Speech outcomes and velopharyngeal function after surgical treatment of velopharyngeal insufficiency in individuals with signs of velocardiofacial syndrome.

OBJECTIVE: The objective of the study was to analyze if individuals with velocardiofacial syndrome (VCFS) present the same characteristics of speech and velopharyngeal function (VPF) compared with patients with nonsyndromic submucous cleft palate, as well as to compare the effectiveness of palate surgery on the speech function and VPF between groups. METHODS: This was a prospective study performed at the Speech Therapy Sector and Physiology Laboratory, Hospital for Rehabilitation of Craniofacial Anomalies/University of São Paulo.The procedure performed was primary palatoplasty associated or not to superiorly based pharyngeal flap surgery.There were 50 patients with velopharyngeal insufficiency: 25 with signals of VCFS (VCFS group) and 25 without syndrome with submucous cleft palate (SMCP group).The hypernasality was scored by 3 examiners; nasalance was evaluated by nasometry, and VPF was assessed by the size of the velopharyngeal gap on the nasoendoscopy. The evaluations were conducted before and, in average, 18 months after surgery. RESULTS: Before surgery, the VCFS and SMCP groups presented similar speech function and VPF characteristics in all parameters, with no statistically significant differences. After surgery, there was reduction in the hypernasality, nasalance, and VPF in, respectively, 20%, 31%, and 36% of patients in the VCFS group and in 24%, 30%, and 30% in the SMCP group. Elimination/normalization of variables was obtained in 28%, 19%, and 8% of patients in the VCFS group and 20%, 40%, and 25% in the SMCP group, respectively, for hypernasality, nasalance, and VPF. There was no statistically significant difference between groups. CONCLUSIONS: Patients with VCFS presented similar speech function and VPF characteristics as patients with nonsyndromic SMCP. The surgery for velopharyngeal insufficiency correction was equally effective for the improvement and resolution of speech symptoms and VPF in patients with VCFS compared with the SMCP group.

Validation of the MBGR orofacial myofunctional assessment protocol for adults with temporomandibular disorders with disc displacement with reduction. / Validação do protocolo de avaliação miofuncional orofacial MBGR para adultos com disfunção temporomandibular com deslocamento de disco com redução.

PURPOSE: This study aimed at validating the MBGR Orofacial Myofunctional Assessment Protocol (MBGR Protocol) for adults with Temporal Mandibular Disorders (TMD). METHODS: The study sample was composed of 30 adults: 15 with TMD (disc displacement with reduction according to the Research Diagnostic Criteria for Temporomandibular Disorders) and 15 control individuals. The validation process encompassed the content, criterion, and construct of the protocol, as well as its inter- and intra-rater agreement levels and sensitivity and specificity values, considering a 5% statistical significance level. RESULTS: The following validities were confirmed: of content, as the MBGR Protocol covers all functional issues present in patients with TMD; of criterion, with significant correlations between the MBGR and Orofacial Myofunctional Evaluation with Scores (OMES) protocols; of construct, differentiating individuals with and without Orofacial Myofunctional Disorders (OMD) as for pain on palpation and mandible range of motion, with significant correlation between the MBGR clinical evaluation and that using a digital algometer, as well as confirmation of the instrumental assessment for the breathing mode classification. Agreement ranged from poor to very good and from reasonable to very good for the inter- and intra-rater power analyses, respectively. High sensitivity and specificity values were observed. CONCLUSION: The MBGR Protocol proved to be valid for use in adults presented with TMD with disc displacement with reduction and controls, covering all aspects that enable the analysis of OMD in these individuals.

OBJETIVO: Este estudo visou validar o Protocolo de Avaliação Miofuncional Orofacial MBGR para adultos com DTM. MÉTODO: Participaram 30 adultos, sendo 15 com DTM (deslocamento de disco com redução segundo o Research Diagnostic Criteria for Temporomandibular Disorders) e 15 Controles. O processo de validação envolveu a validade de conteúdo, de critério e de construto, além da concordância inter e intra-avaliador, sensibilidade e especificidade. Considerou-se nível de significância de 5%. RESULTADOS: Foram confirmadas as validades de conteúdo, visto que o Protocolo MBGR abarca todas as questões funcionais presentes em indivíduos com DTM; de critério, com correlações significantes entre o MBGR e AMIOFE; e de construto, diferenciando indivíduos com e sem DMO quanto à dor à palpação e mobilidade mandibular, com correlação significante entre a avaliação clínica do MBGR e o uso do algômetro digital, bem como confirmação do exame instrumental para a classificação do modo respiratório. A força de concordância variou de pobre a muito boa para a análise interavaliador e de razoável a muito boa para intra-avaliador. Os valores de sensibilidade e especificidade foram elevados. CONCLUSÃO: O Protocolo MBGR mostrou-se válido para aplicação em adultos com DTM com deslocamento de disco com redução e controles, contemplando todos os aspectos que possibilitam a análise das condições oromiofuncionais nesses indivíduos.

Tongue function and swallowing in individuals with temporomandibular disorders.

BACKGROUND: The tongue participates in the oral phase of swallowing by pushing the food bolus toward the oropharynx. This relationship between tongue function and swallowing is little addressed addressed in individuals with temporomandibular dysfunction (TMD). OBJECTIVE: To analyze the association of functional tongue conditions on swallowing in individuals with TMD. METHODOLOGY: After approval by the Institutional Review Board, the study was conducted on 30 individuals of both sexes, aged 18 to 28 years, with TMD, and not treated for the disorder. Tongue function was assessed as to the mobility, pressure, and oral motor control. Swallowing was analyzed by clinical assessment during ingestion of solid (wafer biscuit) and liquid (water). Data regarding mobility and swallowing were collected using the orofacial myofunctional evaluation protocol. Tongue pressure was measured by the Iowa Oral Performance Instrument, during elevation, protrusion, swallowing, and resistance test. The oral motor control was assessed by the oral diadochokinesis (DDK) test by rapid and repeated emissions of syllables "ta" and "ka". Data were statistically analyzed by the Spearman correlation coefficient, at a significance level of 5%. RESULTS: Relationships were found between tongue function and swallowing for the following aspects: mobility (r=0.741), pressure in protrusion (r=-0.366), swallowing of saliva (r=-0.499), mean DDK rate in emissions "ta" (r=-0.424) and "ka" (r=-0.446), and mean DDK period in emissions "ta" (r=0.424) and "ka" (r=0.446). Thus, the greater the change in tongue mobility, the lower the tongue pressure in protrusion and swallowing of saliva, the lower the emissions per second, the longer the mean time between vocalizations, and the worse the swallowing of individuals with TMD. CONCLUSION: The functional conditions of the tongue regarding mobility, pressure, and oral DDK were associated with swallowing in individuals with TMD.

Effects of mandibular fixed implant-supported prostheses on masticatory and swallowing functions in completely edentulous elderly individuals.

PURPOSE: To evaluate the effect of oral rehabilitation with immediately loaded fixed implant-supported mandibular prostheses on chewing and swallowing in elderly individuals. MATERIALS AND METHODS: Fifteen completely edentulous patients aged more than 60 years (10 women and five men), wearing removable dentures in both arches, had a mandibular denture replaced by an implant-supported prosthesis. All individuals were evaluated before surgery and again 3, 6, and 18 months later with regard to mastication and swallowing conditions. Examinations entailed an interview, evaluation of tactile sensitivity of the face, and observation of food intake, masticatory type, formations of bolus, and pain during mastication. The swallowing evaluation comprised observation of clinical signs related to the oral and pharyngeal stages of swallowing, as well as the presence of oral residue. The findings of different evaluations before and 3, 6, and 18 months after the surgical-prosthetic procedure were statistically compared by analysis of variance for repeated measurements at a significance level of 5%. RESULTS: The questionnaire revealed a reduction in complaints of masticatory and swallowing disturbances, a decreased need for liquid ingestion, and reduced choking and coughing. Clinical evaluations showed improved oral function and bolus propulsion for both solid and paste-consistency foods; pain during mastication was also resolved. CONCLUSION: Treatment with mandibular implant-supported dentures had positive effects on the clinical aspects of mastication and swallowing in elderly individuals.

Duration of mastication and oral phase of swallowing in the elderly with different dental conditions: a clinical analysis / Duração da mastigação e da fase oral da deglutição em idosos com diferentes condições dentárias: análise clínica

ABSTRACT Purpose: to measure the total time of mastication and oral phase of swallowing in healthy elderly people, considering different food consistency, the presence of natural teeth, and the type of prosthetic oral rehabilitation, as well to compare dental conditions and consistencies. Methods: a cross-sectional study with 57 healthy elderly people, aged between 60 and 82 years, divided into: dentate group (D) (n=15); and rehabilitated groups; PD: fixed or removable partial dentures in one or both arches (n=15); CRD: maxillary and mandibular complete removable dentures (n=15); ISCD: complete dentures - maxillary removable denture and mandibular implant-supported dentures (n=12). The duration time (seconds) of chewing and of the oral phase of swallowing was measured in the consistencies: solid (a roll slice), pudding (10 ml) and liquid (10 ml). Results: healthy dentate elderly subjects had the following intervals: liquid=1.07±0.35 s; pudding=3.48±1.76 s; and solid=27.88±7.11 s. Statistically significant differences were observed between the D and ISCD groups (p=0.0056) and between D and CRD (p=0.0056) for liquid. For all groups, there was a statistically significant increase between liquid and solid consistencies and between pasty and solid ones (p<0.001). Conclusions: the dentate elderly had shorter oral phase time of swallowing for liquids than the rehabilitated edentulous elderly, but not different from the elderly with partial dentures. Chewing and swallowing time for solid food was longer than that for the other consistencies, regardless of dental condition.

RESUMO Objetivo: mensurar o tempo total da mastigação e da fase oral da deglutição em idosos saudáveis, considerando diferentes consistências alimentares, a presença de dentes naturais e o tipo de reabilitação oral protética, bem como realizar comparação entre as condições dentárias e as consistências. Métodos: estudo transversal com 57 idosos saudáveis, entre 60 e 82 anos, distribuídos em grupo dentado (D) (n=15) e grupos reabilitados: próteses parciais fixas ou removíveis em uma ou ambas as arcadas (PP) (n=15); prótese total removível maxilar e mandibular (PTR) (n=15); prótese total - prótese removível superior e prótese implanto-suportada inferior (PTIS) (n=12). O tempo de duração (segundos) da mastigação e da fase oral da deglutição foi medido nas consistências: sólida (pão francês), pudim (10 ml) e líquida (10 ml). Resultados: idosos dentados saudáveis apresentaram os intervalos: líquido=1,07±0,35 s; pudim=3,48±1,76 s; e sólido=27,88±7,11 s. Foram observadas diferenças estatisticamente significativas entre os grupos D e PTIS (p=0,0056) e entre D e PTR (p=0,0056) para líquido. Para todos os grupos, houve aumento estatisticamente significante entre as consistências líquida e sólida e entre pastosa e sólida (p<0,001). Conclusões: idosos dentados apresentaram menor tempo de fase oral da deglutição para líquidos do que idosos edêntulos totais reabilitados, mas não diferente dos idosos com prótese parcial. O tempo de mastigação e deglutição do alimento sólido foi maior que o das demais consistências, independente da condição dentária.

Identificação perceptiva do posicionamento da língua na produção de [s] por acadêmicos em Fonoaudiologia / Identificación perceptiva del posicionamiento de la lengua de la producción de [s] por académicos en Fonoaudiología / Perceptual analysis of the tongue position in the production of [s] by SLP students

Introdução: a identificação visual do posicionamento dos articuladores e o resultado auditivo na produção de [s] são necessários para decisões clínicas e monitoramento de tratamento. Para avaliadores não treinados esta tarefa pode ser desafiadora. Objetivo: verificar se avaliadores não treinados são capazes de identificar visualmente posições normal e alterada da língua na produção do [s] e perceber, auditivamente, produções normais e alteradas; bem como buscar quais ajustes da língua são mais difíceis de serem percebidos visualmente e quais resultados auditivos são mais facilmente identificados. Método: dez acadêmicos de Fonoaudiologia analisaram 20 amostras de fala gravadas, 10 com produção normal e 10 alterada do fone [s], sendo as respostas comparadas a uma avaliação padrão-ouro. Na análise foi utilizada a concordância Kappa, o teste Qui-quadrado, o Anova de Medidas repetidas e o teste t Student, com 5% de significância. Resultados: houve associação e concordância com a avaliação padrão-ouro para a posição da língua, com porcentagem média de 40% de respostas corretas para a posição normal, 17,5% quando a língua estava contra os dentes e 10% quando interposta. No resultado auditivo, a maioria dos avaliadores não apresentou associação e concordância com o padrão-ouro, sendo a porcentagem média de 50% de respostas corretas na ausência de distorção e com redução significativa quando presente (18,5%). Conclusão: os acadêmicos tiveram dificuldade na identificação visual da posição da língua, particularmente, quando alterada, bem como na identificação auditiva das produções normal ou alterada, sendo maior quando a distorção estava presente.

Introduction: thevisual identification of articulator positioning and auditory perception in the phoneme [s] are needed for clinical decisions and treatment monitoring. This can be challenging for untrained evaluators. Objective: to verify whether untrained evaluators are able to visually identify typical and atypical tongue positions in the production of phoneme [s] and to auditorily perceive typical and atypical productions; as well as to understand which tongue adjustments are more difficult to be visually perceived and which auditory productions are more easily identified. Methods: ten speech-language pathology students analyzed 20 recorded speech samples, being 10 with typical speech production and 10 atypical speech production regarding the [s] movement, and the answers were compared with a gold-standard evaluation. The Kappa agreement, Chi-squared test, Anova repeated measures and Student ́s t-test were used with 5% of significance. Results: there was an association and agreement with the gold standard evaluation for tongue positioning, with a mean percentage of 40% for correct answers regarding typical position, 17.5% when the tongue was against the teeth and 10% when interposed. In the auditory perception; most evaluators did not show association and agreement with the gold standard evaluation, with an average percentage of 50% for correct answers in the absence of distortion and a significant reduction in the presence (18.5%). Conclusion: the students had difficulty in the visual identification of the tongue positioning for atypical speech productions, as well as in the auditory identification of typical or atypical productions, and the greater difficulty occurred when there was distortion.

Introducción: identificar visualmente el posicionamiento del articulador y el resultado auditivo en la producción del [s] son necesarios para tomar decisiones clínicas y monitorear el tratamiento. Objetivo:verificar si los evaluadores no capacitados pueden identificar visualmente las posiciones normales y alteradas de la lengua en la producción del [s] y percibir auditivamente las producciones normales y alteradas; además buscar qué ajustes de la lengua son más difíciles de percibir visualmente y qué resultados auditivos se identifican más fácilmente. Método: estudiantes de Fonoaudiología analizaron 20 muestras de habla grabadas, 10 con producción normal y 10 con producción del fono [s] alterado. Compararon las respuestas con una evaluación patrón oro. En el análisis utilizaron la concordancia Kappa, la prueba Chi-cuadrado, el Anova de Medidas repetidas y la prueba t de Student, con 5% de significancia. Resultados:hubo asociación y concordancia con la evaluación patrón oro para la posición de la lengua, con media de 40% de respuestas correctas para la posición normal, 17,5% con la lengua contra los dientes y 10% cuando interpuesta. En el resultado auditivo, la mayoría de los evaluadores no presentaron asociación y concordancia con el patrón oro, con media de 50% de aciertos en ausencia de distorsión y con reducción significativa cuando presente (18,5%). Conclusión: los estudiantes tuvieron dificultad en identificar visualmente la posición de la lengua, particularmente cuando alterada, y en la identificación auditiva de producciones normales o alteradas, siendo mayor con la distorsión presente.

Proposal and content validation of an orofacial myofunctional assessment protocol for individuals with cleft lip and palate.

PURPOSE: To create and validate the content of an orofacial myofunctional assessment protocol for individuals with cleft lip and palate. METHODS: The first version of an orofacial myofunctional assessment protocol for individuals with cleft lip and palate was created by two speech-language pathologists, who contemplated the structural and functional aspects of the stomatognathic system. This version was analyzed by other two speech-language pathologists experienced in cleft lip and palate assessment, who suggested changes that led to the second version of the protocol. Dynamic and static images necessary for performing the orofacial myofunctional examination were recorded from three individuals with cleft lip and palate, who represented three life stages: childhood, adolescence, and adulthood. Five examiners evaluated the images, applied the proposed protocol, and judged each item regarding its clarity to validate the content, from Content Validity Index. RESULTS: The assessment protocol was finalized with 13 items, ten related to structural aspects and three related to functional aspects, with their corresponding sub-items. The general agreement in the validation of its content was 100%, so that only one stage was required. CONCLUSION: A protocol to evaluate the orofacial myofunctional aspects of individuals with cleft lip and palate was created with 13 items, as well as their corresponding sub-items, and its content was validated.

Tongue function and swallowing in individuals with temporomandibular disorders

Abstract The tongue participates in the oral phase of swallowing by pushing the food bolus toward the oropharynx. This relationship between tongue function and swallowing is little addressed addressed in individuals with temporomandibular dysfunction (TMD). Objective: To analyze the association of functional tongue conditions on swallowing in individuals with TMD. Methodology: After approval by the Institutional Review Board, the study was conducted on 30 individuals of both sexes, aged 18 to 28 years, with TMD, and not treated for the disorder. Tongue function was assessed as to the mobility, pressure, and oral motor control. Swallowing was analyzed by clinical assessment during ingestion of solid (wafer biscuit) and liquid (water). Data regarding mobility and swallowing were collected using the orofacial myofunctional evaluation protocol. Tongue pressure was measured by the Iowa Oral Performance Instrument, during elevation, protrusion, swallowing, and resistance test. The oral motor control was assessed by the oral diadochokinesis (DDK) test by rapid and repeated emissions of syllables "ta" and "ka". Data were statistically analyzed by the Spearman correlation coefficient, at a significance level of 5%. Results: Relationships were found between tongue function and swallowing for the following aspects: mobility (r=0.741), pressure in protrusion (r=-0.366), swallowing of saliva (r=-0.499), mean DDK rate in emissions "ta" (r=-0.424) and "ka" (r=-0.446), and mean DDK period in emissions "ta" (r=0.424) and "ka" (r=0.446). Thus, the greater the change in tongue mobility, the lower the tongue pressure in protrusion and swallowing of saliva, the lower the emissions per second, the longer the mean time between vocalizations, and the worse the swallowing of individuals with TMD. Conclusion: The functional conditions of the tongue regarding mobility, pressure, and oral DDK were associated with swallowing in individuals with TMD.

Influence of vocal and aerodynamics aspects on the voice-related quality of life of older adults

Abstract The pursuit for quality of life urged a better understanding of aspects involved in ageing to minimize its consequences. Although many studies investigated older adults' voice, aspects affecting this population voice-related quality of life have not yet been explored. Objective To investigate how aerodynamics and vocal aspects are associated with voice-related quality of life in older adults. Methodology fifty-six older adults aged 60 years or above - 39 women and 17 men - were evaluated. The following procedures were performed: application of the Voice-Related Quality of Life (V-RQOL) protocol; vocal assessment, including auditory-perceptual and acoustic analysis, from which we obtained fundamental frequency (F 0 ), standard deviation of fundamental frequency (SDF 0 ), shimmer, amplitude perturbation quotient (APQ), jitter, pitch period perturbation quotient (PPQ), and harmonics to noise ratio (HNR); aerodynamic assessment using a spirometer; and maximum phonation time (MPT) for /a/, /s/, /z/ and number counting. Results older adults tend to present high V-RQOL scores. Among women, roughness, APQ, and HNR parameters were negatively correlated with V-RQOL, whereas F 0 was positively. We found no correlation between spirometry measurements and V-RQOL. MPT for /a/, /z/, and number counting was positively correlated with V-RQOL solely among men. Conclusion Vocal roughness and acoustic parameters have a negative impact on the quality of life of older women. Respiratory aspects related to the available air support for speaking affected the most the voice-related quality of life of older men.

Ampliação e validação do protocolo de avaliação miofuncional orofacial para indivíduos com fissura labiopalatina / Extension and validation of the protocol of orofacial myofunctional assessment for individuals with cleft lip and palate

RESUMO Objetivo Realizar a ampliação, validação de conteúdo, critério e construto de um protocolo de avaliação miofuncional orofacial para indivíduos com fissura labiopalatina e definir parâmetros de avaliação para a utilização do instrumento. Método A ampliação do instrumento foi realizada com base no protocolo MBGR; os itens, subitens e possibilidades de respostas do instrumento ampliado foram analisados quanto à clareza por sete examinadores para a validação do conteúdo. Parâmetros de avaliação para a utilização do instrumento foram estabelecidos a fim de minimizar a subjetividade. Quatro examinadores compararam os aspectos do protocolo aos de outro instrumento para a validação de critério, e a validação de construto foi realizada comparando os resultados pré e pós-tratamento cirúrgico do avanço da maxila. Aplicou-se o Índice de Validação do Conteúdo e os testes Kappa, Correlação de Spearman e Wilcoxon para as validações. Resultados Foram acrescentados os aspectos da avaliação da mobilidade, tonicidade e sensibilidade ao protocolo; na validação do conteúdo, 72% dos itens foram classificados como muito claro e 28%, como claro; construiu-se um manual com parâmetros de avaliação para todos os itens e subitens do protocolo. A concordância interexaminadores apresentou-se moderada. Na comparação dos protocolos, para a validação de critério, foi observada boa relação entre eles. Para a validação do construto, o protocolo demonstrou ser capaz de identificar resultado de tratamento após a realização do tratamento. Conclusão O protocolo foi ampliado e considerado validado em sua totalidade: conteúdo, critério e construto, e estabelecidos parâmetros de avaliação para a sua utilização.

ABSTRACT Purpose To perform the expansion, validation of the content, criterion and construct of an orofacial myofunctional assessment protocol for individuals with cleft lip and palate; and to define evaluation parameters for the instrument use. Methods The expansion of the instrument was performed based on the MBGR protocol; the items, sub items and possibilities of answers of the amplified instrument were analyzed for their clarity by seven examiners for the content validation.. Assessment parameters were developed for the use of the instrument in order to minimize the subjectivity. Four examiners compared the aspects of the protocol to those of another instrument for the criterion validation, and the construct validation was performed comparing the results of pre and post orthognathic surgery treatment. The Content Validation Index and the Kappa, Spearman and Wilcoxon Correlation tests were applied for the validations. Results The mobility, tonicity and sensitivity aspects of the evaluation were added to the protocol and at content validation, 72% of the items were classified as very clear and 28% as clear. A manual with assessment parameters for all items and sub items of the protocol was constructed. The inter-examiner agreement was moderate. In the comparison of the protocols, for the validation of the criterion, a good relation among them was observed. For the validation of the construct the protocol was able to identify outcome after the treatment. Conclusion The protocol was expanded and considered validated in its entirety: content, criterion and construct, and evaluation parameters for its use were established.

Proposal and content validation of an orofacial myofunctional assessment protocol for individuals with cleft lip and palate / Proposta e validação do conteúdo de um protocolo de avaliação miofuncional orofacial para indivíduos com fissura labiopalatina

Purpose: To create and validate the content of an orofacial myofunctional assessment protocol for individuals with cleft lip and palate. Methods: The first version of an orofacial myofunctional assessment protocol for individuals with cleft lip and palate was created by two speech-language pathologists, who contemplated the structural and functional aspects of the stomatognathic system. This version was analyzed by other two speech-language pathologists experienced in cleft lip and palate assessment, who suggested changes that led to the second version of the protocol. Dynamic and static images necessary for performing the orofacial myofunctional examination were recorded from three individuals with cleft lip and palate, who represented three life stages: childhood, adolescence, and adulthood. Five examiners evaluated the images, applied the proposed protocol, and judged each item regarding its clarity to validate the content, from Content Validity Index. Results: The assessment protocol was finalized with 13 items, ten related to structural aspects and three related to functional aspects, with their corresponding sub-items. The general agreement in the validation of its content was 100%, so that only one stage was required. Conclusion: A protocol to evaluate the orofacial myofunctional aspects of individuals with cleft lip and palate was created with 13 items, as well as their corresponding sub-items, and its content was validated. .

Objetivo: Elaborar e validar o conteúdo de uma proposta de protocolo de avaliação miofuncional orofacial para indivíduos com fissura labiopalatina. Métodos: Uma primeira versão do protocolo de avaliação miofuncional orofacial para indivíduos com fissura labiopalatina foi elaborada por duas fonoaudiólogas e contemplaram-se os aspectos estruturais e funcionais do sistema estomatognático. Essa versão foi analisada por outras duas fonoaudiólogas com experiência em avaliação de indivíduos com fissura labiopalatina, as quais apresentaram sugestões, e foi obtida a segunda versão. Foram registradas imagens dinâmicas e estáticas, necessárias à realização do exame miofuncional orofacial, de três indivíduos com fissura labiopalatina, representantes das três fases da vida: infância, adolescência e adulta. Cinco examinadores as analisaram e aplicaram o protocolo proposto; além disso, julgaram cada item quanto à clareza para a validação do conteúdo, a partir da aplicação do Índice de Validação do Conteúdo. Resultados: O instrumento foi finalizado em 13 itens, dez referentes aos aspectos estruturais e três funcionais, com seus respectivos subitens. Houve 100% de concordância na validação do seu conteúdo e, assim, foi necessária uma única etapa. Conclusão: Um protocolo para avaliação miofuncional orofacial de indivíduos com fissura labiopalatina foi elaborado com 13 itens, e os respectivos subitens, e teve seu conteúdo validado. .

Speech in different oral prosthetic rehabilitation modalities for elderly individuals.

BACKGROUND: speech production in different modalities of oral prosthetic rehabilitation. AIM: to study the speech production of subjects submitted to different oral rehabilitation modalities. METHOD: 36 elderly individuals (average = 68 years) of both gender were evaluated. Participants were divided in three groups: 13 subjects with natural teeth (A); 13 edentate using maxillary and mandibular conventional dentures (B); and 10 edentate using maxillary conventional dentures and mandibular implant-supported prosthesis (C). Prosthesis stability was evaluated by a dentist and speech samples were analyzed by five speech-language pathologists. In order to determine the frequency of speech sound alterations, the Percentage of Correct Consonants (PCC) was used. RESULTS: few individuals presented speech alterations. Group C presented a higher occurrence of speech alterations (23.08%). Locked articulation was present in all groups; the reduction in lip movement was observed for groups A and B; exaggerated articulation and absence of saliva control was observed for group C. A smaller Percentage of Correct Consonants value was observed for the linguodental phonemes, in groups B and C, followed by the alveolar phonemes. Group A presented the majority of individuals with no speech alterations. On the other hand, for groups B and C, lips and tongue projection was frequently observed. No statistical difference was found between the groups. Most of the individuals in group B presented unsatisfactory prosthesis stability, but no association was identified between speech alterations and prosthesis stability. CONCLUSION: despite the small sample, the results of the study suggest that individuals using dentures present alterations in linguodental and alveolar phonemes. The type of prosthesis and its stability do not seem to interfere in speech production.

Atividade muscular da mastigação na anquilose temporomandibular / Muscle activity of chewing in temporomandibular joint ankylosis

OBJETIVO: devido à presença de importante disfunção mastigatória em casos com anquilose da articulação temporomandibular (ATM), este trabalho analisou a abertura bucal e a atividade eletromiográfica dos músculos mastigatórios para detectar mudanças nesses parâmetros após a cirurgia de liberação da anquilose mandibular. MÉTODO: em 7 indivíduos com anquilose temporomandibular, entre 7 e 30 anos (mediana=9 anos), foi mensurada a distância interincisal máxima ativa (DIMA) e registrada a atividade eletromiográfica (EMG) dos músculos masseteres e temporais durante a contração voluntária isométrica máxima (CVIM) e a mastigação habitual, comparando-se os dados pré e pós cirúrgicos pelo teste de Wilcoxon. RESULTADOS: maiores valores foram observados para a DIMA após a cirurgia (p=0,0277); o índice de assimetria, não mostrou diferença entre os dois momentos avaliados para ambos os músculos estudados; os valores da EMG durante a CVIM diminuíram após a cirurgia para os músculos masseter direito (p=0,0179) e esquerdo (p=0,0179), mas não para os temporais; não houve modificação nos valores EMG para os músculos estudados, durante a mastigação. CONCLUSÃO: a cirurgia para liberação da anquilose da ATM resultou em aumento da abertura bucal e diminuição da amplitude dos potenciais de ação gerados durante a contração voluntária isométrica máxima para o músculo masseter, em ambos os lados; não modificou o índice de assimetria dos músculos masseter e temporal, bem como a atividade eletromiográfica do músculo temporal, bilateralmente, durante a contração isométrica máxima e músculos masseter e temporal durante a mastigação habitual.

PURPOSE: due to the presence of major masticatory dysfunction in patients with temporomandibular joint (TMJ) ankylosis, this study analyzed mouth opening and EMG activity of masticatory muscles in order to detect changes in these parameters after surgical release of mandible ankylosis. METHOD: in 7 patients with temporomandibular ankylosis, between 7 and 30 years (median = 9 years), the distance was measured as interincisal maximum active (DIMA) and we recorded the electromyographic activity (EMG) of masseter and temporal muscles during voluntary isometric contraction (VIC) and chewing, comparing the data before and after surgery using the Wilcoxon test. RESULTS: higher values were observed for DIMA after surgery (p=0.0277), the asymmetry index showed no difference between the two evaluated periods for both studied muscles, the values of the EMG during VIC decreased after surgery for the right (p=0.0179) and left (p=0.0179) masseter but not for the temporal muscle, there were no changes in EMG values for the studied muscles during mastication. CONCLUSION: the surgical release of TMJ ankylosis resulted in an increase of mouth opening and decreased amplitude of action potentials generated during maximum isometric voluntary contraction of the masseter muscle on both sides, this did not change the asymmetry index of the masseter and temporal as well as the electromyographic activity of the temporal muscle bilaterally during isometric contraction and masseter and temporal muscles during mastication.

A fala nas diferentes modalidades de reabilitação oral protética em idosos / Speech in different oral prosthetic rehabilitation modalities for elderly individuals

BACKGROUND: speech production in different modalities of oral prosthetic rehabilitation. AIM: to study the speech production of subjects submitted to different oral rehabilitation modalities. METHOD: 36 elderly individuals (average = 68 years) of both gender were evaluated. Participants were divided in three groups: 13 subjects with natural teeth (A); 13 edentate using maxillary and mandibular conventional dentures (B); and 10 edentate using maxillary conventional dentures and mandibular implant-supported prosthesis (C). Prosthesis stability was evaluated by a dentist and speech samples were analyzed by five speech-language pathologists. In order to determine the frequency of speech sound alterations, the Percentage of Correct Consonants (PCC) was used. RESULTS: few individuals presented speech alterations. Group C presented a higher occurrence of speech alterations (23.08 percent). Locked articulation was present in all groups; the reduction in lip movement was observed for groups A and B; exaggerated articulation and absence of saliva control was observed for group C. A smaller Percentage of Correct Consonants value was observed for the linguodental phonemes, in groups B and C, followed by the alveolar phonemes. Group A presented the majority of individuals with no speech alterations. On the other hand, for groups B and C, lisp and tongue projection was frequently observed. No statistical difference was found between the groups. Most of the individuals in group B presented unsatisfactory prosthesis stability, but no association was identified between speech alterations and prosthesis stability. CONCLUSION: despite the small sample, the results of the study suggest that individuals using dentures present alterations in linguodental and alveolar phonemes. The type of prosthesis and its stability do not seem to interfere in speech production.

TEMA: a produção da fala nas modalidades de reabilitação oral protética. OBJETIVO: verificar se o tipo de reabilitação oral interfere na produção da fala. MÉTODO: 36 idosos (média = 68 anos), divididos em 3 grupos, foram avaliados: 13 com dentes naturais (A), 13 com prótese total mucosossuportada superior e inferior (B) e 10 com prótese total mucosossuportada superior e implantossuportada inferior (C). A estabilidade das próteses foi avaliada por um dentista e amostras de fala foram analisadas por 5 fonoaudiólogos. Para determinar a freqüência de alteração dos sons da fala utilizou-se o cálculo da Porcentagem de Consoantes Corretas (PCC). RESULTADOS: observou-se poucos casos com alteração de fala, com maior freqüência no grupo C (23,08 por cento), sendo a articulação travada presente em todos os grupos, a redução dos movimentos labiais em dois grupos (A e B) e a articulação exagerada e a falta de controle salivar em um dos grupos (C e B). Quanto à PCC, menor valor foi observado para os fones linguodentais nos grupos B e C (maior ocorrência de alteração), seguido dos fones alveolares, predominando casos sem alteração no grupo A, contrariamente aos demais grupos, sendo a projeção lingual e o ceceio as alterações mais encontradas. Não houve diferença entre os grupos e a maioria do grupo B estava com a prótese inferior insatisfatória, não havendo associação entre alteração de fala e prótese insatisfatória. CONCLUSÃO: apesar da amostra pequena, indivíduos reabilitados com prótese total apresentam alteração nos fones linguodentais e alveolares e o tipo de prótese, bem como a estabilidade desta parece não interferir na produção da fala.

Avaliação miofuncional orofacial: protocolo MBGR / Orofacial myofunctional evaluation - MBGR protocol

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

PURPOSE: to present a protocol with scores on the Orofacial Myofunctional area. This protocol is called MBGR. METHODS: based on different protocols used in the Orofacial Myofunctional area, a new protocol with scores was elaborated. This protocol was applied in both, patients and non-patients during five distinct phases during the elaboration. After each phase, the results were analysed and the necessary corrections were performed in order to improve the protocol and, in this way, provide an accurate diagnosis and prognosis. It took two years to elaborate the protocol. During those two years, independent judges were responsible for testing the protocol in each phase. RESULTS: a new protocol with scores on the Orofacial Myofunctional area was elaborated and tested during two years in different phases. The new MBGR Protocol gives the possibility to obtain numeric parameters. CONCLUSION: the MBGR Protocol with scores was presented. This protocol helps the Speech-Language Pathologist to evaluate and give the diagnosis and the prognosis on the Orofacial Myology area.

Ocorrência de disfunção temporomandibular (DTM) e sua relação com hábitos orais deletérios em crianças do município de Monte Negro - RO / Occurrence of temporomandibular disorder (TMD) and its relationship with harmful oral habits in children from Monte Negro - RO

OBJETIVO: verificar a ocorrência de disfunção temporomandibular em crianças do município de Monte Negro/RO, correlacionando os achados à presença de hábitos orais deletérios. MÉTODOS: investigou-se a presença de quadros de disfunção temporomandibular, classificando-se em disfunção temporomandibular articular, muscular ou mista, bem como a presença de hábitos orais deletérios de sucção (mamadeira, chupeta e digital) e mastigação (onicofagia, morder objetos, morder a mucosa oral ou labial, bruxismo e apertamento dentário), em 79 crianças de seis a 11 anos (41 meninas e 38 meninos). RESULTADOS: dentre as 79 crianças investigadas, 27 (34,18 por cento) apresentaram sinais de disfunção temporomandibular, sendo a disfunção articular a mais encontrada (48,15 por cento n=13), seguida da mista (33,33 por cento, n=9) e, com menor ocorrência, a muscular (18,52 por cento, n=5 crianças). Hábitos orais deletérios foram encontrados em 69,62 por cento (n=55) da amostra, sendo maior o número de crianças com hábitos de mastigação (39,91 por cento, n=26) que de sucção (8,86 por cento, n=7), observando-se casos em que os dois tipos de hábito estavam presentes (27,85 por cento, n=22). Os resultados não demonstraram associação entre a presença de hábitos orais deletérios e disfunção temporomandibular (teste Qui-quadrado), independentemente do tipo de hábito. CONCLUSÃO: das crianças avaliadas, um terço (34 por cento) apresentou sinais de disfunção temporomandibular, não havendo associação entre a disfunção temporomandibular com a presença de hábitos orais deletérios.

PURPOSE: to check the occurrence of temporomandibular disorder in children from Monte Negro/RO, correlating the findings to the presence of harmful oral habits. METHODS: the study was conducted on 79 children aged form 6 to 11-year old (41 girls and 38 boys). The presence of temporomandibular disorder was investigated and classified into articular, muscular and mixed. The presence of harmful oral habits involving sucking (baby bottle, pacifier, finger/thumb sucking) and chewing (nail biting, biting objects, biting the oral or labial mucosa, bruxism and clenching) was also found. RESULTS: among the 79 investigated children, 27 (34.18 percent) showed symptoms of temporomandibular disorder, with highest periodicity of articular disorder (48.15 percent, n=13), followed by mixed (33.33 percent, n=9) and muscular disorder (18.52 percent, n=5). Harmful oral habits were found in 69.62 percent (n=55), mostly involving chewing habits (39.91 percent, n=26) followed by sucking (8.86 percent, n=7); some children showed both types of habits (27.85 percent, n=22). The results did not demonstrate any association among harmful oral habits and temporomandibular disorder according to the chi-square test, regardless of the type of habit (chewing or suction). CONCLUSION: one third of children evaluated (34 percent) presented symptoms of temporomandibular disorder, without any association between temporomandibular disorder and the presence of harmful oral habits.

Masticatory function in temporomandibular dysfunction patients: electromyographic evaluation%Função mastigatória em pacientes com disfunção temporomandibular: avaliação eletromiográfica

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

Speech resonance in orthognathic surgery in subjects with cleft lip and palate

O propósito deste estudo foi verificar o impacto do avanco de maxila na ressonância de fala em sujeitos com fissura labiopalatina. A amostra do presente estudo foi composta por 42 sujeitos, entre 16 e 41 anos de idade, com fissura de palato associada ou não à de lábio submetidos ao avanco da maxila. A ressonância foi avaliada entre 3 e 12 meses após a cirurgia por análise e perceptual e graduada de ausente a severa. Observou-se que 47.5% dos sujeitos apresentaram prejuízo da ressonância após a cirurgia ortognática, com um intervalo de confianca (a 95%) de 31.5% a 63.9%. Esses resultados sugerem que a cirurgia ortognática, em sujeitos com fissura palatina, pode interferir na ressonância, causando ou aumentando o grau de hipernasalidade. Portanto, isso elucida a importância da orientacão sobre os riscos e benefícios da cirurgia de avanco da maxila e acompanhamento desses pacientes.

Masticatory function in temporomandibular dysfunction patients: electromyographic evaluation

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.