Terapia miofuncional orofacial na reabilitação das queimaduras de face em crianças e adolescentes: Uma revisão sistemática / Orofacial myofunctional therapy in the rehabilitation of face burns in children and adolescents: A systematic review

OBJETIVO: Identificar e analisar os achados da literatura referentes a terapia miofuncional orofacial em crianças e adolescentes que sofreram queimaduras de cabeça e/ou pescoço. MÉTODO: Revisão sistemática na qual foram incluídos estudos com desenho analítico observacional, sem restrição de idioma ou data de publicação, com a população de crianças de ambos os sexos, faixa etária de 0 a 18 anos, expostas à queimadura de cabeça e/ou pescoço e como desfecho, que tivessem realizado alguma modalidade de terapia miofuncional orofacial. As bases de dados utilizadas para a busca de artigos científicos foram PubMed, Cochrane CENTRAL, LILACS, CidSaude, PAHO, REPIDISCA, BDENF, MedCarib, WHOLIS, IBECS e SciELO, incluindo estudos indexados até dezembro de 2019. A estratégia de busca foi adaptada para cada base de dados. A seleção dos resumos, seleção dos artigos incluídos, extração de dados e análise de viés foi realizada por três pesquisadores separadamente. RESULTADOS: Foram encontrados 311 artigos nas bases de dados e, desses, quatro foram selecionados para compor o estudo. Identificaram-se diferentes intervenções nos pacientes, variando o tempo e o número de sessões realizadas durante o tratamento de acordo com o tipo de queimadura de exposição, incluindo terapia por pressão, aplicação de silicone, massagem e exercício facial, massagens e uso de aparelhos (placas) associados. CONCLUSÃO: Há falta de evidências sobre a terapia miofuncional orofacial como forma de tratamento para pacientes pediátricos com queimaduras de cabeça e/ou pescoço.

OBJECTIVE: To identify and to analyze the findings in the literature regarding an orofacial myofunctional therapy in children and adolescents who suffered head andor neck burns. METHODS: Systematic review which included studies with observational analytical design, with no restriction on language or publication data, with a population of children of both sexes, aged 0 to 18 years, exposure to head and/or neck burns and as an outcome, they had undergone some modality of orofacial myofunctional therapy. The databases used to search for scientific articles were PubMed, Cochrane CENTRAL, LILACS, CidSaude, PAHO, REPIDISCA, BDENF, MedCarib, WHOLIS, IBECS and SciELO, including studies indexed until December 2019. The search strategy was adapted for each database. The selection of abstracts, selection of included articles, data extraction and bias analysis was performed by three researchers separately. RESULTS: 311 articles were found in the databases, and four were selected to compose the study. Different treatments were identified in patients, varying the time and number of combinations during treatment according to the type of exposure burn, including pressure therapy, silicone application, massage and facial exercise, massage and use of devices (plates) associates. CONCLUSION: There is a lack of evidence on orofacial myofunctional therapy as a form of treatment for pediatric patients with head and/or neck burns.

Microstomia: Aplicação da fotogrametria para mensurar a eficiência da órtese oral associada à terapia fonoaudiológica / Microstomy: Application of photogrammetry to measure the efficiency of oral orthosis associated with speech therapy

OBJETIVO: Esse estudo teve como propósito verificar, por meio da fotogrametria computadorizada, a eficácia do uso da órtese oral como auxiliar na terapia fonoaudiológica. MÉTODO: Após a documentação fotográfica, cada paciente foi submetido a terapia fonoaudiológica, por meio da terapia miofuncional orofacial, associada ao uso da órtese oral, confeccionada segundo Borges et al. (2011). Ao término do tratamento, foi realizado novo registro fotográfico, em seguida, a mensuração da dimensão vertical (distância entre lábio superior/inferior) e horizontal (distância entre comissuras direita/esquerda), com o uso do programa Corel Draw X3. RESULTADOS: As médias da abertura bucal aumentaram da avaliação inicial para a avaliação final, tendo aumentado 5,1 mm no sentido horizontal (67,3 mm para 72,4 mm) e 13,9 mm no sentido vertical (de 32,7 mm para 46,6 mm). Essas diferenças se revelam significativas para as avaliações (p <0,05). CONCLUSÃO: O uso da órtese oral associado a terapia fonoaudiológica demonstrou ser eficaz como mais um instrumento na prevenção da microstomia.

OBJECTIVES: The aim of this study was to through computerized photogrammetry, the efficacy of oral orthosis as an aid in speech therapy. METHODS: After the photographic documentation, each patient underwent speech therapy, through orofacial myofunctional therapy, associated with the use of an oral orthosis, made according to Borges et al. (2011). At the end of the treatment, a new photographic record was taken, then the vertical dimension measurement (distance between upper lip) and horizontal (distance between corners right/left), using the program Corel Draw X3. RESULTS: The mean mouth opening increased from the initial evaluation to the final evaluation, increasing 5.1 mm in the horizontal direction (67.3 mm to 72.4 mm) and 13.9 mm in the vertical direction (from 32.7 mm to 46.6 mm). These differences are significant for the evaluations (p<0.05). CONCLUSION: The use of oral orthosis associated with speech therapy proved to be effective as another tool in the prevention of microstomia.

The Use of Oral Appliances in the Management of Temporomandibular Disorders.

Oral appliances (OAs) are widely used for treating various types of temporomandibular disorders (TMDs); however, many controversies persist about how they should be designed, how they should be used, and even what their ultimate purpose might be. This article discusses 6 of the current controversies, with a focus on the evidence available to support reasonable practice guidelines for the clinical use of OAs in treating certain TMDs.

Intervención fonoaudiológica en quemados: relato de un caso en el Hospital de Urgencia Asistencia Pública, Chile / Speech Language Pathologist intervention in burns: a case report of Hospital de Urgencia Asistencia Pública, Chile / Intervenção fonoaudiológica em queimados: relato de caso no Hospital de Urgencia Asistencia Pública, Chile

Introducción: En la área de fonoaudiología, una quemadura puede producir secuelas en deglución, comunicación (habla y voz) y motricidad orofacial. La inclusión del fonoaudiólogo en el trabajo con quemados ha sido paulatina y con escasa evidencia científica. El objetivo fue describir la intervención fonoaudiológica en un paciente adulto gran quemado internado en la UCI del Hospital de Urgencia Asistencia Pública (HUAP) en Santiago de Chile. Presentación del caso: Paciente masculino de 44 años, con intento de autolisis, 53% de superficie corporal quemada por fuego, con quemadura orofacial e injuria inhalatoria. Resultados: La evaluación fonoaudiológica evidenció trastorno deglutorio, vocal y de la motricidad orofacial. Posteriormente se inició terapia en estas tres áreas. Luego de dos meses, al momento del alta, paciente recuperó en su totalidad función deglutoria y vocal, con mínimas secuelas en motricidad orofacial. Conclusión: La intervención fonoaudiológica precoz favorece la recuperación de la persona quemada y ayuda a disminuir las secuelas posteriores. Es fundamental la inclusión de este profesional en el equipo de rehabilitación del paciente quemado, tanto a nivel nacional como internacional

Introdução: Na área da fonoaudiologia, uma queimadura, uma queimadura pode produzir sequelas na deglutição, comunicação (fala e voz) e motricidade orofacial. A inclusão do fonoaudiólogo no trabalho com queimados tem sido paulatina e com escassa evidência científica. O objetivo foi descrever a intervenção fonoaudiológica em um paciente adulto grande queimado internado na unidade de terapia intensiva do Hospital de Urgencia Asistencia Pública (HUAP), em Santiago do Chile. Relato do caso: paciente, do sexo masculinho, com 44 anos de idade, com tentativa de autoextermínio, 53% da superfície corporal queimada por fogo, com queimadura orofacial e lesão inalatória. Resultados: Avaliação fonoaudiológica evidenciou alteração na deglutição, vocal e da motricidade orofacial. Foi iniciada terapia nestas três áreas. Após dois meses, na alta hospitalar, o paciente recuperou em totalidade sua função deglutativa e vocal, com mínimas sequelas em motricidade orofacial. Conclusão: A intervenção fonoaudiológica precoce favorece a recuperação da pessoa queimada e ajudana diminuição as sequelas posteriores. Torna-se fundamental a inclusão deste profissional na equipe de reabilitação ao paciente queimado, tanto em nível nacional como internacional.

Introduction: Burns can produce Speech-Language Pathology disorders which can include difficulty in swallowing, communication (speech and voice) and orofacial motricity. The inclusion of speech therapist in burn people intervention has been gradual and with limited scientific evidence. The aim was to describe the speech-language intervention in a adult burn interned in the ICU of Hospital de Urgencia Asistencia Pública (HUAP) in Santiago, Chile. Case report: 444-year old male patient, due to attempt suicide, 53% of body surface burned by fire, with orofacial burn and inhalation injury. Results: A speech-language assessment revealed swallowing, voice and orofacial motricity disorders. Subsequently, therapy was started in these three areas. After two months, at discharge, the patient recovered his entirety deglutory and vocal function, with minimal sequelae in orofacial motricity. Conclusion: Early speech therapy favors the recovery of the burned person and helps to reduce subsequent sequelae. It is fundamental the inclusion of this professional in the burn patient rehabilitation team, both nationally and internationally.

Dilemmas in Treatment of Recurrent Recalcitrant Dental Anterior Open Bite.

An anterior open bite is one of the most difficult occlusal abnormalities to treat. Quite often this aberration entails dental component and/or skeletal component. The skeletal open bite will require intrusion of the posterior sextants with the assistance of bite blocks, temporary anchorage devices, high pull headgear, and as a last resort - orthognathic surgery. The orthodontic treatment should be augmented with the orofacial myofunctional therapy. In this article, the author describes 3 different variations of treatment of the dental anterior open bite, first on acrylic models, and then on the actual patients. Consideration should be given to patients with a 'short upper lip," and in this case, surgical correction should be entertained.

Combined Mandibular Guidance Therapy in the Management of a Hemimandibulectomy Patient.

This case history report describes two different devices, maxillary ramp prostheses (MRP) and mandibular guide flange prostheses (MGFP), prescribed for managing a hemimandibulectomy patient's deviated mandible. The patient was given muscle reprogramming exercises with coordinated use of both guidance prostheses for 2 months, leading to improvements in both postsurgical mandibular deviation and occlusal equilibration. A successful intercuspal position was eventually accomplished through the use of the combination therapy. MRP and MGFP can be a useful approach to avoid mandibular deviation and compromised function following a partial mandibular resection.

Myofunctional and speech rehabilitation after orthodontic-surgical treatment of dento-maxillofacial dysgnathia.

OBJECTIVES: The lingual dysfunctions play a considerable role in the pathogenesis of dentoskeletal dysmorphisms. The treatment of dento-maxillofacial dysgnathia implies a functional rehabilitation to re-harmonize the stomatognathic system. This study aims to demonstrate the importance of a rehabilitation protocol of functional orofacial parameters at the end of a surgical-orthodontic treatment in order to achieve long-term success. MATERIALS AND METHODS: After orthognathic surgery, facial expression exercises and jaw exercises are prescribed to promote the recovery of neuromuscular function. At the end of treatment, a sample of 30 dysgnathic patients underwent a functional evaluation of the orofacial district to identify any lingual or articulatory dysfunctions. The information gathered led to an individual re-education program that consisted of an active myofunctional-logopedic approach integrated with appliances used as retention. RESULTS: 19 patients needed myofunctional therapy to re-educate deglutition and tongue posture. Articulatory disorders were found in 7 patients originally suffering from Class III and/or open-bite skeletal disharmony; 5 of these completed rehabilitation with speech therapy. After rehabilitation the functional parameters were completely normalized in 12 patients; in 5 cases, partial improvements were obtained, while in 2 cases the therapy was ineffective. CONCLUSIONS: In a patient undergoing post-surgical reconsolidation of his/her functional equilibrium even an uncontrolled speech defect may lead to an instable result. Only through an interdisciplinary approach it is possible to intercept and re-educate all the functions that are not compliant with the structural changes and to eliminate a tendency to relapse of the dysgnathia.

Improvement of mouth opening for a patient with fibrodysplasia ossificans progressiva: a case report.

The aim of this article is to describe the care of a patient with fibrodysplasia ossificans progressiva (FOP) and to provide dentists with a guide for how to safely care for patients with FOP. Treatment improved the patient's limited mouth opening. FOP is a rare autosomal dominant disorder characterized by congenital malformation of the fingers and toes by heterotopic ossification progressiva of the connective tissue. This ossification causes a limitation in osteoradicular mobility, mainly affecting the spine, shoulders, hips, and peripheral joints. The disease can manifest from pregnancy until adulthood, with no greater prevalence associated with race or gender. Although rare, the disease can be easily identified by its clinical features, and diagnosis can be confirmed by a radiographic examination. There is no known effective treatment for this disease. All therapeutic treatment must be conservative to avoid any condition that may cause heterotopic ossification. Guidelines to prevent new ossifications are important for patients with FOP. Dental professionals should be cautious in planning treatment, avoiding anesthesia, especially in the mandible, to prevent ankylosis of the temporo-mandibular joints. The prevention of dental caries is essential to avoid the need for more invasive treatment.

Accidental ingestion of a fractured Twin-block appliance.

Orthodontic appliances that become dislodged can cause problems in the airway or the gastrointestinal tract. Accidental ingestion of an appliance during a chair-side procedure or because of inadequate retention of the appliance can create a medical emergency with potentially serious complications, including death from aspiration of the foreign body. This article reports the accidental ingestion of a fractured Twin-block appliance. The ease with which removable appliances can become dislodged if retention is inadequate is discussed, and some serious complications that can arise are described. Precautions the orthodontist can take to prevent such accidents are presented.

A clinical, MRI, and EMG analysis comparing the efficacy of twin blocks and flat occlusal splints in the management of disc displacements with reduction.

Internal derangement of the temporomandibular joint (TMJ) is characterized by an abnormal disc-condyle relationship. Of all the various treatment modalities used in the management of disc displacements, flat occlusal and anterior repositioning splints are the most commonly used. Myofunctional appliances (such as bite-jumping appliances) are also advocated to treat anterior disc displacements. The present study compares the efficacy of twin blocks with conventional flat occlusal splints in patients with anterior disc displacement with reduction using clinical examination, MRI, and EMG. The sample consisted of 20 subjects between 12 and 20 years of age, who were randomly divided into two groups of 10 patients each: Group 1 was treated with twin blocks, while group 2 was treated using maxillary flat occlusal splints. The twin block is more effective in relieving joint pain, diminishing joint dysfunction, reducing joint clicking, and eliminating muscle tenderness in patients with anterior disc displacement with reduction as compared to the occlusal splint.

Non-invasive 3D facial analysis and surface electromyography during functional pre-orthodontic therapy: a preliminary report

OBJECTIVES: Functional orthodontic devices can modify oral function thus permitting more adequate growth processes. The assessment of their effects should include both facial morphology and muscle function. This preliminary study investigated whether a preformed functional orthodontic device could induce variations in facial morphology and function along with correction of oral dysfunction in a group of orthodontic patients in the mixed and early permanent dentitions. MATERIAL AND METHODS: The three-dimensional coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw and ears) were collected in 10 orthodontic male patients aged 8-13 years, and in 89 healthy reference boys of the same age. Soft tissue facial angles, distances, and ratios were computed. Surface electromyography of the masseter and temporalis muscles was performed, and standardized symmetry, muscular torque and activity were calculated. Soft-tissue facial modifications were analyzed non-invasively before and after a 6-month treatment with a functional device. Comparisons were made with z-scores and paired Student's t-tests. RESULTS: The 6-month treatment stimulated mandibular growth in the anterior and inferior directions, with significant variations in three-dimensional facial divergence and facial convexity. The modifications were larger in the patients than in reference children. In several occasions, the discrepancies relative to the norm became not significant after treatment. No significant variations in standardized muscular activity were found. CONCLUSIONS: Preliminary results showed that the continuous and correct use of the functional device induced measurable intraoral (dental arches) and extraoral (face) morphological modifications. The device did not modify the functional equilibrium of the masticatory muscles.

Effectiveness of circumoral muscle exercises in the developing dentofacial morphology in adenotonsillectomized children: an ultrasonographic evaluation.

Alterations in the functions of the facial muscle can establish changes in facial skeleton and in the development of occlusion. The effect of mouth breathing on the facial morphology is probably greatest during the growth period. Removal of nasal obstruction, adenoids, and tonsils have not given beneficial results in the reversion of the habit unless intercepted with various muscle exercises. Hence, this study was conducted to ultrasonographically evaluate the effectiveness of circumoral muscle exercises in the developing dentofacial morphology in adenotonsillectomized children.

Treating trismus with dynamic splinting: a case report.

Trismus is a pathological condition of the muscles of mastication which commonly affects patients who have undergone dental procedures, oral surgery, and radiation therapy for head and neck cancer. The purpose of this case report is to describe the use of dynamic splinting, a noninvasive modality to reduce trismus which occurred in a patient following multiple dental procedures. A 26 year old man of African descent was referred for severe trismus and pain following three dental procedures on the lower right molars. The patient presented with Maximal Interincisal (opening) Distance (MID) of only 5mm and mastication muscle spasticity. Following physical therapy (massage, ultra sound, NMES, moist heat) three times per week for two months and additional treatment of dynamic splinting for four weeks (TID) the patient increased his MID to 52 mm and returned to normal eating and speaking.

Oral appliances in the management of temporomandibular disorders.

Various types of oral appliances (OAs) have been used for over half a century to treat temporomandibular disorders (TMDs), but there has been considerable debate about how OAs should be designed, how they should be used, and what they actually do therapeutically. However, there is enough information in the scientific literature at this time to reach some evidence-based conclusions about these issues. The main focus of this review is on the materials and designs of various OAs in terms of their proposed mechanisms of action and their claimed clinical objectives. Based on current scientific evidence, an analysis is presented regarding the role that OAs can or cannot play in the management of TMDs. Finally, the concept that OAs may be an effective treatment modality for some TMDs owing to their potential for acting as an elaborate placebo rather than any specific therapeutic mechanism is considered.

Importance of patient's cooperation in surgical treatment for oral submucous fibrosis.

PURPOSE: The aim of this study was to investigate the results of surgical treatment for oral submucous fibrosis (OSF) in patients who did or did not cooperate with the rehabilitation regimen. PATIENTS AND METHODS: There were 54 patients who had surgical treatment of trismus caused by OSF. Split-thickness skin grafts were used to repair surgical defects after surgery on the fibrous bands. According to postoperative collaboration in the rehabilitation regimen, patients were defined as non-cooperative patients (group I) and cooperative patients (group II). Group I (n = 28) and group II (n = 26) were analyzed separately for changes in preoperative, intraoperative, and postoperative interincisal distances (ID) for at least 6 months after surgery. RESULTS: The mean preoperative ID was 18.9 mm (range, 8 to 25 mm) in group I and 18 mm (range, 7 to 25 mm) in group II. The intraoperative ID increased to an average of 39 mm in group I and 38.5 mm in group II. The mean final follow-up ID was 22 mm in group I and 36.1 mm in group II. When evaluating the changes of ID, only a statistically significant difference was found at final visit between groups. CONCLUSIONS: In our study, we found the patient's cooperation is the primary requirement for success in the treatment of OSF.

Development of an intraoral device for facial muscle retraining and its clinical application.

The aim of this work was to develop a facial neuromuscular retraining technique for cases of facial palsy, involving an easy-to use intraoral device that allows correcting abnormal neuromuscular patterns and improving esthetics. Facial palsy is a motor alteration of multiple origin that results in facial asymmetry. Treatment remains controversial to date and includes, surgical anastomosis and decompressive and plastic surgery, corticosteroids therapy, injection of botulinum toxin, and administration of other medicinal drugs. Physical therapy involving electrical stimulation and feedback are also used to retrain facial muscles. A removable thermopolymerized acrylic intraoral device with wrought wire clasps was developed and constructed. The device was used on a patient with facial palsy who was instructed to wear it 4 times a day during 20 minutes and perform exercises in front of the mirror, trying to coordinate the action of the device with the smile movement on the unaffected side of the face. Digital photographs of the patient were taken during smile movement and at rest with and without the device, and movements of the oral commissures were compared using specific software. Results showed anatomic and nonanatomic indices of facial motion for the lower part of the face with the device to be 1.77 and 0 respectively. The device improved facial symmetry during rest by opposing traction forces of the contralateral muscles, resulting in a better position of the filtrum during rest, and allowed the patient to exercise smile movements at home.

Proposta de documentação fotográfica em motricidade oral / Oral motricity photographic registration proposal

Objetivo: propor um protocolo específico para documentação fotográfica do paciente na área deMotricidade Oral. Método: foi utilizada uma câmera digital fixada em um tripé e foram realizadasfotografias padronizadas corporais e de face. Realizou-se ainda, a teleradiografia lateral contrastadacom bário sobre a língua. Resultados: as fotografias facilitaram a visualização dos nossos resultadosterapêuticos. Conclusão: concluiu-se que a documentação proposta auxilia no diagnóstico e no estudodo prognóstico do paciente, bem como, pode ser utilizado como material auxiliar nas orientaçõesaos responsáveis e ao paciente.

Purpose: to propose a specific protocol for photographic register of Oral Motricity patients. Methods:a digital camera mounted on a tripod was used. Standardized photos of body and face were taken. Atele-radiography modified by using contrast with barium which was spread over the patient’s tonguewas taken. Result: the pictures made easy the visualization of our therapeutic results. Conclusion:so far it is possible to conclude that the proposed documentation helps in the diagnosis process andprognosis analysis, and it may be used as supplementary material for guiding patients and parents onthe best treatment to follow.

The effect of tongue appliance on the nasomaxillary complex in growing cleft lip and palate patients.

Midfacial deficiency is a common feature of cleft lip and palate patients due to scar tissue of the lip and palate closure procedure. The aim of this study was to evaluate the effectiveness of the physiological force of the tongue to move the maxilla in forward position. This research has been done experimentally by, before and after treatment following up in private practice. Ten patients (6 female, 4 male) with complete bilateral cleft lip and palate were selected. All of them had Cl III malocclusion with maxillary deficiency due to scar tissue of lip and palate surgery. Their age ranged from 7.6 to 9.8 years. All the patients were delivered tongue appliance to transfer the force of the tongue to maxillary complex. The mean observation time was 13+/-2 months to achieve positive overjet. Pre- and post-lateral cephalograms were compared to evaluate the skeletal changes with paired t-test. The results showed that after the application of tongue appliance, normal sagittal maxillomandibular relationship was achieved. SN-ANS angle was increased 1.9+/-1.8 - P < 0.03. This study showed that the tongue appliance could transfer considerable force during rest and swallowing period to the maxilla. This method might be considered to improve the deficient maxilla by means of growth modification and redirect concept.

Case report: surgeon and orthodontist work together from patient's birth.

This case report presents one of the initial participants of a new treatment protocol started in 1965 for children born with complete clefts of the lip, alveolus, and palate at Children's Memorial Hospital, Chicago, USA. The surgeon and orthodontist worked together and in tandem from the time of the patient's birth. The protocol involves lip and palate closure, along with the placement of a passive maxillary prosthesis and minimal primary osteoplasty to the alveolus to help stabilize the maxillary segments. This case is noteworthy in that the patient had a number of congenitally missing teeth, and treatment required moving a tooth into and through an area originally cleft. The patient is now 40 years of age. Intra- and extraoral photographs, cephalometric radiographs, occlusal dental radiographs, and dental casts through the treatment stages are presented.

[Efficacy of treatment with hard and soft occlusal appliance in TMD].

Temporomandibular disorders (TMD) include clinical disorders involving the masticatory muscles, the temporomandibular joints (TMJ) and the adjacent structures. TMD was recognized as a main source for pains in the orofacial area, which are not caused from dental origin, and is defined by the American Academy of Orofascial Pain (AAOP) as a sub-group within the frame of musculoskeletal disorders. The main etiology for TMD has not been found yet. The customary treatments for this disorder include treatment with occlusal splints, physiotherapy, medicaments, behavioral-cognitive treatment, hypnosis, acupuncture and surgery that should be considered only if all conservative treatments were unsuccessful. Occlusal splint is the most common and efficient treatment for TMD patients proved by many studies with a successful rate of 70-90%. The following article reviews the different opinions in the treatment of TMD with special attention to hard and soft occlusal appliances. Based upon much research, and despite the many disagreements regarding its efficacy, the hard splint is a customary application which has the most successful outcome in patients who suffer from functional disorders of the masticatory system. The stabilization splint has an important benefit for being a non-penetrating and reversible appliance. However, despite this, the dentist should evaluate the joint or muscular problem, and seriously consider the various available treatments before deciding to use the appliance as a means of treatment.