Thoracic Spine Pain and Factors Associated in High School Students.

BACKGROUND: Thoracic spine pain (TSP) is relatively common in children and adolescents. AIMS: To determine the prevalence of TSP in adolescents and analyze its association with sociodemographic characteristics, use of electronic devices, physical activity, and mental health. DESIGN: Cross-sectional epidemiological study. SETTING: A high school in Bauru City, São Paulo, Brazil. PARTICIPANTS/SUBJECTS: In total, 1,628 students aged 14-18 years. METHODS: Participants were selected by cluster sampling in two stages, and data were collected via face-to-face interviews. Data regarding the following were collected: (1) sociodemographic aspects; (2) use of electronic devices; (3) regular physical activity level; (4) mental health; and (5) TSP. RESULTS: The prevalence of TSP was 51.5% (95% confidence interval, 49.1-53.9) and the variables associated with TSP were female participant sex (prevalence ratio [PR] = 1.96; 1.61-2.38), use of computers for >3 hours per day (PR = 1.29; 1.01-1.66), use of computers >3 times per week (PR = 1.35; 1.03-1.75), use of cell phones in a semi-lying position (PR = 1.37; 1.11-1.69), use of cell phones for >3 hours per day (PR = 1.44; 1.12-1.85), use of tablets in the sitting position (PR = 1.47; 1.07-2.01), and presence of mental health problems (PR = 2.10; 1.63-2.70). Physical activity was a protective factor (PR = 0.84; 0.73-0.96). CONCLUSIONS: There is a high prevalence of TSP in adolescents, with a marked association with female participant sex, use of electronic devices, and presence of mental health problems Physical activity is a protective factor. Understanding the relationship between risk factors and adolescent spinal pain may be important in both the prevention and treatment of spinal pain in this age group.

Upper Airway 3D Changes of Patients With Cleft Lip and Palate After Orthognathic Surgery.

OBJECTIVES: The purpose of this study was to 3-dimensionally assess the airway characteristics of patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) who underwent orthognathic surgery. DESIGN: This was a retrospective study. SETTING: The study took place at a national referral center for cleft lip and palate rehabilitation. PATIENTS AND PARTICIPANTS: The sample comprised cone-beam computed tomography (CBCT) scans obtained before and after orthognathic surgery of 15 individuals (30 CBCT scans), divided into 2 groups: UCLP group (n = 9 patients/18 CBCT scans) and BCLP group (n = 6/12 CBCT scans). All patients had a nonsyndromic UCLP or BCLP and a skeletal class III malocclusion at the preoperative period. INTERVENTIONS: Airway volume, pharyngeal minimal cross-sectional area (mCSA), location of mCSA, sella-nasion-A point (SNA) and sella-nasion-B point (SNB) angles, and condylion-A point and condyloid-gnathion linear measurements were assessed in open-source software (ITK-SNAP and SlicerCMF). MAIN OUTCOME MEASURE: Airway dimensions of patients with UCLP and BCLP increase after orthognathic surgery. RESULTS: After orthognathic surgery, UCLP group showed a significant 20% increase in nasopharynx volume. Although not significant, BCLP group also showed an increase of 18% in the same region. Minimal cross-sectional area remained dimensionally stable after surgery and was all located in the oropharynx region, on both groups. Additionally, a positive correlation was observed between volume and mCSA on both groups. CONCLUSION: Overall, individuals with UCLP and BCLP showed an increase in the upper airway after orthognathic surgery and this might explain the breathing and sleep improvements reported by the patients after the surgery.

Tomographic Pharyngeal Dimensions in Individuals With Unilateral Cleft Lip/Palate and Class III Malocclusion Are Reduced When Compared With Controls.

OBJECTIVE: The objective of this study was to three-dimensionally evaluate the pharyngeal dimensions of individuals with complete nonsyndromic unilateral cleft lip and palate (UCLP) using cone beam computed tomography. DESIGN: This was a cross-sectional prospective study. SETTING: The study took place at the Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil. PATIENTS AND PARTICIPANTS: The control group (CON) consisted of 23 noncleft adults with class III malocclusion, and the cleft group (UCLP) consisted of 22 individuals with UCLP and class III malocclusion. Two subgroups of individuals with class III malocclusion as a result of maxillary retrusion with (UCLP'; n = 19) and without (CON'; n = 8) clefts were also assessed. INTERVENTIONS: Pharyngeal volume, pharyngeal minimal cross-sectional area (CSA), location of CSA, pharyngeal length, sella-nasion-A point angle (SNA), sella-nasion-B point angle (SNB), and A point-nasion-B point angle (ANB), and body mass index were assessed using Dolphin software. MAIN OUTCOME MEASURE: The pharyngeal dimensions of UCLP individuals are smaller when compared with controls. RESULTS: Mean pharyngeal volume (standard deviation) for the UCLP patients (20.8 [3.9] cm3) and the UCLP' patients (20.3 [3.9] cm3) were significantly decreased when compared with the CON (28.2 [10.0] cm3) and CON' patients (29.1 [10.2] cm3), respectively. No differences were found in the pharyngeal minimal CSA, ANB, or pharyngeal length values between groups (CON versus UCLP and CON' versus UCLP'). CSAs were located mostly at the oropharynx, except in the UCLP' patients, which were mainly at the hypopharynx. Mean SNA in the UCLP (76.4° [4.6°]) and UCLP' groups (75.1° [3.1°]) were significantly smaller than those in the CON (82.8° [4.1°]) and CON' groups (78.6° [1.2°]). SNB values were statistically smaller only for the comparison of CON versus UCLP patients. CONCLUSION: The pharynx of individuals with UCLP and class III malocclusion is volumetrically smaller than that of individuals with class III malocclusion and no clefts.

Rapid Maxillary Expansion Increases Internal Nasal Dimensions of Children With Bilateral Cleft Lip and Palate.

OBJECTIVE: The transverse maxillary deficiency frequently observed in patients with cleft lip and palate (CLP) is usually treated by rapid maxillary expansion (RME). Considering that RME causes a significant increase of the internal nasal dimensions in children with unilateral CLP (UCLP), this study aimed to characterize the internal nasal geometry of children with bilateral CLP (BCLP) and transverse maxillary deficiency using acoustic rhinometry. The study also aimed to analyze changes caused by RME. DESIGN: Cross-sectional prospective study. SETTING: Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil. PARTICIPANTS: Fifteen children with repaired BCLP of both genders, aged 8 to 15 years, referred for RME, were prospectively analyzed. INTERVENTIONS: Subjects underwent acoustic rhinometry before the expander installation and after the active phase of expansion. Cross-sectional areas (CSA) and volumes (V) of the nasal valve regions (CSA1 and V1) and turbinates (CSA2, CSA3, and V2), were measured after nasal decongestion. MAIN OUTCOME MEASURES: In the majority of the subjects, an increase of internal nasal dimensions was observed. RESULTS: Percent changes of CSA1, CSA2, CSA3, V1, and V2 were: +25%, +11%, +9%, 20%, and +12%, respectively. Differences were significant for all variables studied, except CSA3 (P < .05). CONCLUSIONS: RME promotes an increase in the internal nasal dimensions of children with BCLP, suggesting that RME is capable of substantially improving nasal patency in this population.

Obstructive Sleep Apnea Following Pharyngeal Flap Surgery for Velopharyngeal Insufficiency: A Prospective Polysomnographic and Aerodynamic Study in Middle-Aged Adults.

OBJECTIVE: To compare the frequency and severity of obstructive sleep apnea (OSA) in middle-aged adults who underwent pharyngeal flap surgery for velopharyngeal insufficiency (VPI) with matched subjects who did not undergo pharyngeal flap surgery and to verify the relationship between OSA severity and internal pharyngeal dimensions. SETTING: National referral care center for cleft lip and palate. METHOD: Prospective study on 42 nonsyndromic subjects with repaired cleft palate with flap (F group, n = 22) and without flap (NF group, n = 20), aged 40 to 58 years. The main outcome measure was the apnea-hypopnea index (AHI), measured by in-lab nocturnal polysomnography (PSG). The OSA-related symptoms were investigated by Pittsburgh, Epworth, and Berlin questionnaires. The nasopharyngeal or velopharyngeal (NP/VP) cross-sectional area was measured by modified anterior rhinomanometry in subgroups of the F (n = 14) and NF (n = 10) groups at rest and during speech. Differences were considered significant at P < .05. RESULTS: Questionnaire scores and frequency of self-reported symptoms of snoring, nasal obstruction, and breathing interruptions during sleep did not differ between groups. OSA was diagnosed by PSG in 60% and 77% of the NF and F subjects, respectively. The difference was not significant. No cases of severe OSA were observed. There was no correlation between AHI and NP/VP area. CONCLUSION: A significant number of middle-aged adults with repaired cleft palate had OSA and related symptoms, regardless of the presence of a pharyngeal flap. Results suggest that VPI treatment with a flap may not cause sleep-disordered breathing in the cleft population. Besides advancing age, congenital upper airway abnormalities may be involved.

Effects of 3D Airway Geometry on the Airflow of Adults with Cleft Lip and Palate and Obstructive Sleep Apnea: A Functional Imaging Study.

Objective Individuals with cleft lip and palate (CLP) are at a high risk of developing obstructive sleep apnea (OSA). Hypothetically, the severity of OSA might be associated with the morphology of the upper airway (UAW) and the characteristics of the airflow. Thus, the present study aimed to assess and compare, in adults with CLP and skeletal class-III discrepancy, with or without OSA, simulations of airflow resistance and pressure according to the geometrical characteristics of the UAW and cephalometric parameters. Materials and Methods According to the results of type-I polysomnography tests, the sample ( n = 21) was allocated in 2 groups: 1) without OSA (N-OSA; n = 6); and 2) with OSA (OSA; n = 15). Cephalometric measurements were performed on the cone-beam computed tomography (CBCT) scans of the groups. After three-dimensional (3D) reconstructions, the volume (V) and minimal cross-sectional area (mCSA) of the UAW were generated. Computational fluid dynamics (CFD) simulations were used to assess key airflow characteristics. The results were presented at a significance level of 5%. Results The UAW pressure values and airway resistance did not differ between the groups, but there was a tendency for more negative pressures (26%) and greater resistance (19%) in the OSA group. Volume and mCSA showed a moderate negative correlation with resistance and pressure. The more inferior the hyoid bone, the more negative the pressures generated on the pharyngeal walls. Conclusion The position of the hyoid bone and the geometry of the UAW (V and mCSA) exerted effects on the airway-airflow resistance and pressure. However, key airflow characteristics did not differ among subjects with CLP, were they affected or not by OSA.

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines.

This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.

Reduced pharyngeal dimensions and obstructive sleep apnea in adults with cleft lip/palate and Class III malocclusion.

Objective: To three-dimensionally evaluate the upper airway of individuals with cleft lip and palate (CLP) and Class III malocclusion and the occurrence of obstructive sleep apnea (OSA).Methods: Twenty-one CLP individuals with Class III malocclusion, 20-29 years of age, who underwent computed tomography for orthognathic surgery planning, were prospectively evaluated. All participants underwent polysomnography, and the apnea-hypopnea index ≥ 5 events/hour was considered indicative of OSA. The total upper airway and its subdivisions volumes, as well as the minimum pharyngeal cross-sectional area (CSA), were assessed using Mimics software.Results: Among the 21 individuals analyzed, 6 (29%) presented with OSA. The total upper airway and the oropharynx mean volumes were significantly decreased in subjects with OSA when compared to individuals without OSA. Mean CSA was not statistically different between groups.Conclusion: CLP individuals with Class III malocclusion and OSA have an upper airway significantly smaller than individuals without OSA.

Avaliação das vias aéreas superiores por meio de tomografia computadorizada de feixe cônico em indivíduos submetidos à cirurgia ortognática: revisão de literatura / Upper airway evaluation by cone beam computerized tomography in individuals who underwent ortognactic surgery: literature review

Introdução: além de amplamente utilizada na área odontológica Recebido em: 06/01/2018 para avaliação de tratamentos ortodônticos e para planejamento de cirurgias, a Tomografia Computadorizada de Feixe Cônico tem ganhado espaço também na literatura médica para avaliação das vias aéreas superiores. Isto porque as imagens tridimensionais da TCFC permitem a avaliação das áreas seccionais e volumes do espaço aéreo faríngeo. Objetivo: demonstrar, por meio de revisão da literatura, os efeitos da cirurgia ortognática sobre as vias aéreas superiores, avaliados por meio de tomografia computadorizada de feixe cônico (TCFC) e sua relação com a AOS. Material e Método: foi realizada uma busca nas bases de dados Lilacs e Pubmed utilizando como palavras-chave: tomografia computadorizada de feixe cônico, apneia do sono e cirurgia ortognática. Foram incluídos artigos nos idiomas português e inglês, sem limitação temporal, que tinham como principal foco avaliar as mudanças na via aérea superior após a cirurgia ortognática por meio de TCFC. Resultados: ao todo foram encontrados 11 artigos, dos quais 5 atenderam os critérios de inclusão e foram, portanto, analisados. Observou-se que: 3 artigos realizaram cirurgia bimaxilar e, neles, os resultados mostraram que não houve alteração da via aérea total após a cirurgia; 1 utilizou a técnica de retroposicionamento mandibular e observou que, após a cirurgia, houve diminuição significativa do volume total da via aérea e do seu segmento hipofaríngeo, bem como redução da área seccional faríngea mínima; 2 realizaram cirurgia de avanço maxilar que levou ao aumento significativo do volume da via aérea superior em ambos; 1 realizou cirurgia de avanço maxilomandibular que levou ao aumento significativo do espaço aéreo posterior. Conclusão: os resultados da presente revisão de literatura mostraram que a cirurgia ortognática levou a alterações da dimensão da via aérea superior na maior parte dos estudos analisados, a depender da técnica utilizada, que não se relacionou com a ocorrência de sintomas respiratórios ou AOS.

Introduction: in addition to being widely used in the dental area, for the evaluation of orthodontic treatments and for the planning of surgeries, Cone-Beam Computed Tomography has also gained space in the medical literature for evaluation of the upper airways. This is because the three-dimensional images of the CBCT allow the evaluation of the sectional areas and volumes of the pharyngeal space. Objective: to demonstrate, through a literature review, the effects of orthognathic surgery on the upper airways, by means of cone-beam computed tomography (CBCT), and its relationship with OSA. Material and Method: a search was carried out at Bireme and Pubmed databases using the following keywords: CBCT, sleep apnea and orthognathic surgery. Articles with the main focus of evaluating changes in the upper airway after an orthognathic surgery by means of CBCT was included in the study. Results: A total of 11 articles were found, of which 5 met the inclusion criteria and were, therefore, analyzed. It was observed that: in 3 studies bimaxillary surgery was performed and the results showed that there was no alteration of the total airway after surgery; 1 used the mandibular setback technique and observed that, after surgery, there was a significant decrease in the total volume of the airway and its hypopharyngeal segment, as well as reduction of the minimal pharyngeal cross-sectional area; in 2 maxillary advancement surgery was performed, which led to a significant increase in upper airway volume; 1 performed maxillomandibular advancement surgery, which led to a significant increase in posterior airway space. Conclusion: the results of the present literature review showed that orthognathic surgery led to alterations in the size of the upper airway in most of the studies analyzed, depending on the technique used. These alterations were not related to the occurrence of respiratory symptoms or OSA.