Orofacial Myofunctional Evaluation Research Articles

Three-dimensional analysis of jaw kinematic alterations in patients with chronic TMD - disc displacement with reduction.

The study investigated whether chronic TMD patients with disc displacement with reduction (DDR), performing non-assisted maximum jaw movements, presented any changes in their mandibular kinematics with respect to an age-matched control group. Moreover, it was examined whether jaw kinematics and a valid clinic measure of oro-facial functional status have significant associations. Maximum mouth opening, mandible protrusion and bilateral laterotrusions were performed by 20 patients (18 women, 2 men; age, 18-34 years) and 20 healthy controls (17 women, 3 men; age, 20-31 years). The three-dimensional coordinates of their mandibular interincisor and condylar reference points were recorded by means of an optoelectronic motion analyser and were used to quantitatively assess their range of motion, velocity, symmetry and synchrony. Three functional indices (opening-closing, mandibular rototranslation, laterotrusion - right and left - and protrusion) were devised to summarise subject's overall performance, and their correlation with the outcome of a clinical protocol, the oro-facial myofunctional evaluation with scores (OMES), was investigated. TMD patients were able to reach maximum excursions of jaw movements comparable to healthy subjects' performances. However, their opening and closing mandibular movements were characterised by remarkable asynchrony of condylar translation. They had also reduced jaw closing velocity and asymmetric laterotrusions. The functional indices proved to well summarise the global condition of jaw kinematics, highlighting the presence of alterations in TMD-DDR patients, and were linearly correlated with the oro-facial functional status. The jaw kinematic alterations seem to reflect both oro-facial motor behaviour adaptation and a DDR-related articular impairment.

Assessment of the differences in masticatory behavior between male and female adolescents

Chewing behavior may show sex differences; thus, the present study aimed to compare the masticatory aspects and the prediction of masticatory performance between male and female adolescents. Ninety-one healthy subjects (47 girls, 44 boys), caries-free and aged 14–17years, were included. Masticatory performance and maximal bite force were evaluated using a color-changeable chewing gum and digital gnathodynamometer, respectively. Masticatory behavior was assessed by the subjective aspect of the quality of the masticatory function (validated questionnaire) and the Orofacial Myofunctional Evaluation with Scores expanded (OMES-e) was used to determine chewing time, frequency of chewing cycles and other aspects. Salivary flow rate was also assessed. The physical examination involved measurements of facial morphometry, body weight, height, skeletal muscle mass, and dental/occlusal evaluations. It was observed that boys showed larger facial dimensions, higher bite force and chewing frequency and better masticatory performance than girls. They also showed shorter chewing time, fewer chewing cycles and lower score for OMES-e (that is, more changes in orofacial myofunctional aspects). Bite force showed a weak correlation with skeletal muscle mass only in boys (r=0.3035; p=0.0451). The masticatory performance was dependent on the bite force in boys (Adj R2=19.2%; Power=84.1%); among girls, masticatory performance was dependent on the frequency of chewing cycles and masticatory behavior (subjective aspect) (Adj R2=34.1%; Power=96.1%). The findings support the existence of sex differences in many masticatory aspects of function and behavior, hence the importance of considering sex differences when evaluating masticatory function and myofunctional therapy outcomes among young subjects.

Translation and cross-cultural adaptation of the protocol of orofacial myofunctional evaluation with scores for Italian Language.

The protocol of orofacial myofunctional evaluation with scores (OMES-protocol or AMIOFE in Portuguese language) is a validated instrument for the diagnosis of orofacial myofunctional disorders that can be used in clinical practice for speech-language pathologists. Because in the Italian language there is no validated tool for such purpose, this study was developed. To translate and culturally adapt the OMES-protocol for Italian language and determine the normal score value in a group of young Italian adults. The OMES-protocol was translated from English to Italian by three bilingual individuals. From these translations, a consensus version was prepared by a research committee (three speech therapists and one physician and submitted to a committee of judges composed by eight speech therapists experienced in the area. The authors of the original version verified and approved the Italian version of the protocol. The instrument was tested via evaluations of 40 young and grown-up Italians (age range: 18-56 years) performed by two speech therapists. A cutoff score, previously described, was used to determine the mean and standard deviation. The translation stage and the final Italian version of the OMES-protocol are shown. The mean of scores for individuals with and without orofacial myofunctional disorders were presented. The Italian version of the OMES-protocol was developed, translated, and cross-culturally adapted. Normal values for young and adult Italian subjects are presented.

Ganhos funcionais mensurados pelo MBGR e impacto na qualidade de vida em sujeito submetido à cirurgia ortognática: relato de caso

Resumo: O tema proposto é Intervenção Fonoaudiológica pré e pós Cirurgia Ortognática. Foi realizada avaliação (por meio do Protocolo de Avaliação Miofuncional Orofacial MBGR com escores) e intervenção fonoaudiológica em período pré-operatório (por três meses) e pós-operatório iniciado no 20º dia (por três meses), após a liberação do cirurgião. Além disso, investigou-se o impacto da deformidade dentofacial na qualidade de vida do paciente, por meio do Oral Health Impact Profile - versão reduzida. Na avaliação pré-operatória, foram encontradas mastigação bilateral simultânea, presença de ruídos na Articulação Temporomandibular e fechamento labial assistemático durante a realização da função. Durante a deglutição houve contração da musculatura perioral e presença de resíduos após essa função. Encontrou-se na fala distorção no fonema /r/. Houve dor à palpação nos músculos mastigatórios e diminuição da tonicidade na musculatura perioral e mastigatória. Encontrou-se alto impacto na qualidade de vida, totalizando em 32 pontos. Na avaliação após a intervenção fonoaudiológica, observou-se melhora nas funções de mastigação (pré: 4 pontos, pós: 1 ponto), deglutição (pré:14, pós :5), respiração (pré: 3, pós: 1) e fala (pré: 7, pós: 1), na mobilidade muscular (pré: 8, pós 1), na tonicidade da musculatura (pré 5, pós: 0) e na dor à palpação (pré: 10, pós: 2). Houve melhora na postura dos lábios e melhora significante na qualidade de vida, passando de 32 para 8 pontos. Constatou-se melhora na fisiologia das funções estomatognáticas, diminuição da dor à palpação, equilíbrio no tônus, na mobilidade muscular e melhora na qualidade de vida.

Validity and reliability of a protocol of orofacial myofunctional evaluation for patients with obstructive sleep apnea

There is no standardized protocol for the clinical evaluation of orofacial components and functions in patients with obstructive sleep apnea. The aim of this study was to examine the validity, reliability, and psychometric properties of the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES-expanded) in subjects with obstructive sleep apnea. Patients with obstructive sleep apnea and control subjects were evaluated, and the validity of OMES-expanded was tested by construct validity (i.e. the ability to discriminate orofacial status between apneic and control subjects) and criterion validity (i.e. correlation between OMES-expanded and a reference instrument). Construct validity was adequate; the apneic group showed significantly worse orofacial status than did control subjects. Criterion validity of OMES-expanded was good, as was its reliability. The OMES-expanded is valid and reliable for evaluating orofacial myofunctional disorders of patients with obstructive sleep apnea, with adequate psychometric properties. It may be useful to plan a therapeutic strategy and to determine whether the effects of therapy are related to improved muscle and orofacial functions.

Muscular and functional changes following adenotonsillectomy in children

BackgroundIt is recognized that adenotonsillar hypertrophy leads to muscular and functional changes in face, and that adenotonsillectomy is associated to improvement in this condition. However, the ideal interval one should wait until this spontaneous recovery is not well defined, neither if this recovery is expected to be complete or partial. ObjectiveTo compare the muscular and functional changes in face of children prior and after adenotonsillectomy in a monthly evaluation. Methods8 children aged from 4 to 6 years were prospectively studied. All patients underwent adenotonsillectomy, and were assessed before and monthly-after surgery up to 6 months, through the Protocol of Orofacial Myofunctional Evaluation with Scores (OMES). ResultsThere was a progressive improvement in OMES score in all measured parameters, including the “mobility” and “posture” sub-tests; this improvement was significant at the first month after surgery. The sub-test “function” was not affected by surgery. Improvement continued from the first to the sixth month after surgery, although it was not significant between these two periods. Additionally, all parameters remained altered after the final evaluation at six months. There was a significant correlation between the improvement in “mobility” sub-test and in total score of OMES. ConclusionWe observed a partial recovery in facial muscular and functional changes following adenotonsillectomy, particularly during the first month after surgery. This improvement was especially observed in the “mobility” and “posture” sub-tests. We conclude that waiting for a spontaneous muscular and functional facial recovery during the first month post-operatively seems reasonable. Nevertheless, after this period, if the patient fails to achieve recovery, it may be advised that this child should undergo myofunctional therapy.

Caracterização da pressão da língua em idosos

Objetivo Caracterizar a pressão da língua em idosos. Métodos Estudo transversal, com a participação de 45 idosos, de 61 a 96 anos, sendo 34 (75,6%) do gênero feminino e 11 (24,4%) do masculino, sem distúrbios neurológicos e cognitivos, sem histórico de câncer de cabeça e pescoço e de procedimento radioterápico. Consistiu na aplicação de questionário, com registro da presença ou ausência de queixa de problemas na deglutição, seguido da avaliação miofuncional orofacial, enfocando a mobilidade e tensão de língua. Para a mensuração da pressão da língua, foi utilizado o Iowa Oral Performance Instrument (IOPI). A análise dos dados foi descritiva, com nível de significância de 5%. Resultados A média do pico pressórico foi de 44,6 KPa (±16), com os valores mínimo e máximo entre 9 e 88 KPa. Houve correlação moderada negativa entre pico pressórico e idade. Os longevos apresentaram a menor média de pico pressórico e inferior ao padrão de normalidade. Houve diferença entre a média de pico pressórico e uso de próteses, tensão de língua e mobilidade de língua no estalo. Conclusão Houve diminuição moderada do pico pressórico da língua com o aumento da idade e redução pressórica com o decréscimo da tensão da língua e de sua mobilidade no estalo. Em contrapartida, os valores de pico foram maiores nos idosos que utilizam próteses dentárias, quando comparados aos que destas não fazem uso.

Computerized protocol of orofacial myofunctional evaluation with scores: usability and validity.

To test the usability of Computerized Orofacial Myofunctional Evaluation (OMES) protocol and analyze its validity. The study was divided into three stages: the first stage, production of the computerized version of OMES. The second stage was the validation of the user's interface, in which 100 OMES protocols of a database, filled in printed version, were transferred using the computerized instrument. Necessary changes to the system have occurred at this stage. In the third stage, usability of the OMES protocol in multimedia version, three evaluators transferred data from other 25 printed protocols from database for the computerized version, and the time to transfer the data of each protocol was computed and compared between examiners by one-way ANOVA. Moreover, these evaluators analyzed the usability of computerized protocol according to the "Ten principles of Heuristics usability" as described in the literature. The computerized protocol satisfied the principles of heuristics usability, according to the evaluation of the three Speech-Language Pathology evaluators, and the average time spent by the evaluators to transpose the data of each protocol to the software ranged from 3.1 ± 0.75 to 3.83 ± 0.91 minutes. The Computerized AMIOFE protocol is valid and had its usability/functionality confirmed.

Analysis of validity in adults of the expanded protocol of orofacial myofunctional evaluation with scores

Patients with various acquired diseases (e.g. cerebrovascular accident, traumatic brain injury), degenerative diseases (e.g. Parkinson’s disease, multiple sclerosis), obstructive sleep apnea (OSA), among others, may benefit from therapy protocols with orofacial exercise. But, an important role for this therapy process as documentation of the orofacial myofunctional characteristics is necessary. The Orofacial Myofunctional Evaluation Protocol with Scores (OMES) is an instrument validated to assess orofacial myofunctional status on children and adults. So far, the expanded version (OMES-E) in terms of numerical scales and items was validated for children only. The aims of this study were to analyze the validity, the reliability of the OMES-E protocol in adults. Participants were 50 subjects (21 to 59 years old, mean 41.44 ± 11.38), without distinction of race and gender. The exclusion criteria were neurological or cognitive deficit, tumors or traumas in the head and neck, and use of medication. One speech therapist performed the examination . To analyze criterion validity, the subjects were evaluated individually with the OMES-E protocol, according to the previously described methodology. After, based on video-recorded images, the subjects were revaluated using the OMES as reference protocol. The correlation between the protocols was calculated. The test of the reliability of interpretation of the OMES-E was performed with revaluation of 20% of the sample. To analyze the construct validity, we calculated the sensitivity (S), specificity (E), accuracy (A) and predictive values (VP+ e VP−). For these, the cut-off point proposed for OMES and OMES-S, the 75th, was adopted. Thus, subjects who presented an OMES score lower than 80 and an OMES-E score lower than 152 were considered to have relevant OMD. Descriptive statistical analysis for the OMES-E protocol was performed. Spearman correlation and coefficient Kappa weighted (Kw) was performed using the MedCalc software. Significance level was 0.05. There was statistical correlation between the OMES and OMES-E protocols ( r = 0.87). Inter-examiner (E1 × E2) agreement and reliability with the OMES-E protocol was 0.74 and r = 0.75 respectively. For the OMES-E protocol mean values of 0.90 for A, 0.67 for S, 0.91 for E, 0.77 for VP+ and 0.86 for VP− were found. Thus, the OMES-E protocol is valid and reliable for adult orofacial myofunctional evaluation, with good S, E and A, as well as predictive values. This work received support from CAPES, the Brazilian Federal Agency for Support and Evaluation of Postgraduate Education.

Orofacial myofunctional evaluation with scores in subjects with obstructive sleep apnea

Orofacial myofunctional disorders (OMD) are common in patients with Obstructive Sleep Apnea (OSA), thus, it is necessary a detailed and precise clinical instrument for assessment of the OMD in this population, since the orofacial exercise has been recommended with positive results in patients with OSA. The Expandend Protocol of Orofacial Myofunctional Evaluation with Scores (OMES-E) is a validity instrument for the clinical evaluation of the orofacial myofunctional condition, that permit the examiner to express numerically the perception of the characteristics and behaviors observed in children. Thus, the aim of this study was to verify if the OMES-E protocol can discriminate the myofunctional orofacial characteristics in healthy adults and with OSA. Participated 133 subjects (19–60 years old), both genders (99 with untreated OSA, diagnosed by polysomnography - group OSA) and 34 healthy subjects, without OSA signs or symptoms (group C). Exclusion criteria were neurological or cognitive deficit, tumors or traumas in the head and neck, and use of analgesic, anti-inflammatory and psychiatric drugs. One speech therapist with experience in orofacial myofuncional evaluation performed the examination. The subjects were evaluated individually with the OMES-E protocol, according to the previously described methodology. To verify if the OMES-E protocol would be able to discriminate the myofunctional orofacial characteristics in the subjects with and without OSA, the analysis of covariance adjusted for the mean, with two variation factors (Group and Gender) was performed for the protocol Categories (Appearance/Posture, Mobility, Respiration, Deglutition and Mastication). Multiple Regression Analysis was calculated to verify the possible association between the variables Age and Body Mass Index (BMI) with the protocol Categories. Statistica software was used, significance level at 0.05. There was a higher percentage of OMD in group OSA compared to C ( p < 0.001). There were no differences regarding Gender to Categories of the protocol or interaction effect between Gender and Categories, but between Group and Categories. There was association between BMI with the Categories Appearance/Posture, Respiration ( p < 0.01) and Mobility ( p < 0.05), and between Age with Mobility ( p < 0.05). Thus, the OMES-E protocol is able to discriminate the orofacial myofunctional characteristics in health adults and in patients with OSA. This work received support from CAPES, the Brazilian Federal Agency for Support and Evaluation of Postgraduate Education.

Mastigação e deglutição em mulheres jovens com desordem temporomandibular

To evaluate chewing and swallowing functions in women with and without temporomandibular disorder (TMD) and investigate the position of the mandible and the hyoid bone as they are important structures in the development of these functions. Seventy women were evaluated in relation to TMD diagnosis according to the Research Diagnostic Criteria, among them, 34 composed the study group (SG) with TMD and 36 took part in the control group (CG). Evaluation of the masticatory and swallowing functions was performed according to the Protocol of Orofacial Myofunctional Evaluation with Scores. Mandibular and hyoid bone position variables were measured by cephalometric analysis. TMD subjects showed a significant difference on tongue (p=0.03) and lip (p=0.04) posture during swallowing function, and a more frequent adoption of a chronic unilateral chewing pattern as well (p=0.03). Moreover, they presented a lower position of the hyoid bone in relation to the mandible (p=0,00). TMD presence resulted on a higher frequency of myofunctional alterations during masticatory and swallowing functions. A greater distance from hyoid bone to the mandible in addition with the presence of painful symptom can justify, partly, the atypical behaviors of the tongue and lips observed on TMD group. The TMD repercussion on alimentaires functions in a young age group justifies the importance of an earlier diagnosis and therapeutic intervention in these individuals.

Does Low Intensity Laser Therapy Reduce Pain and Change Orofacial Myofunctional Conditions?

Due to its multifactorial pain aspects, combined therapies are required for the the comprehensive management of temporomandibular joint disorders (TMD). Interdisciplinary forms of therapies, such as laser therapy, and health care or medical professionals, such as speech therapists, have been proposed for this comprehensive management. The aims of this study were the following: 1. verify whether low-intensity laser therapy would promote significant pain remission; 2. evaluate whether this changes orofacial myofunctional conditions in the sample, as tested, using the Orofacial Myofunctional Evaluation with Scores (OMES); and 3. evaluate whether or not the pain improvement would remain stable after a 30-day follow-up for pain conditions. The study included 12 female volunteers diagnosed with myofascial pain and ages ranging from 18 to 60 years old, with or without intra-articular TMD, according to axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Participants were assessed for pain on palpation, using a visual analogue scale (VAS), before treatment (A1), immediately after 30 days of intervention, i.e, after eight sessions of Low Intensity Laser Therapy (LILT) (A2), and 30 days after the end of the treatment with LILT (A3) (follow-up). Comparing the three evaluation times, it was observed that there was a significant decrease in the values of subjective pain to palpation (p<0.05). The initial pain (A1) differed significantly from the A2, but did not differ significantly from A3.

Relationship between craniocervical posture, mandible and hyoid bone and influence on alimentary functions

Aim: To evaluate the anatomical relationship between craniocervical posture and mandibular and hyoid bone position and the influence on the masticatory and swallowing functions. Methods: Thirty-six women aged 19 to 35 years without temporomandibular disorder diagnosis were evaluated. Variables related to the craniocervical posture and mandibular and hyoid bone position were obtained by cephalometric measurements. Masticatory and swallowing function evaluations were performed according to a protocol of orofacial myofunctional evaluation with scores. Results: Significant correlations were observed between craniovertebral angle and the linear distance from the hyoid bone to the mentum (p=0.02) and to the mandible (p=0.03). The angle that measured the forward head position also demonstrated a significant correlation with the linear distance between hyoid bone and jaw (p=0.00). The cervical curvature degree showed a significant correlation with the linear distance from hyoid bone to the third cervical vertebra (p=0.01). Modifications of the cranium base inclination in relation to the cervical column at the two levels (NSL/CVT and NSL/OPT) were the only variables, which showed a significant correlation with the mandible position. Important craniocervical postural changes were observed in the subjects, although there was no association between them and a higher frequency of atypical behaviors evaluated during masticatory and swallowing functions. Conclusions: Cephalometric findings confirm the anatomical relationship between craniocervical posture, mandible and hyoid bone. However, association between craniocervical posture alterations and masticatory and swallowing function impairments was not detected. Such findings suggest that, in the presence of a musculoskeletal imbalance, the body readapts itself ensuring that alimentary functions will not be affected.

Validity of the ‘protocol of oro‐facial myofunctional evaluation with scores’ for young and adult subjects

The aims of this study were to analyse the validity, sensitivity and specificity of the protocol of oro-facial myofunctional evaluation with scores (OMES) for oro-facial myofunctional disorder (OMD) diagnosis in young and adult subjects. Eighty subjects were examined. The OMES was validated against the Nordic orofacial test-screening (NOT-S) protocol (criterion validity) (Spearman correlation test). The construct validity was tested by analysis of the ability of the OMES (i) to differentiate healthy subjects (n = 22) from temporomandibular disorder (TMD) patients (n = 22), which frequently have OMD (Mann-Whitney test) and (ii) to measure the changes that occurred in a subgroup with TMD between the period before and after oro-facial myofunctional therapy (T group, n = 15) (Wilcoxon test). Two speech therapists trained with the OMES participated as examiners (E). There was a statistically significant correlation between the OMES and NOT-S protocols, which was negative because the two scales are inverse (r = -0·86, P < 0·01). There was a significant difference between the healthy and TMD subjects regarding the oro-facial myofunctional status (OMES total score, P = 0·003). After therapy, the T group showed improvement in the oro-facial myofunctional status (OMES total score, P = 0·001). Inter- and intra-examiner agreement was moderate, and the reliability coefficients ranged from good to excellent. The OMES protocol presented mean sensitivity and specificity = 0·80, positive predictive value = 0·76 and negative predictive value = 0·84. The OMES protocol is valid and reliable for clinical evaluation of young and adult subjects, among them patients with TMD.

Effects of Orofacial Myofunctional Therapy on Temporomandibular Disorders

The objectives of the current study were to analyze the effects of orofacial myofunctional therapy (OMT) on the treatment of subjects with associated articular and muscular temporomandibular disorders (TMD). Thirty subjects with associated articular and muscular TMD, according to the Research Diagnostic Criteria (RDC/TMD), were randomly divided into groups: 10 were treated with OMT (T group), 10 with an occlusal splint (OS group), and 10 untreated control group with TMD (SC). Ten subjects without TMD represented the asymptomatic group (AC). All subjects had a clinical examination and were interviewed to determine Helkimo’s Indexes (Di and Ai), the frequency and severity of signs and symptoms, and orofacial myofunctional evaluation. During the diagnostic phase, there were significant differences between groups T and AC. There were no significant differences between group T and OC and SC groups. During the final phase, groups T and OS presented significant improvement, however, the group T presented better results and differed significantly from group OS regarding the number of subjects classified as AiII; the severity of muscular pain and TMJ pain; the frequency of headache and the muscles and stomatognathic functions. The group T differed significantly from the SC group but no longer differed significantly from the AC group. OMT favored a significant reduction of pain sensitivity to palpation of all muscles studied but not for the TMJs; an increased measure of mandibular range of motion; reduced Helkimo’s Di and Ai scores; reduced frequency and severity of signs and symptoms; and increased scores for orofacial myofunctional conditions.

Expanded protocol of orofacial myofunctional evaluation with scores: Validity and reliability

Objective Clinical evaluation of the stomatognathic system is indispensable for the diagnosis of orofacial myofunctional disorders. In order to obtain a more precise diagnosis, the protocol of orofacial myofunctional evaluation with scores (OMES protocol) (Int. J. Pediatr. Otorhinolaryngol. 72 (2008) 367–375) was expanded in terms of number of items and scale amplitude. The proposal of this study is to describe the expanded OMES protocol (OMES-E) for the evaluation of children. Validity of the protocol, reliability of the examiners and agreement between them were analyzed, as also were the sensitivity, specificity and predictive values of the instrument. Methods The sample consisted of videorecorded images of 50 children, 25 boys (mean age = 8.4 years, SD = 1.8) and 25 girls (mean age = 8.2 years, SD = 1.7) selected at random from 200 samples. Three speech therapists prepared for orofacial myofunctional evaluation participated as examiners (E). The OMES and OMES-E protocols were used for evaluation on different days. E1 evaluated all images, E2 analyzed children with recordings from 1 to 25 and E3 analyzed children with recordings from 26 to 50. The validity of OMES-E was analyzed by comparing the instrument to the OMES protocol using the Pearson correlation test complemented with the split-half reliability test ( p < 0.05). The linear weighted Kappa coefficient of agreement (Kw′), the sensitivity, specificity and predictive values and the prevalence of OMD were calculated. Results There was a statistically significant correlation between the OMES and OMES-E protocols (0.79 > r < 0.94, p < 0.01) and a significant test–retest correlation with the OMES-E (0.75 > r < 0.86, p < 0.01), with a reliability range of 0.86–0.93. The correlation and reliability coefficients between examiners were: E1 × E2 ( r = 0.74, 0.84), E1 × E3 ( r = 0.70, 0.83) ( p < 0.01). Kw′ coefficients with moderate and good strength predominated. The OMES-E protocol presented mean sensitivity = 0.91, specificity = 0.77, positive predictive value = 0.87 and negative predictive value = 0.85. The mean prevalence of OMD was 0.58. Conclusion The OMES-E protocol is valid and reliable for orofacial myofunctional evaluation.

Distância interincisiva máxima em crianças respiradoras bucais

INTRODUÇÃO: a distância interincisiva máxima é um importante aspecto na avaliação miofuncional orofacial, pois distúrbios miofuncionais orofaciais podem limitar a abertura da boca. OBJETIVO: mensurar a distância interincisiva máxima de crianças respiradoras bucais, relacionando-a com a idade, e comparar as médias dessas medidas com as médias dessa distância em crianças sem queixas fonoaudiológicas. MÉTODOS: participaram 99 crianças respiradoras bucais, de ambos os gêneros, com idades entre 7 anos e 11 anos e 11 meses, leucodermas, em dentadura mista. O grupo controle foi composto por 253 crianças, com idades entre 7 anos e 11 anos e 11 meses, leucodermas, em dentadura mista, sem queixas fonoaudiológicas. RESULTADOS: os achados evidenciam que a média das distâncias interincisivas máximas das crianças respiradoras bucais foi, no total da amostra, de 43,55mm, não apresentando diferença estatisticamente significativa entre as médias, segundo a idade. Não houve diferença estatisticamente significativa entre as médias da distância interincisiva máxima dos respiradores bucais e as médias dessa medida das crianças do grupo controle. CONCLUSÕES: a distância interincisiva máxima é uma medida que não variou nos respiradores bucais, durante a dentadura mista, segundo a idade, e parece não estar alterada em portadores desse tipo de disfunção. Aponta-se, também, a importância do uso do paquímetro na avaliação objetiva da distância interincisiva máxima.

Protocol of orofacial myofunctional evaluation with scores

In the literature there is no validated instrument for the clinical evaluation of the orofacial myofunctional condition of children that will permit the examiner to express numerically his perception of the characteristics and behaviors observed. The proposal of this study is to describe a protocol for the evaluation of children aged 6-12 years in order to establish relations between the orofacial myofunctional conditions and numerical scales. The protocol validity, reliability of the examiners and agreement between them was analyzed. Eighty children aged 6-12 years participated in the study. All were evaluated and 30 were selected at random for the analyses (age range: 72-149 months, mean=103.3, S.D.=23.57). Individuals with and without orofacial myofunctional disorders were included. The examiners were two speech therapists properly calibrated in orofacial myofunctional evaluation. Two protocols were constructed. One, based on traditional models, was called traditional orofacial myofunctional evaluation (TOME), and the other, with the addition of numerical scales, was called orofacial myofunctional evaluation with scores (OMES). The clinical conditions included were: appearance, posture and mobility of lips, tongue, cheeks and jaws, respiration, mastication and deglutition. Statistical analysis was performed using the split-half reliability method. Means, standard deviations and the Spearman correlation coefficient were also calculated. There was a statistically significant correlation between the evaluations of 30 children assessed with the TOME and OMES protocols (r=0.85, p<0.01). The reliability between protocols was 0.92. The test-retest reliability of the OMES instrument was 0.99 and the correlation was 0.98. Reliability between examiners 1 and 2 using the OMES protocol was 0.99, and the correlation was 0.98 (p<0.01). The OMES protocol proved to be a valid and reliable instrument for orofacial myofunctional evaluation, permitting the grading of orofacial myofunctional conditions within the limits of the selected items.

Occlusal and orofacial myofunctional evaluation in children with primary dentition, anterior open bite and pacifier sucking habit

The aim of this study was to evaluate occlusal and orofacial myofunctional characteristics in children three to five years of age with anterior open bite related to a pacifier sucking habit. Sixty-nine children participated in this study: 35 with anterior open bite (Anterior Open Bite Group - AOBG) and 34 with normal occlusion (Control Group - CG). In AOBG, the mean anterior open bite was 2.96 mm, the mean overjet was 4.1 mm and the mean upper intercanine distance was 28.7 mm. In the CG, the mean overjet was 2.6 mm and the upper intercanine distance was 30.3 mm. The mean overjet was greater (p=0.001) in AOBG than in CG, and the mean upper intercanine distance was smaller (p&lt;0.001) in AOBG. The number of children with a canine Class II relationship was greater in AOBG than in CG (p&lt;0.001). Simple logistic regression analysis showed that greater overjet, smaller upper intercanine distance and Class II canine relationship coexisted with anterior open bite. In AOBG, the number of children with incompetent lips, inadequate lip tonus, lack of proper tongue rest position, inadequate cheek tonus, anterior tongue interposition during swallowing and speech was greater (p&lt;0.05) than in CG. Multiple logistic regression analysis identified anterior tongue interposition during swallow and speech, as well as incompetent lips, as the main orofacial myofunctional characteristics in children with anterior open bite.

Distância interincisiva máxima em crianças na dentadura mista

A distância interincisiva máxima é muito importante na avaliação miofuncional orofacial, pois distúrbios miofuncionais orofaciais e cervicais podem limitar a abertura da boca. O objetivo deste estudo foi descrever a distância interincisiva máxima e verificar se há diferença estatisticamente significante entre as médias desta medida, segundo idade e gênero. Participaram 253 crianças, com idades entre 7,0 e 11,11 anos, leucodermas, na dentadura mista, sem queixas fonoaudiológicas. Os resultados mostram que a média da distância interincisiva máxima foi, no total das crianças, 44,75mm e apresentou diferença estatisticamente significante entre as médias das idades, no gênero masculino. As meninas apresentaram médias inferiores às dos meninos. Como conclusão da pesquisa, aponta-se a importância de considerar a idade e o gênero durante a avaliação da distância interincisiva máxima em crianças