Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review

Abstract Objective To compare polysomnographic parameters with others from the literature in order to provide more accurate information about Rapid Maxillary Expansion (RME) for treating Obstructive Sleep Apnea (OSA) in children, through raising the question: Is RME a good option for treating OSA in children? Prevention of mouth breathing during children's growth remains a challenge with significant clinical consequences. In addition, OSA induces anatomofunctional changes during the critical period of craniofacial growth and development. Methods The Medline, PubMed, EMBASE, CINAHL, Web of Science, SciELO and Scopus electronic databases were searched up to February 2021 for systematic reviews with meta-analysis in the English language. Among 40 studies on RME for treating OSA in children, we selected seven in which polysomnographic measurements of the Apnea-Hypopnea Index (AHI) had been made. Data were extracted and examined in order to clarify whether any consistent evidence exists for indicating RME as a treatment for OSA in children. Results We found no consistent evidence favoring RME for long-term treatment of OSA in children. All the studies presented considerable heterogeneity due to variability of age and length of follow-up. Conclusion Through this umbrella review, the need for methodologically better studies on RME is supported. Moreover, it can be considered that RME is not recommended for treating OSA in children. Further studies and more evidence identifying early signs of OSA are necessary in order to achieve consistent healthcare practice.

Effectiveness of functional orthopedic appliances as an alternative treatment among children and adolescents with obstructive sleep apnea: Systematic review and meta-analysis.

INTRODUCTION: The objective here was to review the efficacy of functional jaw orthopedic appliances for treating children/adolescents with obstructive sleep apnea (OSA), through correlating the apnea/hypopnea index (AHI) and oxygen saturation (SaO2) in polysomnography (PSG), in addition to questionnaire scores from the obstructive sleep apnea-18 (OSA-18). METHODS: The PRISMA 2020 guidelines1 were followed. A search was conducted in October 2021, with updating to May 2022, in the MEDLINE/PubMed, BVS (LILACS/BBO), ISI, SciELO (Web of Science), COCHRANE, EMBASE, SCOPUS and WHO databases and the gray literature. Data selection and extraction were performed by two independent reviewers, with Cohen kappa testing. All articles included in the meta-analyses showed good quality and low risk of bias. Statistical analyses were performed in the "R" software, using means with standard deviations, and differences in the means were represented graphically in forest plots. Heterogeneity was tested using I2, in random-effect models. RESULTS: From before to after treatment, treated individuals showed improved AHI, SaO2 and OSA-18 scores2. Comparing treated individuals and controls, AHI decreased in treated individuals and increased in controls. For SaO2, the increase in treated individuals was greater than in controls. For OSA-18, daytime/nighttime symptoms decreased in treated individuals and increased in controls. CONCLUSION: Functional jaw orthopedic appliances are appropriate and effective for children/adolescents with OSA whose etiology is deficient maxillomandibular growth and development. Functional jaw orthopedics treats the form and function of the stomatognathic system, thereby enhancing quality of life. PROSPERO REGISTRATION PROTOCOL: CRD42021253341.

Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review.

OBJECTIVE: To compare polysomnographic parameters with others from the literature in order to provide more accurate information about Rapid Maxillary Expansion (RME) for treating Obstructive Sleep Apnea (OSA) in children, through raising the question: Is RME a good option for treating OSA in children? Prevention of mouth breathing during children's growth remains a challenge with significant clinical consequences. In addition, OSA induces anatomofunctional changes during the critical period of craniofacial growth and development. METHODS: The Medline, PubMed, EMBASE, CINAHL, Web of Science, SciELO and Scopus electronic databases were searched up to February 2021 for systematic reviews with meta-analysis in the English language. Among 40 studies on RME for treating OSA in children, we selected seven in which polysomnographic measurements of the Apnea-Hypopnea Index (AHI) had been made. Data were extracted and examined in order to clarify whether any consistent evidence exists for indicating RME as a treatment for OSA in children. RESULTS: We found no consistent evidence favoring RME for long-term treatment of OSA in children. All the studies presented considerable heterogeneity due to variability of age and length of follow-up. CONCLUSION: Through this umbrella review, the need for methodologically better studies on RME is supported. Moreover, it can be considered that RME is not recommended for treating OSA in children. Further studies and more evidence identifying early signs of OSA are necessary in order to achieve consistent healthcare practice.

Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review.

Introduction Obstructive sleep apnea (OSA) is defined as intermittent partial or complete collapse of the upper airway during sleep. It is a common condition in childhood, with an incidence ranging from 1.2% to 5.7%, and it can harm several aspects of children's life, such as cognitive, metabolic and cardiovascular functions, among others. There are treatment options, such as adenotonsillectomy, myofunctional therapy, mandibular advancement appliances (MAAs), rapid maxillary expansion, and positive airway pressure devices, but there is still doubt about which method is more suitable for the treatment of OSA in children. Objective To analyze the effectiveness of MAAs in the treatment of pediatric OSA. Materials and Methods The search was conducted in August 2021 in different electronic databases, such as PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS, Ovid, SciELO, Web of Science, EMBASE BIREME, BBO BIREME, and the Cochrane Library. Results Only three systematic reviews and two meta-analyses were included in the present study. All studies showed improvement in the score on the apnea-hypopnea index after using MAAs in the treatment of pediatric OSA. Conclusion Although more randomized studies are needed, based on the present umbrella review, MAAs must be considered part of the multidisciplinary treatment for pediatric OSA.

Is ankyloglossia associated with obstructive sleep apnea?

OBJECTIVES: To investigate the evidence on the association between ankyloglossia and obstructive sleep apnea. METHODS: An integrative literature review was carried out in the databases. Observational and interventional studies that assessed the lingual frenulum in children with sleep-disordered breathing were included. As exclusion criteria: studies in animals, in vitro, letters to the editor, expert opinions, other reviews. The selected articles were analyzed regarding the study design, sample, characterization of the lingual frenulum and sleep assessment, in addition to the main results and conclusions. RESULTS: Ninety-seven articles were identified, but only 4 met the inclusion criteria. Two retrospective studies concluded that the untreated shortened lingual frenulum at birth is associated with obstructive sleep apnea. A prospective study concluded that there was an improvement in speech and deglutition after lingual frenectomy, in addition to improved sleep. A retrospective cohort concluded that lingual frenuloplasty combined with myofunctional therapy is effective in the treatment of snoring and mouth breathing. CONCLUSION: The studies included in this review contribute to corroborate the association between ankyloglossia and obstructive sleep apnea.

Is ankyloglossia associated with obstructive sleep apnea? / Anquiloglossia se associa à apneia obstrutiva do sono?

Abstract Objectives To investigate the evidence on the association between ankyloglossia and obstructive sleep apnea. Methods An integrative literature review was carried out in the databases. Observational and interventional studies that assessed the lingual frenulum in children with sleep-disordered breathing were included. As exclusion criteria: studies in animals, in vitro, letters to the editor, expert opinions, other reviews. The selected articles were analyzed regarding the study design, sample, characterization of the lingual frenulum and sleep assessment, in addition to the main results and conclusions. Results Ninety-seven articles were identified, but only 4 met the inclusion criteria. Two retrospective studies concluded that the untreated shortened lingual frenulum at birth is associated with obstructive sleep apnea. A prospective study concluded that there was an improvement in speech and deglutition after lingual frenectomy, in addition to improved sleep. A retrospective cohort concluded that lingual frenuloplasty combined with myofunctional therapy is effective in the treatment of snoring and mouth breathing. Conclusion The studies included in this review contribute to corroborate the association between ankyloglossia and obstructive sleep apnea.

Resumo Objetivo Investigar as evidências sobre a associação entre a anquiloglossia e a apneia obstrutiva do sono. Método Foi feita revisão de literatura integrativa nas bases de dados. Foram incluídos estudos observacionais e intervencionais em que foi feita a avaliação do frênulo de língua em crianças com distúrbios respiratórios do sono. Como critérios de exclusão: estudo em animais, in vitro, carta ao editor, opinião de expert, outras revisões. Os artigos selecionados foram analisados quanto ao desenho do estudo, casuística, caracterização da avaliação do frênulo lingual e do sono, além dos principais resultados e conclusões. Resultado Foram localizados 97 artigos, porém apenas 4 atenderam aos critérios de inclusão. Dois estudos retrospectivos concluiram que o frênulo lingual curto não tratado ao nascimento está associado à apneia obstrutiva do sono. Um estudo prospectivo concluiu que, após a frenectomia lingual, além da melhoria do sono, houve melhoria na fala e deglutição. Um coorte retrospectivo concluiu que a frenuloplastia lingual associada à terapia miofuncional é eficaz no tratamento do ronco e respiração oral. Conclusão Os estudos incluídos na presente revisão contribuem para corroborar a associação entre anquiloglossia e apneia obstrutiva do sono.

Randomized controlled study of a mandibular advancement appliance for the treatment of obstructive sleep apnea in children: A pilot study

BACKGROUND: The current limited evidence may be suggestive that mandibular advancement appliance (MAAs) result in improvements in AHI scores, but it is not possible to conclude that MAAs are effective to treat paediatric OSA. There are significant weaknesses in the existing evidence due primarily to absence of control groups, small sample sizes, lack of randomization and short-term results. AIM: the objective of the present study was to evaluate MAAs in children with OSA. MATERIAL AND METHODS: Children presenting an apnea-hypopnea index (AHI) greater than or equal to one event per hour were considered to be apneic. This group of children with AHI greater than or equal to one was randomly divided through a draw into two subgroups: half of them in an experimental subgroup and half of them in a control subgroup. In the experimental subgroup, molds of each of these children's maxillary and mandibular arches were taken using standard molds and molding material. The control group did not use any intraoral device and did not undergo any type of treatment for OSAS. The MAAs used in this study had the aim of achieving mandibular advancement, thereby correcting the mandibular position and dental occlusion, and perhaps increasing the airway and treating OSAS. After 12 consecutive months of use of the mandibular advancement devices, polysomnography examinations using the same parameters as in the initial examinations were requested for both the experimental and the control subgroup. RESULTS: There was a decrease in AHI in the experimental group and an increase in the control group, with statistical significance. These data were used to calculate the sample size, which was 28 children in total in the groups. CONCLUSIONS: There was a decrease in AHI one year after implementing use of mandibular advancement devices, in comparison with the group that did not use these devices

Rapid maxillary expansion and obstructive sleep apnea: A review and meta-analysis

BACKGROUND: OSAS during childhood leads to significant physical and neuropsychomotor impairment. Thus, it needs to be recognized and treated early in order to avoid or attenuate the chronic problems associated with OSAS, which are deleterious to a child's development. Adenotonsillectomy and, in select cases, continuous positive airway pressure (CPAP) have been the preferred treatments for OSAS in children, and yet they are ineffective at fully ameliorating the disease. Minimally invasive treatments have recently been proposed, comprising intra-oral and extra-oral devices as well as speech therapy. OBJECTIVE: to conduct a meta-analysis on studies from around the world that used rapid maxillary expansion (RME) to treat OSAS in children. MATERIAL AND METHODS: We performed a meta-analysis of studies using RME for OSA treatment in children. A literature survey was conducted using PubMed and Medline for English articles published up to December 2014 with the following descriptors: Sleep Apnea, Obstructive, Children, Treatment, Orthodontic, Othopaedic, Maxillary expansion. Studies were included in the meta-analysis if they were case-controlled studies, randomized, and involved non-syndromic children aged 0 to 12years old diagnosed with OSA by the polysomnography apnea hypopnea index (AHI) before and after the intervention, submitted RME only. RESULTS: In all, 10 articles conformed to the inclusion criteria and were included in this meta-analysis. The total sample size across all these articles was 215 children, having a mean age of 6.7 years, of whom58.6%were male. The mean AHI during the follow-up was -6.86 (p< 0.0001). CONCLUSIONS: We concluded that rapid maxillary expansion (RME) in children with OSAS appears to be an effective treatment for this syndrome. Further randomized clinical studies are needed to determine the effectiveness of RME in adults

Laryngeal Electromyography: Are the Results Reproducible?

UNLABELLED: Laryngeal electromyography (LEMG) is an auxiliary diagnostic technique that is used to study neurologic diseases that affect the larynx. This study aimed to verify the reproducibility and accordance of LEMG findings obtained by different approaches applied to the same intrinsic laryngeal muscle in patients with neurologic disorders of the larynx. STUDY DESIGN: This study is prospective, blind, randomized, and controlled. METHODS: Forty subjects (20 males and 20 females) aged between 21 and 78 years underwent LEMG of the thyroarytenoid muscles by different techniques, with a total of 120 insertion sites for analysis. The electrophysiological findings were grouped as follows: (1) equal LEMG findings; (2) different LEMG findings but in agreement on the same electromyographic pattern; and (3) different LEMG findings and in discord on the same electromyographic pattern. RESULTS: We found 5% discordance in the LEMG findings between the sites analyzed. CONCLUSIONS: LEMG is an important and useful technique, but caution must be taken to avoid misinterpretation and the wrong muscle approach.

Anatomical study of minor alterations in neonate vocal folds / Estudo de alterações anatômicas menores em pregas vocais de neonatos

INTRODUCTION: Minor structural alterations of the vocal fold cover are frequent causes of voice abnormalities. They may be difficult to diagnose, and are expressed in different manners. Cases of intracordal cysts, sulcus vocalis, mucosal bridge, and laryngeal micro-diaphragm form the group of minor structural alterations of the vocal fold cover investigated in the present study. The etiopathogenesis and epidemiology of these alterations are poorly known. OBJECTIVE: To evaluate the existence and anatomical characterization of minor structural alterations in the vocal folds of newborns. METHODS: 56 larynxes excised from neonates of both genders were studied. They were examined fresh, or defrosted after conservation via freezing, under a microscope at magnifications of 25× and 40×. The vocal folds were inspected and palpated by two examiners, with the aim of finding minor structural alterations similar to those described classically, and other undetermined minor structural alterations. Larynges presenting abnormalities were submitted to histological examination. RESULTS: Six cases of abnormalities were found in different larynges: one (1.79%) compatible with a sulcus vocalis and five (8.93%) compatible with a laryngeal micro-diaphragm. No cases of cysts or mucosal bridges were found. The observed abnormalities had characteristics similar to those described in other age groups. CONCLUSION: Abnormalities similar to sulcus vocalis or micro-diaphragm may be present at birth. .

INTRODUÇÃO: As alterações estruturais mínimas (AEM) da cobertura das pregas vocais são causas frequentes de alterações vocais. Podem ser de diagnóstico difícil, e expressam-se de modo variável. O cisto intracordal, o sulco vocal, a ponte de mucosa e o microdiafragama laríngeo constituem o grupo das AEM da cobertura das pregas vocais pesquisadas neste estudo. Sua etiopatogenia e epidemiologia não são bem conhecidas. OBJETIVO: Avaliar a existência e a caracterização anatômica das AEM em prega vocal de neonatos. MÉTODOS: Foram estudadas 56 laringes excisadas de neonatos, de ambos os sexos. As laringes foram examinadas a fresco ou descongeladas após conservação por congelação, sob microscopia com aumento de 25 e 40×. As pregas vocais foram inspecionadas e palpadas por dois examinadores, com o intuito de encontrar AEM semelhantes às classicamente descritas e outras indeterminadas. As laringes com alterações foram submetidas a exame histológico. RESULTADOS: Foram encontradas seis alterações em laringes distintas: uma (1,79%) compatível com sulco vocal e cinco (8,93%) compatíveis com microdiafragma laríngeo. Não foram encontrados cistos e pontes de mucosa. As alterações presentes apresentavam características semelhantes às descritas em outras faixas etárias. CONCLUSÃO: Alterações semelhantes ao sulco vocal e ao microdiafragma laríngeo podem estar presentes ao nascimento. .

Evaluation of the lacrimal recess of the maxillary sinus: an anatomical study.

UNLABELLED: The anatomical relation between the maxillary sinus and the nasolacrimal duct has gained greater importance with the advent of microsurgeries and endoscopic-assisted sinonasal procedures, and the growing use of endonasal surgery to perform middle meatus procedures and transnasal dacryocystorhinostomy. We did not find reports on maxillary sinus classification concerning its lacrimal recess, nor how often it is found. OBJECTIVE: To assess how frequent the lacrimal recess can be found in the maxillary sinuses of dissected anatomical specimens. METHOD: We assessed 31 half-heads from cadavers. We dissected the area corresponding to the middle third of the face, by lateral access so as to be able to observe the most lateral portion of the nasolacrimal duct vis-à-vis the maxillary sinus.The maxillary sinuses were assessed by two examiners simultaneously, getting to a consensus in relation to the type of nasolacrimal duct. RESULTS: We assessed 18 maxillary sinuses of the lateral type (58.1%) and 13 anterior sinuses (41.9%). The difference in frequency of the anterior type of maxillary type of the right side (35.7%) and left (47.1%) did not have statistical significance (p = 0.524). CONCLUSION: We found a frequency of 41.9% of lacrimal recesses in the maxillary sinuses.

Avaliação do recesso lacrimal do seio maxilar: estudo anatômico / Evaluation of the lacrimal recess of the maxillary sinus: an anatomical study

Arelação anatômica entre seio maxilar e ducto lacrimonasal adquiriu maior importância com o advento das microcirugias e cirurgias nasossinusais assistidas por endoscopia e pelo crescente uso da endoscopia nasal na realização das meatotomias médias e dacriocistorrinostomiastransnasais. Não foram encontrados relatos de classificação do seio maxilar quanto ao seu recesso lacrimal, tampouco sua frequência. OBJETIVO: Avaliar a frequência do recesso lacrimal do seio maxilar em peças anatômicas dissecadas. MÉTODO: Foram avaliadas 31 partes de hemicabeças de cadáveres. Procedeu-se à dissecção da área correspondente ao terço médio da face, por acesso lateral, para que se pudesse observar a posição da porção mais lateral do ducto lacrimonasal em relação ao seio maxilar. Os seios maxilares foram avaliados, por dois examinadores simultaneamente, chegando ao consenso do tipo de ducto lacrimonasal. RESULTADOS: Foram encontrados 18 seios maxilares do tipo lateral (58,1%) e 13 do tipo anterior (41,9%). A diferença entre a frequência de seios maxilares do tipo anterior nos lados direito (35,7%) e esquerdo (47,1%) não mostrou significância estatística (p = 0,524). CONCLUSÃO: Observou-se frequência de 41,9% de recessos lacrimais nos seios maxilares.

The anatomical relation between the maxillary sinus and the nasolacrimal duct has gained greater importance with the advent of microsurgeries and endoscopic-assisted sinonasal procedures, and the growing use of endonasal surgery to perform middle meatus procedures and transnasal dacryocystorhinostomy. We did not find reports on maxillary sinus classification concerning its lacrimal recess, nor how often it is found. OBJECTIVE: To assess how frequent the lacrimal recess can be found in the maxillary sinuses of dissected anatomical specimens. METHOD: We assessed 31 half-heads from cadavers. We dissected the area corresponding to the middle third of the face, by lateral access so as to be able to observe the most lateral portion of the nasolacrimal duct vis-à-vis the maxillary sinus.The maxillary sinuses were assessed by two examiners simultaneously, getting to a consensus in relation to the type of nasolacrimal duct. RESULTS: We assessed 18 maxillary sinuses of the lateral type (58.1%) and 13 anterior sinuses (41.9%). The difference in frequency of the anterior type of maxillary type of the right side (35.7%) and left (47.1%) did not have statistical significance (p = 0.524). CONCLUSION: We found a frequency of 41.9% of lacrimal recesses in the maxillary sinuses.

Postural evaluation in children with atypical swallowing: radiographic study.

PURPOSE: To evaluate the cranial posture on lateral teleradiographs of children with atypical swallowing in mixed dentition. METHODS: By using cephalometric analysis on lateral teleradiographs, the angles between the odontoid process and cranial base (CC1) and the odontoid process and Frankfurt plane (CC2) were measured in two groups: 55 teleradiographs from the experimental group (with atypical swallowing), and 55 lateral teleradiographs from the control group (normal swallowing). These angular measurements were subjected to statistical analysis. RESULTS: The means of the variable CC1 were 99.95 degrees in the experimental group and 96.42 degrees in the control group, with significant difference between them. The means of the variable CC2 were 90.60 degrees in the experimental group and 86.35 degrees in the control group, which was also statistically significant. CONCLUSION: The angles CC1 and CC2 are increased in the group with atypical swallowing.

Avaliação cefalométrica do espaço orofaríngeo em crianças com deglutição atípica / Cephalometric evaluation of the oropharyngeal space in children with atypical deglutition

Por diversos fatores, ainda não explicados completamente até hoje, pode haver a permanência da deglutição infantil após a troca dos dentes decíduos e esta deglutição é classificada como deglutição atípica. Entre as causas possíveis: sucção do dedo, alimentação por mamadeira, sucção da língua e respiração oral. Não há consenso sobre a etiologia da deglutição atípica. OBJETIVO: O objetivo deste estudo foi comparar o espaço orofaríngeo em telerradiografias laterais de crianças com deglutição atípica e deglutição normal. MATERIAL E MÉODOS: Neste estudo clínico retrospectivo, por meio de análise cefalométrica em telerradiografias laterais foi mensurada a dimensão ântero-posterior da luz de via aérea em dois grupos: 55 telerradiografias do grupo experimental (com deglutição atípica) e 55 telerradiografias do grupo controle (deglutição normal). Tais medidas lineares foram submetidas ao teste estatístico Mann-Whitney com nível de significância de 5 por cento. RESULTADOS: A mediana no grupo controle foi de 10 mm e do grupo experimental foi de 7 mm, com diferença estatisticamente significativa (p-valor < 0,001). CONCLUSÃO: O espaço orofaríngeo está diminuído no grupo de deglutição atípica.

For several factors, not yet fully explained until now, infant deglutition may persist after changing the primary teeth and such swallowing is classified as atypical swallowing. Possible causes: finger sucking, bottle feeding, sucking the tongue and mouth breathing. There is no consensus about the etiology of atypical deglutition. OBJECTIVE: The aim of this study was to compare the oropharyngeal space in side-view radiographs of children with atypical deglutition and normal deglutition. METHODS: Retrospective study, by means of cephalometric analysis of side-view radiographs, measuring the anteroposterior distance of the lumen of the airway in two groups: 55 cephalograms from the experimental group (with atypical deglutition) and 55 side-view radiographs from the control group (normal deglutition). Measurements from the groups were compared using Mann-Whitney U test and a p value <0.05 was considered as an indication of statistical significance. RESULTS: The median in the control group was 10 mm and in the experimental group it was 7 mm, with a statistically significant difference (p <0.001). CONCLUSION: The oropharyngeal space is reduced in the group with atypical deglutition.

Postural evaluation in children with atypical swallowing: radiographic study / Avaliação postural em crianças com deglutição atípica: estudo radiográfico

PURPOSE: To evaluate the cranial posture on lateral teleradiographs of children with atypical swallowing in mixed dentition. METHODS: By using cephalometric analysis on lateral teleradiographs, the angles between the odontoid process and cranial base (CC1) and the odontoid process and Frankfurt plane (CC2) were measured in two groups: 55 teleradiographs from the experimental group (with atypical swallowing), and 55 lateral teleradiographs from the control group (normal swallowing). These angular measurements were subjected to statistical analysis. RESULTS: The means of the variable CC1 were 99.95 degrees in the experimental group and 96.42 degrees in the control group, with significant difference between them. The means of the variable CC2 were 90.60 degrees in the experimental group and 86.35 degrees in the control group, which was also statistically significant. CONCLUSION: The angles CC1 and CC2 are increased in the group with atypical swallowing.

OBJETIVO: Avaliar a postura craniana em telerradiografias laterais de crianças com deglutição atípica em dentição mista. MÉTODOS: Por meio de análise cefalométrica em telerradiografias laterais, foram mensurados os ângulos entre processo odontóide e base do crânio (CC1) e processo odontóide e plano de Frankfurt (CC2) em dois grupos: 55 telerradiografias do grupo experimental (com deglutição atípica) e 55 telerradiografias do grupo controle (deglutição normal). Tais medidas angulares foram submetidas a análise estatística. RESULTADOS: As médias da variável CC1 foram de 99,95 graus no grupo experimental e de 96,42 graus no grupo controle, havendo diferença entre elas. As médias da variável CC2 foram de 90,60 graus no grupo experimental e de 86,35 graus no grupo controle, também com diferença. CONCLUSÃO: Os ângulos CC1 e CC2 estão aumentados no grupo de deglutição atípica.

Cephalometric evaluation of the airway space and hyoid bone in children with normal and atypical deglutition: correlation study / Avaliação cefalométrica de via aérea e do osso hioide em crianças com deglutição normal e atípica: estudo de correlações

CONTEXT AND OBJECTIVE: Although there is a close relationship between swallowing and breathing, there are no studies evaluating the radiographic anatomy of the airway and its possible correlation with the radiographic position of the hyoid bone. The aim of this study was to evaluate the possible correlation of the radiographic position of the hyoid bone and airway space (PAS) in lateral radiographs on children with atypical deglutition, in comparison with those with normal swallowing. DESIGN AND SETTING: Cross-sectional analytical study with control group in a public university. METHODS: Using cephalometric analysis on lateral teleradiographs, the distance from the hyoid bone to the mandibular plane (MP-H) and the distance from the hyoid bone to the tuber (T-H) were correlated with the PAS measurement (airway) in two groups: 55 teleradiographs in the experimental group (with atypical deglutition) and 55 teleradiographs in the control group (normal deglutition). Both groups included subjects at the mixed dentition stage. RESULTS: The variable T-H presented a statistically significant correlation with PAS (0.0286) and the variable MP-H had a significant correlation with the variable PAS (0.0053). This positive correlation was significant only in the control group and not in the group with atypical swallowing. CONCLUSIONS: There was a positive correlation between the MP-H and PAS measurements and between the T-H and PAS measurements only in the group with normal swallowing. These correlations were not observed in the group with atypical swallowing.

CONTEXTO E OBJETIVO: Embora haja estreita relação entre respiração e deglutição, não existem estudos que avaliem a anatomia radiográfica de via aérea e sua possível correlação com a posição radiográfica do osso hioide. O objetivo deste estudo foi avaliar possível correlação da posição radiográfica do osso hioide e do espaço aéreo na radiografia lateral de crianças com deglutição atípica quando comparada com aquelas com deglutição normal. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico com grupo controle em universidade pública. MÉTODOS: Por meio de análise cefalométrica em telerradiografias laterais, foi correlacionada a distância do osso hioide ao plano mandibular (MP-H) e do túber ao osso hioide (T-H) com a medida do espaço da via aérea (PAS) em dois grupos: 55 telerradiografias do grupo experimental (com deglutição atípica) e 55 telerradiografias do grupo controle (deglutição normal). Ambos os grupos incluíram indivíduos em fase de dentição mista. RESULTADOS: A variável T-H apresentou correlação estatisticamente significativa com PAS (0,0286) e a variável MP-H teve correlação significativa com a variável PAS (0,0053). Esta correlação positiva foi significativa apenas no grupo controle e não no grupo de deglutição atípica. CONCLUSÕES: Há correlação positiva entre as medidas MP-H e PAS e entre as medidas T-H e PAS somente no grupo de deglutição normal. Estas correlações não foram observadas no grupo de deglutição atípica.

Cephalometric study of alterations induced by maxillary slow expansion in adults.

UNLABELLED: Maxilla expansion is a procedure that aims at increasing the maxillary dental arch to correct occlusal disharmony. Largely used in children, its efficacy in adults, when craniofacial growth has attained bone maturity, is controversial. AIM: The present study has the objective of evaluating cephalometric modifications resulting from maxilla expansion in adult patients, observing the following linear measurements: facial width, nasal width, nasal height, maxillary width, mandibular width and maxillary molar width. MATERIAL AND METHODS: The sample was composed of 24 frontal teleradiographs, taken before and immediately after the expansions, from 12 male and female patients aged between 18 years and two months and 37 years and eight months. All patients were submitted to slow expansion of the maxillary bones by means of an appliance used in the technique named "dynamic and functional maxillary rehabilitation". Wilcoxon paired statistical test was used for related samples with a 5% significance level. RESULTS: There was a mean increase of 1.92 mm in nasal width and 2.5 mm in nasal height. As regards the linear measurements maxillary and mandibular width, the mean increase was 2.42 mm and 1.92 mm, respectively. A mean increase of 1.41 mm was found for facial width and 2.0 mm for maxillary molar width, alterations which were statistically significant, the mean time was 5.3 months. CONCLUSION: Based on the results obtained, it may be concluded that the use of maxillary expansion induces increase of the facial measurements studied in adults.

Estudo cefalométrico de alterações induzidas por expansão lenta da maxila em adultos / Cephalometric study of alterations induced by maxillary slow expansion in adults

A expansão da maxila é um procedimento que objetiva o aumento do arco dental maxilar para correção de desvios oclusais. Amplamente empregada em crianças, há controvérsias sobre sua eficácia em adultos, quando o crescimento crânio-facial já atingiu sua maturidade óssea. OBJETIVO: O presente estudo tem como objetivo avaliar modificações cefalométricas decorrentes da expansão da maxila em pacientes adultos, observando as seguintes medidas lineares: largura facial, largura nasal, altura nasal, largura maxilar, largura mandibular e largura molar-maxilar. MATERIAL E MÉTODOS: A amostra constituiu-se de 24 telerradiografias frontais, tomadas antes e imediatamente após as expansões, obtidas de 12 pacientes, ambos os sexos, com idade entre 18 anos e dois meses e 37 anos e oito meses. Todos os pacientes foram submetidos à expansão lenta dos ossos maxilares com o uso do aparelho expansor da técnica denominada "reabilitação dinâmica e funcional dos maxilares". Foi utilizado teste estatístico de Wilcoxon pareado, para amostras relacionadas e nível de significância 5 por cento. RESULTADOS: Ocorreu aumento médio de 1,92mm na largura nasal e altura nasal 2,5mm. Nas medidas lineares largura maxilar e largura mandibular o aumento médio foi de 2,42mm e 1,92mm respectivamente. Para largura facial encontrou-se aumento médio de 1,41mm e largura molar-maxilar 2,0mm, sendo tais alterações estatisticamente significativas, obtidas em um tempo médio de 5,3 meses. CONCLUSÃO: Baseado nos resultados obtidos conclui-se que o uso da expansão maxilar induz o aumento das medidas faciais estudadas em adultos.