Diagnostic properties of sensitivity changes in patients with maxillofacial fractures: a systematic review

Aim: Verify the accuracy of objective assessments compared to subjective tests in detecting changes in somatosensory perception in individuals affected by maxillofacial trauma. Methods: The review (PROSPERO n ° CRD42019125546) used the databases: MEDLINE, Cochrane, EMBASE, LILACS and other bibliographic resources. Prospective and retrospective studies that used objective and subjective methods of assessing facial sensitivity in maxillofacial fractures were included. There was no restriction on language or publication date. Risk of bias was assessed using the QUADAS-2. Data extraction and analysis were performed using a form developed for the study. Results: 21 studies were included. The clinical objective examination mainly includes assessments of: tactile sensitivity (95.24%) and nociceptive sensitivity (57.14%). The subjective assessment was based on the patient's report, spontaneously (61.90%), guided by structured questionnaires (33.33%) and/or using scales (9.52%) to measure the degree of impairment. In risk of bias assessment, were observed no adequate interpretation and classification of changes in subjective sensitivity, subject to inappropriate analysis of the data. In addition, the studies bring several instruments without standardization for assessing sensory modalities. Conclusion: The objective assessment is a complement to the subjective assessment, using the touch assessment as the main parameter in the profile of the facial peripheral integrity, associated or not with nociceptive assessment. Lack of consensus on the indication of specific instruments for testing is a limiting factor. Thus, based on the studies, is proposed a minimum battery of sensitivity assessment to obtain an overview of the patient's peripheral nervous situation

Presença de Centros de Especialidades Odontológicas e sua relação com a realização de exodontias na rede de atenção de saúde bucal no Brasil / Presence of Specialized Dentistry Centers and the relationship with dental extractions in the oral healthcare network in Brazil / Presencia de Centros de Especialidades Odontológicas y su relación con la realización de exodoncias en la red de atención de salud bucal en Brasil

Resumo: Objetivou-se avaliar a associação entre presença de Centros de Especialidades Odontológicas (CEO) e a proporção de exodontias em relação ao total de procedimentos odontológicos em serviços públicos do Brasil. Trata-se de um estudo ecológico, em que foram avaliados dados sociodemográficos, dos serviços de saúde bucal e produção ambulatorial de 5.333 municípios nos biênios de 2000/2001 e 2015/2016. A principal variável de exposição foi a presença de CEO, e o desfecho a média nacional da proporção de exodontias em relação ao número de procedimentos odontológicos preventivos e curativos. Foram realizadas análises de interação e regressão múltipla usando modelo binomial com função de ligação logito. A média nacional da proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos foi 27,07% e 15,11% em 2000/2001 e 2015/2016, respectivamente. Na análise de interação entre a presença de CEO e a cobertura superior a 80% de equipes de saúde bucal (ESB), houve menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos (OR = 0,71; IC95%: 0,71-0,72). Na análise de regressão múltipla, municípios com Índice de Desenvolvimento Humano entre 0,6-0,7 (OR = 0,77; IC95%: 0,77-0,77), Produto Interno Bruto per capita maior que 20 mil Reais (OR = 0,45; IC95%: 0,45-045) e maior população residente em zona urbana (OR = 0,72; IC95%: 0,72-0,72) apresentaram menor proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos em 2015/2016. Conclui-se que ocorreram menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos em municípios com ao menos um CEO e com mais de 80% de cobertura de ESB, o que aponta que municípios com Rede de Atenção à Saúde Bucal consolidada têm melhor desempenho na oferta de cuidados odontológicos.

Abstract: This study aimed to assess the association between the presence of Specialized Dentistry Centers and dental extractions as a proportion of all dental procedures in public services in Brazil. This was an ecological study that assessed sociodemographic data, oral health services, and outpatient production in 5,333 municipalities in 2000-2001 and 2015-2016. The principal exposure variable was the presence of Specialized Dentistry Centers, and the outcome was the mean national proportion of dental extractions in relation to all preventive and curative dental procedures. Interaction and multiple regression analyses were performed using a binomial model with log link function. The mean national proportions of dental extractions in relation to preventive and curative dental procedures were 27.07% and 15.11% in 2000-2001 and 2015-2016, respectively. In the analysis of interaction between the presence of Specialized Dentistry Centers and coverage greater than 80% by the oral health teams, there were lower proportions of dental extractions in relation to preventive and curative dental procedures (OR = 0.71; 95%CI: 0.71-0.72). In the multiple regression analysis, municipalities with Human Development Index of 0.6-0.7 (OR = 0.77; 95%CI: 0.77-0.77), annual per capita GDP greater than BRL 20,000 (OR = 0.45; 95%CI: 0.45-045), and proportionally higher urban populations (OR = 0.72; 95%CI: 0.72-0.72) showed fewer dental extractions as a proportion of all preventive and curative dental procedures in 2015-2016. In conclusion, there were lower proportions of tooth extractions in municipalities with at least one Specialized Dentistry Center and with a coverage of greater than 80% by the oral health teams, highlighting that municipalities with a consolidated Oral Health Care Network present better performance in the supply of dental care.

Resumen: Este trabajo tuvo el objetivo de evaluar la asociación entre la presencia de Centros de Especialidades Odontológicas (CEO) y su proporción de exodoncias, en relación con el total de procedimientos odontológicos en los servicios públicos de Brasil. Se trata de un estudio ecológico, en que se evaluaron datos sociodemográficos, servicios de salud bucal y atención ambulatoria en 5.333 municipios, durante los bienios de 2000/2001 y 2015/2016. La principal variable de exposición fue la presencia de CEO y el resultado la media nacional de la proporción de exodoncias, respecto al número de procedimientos odontológicos preventivos y curativos. Se realizó tanto un análisis de interacción, como de regresión múltiple, usando un modelo binomial con función de vinculación logit. La media nacional de la proporción de exodoncias, en relación con los procedimientos odontológicos preventivos y curativos, fue 27,07% y 15,11% en 2000/2001 y 2015/2016, respectivamente. En el análisis de interacción entre la presencia de CEO y la cobertura superior a un 80% de equipos de salud bucal (ESB) hubo menores proporciones de exodoncias, en relación con los procedimientos odontológicos preventivos y curativos (OR = 0,71; IC95%: 0,71-0,72). En el análisis de regresión múltiple, los municipios con un Índice de Desarrollo Humano entre 0,6-0,7 (OR = 0,77; IC95%: 0,77-0,77), PIB per cápita mayor que BRL 20.000 (OR = 0,45; IC95%: 0,45-045) y mayor población residente en zona urbana (OR = 0,72; IC95%: 0,72-0,72) presentaron una menor proporción de exodoncias, respecto a los procedimientos odontológicos preventivos y curativos en 2015/2016. Se concluye que hubo menores proporciones de exodoncias, en lo que respecta a los procedimientos odontológicos preventivos y curativos en municipios con al menos un CEO, y con más de un 80% de cobertura de ESB, lo que apunta a que los municipios con una Red de Atención a la Salud Bucal consolidada tienen un mejor desempeño en la oferta de cuidados odontológicos.

Prevalência e fatores de risco para disfagia orofaríngea em idosos frágeis com fraturas traumato-ortopédicas / Prevalence and risk factors for oropharyngeal dysphagia in fragile older adults with orthopedic fractures

RESUMO Objetivo Estimar a prevalência e fatores de risco para disfagia orofaríngea em indivíduos idosos hospitalizados por fraturas traumato-ortopédicas. Métodos Foram coletados dados sociodemográficos, incluindo comorbidades clínicas, autopercepção do desempenho de deglutição (Eating Assessment Tool) e identificação de risco nutricional (Mini Avaliação Nutricional). Para avaliar o sistema estomatognático e a deglutição, foram utilizados os protocolos Avaliação Miofuncional para Pessoas Idosas e o Volume Viscosity Swallow Test, compilados para composição do desfecho a partir da Functional Oral Intake Scale (FOIS). Resultados O estudo evidenciou que 58% dos indivíduos apresentaram restrições de consistências alimentares devido à disfagia orofaríngea (FOIS ≤ 6). Observou-se, também, risco de diminuição funcional entre aqueles com idade maior ou igual a 70 anos, com piores condições dentárias, diminuição da funcionalidade global, doenças neurológicas associadas e com percepção de alterações na deglutição. Conclusão Houve prevalência de disfagia orofaríngea em seis a cada dez indivíduos, sendo a fragilidade, idade avançada, múltiplas doenças e condições orais deficitárias os fatores de risco para a alteração, fatores estes que devem ser identificados para a prevenção de aspiração alimentar.

ABSTRACT Purpose To estimate the prevalence of and risk factors for oropharyngeal dysphagia in older adults hospitalized for orthopedic trauma fractures. Methods Sociodemographic data, clinical comorbidities, auto-perception of swallowing performance (Eating Assessment Tool) and identification of nutritional risk (Mini Nutritional Assessment) were collected. In order to evaluate the stomatognathic system and swallowing, the Orofacial Myofunctional Evaluation Protocol for older people and the Volume Viscosity Swallow Test protocols were used to assess the outcome through the Functional Oral Intake Scale (FOIS). Results 58% individuals presented dietary consistency restrictions due to oropharyngeal dysphagia (FOIS ≤ 6). A risk for functional decrease was observed among patients 70 years or older, with worse dental conditions, global functionality decreased, neurologic disorders and self-perception of swallowing changes. Conclusion The study observed a prevalence of oropharyngeal dysphagia in six out of ten individuals. Frailty, advanced age, multiple comorbidities and deficient oral conditions are risk factors that should be identified in order to prevent food aspiration.

Influence of Masticatory Behavior on Muscle Compensations During the Oral Phase of Swallowing of Smokers

Abstract Introduction Chewing and swallowing are physiologically interconnected functions, which share motor structures and supranuclear regions of the central nervous system (CNS), involving a sensorimotor synchrony. Objective To analyze the influence of masticatory behavior on muscular compensations in the oral phase of swallowing in smokers compared with nonsmokers. Methods A cross-sectional study comparing smokers and nonsmokers composed of 24 participants in each group. The aspects of food crunching, masticatory pattern, masticatory speed, atypical muscular contractions, and lip closure were analyzed during mastication. In swallowing, aspects of contraction of the orbicular and mental muscles, head movement and presence of deglutition, mastication, smoking, and of stomatognathic system of residues after swallowing were characterized. Results Statistically significant differences were identified between the study groups related to food grinding pattern, masticatory velocity, and mental contraction during swallowing. There was no significant association between masticatory function and compensations during swallowing. Conclusion Differences were observed in the pattern of chewing and swallowing in smokers compared with nonsmokers, but no influence of masticatory performance was observed in the presence of muscle compensations during the oral phase of swallowing.

Influence of Masticatory Behavior on Muscle Compensations During the Oral Phase of Swallowing of Smokers.

Introduction Chewing and swallowing are physiologically interconnected functions, which share motor structures and supranuclear regions of the central nervous system (CNS), involving a sensorimotor synchrony. Objective To analyze the influence of masticatory behavior on muscular compensations in the oral phase of swallowing in smokers compared with nonsmokers. Methods A cross-sectional study comparing smokers and nonsmokers composed of 24 participants in each group. The aspects of food crunching, masticatory pattern, masticatory speed, atypical muscular contractions, and lip closure were analyzed during mastication. In swallowing, aspects of contraction of the orbicular and mental muscles, head movement and presence of deglutition, mastication, smoking, and of stomatognathic system of residues after swallowing were characterized. Results Statistically significant differences were identified between the study groups related to food grinding pattern, masticatory velocity, and mental contraction during swallowing. There was no significant association between masticatory function and compensations during swallowing. Conclusion Differences were observed in the pattern of chewing and swallowing in smokers compared with nonsmokers, but no influence of masticatory performance was observed in the presence of muscle compensations during the oral phase of swallowing.

[Presence of Specialized Dentistry Centers and the relationship with dental extractions in the oral healthcare network in Brazil]. / Presença de Centros de Especialidades Odontológicas e sua relação com a realização de exodontias na rede de atenção de saúde bucal no Brasil.

This study aimed to assess the association between the presence of Specialized Dentistry Centers and dental extractions as a proportion of all dental procedures in public services in Brazil. This was an ecological study that assessed sociodemographic data, oral health services, and outpatient production in 5,333 municipalities in 2000-2001 and 2015-2016. The principal exposure variable was the presence of Specialized Dentistry Centers, and the outcome was the mean national proportion of dental extractions in relation to all preventive and curative dental procedures. Interaction and multiple regression analyses were performed using a binomial model with log link function. The mean national proportions of dental extractions in relation to preventive and curative dental procedures were 27.07% and 15.11% in 2000-2001 and 2015-2016, respectively. In the analysis of interaction between the presence of Specialized Dentistry Centers and coverage greater than 80% by the oral health teams, there were lower proportions of dental extractions in relation to preventive and curative dental procedures (OR = 0.71; 95%CI: 0.71-0.72). In the multiple regression analysis, municipalities with Human Development Index of 0.6-0.7 (OR = 0.77; 95%CI: 0.77-0.77), annual per capita GDP greater than BRL 20,000 (OR = 0.45; 95%CI: 0.45-045), and proportionally higher urban populations (OR = 0.72; 95%CI: 0.72-0.72) showed fewer dental extractions as a proportion of all preventive and curative dental procedures in 2015-2016. In conclusion, there were lower proportions of tooth extractions in municipalities with at least one Specialized Dentistry Center and with a coverage of greater than 80% by the oral health teams, highlighting that municipalities with a consolidated Oral Health Care Network present better performance in the supply of dental care.

Objetivou-se avaliar a associação entre presença de Centros de Especialidades Odontológicas (CEO) e a proporção de exodontias em relação ao total de procedimentos odontológicos em serviços públicos do Brasil. Trata-se de um estudo ecológico, em que foram avaliados dados sociodemográficos, dos serviços de saúde bucal e produção ambulatorial de 5.333 municípios nos biênios de 2000/2001 e 2015/2016. A principal variável de exposição foi a presença de CEO, e o desfecho a média nacional da proporção de exodontias em relação ao número de procedimentos odontológicos preventivos e curativos. Foram realizadas análises de interação e regressão múltipla usando modelo binomial com função de ligação logito. A média nacional da proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos foi 27,07% e 15,11% em 2000/2001 e 2015/2016, respectivamente. Na análise de interação entre a presença de CEO e a cobertura superior a 80% de equipes de saúde bucal (ESB), houve menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos (OR = 0,71; IC95%: 0,71-0,72). Na análise de regressão múltipla, municípios com Índice de Desenvolvimento Humano entre 0,6-0,7 (OR = 0,77; IC95%: 0,77-0,77), Produto Interno Bruto per capita maior que 20 mil Reais (OR = 0,45; IC95%: 0,45-045) e maior população residente em zona urbana (OR = 0,72; IC95%: 0,72-0,72) apresentaram menor proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos em 2015/2016. Conclui-se que ocorreram menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos em municípios com ao menos um CEO e com mais de 80% de cobertura de ESB, o que aponta que municípios com Rede de Atenção à Saúde Bucal consolidada têm melhor desempenho na oferta de cuidados odontológicos.

Este trabajo tuvo el objetivo de evaluar la asociación entre la presencia de Centros de Especialidades Odontológicas (CEO) y su proporción de exodoncias, en relación con el total de procedimientos odontológicos en los servicios públicos de Brasil. Se trata de un estudio ecológico, en que se evaluaron datos sociodemográficos, servicios de salud bucal y atención ambulatoria en 5.333 municipios, durante los bienios de 2000/2001 y 2015/2016. La principal variable de exposición fue la presencia de CEO y el resultado la media nacional de la proporción de exodoncias, respecto al número de procedimientos odontológicos preventivos y curativos. Se realizó tanto un análisis de interacción, como de regresión múltiple, usando un modelo binomial con función de vinculación logit. La media nacional de la proporción de exodoncias, en relación con los procedimientos odontológicos preventivos y curativos, fue 27,07% y 15,11% en 2000/2001 y 2015/2016, respectivamente. En el análisis de interacción entre la presencia de CEO y la cobertura superior a un 80% de equipos de salud bucal (ESB) hubo menores proporciones de exodoncias, en relación con los procedimientos odontológicos preventivos y curativos (OR = 0,71; IC95%: 0,71-0,72). En el análisis de regresión múltiple, los municipios con un Índice de Desarrollo Humano entre 0,6-0,7 (OR = 0,77; IC95%: 0,77-0,77), PIB per cápita mayor que BRL 20.000 (OR = 0,45; IC95%: 0,45-045) y mayor población residente en zona urbana (OR = 0,72; IC95%: 0,72-0,72) presentaron una menor proporción de exodoncias, respecto a los procedimientos odontológicos preventivos y curativos en 2015/2016. Se concluye que hubo menores proporciones de exodoncias, en lo que respecta a los procedimientos odontológicos preventivos y curativos en municipios con al menos un CEO, y con más de un 80% de cobertura de ESB, lo que apunta a que los municipios con una Red de Atención a la Salud Bucal consolidada tienen un mejor desempeño en la oferta de cuidados odontológicos.

Postswallow voice modification: compatibility with videofluoroscopy findings. / Modificação da voz após deglutição: compatibilidade com achados da videofluoroscopia.

PURPOSE: Verify whether voice modification after swallowing is associated with videofluoroscopic examination data. METHODS: 27 patients with oropharyngeal dysphagia underwent recording of sustained phonation of vowel /a/ before and after swallowing during videofluoroscopy. The GRBAS scale and the wet voice parameter were used to evaluate the data. Videofluoroscopy results showed stasis of food in the valleculae and piriform recesses, laryngeal penetration, tracheal aspiration, and degree of dysphagia. RESULTS: Decreased dysphonia grade and asthenia and increased strain were observed after swallowing, with no difference for the wet voice parameter. Sensitivity and specificity of ± 50% were observed for food stasis in the valleculae and piriform recesses. Sensitivity values of 80 and 66-75% were observed for detection of laryngeal penetration and tracheal aspiration and modification of vocal strain, respectively. Negative predictive values of 77-91% were found for the three assessment parameters with no correlation with the degree of oropharyngeal dysphagia. CONCLUSION: Modification of the GRBAS scale parameters after swallowing showed good compatibility with videofluoroscopy findings.

OBJETIVO: Verificar se a modificação da voz após a deglutição relaciona-se com os dados do exame de videofluoroscopia. MÉTODO: 27 indivíduos com disfagia orofaríngea realizaram a gravação da vogal sustentada /a/ antes e após a deglutição durante exame de videofluoroscopia. Utilizou-se a escala GRBAS e acrescentou-se o aspecto voz molhada para avaliação dos dados. Em relação ao exame, verificou-se estase de alimento em valéculas e recessos piriformes, penetração laríngea, aspiração traqueal e grau de disfagia. RESULTADOS: Houve diminuição do grau de alteração e astenia e aumento da tensão fonatória após a deglutição, sem diferença para o parâmetro voz molhada. Obteve-se sensibilidade e especificidade de ±50% para estase em recessos piriformes e valéculas; porém, sensibilidade de 80% para detecção de penetração e de 66-75% para aspiração e modificação da tensão fonatória, com 77-91% de valores preditivos negativos para os três parâmetros de avaliação, sem correlação com o grau de disfagia. CONCLUSÃO: A modificação dos parâmetros da escala GRBAS após a deglutição apresentou boa compatibilidade com achados da videofluoroscopia.

Modificação da voz após deglutição: compatibilidade com achados da videofluoroscopia / Postswallow voice modification: compatibility with videofluoroscopy findings

RESUMO Objetivo Verificar se a modificação da voz após a deglutição relaciona-se com os dados do exame de videofluoroscopia. Método 27 indivíduos com disfagia orofaríngea realizaram a gravação da vogal sustentada /a/ antes e após a deglutição durante exame de videofluoroscopia. Utilizou-se a escala GRBAS e acrescentou-se o aspecto voz molhada para avaliação dos dados. Em relação ao exame, verificou-se estase de alimento em valéculas e recessos piriformes, penetração laríngea, aspiração traqueal e grau de disfagia. Resultados Houve diminuição do grau de alteração e astenia e aumento da tensão fonatória após a deglutição, sem diferença para o parâmetro voz molhada. Obteve-se sensibilidade e especificidade de ±50% para estase em recessos piriformes e valéculas; porém, sensibilidade de 80% para detecção de penetração e de 66-75% para aspiração e modificação da tensão fonatória, com 77-91% de valores preditivos negativos para os três parâmetros de avaliação, sem correlação com o grau de disfagia. Conclusão A modificação dos parâmetros da escala GRBAS após a deglutição apresentou boa compatibilidade com achados da videofluoroscopia.

ABSTRACT Purpose Verify whether voice modification after swallowing is associated with videofluoroscopic examination data. Methods 27 patients with oropharyngeal dysphagia underwent recording of sustained phonation of vowel /a/ before and after swallowing during videofluoroscopy. The GRBAS scale and the wet voice parameter were used to evaluate the data. Videofluoroscopy results showed stasis of food in the valleculae and piriform recesses, laryngeal penetration, tracheal aspiration, and degree of dysphagia. Results Decreased dysphonia grade and asthenia and increased strain were observed after swallowing, with no difference for the wet voice parameter. Sensitivity and specificity of ± 50% were observed for food stasis in the valleculae and piriform recesses. Sensitivity values of 80 and 66-75% were observed for detection of laryngeal penetration and tracheal aspiration and modification of vocal strain, respectively. Negative predictive values of 77-91% were found for the three assessment parameters with no correlation with the degree of oropharyngeal dysphagia. Conclusion Modification of the GRBAS scale parameters after swallowing showed good compatibility with videofluoroscopy findings.

Utilização de Softwares por Fonoaudiólogos no Rio Grande do Sul / Use of Softwares for Speech Language Pathologists in Rio Grande do Sul / El uso de softwares por Fonoaudiologos en Rio Grande do Sul

Averiguar a utilização de softwares na prática dos fonoaudiólogos no Rio Grande do Sul. Métodos: Realizou-se um estudo transversal, com os fonoaudiólogos registrados no conselho regional de fonoaudiologia da 7a região, com aplicação de um questionário on line, onde se obteve dados sobre: formação; cidades e áreas de atuação; objetivos e reação dos pacientes quanto ao uso dos softwares na prática clínica. Resultados: Dos dados coletados, verificou-se que 62,5% profissionais utilizam softwares, sendo a maioria localizada na região metropolitana e Porto Alegre. As especialidades mais citadas na utilização de softwares foram linguagem, motricidade orofacial, disfagia e audiologia, com principal finalidade terapêutica, havendo uma boa aceitação pelos pacientes. Conclusão: Foi possível demostrar que a utilização de softwares pelos fonoaudiólogos no Rio Grande do Sul contribui no processo terapêutico, baseando-se em uma metodologia diferenciada da prática convencional, uma vez que apresenta uma boa receptividade pelos pacientes...

To investigate the use of software in the practice of for Speech Language Pathologists in Rio Grande do Sul. Methods: A cross-sectional study was conducted, with the for Speech Language Pathologists registered in the regional council of the 7th region, with application of an online survey, which was analyzed: instruction; cities and areas of working; objectives and reaction of patients to use the software in clinical practice. Results: From the data collected, it was found that 62.5% professionals use software in their practice, with the majority located in the metropolitan region and Porto Alegre city. The specialties most often cited is the use of software was language orofacial myology, dysphagia and audiology, with main therapeutic purpose, with good patient acceptance. Conclusion: It was possible to demonstrate that the use of software by Speech Language Pathologists in Rio Grande do Sul contributes to the therapeutic process, based on a different methodology from conventional practice, since it provides a good reception by patients...

Investigar el uso de software en la práctica del Fonoaudiólogo en Rio Grande do Sul. Métodos: Se realizo un estudio transversal, con los Fonoaudiólogos registrados en el consejo regional de la séptima región, con la aplicación de un cuestionario on line, que revelo: la formación; ciudades y áreas de actuación; objetivos y reacción de los pacientes a utilizar el software en la práctica clínica. Resultados: A partir de los datos, se encontró que 62,5% de los profesionales usan software, con su mayoría ubicados en la región metropolitana y Porto Alegre. Las especialidades más frecuentemente citado en el uso de software fueron lenguaje, motricidad orofacial, disfagia y audiología, con finalidad terapéutica principal, con buena aceptación del paciente. Conclusión: Se ha podido demostrar que el uso de software por fonoaudiólogos en Rio Grande do Sul contribuye al proceso terapéutico, basado en una metodología diferente de la práctica convencional, ya que ofrece una buena recepción por parte de los pacientes...

Vocal Variability Post Swallowing in Individuals with and without Oropharyngeal Dysphagia.

Introduction Voice modification after swallowing may indicate changes in the transit of the bolus. Objective The aim of this study is to verify the use of perceptual voice analysis to detect oropharyngeal dysphagia. Study Design Case series. Methods Twenty-seven patients with dysphagia as diagnosed by videofluoroscopy and 25 without were evaluated. The sustained vowel /a/ was recorded before this exam and after swallowing different consistencies (pasty, liquid and solid). For the voice evaluation, the GRBAS scale (grade, roughness, breathiness, asthenia and strain) and the parameter "wet voice" were used. Three judges blinded to study group and time of emission performed voice analysis. Results Individuals with dysphagia showed significant decrease in grade of voice and asthenia and increase in strain after swallowing pasty substances, differing from individuals without dysphagia who showed no modification of the parameters after swallowing. The wet voice parameter showed no difference after swallowing in both study groups. Conclusion The decrease in grade and asthenia and increased strain are indicative of a swallowing disorder, indicating increased vocal strain to clean the vocal tract of food. The modification of vocal production after swallowing proved to be a trusted resource for detection of swallowing disorders.

Vocal Variability Post Swallowing in Individuals with and without Oropharyngeal Dysphagia

Introduction Voice modification after swallowing may indicate changes in the transit of the bolus. Objective The aim of this study is to verify the use of perceptual voice analysis to detect oropharyngeal dysphagia. Study Design Case series. Methods Twenty-seven patients with dysphagia as diagnosed by videofluoroscopy and 25 without were evaluated. The sustained vowel /a/ was recorded before this exam and after swallowing different consistencies (pasty, liquid and solid). For the voice evaluation, the GRBAS scale (grade, roughness, breathiness, asthenia and strain) and the parameter "wet voice" were used. Three judges blinded to study group and time of emission performed voice analysis. Results Individuals with dysphagia showed significant decrease in grade of voice and asthenia and increase in strain after swallowing pasty substances, differing from individuals without dysphagia who showed no modification of the parameters after swallowing. The wet voice parameter showed no difference after swallowing in both study groups. Conclusion The decrease in grade and asthenia and increased strain are indicative of a swallowing disorder, indicating increased vocal strain to clean the vocal tract of food. The modification of vocal production after swallowing proved to be a trusted resource for detection of swallowing disorders. .

Medidas faciais em indivíduos adultos sem queixas orofaciais: compatibilidade entre medidas antropométricas e percepção facial / Facial measurements in adults with no orofacial complaints: compatibility between anthropometric measurements and facial perception

OBJETIVO: verificar a compatibilidade entre os achados de medidas faciais mensuradas pelo paquímetro e a percepção das características faciais realizada subjetivamente por um avaliador experiente. MÉTODOS: foram avaliados 24 sujeitos do sexo feminino e 24 do sexo masculino, pareados por sexo e idade, sem queixas morfológicas e funcionais do sistema estomatognático. Foram avaliados os aspectos de simetria entre os terços médio e inferior, altura e largura da face, e canto externo dos olhos direito e esquerdo às comissuras do lábio direita e esquerda, respectivamente. Cada medida foi realizada três vezes por paquímetro digital para consideração da média entre estes valores, considerando-se assimétricas comparações com diferenças superiores à 4 milímetros. A largura da face foi obtida por meio do paquímetro digital adaptado com prolongamento de 10 centímetros. Já a avaliação da percepção das características faciais foi realizada por um avaliador cegado quanto às medidas obtidas, devendo assinalar simetrias e assimetrias nestes mesmos aspectos avaliativos. RESULTADOS: por meio do teste de concordância de Kappa e Qui-quadrado, pode-se verificar uma boa compatibilidade entre as avaliações realizadas, demonstrando-se a fidedignidade entre os métodos utilizados. Além disso, verificou-se que existe uma relação entre a simetria dos terços da face e a atribuição da tipologia facial na avaliação perceptiva, observando-se simetria em faces médias e curtas e ausência de um padrão determinante para faces longas. CONCLUSÃO: a caracterização da simetria facial por paquímetro apresenta uma boa compatibilidade com a percepção subjetiva de um avaliador experiente. .

PURPOSE: to verify the compatibility between findings of facial measurements by caliper and perception of facial features made ​​subjectively by an experienced evaluator. METHODS: 24 female and 24 male subjects, paired for sex and age, without morphological and functional complaints of the stomatognathic system were evaluated. Aspects of symmetry between the middle and lower thirds, height and width of the face, and outer corner of the right and left eyes to the corners of the right and left respectively lip were evaluated. Each measurement was performed three times by a digital caliper to consider the average of these values, considering asymmetric comparisons with differences more than 4 millimeters. The width of the face was obtained through digital caliper fitted with extension 10 centimeters. The evaluation of the perception of facial features was performed by a blinded evaluator as to the digital caliper measurements that should point symmetries and asymmetries in these same evaluative aspects. RESULTS: through the agreement Kappa and Chi- square test, it was possible to verify proper compatibility between the assessments, demonstrating the reliability of the methods used. Furthermore, it was found that there is a relationship between symmetry thirds of the face and assignment of facial typology on the perceptual evaluation, observing symmetry in medium and short faces and absence of a decisive standard for long faces. CONCLUSION: the characterization of facial symmetry by a digital caliper has a good compatibility with the subjective perception of an experienced evaluator. .

Dysfunctions of the stomatognathic system and vocal aspects in Fahr disease: case report.

The aim of this study is to report the case of a patient with Fahr's Disease in order to describe the main stomatognathic and vocal changes that can be found in individuals with this disease. In order to establish the diagnosis, an assessment of the conditions of orofacial motor system and speech production, as well the efficiency of swallowing, was realized. Based on these assessments, there were difficulties in coordinating and sustaining muscle during speech and presence of oropharyngeal dysphagia. Speech disorders found in Fahr's disease manifest themselves in complex and cover various aspects of phonological knowledge and the diseases that affect the basal ganglia have similar frames of speech-language disorders of the stomatognathic system, being able to present a picture of dysarthria.

Influence of gustatory and olfactory perception in the oral phase of swallowing in smokers.

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.

Dysfunctions of the stomatognathic system and vocal aspects in Fahr disease: case report / Disfunções do sistema estomatognático e aspectos vocais na doença de Fahr: relato de caso

The aim of this study is to report the case of a patient with Fahr's Disease in order to describe the main stomatognathic and vocal changes that can be found in individuals with this disease. In order to establish the diagnosis, an assessment of the conditions of orofacial motor system and speech production, as well the efficiency of swallowing, was realized. Based on these assessments, there were difficulties in coordinating and sustaining muscle during speech and presence of oropharyngeal dysphagia. Speech disorders found in Fahr's disease manifest themselves in complex and cover various aspects of phonological knowledge and the diseases that affect the basal ganglia have similar frames of speech-language disorders of the stomatognathic system, being able to present a picture of dysarthria.

O objetivo deste estudo consiste em relatar o caso de uma paciente com Doença de Fahr buscando descrever as principais alterações estomatognáticas e vocais que podem ser encontradas em indivíduos com essa doença. A fim de estabelecer o diagnóstico fonoaudiológico, foi realizada avaliação das condições motoras orofaciais e produção da fala, além de eficiência da deglutição. Com base nessas avaliações, observaram-se dificuldades na coordenação e na sustentação muscular durante a fala e presença de disfagia orofaríngea. Os achados fonoaudiológicos na Doença de Fahr manifestam-se de forma complexa, incluindo disfagias e disartria e as doenças que acometem os núcleos da base apresentam quadros semelhantes de alterações fonoaudiológicas do sistema estomatognático, podendo apresentar quadro de disartria.

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 ...

Association between Lung Function and Vocal Affections Arising from Tobacco Consumption

Introduction: Smoking is a major risk factor for numerous diseases; it is necessary to analyze the impact that the habit can have on vocal health. Objectives: To determine the influence of smoking on changes in vocal production and lung vital capacity compared with nonsmokers. Methods: This cross-sectional study compared smokers and nonsmokers (24 subjects each). Each participant underwent a vocal and spirometric evaluation to measure vital lung capacity. Results: The results showed a worsening in lung vital capacity and other parameters of voice in smokers compared with nonsmokers. Furthermore, the decreased pulmonary vital capacity affected the evaluated voice parameters, and decreased carrying capacity was closely related to smoking. The time and amount of consumption had a direct relationship with the vocal and maximum phonation time. Conclusions: This study showed that smoking causes voice disorders due to lung weakness. Thus, voice changes are affected both directly by interference of smoking on vocal structures and indirectly by increased weakness, which impairs lung vocal production...

Association between Lung Function and Vocal Affections Arising from Tobacco Consumption.

Introduction Smoking is a major risk factor for numerous diseases; it is necessary to analyze the impact that the habit can have on vocal health. Objectives To determine the influence of smoking on changes in vocal production and lung vital capacity compared with nonsmokers. Methods This cross-sectional study compared smokers and nonsmokers (24 subjects each). Each participant underwent a vocal and spirometric evaluation to measure vital lung capacity. Results The results showed a worsening in lung vital capacity and other parameters of voice in smokers compared with nonsmokers. Furthermore, the decreased pulmonary vital capacity affected the evaluated voice parameters, and decreased carrying capacity was closely related to smoking. The time and amount of consumption had a direct relationship with the vocal and maximum phonation time. Conclusions This study showed that smoking causes voice disorders due to lung weakness. Thus, voice changes are affected both directly by interference of smoking on vocal structures and indirectly by increased weakness, which impairs lung vocal production.

Masticatory changes as a result of oral disorders in smokers.

Introduction For chewing to occur properly, it is necessary that all oral structures are present and of normal standard. Objectives The aim of this study is to verify the presence of oral changes in smokers and the impact of the changes on masticatory function compared with individuals who never smoked. Methods Forty-eight subjects were evaluated, split into two study groups (24 subjects each) of current tobacco users and individuals who have never smoked. The variables halitosis, presence of lesions suggestive of caries and periodontal problems, number of teeth, classification of malocclusions according to angle, standard grinding food, chewing pattern, and speed of chewing were evaluated. Results There was no statistically significant difference in tooth loss between the groups, but the smokers had more losses manifesting malocclusion. Most smokers had halitosis and lesions suggestive of caries and periodontal problems; the halitosis was associated with the latter variable. Masticatory speed was also reduced significantly in these individuals compared with the control group when associated with occlusal alterations, in addition to grinding food with the tongue. No difference was observed regarding the chewing pattern. The presence of halitosis and periodontal problems were more common in those who smoke more than 20 years. Conclusion There is an association between smoking and dental changes, which cause increased masticatory changes.

Masticatory Changes as a Result of Oral Disorders in Smokers

Introduction: For chewing to occur properly, it is necessary that all oral structures are present and of normal standard. Objectives: The aim of this study is to verify the presence of oral changes in smokers and the impact of the changes on masticatory function compared with individuals who never smoked. Methods: Forty-eight subjects were evaluated, split into two study groups (24 subjects each) of current tobacco users and individuals who have never smoked. The variables halitosis, presence of lesions suggestive of caries and periodontal problems, number of teeth, classification of malocclusions according to angle, standard grinding food, chewing pattern, and speed of chewing were evaluated. Results: There was no statistically significant difference in tooth loss between the groups, but the smokers had more losses manifesting malocclusion. Most smokers had halitosis and lesions suggestive of caries and periodontal problems; the halitosis was associated with the latter variable. Masticatory speed was also reduced significantly in these individuals compared with the control group when associated with occlusal alterations, in addition to grinding food with the tongue. No difference was observed regarding the chewing pattern. The presence of halitosis and periodontal problems were more common in those who smoke more than 20 years. Conclusion: There is an association between smoking and dental changes, which cause increased masticatory changes...