RESUMO
Objectives: To organize an assessment instrument with questionnaires and myofunctional orofacial/oropharyngeal assessment for OSA patients and correlate it with the upper airway obstructive site detected during drug-induced sleep endoscopy (DISE). Material and Methods: 29 OSA patients aged 22-65 years with an indication to undergo DISE to evaluate an alternative treatment to PAP and signed the consent form. Patients over 65 years old with maxillofacial deficiency and BMI>30 were excluded. The subjects answered the Pittsburgh, Berlin (snore), and Epworth questionnaires. The myofunctional orofacial/oropharyngeal assessment comprised soft palate, palatine pillars, and uvula (structure and mobility), tonsils (size), mandible (bony bases), hard palate (depth and width), tongue (posture, volume, width, and height), floor of mouth (mylohyoid), tongue suction and sustaining (mobility), "lowering of the back of the tongue" (stimulus), which were scored by three speech-language pathologists with expertise. DISE was scored according to VOTE classification. The statistical analysis (t-test) compared groups without and with obstruction in VOTE with questionnaires and myofunctional orofacial/oropharyngeal assessment. Results: The following were significantly different: snoring frequency (p=0.03) with VOTE/velopharynx; intensity (p=0.02) and frequency of snoring (p=0.03) with VOTE/lateral wall of oropharynx; suction the tongue and sustain (p=0.02) with VOTE/velopharynx; hard palate depth (p=0.02) and width (p=0.05) with obstruction VOTE/epiglottis; tonsils volume (p=0.05) with VOTE/epiglottis; tongue posture (p=0.00) with obstruction VOTE/epiglottis; floor of the mouth (p=0.02) with VOTE/epiglottis. Conclusion: Higher snoring frequency and intensity was observed in patients with obstruction at the velopharynx and oropharyngeal lateral wall. Obstruction at the velopharynx was associated with poor tongue ability to suck the tongue against the hard palate. Obstruction at the epiglottis had structural and functional associations, including the oropharyngeal lateral wall, affected by the palatine tonsils size, depth and width of the hard palate, tongue position, and flaccidity of the floor of mouth. Considering that this is a preliminary study, the data should be carefully verified and not generalized.
RESUMO
TEMA: ferimentos causados por projéteis de arma de fogo apresentam alta incidência na região da cabeça e face. A articulação temporomandibular pode estar envolvida, além de estruturas anatômicas importantes como o nervo facial, necessitando de equipe multidisciplinar para efetuar tratamento adequado. PROCEDIMENTOS: apresentação de caso clínico de fratura condilar cominutiva causada por projétil de arma de fogo tratado de forma não-cirúrgica associado à terapia miofuncional orofacial. Paciente encaminhado para avaliação e procedimentos fonoaudiológicos após conduta da equipe de cirurgia bucomaxilofacial, sem remoção do projétil, alojado superficialmente, próximo da origem do músculo esternocleidomastóideo à direita, com fratura condilar cominutiva e lesão do nervo facial. Foram aspectos observados em avaliação: mordida aberta anterior, importante redução da amplitude dos movimentos mandibulares com desvios para o lado acometido, ausência de lateralidade contralateral, dor muscular, paralisia e parestesia em terço médio e superior da hemiface direita. Realizadas sessões de terapia miofuncional seguindo protocolo específico para traumas de face constando de: drenagem de edema; manipulações na musculatura levantadora da mandíbula ipsilateral; ampliação e correção dos movimentos mandibulares; procedimentos específicos referentes à paralisia facial e reorganização funcional direcionada. RESULTADOS: após oito semanas de terapia os resultados obtidos mostram restabelecimento de amplitude e da simetria dos movimentos mandibulares, reorganização da mastigação, adequação da deglutição e fala, remissão da sintomatologia dolorosa e remissão da paralisia do terço médio. CONCLUSÃO: o tratamento conservador da fratura por meio da terapia miofuncional orofacial resultou na reabilitação funcional da mandíbula e face dirigindo os movimentos e estimulando a adequação das funções estomatognáticas.
BACKGROUND: firearm wounds are relatively frequent and show high incidence at the head and face area. Temporomandibular joint may be involved, and also some important anatomic structures as the facial nerve directing the need for an interdisciplinary team in order to promote an efficient treatment. PROCEDURES: a case report related to a comminuted condyle fracture caused by firearms with a nonsurgical treatment associated to myofunctional therapy. The patient was referred to Speech and Language Pathologist after the conduct of oral and maxillofacial surgery team, without removing the bullet, lodged superficially near the origin of the sternocleidomastoid muscle on the right side; with comminuted condyle fracture and facial nerve damage. Myofunctional evaluation found an important reduction in the mandibular movement amplitude with severe deviations as for the affected side, no contralateral laterality, muscle pain; paralysis and paresthesia on the right side of the face. Myofunctional therapy followed a specific protocol for facial trauma including: drainage of edemas, specific ipsilateral manipulations on jaw muscles; correction and enlargement of the mandibular movements, specific procedures related to facial paralysis and directed functional reorganization. RESULTS: after eight therapy sessions we obtained: mandibular movements with adequate amplitude and symmetry, chewing reorganization, adequacy of swallowing and speech, remission of painful symptoms and remission of paralysis in the medium third of the face. CONCLUSION: the conservative treatment for comminuted condyle fracture through myofunctional therapy resulted in functional rehabilitation of the jaw and face, directing the movements and stimulating the adequacy of the sthomatognatic functions.
