The therapeutic effects of a modified palatal memory plate on oral motor function in children with Trisomy 21 at age 3 and 4 years: Case Reports

ABSTRACT People with Trisomy 21 (T21) have generalized hypotonia, also manifesting in oral structures. The palatal memory plate (PMP) is a removable appliance to improve tongue and lip posture. The evidence of research elucidates an improvement in oral motor function in children with T21 up to the age of 2 who received PMP-based therapy, with only limited, scanty reports in the literature concerning older children. Therefore, the aim of this study is to evaluate the effects of modified PMP on an oral motor function in patients over 2 years old. Two patients with T21, aged 4 and 3, with absence of lip seal and tongue malposition, were subjected to PMP-based therapy for 6 months. The patients were evaluated for an extra and intra oral exam; their parents answered a questionnaire about their children's habitual tongue and lip position. Two-minute footage to record orofacial motor functions was performed monthly, during follow-up appointments to assess the changes. The substantial improvement of tongue and lip posture was observed after 6 months of plate regular use. PMP has proved to be clinically effective in children over 2 years old, presented with T21, leading to improvement of lip and tongue posture, observed by parents and professionals.

Morphofunctional Improvement of the Facial Nerve and Muscles with Repair Using Heterologous Fibrin Biopolymer and Photobiomodulation.

Peripheral nerve injuries impair the patient's functional capacity, including those occurring in the facial nerve, which require effective medical treatment. Thus, we investigated the use of heterologous fibrin biopolymer (HFB) in the repair of the buccal branch of the facial nerve (BBFN) associated with photobiomodulation (PBM), using a low-level laser (LLLT), analyzing the effects on axons, muscles facials, and functional recovery. This experimental study used twenty-one rats randomly divided into three groups of seven animals, using the BBFN bilaterally (the left nerve was used for LLLT): Control group-normal and laser (CGn and CGl); Denervated group-normal and laser (DGn and DGl); Experimental Repair Group-normal and laser (ERGn and ERGl). The photobiomodulation protocol began in the immediate postoperative period and continued for 5 weeks with a weekly application. After 6 weeks of the experiment, the BBFN and the perioral muscles were collected. A significant difference (p < 0.05) was observed in nerve fiber diameter (7.10 ± 0.25 µm and 8.00 ± 0.36 µm, respectively) and axon diameter (3.31 ± 0.19 µm and 4.07 ± 0.27 µm, respectively) between ERGn and ERGl. In the area of muscle fibers, ERGl was similar to GC. In the functional analysis, the ERGn and the ERGI (4.38 ± 0.10) and the ERGI (4.56 ± 0.11) showed parameters of normality. We show that HFB and PBM had positive effects on the morphological and functional stimulation of the buccal branch of the facial nerve, being an alternative and favorable for the regeneration of severe injuries.

Orofacial myofunctional assessment and quality of life of individuals with Parkinson's disease.

OBJECTIVES: To characterize orofacial myofunctional structures of elders with Parkinson's disease (PD) and examine the relationship with the stages of PD, pharmacotherapy, and quality of life. METHODS: PD Group with 45 elders and a control group (CG) of 10 healthy elders of both sexes were included (60-86 years). Structured interviews, medical records, and clinical examination gathered information on health aspects such as the use of drugs, Hoehn & Yahr stages 1-4, and oral health status. The Mini-Mental State Examination, Parkinson's Disease Questionnaire, and Orofacial Myofunctional Evaluation with Scores for Elders were applied. RESULTS: Better oral health status was found in participants diagnosed as Hoehn & Yahr stage 1 compared to the later stages. OMES-Elders scores for appearance/posture, mobility, breathing, and speech functions were different between groups, and decreased overall OMES-Elders was observed across the Hoehn & Yahr stages. A higher number of masticatory cycles was required for chewing and ingestion of the test food in the PD group compared to CG (p < .05). Significant differences were found in the mobility and daily living activities domains and an overall score of QoL between the Hoehn & Yahr stages 1 and 4, and worst orofacial functioning was accompanied by the worst self-perception of QoL in the communication domain (rho = -0.32; p = .034). The use of xerogenic drugs did not affect the OMES-Elders swallowing domain. CONCLUSION: Worse dental condition and performance of orofacial functions was observed in the elders with PD as the disease progresses, and poorer orofacial performance negatively affects their perception of communication skills.

Thermography in complementary assessments of head and neck muscles: A scoping review.

INTRODUCTION: Infrared thermography has the potential to help assess human head and neck muscles, as thermal variation measurements due to muscle imbalance can contribute to the evaluation and therapeutic follow-up of various clinical conditions in the field of health. OBJECTIVE: This study investigated, with a scoping review, the use of infrared thermography in complementary assessments of human head and neck muscles to determine the extent of research on the topic, what methodologies are used in thermal assessment and thermographic analysis, what regions are assessed, and what results are expected in thermography. METHODS: LILACS, MEDLINE, SciELO, and Web of Science were the databases searched to identify articles published on the topic, with no restriction of language or time of publication. Descriptive, analytical, and experimental observational studies on the assessment of the human head and neck muscle surface temperature with infrared thermography were included. Case studies, case series, methodological accuracy, literature review, animal studies, studies that assessed patients with head and neck cancer, and studies that did not assess head and neck muscle temperature with thermography were excluded. The articles were analysed with a protocol developed by the authors, with data on author, year, country, type of study, sample characterisation, muscles assessed, outcomes investigated, thermal assessment methodology, thermographic analysis methodology and thermography measurements. RESULTS: This review identified and analysed 27 articles. The studies assessed thermal distribution in normal individuals and those with pathologies related to hyper- and hypofunctional head and neck muscle conditions for diagnosis or therapeutic follow-up. The masseter, temporal, digastric, anterior cervical region, orbicularis oris, frontalis, buccinator, suprahyoid, trapezius, sternocleidomastoid and levator scapulae muscles were assessed. Quantitative analyses with area selection tool predominated, considering absolute temperatures and temperature differences. The studies investigated temperature and its relationship with myogenic pain, quantitative assessment of muscle parameters and blood flow velocity. The mean temperature ranged from 32.97°C (±2.21) to 34.90°C, and hyper-radiant and/or asymmetric regions were observed in hyperfunctional conditions and normal subjects after muscle activation. CONCLUSION: Thermography is used in complementary assessments of head and neck muscles, identifying hyper-radiant regions and thermal asymmetry related to muscle tension and activation state. Papers are limited to specific clinical conditions and few muscle groups, besides having great methodological variability.

Proposal of a protocol for thermographic assessment of the orbicularis oris muscle.

BACKGROUND: The orbicularis oris muscle is extremely important to performing various oral functions, including mastication, swallowing and speech. Infrared thermography is a non-invasive painless technique that does not require either contrast or ionisation. It has been increasingly used in speech-language-hearing therapy in the last years. OBJECTIVE: The objective of the study was to propose a thermographic analysis method for the orbicularis oris muscle. METHODS: This is an observational, analytical, cross-sectional study. The area of the orbicularis oris muscle was defined based on its anatomy with thermographic images of 11 children and 13 adults. Then, this area was divided into four quadrants, each of which was analysed considering four different shapes: a triangle; a rectangle; a triangle with a rounded side, including the vermilion zone; and a customised shape encompassing only the region of the orbicularis oris muscle, not including the vermilion zone. Data were collected and analysed with the coefficient of variation and interrater agreement. RESULTS: Data variability for the four shapes had similar dispersions per region of the orbicularis oris muscle, in both maximum and mean temperatures and in both children and adults. The rectangle was the shape with the lowest coefficient of variation in more regions of both adults and children. Interrater agreement was excellent for all shapes, in both children and adults. CONCLUSION: Currently, the best way to analyse the orbicularis oris muscle's quadrants is to use the maximum temperature and the rectangle, based on an initial ellipsis encompassing the whole muscle.

Padrões de contração muscular e suas associações no terço superior da face: um estudo clínico e epidemiológico / Muscle contraction patterns and their associations in the upper third of the face: a clinical and epidemiological study

Introdução: o uso da toxina botulínica tornou-se um dos procedimentos cosméticos mais importantes realizados no mundo. Objetivo: identificar padrões de contração muscular da fronte, complexo glabelar e músculo orbicular dos olhos em pacientes do sul do Brasil, estabelecendo sua epidemiologia e possíveis associações entre eles. Métodos: foram incluídos 101 pacientes que buscaram tratamento com toxina botulínica para fronte, glabela e linhas perioculares entre 2012 e 2016. Análises foram feitas por meio de fotografias digitais tiradas durante consulta médica, antes da aplicação dos produtos. Os pacientes foram tratados com diferentes marcas de toxina botulínica, de acordo com suas preferências ou com as do médico. Resultados: os padrões de contração mais comuns foram frontal completo, glabelar em setas convergentes e periocular completo. Mulheres representaram 94,1% dos pacientes. A maioria tinha idade entre 31 e 50 anos, com média de 44,57 anos. Padrões mais frequentes em cada área individual foram mais frequentemente associados. Conclusões: o estudo mostra os principais padrões de contração muscular do terço superior da face em 101 pacientes, bem como suas características clínicas, e os compara com artigos publicados anteriormente. Estudos sobre padrões de contração muscular podem auxiliar no uso mais seguro e racional dos produtos disponíveis, evitando desperdícios e complicações.

Introduction: The use of botulinum toxin has become one the essential cosmetic procedures performed in the world. Objective: To identify patterns of muscle contraction of the forehead, glabellar complex, and orbicularis oculi muscle in patients from southern Brazil, establishing their epidemiology and possible associations between them. Methods: One hundred and one patients who sought treatment with botulinum toxin for the forehead, glabella, and periocular lines between 2012 and 2016 were included. Analyzes were made using digital photographs taken during a medical consultation before applying the products., The subjects received with different brands of botulinum toxin, according to the patients' or the doctors' preference Results: The most common contraction patterns were complete frontal, glabellar in converging arrows, and complete periocular. Women represented 94.1% of patients. Most patients were between 31 and 50 years old, with an average of 44.57 years. More frequent patterns in each area were more frequently associated. Conclusions: The study shows the main muscle contraction patterns of the upper third of the face in 101 patients, as well as their clinical characteristics, comparing them with previously published articles. Studies on muscle contraction patterns can assist in the safer and more rational use of the products available, avoiding waste and complications.

Muscle Function Recovery Following Botulinum Toxin Type A Facial Injections: A Case Managed With Photobiomodulation Therapy.

Introduction: Aesthetic applications of botulinum toxin type A (BoNT-A) may lead to some complications, including unwanted muscle paralysis. Moreover, BoNT-A effects may last several months, and there is no medical intervention so far to accelerate muscle function recovery. Case Report: A female patient with a movement disorder of the mimic muscles resulting from BoNT-A injections received daily sessions of photobiomodulation therapy (PBMT). A fast improvement in both facial asymmetry and muscle function was noted within a few weeks. After nine weeks, almost complete recovery was achieved. Conclusion: According to the current case, PMBT seems to be an effective intervention to accelerate muscle function recovery following BoNT-A use.

Influência da intubação orotraqueal nas alterações miofuncionais orofaciais em lactentes / Influencia de la intubación orotraqueal sobre los cambios miofuncionales orofaciales en lactantes / Influence of orotracheal intubation on orofacial myofuncional changes in infants

Introdução: As alterações da deglutição pós-extubação são amplamente identificadas e estudadas, nas quais a disfagia é identificada nas fases oral e faríngea, acompanhada de penetração laríngea e aspiração traqueal. Entretanto, as alterações miofuncionais orofaciais em pacientes pós-extubação ainda não estão bem descritas em Pediatria. Objetivo: Verificar a influência da intubação orotraqueal (IOT) nas alterações miofuncionais orofaciais do lactente. Método: Estudo transversal, realizado em uma Unidade de Terapia Intensiva Pediátrica no período entre novembro de 2015 a setembro de 2016. Os participantes foram divididos em dois grupos: grupo estudo, com diagnóstico médico de cardiopatia congênita, pós-operatório de cirurgia cardíaca, em IOT por no mínimo 6 horas, e grupo controle composto por lactentes de 0 a 6 meses, previamente saudáveis, que não tiveram histórico de qualquer IOT anterior. Após a seleção, ambos os grupos foram submetidos ao Protocolo de Avaliação de Disfagia Pediátrica. Resultados: Postura e tônus labial, postura de língua, palato e qualidade vocal estiveram significativamente associados ao uso de IOT, pressão intraoral e padrão de sucção. Ao analisar a distribuição de frequência da comparação com e sem IOT, observa-se que não há um padrão específico que indique se a associação é prejudicial, protetora ou não interfere no padrão das características miofuncionais nesses casos. Conclusão: A influência da IOT foi encontrada nas estruturas miofuncionais orofaciais de bebês, quando comparados a bebês não intubados.

Introduction: Post-extubation swallowing changes are widely identified and studied, in which dysphagia is identified in the oral and pharyngeal phases, accompanied by laryngeal penetration and aspiration. However, orofacial myofunctional changes in post-extubation patients are still not well described in pediatrics. Objective: Verify the influence of orotracheal intubation on orofacial myofunctional changes in lactates. Methods: Cross-sectional study, performed in a Pediatric Intensive Care Unit from November 2015 to September 2016. Participants were divided into two groups: study group, with medical diagnosis of congenital heart disease, post-cardiac surgery, undergoing OTI for at least 6 hours, and the control group was composed of infants aged 0 to 6 months, previously healthy, who did not have any previous IOT. After selection, babies from both groups were submitted to the same assessment protocols. The clinical evaluation of the child's orofacial myofunctional structures was performed using the Pediatric Dysphagia Assessment Protocol. Results: Lip posture, lip tone, tongue posture, palate, and vocal quality were significantly associated with the use of OIT, intraoral pressure and suction pattern. When analyzing the frequency distribution of the comparison with and without OIT, it is observed that there is no specific pattern that indicates whether the association is harmful, protective or does not interfere in the pattern of myofunctional characteristics in these cases. Conclusion: OIT influence was found in orofacial myofunctional structures in infants, when compared to babies who were not intubated.

Introducción: Los cambios en la deglución post-extubación están ampliamente identificados y estudiados, en los que se identifica disfagia en las fases oral y faríngea, acompañada de penetración y aspiración laríngea. Sin embargo, los cambios miofuncionales orofaciales en pacientes post-extubación todavía no están bien descritos en pediatría. Objetivo: Verificar la influencia de la intubación orotraqueal sobre los cambios miofuncionales orofaciales en lactatos. Metodos: estudio transversal, realizado en una Unidad de Cuidados Intensivos Pediátricos desde noviembre de 2015 hasta septiembre de 2016. Los participantes se dividieron en dos grupos: grupo de estudio, con diagnóstico médico de cardiopatía congénita, postoperatorio cardíaco, sometidos a IOT durante al menos 6 horas y el grupo control, compuesto por lactantes de 0 a 6 meses, previamente sanos, que no tiene alguna IOT anterior. Después de la selección, los bebés de ambos grupos fueron sometidos a los mismos protocolos de evaluación. La evaluación clínica de las estructuras miofuncionales orofaciales del niño se realizó mediante el Protocolo de Evaluación de Disfagia Pediátrica. Resultados: La postura de los labios, el tono de los labios, la postura de la lengua, el paladar, la calidad vocal se asociaron significativamente con el uso de ITO, la presión intraoral y el patrón de succión. Al analizar la distribución de frecuencias de la comparación con y sin ITO, se observa que no existe un patrón específico que indique si la asociación es dañina, protectora o no interfiere en el patrón de características miofuncionales en estos casos. Conclusión: la influencia de la ITO se encontró en las estructuras miofuncionales orofaciales en los bebés, en comparación con los bebés que no fueron intubados.

Relation between oro-facial thermographic findings and myofunctional characteristics in patients with obstructive sleep apnoea.

AIM: To evaluate the thermographic characteristics of oro-facial structures and submental triangle of participants with obstructive sleep apnoea (OSA), as well as to investigate its correlation with the anatomy, posture and functions of the oro-facial structures. METHOD: Eighteen patients diagnosed with OSA by polysomnography (OSA group; 57.4 ± 15.8 years) and 13 healthy participants screened for OSA (control group; 57.8 ± 18.1 years) were included. All participants answered to questionnaires for OSA and excessive daytime sleepiness, and were submitted to infrared image thermography analysis of facial regions of interest (ROIs), oro-facial myofunctional evaluation (OMES-E protocol) and masticatory performance. Statistical analysis included one-way ANOVA and Pearson/Spearman correlation test. RESULTS: Obstructive sleep apnoea group showed lower thermographic measures in many ROIs in the frontal and lateral views of the face, including the submental triangle region, and lower scores of aspect/posture and performance of oro-facial structures, as well lower total score of OMES-E evaluation (P < .05). Scores of aspect/posture and mobility were correlated with the temperature of some ROIs in the frontal and lateral views. CONCLUSION: Lower facial skin and submental triangle region temperatures, measured by infrared thermography, and a worse oro-facial myofunctional condition were identified in the group of individuals with OSA. The higher temperatures of the ROIs were correlated with the better status of aspect/posture and performance of the oro-facial myofunctional structures.

Orofacial myofunctional changes and electromyographic activity of the orbicularis oris muscle in trombonists / Alterações miofuncionais orofaciais e atividade eletromiográfica do músculo orbicular da boca em trombonistas

ABSTRACT Objective: to analyze whether trombonists present orofacial myofunctional changes and compare the electrical activity of the orbicularis oris muscle before and after playing their instrument. Methods: an observational, descriptive, and cross-sectional study. The sample consisted of 20 university trombonists. Data collection involved three steps: application of a questionnaire investigating some peculiarities of trombonists (Orofacial Myofunctional Evaluation with Expanded Scores - OMES-E), and electromyographic analysis of the orbicularis oris muscle before and after performing a piece with the trombone. The mean, standard deviation, frequency, and percentage were calculated, and the paired Student's t test was used to compare the means of the electromyographic records before and after playing the trombone, at a 5% significance. Results: seventy per cent of trombonists reported some symptom of orofacial myofunctional alteration, namely, muscle compensations, tension, and pain. The myofunctional evaluation showed a mild change in cheek volume (90%) and labial commissure asymmetry (60%). The electrical activity of the lower orbicularis oris muscle decreased significantly after the trombone practice (p = 0.04), while that of the superior orbicularis oris muscle remained unchanged. Conclusion:trombonists show clinical and self-reported oromyofunctional changes as well as decreased electrical activity of the lower orbicularis oris muscle, after playing the trombone.

RESUMO Objetivos: analisar se existem alterações miofuncionais orofaciais clínicas e autorreferidas em trombonistas, assim como comparar a atividade elétrica do músculo orbicular da boca antes e após o uso do trombone. Métodos: estudo transversal e observacional, cuja amostra foi composta por 20 universitários trombonistas. Foi utilizado um questionário que investiga algumas particularidades sobre o instrumentista, da Avaliação Miofuncional Orofacial Com Escores Ampliados - AMIOFE-A e análise eletromiográfica do músculo orbicular da boca antes e após execução de uma tarefa com o trombone. Foram calculadas: média, desvio padrão, frequência e porcentagem e utilizou-se o teste t-Student pareado na comparação das médias dos registros eletromiográficos pré e pós-execução do trombone, significância=5%. Resultados: setenta por centro dos trombonistas relataram algum sintoma de alteração miofuncional orofacial, sendo compensações musculares, tensão e dor. Na avaliação miofuncional encontrou-se alteração leve no volume de bochechas (90%) e comissuras labiais com assimetria (60%). Houve redução significante da atividade elétrica do músculo orbicular inferior após a execução de tarefa com trombone (p=0,04), enquanto a do superior permaneceu inalterada. Conclusão: trombonistas apresentam alterações oromiofuncionais clínicas e autorreferidas e diminuição da atividade elétrica do músculo orbicular inferior da boca após uso do trombone.

The use of photobiomodulation for the muscles of head and neck: an integrative review / O uso da fotobiomodulação nos músculos da cabeça e pescoço: revisão integrativa da literatura

ABSTRACT Purpose To carry out an integrative review of the literature on the use of photobiomodulation (PBM) for the head and neck muscles. Research strategy The research took place between June/2019 and March/2021, in the following databases: PubMed, Scopus, Web of Science, LILACS, and SciELO. The MeSH used were Low-Level Light Therapy, Phototherapy, Masseter Muscle, Masticatory Muscles, Tongue, Palate, Mouth, Neck Muscles, and Facial Muscles in English and Portuguese. No limitation was imposed on the year and language of publication. Selection criteria studies that answered the guiding question: what is the use of photobiomodulation to the head and neck muscles?. Results 2857 articles were found, of which 102 were selected for full reading, 52 of those were excluded, giving a total of 50 articles included. The included publications date from 2003 to 2020. Brazil was the country that most published on the topic. With regard to the objectives, 82% of the studies aimed to investigate the analgesic effect of PBM, of these, 50% were related to articular or muscular temporomandibular disorders (TMD). The heterogeneity of the studies makes it impossible to define the dose protocols. Conclusion PBM has been applied to the head and neck muscles mainly for the treatment of pain caused by TMD. There is no treatment protocol to define the doses to be used, due the heterogeneity of the methodologies applied and results found.

RESUMO Objetivos realizar uma revisão integrativa da literatura sobre o uso da fotobiomodulação nos músculos de cabeça e pescoço. Estratégia de pesquisa As buscar foram realizadas nas bases de dados: PubMed, Scopus, Web of Science, LILACS e SciELO. A pesquisa ocorreu entre junho de 2019 e março de 2021. Os descritores utilizados foram Terapia com Luz de Baixa Intensidade, Fototerapia, Músculo Masseter, Músculos Mastigatórios, Língua, Palato, Boca, Pescoço, Músculos do Pescoço, Músculos Faciais e seus respectivos termos em inglês. Não houve limitação de ano de publicação e idioma. Critérios de seleção estudos que respondessem a pergunta norteadora: qual o uso da fotobiomodulação na musculatura de cabeça e pescoço?. Resultados Foram encontrados 2857 artigos, sendo selecionados 102 para leitura completa, dos quais 52 foram excluídos, totalizando 50 artigos incluídos. As publicações incluídas datam de 2003 a 2020. O Brasil foi o país que mais publicou sobre o tema. Quanto aos objetivos, 82% dos estudos pesquisaram o efeito analgésico da fotobiomodulação, e desses, 50% eram relacionados à disfunção temporomandibular (DTM) articular ou muscular. A heterogeneidade dos estudos impossibilita a definição de protocolos dosimétricos. Conclusão A fotobiomodulação tem sido utilizada na musculatura de cabeça e pescoço principalmente para o tratamento da dor proveniente de DTM. Não existe um protocolo de aplicação que defina os parâmetros dosimétricos a serem utilizados, devido a heterogeneidade das metodologias e dos resultados encontrados.

Análise de diferentes tarefas para normalização do sinal elétrico do músculo orbicular da boca pela contração voluntária máxima: estudo piloto / Analysis of different tasks to normalize the electrical signal of the orbicularis oris muscle by maximum voluntary contraction: pilot study

RESUMO Objetivo pesquisar a atividade elétrica do músculo orbicular da boca em quatro diferentes tarefas isométricas e indicar a mais apropriada para utilização como referência na normalização do sinal elétrico do músculo orbicular da boca pela contração voluntária máxima. Métodos participaram do estudo 22 indivíduos, sendo dez do sexo masculino e 12 do feminino, com idades entre 20 e 33 anos. A atividade elétrica das porções superior e inferior do músculo orbicular da boca foi registrada durante a realização das seguintes tarefas isométricas: protrusão labial com fechamento, protrusão labial sem fechamento, contrarresistência com a placa de resistência labial e preensão de lábios. A ordem de realização das tarefas foi randomizada entre os participantes. Os dados foram comparados entre as tarefas, para cada seguimento labial. Resultados no segmento marginal superior, a tarefa com maior média e mediana de amplitude foi preensão labial, embora sem diferença significativa entre tarefas. O menor coeficiente de variação foi obtido na tarefa de contrarresistência com a placa de resistência labial. No segmento marginal inferior, a tarefa com maior média e mediana de amplitude foi protrusão labial com fechamento, que também teve o menor coeficiente de variação e diferença significativa entre as tarefas protrusão labial com fechamento e preensão, sendo os maiores valores obtidos na primeira. Conclusão indica-se como referência para a normalização do sinal elétrico do músculo orbicular da boca, pela contração voluntária máxima, a tarefa de protrusão labial com fechamento.

ABSTRACT Purpose To verify the electrical activity of the orbicularis oris in four different isometric tasks and to indicate the most appropriate task for use as a reference in the normalization of the electrical signal of the orbicularis oris muscle by maximum voluntary contraction. Methods Twenty-two individuals participated in the study, of which 10 were male and 12 were female, with ages ranging from 20 to 33 years. The electrical activity of the upper and lower parts of orbicularis oris muscle was recorded during the following isometric tasks: lip protrusion with bilabial closure; lip protrusion without bilabial closure; the counter resistance using the plate of labial resistance and lips prehension. The order of the tasks was randomized among participants. Data were compared between tasks for each lip part. Results in the upper marginal segment, the task with the highest mean and median amplitude was lip prehension, although there was no significant difference between tasks. The lowest coefficient of variation was obtained in the counter resistance task with the plate of labial resistance. In the lower marginal segment, the task with the highest mean and median amplitude was labial protrusion with lips closure, which also had the lowest coefficient of variation. In this segment, there was a significant difference between labial protrusion with lips closure and prehension, with the highest values obtained in the first task. Conclusion lip protrusion with bilabial closure is suggested as reference for the normalization of the electrical signal of the orbicularis oris muscle, by maximum voluntary contraction.

Tratamento ortodôntico em paciente com queimadura facial ­ relato de caso / Orthodontic treatment in patient with facial burn injury ­ case report

Resumo Inúmeras variáveis são consideradas em uma oclusão normal, uma delas é a homeostasia da musculatura facial e sua harmonia com os ossos e dentes. Diversos fatores podem levar a alterações na funcionalidade muscular. Um exemplo é a queimadura facial, na qual é comum a formação de cicatrizes hipertróficas que provocam disfunção nas estruturas musculares e impactam no crescimento facial e no desenvolvimento da dentição. Paciente K.R.S, sexo feminino, 15 anos, procurou tratamento no Centro de Atenção e Pesquisa de Anomalias Craniofaciais (CEAPAC) com queixa de "dentes tortos". Durante anamnese relatou que quando criança sofreu um acidente doméstico que acarretou queimaduras na face e parte do corpo. A paciente era portadora de má oclusão de Classe I de Angle e lingualização dos incisivos superiores e inferiores. Observou-se atresia das arcadas dentárias e apinhamento moderado. Realizou-se a expansão rápida da maxila e expansão dentária inferior com a placa lábio ativa, seguida de alinhamento e nivelamento dos dentes com aparelho fixo. Na fase de contenção utilizaram-se placas de Hawley (superior e inferior), além de uma contenção fixa inferior. Os tratamentos de expansão das arcadas e alinhamento se mostraram viáveis e previsíveis. Entretanto a estabilidade tem prognóstico duvidoso, o que levou os autores a indicarem o uso das contenções por tempo indeterminado.(AU)

Abstract Numerous variables are considered in a normal occlusion, one of those is the homeostasis of the facial musculature and its harmony with bones and teeth. Several factors can lead to change in muscle functionality. An example is the facial burn injury in which it is common formation of hypertrophic scars that cause muscle structures dysfunction and impact on facial growth and dentition development. Patient K.R.S, 15-years-old, female, sought treatment at the Center for Attention and Research of Craniofacial Anomalies (CEAPAC) complaining of "crooked teeth". She reported during anamnesis that when she was a child, she suffered a domestic accident which caused facial, and body burn injury. The patient had Angle Class I malocclusion and upper and lower incisor lingualization. Dental arch atresia and moderate crowding were observed. Rapid maxillary expansion and lower dental expansion were performed with the lip bumper, followed by teeth alignment and leveling with a fixed appliance. In the retainment phase, Hawley plates (upper and lower) were used in addition to a fixed lower retainer. The treatment of arch expansion and alignment proved to be viable and predictable, however, the stability has a dubious prognosis, which led the authors to indicate the use of retainers indefinitely. (AU)

Funcionamento do músculo bucinador em bebês que utilizam e não utilizam bicos artificiais / Operation of the buccinator muscle in babies using and not using artificial tips

Com objetivo de identificar e comparar o funcionamento do músculo bucinador em bebês que utilizam e não utilizam bicos artificiais, foi realizada eletromiografia de superfície em 14 bebês entre zero e seis meses de idade, divididos em três grupos: Grupo A, com cinco bebês que utilizam mamadeira e chupeta; Grupo B, com três bebês amamentados e que utilizam chupeta, e Grupo C, com seis bebês que são apenas amamentados, sem uso de chupeta; e mamadeira. A análise quantitativa foi realizada por meio das medianas e RMS de cada grupo. Observou-se que o Grupo A revelou os maiores valores de contração muscular, o Grupo B valores intermediários e o Grupo C, os menores valores de contração do músculo bucinador, devido ao fato de que nos bicos artificiais há maior atividade deste músculo do que em aleitamento materno. Conclui-se que, a partir do momento em que o bebê inicia a sucção de um bico artificial, ocorre aumento da atividade desse músculo. Quando há uso de dois bicos, a atividade é maior ainda e em aleitamento materno a atividade é menor, já que a função do músculo bucinador refere-se apenas à manutenção da mama na cavidade oral do bebê. Deste modo, não há indicação do uso de bicos artificiais em bebês, pois a atividade aumentada dos bucinadores pode trazer consequências negativas ao crescimento das estruturas orais ou no desempenho das funções do sistema estomatognático (sucção, mastigação, deglutição, respiração, expressão facial e articulação dos sons da fala).

Electromyography of muscles involved in feeding premature infants / Avaliação eletromiográfica dos músculos envolvidos na alimentação de recém-nascidos prematuros

PURPOSE: To measure and compare the electrical activity of masseter, temporal, and suprahyoid muscles in premature newborn infants during breast-feeding and cup-feeding.METHODS: This cross-sectional observational study was carried out by the electromyographic assessment of 36 preterm infants, 53% of whom were male, with mean gestational age of 32 weeks and birth weight of 1,719 g, fed via oral route, by full breast-feeding and supplementation of diet, through cup with expressed breast milk, until 15 days after hospital discharge. Children with neurological disorders, genetic syndromes, oral-motor, and/or congenital malformations were excluded. The different methods of feeding and the variables gestational age at birth, corrected gestational age, chronological age, birth weight and size, head circumference, and Apgar scores at 1 and 5 minutes were analyzed and compared by appropriate statistical analysis.RESULTS: No difference was observed between breast-feeding and cup-feeding in the analysis of the temporal and masseter muscles. However, higher activity of suprahyoid musculature was observed during cup-feeding (p=0.001). The other variables were not correlated with the electrical activity of the muscles during the different feeding methods.CONCLUSION: There may be a balance between the activity of the temporal and masseter muscles during breast-feeding and cup-feeding. There was higher activity of suprahyoid musculature during cup-feeding. This can be explained by the greater range of tongue movement, as premature infants usually perform tongue protrusion to get the milk from the cup.

OBJETIVOS: Mensurar e comparar a atividade elétrica dos músculos temporal, masseter e supra-hióideos de prematuros durante o aleitamento materno e por copo.MÉTODOS: Estudo transversal observacional, realizado por meio da avaliação eletromiográfica de superfície em 36 prematuros, 53% do gênero masculino, com idade gestacional média de 32 semanas e peso médio ao nascimento de 1.719 g, em aleitamento misto, com suplementação de dieta por copo, até 15 dias após a alta hospitalar. Crianças com alterações neurológicas, síndromes genéticas, malformações craniofaciais, que utilizaram mamadeira, chupeta e/ou bico intermediário de silicone foram excluídas. A atividade elétrica dos músculos temporal, masseter e supra-hióideos foi comparada nos diferentes tipos de alimentação, entre os gêneros e entre as classificações do Apgar no 1º e 5º minuto e correlacionadas às variáveis idade gestacional ao nascimento, idade corrigida, idade cronológica, peso ao nascimento, estatura e perímetro cefálico ao nascimento.RESULTADOS: Não houve diferença entre os métodos de alimentação avaliados quanto à atividade elétrica dos músculos temporal e masseter, no entanto verificou-se maior atividade da musculatura supra-hióidea durante a alimentação por copo (p=0,001). As demais variáveis não apresentaram correlação com a atividade elétrica dos músculos estudados durante os diferentes métodos de alimentação.CONCLUSÃO: Parece haver equilíbrio entre a atividade dos músculos temporal e masseter durante a alimentação ao seio materno e por copo. A musculatura supra-hióidea apresentou-se mais ativa no copo, o pode ser justificado pela maior amplitude de movimentação da língua, já que geralmente os RNPT realizam a protrusão da língua para obter o leite no copo.

Measurement of effective remnant power in low intensity laser after passage through the buccinator muscle in anatomical human hemifaces / Determinação da potência efetiva remanescente após a passagem do laser de baixa intensidade através do músculo bucinador em peças anatômicas/hemifaces

Objective: To determine the effective remnant power after the passage of low intensity laser of two different wavelengths (660 and 780 nm) through buccinator muscle in anatomical hemifaces. Methods: Five human hemifaces were dissected, and a laser was shone in the central region of the muscle with a receiver placed on the opposite side. The hemifaces were irradiated using the same dosimetric parameters (40 mW, 1 W/cm2, continuous mode, 0.04 cm2) and at the same point in every muscle; remnant power was measured for each irradiation. Results: The average remnant power after irradiation with 660 nm (149 ± 15 µW) light was significantly lower (p<0.0001) than with that of 780 nm (380 ± 40 µW). Conclusion: The LIL of 780 nm presented greater remnant power in comparison to the 660 nm laser after passage through the buccinator muscle, indicating the latter ́s greater penetration capacity.

Objetivo: Determinar a potência remanescente após a passagem do laser de baixa intensidade em dois comprimentos de onda (660 e 780 nm) através do músculo bucinador em peças anatômicas dissecadas. Métodos: Dissecaram-se cinco hemifaces humanas expondo o músculo bucinador. Aplicou-se o laser na região central de cada músculo, e o receptor, para aferir a potência remanescente, foi posicionado na superfície intraoral contrária. As hemifaces foram irradiadas nos mesmos parâmetros dosimétricos (40 mW, 1 W/cm2, modo contínuo, 0,04 cm2) e no mesmo ponto em cada músculo, sendo a potência remanescente aferida a cada repetição. Resultados: A potência média restante após as irradiações de 660 nm (149 ± 15 µW) foi menor (p <0,0001) que com as irradiações de 780 nm (380 ± 40 µW). Conclusão: O LBI de 780 nm apresentou maior potência remanescente que o LBI de 660 nm, após passagem pelo músculo bucinador, denotando sua maior capacidade de penetração.

Pesquisa da fadiga nos músculos faciais e mastigatórios: revisão de literatura / Research on fatigue in facial and jaw muscles: review of the literature

O objetivo deste estudo foi aprofundar os conhecimentos acerca da fadiga muscular dos músculos faciais e mastigatórios por meio da análise da literatura científica. A estratégia de pesquisa baseou-se nas indicações da Biblioteca Cochrane. Os artigos foram selecionados por meio da base de dados PubMed, utilizando-se o descritor "muscle fatigue" em conjunto com os seguintes descritores: "speech therapy", "facial muscles", "jaw muscles", "mastication", "chewing", "lip" e "clenching". Foram incluídos artigos dos últimos dez anos, independente de idioma. Os textos foram analisados inicialmente em seu abstract, sendo excluídos os que não se adequavam ao objetivo. Em seguida foram analisados os textos integralmente e considerou-se: objetivo, delineamento do estudo, formação dos grupos, critérios e rigor metodológico, protocolos aplicados, resultados encontrados e a existência de discussão sobre a fadiga nos músculos objetivados. Nesta última etapa, aqueles que não estavam de acordo com o propósito deste estudo também foram excluídos. Assim, foram encontrados 138 artigos, dos quais 54 foram excluídos devido à repetição mediante cruzamento dos termos e 84 foram analisados. Destes, 46 foram excluídos na etapa do abstract e 38 analisados na íntegra. Destes 38, 24 foram mantidos e 14 excluídos por não se adequarem aos critérios do estudo. Embora existam alguns trabalhos referentes à análise da fadiga, a metodologia dos mesmos é muito variada, dificultando a sua comparação e detalhamento. Enquanto alguns estudos observaram, por exemplo, maior fadiga dos músculos masseteres e orbiculares da boca, outros não encontraram os mesmos resultados, o que pode ter sofrido influência da população alvo de cada estudo.

The purpose of this study was to deepen the knowledge about muscle fatigue of masticatory and facial muscles through analysis of scientific literature. The search strategy was based on the statements of the Cochrane Library. Articles were selected through the PubMed database, using the descriptor “muscle fatigue” in conjunction with the following descriptors: “speech therapy”, “facial muscles”, “jaw muscles”, “mastication”, “chewing” , “lip” and “clenching”. Articles from the last ten years were included, regardless of the language. The texts were analyzed, at first, in its abstract and those that did not fit the study`s objective were excluded. Then, the full texts were analyzed, being considered: aim, study design, control and study groups, criteria and methodological rigor, applied protocols, results and discussion about the presence of fatigue in the targeted muscles. In a last stage, studies that were not in accordance with the purpose of the study, were excluded. Thus, out of 138 articles found, 54 were excluded due to the repetition by crossing key-words and 84 were analyzed. In the abstract analysis, 46 were excluded and 38 were fully analyzed. 24 articles were maintained and 14 were excluded because they do not fit the study`s criteria. Despite there are some studies regarding the analysis of fatigue, their methodology is very varied, making difficult the comparison and detailing. While some studies have found, for example, greater fatigue of the masseter and orbicularis oris muscles, others have not found the same results, which may have influenced the target population for each study.

Influence of gustatory and olfactory perception in the oral phase of swallowing in smokers / Influência da percepção olfativa e gustativa na fase oral da deglutição de indivíduos tabagistas

Purpose: To analyze the difference between nonsmokers and smokers on the changes in the perceptions of smell and taste and to verify the influence of these aspects in the emergence of compensatory movements during swallowing. Methods: To evaluate these aspects, capabilities of olfactory and gustatory recognition were observed, as well as the compensation swallowing. Twenty-four patients were evaluated in each study group aged from 18 years, grouped in a stratified way. The olfactory evaluation consisted in presenting seven essences and one of three options should be chosen. For the taste test, 16 flavors were offered in a non-sequential and decreasing way in amount of solute. Swallowing solid and liquid was evaluated, in which aspects of compensation perioral muscles were observed. Results: Worst performance in olfactory and gustatory tests among smokers (p≤0.01) was found. Through the results of χ2 and Fisher's exact tests, it was found that the contraction of the mentalis muscle is less observed in non-smokers, and smokers have an average degree of statistically significant change compared to nonsmokers. Furthermore, through the Spearman correlation coefficient, it was found that the worsening in the sensory tests implies increased compensation during swallowing in smokers. Conclusion: These data allowed us to verify that the sensory changes have influence on swallowing pattern, indicating that these changes are aspects that should be considered in the differential diagnosis of changes in swallowing. .

Objetivo: Analisar a diferença entre indivíduos não fumantes e fumantes quanto às modificações nas percepções de olfato e paladar e verificar a influência desses aspectos no aparecimento de movimentos compensatórios durante a deglutição. Métodos: Para avaliação desses aspectos, foram verificadas as capacidades de reconhecimento olfativo e gustativo, bem como as compensações de deglutição. Foram avaliados 24 indivíduos em cada grupo de estudo com idade a partir de 18 anos, agrupados de forma estratificada. A avaliação olfativa consistiu na apresentação de sete essências, devendo ser escolhida uma entre três opções. Para o teste de paladar, foram oferecidos 16 sabores de forma não sequencial e decrescente em quantidade de soluto. Foi avaliada a deglutição de sólido e líquido na qual se observaram aspectos de compensação da musculatura perioral. Resultados: Foi verificado pior desempenho nos testes olfativo e gustativo entre indivíduos tabagistas (p≤0,01). Por meio dos resultados dos testes do χ2 e exato de Fisher, foi verificado que a contração da musculatura mentual é menos observada em não fumantes, sendo que fumantes apresentam grau médio de alteração estatisticamente significativo em relação a não fumantes. Além disso, por meio do coeficiente de correlação de Spearman, verificou-se que a piora no desempenho dos testes sensoriais implica aumento de compensações durante a deglutição em indivíduos fumantes. Conclusão: Estes dados permitiram verificar que as modificações sensoriais apresentam influência no padrão de deglutição, evidenciando que essas alterações são aspectos que devem ser considerados ...

Oral motor assessment in individuals with Moebius syndrome.

BACKGROUND: Moebius syndrome (MS) is a rare congenital condition that is characterised by facial hypomimia and congenital strabismus caused by complete or partial impairment of the 6th and 7th cranial nerves. MS may be further associated with other nerves or malformations, mainly involving the extremities. The objective of this study was to quantify the decrease in oral motor performance in people with MS compared with normoreactive individuals using the Oral Motor Assessment Scale (OMAS). METHODS: The study group comprised 33 subjects between the ages of 2 and 20 years (average age: 10 ± 5 years) with MS along with 46 age- and gender-matched control subjects. RESULTS: The study group displayed a lower average functional score than the control group (P < 0.0001). A significant lack of lip closure (P = 0.03) and anterior lingual seal during swallowing (P = 0.03) occurred in the study group; in most cases, the individuals with MS were classified as 'subfunctional'. In addition, individuals with MS in the older age group displayed better functional scores than those in the younger group (P = 0.05). CONCLUSIONS: Functional damage to oral motor function in individuals with MS is evident, but differs among patients with respect to severity and the movements that are compromised. However, overall, improvements in the functional patterns of these individuals can be observed as they mature in age.

Mastigação, deglutição e suas adaptações na paralisia facial periférica / Mastication, deglutition and its adaptations in facial peripheral paralysis

OBJETIVO: caracterizar mastigação, fase oral da deglutição e possíveis adaptações funcionais observadas nos portadores de Paralisia Facial Periférica. MÉTODO: participaram desta pesquisa 30 indivíduos com Paralisia Facial Periférica grau IV, com história de até 30 dias, sem distinção de etiologia e divididos em três grupos, os que apresentavam a paralisia em até 10 dias, de 11 a 20 e de 20 a 30 dias. As funções mastigação e fase oral da deglutição foram avaliadas tanto com alimento sólido e como com água natural. Os indivíduos responderam questões relacionadas às dificuldades imediatamente após a instalação da paralisia. Os dados foram analisados estatisticamente pelo Teste da Razão de Verossimilhança e pelo Teste Exato de Fisher. RESULTADOS: foram constatadas alterações nas funções de mastigação e fase oral da deglutição pela diminuição do tônus no músculo orbicular dos lábios e do músculo bucinador, que diminuindo a pressão intra-oral, favorece o escape de alimento e líquido. À observação da Fonoaudióloga a variável "derrama líquido enquanto bebe" apresentou dados estatisticamente significante (p=0,003) nos três grupos estudados. A variável "acúmulo de alimento entre os dentes e a gengiva no lado paralisado" foi estatisticamente significante nos grupos de 11 a 20 dias (p= 0,002). CONCLUSÃO: os indivíduos da amostra mastigam no lado paralisado com dificuldade, mediante ciclos mastigatórios lentos e inconsistentes. Ocorre um incremento nos movimentos de língua para limpeza de resíduos retidos no vestíbulo oral no lado paralisado. Este é o sintoma que mais incomoda o paciente. Apresentam dificuldade no beber de forma contínua. Desenvolvem adaptações para compensar suas dificuldades funcionais.

PURPOSE: to describe mastication, swallowing oral phase and possible functional adaptations observed in Facial Peripheral Paralysis subjects. METHOD: there were 30 subjects with grade IV Facial Peripheral Paralysis, with at the most 30 days paralysis history and no etiology differentiation. They were separated in three groups, 1 to 10 days paralysis, 11 to 20 days and 21 to 30 days. Mastication and swallowing oral phase functions were assessed with both solid food and water. Participants answered questions related to the difficulties right after the paralysis. Data were statistically analyzed using the Likelihood Ratio Test and Fisher Exact Test. RESULTS: changes were observed in mastication and swallowing oral phase due to the lowering of lips tonus, orbicular muscle and buccinator muscle that allows the escaping of food and liquid by decreasing intra-oral pressure. To the speech therapist's observation "spill liquid while drinking" presented statistically significant data (p=0,003) in the three observed groups. Variable "accumulate food between teeth and gums" was statistically significant in groups of 11 to 20 days (p= 0,002). CONCLUSION: sample subjects chew with difficulty in the paralyzed side, showing slow and inconsistent mastication cycles. There is an increased tongue movements for cleaning the residues kept in oral vestibule in the paralyzed side. This is the most annoying symptom according to the patients. They develop adaptation strategies to compensate their functional difficulties.