Abordaje miofuncional / Myofunctional approach

La Ortodoncia Miofuncional basa sus objetivos de diagnóstico y tratamiento en el abordaje integral del paciente, tomando el cuerpo en su conjunto y la boca como expresión de desequilibrios funcionales. Los huesos responden a la acción muscular; si no se recupera la función, se compromete la estabilidad de la forma. El objetivo de este artículo es describir el potencial de los dispositivos preformados, que se trabajan en tres fases. • Fase 1: un dispositivo de silicona blanda para relajar los músculos y recuperar la respiración nasal. • Fase 2: un dispositivo de silicona reforzada para estimular el desarrollo transversal de los arcos. Se entrena la correcta posición de la lengua y el cierre labial. Se indican ejercicios de deglución y una alimentación saludable como parte de la terapia. • Fase 3: se instala otro dispositivo de silicona rígida para lograr estabilidad de las estructuras, ganando el paladar libre. Todos los dispositivos cuentan con una guía para la correcta ubicación de la lengua. Restaurar los patrones funcionales saludables es un requisito imprescindible en todo tratamiento de Ortodoncia. Tanto más favorable será si iniciamos el tratamiento en las fases más tempranas en que se diagnostican los Desórdenes Miofuncionales Orofaciales (DMO). Desórdenes Miofuncionales de los músculos y funciones de la cara y la boca Los DMO pueden afectar, directa o indirectamente, la lactancia materna, el crecimiento y desarrollo del esqueleto facial, la masticación, la deglución, el habla, la oclusión, la cinemática de la articulación temporomandibular, la higiene bucal, la estabilidad del tratamiento de Ortodoncia, la estética facial, etcétera. Con la terapia miofuncional, un paciente puede recuperar la alegría de comer, hablar, respirar e incluso dormir más profundamente, y además las mejoras cosméticas pueden ayudar a recuperar la confianza y la autoestima de los pacientes.

OMT (Orofacial myofunctional therapy), is definitely an interesting tool in nowadays, offering a higher range of treatment for both adults and children's… The Myofunctional orthodontics bases its diagnosis and treatment goals, by approaching the patient comprehensively from the macro to the micro, taking the body as a whole and the mouth as an expression of functional imbalances. The bones are slaves to the muscles, if the function not be recovered, it will compromises the stability of form. The aim of this article is to share the potential of preformed devices worked in three Phases •Phase 1: A device of soft silicone to relax the muscles and recover nasal breathing; •Phase Phase 2: reinforced silicone to stimulate the transversal development of the arches along with lip-tongue postures and swallowing exercises, even taking a healthy eating as part of the therapy. •Phase In a Phase 3: Another device of rigid silicone to achieve stability of the structures, gaining the free palate stands out, and all devices have a guide for the correct location of the tongue. Restoring healthy functional patterns is an essential requirement in all orthodontic treatments, even more if we help them from earlier stages of their OMDs (Orofacial Myofunctional Disorders), of the muscles and functions of the face and mouth. OMDs may affect, directly and/or indirectly, breastfeeding, facial skeletal growth and development, chewing, swallowing, speech, occlusion, temporomandibular joint movement, oral hygiene, stability of orthodontic treatment, facial esthetics, and more. We are completely aware that with myofunctional therapy, a patient can regain the joy of eating, speaking, breathing, and even sleeping more soundly, and also cosmetics improvements can help restore confidence and self's teams of our patients

Towards a better diagnosis of mouth breathing: validity and reliability of a protocol for assessing the awake breathing pattern in preschool children.

PURPOSE: The Awake Breathing Pattern Assessment (ABPA) is a prototypical clinical grid recently designed through an international consensus of Speech and Language Pathologists (SLPs) to categorize the awake and habitual breathing pattern during the orofacial myofunctional assessment. This cross-sectional study aims to explore the psychometric properties of the ABPA in a preschool population. METHODS: 133 children from 2;11 to 6 years old were assessed with the ABPA. The percentage of time spent breathing through the mouth was objectively measured by a CO2 sensor and used as a baseline measurement. We first performed a multivariate Latent Profile Analysis based on the CO2 measurement and a parental questionnaire to define the number of categories that best characterize the breathing pattern. Subsequently, we assessed the intra- and inter-rater reliability, internal consistency criterion validity, construct validity and sensitivity and specificity. RESULTS: The awake breathing pattern can best be described by two groups: nasal and mouth breathing. The ABPA, initially designed in three groups, was adjusted accordingly. This final version showed excellent intra-rater and inter-rater reliability. There was a significant correlation between the ABPA and the CO2 measurement. The ABPA showed a fair sensitivity and a good specificity. CONCLUSION: The reference tool based on CO2 data was used in children for the first time and was found to be reliable. The ABPA is a suitable tool for SLPs to confirm the diagnosis of mouth breathing in preschool children if more sensitive screening tools, like parental questionnaires, are used beforehand.

Orofacial myofunctional and polysomnographic characteristics of children with Down syndrome and obstructive sleep apnea: a pilot study. / Características miofuncionais orofaciais e polissonográficas de crianças com Síndrome de Down e apneia obstrutiva do sono: estudo piloto.

PURPOSE: To investigate oropharyngeal structures and functions in a pediatric population with Down Syndrome (DS) and obstructive sleep apnea (OSA) and to correlate with the apnea/hypopnea index (AHI) and sleep questionnaires. METHODS: 12 Children with DS and OSA, between the age of 4 and 12 years old, underwent polysomnography (PSG); sleep questionnaires, Pediatric Sleep Questionnaire (PSQ) and Obstructive Sleep Apnea-18 (OSA-18); and speech-language evaluation using the Short Evaluation of Orofacial Myofunctional Protocol (ShOM). RESULTS: There was a positive correlation between ShoM higher scores and the apnea-hypopnea index (AHI) and between ShoM and the number of hypopneas. The orofacial myofunctional alterations observed in the studied group were: oral breathing, alteration in lip tonus and competence, tongue posture at rest and in swallowing, and occlusal alteration. There was also an increased risk for OSA according to the sleep questionnaires, as well as the presence of obesity and overweight, but without correlation with the severity of OSA. CONCLUSION: All DS children show alterations in orofacial characteristics, higher scores being associated to severe OSA. Orofacial myofunctional evaluation may help to identify different phenotypes in Down syndrome children with Obstructive sleep Apnea, enhancing the need for a multidisciplinary approach.

OBJETIVO: Investigar as estruturas e funções orofaríngeas de uma população pediátrica com Síndrome de Down (SD) e apneia obstrutiva do sono (AOS) e correlacionar com o índice de apneia/hipopneia (IAH) e questionários do sono. MÉTODO: 12 Crianças com SD e AOS, entre 4 e 12 anos, foram submetidas à polissonografia (PSG); questionários do sono, Pediatric Sleep Questionnaire (PSQ) e Obstructive Sleep Apnea-18 (OSA-18); e triagem fonoaudiológica por meio do Short Evaluation of Orofacial Myofunctional Protocol (ShOM). RESULTADOS: Verificou-se uma correlação positiva entre pontuações mais elevadas no ShOM e o índice de apneia hipopneia (IAH) e entre o ShOM e número de hipopneias. As alterações miofuncionais orofaciais observadas no grupo estudado foram: respiração oral, alteração no tônus e competência labial, na postura de língua em repouso e na deglutição e alteração oclusal. Verificou-se também, um risco aumentado para AOS conforme os questionários do sono, bem como presença de obesidade e sobrepeso, mas sem correlação com a gravidade da AOS. CONCLUSÃO: Todas as crianças apresentaram alterações miofuncionais orofaciais, sendo que escores mais altos no ShOM, ou seja, um maior comprometimento miofuncional orofacial, estavam associados à maior gravidade de AOS, sugerindo que a avaliação miofuncional orofacial dentro de uma abordagem multidisciplinar pode auxiliar na identificação de fatores de risco para AOS em crianças com SD.

Breathing mode assessment with thermography: a pilot study. / Avaliação do modo respiratório por meio da termografia: um estudo piloto.

PURPOSE: To present a method for analyzing breathing modes with infrared thermography. METHODS: This exploratory cross-sectional study used 38 thermal images of inspiration and expiration with nasal breathing and simulated mouth breathing in four nasal breathers without respiratory complaints. Three different data selection forms (line, rectangle, and ellipse) were used to extract the minimum, mean, and maximum temperatures of the regions of interest (nose and mouth) using the FLIR Tools® software. RESULTS: Among the three selection forms, there was greater temperature variability obtained with the line, revealing limitations in this measurement. There were no differences between the rectangle and ellipse values, showing that both selection forms present similar temperature extraction results. The comparison results between nose and mouth temperatures during inspiration and expiration indicated a statistically significant difference between all measurements, except for mean inspiration temperatures with the rectangle and ellipse. The breathing mode can be distinguished in both inspiration and expiration when using mean mouth temperatures with the rectangle and ellipse. CONCLUSION: Breathing modes should be assessed based on mean mouth temperatures during inspiration, using the ellipse.

OBJETIVO: Apresentar um método de análise do modo respiratório por meio da termografia infravermelha. MÉTODO: Estudo transversal exploratório de 38 imagens térmicas que representavam o momento da inspiração e da expiração durante a respiração nasal e durante a simulação da respiração oral de quatro voluntárias respiradoras nasais sem queixas respiratórias. Para a extração da temperatura das regiões de interesse (nariz e boca) foram utilizadas três formas de seleção distintas de dados (linha, retângulo e elipse) e três medidas de temperatura (mínima, média e máxima) por meio do software FLIR Tools®. RESULTADOS: Dentre as três formas de seleção houve maior variabilidade nas medidas obtidas pela linha, revelando limitações nessa medida. Não houve diferenças entre as medidas do retângulo e elipse, mostrando que ambas as formas de seleção apresentam resultados semelhantes para a extração das temperaturas. Na comparação entre as temperaturas do nariz e da boca na inspiração e expiração, os resultados indicaram que houve diferença com relevância estatística em todas as medidas realizadas, exceto para as medidas de temperatura média da inspiração, usando o retângulo e a elipse. Percebe-se diferenciação do modo respiratório tanto na inspiração quanto na expiração quando utilizada a temperatura média da boca com o retângulo e a elipse. CONCLUSÃO: Sugere-se para avaliação do modo respiratório a avaliação da boca, por meio da elipse, com análise da temperatura média durante a inspiração.

A expansão rápida da maxila e sua relação com a qualidade de vida em pacientes respiradores bucais / Rapid maxillary expansion and its relation with quality of life in mouth breathing patients

Este estudo avaliou, em curto prazo, mudanças após a expansão rápida da maxila em pacientes respiradores bucais e correlacionou esses achados com a qualidade de vida dos pacientes. Este estudo teve como objetivo avaliar se a expansão rápida da maxila (ERM) está associada à melhora na qualidade de vida pós-tratamento. Foram avaliadas 35 crianças (média de idade 10,3 anos) com respiração bucal com hipoplasia maxilar. Os sintomas subjetivos foram avaliados por questionário padronizado de qualidade de vida, respondido pelos pacientes e seus pais ou responsáveis legais pré e pós-ERM. As condições respiratórias subjetivas do pré-tratamento apresentaram melhora significativa seis meses após a ERM. Concluiu-se que a ERM promoveu melhora na qualidade de vida dos pacientes com respiração bucal e hipoplasia maxilar (AU)

This study evaluated short-term changes after rapid maxillary expansion in mouth breathing patients and correlated these findings with their quality of life. This study aimed to evaluate whether rapid maxillary expansion (RME) is associated with improved post-treatment quality of life. Thirty-five mouth breathing children (mean age 10.3 years old) with maxillary hypoplasia were evaluated. Subjective symptoms were assessed by a standardized quality of life questionnaire, answered by patients and their parents or legal guardians before and after RME. Pre-treatment subjective respiratory conditions showed significant improvement six months after RME. It was concluded that RME improves the quality of life for patients with mouth breathing and maxillary hypoplasia (AU)

Predictors associated with malocclusion in children with and without sleep disorders: a cross-sectional study.

The aim of the present study was to investigate predictors of malocclusion in Brazilian schoolchildren eight to ten years of age based on a causal directed acyclic graph model. A cross-sectional study was conducted with 739 schoolchildren eight to ten years of age. Parents/guardians provided information on sleep disorders of the child (Sleep Disturbance Scale for Children) and family characteristics (Family Adaptability and Cohesion Evaluation Scale). The diagnosis of malocclusion was performed by four trained examiners using the Dental Aesthetic Index. Control variables were selected using a directed acyclic graph. Descriptive analysis was performed, followed by robust logistic regression analysis for complex samples (α = 5%). The following variables were associated with malocclusion in the final model: sleep disorders (OR = 2.61; 95%CI: 2.43-2.86), mouth breathing (OR = 1.04; 95%CI: 1.02-1.99), non-nutritive sucking habits (OR = 2.45; 95%CI: 2.37-4.85), and obesity (OR = 1.54; 95%CI: 1.02-2.33). Sociodemographic characteristics, family functioning, and premature tooth loss did not remain associated with malocclusion. Sleep disorders, mouth breathing, sucking habits, and obesity are predictors of malocclusion in schoolchildren eight to ten years of age.

Rapid maxillary expansion and nasal patency in mouth breathing children with maxillary atresia due to or not due to allergic rhinitis.

AIM: To evaluate the effects of rapid maxillary expansion (RME) on nasal patency in mouth breathing (MB) children with maxillary atresia due to or not due to allergic rhinitis (AR) associated with asthma. METHODS: Fifty-three MB children/adolescents (aged 7-14 years) with mixed or permanent dentition and maxillary atresia participated, with or without unilateral or bilateral crossbite. They formed the groups: RAD (AR + asthma; clinical treatment, RME); RAC (AR + asthma; clinical treatment, no RME); and D (mouth breathers; RME only). RAD and RAC patients received topical nasal corticosteroid and/or systemic H1 antihistamine (continuous use) and environmental exposure control. All were evaluated before RME (T1) and 6 months after (T2) with the CARATkids score, acoustic rhinometry, and nasal cavity computed tomography (CT). Patients RAD and D underwent RME (Hyrax® orthopedic appliance). RESULTS: A significant reduction in the CARATkids score occurred in the RAD (-4.06; p < 0.05), similarly when patient and parent/guardian scores were evaluated (-3.28 and -3.16, respectively). Acoustic rhinometry (V5) showed increased nasal volume in all groups, significantly higher in RAD patients than in RAC and D (0.99 × 0.71 × 0.69 cm3, respectively). CT of the nasal cavity documented increased volume in all three groups, with no significant differences between them. CONCLUSION: In MB patients with AR, asthma, and maxillary atresia, RME increased nasal cavity volume and improved respiratory symptoms. However, it should not be used as the only treatment for managing patients with respiratory allergies.

Assessment of mouth breathing by Speech-Language Pathologists: an international Delphi consensus.

PURPOSE: mouth breathing (MB) has detrimental effects on children's growth. Diagnosis of MB is possible through a multidisciplinary approach including Speech-Language Pathologist's (SLP) assessment; however, SLPs currently have little to no defined selection criteria to determine the awake and habitual breathing pattern. This study aims at identifying relevant criteria for the assessment of the habitual and awake breathing pattern of preschool children, and developing a grid that would help SLPs diagnose MB in their clinical practice. METHODS: A three-rounded online international Delphi process was conducted to achieve a consensus on the relevant items and their interpretation. Agreement was established through a Content Validity Ratio calculation. Based on the agreed items, we developed a grid through a scoring function. RESULTS: Observing the child at rest (i.e., time spent with an open/closed mouth and position of the tongue/lips) was considered the most important criterion. The experts also considered that observing the breathing pattern while chewing (open/closed mouth) and after swallowing (i.e., air intake and open/ closed mouth just after swallowing) should provide relevant but secondary information in decision-making. We were able to establish a clinical grid based on those criteria. CONCLUSION: The Delphi procedure provided content-valid criteria and conditions of observation for the myofunctional SLP assessment of the awake and habitual breathing pattern in preschoolers. A clinical validation of the developed prototype grid should be conducted in preschool children to explore its effectiveness in the diagnosis of MB.

Comparative study between photodynamic therapy and the use of probiotics in the reduction of halitosis in mouth breathing children: Study protocol for a randomized controlled clinical trial.

INTRODUCTION: Halitosis is a term that defines any odor or foul smell the emanates from the oral cavity, the origin of which may be local or systemic. One of the causes of local or oral halitosis is low salivary flow and dry mouth, which is also one of the complaints of individuals with the mouth-breathing habit. The aim of this study is to determine the effectiveness of antimicrobial photodynamic therapy (aPDT) and the use of probiotics for the treatment of halitosis in mouth-breathing children. METHODS: Fifty-two children between 7 and 12 years of age with a diagnosis of mouth breathing and halitosis determined through an interview and clinical examination will be selected. The participants will be divided into 4 groups: Group 1-treatment with brushing, dental floss and tongue scraper; Group 2-brushing, dental floss and aPDT applied to the dorsum and middle third of the tongue; Group 3-brushing, dental floss and probiotics; Group 4-brushing, dental floss, aPDT and probiotics. The use of a breath meter and microbiological analysis of the tongue coating will be performed before, immediately after treatment and 7 days after treatment. The quantitative analysis will involve counts of colony-forming bacteria per milliliter and real-time polymerase chain reaction. The normality of the data will be determined using the Shapiro-Wilk test. Parametric data will be submitted to analysis of variance and nonparametric data will be compared using the Kruskal-Wallis test. The results of each treatment in the different periods of the study will be compared using the Wilcoxon test. DISCUSSION: Due to the low level of evidence, studies are needed to determine whether treatment with aPDT using annatto as the photosensitizer and blue led as the light source is effective at diminishing halitosis in mouth-breathing children.

Patência nasal em crianças respiradoras orais / Nasal patency in mouth breathing children

RESUMO Vários estudos mostram a importância da avaliação quantitativa na patência nasal e do estado funcional das vias aéreas superiores para fornecer informações clínicas e diagnósticas em indivíduos respiradores orais, as quais são de grande interesse para a fonoaudiologia. O objetivo deste estudo foi avaliar o efeito da irrigação de solução salina nasal nas vias aéreas superiores através da aeração nasal e rinomanometria anterior ativa em crianças respiradoras orais. Estudo de série de oito casos, realizado em crianças com idades entre 7 e 10 anos, com diagnóstico clínico otorrinolaringológico de respiração oral. O estudo consistiu em três etapas: avaliação inicial; intervenção e avaliação final. Foram aplicados os questionários do Índice de Identificação dos Sinais e Sintomas da Respiração Oral e qualidade de vida específica para doenças em pacientes pediátricos com queixas sinonasais. Realizaram-se as avaliações da aeração nasal e o exame da rinomanometria anterior ativa. A intervenção foi realizada por meio da irrigação de solução salina nasal com 10 ml. Em seguida, os pacientes foram reavaliados pela avaliação da aeração nasal e rinomanometria, para comparar os resultados. Em relação à avaliação da aeração nasal e rinomanometria, das 16 medidas comparativas entre pré e pós-irrigação nasal, constataram-se mudanças significativas na aeração nasal e na resistência nasal. A irrigação nasal resultou em melhora nas medidas da aeração nasal, enquanto para o fluxo nasal da rinomanometria, as medidas permaneceram inalteradas entre pré e pós-irrigação nasal.

ABSTRACT Several studies have shown the importance of quantitative assessment in nasal patency and functional status of the upper airways to provide clinical and diagnostic information in oral breather individuals, which are of great interest to speech therapy. The aim of the study was to evaluate the effect of nasal saline solution irrigation on the upper airways through nasal aeration and active anterior rhinomanometry in oral breathing children. This was an eight case series study, carried out in children aged 7 to 10 years with an otorhinolaryngological clinical diagnosis of mouth breathing. The study consisted of three stages: (I) initial evaluation; (II) intervention; and (III) final evaluation. The questionnaires of the Index for the Identification of Oral Breathing Signs and Symptoms and disease-specific quality of life in pediatric patients with sinonasal complaints were applied, nasal aeration assessments and the anterior active rhinomanometry exam were carried out. The intervention was performed by irrigating nasal saline solution with 10ml. Afterwards, they were re-evaluated by nasal aeration evaluation and rhinomanometry to compare the results. Regarding nasal aeration and rhinomanometry evaluation, from the 16 comparative measurements between pre and post nasal irrigation, we obtained significant changes in nasal aeration and nasal resistance. Nasal irrigation resulted in improvement in nasal aeration measurements while nasal flow measurements from rhinomanometry remained unchanged considering pre and post nasal irrigation.

Three-dimensional image study of accelerated maxillary expansion in oral breathing kids.

OBJECTIVE: To evaluate, by a three-dimensional study, the volumetric and integumentary effects of rapid maxillary expansion on the nose, in mouth breathing kids with maxillary hypoplasia, in the short term, assessing the possible interference of gender, growth and age on the results achieved. METHODS: 120 mouth breathing patients with maxilla hypoplasia were divided into an Experimental Group treated by rapid maxillary expansion (n = 104, 62 males and 42 females, mean age 10.1 years, SD = 2.10, ranging from 5.1 to 13.9 years); and Control Group, constituted by 16 patients (9 males and 7 females, mean age 9.3 years, SD = 2.1 years, ranging from 6.1 to 13.2 years). Patients in the experimental group underwent multislice computed tomography examinations at two different times: (T1) pre-expansion and (T2) post-expansion. The control group was submitted to the same tests at the same time intervals. Six soft tissue variables of the nose were studied, besides the volume and area of the nasal cavity, and the measurement and comparison of data between T1 and T2 were performed using the Dolphin Imaging 11.7 Premium software. RESULTS: The experimental group showed significant mean increases in all soft tissue variables studied (p < 0.005), yet there were no significant changes in the control group. In the comparison between groups, only inclination of the nasal dorsum did not present any significant change. CONCLUSION: Rapid maxillary expansion may alter the nasal shape and physiology, by anatomical changes in the nose soft tissues, making it an important aid in the treatment of mouth breathing in childhood. LEVEL OF EVIDENCE: The soft tissues of the nose play an important role in nasal shape and physiology and facial esthetics, and since they are directly related to the nasal valves, they are fundamental for maintenance and stability of the nasal breathing pattern.

Termografia da face de crianças respiradoras orais e nasais / Facial thermography of mouth and nose breathing children

Introdução: A respiração oral é uma alteração prevalente na infância, que tem como uma das consequências a alteração na musculatura dos lábios. A termografia infravermelha, é uma opção para se avaliar a população infantil, pois não gera incômodo, é segura e não emite radiação. Acredita-se que a termografia da face e dos lábios possa auxiliar no diagnóstico e acompanhamento fonoaudiológico. Objetivo: 1) descrever a distribuição de temperatura na face de crianças respiradoras nasais; 2) verificar se os pontos termoanatômicos descritos para adultos pela literatura são facilmente visualizados nas crianças; 3) comparar os resultados da temperatura média dos pontos termoanatômicos da face entre os sexos; e 4) comparar a temperatura dos pontos termoanatômicos e áreas do lábio superior e lábio inferior entre crianças respiradoras orais e nasais. Métodos: estudo observacional transversal realizado com 30 crianças respiradoras nasais e 30 orais de quatro a 11 anos, de ambos os sexos. Utilizou-se a termografia infravermelha da face para obter um termograma frontal, um de perfil direito e outro esquerdo de cada participante. Foram marcados 14 pontos termoanatômicos no termograma frontal e 6 em cada de perfil, mais as áreas de lábio superior e inferior. Foi realizada análise qualitativa visual das imagens, além de análise descritiva e cálculo do ∆T (diferença entre os dois lados da face). Também foi realizada análise de concordância intra e interavaliadores na avaliação dos pontos utilizando-se o Coeficiente de correlação intraclasse. Comparou-se as temperaturas entre os sexos de respiradores nasais, temperatura de respiradores orais e nasais por meio dos Testes T e Mann Whitney. Além disso, comparou-se a diferença entre a temperatura da área de lábio superior e inferior (∆T área) e dos pontos localizados no lábio superior com os do inferior (∆T pontos) entre respiradores orais e nasais utilizando-se os mesmos testes. Resultados: As maiores temperaturas foram no ponto Comissura Palpebral Medial na vista frontal e no ponto Temporal de perfil. O ponto supratroclear não é um ponto que se destaca na face das crianças. O ∆T foi maior que 0,3 para a maioria dos pontos. As regiões hiperradiantes foram testa, olhos e região perioral e as hiporradiantes nariz, bochechas e região do mento. A análise de concordância intra e interavaliadores na avaliação dos pontos variou de boa a ótima. Não foi encontrada diferença de temperatura entre os sexos. Verificou-se que os pontos termoanatômicos mais próximos ao lábio, áreas dos lábios e meato acústico externo apresentaram temperatura menor nos respiradores orais do que nos nasais. Não houve diferença entre os grupos no ∆T de área e pontos. Conclusão: as crianças respiradoras nasais apresentaram como regiões hiperradiantes a testa, os olhos e a região perioral. Os pontos termoanatômicos encontrados nas crianças, são coincidentes com os da população adulta, exceto o ponto Supratroclear, que não é nítido. Os respiradores nasais apresentaram assimetria térmica e não houve diferença entre os sexos. Crianças respiradoras orais apresentaram menor temperatura na região dos lábios e do meato acústico externo do que as respiradoras nasais e não houve diferença entre lábio superior e inferior.

Introduction: mouth breathing is a prevalent disorder in childhood, which has as consequence alteration in the muscle of the lips. Infrared thermography, is an interesting option to assess the child population, as it is safe and does not cause discomfort nor emit radiation. It is believed that thermography of the face and lips can help in the orofacial myology diagnosis and follow-up. Objective: 1) to describe the facial spatial temperature distribution of nose breathing children; 2) verify if the thermoanatomical points described for adults in the literature are easily viewed in nose breathing children; 3) to compare the results of the mean temperature of the thermoanatomical points of the face of nose breathing children between sexes; 4) to compare the temperature of the thermoanatomical points and areas of lips between mouth and nose breathing children. Methods: Cross-sectional observational study of 30 nose-breathing and 30 mouth breathing children of both sexes aged 4 to 11 years. Front view, right side view, and left side view thermogram of each participant were recorded. The mean temperatures of 14 anatomical thermal points in the front view thermogram and 12 points in the side view and lip areas were assessed. A visual qualitative analysis of the images was performed, in addition to a descriptive analysis, and calculation of the ∆T (difference between the two sides of the face). Intra- and interrater agreement analyses of point assessment were made using the intraclass correlation coefficient. Temperatures were compared between sexes of nasal breathers, and temperatures of nose and mouth breathers using the T and Mann Whitney tests. In addition, the difference between the temperature of the upper and lower lip area (∆T area) and between the points located on the upper lip with those on the lower lip (∆T points) of mouth and nose breathers were compared using the same tests. Results: Medial Palpebral Commissure point had the highest temperature in the front view thermogram and Temporal point in the side view. The Supratrochlear point is not a point that stands out on the face of children. ∆T was greater than 0.3 for most points. The warmest regions were forehead, eyes and perioral region and the coldest, nose, cheeks and chin region. The analysis of intra- and inter-rater agreement in the assessment of points ranged from good to excellent. No temperature difference was found between the sexes. It was found that the thermoanatomical points closest to the lip, areas of the lips and External Acoustic Meatus presented lower temperature in mouth breathers than in nose ones. There was no difference between the groups in ∆T area and points. Conclusion: nose breathing children presented the forehead, eyes and perioral region as the hottest regions. The thermoanatomical points found in children are similar to those on the adult population, except for the Supratrochlear point, which does not stand out. Nose breathers showed thermal asymmetry and there was no difference between the sexes. Mouth breathing children have lower temperature in the region of the lips than nose breathing children.

Repercussão da adenotonsilectomia sobre o estado nutricional em crianças respiradoras orais / Repercussion of adenotonsillectomy on the nutritional status of mouth breathing children

Introdução: a hiperplasia adenotonsilar (HAT) é uma das causas mais comuns da Síndrome do Respirador Oral (SRO) devido à obstrução de via aérea superior em crianças e adolescentes. Tal afecção pode causar alterações ortodônticas, miofuncionais orofaciais, posturais, cardiopulmonares, antropométricas e polissonográficas. O diagnóstico precoce e indicação de Adenotonsilectomia (A&T) é essencial para reversão dessas consequências deletérias da SRO e restauração do bem estar biopsicossocial da criança.Objetivo: avaliar o estado nutricional, patência nasal, distúrbios do sono e fator de crescimento semelhante à insulina tipo 1 (IGF-1) em crianças de dois a doze anos de idade com SRO devido HAT grave e comparar com a reavaliação após seis meses de pós-cirúrgico das crianças operadas e com as demais que permanecem com obstrução da via aérea e aguardam a cirurgia na fila de espera do Sistema Único de Saúde. Métodos: trinta pacientes com SRO por HAT grave e indicação de A&T foram submetidos à avaliação antropométrica, polissonográfica, dosagem do IGF-1, rinomanométrica, teste alérgico cutâneo, questionário de padrão alimentar e prática de atividade física antes da A&T. Dez pacientes repetiram essa avaliação seis meses após o procedimento cirúrgico (grupo intervenção). Vinte pacientes aguardam a cirurgia na fila de espera do SUS e tiveram seus dados antropométricos e de IGF-1 reavaliados após seis meses com obstrução da via aérea (grupo controle). Resultados: trinta crianças realizaram a fase pré-operatória do estudo. A idade média foi de 5,6 anos (±2,17). Dezessete (56,7%) eram do sexo masculino e treze (43,3%) do sexo feminino. O teste cutâneo foi positivo em dezesseis indivíduos (53,3%) As médias dos escores Z de estatura por idade foi de -0,95 (±1,09); peso por idade de 0,17 (±1,42); índice de massa corporal (IMC) por idade de 0,31 (±1,36). A média do fluxo nasal inspiratório total (FNIT) foi de 444,63 ml/s (±161,02) e da patência nasal de 72,9% (±24,76). A média do índice de Apneia e Hipopneia (IAH) do sono foi de 4,95 ev/h (±4,07); da saturação mínima de oxihemoglobina no sono (Nadir de O2) de 78,93% (±6,00); da percentagem de sono com saturação menor que 90% (T90) de 4,16% (±5,48); da porcentagem do sono com ondas lentas (sono N3) de 37,62% (±9,61). A média do escore Z de IGF-1 foi de 0,72 (±1,30). O grupo intervenção e grupo controle não apresentaram alterações dos dados antropométricos com significância estatística. Houve diminuição do IGF-1 após a cirurgia sendo a média do escore Z de IGF-1 pré-operatório de 1,33 (±1,74) e pós-cirúrgico de -0,07 (±0,85); p=0,03. No grupo controle a variação do IGF-1 não foi significativa. O grupo intervenção não apresentou alteração com significância estatística do FNIT e da patência nasal. Nas dez crianças operadas foi constatada uma melhora da média do IAH de 5,25 ev/h (±4,29) para 1,99 ev/h (±1,16) e do T90 de 6,27% (±7,46) para 0,64% (±0,55) com p<0,05. Já o sono N3 e o Nadir de O2 não apresentaram alterações significativas. Não houve mudança qualitativa no padrão alimentar e na prática de atividade física nos dois períodos avaliados na vigência da pandemia de COVID19. Conclusão: Após A&T houve diminuição do IGF-1; p=0,03, melhora do IAH; p=0,03 e do T90; p=0,04. A cirurgia não modificou o estado nutricional com significância estatística nas dez crianças após 6 meses de pós-operatório. No pós-cirúrgico, não houve diferença estatística do FNIT e da patência nasal, assim como nessa amostra também não ocorreram alterações significativas do sono N3 e do Nadir de O2. O padrão alimentar e a prática de atividade física foram semelhantes qualitativamente no pré e no pós-operatório. Vinte crianças no grupo controle não tiveram alterações significativas dos dados antropométricos e do IGF-1 com seis meses de espera pela cirurgia e permanência da obstrução da via aérea. Não houve diferença estatística dos dados antropométricos e do IGF-1 entre o grupo controle e o grupo intervenção.

Introduction: adenotonsillar hyperplasia (ATH) is one of the most common causes of Mouth Breathing Syndrome (MBS) due to upper airway obstruction in children and adolescents. This condition can cause orthodontic, orofacial myofunctional, postural, cardiopulmonary, anthropometric and polysomnographic changes. Early diagnosis and indication of Adenotonsillectomy (T&A) is essential to revert these deleterious consequences of MBS and restore the child's biopsychosocial well-being. Objective: to evaluate the nutritional status, nasal patency, sleep disorders and insulin-like growth factor 1 (IGF-1) in children aged two to twelve years old with MBS due to severe ATH and compare with reassessment after six months post-surgical care of operated children and others who remain with airway obstruction and are waiting for surgery on the Unified Health System (UHS) waiting list. Methods: Thirty patients with MBS due to severe ATH and indication for T&A were submitted to anthropometric, polysomnographic, IGF-1 dosage, rhinomanometric, allergic skin test, dietary pattern questionnaire and physical activity practice before T&A. Ten patients repeated this evaluation six months after the surgical procedure (intervention group). Twenty patients were waiting for surgery on the UHS waiting list and had their anthropometric and IGF-1 data reassessed after six months with airway obstruction (control group). Results: Thirty children underwent the preoperative phase of the study. The mean age was 5.6 years (±2.17). Seventeen (56.7%) were male and thirteen (43.3%) were female. The skin test was positive in sixteen individuals (53.3%) The average Z-scores for height for age were -0.95 (±1.09); weight for age 0.17 (±1.42); body mass index (BMI) for age of 0.31 (±1.36). The mean total inspiratory nasal flow (TINF) was 444.63 ml/s (±161.02) and nasal patency was 72.9% (±24.76). The average sleep apnea and hypopnea index (AHI) was 4.95 ev/h (±4.07); minimum oxyhemoglobin saturation during sleep (O2 Nadir) of 78.93% (±6.00); percentage of sleep with saturation lower than 90% (T90) of 4.16% (±5.48); percentage of sleep with slow waves (N3) of 37.62% (±9.61). The mean IGF-1 Z-score was 0.72 (±1.30). The intervention group and control group did not show statistically significant changes in anthropometric data. There was a decrease in IGF-1 after surgery, with a mean preoperative IGF-1 Z-score of 1.33 (±1.74) and postoperative value of -0.07 (±0.85); p=0.03. In the control group, the IGF-1 variation was not significant. The intervention group did not show statistically significant changes in TINF and nasal patency. In the ten operated children, an improvement in the mean AHI from 5.25 ev/h (±4.29) to 1.99 ev/h (±1.16) and T90 of 6.27% (±7. 46) to 0.64% (±0.55) with p<0.05. On the other hand, N3 sleep and O2 Nadir showed no significant changes. There was no qualitative change in dietary patterns and physical activity in the two periods evaluated during the COVID19 pandemic. Conclusion: After T&A there was a decrease in IGF-1; p=0.03, AHI improvement; p=0.03 and T90 too; p=0.04. The surgery did not change the nutritional status with statistical significance in the ten children after 6 months postoperatively. Post-surgery, there was no statistical difference in TINF and nasal patency, as well as in this sample there were no significant changes in N3 sleep and O2 Nadir either. The dietary pattern and the practice of physical activity were qualitatively similar before and after the operation. Twenty children in the control group did not have significant alterations in anthropometric data and IGF-1 after six months of waiting for the surgery and the remaining airway obstruction. There was no statistical difference in anthropometric and IGF-1 data between the control and intervention groups.

Breathing pattern, orthognathic surgery and head posture in dentofacial deformity / Padrão respiratório, cirurgia ortognática e postura de cabeça na deformidade dentofacial

Abstract Introduction: Dentofacial deformity (DFD) and the breathing mode can change the head posture. However, head posture changes after orthognathic surgery are controversial, and no studies were found on the relationship between the head posture and breathing mode in adults with DFD. Objective: To identify the main head posture changes in young adults affected by DFD, to verify if orthognathic surgery modifies the breathing mode and head posture, and if the breathing mode is associated with the head posture. Methods: Twenty-five young adults were assessed and divided in dentofacial deformity group (DFD; n = 15; x̅ = 28 years) and control group with dentofacial harmony (CG; n = 10; balanced by gender and age with the study group). Breathing mode was evaluated according to the orofacial myofunctional evaluation protocol, and biophotogrammetry was used in the head posture analyses. For the DFD group, the evaluations were performed pre and post the orthognathic surgery (pre- and post-DFD). Results: For the DFD group, the breathing mode modified after orthognathic surgery (p = 0.003), but with difference from GC (p = 0.027). No changes were found in head posture after orthognathic surgery, but significant difference was seen between post-DFD and GC for head inclination (p = 0.017). No relationship was observed between breathing mode and head posture (p > 0.05). Conclusion: After orthognathic surgery, a spontaneous improvement of breathing was seen in the sample. It was not possible to verify changes in head posture and association with breathing mode and head posture.

Resumo Introdução: A deformidade dentofacial (DDF) e o modo respiratório podem alterar a postura de cabeça. Entretanto as modificações da postura de cabeça após a cirurgia ortognática são controversas e não foram encontrados estudos que apontassem relação entre a postura de cabeça e o modo respiratório em adultos com DDF. Objetivo: Identificar as principais alterações na postura de cabeça em adultos jovens com DDF, verificar se a cirurgia ortognática altera o modo respiratório e a postura de cabeça e se o modo respiratório está associado com a postura de cabeça. Métodos: Foram avaliados 25 jovens adultos, os quais foram divididos no grupo deformidade dentofacial (DDF; n = 15; x̅ = 28 anos) e grupo controle com harmonia dentofacial (GC; n = 10; equilibrados por gênero e idade com o grupo de estudo). O modo respiratório foi analisado de acordo com o protocolo de avaliação miofuncional orofacial e a postura de cabeça foi avaliada por meio da biofotogrametria. Para o grupo DDF, as avaliações foram realizadas antes e após a cirurgia ortognática (pré e pós-DDF). Resultados: Para o grupo DDF, o modo respiratório se modificou após a cirurgia ortognática (p = 0,003), porém com diferença em relação ao GC (p = 0,027). Não houve modificação na postura de cabeça após a cirurgia ortognática, porém observou-se diferença significativa entre os grupos pós-DDF e GC para a inclinação de cabeça (p = 0,017). Não observou-se relação entre o modo respiratório e a postura de cabeça (p > 0,05). Conclusão: Após a cirurgia ortognática, notou-se melhora espontânea da respiração na amostra estudada. Não foi possível verificar modificações na postura de cabeça e associação entre modo respiratório e postura de cabeça.

Maloclusiones funcionales y su relación con hábitos orales en niños con dentición mixta / Functional malocclusions and their association with oral habits in children with mixed dentition

Objetivo: Relacionar la prevalencia de maloclusiones funcionales con hábitos orales en niños con dentición mixta. Materiales y métodos: La muestra estuvo constituida por 61 pacientes que asistieron a la Facultad de Odontología de la UNNE entre los meses de abril y noviembre de 2018, seleccionados mediante un muestreo al Azar Sistemático. Se evaluó en ellos la presencia de maloclusiones funcionales como mordidas abiertas y cruzadas, líneas medias desviadas, apiñamiento dentario, resalte maxilar. Como hábitos orales se consideró la succión digital, interposición lingual y deglución atípica, interposición de labios y objetos, respiración bucal, onicofagia. Se realizó un análisis descriptivo empleando el software estadístico InfoStat Versión 2019 y para conocer la asociación entre las maloclusiones funcionales y los hábitos orales se emplearon pruebas de Chi cuadrado (nivel de signi- ficación de P ≤0,05). Resultados: Se observó la presencia de maloclusiones funcionales en un 64% de los niños, y se encontró que el api- ñamiento dentario fue el predominante con un 39%. La pre- valencia de hábitos orales fue de 66%, la interposición labial y de objetos fue la que se detectó con mayor frecuencia con un 39%. Se observó mayor presencia de mordida abierta en pacientes con hábitos parafuncionales como ser succión digi- tal e interposición lingual. La asociación entre maloclusiones funcionales y hábitos orales fue estadísticamente significativa (χ 2 = 6,17, P = 0.0130). Conclusión: Se identificó una alta prevalencia de malo- clusiones funcionales en niños con dentición mixta, asociadas a hábitos orales (AU)

Aim: To determine the association between prevalence of functional malocclusions and oral habits in children with mixed dentition. Materials and methods: The sample consisted of 61 patients who attended the UNNE School of Dentistry from April to November 2018, selected through systematic random sampling. Presence of functional malocclusions such as open bite, crossbite, deviated midlines, dental crowding, and maxil- lary protrusion were evaluated. The oral habits of finger suck- ing, lingual interposition and atypical swallowing, interposi- tion of lips and objects, mouth breathing, and onychophagia were considered. A descriptive analysis was performed using the Statistical Software InfoStat Version 2019. Chi-square tests were used to determine the association between function- al malocclusions and oral habits (significance level P ≤0.05). Results: Functional malocclusions were present in 64% of the children, with dental crowding being the most prevalent, in 39%. Prevalence of oral habits was found in 66%, with la- bial and object interposition having the highest frequency, in 39%. Open bite was more frequent in patients with parafunc- tional habits such as finger sucking and lingual interposition. The association between functional malocclusions and oral habits was statistically significant (χ2 = 6.17, P = 0.0130). Conclusion: High prevalence of functional malocclu- sions was identified in children with mixed dentition, associ- ated with oral habits (AU)

Relation of sensory processing and stomatognical system of oral respiratory children. / Relação do processamento sensorial e sistema estomatognático de crianças respiradoras orais.

PURPOSE: To verify the relationship between sensory processing and changes in the functions of the stomatognathic system in mouth breathing children, characterizing their sensory processing and comparing it with that of nasal breathing children. METHODS: 50 children (5 to 12 years) who were diagnosed with mouth breathing and 50 without signs and symptoms of mouth breathing or allergic rhinitis were selected to be part of the control group, matched for age and sex. Oral and nasal breathing children underwent sensory processing evaluation, through the Sensory Processing Measure - home form, and mouth breathers, through the evaluation of orofacial motricity through the Orofacial Myofunctional Evaluation with score. The results were presented in table form and with their respective absolute and relative frequencies. RESULTS: Most of the children evaluated were male, with an average age of eight years. Most mouth breathers presented alteration in the processing of all senses, with a statistically significant relationship when compared to nasal breathers. There was a relationship, in mouth breathers, between proprioceptive sensory processing and the movement of the cheeks, visual sensory processing and head movement during swallowing, and between the type of chewing and tactile sensory processing. CONCLUSION: After analyzing the data, it was possible to see that the sensory processing of all systems presents with changes in mouth breathers and that this poor processing is related to orofacial mobility, as well as functions of the stomatognathic system, in addition to the type of chewing of this population.

OBJETIVO: Verificar a relação entre o processamento sensorial e as alterações das funções do Sistema Estomatognático de crianças respiradoras orais, caracterizando o processamento sensorial destas e comparando-o com o de respiradoras nasais. MÉTODO: Foram selecionadas 50 crianças (5 a 12 anos) que apresentaram diagnóstico de respiração oral e 50 sem sinais e sintomas de respiração oral ou rinite alérgica para fazer parte do grupo controle, pareadas por idade e sexo. As crianças respiradoras orais e nasais passaram por avaliação do processamento sensorial, através da Sensory Processing Measure ­ Home form, e as respiradoras orais por avaliação da motricidade orofacial através da Avaliação Miofuncional Orofacial com Escore. Os resultados foram apresentados em forma de tabela e com suas respectivas frequências absoluta e relativa. RESULTADOS: A maioria das crianças avaliadas foi do sexo masculino, estando com idade média de 8 anos. A maioria dos respiradores orais apresentou alteração no processamento de todos os sentidos, com relação estatisticamente significativa quando comparados com os respiradores nasais. Houve relação, nos respiradores orais, entre o processamento sensorial proprioceptivo e o movimento das bochechas, processamento sensorial visual e movimentação da cabeça durante a deglutição e entre o tipo de mastigação e o processamento sensorial tátil. CONCLUSÃO: Após análise dos dados foi possível perceber que o processamento sensorial de todos os sistemas se apresenta com alteração nos respiradores orais e que esse mau processamento se relaciona a mobilidade orofacial, bem como com funções do Sistema Estomatognático, além do tipo de mastigação dessa população.

Evaluación interdisciplinaria estomatognática y postural en un paciente pediátrico respirador oral: Reporte de caso / Interdisciplinary stomatognathic and postural assessment in a pediatric mouth-breathing patient: A case report

Introducción: La respiración oral se asocia con trastornos de los órganos del habla, que generalmente se combina con deformidades faciales y problemas de oclusión dental. Objetivo: Evaluar interdisciplinariamente la fisiología del sistema estomatognático y postural en un paciente respirador oral de 11 años. Presentación del caso: Paciente de sexo masculino, se le realizó examen orofacial mediante mioescanografía, dinamometría y electromiografía, técnica de Payne y prueba Rosenthal. Se evaluó alineación postural, estabilidad con índice de Romberg y presiones plantares con baropodometría. Resultados: El paciente presentó mal oclusión clase I, hipoplasia maxilar hiperdivergente y micrognatismo, en actividad muscular, índice de asimetría 34% en maseteros durante la masticación, en temporales durante la protrusión la simetría fue de 67% y de 62%, alteración de la estabilidad estática con Índice de Romberg de 1,22 y distribución de presión plantar en pie izquierdo 42,2% y derecho 57,8%. Conclusiones: El sujeto presentó disminución en actividad de fuerza muscular orofacial, alteraciones en la alineación de cabeza, hombros, región pélvica, alteración de la estabilidad estática y presiones plantares con mayor distribución en retropié bilateral y miembro inferior derecho.

Introduction: Oral respiration is associated with speech organs disorders, which are generally combined with facial deformities and dental occlusion problems. Objective: To conduct an interdisciplinary assessment of the physiology of the stomatognathic and postural system in a 11-year old mouth-breathing patient. Case presentation: The male subject underwent orofacial examination using myoscanography, dynamometry, electromyography, Payne technique, and Rosenthal test. Postural alignment, stability (Romberg index) and plantar pressures (baropodometry) were evaluated. Results: The subject displayed: class I malocclusion; hyperdivergent maxillary hypoplasia, and micrognathism in muscular activity; a 34% asymmetry index in masseters during mastication; the symmetry in temporals was 67% and 62% during protrusion; alteration of the static stability with a Romberg index of 1.22; and 42.2% and 57.8% plantar pressure distributions in the left and right feet, respectively. Conclusions: The subject showed a reduction in orofacial muscle strength activity, alterations in the alignment of the head, shoulders and pelvic region, an alteration of the static stability, and plantar pressures with a greater distribution on the bilateral hindfoot and right lower limb.

Hyperextension of the head versus cervical vertebrae morphology in mouth and nasal breathers: a preliminary study

Objective: This study aimed to compare through cone-beam computed tomography (CBCT) the morphology of the cervical vertebrae atlas (C1) and axis (C2) in mouth breathers (MB) and nose breathers (NB), correlating them with the head and neck postures of the two groups. Materials and Methods: CBCT images of 36 subjects aged 11 to 22 years were evaluated using the InVivo Dental 5.1 (Anatomage, San Jose, California) software. The following measurements were used to assess C1 and C2 morphology: posterior height, anterior height, length, and volume. The craniocervical angle (NSL/OPT) was used to evaluate head posture concerning the neck. Results: The posterior height, length, and volume of C1 and C2 were lower in the MB group, but only the posterior size was significantly shorter than the NB group (C1, p=0.01 / C2, =0.05). Mouth breathers also showed a considerably higher craniocervical angle (p=0.04). Spearman test showed a significant positive correlation between C1 and C2 length and craniocervical angle (C1, =0.629, p=0.005 / C2, =0.665, p=0.003). Conclusion: The mouth breathers showed an increased craniocervical angle and decreased posterior height of the C1 vertebra concerning nasal breathers. The hyperextension of the head present is positively correlated with the length of the vertebra.

Objetivo: Este estudo teve como objetivo comparar por meio da tomografia computadorizada de feixe cônico (TCFC) a morfologia do atlas das vértebras cervicais (C1) e do eixo (C2) em respiradores orais (MB) e nasais (RN), correlacionando-os com a cabeça e posturas do pescoço dos dois grupos. Materiais e Métodos: Imagens de CBCT de 36 indivíduos com idades entre 11 e 22 anos foram avaliadas usando o software InVivo Dental 5.1 (Anatomage, San Jose, Califórnia). As seguintes medidas foram usadas para avaliar a morfologia de C1 e C2: altura posterior, altura anterior, comprimento e volume. O ângulo craniocervical (NSL/OPT) foi utilizado para avaliar a postura da cabeça em relação ao pescoço. Resultados: A altura posterior, comprimento e volume de C1 e C2 foram menores no grupo MB, mas apenas o tamanho posterior foi significativamente menor que o grupo RN (C1, p=0,01 / C2, =0,05). Os respiradores orais também apresentaram um ângulo craniocervical consideravelmente maior (p=0,04). O teste de Spearman mostrou correlação positiva significativa entre comprimento de C1 e C2 e ângulo craniocervical (C1, =0,629, p=0,005 / C2, =0,665, p=0,003). Conclusão: Os respiradores orais apresentaram aumento do ângulo craniocervical e diminuição da altura posterior da vértebra C1 em relação aos respiradores nasais. A hiperextensão da cabeça presente está positivamente correlacionada com o comprimento da vértebra.

Do breastfed children have a lower chance of developing mouth breathing? A systematic review and meta-analysis.

OBJECTIVE: Determine the association between breastfeeding and the development of mouth breathing in children. MATERIALS AND METHODS: Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding. RESULTS: The overall prevalence of mouth breathing was 44% (95% CI: 38-49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41-0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31-1.18). CONCLUSIONS: Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern. CLINICAL RELEVANCE: The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding. TRIAL REGISTRATION: PROSPERO registry: CRD42017062172.