The Effect of Adenoidectomy or Adenotonsillectomy on Occlusal Features in Mouth-breathing Preschoolers

Purpose: The purpose of this study was to evaluate mouth-breathing and nasal-breathing children prior to surgical intervention and 28 months postoperatively, comparing the occlusal features obtained pre- and postoperatively through orthodontic study costs. Methods: The mouth-breathing (MB) group consists of 33 MB children who underwent surgery and presented a nasal-breathing (NB) pattern after surgery The control group comprised 22 NB children. The orthodontic examinations were accomplished prior to surgery (77) and an average of 28 months postoperatively (T2). Results: At T1, the MB and NB children presented no statistically significant difference in any analyzed occlusal features and measurements. At T2, the MB presented larger overjet comparing to NB children (P<.05). MB and NB groups presented statistically similar results (P>.05) concerning intercanine and intermolor distances, second primary molar terminal plane and canine relationship, overbite, crossbite, and open bite. From T1 to T2, the MB and NB groups showed a statistically significant difference in the molar terminal plane. Conclusion: Neither the breathing pattern nor the surgery had any effect on occlusal features in 3- to 6-year-olds. (Pediatr Dent 2012;34:10842) Received May 14, 2010 vertical bar Last Revision April 11, 2010 vertical bar Accepted April 12, 2010

Influence of adenotonsillectomy on hard palate dimensions

Objective: To evaluate hard palate width and height in mouth-breathing children pre- and post-adenotonsillectomy. Methods: We evaluated 44 children in the 3-6 year age bracket, using dental study casts in order to determine palatal height, intercanine width, and intermolar width. The children were divided into two groups: nasal breathing (n = 15) and mouth breathing (n = 29). The children in the latter group underwent adenotonsillectomy. The study casts were obtained prior to adenotonsillectomy, designated time point 1(11), at 13 months after adenotonsillectomy (T2), and at 28 months after adenotonsillectomy (13). Similar periods of observation were obtained for nasal breathing children. Results: At T1, there was a significantly lower intercanine width in mouth breathing children; intermolar width and palate height were similar between groups. After surgery, there was a significant increase in all the analyzed parameters in both groups, probably due to facial growth. Instead, the increase in intercanine width was substantially more prominent in mouth breathing children than in nasal breathing children, and the former difference failed in significance after the procedure. Conclusions: There were no significant differences between the nasal-breathing and mouth-breathing children in terms of intermolar width and palatal height prior to or after tonsillectomy. Although intercanine width was initially narrower in the mouth-breathing children, it showed normalization after the surgical procedure. These results confirm that the restoration of nasal breathing is central to proper occlusal development. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Effect of rapid maxillary expansion on the dimension of the nasal cavity and on facial morphology assessed by acoustic rhinometry and rhinomanometry

OBJECTIVE: To assess the effects of rapid maxillary expansion on facial morphology and on nasal cavity dimensions of mouth breathing children by acoustic rhinometry and computed rhinomanometry. METHODS: Cohort; 29 mouth breathing children with posterior crossbite were evaluated. Orthodontic and otorhinolaryngologic documentation were performed at three different times, i.e., before expansion, immediately after and 90 days following expansion. RESULTS: The expansion was accompanied by an increase of the maxillary and nasal bone transversal width. However, there were no significant differences in relation to mucosal area of the nose. Acoustic rhinometry showed no difference in the minimal cross-sectional area at the level of the valve and inferior turbinate between the periods analyzed, although rhinomanometry showed a statistically significant reduction in nasal resistance right after expansion, but were similar to pre-treatment values 90 days after expansion. CONCLUSION: The maxillary expansion increased the maxilla and nasal bony area, but was inefficient to increase the nasal mucosal area, and may lessen the nasal resistance, although there was no difference in nasal geometry. Significance: Nasal bony expansion is followed by a mucosal compensation.

Reliability of radiographic parameters in adenoid evaluation

The assessment of adenoids by x-ray imaging has been the topic of heated debate, but few studies have looked into the reliability of most existing radiographic parameters. Objective: This study aims to verify the intra-examiner and inter-examiner reproducibility of the adenoid radiographic assessment methods. Materials and Methods: This is a cross-sectional case series study. Forty children of both genders aged between 4 and 14 were enrolled. They were selected based on complaints of nasal obstruction or mouth breathing and suspicion of pharyngeal tonsil hypertrophy. Cavum x-rays and orthodontic teleradiographs were assessed by two examiners in quantitative and categorical terms. Results: All quantitative parameters in both x-ray modes showed excellent intra and inter-examiner reproducibility. Relatively better performance was observed in categorical parameters used in cavum x-ray assessment by C-Kurien, C-Wang, C-Fujioka, and C-Elwany over C-Cohen and C-Ysunza. As for orthodontic teleradiograph grading systems, C-McNamara has been proven to be more reliable than C-Holmberg. Conclusion: Most instruments showed adequate reproducibility levels. However, more research is needed to properly determine the accuracy and viability of each method.

Efetividade da fonoterapia e proposta de intervenção breve em respiradores orais

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.

Ambulatory blood pressure monitoring in children with obstructive sleep apnea and primary snoring

Objective: To evaluate the systemic blood pressure (BP) during daytime and nighttime in children with sleep breathing disorders (SBD) and compare parameters of BP in children with diagnosis of obstructive sleep apnea syndrome (OSA) to those one with primary snoring (PS). Methods: Children, both genders, aged from 8 to 12 years, with symptoms of SBD realized an overnight polysomnography followed by a 24 h recording of ambulatory BP. Results: All subjects presented with a history of snoring 7 nights per week. Children who have apnea/hipoapnea index >= four or a apnea index >= one presented a mean BP of 93 +/- 7 mmHg and 85 +/- 9 mmHg diurnal and nocturnal respectively whereas children who have a apnea/hipoapnea < four or a apnea index < one presented 90 +/- 7 mmHg and 77 +/- 2 mmHg. Eight children out of fourteen, from OSA group, lost the physiologic nocturnal dipping of the blood pressure. Among OSA children 57% were considered non-dippers. Two (16%) have presented absence of nocturnal dipping among children with primary snoring. The possibility of OSA children loosing physiologic blood pressure dipping was 6.66 higher than the possibilities of patients from PS group. Discussion: Our results indicate that children with sleep apnea syndrome exhibit a higher 24 h blood pressure when compared with those of primary snoring in form of decreased degree of nocturnal dipping and increased levels of diastolic and mean blood pressure, according to previous studies in literature. OSA in children seems to be associated to the development of hypertension or other cardiovascular disease. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

What types of unintentional injuries kill our children? Do infants die of the same types of injuries? A systematic review

The objective of this study was to review mortality from external causes (accidental injury) in children and adolescents in systematically selected journals. This was a systematic review of the literature on mortality from accidental injury in children and adolescents. We searched the Pubrvled, Latin-American and Caribbean Health Sciences and Excerpta Medica databases for articles published between July of 2001 and June of 2011. National data from official agencies, retrieved by manual searches, were also reviewed. We reviewed 15 journal articles, the 2011 edition of a National Safety Council publication and 2010 statistical data from the Brazilian National Ministry of Health Mortality Database. Most published data were related to high-income countries. Mortality from accidental injury was highest among children less than 1 year of age. Accidental threats to breathing (non-drowning threats) constituted the leading cause of death among this age group in the published articles. Across the pediatric age group in the surveyed studies, traffic accidents were the leading cause of death, followed by accidental drowning and submersion. Traffic accidents constitute the leading external cause of accidental death among children in the countries understudy. However, infants were vulnerable to external causes, particularly to accidental non-drowning threats to breathing, and this age group had the highest mortality rates for external causes. Actions to reduce such events are suggested. Further studies investigating the occurrence of accidental deaths in low-income countries are needed to improve the understanding of these preventable events.