Tongue function and swallowing in individuals with temporomandibular disorders

Abstract The tongue participates in the oral phase of swallowing by pushing the food bolus toward the oropharynx. This relationship between tongue function and swallowing is little addressed addressed in individuals with temporomandibular dysfunction (TMD). Objective: To analyze the association of functional tongue conditions on swallowing in individuals with TMD. Methodology: After approval by the Institutional Review Board, the study was conducted on 30 individuals of both sexes, aged 18 to 28 years, with TMD, and not treated for the disorder. Tongue function was assessed as to the mobility, pressure, and oral motor control. Swallowing was analyzed by clinical assessment during ingestion of solid (wafer biscuit) and liquid (water). Data regarding mobility and swallowing were collected using the orofacial myofunctional evaluation protocol. Tongue pressure was measured by the Iowa Oral Performance Instrument, during elevation, protrusion, swallowing, and resistance test. The oral motor control was assessed by the oral diadochokinesis (DDK) test by rapid and repeated emissions of syllables "ta" and "ka". Data were statistically analyzed by the Spearman correlation coefficient, at a significance level of 5%. Results: Relationships were found between tongue function and swallowing for the following aspects: mobility (r=0.741), pressure in protrusion (r=-0.366), swallowing of saliva (r=-0.499), mean DDK rate in emissions "ta" (r=-0.424) and "ka" (r=-0.446), and mean DDK period in emissions "ta" (r=0.424) and "ka" (r=0.446). Thus, the greater the change in tongue mobility, the lower the tongue pressure in protrusion and swallowing of saliva, the lower the emissions per second, the longer the mean time between vocalizations, and the worse the swallowing of individuals with TMD. Conclusion: The functional conditions of the tongue regarding mobility, pressure, and oral DDK were associated with swallowing in individuals with TMD.

Effects of orofacial myofunctional therapy on masticatory function in individuals submitted to orthognathic surgery: a randomized trial

Abstract Objectives: The esthetic and functional results of orthognathic surgery of severe dentofacial deformities are predictable, however there are differences regarding the effects on stomatognathic system. The aim was to investigate the effects of orofacial myofunctional therapy (OMT) on the masticatory function in individuals with dentofacial deformity submitted to orthognathic surgery (OGS). Material and Methods: Forty-eight individuals (18-40 years) were evaluated, 14 undergoing OMT (treated group-TG), 10 without this treatment (untreated group-UTG) and 24 in a control group with normal occlusion; for clinical aspects the data of an individual was missed (n=46). Chewing was performed using the Expanded protocol of orofacial myofunctional evaluation with scores (OMES-E). Muscle tone and mobility were also analyzed before (P0), three (P1) and six months (P2) after OGS. Surface electromyography of the masseter and temporalis muscles was performed, considering the parameters amplitude and duration of act and cycle, and the number of masticatory cycles. The OMT consisted of ten therapeutic sessions along the postoperative period. The results were compared using parametric and non-parametric tests. Results: TG showed higher scores in P1 and P2 than P0; for the masticatory type the scores in P2 were significantly higher than P0. In addition, the proportion of individuals with adequate tone of lower lip and adequate tongue mobility for TG increased significantly from P1 and P2 in relation to P0. The EMG results showed a decrease in act and cycle duration in P2 in relation to P0 and P1 for the TG; furthermore the values were close to controls. An increase in the number of cycles from P0 to P2 was also observed, indicating faster chewing, which may be attributed to an improvement of balanced occlusion associated with OMT. Conclusion: There were positive effects of OMT on the clinical and electromyography aspects of chewing in individual submitted to orthognathic surgery.

Programa de terapia miofuncional orofacial para indivíduos submetidos à cirurgia ortognática / Orofacial myofunctional therapy program for individuals undergoing orthognathic surgery

RESUMO Objetivo: apresentar um Programa de Terapia Miofuncional Orofacial para indivíduos submetidos à cirurgia ortognática. Métodos: foram realizadas 3 etapas distintas: a primeira envolveu a elaboração do programa inicial a partir da revisão da literatura sobre o processo terapêutico após a cirurgia; a segunda a aplicação do programa inicial por duas fonoaudiólogas especialistas em motricidade orofacial em 21 indivíduos, após ortognática, que sugeriram modificações no protocolo inicial, resultando numa segunda versão; na terceira e última etapa, o mesmo foi analisado quanto ao conteúdo por três fonoaudiólogas especialistas em Motricidade Orofacial e novas modificações foram realizadas. Resultado: o programa foi elaborado com base em 38 trabalhos científicos, cuja aplicação pelas fonoaudiólogas resultou em modificações considerando a tipologia facial e as condições dento-oclusais, armazenamento do soro fisiológico; detalhamento dos objetivos das atividades propostas e alongamento do lábio superior. Após as sugestões das especialistas a versão final foi constituída de 12 sessões, sendo a primeira avaliação, 10 sessões de terapia uma vez por semana, envolvendo exercícios miofuncionais, estimulação sensorial e treino funcional, sendo a última sessão de reavaliação. Conclusão: foi possível desenvolver um Programa de Terapia Miofuncional Orofacial para indivíduos submetidos à cirurgia ortognática, sendo necessário que o mesmo seja validado.

ABSTRACT Purpose: to present an Orofacial Myofunctional Therapy Program for individuals submitted to orthognathic surgery. Methods: 3 different steps were performed: the first involved preparation of the initial program, by reviewing the literature on the therapeutic process after surgery; the second comprised the application of the initial program by two speech therapists qualified in orofacial motricity, to 21 individuals, after orthognathic surgery, who suggested changes in the initial protocol, resulting in a second version; on the third and last stage, the content of the Therapy Program was analyzed regarding the content, by three speech therapists specialists in Orofacial Motricity and further changes were made. Results: the Therapy Program was developed based on 38 scientific papers, whose application by the speech therapists resulted in changes, taking into account the facial typology and dento-occlusal conditions, storage of saline, detailing of the goals of proposed activities and elongation of the upper lip. After the experts’ suggestions, the final version consisted of 12 sessions, the first being assessment, 10 sessions of therapy once a week, involving myofunctional exercises, sensorial stimulation and functional training, and the last session for re-assessment. Conclusion: it was possible to develop a Myofunctional Orofacial Therapy Program aimed at individuals submitted to orthognathic surgery, to be validated in future studies.

Avaliação estética da face em indivíduos com deformidades dentofaciais / Aesthetic face evaluation in individuals with Dentofacial Deformities

RESUMO Objetivo: analisar as características estéticas da face em indivíduos com deformidades dentofaciais (DDF) e os possíveis aspectos que se relacionam com aspectos da pele quanto às rugas e sulcos. Métodos: avaliou-se 36 adultos jovens (média de 27,22 anos), em três grupos, DDF padrão II, III e grupo controle (GC). Realizou-se análise facial utilizando o Protocolo de Avaliação Miofuncional Orofacial MBGR. Elaborou-se um protocolo de avaliação estético facial a partir das análises validadas para a classificação de rugas, linhas de marionete e sulcos na região orbicular dos olhos. Aplicaram-se testes estatísticos pertinentes. Resultados: indivíduos com DDF e 50% do GC apresentaram alteração quanto à assimetria facial e ângulo nasolabial, com diferença estatisticamente significante entre DDF-II, DDF-III e GC. Indivíduos com DDF mostraram maior frequência de alteração para os sulcos verticais na região dos lábios e linhas de marionete, sem diferenças entre os grupos. Houve correlação positiva entre sulco na região do prócero e os sulcos verticais nos lábios, sulco na região do orbicular dos olhos com o sulco nasogeniano e com as linhas de marionete. O ângulo nasolabial correlacionou-se com sulco na região da testa. A idade correlacionou-se com sulco nasogeniano, sulco na região do prócero, linhas de marionete e sulcos na região do orbicular dos lábios. Conclusão: indivíduos com DDF apresentaram alteração de simetria facial, ângulo nasolabial e da pele quanto às rugas. Aspectos estéticos da face correlacionaram-se entre si, bem como ângulo nasolabial com sulcos na testa. A idade também demonstrou relação com a estética facial.

ABSTRACT Purpose: to analyze the face aesthetic features of individuals with dentofacial deformities (DDF) and the possible aspects related to skin features such as wrinkles and grooves. Methods: we evaluated 36 young adults (average 27.22 years), in three groups, DDF standard II, III and control group (CG). Facial analysis was performed using the Orofacial Myofunctional Evaluation - MBGR Protocol. We developed a facial aesthetic evaluation protocol from validated analyzes for wrinkle classification, marionette lines and grooves in the orbicularis eye area. The relevant statistical tests were performed. Results: individuals with DDF and 50% of the control group showed changes regarding facial asymmetry and nasolabial angle, with a statistically significant difference between DDF-II, III and DDF-GC. Individuals with DDF presented a greater frequency of changes to the vertical grooves in the lips area as well as marionette lines, with no differences between groups. There was a positive correlation between procerus grooves and vertical lip grooves, grooves in the orbicularis eye region with nasolabial folds and marionette lines. The nasolabial angle was correlated with forehead grooves. Age correlated with nasolabial folds, grooves in the procerus area, marionette lines and lip grooves in the orbicular area. Conclusion: individuals with DDF presented alterations in their facial symmetry, nasolabial angle and skin regarding wrinkles. Facial aesthetic aspects correlated with each other as well as the nasolabial angle with forehead grooves. Age also showed a correlation with facial aesthetics.

Orofacial functions and quality of life in oral health in subjects with dentofacial deformity / Funções orofaciais e qualidade de vida em saúde oral em indivíduos com deformidade dentofacial

PURPOSE: To investigate the influence of the facial pattern in orofacial functions (OFFs) and quality of life (QoL), and their relationship in individuals with dentofacial deformities (DFD). METHODS: As approved by the Research Ethics Committee, 36 subjects, aged between 18 and 40 years, divided into three groups of seven female and five male participants, i.e., facial pattern I (n=12), pattern II (n=12) and pattern III (n=12), participated in this study. The OFFs were assessed using the MBGR protocol and QoL by the Oral Health Impact Profile (OHIP-14) questionnaire. Comparisons between OFFs and facial patterns were made using the Kruskal-Wallis test, and the correlation between the facial pattern and QoL by means of Spearman's test, considering a 5% significance level. RESULTS: A significant difference (p<0.05) was observed when comparing patterns I and II, and patterns I and III, with no difference between patterns II and III, neither in the OHIP-14 nor in the MBGR. A significant linear correlation (r=0.666; p<0.05) was verified between the MBGR and the OHIP-14, showing that the worse the OFFs, the worse the QoL. CONCLUSION: The facial pattern influenced the performance of the OFFs and the QoL in individuals presenting DFD, with a greater occurrence of changes for patterns II and III, and the worse the OFFs, the worse the QoL in cases with DFD. .

OBJETIVO: Verificar a influência do Padrão Facial nas funções orofaciais (FOF) e na qualidade de vida (QV), e a relação entre elas em indivíduos com deformidades dentofaciais (DDF). MÉTODOS: Aprovado pelo Comitê de Ética em Pesquisa. Participaram 36 indivíduos entre 18 e 40 anos de idade, distribuídos em 3 grupos: Padrão I (n=12), Padrão II (n=12) e Padrão III (n=12), sendo 7 mulheres e 5 homens. As FOF foram avaliadas pelo protocolo MBGR e a QV foi aplicado o questionário Oral Health Impact Profile (OHIP-14). Para as comparações entre as FOF e os Padrões Faciais, foi aplicado o teste de Kruskal-Wallis, e para a correlação entre Padrão Facial e QV, o coeficiente de correlação de Spearman, considerando nível de significância de 5%. RESULTADOS: Houve diferença significativa (p<0,05) ao comparar os Padrões Faciais I e II, e os Padrões I e III, não tendo sido encontrada diferença entre os Padrões II e III, tanto para o OHIP-14 como para o MBGR. Verificou-se correlação linear significativa (r=0,666; p<0,05) entre o MBGR e o OHIP-14, demonstrando que quanto piores as FOF, pior também a QV. CONCLUSÃO: O Padrão Facial influenciou o desempenho das FOF e a QV em indivíduos com DDF, com maior ocorrência de alterações para os Padrões Faciais II e III. .

Influência do tratamento ortodôntico-cirúrgico nos sinais e sintomas de disfunção temporomandibular em indivíduos com deformidades dentofaciais / Influence of orthodontic-surgical treatment on signs and symptoms of temporomandibular dysfunction in subjects with dentofacial deformities

OBJETIVO: Verificar se o tratamento ortodôntico-cirúrgico acarreta modificações nos sinais e sintomas de disfunção temporomandibular em indivíduos com deformidades dentofaciais. MÉTODOS: Participaram do estudo 20 pacientes de ambos os gêneros (idades entre 15 e 44 anos), com diferentes características dento-oclusais e faciais, submetidos a osteotomias mandibulares e/ou maxilares. Todos os pacientes apresentavam pelo menos um sinal ou sintoma de disfunção temporomandibular, verificado por meio de entrevista e de avaliação clínica realizada pré e após 30 a 60 dias da cirurgia ortognática. Nesta última buscou-se dor à palpação dos músculos mastigatórios, cervicais e da articulação temporomandibular; foi realizada ausculta das articulações temporomandibulares e mediu-se movimentos mandibulares. RESULTADOS: Quanto aos sintomas investigados na entrevista, os resultados demonstraram que após a cirurgia ortognática houve redução de todos os sintomas. No que diz respeito aos movimentos mandibulares, observou-se significante diminuição da abertura da boca no pós-operatório e pouca variação nas medidas de lateralidade mandibular. Em relação à presença de dor à palpação, notou-se diminuição da dor para os músculos cervicais. CONCLUSÃO: O tratamento ortodôntico-cirúrgico acarretou, em curto prazo, diminuição dos sintomas investigados e dos sinais clínicos de dor à palpação na musculatura cervical e redução da abertura da boca em pacientes com deformidades dentofaciais. Registro de ensaio clínico: 083578.

PURPOSE: To verifying whether orthodontic-surgical treatment results in modification on the signs and symptoms of temporomandibular dysfunction in individuals with dentofacial deformities. METHODS: Twenty patients of both genders (ages between 15 and 44 years) with different dental-occlusion and facial characteristics, submitted to mandibular and/or maxillary osteotomy, participated in this study. All patients presented at least one sign or symptom of temporomandibular dysfunction, verified through interview and clinical evaluation carried out before and after 30 to 60 days of the orthognathic surgery. The final evaluation investigated the presence of pain on palpation of masticatory and cervical muscles, and temporomandibular joint pain; auscultation of the temporomandibular joints was performed, and jaw movements were measured. RESULTS: All symptoms investigated in the interview decreased after the orthognathic surgery. Regarding mandibular movements, there was a significant decrease in postoperative mandibular opening, and little variation was observed in measures of lateral excursions. It was also noticed a decrease of pain in cervical muscles. CONCLUSION: The orthodontic-surgical treatment resulted in short term decrease of the investigated symptoms and clinical signs of pain in cervical muscles, and reduction of mandibular opening in patients with dentofacial deformities.Clinical trials register: 083578.