Teste de caminhada de seis minutos em crianças com doença respiratória crônica / Six-minute walk test in children with chronic respiratory disease

Introdução: o teste de caminhada de seis minutos (TC6) é amplamente utilizado para avaliar a capacidade funcional em pediatria por ser de fácil administração e baixo custo. Objetivo: avaliar e comparar o desempenho de crianças saudáveis (GC), com fibrose cística (GFC) e síndrome da respiração oral (GRO) no TC6. Método: estudo transversal comparativo controlado. Realizaram-se dois TC6 (TC61 e TC62) segundo recomendação da American Thoracic Society. Aplicou-se o teste de normalidade de Shapiro-Wilk e, para comparação dos dois TC6 em cada grupo, realizou-se o teste-t pareado e posteriormente Anova post-hoc de Bonferroni para as distâncias percorridas (DPTC6). Resultados: participaram 51 crianças (oito a 12 anos), sendo 17 por grupo. Na comparação das DPTC6, apenas o GFC obteve desempenho inferior ao GC nos dois TC6 (p=0,001). Conclusão: o menor desempenho pelo GFC reforça o TC6 como instrumento sensível na avaliação da capacidade de exercício de crianças com doença pulmonar crônica.

Introduction: the six-minute walk test (6MWT) is widely used to assess functional capacity in children because of its easy administration and low cost. Objective: to evaluate and compare the performance of healthy children (CG), cystic fibrosis (CFG) and syndrome of mouth breathing (MBG) the 6MWT. Method: controlled comparative cross-sectional study. There were two 6MWT (6MWT1 and 6MWT2) as recommended by the American Thoracic Society. The Shapiro-Wilk normality test was used and for comparison of the two 6MWT in each group, there was the paired t-test and ANOVA later post-hoc Bonferroni for the distances (D6MWT). Results: 51 children participated (8 to 12 years), 17 per group. In comparing the D6MWT, only the CFG got underperformed the CG in both 6MWT (p = 0.001). Conclusion: the lowest performance by CFG strengthens the 6MWT as a sensitive instrument for assessing exercise capacity of children with chronic lung disease.

Influence of adenotonsillectomy on hard palate dimensions.

OBJECTIVE: To evaluate hard palate width and height in mouth-breathing children pre- and post-adenotonsillectomy. METHODS: We evaluated 44 children in the 3-6 year age bracket, using dental study casts in order to determine palatal height, intercanine width, and intermolar width. The children were divided into two groups: nasal breathing (n=15) and mouth breathing (n=29). The children in the latter group underwent adenotonsillectomy. The study casts were obtained prior to adenotonsillectomy, designated time point 1 (T1), at 13 months after adenotonsillectomy (T2), and at 28 months after adenotonsillectomy (T3). Similar periods of observation were obtained for nasal breathing children. RESULTS: At T1, there was a significantly lower intercanine width in mouth breathing children; intermolar width and palate height were similar between groups. After surgery, there was a significant increase in all the analyzed parameters in both groups, probably due to facial growth. Instead, the increase in intercanine width was substantially more prominent in mouth breathing children than in nasal breathing children, and the former difference failed in significance after the procedure. CONCLUSIONS: There were no significant differences between the nasal-breathing and mouth-breathing children in terms of intermolar width and palatal height prior to or after tonsillectomy. Although intercanine width was initially narrower in the mouth-breathing children, it showed normalization after the surgical procedure. These results confirm that the restoration of nasal breathing is central to proper occlusal development.

Maternal breastfeeding, parafunctional oral habits and malocclusion in adolescents: a multivariate analysis.

OBJECTIVE: Malocclusion may result in esthetic impairment and functional disorders such as bad chewing, speech and swallowing, with a negative impact on quality of life. There is uncertainty regarding the effects of breastfeeding on dentofacial malocclusions. The purpose of the study was to evaluate the relationship between maternal breastfeeding and dental malocclusions and facial characteristics in adolescents with permanent dentition. METHODS: Probabilistic sampling of 2060 12- to 15-year-old students in a cross-sectional study was used. Malocclusion, as defined by Angle, and facial characteristics were the dependent variables. The duration of breastfeeding was the main independent variable. Other covariates were tested as effect modifiers or confounders. The associations were estimated using the odds ratio (OR) in multinomial logistic regression analysis (α=5%). RESULTS: There was an association between a short duration of breastfeeding (less than 6 months) and Angle class II (OR=3.14; 95% CI: 1.28-7.66) and class III (OR=2.78; 95% CI: 1.21-6.36) malocclusion only in students with a prolonged history of bruxism. A higher occurrence of severe convex profile (OR=3.4; 95% CI: 0.63-18.26) and a lower occurrence of cancave profile (OR=0.43; 95% CI: 0.21-0.88) were also observed only among adolescents who had been breastfed for a short period and exposed to a long periods of mouth breathing. CONCLUSIONS: These findings support the hypothesis that breastfeeding alone seems not to be directly associated with malocclusions, but it may have a synergetic effect with parafunctional oral habits on the development of occlusofacial problems. It is recommended that deleterious oral habits be avoided, especially by children who were breast-fed for less than 6 months.

Dimensões do palato duro de respiradores nasais e orais por diferentes etiologias / Hard palate dimensions in nasal and mouth breathers from different etiologies

OBJETIVO: Comparar as dimensões do palato duro de crianças respiradoras nasais, respiradoras orais por etiologia obstrutiva e respiradoras orais por etiologia viciosa. MÉTODOS: A amostra foi composta por 76 crianças, 37 meninos e 39 meninas, com média de idade de 9,32±1,16 anos, distribuídas conforme diagnóstico do modo respiratório e etiologia da respiração oral. Foram obtidos modelos em gesso do arco dental maxilar para a realização de medidas do palato duro com paquímetro digital. Foram obtidas as medidas transversais, verticais e do comprimento anteroposterior do palato duro. A comparação das medidas do palato duro entre os grupos foi realizada por meio de testes estatísticos. RESULTADOS: Na comparação das dimensões do palato duro entre os grupos de respiradores nasais e respiradores orais, verificou-se diferença na distância e profundidade ao nível dos segundos pré-molares e na distância entre os primeiros molares. Também foi verificada diferença entre os grupos de respiradores orais por etiologia obstrutiva e por etiologia viciosa na profundidade do palato duro ao nível dos caninos. CONCLUSÃO: Respiradores orais apresentam palato duro mais estreito ao nível dos segundos pré-molares e primeiros molares, e mais profundo ao nível dos segundos pré-molares quando comparados aos respiradores nasais. Evidencia-se também que os respiradores orais por etiologia viciosa apresentam maior profundidade do palato duro ao nível dos caninos quando comparados aos respiradores orais por etiologia obstrutiva.

PURPOSE: To compare the hard palate dimensions of nasal-breathing children, mouth breathers from obstructive etiology, and habitual mouth breathers. METHODS: The sample comprised 76 children, 37 boys and 39 girls, with mean age of 9.32±1.16 years, distributed according to the diagnosis of breathing mode and to the etiology of mouth breathing. Plaster cast models of the subjects' superior dental arch were obtained in order to measure the hard palate with a digital caliper. Measurements of transverse, vertical and anteroposterior palatal length were taken. The hard palate measures were compared among the groups through statistical analysis. RESULTS: The comparison of hard palate dimensions observed in nasal and mouth breathers showed differences regarding the distance and depth of second premolars, and the distance of first molars. Differences were also found between the groups of mouth breathers regarding the hard palate depth at the level of canines. CONCLUSION: Mouth breathers showed narrower hard palate at the level of second premolars and first molars, and deeper palate in the level of second premolars, when compared to nasal breathers. It is evidenced that habitual mouth breathers presented deeper hard palate at the level of canines, when compared to mouth breathers from obstructive etiology.

Changes in facial morphology after adenotonsillectomy in mouth-breathing children.

BACKGROUND: Morphological and dentofacial alterations have been attributed to impaired respiratory function. OBJECTIVE: To examine the influence of mouth breathing (MB) on children facial morphology before and after adenoidectomy or adenotonsillectomy. METHODS: Thirty-three MB children who restored nasal breathing (NB) after surgery and 22 NB children were evaluated. Both groups were submitted to lateral cephalometry, at time 1 (T1) before and at time 2 (T2) 28 months on average postoperatively. RESULTS: Comparison between the MB and NB groups at T1 showed that mouth breathers had higher inclination of the mandibular plane; more obtuse gonial angle; dolichofacial morphology; and a decrease in the total and inferior posterior facial heights. Twenty-eight months after the MB surgical intervention, they still presented a dolichofacial morphologic pattern. During this period, MB altered the face growth direction and decreased their mandible plane inclination, with reduction in the SN.GoGn, PP.MP, SNGn, and ArGo.GoMe parameters as well as an increase in BaN.PtGn. CONCLUSION: After the MB rehabilitation, children between 3 and 6 years old presented significant normalization in the mandibular growth direction, a decrease in the mandible inclination, and an increase in the posterior facial height. Instead, they still persisted with a dolichofacial pattern when compared with nasal breathers.

Classification of postural profiles among mouth-breathing children by learning vector quantization.

BACKGROUND: Mouth breathing is a chronic syndrome that may bring about postural changes. Finding characteristic patterns of changes occurring in the complex musculoskeletal system of mouth-breathing children has been a challenge. Learning vector quantization (LVQ) is an artificial neural network model that can be applied for this purpose. OBJECTIVES: The aim of the present study was to apply LVQ to determine the characteristic postural profiles shown by mouth-breathing children, in order to further understand abnormal posture among mouth breathers. METHODS: Postural training data on 52 children (30 mouth breathers and 22 nose breathers) and postural validation data on 32 children (22 mouth breathers and 10 nose breathers) were used. The performance of LVQ and other classification models was compared in relation to self-organizing maps, back-propagation applied to multilayer perceptrons, Bayesian networks, naive Bayes, J48 decision trees, k, and k-nearest-neighbor classifiers. Classifier accuracy was assessed by means of leave-one-out cross-validation, area under ROC curve (AUC), and inter-rater agreement (Kappa statistics). RESULTS: By using the LVQ model, five postural profiles for mouth-breathing children could be determined. LVQ showed satisfactory results for mouth-breathing and nose-breathing classification: sensitivity and specificity rates of 0.90 and 0.95, respectively, when using the training dataset, and 0.95 and 0.90, respectively, when using the validation dataset. CONCLUSIONS: The five postural profiles for mouth-breathing children suggested by LVQ were incorporated into application software for classifying the severity of mouth breathers' abnormal posture.

Hard palate dimensions in nasal and mouth breathers from different etiologies.

PURPOSE: To compare the hard palate dimensions of nasal-breathing children, mouth breathers from obstructive etiology, and habitual mouth breathers. METHODS: The sample comprised 76 children, 37 boys and 39 girls, with mean age of 9.32±1.16 years, distributed according to the diagnosis of breathing mode and to the etiology of mouth breathing. Plaster cast models of the subjects' superior dental arch were obtained in order to measure the hard palate with a digital caliper. Measurements of transverse, vertical and anteroposterior palatal length were taken. The hard palate measures were compared among the groups through statistical analysis. RESULTS: The comparison of hard palate dimensions observed in nasal and mouth breathers showed differences regarding the distance and depth of second premolars, and the distance of first molars. Differences were also found between the groups of mouth breathers regarding the hard palate depth at the level of canines. CONCLUSION: Mouth breathers showed narrower hard palate at the level of second premolars and first molars, and deeper palate in the level of second premolars, when compared to nasal breathers. It is evidenced that habitual mouth breathers presented deeper hard palate at the level of canines, when compared to mouth breathers from obstructive etiology.

Long-term effects of rapid maxillary expansion on nasal area and nasal airway resistance.

BACKGROUND: Rapid maxillary expansion (RME) may improve the nasal respiratory pattern. This study was performed to evaluate the effect of RME on the nasal cavity by acoustic rhinometry and computed rhinomanometry and to determine nasal and maxillary width by posteroanterior cephalometric radiography, up to 30 months after the orthodontic procedure. METHODS: Twenty-seven children with oral breathing, ranging in age from 7 to 10 years, and with mixed dentition were selected. The children had uni- or bilateral posterior crossbite involving deciduous canines and the first permanent molars. All subjects were submitted to nasofibroscopy, acoustic rhinometry, and computed rhinomanometry and posteroanterior cephalometric radiography at four different times, i.e., before expansion, immediately, 90 days and 30 months after expansion. RESULTS: The mean linear left-to-right nasal cavity lateral prominence and left-to-right jugal points cephalometric measures increased considerably after expansion and this increase was maintained throughout the period of evaluation. There was an immediate significant decrease in nasal resistance, up to 90 days after RME, but the nasal resistance increased 30 months after the procedure. The acoustic rhinometry results did not show any difference in values throughout time. CONCLUSION: RME significantly increased nasal and maxillary width as measured by frontal cephalometry, but the nasal mucosal effects were more subtle. Also, the influence of RME on nasal resistance was not stable, and nasal resistance values returned to close to the initial ones after 30 months.

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

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

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

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

Quantitative evaluation of the orofacial morphology: anthropometric measurements in healthy and mouth-breathing children.

UNLABELLED: The anthropometric orofacial measurements of mouth-breathing children were compared to those of children with no history of speech-language disorders, according to age. METHODS: 100 children participated, both males and females, with ages ranging from 7 to 11 years and 11 months, leukoderm, in mixed dentition period, with a mouth-breathing diagnosis. The control group was comprised of 254 children, of both sexes, with ages ranging from 7 to 11 years and 11 months, leukoderm, in mixed dentition period, with no history of speech-language disorders. The control group did not demonstrate any mouth-breathing. The children were submitted to anthropometric assessment and the orofacial measurements obtained were upper lip, lower lip, philtrum, upper face, middle face, lower face, and sides of the face. The instrument used was the electronic digital sliding caliper Starrett Series 727. There was statistically significant difference between the majority of the orofacial measurements of mouth-breathing children and the measurements of children with no history of speech-language disorders. Some orofacial measurements were different in the studied populations. The possibility of comparing orofacial measurements of children with and without mouth-breathing behavior allows the clinician to determine normal and altered structures of the orofacial morphology. The main advantages of the anthropometry are its noninvasive nature, its technological simplicity, low cost and objective analysis. The anthropometric procedures also have clinical applications in myofunctional assessment and therapy.

Long-term effects of pharyngeal flaps on the upper airways of subjects with velopharyngeal insufficiency.

OBJECTIVES: To investigate the long-term effects of pharyngeal flap surgery (PFS) on nasal and nasopharyngeal dimensions of patients with velopharyngeal insufficiency (VPI) and to correlate the findings with the onset of respiratory complaints after surgery. DESIGN/PARTICIPANTS: Prospective study in 58 nonsyndromic patients with repaired cleft palate and VPI, evaluated 2 days before and 5 months (POST1) and 1 year (POST2) after PFS, on average. Patients were divided into two groups: one consisting of patients with postoperative respiratory complaints (RC group) and the other without complaints (NRC group). INTERVENTIONS: Superiorly based PFS. MAIN OUTCOME MEASURES: Respiratory complaints (self reports of mouth breathing, snoring, and other sleep obstructive events) assessed at POST1 and POST2, and minimum nasal (NCSA) and nasopharyngeal (NPA) cross-sectional areas assessed by rhinomanometry at POST2. RESULTS: Respiratory complaints were reported by 55% and 36% of the patients evaluated at POST1 and POST2, respectively. Posterior rhinomanometry showed a significant postoperative reduction of mean NCSA in the RC and NRC groups (p < .05), to subnormal levels in some of them. The decrease was more pronounced in the RC group. No significant changes in NCSA were observed by anterior rhinomanometry. Similar results were obtained when NPA was assessed by modified anterior rhinomanometry. CONCLUSION: In the long-term, PFS yielded a significant reduction in upper airways dimensions beyond what should be expected and associated with persistent respiratory complaints in some cases.

Radiological evaluation of facial types in mouth breathing children: a retrospective study.

Mouth breathing is a condition often associated with a long face, half-open mouth and increased anterior facial height. We performed conventional lateral and frontal cephalograms of eighty-nine children with nasal and mouth breathing and independently measured Total Facial Height using the analysis technique of Ricketts, and the Morphologic Facial Index employing the technique of Avila. It was concluded that dolicofacial following mesofacial were the most frequent patterns found in mouth-breathing children and this suggests that both analyses can be used independently.

Estudo comparativo radiológico e nasofibroscópico do volume adenoideano em criancas respiradoras orais / Comparison between radiological and nasopharyngolaryngoscopic assessment of adenoid tissue volume in mouth breathing children

A tonsila faríngea ou adenóides é a extensão superior do anel linfático de Waldeyer e está localizada na porcão alta da cavidade nasofaríngea, próxima à tuba auditiva e à coana. Ela desempenha um papel relevante nas otites médias recorrentes e freqüentemente sua hipertrofia é responsável pela obstrucão das vias aéreas superiores. A tonsilectomia é um tratamento comumente realizado para doencas crônicas das tonsilas e ainda é o procedimento cirúrgico mais freqüente e mais antigo realizado em criancas e adultos jovens. Os critérios para a realizacão da tonsilectomia, o efeito da mesma na integridade imunológica do paciente e seus riscos inerentes à cirurgia são muito discutíveis e controversos em todo o mundo. Estudos de imagem utilizando-se o raio-X do cavo é um método simples, fácil e confortável para avaliar o tamanho das adenóides e o grau de obstrucão das vias aéreas superiores. Um estudo nasofibroscópico da nasofaringe pode fornecer uma informacão melhor sobre essa região, tendo em vista que ele mostra todas as estruturas presentes na nasofaringe e o grau de obstrucão das vias aéreas superiores de forma dinâmica. FORMA DE ESTUDO: Clínico não randomizado. MATERIAL E MÉTODO: Este estudo comparou o grau de hipertrofia e de obstrucão das vias aéreas superiores, usando os dois métodos acima, em criancas de 3 a 10 anos de idade, constatando que a nasofibroscopia flexível é um método diagnóstico excepcionalmente mais fidedigno do que o raio-x do cavo, na avaliacão volumétrica da adenóide.

Implicações clínicas em pacientes respiradores bucais / Clinical implications in oral breathing patients

O crescimento craniofacial é determinado por vários fatores, dentre eles a genética e a presença de respiração bucal crônica. O objetivo deste trabalho foi revisar a literatura sobre as implicações clínicas em pacientes respiradores bucais. Encontramos muitos estudos que correlacionam a respiração bucal crônica às alterações no complexo craniofacial. Concluímos que o diagnóstico e tratamento precoce das alterações do padrão respiratório auxiliam na prevenção das alterações orofaciais

Dentofacial morphology of mouth breathing children.

The relationship between dentofacial morphology and respiration has been debated and investigated from various approaches. The aim of this study was to verify the skeletal and dental relationship of mouth and nose breathing children. Thirty-five children, 7 to 10 years of age, were submitted to orthodontic and otorhinolaryngologic evaluations and were separated into 2 groups: 15 nose breathers and 20 mouth breathers. Each subject underwent a cephalometric radiograph analysis. Statistical analysis (Mann-Whitney U test) indicated that changed mode of breathing was associated with 1) maxillo-mandibular retrusion in relation to the cranial base in the mouth breathers; 2) the SNGoGn and NSGn angles were greater in the mouth breathing group; 3) incisor inclination in both jaws and the interincisal angle were not different between groups. There was no statistically significant difference in the maxillary and mandibular molar heights between the nose breathers and mouth breathers.

Dentofacial morphology of mouth breathing children

The relationship between dentofacial morphology and respiration has been debated and investigated from various approaches. The aim of this study was to verify the skeletal and dental relationship of mouth and nose breathing children. Thirty-five children, 7 to 10 years of age, were submitted to orthodontic and otorhinolaryngologic evaluations and were separated into 2 groups: 15 nose breathers and 20 mouth breathers. Each subject underwent a cephalometric radiograph analysis. Statistical analysis (Mann-Whitney U test) indicated that changed mode of breathing was associated with 1) maxillo-mandibular retrusion in relation to the cranial base in the mouth breathers; 2) the SNGoGn and NSGn angles were greater in the mouth breathing group; 3) incisor inclination in both jaws and the interincisal angle were not different between groups. There was no statistically significant difference in the maxillary and mandibular molar heights between the nose breathers and mouth breathers.