via NVivo software and the final emergent categories were: (1) construction of PPP (creation and implementation of the CoC-Fono, elaboration decision, institutional support, conducting the process, adopted strategies, hindering and facilitating factors, professors and students participation); (2) characteristics of the current PPP (formation profile, theoretical basis, strengths and weaknesses, coherence of curriculum, acceptance level, knowledge and satisfaction of the academic community) and (3) future perspectives (effective changes, proposals of continuity and expectations). Results and Discussion: The analysis identified that the PPP´s construction began with the creation of the CoC-Fono – a document with the SLPA Course guideline already existed, however, it could not be characterized as a PPP. This fact as well as the legal and institutional requirements, led to the decision of elaborating a PPP, this being conducted by the CoC-Fono, with strong institutional support and variable involvement of the academic community. The later was due to initial resistance and limited participation resulting from high demand of other activities in the university. The strategies adopted were discussion forums, meetings, workshops, seminars and university pedagogy courses as well as professors and students evaluation of the course´s curricula. This process was described as being long, but necessary for desensitization of the academic community. The PPP was elaborated collectively, but with a structure similar to what was already being conducted in the SLPA Course. The alumnus profile is generalist, however, there is a strong focus on specialties. There is a definition of the main axes, the use of new methods and attempts to integrate disciplines, although still presented in a curriculum structure with a high workload. There was a good level of acceptance and satisfaction, although professors and students demonstrate low level of knowledge about the PPP. Future perspectives relate to the new proposal of PPP´s revision, with expectations regarding the incorporation of modular and tutorial methods to accommodate the needs of the SLPA course, the society and the profile of incoming students in line with the aspirations of academic and institutional community. Final considerations: The proposed analysis was possible. The fact that the process was collective and led to change, even if by successive approximations, enables the SLPA Course to new curricular changes, so that it is offered in an integrated manner while maintaining the level of excellence in the formation of Speech Language Pathologists and Audiologists at FOB-USP.Introdução: o projeto político-pedagógico (PPP) de um curso de graduação precisa ser realmente abraçado no contexto acadêmico a que pertence, sendo pedagógico por discutir o processo de formação e político por tratar dos fins e valores referentes da universidade. Análises pontuais de PPP auxiliam não somente a instituição analisada, como também outras instituições de ensino em reflexões e ações sobre formação profissional. No entanto, fica sempre a pergunta: o que fazemos em nosso curso é o que realmente está escrito e descrito nas vias documentais? O que está escrito reflete o perfil do egresso que postulamos? Objetivo: analisar se as características atuais do PPP do Curso de Fonoaudiologia da Faculdade de Odontologia de Bauru (FOB), da Universidade de São Paulo (USP) refletem o perfil do egresso a que se deseja formar e o que efetivamente é colocado em prática no curso. Metodologia: este trabalho é o recorte de um dos itens de pesquisa qualitativa (Tese de Livre Docência) realizada por entrevistas semi-estruturadas com membros da Comissão Coordenadora de Curso (CoC-Fono), Chefia de Departamento e Comissão de Graduação da Unidade; as entrevistas conduzidas foram gravadas, transcritas e submetidas à análise de fidedignidade intercodificadores. A análise de conteúdos temático-categorial foi realizada via software NVivo, sendo que a categoria final a ser aqui apresentada é a de características do PPP atual (perfil de formação, base teórica, pontos fortes e fracos, coerência da estrutura curricular, nível aceitação e conhecimento da comunidade acadêmica). Resultados e discussão: a análise realizada identificou que a construção do PPP foi um processo coletivo e longo, mas necessário como dessensibilização da comunidade acadêmica. O perfil do egresso é generalista, embora haja contraditoriamente grande foco nas especialidades, o que reflete que o documento formal mostra mais o que é postulado pelas Diretrizes Curriculares Nacionais do que o realmente desenvolvido na prática. Há definição dos eixos principais, utilização de novas metodologias e tentativas de integração de disciplinas pontuais, embora ainda apresentadas em estrutura de grade, com alta carga horária – o que entra em conflito com a formação de um profissional reflexivo e flexível postulado no PPP. Houve bom nível de aceitação e satisfação, embora docentes e discentes demonstrem baixo nível de conhecimento sobre o PPP – o que parece contraditório, pois não se aprova ou reprova aquilo que não se conhece. Perspectivas futuras se relacionam à nova proposta de reformulação, com expectativa quanto ao método modular e tutorial para contemplar as necessidades do curso, sociedade atual e perfil do aluno ingressante. Considerações finais: embora seja alto o nível de excelência da formação do fonoaudiólogo na FOB-USP, foi possível verificar que o atual PPP reflete de forma parcial o que tem sido realizado no curso, sendo que há dúvidas dos docentes sobre a adequação do perfil do egresso à real proposta do curso. O fato do processo de elaboração do PPP ter sido coletivo e haver mudanças prévias habilita o curso para novas mudanças curriculares, de forma que seja oferecido de maneira integrada, ensejando as atuais propostas da USP para o ensino de graduação

Neuromuscular Electrical Stimulation and Electromyographic Biofeedback as Adjunctive Modalities in the Treatment of Oropharyngeal Dysphagia in Stroke

Dysphagia is a symptom related to swallowing disorders that impede or hamper safe, efficient, and comfortable oral ingestion. In addition to compromising the swallowing process, dysphagia may impair overall health, the nutritional status, and lung conditions, impacting quality of life as well. Different proposals for the rehabilitation of oropharyngeal dysphagia have been researched over the years. As a therapeutic strategy aimed at the rehabilitation of oropharyngeal dysphagias, the electromyographic (EMG) biofeedback provides improved strength in swallowing and its coordination, understood as the best muscle recruitment during the function, associated with the attention and performance of cortical functions, simultaneously. Neuromuscular electrical stimulation (NMES) is another therapeutic approach used in the rehabilitation of oropharyngeal dysphagia (NMES). NMES has been recommended as an adjunctive modality to improve the results of exercises based on dysphagia therapy. In view of the possibility of using technological resources in the diagnosis and treatment of oropharyngeal dysphagia, this chapter presents the theoretical and procedural framework aimed at the application of EMG biofeedback and NMES as supporting methods in the treatment of oropharyngeal dysphagia, in cases affected by stroke

Temporomandibular disorders, voice and oral quality of life in women

Some studies have shown a relationship between temporomandibular disorders (TMD) and dysphonia, as well as quality of life in oral health. OBJECTIVE: The purpose of this study was to investigate the correlation between severity of vocal self-perception and TMD severity and the correlation between oral health-related quality of life impairment and TMD severity. MATERIAL AND METHODS: Thirty-three women aged 20 to 40 years, with or without complaint of dysphonia, were recruited at the Bauru campus of the University of São Paulo, Brazil, and the local community. All participants were subjected to an investigation of quality of life related to dental and speech aspects by the application of Oral Health Impact Profile-short form (OHIP-14) and the Voice-Related Quality of Life (V-RQOL) protocol. Also, a questionnaire was applied to detect the presence and severity of TMD. RESULTS: There was significant correlation between TMD and quality of life for all aspects analyzed in the oral health protocol, except for function and physical limitation (p>0.05). There was negative correlation between TMD and voice-related quality of life in the total score (p=0.007) as weel as physical (p=0.008) and socio-emotional aspects (p=0.017). In addition, there was statistically significant correlation between TMD and vocal self-perception (p=0.037). CONCLUSION: There is an association between TMD severity, voice-related and oral health-related quality of life. It is important to investigate in future studies the vocal self perception as well as the oral and voice conditions in patients with TMD.(FAPESP) São Paulo Research Foundatio

Orofacial myofunctional evaluation: MBGR protocol

OBJETIVO: apresentar um protocolo com escores na área de motricidade orofacial intitulado Protocolo MBGR. MÉTODOS: a partir de protocolos utilizados na área da motricidade orofacial foi elaborado um novo protocolo contendo escores, o qual foi aplicado em sujeitos normais e em pacientes, em cinco fases distintas durante dois anos. A aplicação do protocolo, em cada fase, foi realizada por juízes independentes. Sempre ao final de cada fase o grupo que elaborou o protocolo fez os ajustes necessários para que o mesmo pudesse ser sensível aos problemas da área da motricidade orofacial. RESULTADOS: um novo protocolo na área de motricidade orofacial com escores foi elaborado e testado durante dois anos em cinco diferentes fases possibilitando obter parâmetros numéricos. CONCLUSÃO: foi apresentado o Protocolo MBGR com escores, o qual permite ao fonoaudiólogo avaliar, diagnosticar e estabelecer prognóstico em motricidade orofacial.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

Characteristics of phonetography in women with dentofacial balance

OBJETIVO: Caracterizar o perfil da extensão vocal de mulheres com equilíbrio dentofacial, por meio da fonetografia. MÉTODOS: Fizeram parte desse estudo 22 estudantes do gênero feminino, com idades entre 18 e 29 anos (x = 20±2 anos), falantes do Português Brasileiro, sem alteração ou treino vocal, que apresentaram tipo de face padrão I e harmonia dento-oclusal. Foi aplicado um formulário específico de auto-resposta e também foi realizada avaliação antropométrica da face, avaliação dento-oclusal, exame da fonetografia e análise acústica da frequência fundamental habitual da voz das participantes, realizados no período pós-menstrual. RESULTADOS: Os valores encontrados para os diferentes parâmetros analisados foram: frequência fundamental mínima: x= 167,32±22,27 Hz ou x= 40,09±2,37 st, frequência fundamental máxima: x= 908,45±210,93 Hz ou x= 69,09±4,13 st, extensão vocal: x= 29,00±3,85 st, intensidade mínima: x= 69,32±4,07 dB, intensidade máxima: x= 113,14±6,10 dB, extensão dinâmica máxima: x= 3,91±5,71 dB, área do fonetograma: x=709,50±182,92 dB.st ou x=31,93±8,23 cm², frequência fundamental habitual da vogal "a": x= 211,00±22,55 Hz. CONCLUSÃO: No presente estudo foram obtidas as intensidades mínimas e máximas para as distintas frequências alcançadas pelas participantes, bem como a frequência fundamental habitual, estabelecendo os valores de referência quanto ao perfil da extensão vocal de mulheres brasileiras sem alterações vocais e com equilíbrio dentofacial.PURPOSE: To characterize the vocal extension profile of women with dentofacial balance using phonetography. METHODS: Took part of this study 22 female students with ages between 18 and 29 years (x = 20±2 years), all Brazilian Portuguese speakers, without vocal disorders or vocal training, who presented balanced face pattern I and dental-occlusal harmony. The subjects answered a specific self-response form, and were submitted to anthropometric assessment of the face, dental-occlusal evaluation, phonetography examination, and acoustic analysis of the usual fundamental frequency of the participants' voices, carried out in the post-menstrual period. RESULTS: The values found for the different parameters analyzed were: minimum fundamental frequency: x= 167,32±22,27 Hz or x= 40,09±2,37 st, maximum fundamental frequency: x= 908,45±210,93 Hz or x= 69,09±4,13 st, voice extension: x= 29,00±3,85 st, minimum intensity: x= 69,32±4,07 dB, maximum intensity: x= 113,14±6,10 dB, maximum dynamic extension: x= 3,91±5,71 dB, phonetogram area: x= 709,50 ±182,92 dB.st ou x= 31,93±8,23 cm², usual fundamental frequency of the vowel "a": x= 211,00±22,55 Hz. CONCLUSION: The present study obtained the minimum and maximum intensity levels for different frequencies achieved by the participants, as well as the usual fundamental frequency, establishing reference values for the vocal extension profile of Brazilian woman without voice disorders and with dentofacial balance.PIBIC Programa Institucional de Bolsas de Iniciação Cientific

Função mastigatória em pacientes com disfunção temporomandibular: avaliação eletromiográfica

Temporomandibular dysfunction (TMD) is a complex disturbance that involves the masticatory muscles and/or temporomandibular joint, causing damage to the masticatory function. This study evaluated the electromyographic activity of the masseter muscle during habitual mastication of bread, apple, banana, cashew nut and paraffin film (Parafilm M) in 25 adult subjects, of both gender, with TMD. The results were compared to those of a control group, composed of 15 adult subjects, of both sexes, free of signs and/or symptoms of TMD. The MYO-TRONICS Inc., K6-I computer software was used for electromyographic processing and analyzed the following parameters: duration of the act, duration of the masticatory cycle and number of cycles. No significant differences were found between subjects in the control group and individuals with TMD as to duration of the masticatory act and of the masticatory cycle, considering all materials used for mastication. The duration of the masticatory act and cycle was longer during mastication of paraffin film in both groups. The number of masticatory cycles was higher for mastication of apple in comparison to mastication of banana, in both groups. It can be concluded that the consistency of foods influences the duration parameters of the act, duration of the cycle and the number of masticatory cycles, and the behavior of the masticatory muscles in individuals with TMD during habitual mastication is similar to that verified in individuals without TMD.A disfunção temporomandibular (DTM) representa um quadro complexo que envolve os músculos mastigatórios e/ou a articulação temporomandibular, causando prejuízos à função mastigatória. Este estudo avaliou a atividade eletromiográfica do músculo masseter durante a mastigação habitual de pão, maçã, banana, castanha de caju e folha de parafilme (Parafilm M) em 25 indivíduos adultos, de ambos os gêneros, com DTM. Os resultados foram comparados com os obtidos para o grupo controle, composto por 15 indivíduos adultos, de ambos os gêneros, livres de sinais e/ou sintomas de DTM. Foi utilizado o programa computadorizado MYO-TRONICS Inc., K6-I no modo de processamento eletromiográfico, tendo sido analisados os seguintes parâmetros: duração do ato, duração do ciclo mastigatório e número de ciclos mastigatórios. Não foram encontradas diferenças estatisticamente significantes entre os indivíduos do grupo controle e com DTM no que diz respeito à duração do ato e do ciclo mastigatório, bem como o número de ciclos, considerando todos os materiais utlizados para a mastigação. A duração do ato e do ciclo mastigatório foi maior durante a mastigação de parafilme em ambos os grupos. O número de ciclos mastigatórios foi maior para a mastigação de maçã, em comparação à banana, nos diferentes grupos. Pode ser concluído que a consistência dos alimentos influencia a duração dos parâmetros duração do ato, duração do ciclo e número de ciclos mastigatórios e o comportamento dos músculos mastigatórios em indivíduos com DTM durante a mastigação habitual é semelhante à verificada em indivíduos sem disfunção

Influence of orthodontic-surgical treatment on signs and symptoms of temporomandibular dysfunction in subjects with dentofacial deformities

OBJETIVO: Verificar se o tratamento ortodôntico-cirúrgico acarreta modificações nos sinais e sintomas de disfunção temporomandibular em indivíduos com deformidades dentofaciais. MÉTODOS: Participaram do estudo 20 pacientes de ambos os gêneros (idades entre 15 e 44 anos), com diferentes características dento-oclusais e faciais, submetidos a osteotomias mandibulares e/ou maxilares. Todos os pacientes apresentavam pelo menos um sinal ou sintoma de disfunção temporomandibular, verificado por meio de entrevista e de avaliação clínica realizada pré e após 30 a 60 dias da cirurgia ortognática. Nesta última buscou-se dor à palpação dos músculos mastigatórios, cervicais e da articulação temporomandibular; foi realizada ausculta das articulações temporomandibulares e mediu-se movimentos mandibulares. RESULTADOS: Quanto aos sintomas investigados na entrevista, os resultados demonstraram que após a cirurgia ortognática houve redução de todos os sintomas. No que diz respeito aos movimentos mandibulares, observou-se significante diminuição da abertura da boca no pós-operatório e pouca variação nas medidas de lateralidade mandibular. Em relação à presença de dor à palpação, notou-se diminuição da dor para os músculos cervicais. CONCLUSÃO: O tratamento ortodôntico-cirúrgico acarretou, em curto prazo, diminuição dos sintomas investigados e dos sinais clínicos de dor à palpação na musculatura cervical e redução da abertura da boca em pacientes com deformidades dentofaciais. Registro de ensaio clínico: 083578.PURPOSE: To verifying whether orthodontic-surgical treatment results in modification on the signs and symptoms of temporomandibular dysfunction in individuals with dentofacial deformities. METHODS: Twenty patients of both genders (ages between 15 and 44 years) with different dental-occlusion and facial characteristics, submitted to mandibular and/or maxillary osteotomy, participated in this study. All patients presented at least one sign or symptom of temporomandibular dysfunction, verified through interview and clinical evaluation carried out before and after 30 to 60 days of the orthognathic surgery. The final evaluation investigated the presence of pain on palpation of masticatory and cervical muscles, and temporomandibular joint pain; auscultation of the temporomandibular joints was performed, and jaw movements were measured. RESULTS: All symptoms investigated in the interview decreased after the orthognathic surgery. Regarding mandibular movements, there was a significant decrease in postoperative mandibular opening, and little variation was observed in measures of lateral excursions. It was also noticed a decrease of pain in cervical muscles. CONCLUSION: The orthodontic-surgical treatment resulted in short term decrease of the investigated symptoms and clinical signs of pain in cervical muscles, and reduction of mandibular opening in patients with dentofacial deformities.Clinical trials register: 083578