Developing a core outcome set for anthropometric evaluation for presurgical infant orthopaedics for unilateral cleft lip and palate: e-Delphi consensus.

INTRODUCTION: Presurgical infant orthopaedics (PSIO) in infants with cleft lip and palate focuses on improving the anatomical conditions of the lip, palate and nose before the first lip surgery; however, its effectiveness has not been proven. OBJECTIVE: To develop a core outcome set for reporting anthropometry-based outcomes in studies appraising the PSIO before primary cleft lip repair in unilateral cleft lip palate (UCLP). METHOD: Literature search to identify anthropometric measures. The operational definition and schematic representation of each were elaborated, grouping those apparently the same. By using Delphi methodology with a consensus of 10 subject-matter experts, three rounds were conducted to select a core outcome set of anthropometric measures with a validity V coefficient ≥80% among considered necessary to evaluate the PSIO in UCLP. RESULTS: A total of 101 anthropometric measures were identified in the literature to evaluate PSIO in UCLP. Of these, consensus validated the content of the core outcome set, which comprises 18 anthropometric measures, including columella height, nasal tip projection, projection alar length, width of nostril, nasal basal width, angle of columella, cleft lip segment, height of the non-cleft lip, height of the cleft lip, intersegment distance, arch length, greater segment length, lesser segment length, lateral deviation of the incisal point, posterior width of palatal cleft, arch width, grater segment rotation and lesser segment rotation. CONCLUSIONS: Standardised outcome measures are necessary to evaluate and ensure the quality of treatment in CLP. The core outcome set for anthropometric evaluation validated by consensus subject-matter experts is a clinically useful and low-cost tool for PSIO effectiveness studies.

Factores hipotéticamente influyentes en la aparición del micrognatismo transversal en escolares / Hypothetically influential factors in the appearance of transverse micrognathism in schoolchildren / Fatores hipoteticamente influentes no aparecimento de micrognatismo transversal em escolares

RESUMEN El micrognatismo transversal es una anomalía de volumen de los maxilares en sentido transversal. El objetivo del trabajo fue determinar los factores hipotéticamente influyentes en la aparición del micrognatismo transversal en escolares. Se realizó un estudio de caso y control y otro cuasi-experimental, para evaluar los resultados del proyecto ramal acerca del tratamiento del micrognatismo transversal relacionado con hábitos bucales deformantes en escolares de la Escuela Primaria "Ciro Redondo" en el período de 2015 a 2018. Se estudiaron variables como: edad, sexo, nivel de conocimiento y hábitos bucales deformantes. Predominaron los niños de 8 años de edad con 37,36 %; el 58,24 % de las niñas presentó micrognatismo transversal; la respiración bucal mostró una clara asociación con la aparición de micrognatismo transversal; en los escolares con empuje lingual, el riesgo fue 6,80 (IC 95 % 3,90-11,80) veces mayor de padecer micrognatismo transversal; después de aplicada la fase de la intervención, se obtuvo un incremento en la categoría Bien con 172 escolares que representó el 75,44 % del total de la población de estudio y el 63,16 % de los padres fueron evaluados de Bien. Se concluye que los hábitos bucales deformantes que constituyeron factores de riesgo fueron la respiración bucal como factor con mayor influencia sobre la aparición del micrognatismo transversal, seguidos del empuje lingual, la succión digital y las edades de 8 y 9 años. Predominó el alto nivel de conocimiento de los escolares y de los padres o responsables luego de la intervención.

ABSTRACT Transverse micrognathism is a volume abnormality of the jaws in the transverse direction. The objective of the work was to determine the hypothetically influencing factors in the appearance of transverse micrognathism in schoolchildren. A case-control study and a quasi-experimental study were carried out to evaluate the results of the branch project on the treatment of transverse micrognathism related to deforming oral habits in schoolchildren from the "Ciro Redondo" Primary School in the period from 2015 to 2018. Variables such as: age, sex, level of knowledge and deforming oral habits were studied. 8-year-old children predominated with 37,36 %; 58,24% of the girls presented transverse micrognathism; mouth breathing showed a clear association with the appearance of transverse micrognathism; in schoolchildren with tongue thrusting, the risk was 6.80 (95% CI 3.90-11.80) times higher for transverse micrognathism; After applying the intervention phase, an increase was obtained in the Good category with 172 schoolchildren representing 75,44% of the total study population and 63,16% of the parents were evaluated as Good. It is concluded that the deforming oral habits that constituted risk factors were mouth breathing as the factor with the greatest influence on the appearance of transverse micrognathism, followed by tongue thrusting, digital suction, and the ages of 8 and 9 years. The high level of knowledge of the schoolchildren and of the parents or guardians after the intervention prevailed.

RESUMO Micrognatismo transversal é uma anormalidade de volume das mandíbulas na direção transversal. O objetivo do trabalho foi determinar os fatores de influência hipotética no aparecimento do micrognatismo transversal em escolares. Um estudo de caso-controle e um estudo quase experimental foram realizados para avaliar os resultados do projeto do ramo sobre o tratamento do micrognatismo transversal relacionado à deformação dos hábitos orais em escolares da Escola Primária "Ciro Redondo" no período de 2015 a 2018. Foram estudadas variáveis ​​como: idade, sexo, nível de conhecimento e hábitos orais deformadores. As crianças de 8 anos predominaram com 37,36%; 58,24% das meninas apresentaram micrognatismo transversal; a respiração bucal mostrou uma associação clara com o aparecimento de micrognatismo transversal; em escolares com impulso de língua, o risco foi 6,80 (IC95% 3,90-11,80) vezes maior para micrognatismo transversal; Após a aplicação da fase de intervenção, obteve-se um aumento na categoria Bom, com 172 escolares representando 75,44% da população total do estudo e 63,16% dos pais foram avaliados como Bom. Conclui-se que os hábitos bucais deformadores que constituíram fatores de risco foram a respiração bucal como o fator de maior influência no aparecimento do micrognatismo transverso, seguido de estiramento da língua, sucção digital e idades de 8 e 9 anos. O alto nível de conhecimento dos escolares e dos pais ou responsáveis ​​após a intervenção prevaleceu.

Factores hipotéticamente influyentes en la aparición del micrognatismo transversal en escolares / Hypothetically influential factors in the appearance of transverse micrognathism in schoolchildren

El micrognatismo transversal es una anomalía de volumen de los maxilares en sentido transversal. El objetivo del trabajo fue determinar los factores hipotéticamente influyentes en la aparición del micrognatismo transversal en escolares. Se realizó un estudio de caso y control y otro cuasi-experimental, para evaluar los resultados del proyecto ramal acerca del tratamiento del micrognatismo transversal relacionado con hábitos bucales deformantes en escolares de la Escuela Primaria “Ciro Redondo” en el período de 2015 a 2018. Se estudiaron variables como: edad, sexo, nivel de conocimiento y hábitos bucales deformantes. Predominaron los niños de 8 años de edad con 37,36 por ciento; el 58,24 por ciento de las niñas presentó micrognatismo transversal; la respiración bucal mostró una clara asociación con la aparición de micrognatismo transversal; en los escolares con empuje lingual, el riesgo fue 6,80 (IC 95 por ciento 3,90-11,80) veces mayor de padecer micrognatismo transversal; después de aplicada la fase de la intervención, se obtuvo un incremento en la categoría Bien con 172 escolares que representó el 75,44 por ciento del total de la población de estudio y el 63,16 por ciento de los padres fueron evaluados de Bien. Se concluye que los hábitos bucales deformantes que constituyeron factores de riesgo fueron la respiración bucal como factor con mayor influencia sobre la aparición del micrognatismo transversal, seguidos del empuje lingual, la succión digital y las edades de 8 y 9 años. Predominó el alto nivel de conocimiento de los escolares y de los padres o responsables luego de la intervención(AU)

Transverse micrognathism is a volume abnormality of the jaws in the transverse direction. The objective of the work was to determine the hypothetically influencing factors in the appearance of transverse micrognathism in schoolchildren. A case-control study and a quasi-experimental study were carried out to evaluate the results of the branch project on the treatment of transverse micrognathism related to deforming oral habits in schoolchildren from the “Ciro Redondo” Primary School in the period from 2015 to 2018. Variables such as: age, sex, level of knowledge and deforming oral habits were studied. 8-year-old children predominated with 37,36 percent; 58,24 percent of the girls presented transverse micrognathism; mouth breathing showed a clear association with the appearance of transverse micrognathism; in schoolchildren with tongue thrusting, the risk was 6.80 (95 percent CI 3.90-11.80) times higher for transverse micrognathism; After applying the intervention phase, an increase was obtained in the Good category with 172 schoolchildren representing 75,44 percent of the total study population and 63,16 percent of the parents were evaluated as Good. It is concluded that the deforming oral habits that constituted risk factors were mouth breathing as the factor with the greatest influence on the appearance of transverse micrognathism, followed by tongue thrusting, digital suction, and the ages of 8 and 9 years. The high level of knowledge of the schoolchildren and of the parents or guardians after the intervention prevailed(EU)

Assessment and management of pain in pediatric otolaryngology.

INTRODUCTION: Pain is a disease by itself and it's a public health concern of major implication in children, not just because of the emotional component of the child and his family, but also due to the potential morbidity and mortality involving it. A proper assessment of pain it's a challenge in the pediatric population, due to their lack of understanding and verbalization of hurt. Additionally, a satisfactory treatment of pediatric pain can be arduous due to a lack of clinical knowledge, insufficient pediatric research, and the fear to opioid side effects and addiction. OBJECTIVES: The aim of this review is to address the current definitions of pain, its physiological mechanisms and the consequences of its inadequate management, as well as, to guide the clinicians in the assessment and management of pain in the pediatric population at otolaryngology services. METHODOLOGY: Narrative review by selective MeSH search terms: Children, Pediatrics, Otolaryngology, Pain measurement, Pain Management, Analgesics and Analgesia, from databases: MEDLINE/PubMed, Cochrane, ISI, Current Contents, Scielo and LILACS, between January 2000 and May 2016. RESULTS: 129 articles were reviewed according to the requirements of the objectives. Pain measurement is a challenge in children as there are no physical signs that constitute an absolute or specific indicator of pain, and its diagnosis must rely on physiological, behavioral and self-report methods. Regarding treatment, a suitable alternative are the non-pharmacological cognitive/behavioral therapies helped by pharmacological therapies tailored to the severity of pain and the child's age. We provide evidence-based recommendations on pain treatment, including non-opioid analgesics, opioid analgesics and adjuvant medicines to improve the management of pain in children in otolaryngology services. CONCLUSIONS: We present a global review about assessment and management of pain in pediatric otolaryngology, which leads to future specific reviews on each topic. Research gaps on pain assessment and pharmacological interventions in neonates, infants and children are very wide and it should be promoted ethical and safe research on pain control in this population.