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      Efetividade da fonoterapia e proposta de intervenção breve em respiradores orais Translated title: Effectiveness of speech and language therapy and brief intervention proposal in mouth breathers

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          Abstract

          OBJETIVOS: verificar o efeito da intervenção fonoaudiológica em um grupo de respiradores orais e propor terapia fonoaudiológica mínima no tratamento da respiração oral. MÉTODO: estudo prospectivo longitudinal, casuística de 40 sujeitos respiradores orais tratados no Hospital das Clínicas - setor de Reabilitação Orofacial do Ambulatório de Respirador Oral da Disciplina de Otorrinolaringologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas - UNICAMP. Realizada documentação fotográfica, avaliação clínica, aplicação de protocolo para categorizar modo respiratório, postura (lábios e bochechas); força e praxias (lábios, bochechas e língua) nas semanas 0, 12 e 24. A proposta terapêutica constou de treino e conscientização da respiração nasal; manobras para aquecimento e vascularização da musculatura orofacial; aplicação de pontos e zonas motoras na face; manobras passivas; uso do impulso distal; exercícios miofuncionais e registro da percepção dos pacientes sobre suas condições olfativas e obstruções nasais.Teste estatístico: não paramétrico de Igualdade de Duas Proporções, p < 0,05. RESULTADOS: houve adequação da função respiração nasal. Aumento da força de lábios, língua e bochechas. Melhora nas praxias: bico direita, bico esquerda, estalo e vibração de lábios. Vibração e estalo de língua. Inflar simultaneamente as bochechas, inflar bochecha direita e esquerda. O tempo com maior ganho terapêutico foi de 12 semanas. A partir deste dado foi esquematizado protocolo com 12 sessões estruturadas abordando estratégias utilizadas nesta pesquisa. CONCLUSÃO: a pesquisa demonstrou que o uso da reabilitação miofuncional para pacientes respiradores orais foi eficiente com maior evolução terapêutica observada na semana 12.

          Translated abstract

          PURPOSE: to check the effect of speech and language therapy on a group of mouth breathers, as well proposing a minimum therapy for mouth breathing treatment. METHOD: longitudinal prospective study, casuistic on 40 mouth breather subjects who were patients from the Otorhinolaryngology Ambulatory of UNICAMP Hospital. On weeks 0, 12 and 24, we proceeded photographical documentation, clinical assessment, and protocol application in order to categorize the breathing mode, posture (lips and cheeks), strength and movement (lips, cheeks and tongue). The applied therapeutic proposal consisted of practicing and awareness on nasal breathing; maneuvers to warm and vascularize the orofacial muscles; application of points and motor zones on the face; passive maneuvers; use of distal impulse; myofunctional exercises and register of patients’ perception on their olfactive conditions and nasal obstructions. A non-parametric two proportion equality test was used, p < 0.05. RESULTS: nasal breathing function was adjusted. Increase on lip, tongue and cheek strength. Improvement on the movement: lips pouted to the right and left, snap and lip vibration. Vibration and snap of tongue. Simultaneous inflation of the cheeks, inflation of left and right cheeks alternately. The highest therapeutic gain occurred on 12 weeks. From such data it was possible to come up a protocol made up of 12 structured sessions using the strategies from this study. CONCLUSION: the study has demonstrated the effectiveness of using myofunctional rehabilitation for mouth breathers, and the highest therapeutic evolution took place during the 12th week.

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          Most cited references 38

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          The effect of mode of breathing on craniofacial growth--revisited.

          It has been maintained that because of large adenoids, nasal breathing is obstructed leading to mouth breathing and an 'adenoid face', characterized by an incompetent lip seal, a narrow upper dental arch, increased anterior face height, a steep mandibular plane angle, and a retrognathic mandible. This development has been explained as occurring by changes in head and tongue position and muscular balance. After adenoidectomy and change in head and tongue position, accelerated mandibular growth and closure of the mandibular plane angle have been reported. Children with obstructive sleep apnoea (OSA) have similar craniofacial characteristics as those with large adenoids and tonsils, and the first treatment of choice of OSA children is removal of adenoids and tonsils. It is probable that some children with an adenoid face would nowadays be diagnosed as having OSA. These children also have abnormal nocturnal growth hormone (GH) secretion and somatic growth impairment, which is normalized following adenotonsillectomy. It is hypothesized that decreased mandibular growth in adenoid face children is due to abnormal secretion of GH and its mediators. After normalization of hormonal status, ramus growth is enhanced by more intensive endochondral bone formation in the condylar cartilage and/or by appositional bone growth in the lower border of the mandible. This would, in part, explain the noted acceleration in the growth of the mandible and alteration in its growth direction, following the change in the mode of breathing after adenotonsillectomy.
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            Tratado de fisiologia aplicada à fonoaudiologia

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              The speech pathology treatment with alterations of the stomatognathic system.

               I Q Marchesan (2000)
              This article analyzes differences in orthodontic and craniofacial classifications and the role of the speech-language pathologist in adequately treating those patients with varying Class II and Class III malocclusions. Other symptoms, such as those of mouth breathing and tongue position, are compared and contrasted in order to identify characteristics and treatment issues pertaining to each area. The author emphasizes a team approach to myofunctional therapy and stresses the importance of collaborative treatment.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcefac
                Revista CEFAC
                Rev. CEFAC
                CEFAC Saúde e Educação (São Paulo )
                1982-0216
                December 2012
                : 14
                : 6
                : 1153-1166
                Affiliations
                [1 ] Universidade Estadual de Campinas Brazil
                [2 ] Universidade Estadual de Campinas Brazil
                [3 ] Universidade Estadual de Campinas Brazil
                [4 ] Universidade de São Paulo Brazil
                Article
                S1516-18462012000600017
                10.1590/s1516-18462012005000054
                d39aba6b-506e-407e-83b0-16d57454c737
                Product
                Product Information: website
                Categories
                REHABILITATION

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