1
|
de Felício CM, da Silva Dias FV, Folha GA, de Almeida LA, de Souza JF, Anselmo-Lima WT, Trawitzki LVV, Valera FCP. Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy. Int J Pediatr Otorhinolaryngol 2016; 90:5-11. [PMID: 27729152 DOI: 10.1016/j.ijporl.2016.08.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The purposes of this study were (1) to identify possible differences in muscular and orofacial functions between children with obstructive sleep apnea (OSA) and with primary snoring (PS); (2) to examine the standardized difference between normal values of myofunctional scores and those of subjects with OSA or PS; and (3) to identify the features associated with OSA. METHODS Participants were 39 children (mean age 8 ± 1.2 years) of which, 27 had a diagnosis of OSA and 12 had PS. All participants were examined by an otorhinolaryngologist and underwent overnight polysomnography. Orofacial characteristics were determined through a validated protocol of orofacial myofunctional evaluation with scores (OMES), surface electromyography of masticatory muscles, and measurements of maximal lip and tongue strength. Reference values in the OMES were included to quantify the standardized difference (effect size = ES) relative to the groups studied and in the regression analysis. RESULTS The OSA group had lower scores in breathing and deglutition, more unbalanced masticatory muscle activities than PS group (P < 0.05), but both groups had similar reductions in orofacial strength. OSA had a large ES (Cohen's d > 0.8) in all analysed OMES scores, while PS group showed small and medium differences in breathing and mastication scores, respectively. The mobility of the stomatognathic components score was the most important to contribute for group status (57%, P < 0.0001) in the regression analysis. CONCLUSION Children with tonsillar hypertrophy and OSA had relevant impairments in orofacial functions and lesser muscular coordination than children with PS.
Collapse
Affiliation(s)
- Cláudia Maria de Felício
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil.
| | - Franciele Voltarelli da Silva Dias
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil
| | - Gislaine Aparecida Folha
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil
| | - Leila Azevedo de Almeida
- Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil
| | - Jaqueline Freitas de Souza
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil
| | - Wilma Terezinha Anselmo-Lima
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil
| | - Luciana Vitaliano Voi Trawitzki
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil
| | - Fabiana Cardoso Pereira Valera
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil
| |
Collapse
|
4
|
de Almeida LA, Hueb JC, de Moraes Silva MA, Bazan R, Estrozi B, Raffin CN. Cerebral ischemia as initial neurological manifestation of atrial myxoma: case report. Arq Neuropsiquiatr 2007; 64:660-3. [PMID: 17119814 DOI: 10.1590/s0004-282x2006000400027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 04/19/2006] [Indexed: 11/22/2022]
Abstract
Cerebral infarctions of cardiac etiology are observed in around 20% of patients with ischemic stroke. Cerebral ischemia is the first clinical manifestation in 1/3 of cases of atrial myxomas. Although almost half of patients with atrial myxoma show changes at neurological exam, non-hemorrhagic cerebral infarction is seen in computed tomography in practically all cases. We present the case of a 40 year-old woman whose first clinical manifestation of atrial myxoma was an ischemic stroke. We point out to the possibility of silent cerebral infarction in atrial myxoma patients.
Collapse
|