Orofacial Rehabilitation Research Articles

Management of Ankyloglossia and Breastfeeding Difficulties in the Newborn: Breastfeeding Sessions, Myofunctional Therapy, and Frenotomy.

The problems of suction in newborns give rise to multiple consequences for both the mother and the newborn. The objective of this paper is to present a case of ankyloglossia (“tongue-tie”) and the suction problems that were treated by a multidisciplinary team. The subject is a 17-day-old male patient, with ankyloglossia and suction problems during breastfeeding (pain in the breastfeeding mother, poor weight gain, and long breastfeeds). The patient followed the circuit established in our centre between the services of Oral and Maxillofacial Surgery and Breastfeeding and Speech Therapy and Orofacial Rehabilitation (CELERE). The evolution following the breastfeeding sessions, the myofunctional stimulation, and the lingual frenotomy was very favourable, thereby solving the suction problems that the newborn presented. All our patients receive breastfeeding sessions and myofunctional therapy as treatment. We know that a frenotomy is not always necessary and we believe that the stimulation of sucking before and after the surgical intervention is important in order to improve the final result.

Trophic electrical stimulation: a case for Oro-facial rehabilitation

Trophic electrical stimulation: a case for Oro-facial rehabilitation

Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol

BackgroundPartial ankyloglossia is a limitation which restricts the possibility of protrusion and elevation of the tip of the tongue due to the shortness of either the lingual frenulum or the genioglossus muscles or both. The principal objective of this paper is to present our protocol of action for the treatment of ankyloglossia. The specific objectives are to study patients with ankyloglossia treated by the Service of Maxillofacial Surgery and the Service of Speech Therapy of our pediatric Hospital, describe the diagnostic procedures, the pre-surgical intervention, the surgical technique undertaken and the post-surgical rehabilitation taking into account the level of collaboration of the patients, and finally, describe the surgical complications and the referral of patients.Material and MethodsThis is a descriptive study of healthy patients, without any diagnosis of syndrome, ranging between 4 and 14 years that have been surgically treated and rehabilitated post-surgery within a period of 2 years.Results101 frenectomies and lingual plasties have been performed and patients have been treated following the protocol of action that we hereby present. After the surgical intervention, the degree of ankyloglossia has been improved, considering correction in 29 (28%) of the patients (95% CI: 20%, 38%), reaching, with the post-surgical orofacial rehabilitation, a correction of 97 (96%) of the participants (95% CI: 90%, 98%).ConclusionsThe chosen surgical technique for moderate-severe ankyloglossia in our centre is the frenectomy and lingual plasty. The myofunctional training begins one week before the surgical intervention so that the patients learn the exercises without pain. Key words:Ankyloglossia, tongue-tie, lingual frenum.

Full thickness facial burns: Outcomes following orofacial rehabilitation

PurposeTo document orofacial rehabilitation and outcomes after full thickness orofacial burn. MethodsParticipants included 12 consecutive patients presenting with full thickness orofacial burns. A group of 120 age-matched healthy participants was recruited for normative comparison. Non-surgical exercise was initiated within 48h of admission and continued until wounds had healed, circumoral scar tissue had stabilised and functional goals were achieved to the best of the patient's ability. Outcomes were documented using vertical and horizontal mouth opening measures at start and end of treatment and therapy duration was recorded. ResultsAt commencement of treatment, participants had significantly (p<0.001) reduced vertical and horizontal mouth opening range compared to controls. Average duration of orofacial contracture management was 550 days, with half requiring >2 years rehabilitation. By end of treatment, significant (p<0.01) positive improvement in vertical and horizontal mouth opening had been achieved, however measures had returned to lower limits of normal function and remained significantly (p<0.05) reduced compared to the control group. ConclusionThis study demonstrates that although positive gains can be achieved through non-surgical exercise after full thickness burn, the duration of rehabilitation is considerable and some degree of long term loss in functional mouth opening remains.

Tonsillectomy – Orthodontics: Which sequences in children?

The most common cause of childhood obstructive sleep apnea syndrome (OSAS) is adenotonsillar hypertrophy. Aside from nocturnal symptoms, children with OSAS may present with lower school performance, behavioral disorder, cardiovascular complications and failure to thrive. First-line treatment is adenotonsillectomy; however, residual OSAS on postoperative polygraphy is reported in 20% to 40% of cases. In well-selected cases, orthodontic treatment can play an important role in the management of light to moderate childhood OSAS or residual OSAS after surgery, using growth activators or oral mandibular advancement appliances, rapid maxillary expansion and orofacial rehabilitation. Nevertheless, clinical studies with a high level of evidence of efficacy are lacking. To illustrate therapeutic sequences that may include an orthodontic phase, we present clinical cases encountered in our multidisciplinary outpatients clinic.

The role of the orthodontist in the early simulating plate rehabilitation of children with Down syndrome

Introduction. Abnormalities in the oro-facial complex in children with Down syndrome can be corrected through oro-facial therapy which makes use of a palatal plate.Aim. The aim of this study was to present the therapeutic effects of orthodontic palatal plate therapy in children with Down syndrome.Material and methods. The study was conducted on 50 children with Down syndrome between the ages of 3 months and 2 years who were treated by means of stimulating plate therapy a period of two years.Results. The study found that in 50% children with Down syndrome who underwent palatal plate oro-facial rehabilitation there was a visual improvement of the mimetic muscles, tongue retraction as well as lip closure. Conclusions. The care by orthodontist and early palatal plate therapy ought to constitute an integral part of the comprehensive multidisciplinary rehabilitation of children with Down syndrome.

A two-step (altered cast) impression technique in the prosthetic rehabilitation of a patient after a maxillectomy: A clinical report

This clinical report describes the prosthetic rehabilitation complicated by trismus (as a consequence of surgery and radiation therapy) of a patient with an acquired maxillary defect, after surgical removal of the right maxillary sinus tumor. The patient was restored with a partial removable dental prosthesis with a hollow bulb obturator to obtain orofacial rehabilitation and defect obturation. Precise obturation requires an accurate impression of the resection defect. A 2-step impression was performed because of trismus. A primary maxillary impression was made with an irreversible hydrocolloid, while a secondary (altered cast) impression was made with a silicone material by using the obturator cast framework as a tray. In that way an altered cast was produced. Subsequently, an obturator prosthesis was processed with a conventional technique.

Alterações de funções orais na presença de aparelhos ortodônticos fixos com recursos intraorais

OBJETIVO: investigar as possíveis alterações de fala, mastigação e deglutição em usuários de aparelhos ortodônticos com recursos intraorais fixos no palato. MÉTODO: foram avaliados 28 pacientes de ambos os sexos, na faixa etária de 10 a 24 anos, em tratamento no Centro de Reabilitação Estética Orofacial em Campinas. Tais pacientes foram avaliados por fonoaudiólogas antes da colocação do aparelho e após trinta dias de uso de aparelho ortodôntico com recurso fixo. Todos os sujeitos foram avaliados previamente por ortodontistas e apresentaram indicação de colocação do recurso intraoral. O exame fonoaudiológico foi composto pela avaliação da mastigação, deglutição e fala, segundo protocolo especifico de motricidade orofacial, e de teste de fala na área de fonética. Os testes estatísticos aplicados foram: Teste de ANOVA, teste T-Student Pareado, Teste de Igualdade de duas proporções e Intervalo de Confiança para a média. Foram considerados significantes associações com p-valor &lt; 0,05 . RESULTADOS: para a amostra analisada, não houve alterações de mastigação e deglutição estatisticamente significantes após um mês de uso dos aparelhos selecionados. Na fala, 64,3% da amostra não apresentou alterações, mas em 25% dos pacientes observou-se a presença de distorção de grupos consonantais na presença de aparelhos do tipo disjuntor. CONCLUSÃO: o uso de aparelhos fixos com recursos intraorais, provoca modificações estatisticamente significantes somente na fala.

Orofacial Rehabilitation in Maxillary Aplasia

Orofacial rehabilitation in maxillary aplasia but the premaxilla requires, beyond addressing the oronasal communication, facial functional-aesthetic and dental prosthetic reconstruction.The report of a now 42-year-old patient, born with maxillary aplasia, presenting for surgical rehabilitation in 2002 (at 33 years old), further elaborates this complex challenge.A staged approach that included velopharyngoplasty was performed on the patient in 2002; alternatively to a preformed fibula, 2 zygomatic fixtures were later inserted bilaterally to the malar bone, and premaxillary teeth were retained. Subapical mandibular alveolar osteotomy was performed to reposition the malaligned alveolar process and teeth. Augmentation from the iliac crest to the left congenitally hypoplastic mandible followed, its alveolar nerve running atypically lingual and outside the bone. The maxilla was rehabilitated by telescoped coverdenture on ceramic primary crowns, the mandible with all ceramic crowns on standard implants after orthodontic tooth-arch harmonization.A most satisfying result was obtained regarding chewing, speaking, and swallowing. The good phonation and pharyngeal control that was shown by the patient after velopharyngoplasty was retained. Visual analog scale showed enhanced patient satisfaction from 4 to 8, and oral health impact profile 14G decreased from 16 to 7 impairment scores. Zygomatic implants and ceramic galvano-telescoped coverdenture were shown to be reliable, eventually for similar cases, combined if necessary with orthodontics, orthognathic surgery, and standard implants.

Automatic evaluation of speech impairment caused by wearing a dental appliance

In dentistry, speech evaluation is important for appropriate orofacial dysfunction rehabilitation. The speech intelligibility test is often used to assess patients’ speech, and it involves an evaluation by human listeners. However, the test has certain shortcomings, and an alternative method, without a listening procedure, is needed. The purpose of this study was to test the applicability of an automatic speech intelligibility test system using a computerized speech recognition technique. Speech of 10 normal subjects, when wearing a dental appliance, was evaluated using an automatic speech intelligibility test system that was developed using computerized speech recognition software. The results of the automatic test were referred to as the speech recognition scores. The Wilcoxon signed rank test was used to analyze differences in the results of the test between the following 2 conditions: with the palatal plate in place and with the palatal plate removed. Spearman correlation coefficients were used to evaluate whether the speech recognition score correlated with the result of conventional intelligibility test. The speech recognition score was significantly decreased when wearing the plate (z = -2.807, P = 0.0050). The automatic evaluation results positively correlated with that of conventional evaluation when wearing the appliance (r = 0.729, P = 0.017). The automatic speech testing system may be useful for evaluating speech intelligibility in denture wearers.

Changes in oro-facial function and hand-grip strength during a 2-year observation period after stroke

Recovery from stroke-related oro-facial impairment has rarely been investigated. In this longitudinal study chewing efficiency, maximum lip and bite force as well as masseter muscle thickness were evaluated and compared with hand-grip force. Thirty-one hospitalized stroke patients and 24 controls were recruited for this cohort study with 2-year follow-up. Chewing efficiency was evaluated with a color mixing ability test, lip forces with a traction dynamometer, bite force with a digital gauge, masseter muscle thickness using ultrasound measurements and grip strength with a hand dynamometer. During the 2-year observation period, patients were evaluated four times. A total of 21 patients dropped out of the study. Stroke patients showed significantly impaired chewing efficiency and lower lip forces than controls with no significant improvement over time. Bite forces were not different between ipsi- and contralesional sides, in contrast to contralesional hand-grip strength which was significantly impaired and did not improve during the observation period. On the first examination with a median of 40days after stroke, masseter thickness was reduced contralesional, but did not continue to show significant side-differences during follow-up. Stroke affects the upper limb and the masseter muscles differently on a functional and morphological level. Further research is needed to evaluate the predictive value of oro-facial parameters on functional outcome after stroke. Impaired chewing efficiency and reduced lip force are quantifiable symptoms in stroke patients which seem not to improve in absence of oro-facial rehabilitation procedures.

Evaluation of the quality of life of patients with maxillofacial defects after prosthodontic therapy with obturator prostheses

The purpose of this study was to investigate how patients with maxillofacial defects evaluate their quality of life after maxillectomy and prosthodontic therapy with obturator prostheses. 43 patients were included in the study (25 female, 18 male). 31 (72%) patients completed a standardized questionnaire of 143 items and then answered additional questions in a standardized interview. Global quality of life after prosthodontic therapy with obturator prostheses was 64% (±22.9) on average. Functioning of the obturator prosthesis, impairment of ingestion, speech and appearance, the extent of therapy, and the existence of pain had significant impact on the quality of life (p<0.005). Orofacial rehabilitation of patients with maxillofacial defects using obturator prostheses is an appropriate treatment modality. To improve the situation of patients prior to and after maxillectomy sufficient information about the treatment, adequate psychological care and speech therapy should be provided.

Medida angular para aferição do tônus muscular na paralisia facial

the decrease of facial movements in peripheral facial paralysis and the resulting aesthetical sequels may have important emotional repercussions as a consequence to the functional deficit, and depending on the intensity of the clinical condition. Orofacial rehabilitation has as a purpose to favor the recovery of orofacial movements and to adequate and/or adapt orofacial functions and facial mimic. However, quantifying therapeutic results in an attempt to measure the muscle tonus is a challenge. Generally, the used forms of measurement are general and subjective. to propose the labial commissure angle as an anthropometric marker and to evaluate its reliability as an objective tool to evaluate the modification of the facial muscle tonus after rehabilitation. participants of the study were 20 patients presenting peripheral facial paralysis - level IV. The study was conducted using images from the photographical documentation taken fifteen days to one year post-onset of facial paralysis. The angle was measured by tracings determined by pre-established anthropometric facial points, such as the line between the glabella and the gnation and the crossing with the left and right chelion points determining an angle manually measured with a protractor on the photography. The average Labial Commissure Angle before treatment was of 101.70 and after rehabilitation of 93.80 (standard deviation, SD = 4.3). The statistical analysis indicated a significant difference (p < 0.001). the results obtained suggest that the Labial Commissure Angle allows the objective evaluation of facial muscle tonus modification.

Orofacial rehabilitation of patients with post-cancer treatment-An overview and report of three cases

According to World Health Organisation statistics, individuals of the Indian subcontinent have the highest prevalence of orofacial cancer. Surgery, radiation, chemotherapy or combination therapies are commonly administered treatment modalities for treatment of oral cancer. Surgical resection can be mutilating, disfiguring and may deeply affect self-image of patients. Orofacial defects have unique limitations and challenges. A coordinated effort from the surgeon, oral physician and the maxillofacial prosthodontist to treat such patients is the need of the hour. This article presents an overview of the orofacial rehabilitation of postcancer treatments along with case reports.

Effectiveness of adjuvant radiotherapy in patients with oropharyngeal and floor of mouth squamous cell carcinoma and concomitant histological verification of singular ipsilateral cervical lymph node metastasis (pN1-state) - A prospective multicenter randomized controlled clinical trial using a comprehensive cohort design

BackgroundModern radiotherapy plays an important role in therapy of advanced head and neck carcinomas. However, no clinical studies have been published addressing the effectiveness of postoperative radiotherapy in patients with small tumor (pT1, pT2) and concomitant ipsilateral metastasis of a single lymph node (pN1), which would provide a basis for a general treatment recommendation.Methods/DesignThe present study is a non-blinded, prospective, multi-center randomized controlled trial (RCT). As the primary clinical endpoint, overall-survival in patients receiving postoperative radiation therapy vs. patients without adjuvant therapy following curative intended surgery is compared. The aim of the study is to enroll 560 adult males and females for 1:1 randomization to one of the two treatment arms (irradiation/no irradiation). Since patients with small tumor (T1/T2) but singular lymph node metastasis are rare and the amount of patients consenting to randomization is not predictable in advance, all patients rejecting randomization will be treated as preferred and enrolled in a prospective observational study (comprehensive cohort design) after giving informed consent. This observational part of the trial will be performed with maximum consistency to the treatment and observation protocol of the RCT. Because the impact of patient preference for a certain treatment option is not calculable, parallel design of RCT and observational study may provide a maximum of evidence and efficacy for evaluation of treatment outcome. Secondary clinical endpoints are as follows: incidence and time to tumor relapse (locoregional relapse, lymph node involvement and distant metastatic spread), Quality of life as reported by EORTC (QLQ-C30 with H&N 35 module), and time from operation to orofacial rehabilitation. All tumors represent a homogeneous clinical state and therefore additional investigation of protein expression levels within resection specimen may serve for establishment of surrogate parameters of patient outcome.ConclusionThe inherent challenges of a rare clinical condition (pN1) and two substantially different therapy arms would limit the practicality of a classical randomized study. The concept of a Comprehensive Cohort Design combines the preference of a randomized study, with the option of careful data interpretation within an observational study.Trial registrationClinicalTrials.gov: NCT00964977

Avaliação de um protocolo da reabilitação orofacial na paralisia facial periférica: evaluation of an orofacial rehabilitation protocol

OBJETIVO: avaliar o protocolo proposto de reabilitação neuromuscular orofacial para paralisia facial periférica. MÉTODOS: observação clínica de 20 pacientes com paralisia grau IV, encaminhados para reabilitação orofacial no Ambulatório de Paralisia Facial do Hospital de Clínicas da Unicamp: estudo longitudinal prospectivo. A constatação da evolução funcional ou não, na reabilitação, baseou-se na melhora do tônus muscular, cuja variação foi aferida mediante modificação no ângulo da comissura labial. O estudo se fez sob imagens da documentação fotográfica pré (após quinze dias de instalação da paralisia facial) e pós-tratamento de um ano. Para comprovação da eficácia da reabilitação, mediu-se o ângulo da comissura labial pré e pós-reabilitação. O grupo estudado foi comparado a um grupo controle composto de nove sujeitos com paralisia facial grau IV, não submetidos à reabilitação orofacial. Os dados foram analisados estatisticamente pelo teste emparelhado das amostras (T-Student). RESULTADOS: a média de redução do ângulo da comissura labial, com o tratamento, foi de 7,9º, estatisticamente significantes (p&lt;0.001). Para o grupo controle a média das medidas angulares foi de 100.9º + 1.9. Esse valor não diferencia dos medidos inicialmente no grupo estudado (p=0,723). Foram significantemente mais altos quando comparados à média dos valores angulares finais do grupo estudado com pacientes tratados (p=0.001). CONCLUSÃO: o protocolo de reabilitação empregado nesta amostra promoveu incremento marcante do tônus muscular, com melhora no repouso facial.

Sensorimotor Elements of the Orofacial System: Reviewing the Basics

Abstract The functional ability of the central nervous system (CNS) to transduce and process sensory information directly associated with voluntary action is believed to be an important element in sensorimotor learning and skill acquisition for the orofacial system. Muscles of the lower face insert directly into the facial skin, allowing for sensory endings to encode both the static and dynamic consequences of force and movement related to orofacial behavior. These task-related inputs are subsequently made available to sensorimotor cortices whose functions are known to be highly responsive to the consequences underlying precise adjustments in force during skilled motor control. The purpose of this article is to provide a basic review of the fundamental muscular and sensory elements contributing to orofacial sensorimotor control. In addition, select research on sensorimotor integration in the orofacial system will be summarized with a discussion on the importance of these findings in the context of orofacial rehabilitation.

Increased secretion of salivary glands produced by facial vibrotactile stimulation

Patients with low-back pain can be evaluated immediately by means of an electrical tool that produces bony vibration to the lumbar spinal processes (Yrjama M, Vanharanta H. Bony vibrotactile stimulation: A new, non-invasive method for examining intradiscal pain. European Spine Journal 1994;3:233–235). In the rehabilitation of masticatory disturbance and dysphagia, an electric toothbrush is commonly used as an oral motor exercise tool for the facilitation of blood flow and metabolism in the orofacial region in Japanese hospitals. However, subjects receiving vibration in the facial regions reported increased salivary secretion. We attempted to develop an oral motor exercise apparatus modified by a headphone headset that was fixed and could be used for extended periods. The vibration apparatus of the heating conductor is protected by the polyethyle methacrylate (dental mucosa protective material), and electric motors for vibration control of the PWM circuit. We examined the amount of salivation during vibration stimuli on the bilateral masseter muscle belly, using a cotton roll positioned at the opening of the secretory duct for 3 min. Although the quantity of salivation in each subject showed various and large fluctuations in the right and left sides of the parotid and submandibular and sublingual glands, one or more of the salivary glands were effectively stimulated by 89 Hz vibration. The reported apparatus will be useful as an additional method in orofacial rehabilitation.

Endosseous implants in the irradiated composite radial forearm free flap

This paper describes the application of endosseous titanium implants that have been inserted into the vascularized bone of the radial forearm composite flap, used for mandibular reconstruction. The technique described allows full orofacial rehabilitation to be achieved, following ablative surgery and adjuvant radiotherapy.