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      Utilización de la placa palatina de memoria y desarrollo orofacial en infante con Síndrome de Down Translated title: Use of palatal plate and orofacial development in a child with Down's syndrome

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          Abstract

          Los infantes con Síndrome de Down presentan en general, hipotonía de la muscular, cierre labial incompetente, lengua flácida y protruida. La placa palatina de memoria, propuesta por Castillo Morales, induce el cierre bilabial y posicionamiento correcto de la lengua. Este trabajo tuvo por objetivo evaluar el desarrollo orofacial, de una niña con Síndrome de Down, a través de terapia de estimulación precoz y utilización de placa palatina de memoria. Recibió tratamiento con placa palatina de memoria desde los 5 hasta los 15 meses y fue acompañada por un equipo multidisciplinario hasta los 6 años de edad. En el caso presentado, la terapia empleada permitió un desarrollo bucofacial adecuado, armónico y funcional. La utilización precoz de placa palatina de memoria demostró ser un complemento valioso en el programa multidisciplinario de atención a pacientes con Síndrome de Down.

          Translated abstract

          Babies with Down Syndrome (DS) present, in general, muscle hypotonia, insufficient mouth closure and protrusion of the tongue. The palatal plate therapy, submitted by Castillo Morales, induces the lip closure and the correct position of the tongue. The objective of this research was to evaluate the oral development in a girl with DS through early stimulation and use of palatal plate. She was treated with the palatal plate method from 5 to 15 months of age. She was followed-up by a multidisciplinary team until he was six years of age. In this case report, the palatal therapy allowed adequate, harmonic and functional oral development. The early treatment with palatal plate has shown to be a valuable supplement to the multidisciplinary program of care to Down's syndrome patients.

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          Most cited references22

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          Cranial base, maxillary and mandibular morphology in Down syndrome.

          To test the null hypothesis that there is no difference between craniofacial measurements of individuals with Down syndrome (DS) and normal controls. A cephalometric analysis including additional landmarks and measurements to study specific craniofacial features was undertaken on pretreatment cephalograms of 25 patients with DS (12 male, 13 female; mean age 15.1 years) treated at The Hospital for Sick Children, Toronto. Measurements were compared with those from cephalograms of racial groups age and gender matched, normal, Class I children, available from the Burlington Growth Center. Data were analyzed using paired t-tests. Large reductions were measured in the size and spatial relationships of craniofacial structures in the DS group. The greatest differences included a larger cranial base angle; reduced elevation of sella from FHP; reduced anterior and posterior cranial base lengths; reduced anterior and posterior face heights; smaller maxilla with reduced anterior basal and apical dimensions; and smaller mandibular ramus, body and symphyseal dimensions and proclined symphysis. Maxillary incisors were severely proclined and undererupted, while mandibular incisors were undererupted. Alveolar heights were reduced. Anterior open bite was frequently noted. Maxillary and mandibular planes exhibited forward rotation patterns, promoting overclosure. Mandibular hypoplasia was less severe than cranial base and maxillary hypoplasia. Hypodontia of one or more permanent teeth was found in 92% of the sample. The null hypothesis was rejected. Significant hypoplasia in endochondral, mesodermal, and ectomesenchymal derived structures of the cranium and face in subjects with DS was clearly evident. More severe platybasia than previously reported was found.
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            The Castillo-Morales approach to orofacial pathology in Down syndrome.

            Infants with Down syndrome often present with a familiar orofacial disorder which exists at birth or becomes more pronounced by the end of the first year. The primary pathology includes hypotonicity of the perioral muscles, lips, and masticatory muscles and a protruding tongue, later followed by active tongue protrusion. This results in problems with sucking, swallowing, drooling and dentition. Early intervention methods employing the combination of Castillo-Morales Manual Orofacial Therapy and his specially designed palatal plate, can improve orofacial function, facial appearance and prevent secondary conditions like pseudoprognathism, dental diseases, malocclusions, open mouth habit and pseudomacroglossia. This retrospective study examines the outcome of therapy, as prescribed by Castillo-Morales, in 39 children with Down syndrome. Normally, the average age to begin oral therapy is between six to eight months. The children were treated with the Castillo-Morales Manual Orofacial Therapy and his palatal plate for an average of 17.9 months. In this study, clinical evaluations at the beginning and the end of therapy focused only on open mouth posture and tongue protrusion. In addition, the direct stimulating effect of the palatal plate on tongue protrusion was evaluated. Significant positive results were observed in all three areas.
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              Masticatory dysfunction in persons with Down's syndrome. Part 1: aetiology and incidence.

              The functional and anatomical characteristics of Down's syndrome have direct repercussions on oral health. Orofacial dysfunction is on account of poor neuromotor control, muscle weakness, dental anomalies, dysmorphology and intercurrent illness. In particular, feeding and swallowing are impaired. The aim of this first article was to summarize the orofacial difficulties encountered by persons with Down's syndrome at all stages of life and to explain their aetiology. Indicators are proposed for the identification of masticatory problems within this population and reduced masticatory efficiency is discussed in relation to repercussions on oral and general health and on the social integration of persons with Down's syndrome. A second article will describe techniques for preventing, treating and compensating for masticatory dysfunction in this population.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                est
                Revista Cubana de Estomatología
                Rev Cubana Estomatol
                Editorial Ciencias Médicas (Ciudad de La Habana )
                1561-297X
                December 2012
                : 49
                : 4
                : 305-311
                Affiliations
                [1 ] Universidade Federal do Paraná Brazil
                Article
                S0034-75072012000400006
                597a8f85-4f32-4bc5-83fb-7ae2a8fcdd11

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Cuba

                Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=0034-7507&lng=en
                Categories
                DENTISTRY, ORAL SURGERY & MEDICINE

                Dentistry
                Down syndrome,Infant,Child,Oral health,Primary prevention,treatment,síndrome de Down,infante,niño,salud bucal,prevención primaria,tratamiento

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