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

Prevalence of enuresis in children with cleft lip and palate: preliminary results

Objectives: Nocturnal enuresis (NE) is a common childhood condition, present in about 15% of Brazilian children. There is ongoing debate regarding the relationship between obstructive sleep apnea syndrome (OSAS) and NE. Craniofacial anomalies predispose to upper airway obstruction and OSAS. To study: (1) the prevalence of nocturnal enuresis (NE), diurnal urinary incontinence (DI) and OSAS in children with unilateral cleft lip and palate (UCLP) nonsyndromic, (2) risk factors associated with NE. Methods: Here are preliminary results of an observational cross-sectional study of 83 children (54% males) 6- 12 years of age (mean age 10.4 ± 1.82 years) with UCLP nonsyndromic. Study consisted of a personal interview with the child/caregivers and chart review. Severity of NE and DI, gender, tonsillectomy and/or adenoidectomy, frequency, arousal and sleeping disturbances were assessed. OSAS was identified by the presence of snoring, intermittent pauses and/or gasps. The Sleep Disturbance Scale for Children (SDSC) cut point sleep-disordered breathing (SDB>6) for OSAS. Results: Nocturnal enuresis was reported in 15 of 83 children (18%) (8 males, mean age 9.6±1.32 years), and of these 4(27%) had associated DI. Twelve (84%) had mild enuresis (1-2nights/week). Thirty-four children (40%) had SDB>6.Among 17(21%) children who had previously undergone tonsillectomy and/or adenoidectomy (T&A) 3 (17%) had NE. Of the 15(18%) children with NE 20% had undergone T&A in the past. Five out of 15 enuretic children (30%) had symptoms suggestive of obstructive sleep apnea syndrome (SDB>6). Conclusion: Almost one fourth of children UCLP nonsyndromic had enuresis. OSAS was present in about one third of enuretic children. Tonsillectomy and/or adenoidectomy did not affect the prevalence of enuresis

Nasal obstruction increases the risk of obstructive sleep apnea?

Objective: Craniofacial anomalies predispose to upper airway obstruction. Obstructive sleep apnea syndrome (OSAS) is related obesity, hypertension, attention deficit and learning, nocturnal enuresis. To study: prevalence and association of nasal obstruction and OSAS. Methods: Here are preliminary results of an observational cross-sectional study of 83 children (54% males) 6-12 years of age (mean age 10.4 ± 1.82 years) with unilateral cleft lip and palate (UCLP) nonsyndromic. Study consisted of a personal interview with the child/caregivers. Congestion Quantifier Five-Item Test (CQ5) for nasal, patient with score of ≥ 6 are at a level that warrants examination and possible treatment. SN-5 survey as a measure of longitudinal change in health related quality of life (HRQoL).Visual Analog Scale (VAS), a child was asked to evaluate the level of the obstruction of his/her nose. OSAS was identified by the presence of snoring,intermittent pauses and/or gasps. The Sleep Disturbance Scale for Children (SDSC) cut point sleepdisordered breathing (SDB>6) for OSAS. Results: Twenty-nine children (35%) presented with CQ5 ≥ 6. Mean SN-5 score was 1.8 (± 1.97). Mean SDB 6.3 (± 2.94). Thirtyfour children (40%) had SDB>6 (mean 9.3±3.01). At baseline, the mean VAS on the cleft side was 5.8(±3.13) and noncleft side was 9.1(±3.52). Symptoms of obstructive sleep apnea syndrome (OSAS) with SDB>6 were observed in 69% of children with CQ5 ≥ 6 (mean 11.8 ± 5.92). Consclusion: Children with nonsyndromic UCLP present high prevalence of symptoms suggestive of obstructive sleep apnea syndrome (OSAS). Symptomatic nasal obstruction increases incidence of symptoms of OSAS

Velar activity in individuals with velopharyngeal insufficiency assessed by acoustic rhinometry

Acoustic rhinometry is routinely used for the evaluation of nasal patency. Objective: To investigate whether the technique is able to identify the impairment of velopharyngeal (VP) activity in individuals with clinical diagnosis of velopharyngeal insufficiency (VPI). Methods: Twenty subjects with repaired cleft palate and inadequate velopharyngeal function (IVF) and 18 non-cleft controls with adequate velopharyngeal function (AVF), adults, of both genders, were evaluated. Area-distance curves were obtained during VP rest and speech activity, using an Eccovision Acoustic Rhinometry system. Volume was determined by integrating the area under the curve at the segment corresponding to the nasopharynx. VP activity (ΔV) was estimated by the absolute and relative differences between nasopharyngeal volume at rest (Vr) and during an unreleased /k/ production (Vk). The efficiency of the technique to discriminate IVF and AVF was assessed by a ROC curve. Results: Mean Vk and Vr values (±SD) obtained were: 23.2±3.6 cm3 and 15.9±3.8 cm3 (AVF group), and 22.7±7.9 cm3 and 20.7±7.4 cm3 (IVF group), corresponding to a mean ΔV decay of 7.3 cm3 (31%) for the AVF group and a significantly smaller ΔV decay of 2.0 cm3 (9%) for the IVF group (p<0.05). Seventy percent of the IVF individuals showed a ΔV suggesting impaired VP function (below the cutoff score of 3.0 cm3 which maximized both sensitivity and specificity of the test), confirming clinical diagnosis. Conclusion: Acoustic rhinometry was able to identify, with a good discriminatory power, the impairment of VP activity which characterizes VPI.FAPESPCNPqCAPE

Velar activity in individuals with velopharyngeal insufficiency assessed by acoustic rhinometry

Acoustic rhinometry is routinely used for the evaluation of nasal patency. Objective: To investigate whether the technique is able to identify the impairment of velopharyngeal (VP) activity in individuals with clinical diagnosis of velopharyngeal insufficiency (VPI). Methods: Twenty subjects with repaired cleft palate and inadequate velopharyngeal function (IVF) and 18 non-cleft controls with adequate velopharyngeal function (AVF), adults, of both genders, were evaluated. Area-distance curves were obtained during VP rest and speech activity, using an Eccovision Acoustic Rhinometry system. Volume was determined by integrating the area under the curve at the segment corresponding to the nasopharynx. VP activity (ΔV) was estimated by the absolute and relative differences between nasopharyngeal volume at rest (Vr) and during an unreleased /k/ production (Vk). The efficiency of the technique to discriminate IVF and AVF was assessed by a ROC curve. Results: Mean Vk and Vr values (±SD) obtained were: 23.2±3.6 cm3 and 15.9±3.8 cm3 (AVF group), and 22.7±7.9 cm3 and 20.7±7.4 cm3 (IVF group), corresponding to a mean ΔV decay of 7.3 cm3 (31%) for the AVF group and a significantly smaller ΔV decay of 2.0 cm3 (9%) for the IVF group (

Three-dimensional assessment of the posterior airway space in subjects with cleft lip/palate and maxillomandibular discrepancy: preliminary results

Purpose: Patients with repaired cleft lip and palate usually develop a characteristic concave profile due to retroposition of the atresic maxilla resulting from maxillary growth restriction caused by primary plastic surgeries. These anatomical changes frequently reduce internal nasal dimension, increase nasal patency and may result in oral breathing in a significant number of patients. Reduced posterior airway space (PAS) and reduced nasal dimensions are characteristics also observed in patients with maxillomandibular discrepancy, even without cleft. Therefore, respiratory complaints are frequently observed and, in severe cases, the obstructive sleep apnea syndrome can be present as a result of reduced PAS. As part of a larger project, this study aimed at assessing the PAS of subjects with Angle class III malocclusion + cleft lip/palate, as compared to subjects with Angle class III malocclusion and without cleft lip/palate. Methods: Cone beam computed tomography images of 4 subjects with class III malocclusion, divided into 2 groups, were retrospectively evaluated: G1-cleft lip/palate, and G2-without cleft. PAS volume (mm3) and minimum cross-sectional area (mm2) and were assessed in tomographic images by means of Dolphin Imaging 11.0 software. Results: The mean volume and minimum cross-sectional area of G1 corresponded to 12970mm3 and 96mm2, respectively. In G2, these values were slightly higher and corresponded to 13642mm3 and 107mm2. Conclusions: These data point out to a possible reduction of PAS in subjects with cleft lip and palate. However, these results are preliminary and a larger study is being conducted at the Laboratory of Physiology/HRAC-USP, in order to assess a more representative sample.CAPESPRODO

Complicações respiratórias pós-palatoplastia: análise prospectiva

Objetivo: Identificar complicações respiratórias, com foco nos sintomas sugestivos de apnéia obstrutiva do sono (AOS), no pré-operatório, pós-operatório imediato e tardio, em crianças submetidas à palatoplastia. Método: Participaram 56 crianças de ambos os sexos, idade entre 6 a 15 meses, randomizadas em 2 grupos: caso (G1) e controle (G2). O G1 foi composto por crianças submetidas à palatoplastia e o G2 por crianças submetidas à queiloplastia. Para a coleta de dados utilizou-se o instrumento de MacLean et. al (2009) a fim de calcular o índice de AOS. Os resultados foram calculados por meio da equação: AOS= 1.42D + 1.41A + 0.71R &#8722; 3,83, onde: D avalia a dificuldade de respirar; A avalia a presença de apnéia e R avalia a presença de ronco, e o escore: < que -1 = ausência de AOS; entre -1 e 3,5 = possível AOS e, >3,5 = presença de AOS. As crianças foram analisadas no pré-operatório, no pós-operatório imediato, e no pós-operatório tardio. Para a análise estatística utilizou-se o Teste de Anova com significância de 5% (p&#8804;0,05). Resultados: Nas 3 etapas avaliadas, G1 e G2 apresentaram escores <1,0 indicando ausência de AOS, porém, no G1, observou-se maior incidência de ronco e respiração ruidosa no pós-operatório imediato em relação ao pré-operatório (p=0,00) e pós-operatório tardio (p=0,00). Conclusão: Os resultados sugerem que a palatoplastia contribui para ocorrência de alterações respiratórias agudas

Academic and clinical preparation in speech-language pathology and audiology: a global training consortium

ABSTRACT: Purpose: To describe a research-based global\ud curriculum in speech-language pathology and audiology that\ud is part of a funded cross-linguistic consortium among 2 U.S.\ud and 2 Brazilian universities.\ud Method: The need for a global curriculum in speechlanguage\ud pathology and audiology is outlined, and different\ud funding sources are identified to support development of a\ud global curriculum. The U.S. Department of Education’s Fund\ud for the Improvement of Post-Secondary Education (FIPSE), in\ud conjunction with the Brazilian Ministry of Education (Fundacao\ud Coordenacao de Aperfeicoamento de Pessoal de Nivel\ud Superior; CAPES), funded the establishment of a shared\ud research curriculum project, “Consortium for Promoting\ud Cross-Linguistic Understanding of Communication Disabilities\ud in Children” for East Tennessee State University and the University of Northern Iowa and 2 Brazilian universities\ud (Universidade Federal de Santa Maria and Universidade de\ud São Paulo-Baurú).\ud Results: The goals and objectives of the research-based\ud global curriculum are summarized, and a description of an\ud Internet-based course, “Different Languages, One World,” is\ud provided\ud Conclusion: Partnerships such as the FIPSE–CAPES consortium\ud provide a foundation for training future generations of\ud globally and research-prepared practitioners in speechlanguage\ud pathology and audiology.U.S. Department of Education Fund for the Improvement of Post-Secondary Education P116M100014Brazilian Ministry of Education Fundacao Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior 094/1

Effect of intravelar veloplasty on nasality in patients with velopharyngeal insufficiency

OBJETIVO: verificar o efeito da palatoplastia secundária realizada com veloplastia intravelar sobre a nasalidade e nasalância dos pacientes com fissura de palato reparada e insuficiência velofaríngea (IVF) e comparar os resultados entre estes pacientes, de acordo com o grau de fechamento velofaríngeo aferido na nasofaringoscopia. MÉTODO: estudo prospectivo com 40 pacientes de ambos os sexos, com idades entre 4 e 48 anos, com fissura de palato reparada e IVF residual, avaliado 3 dias antes e 8 meses após a palatoplastia, em média, divididos em dois grupos: um com 25 pacientes com falhas pequenas (grupo I) e outro com 15 pacientes com falhas médias a grandes (grupo II) no fechamento velofaríngeo. A hipernasalidade foi avaliada perceptivamente e nasalância foi avaliada por meio da nasometria. Diferenças entre grupos e etapas foram consideradas significativas ao nível de 5%. O estudo foi aprovado pelo Comitê de Ética para Pesquisa com Seres Humanos da Instituição. RESULTADOS: após a cirurgia, verificou-se redução da hipernasalidade em 84% dos pacientes do grupo I e em 73% dos pacientes do grupo II. Redução da nasalância foi observada em 52% dos casos do grupo I e em 43% dos pacientes do grupo II. CONCLUSÃO: a palatoplastia secundária com veloplastia intravelar levou à melhora da nasalidade na maioria dos pacientes analisados. Os resultados também demonstraram que a cirurgia foi mais efetiva nos pacientes que apresentavam falhas pequenas no fechamento velofaríngeo.PURPOSE: to check the effect of secondary palatoplasty performed with intravelar veloplasty on the nasality and nasalance of patients with repaired cleft palate and velopharyngeal insufficiency (VPI) and compare the outcome among these patients, according to the degree of velopharyngeal closure as analyzed by nasopharyngoscopy. METHOD: prospective study with 40 patients of both genders, aged from 4 to 48 years, with repaired cleft palate and residual VPI, evaluated for 3 days before and 8 months after palatoplasty, on average, divided into two groups: one with 25 patients with minor defect (group I) and the other with 15 patients with medium to large defect (group II) in velopharyngeal closure. Hypernasality was evaluated perceptually and nasalance was assessed by nasometry. Differences between groups and stages were considered to be significant at the 5% level. The local Ethics Committee for Human Research approved the study. RESULTS: after surgery, we observed a reduction of hypernasality in 84% of the patients from group I, and in 73% of the patients from group II. Reduction of nasalance scores were observed in 52% of the group I cases and in 43% of the group II. CONCLUSION: secondary palatoplasty performed with intravelar veloplasty led to improvement in nasality in most of the analyzed patients. The results further demonstrated that surgery was more effective in patients with minor defects in velopharyngeal closure

Increase in age is associated with worse outcomes in alveolar bone grafting in patients with bilateral complete cleft palate

Abstract: This prospective study aimed at evaluating the surgical outcomes of alveolar bone grafting (ABG) in subjects with bilateral cleft lip and palate treated at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil, by means of cone-beam computed tomography. Twenty-five patients with bilateral complete cleft lip and palate, resulting in 50 clefts, were analyzed. Subjects were divided into 2 groups according to the dentition status at the time of surgery: (1) SABG group: subjects with mixed dentition operated on before or immediately after eruption of the permanent canine (10–13 years); (2) TABG group: subjects with permanent dentition (15–23 years). Cone-beam computed tomography analysis was performed in the buccal, intermediate, and palatal views, 2 and 6 to 12 months postoperatively. In the SABG group, 96% of the grafts were classified as successful, and no failure cases were observed. In the TABG group, successful cases decreased to 65%, and failures were seen in 27% of the cleft sites. In both postoperative periods, significantly better outcomes (lower mean scores) were observed for the SABG group in all the cone-beam computed tomography views (P < 0.05). Results show that the timing of surgery is an important factor in determining the outcomes of ABG in patients with bilateral cleft lip and palate, with increasing age being associated with the worse outcomes.CAPESPRODO