International SYMPOSIUM on OROFACIAL MYOFUNCTIONAL Therapy roma 6,7,8 giugno 2014

1. INTERDISCIPLINARY DETECTION OF
OROFACIAL DISFUNCTIONS
IN CHILDREN AND ADOLESCENTS
Grandi,
Diana
(MS,
SLP);
Bo3ni,
Elsa
(Orthodon:st)
&
Lapitz,
Lyda
(SLP)
-­‐
Barcelona,
SPAIN.
Introduction
The Interdisciplinary Orofacial Examination Protocol for Children and
Adolescents, authored by a group of professionals consisting of ENTs,
Orthodontists, and SLPs (Bottini E., Carrasco A., Coromina J., Donato G., Echarri P.,
Grandi D., Lapytz L. & Vila E. , Barcelona, 2008) is an efficient and easy to use
resource that facilitates the interdisciplinary detection of alterations in the
Stomatognatic System.
Normal. Class I Convex. Class II Concave. Class III
Yes No
INTERDISCIPLINARY OROFACIAL EXAMINATION PROTOCOL FOR CHILDREN AND ADOLESCENTS
(For ENT, Pediatricians, Dentists and Speech Therapists)
Concept:
Extra and intra-oral interdisciplinary orofacial exploration, which includes the examination to detect possible morphological
alterations and/or dysfunctions.
1.Speed (5-8 minutes)
2.Simplicity
This suggestion is an approximation to the exploration protocol which entails 2 characteristics:
Parents Anamnesis:
1- Does your child usually snore while sleeping?
2- Have you noticed that your child has difficulties in breathing
or he/she breathes with lots of effort?
3- Have you noticed in your child while sleeping:
Break or pause in breathing?
Restless or agitated sleep?
Abnormal head postures (hyperextension, etc)?
Excessive sweating?
4- Does he/she wet the bed with saliva?
5- Does he get easily tired after running or doing exercises?
6- Does your child keep his/her mouth open while watching TV or using the computer?
7- Does he/she drool during the day?
8- Does he frequently catch a cold?
9- Is he/she allergic?
10- Habits: pacifier/ thumb sucking / nail-biting/ cheilophagia / other
11- Does he/she frequently get voiceless?
12- Does he/she have pronunciation problems?
Don’t know
Breathing:
Nasal Buccal Mixed
Profile:
Patient personal data:
Name:...................................................................................Age:...................Date:......................................................
Sex:..............Weight:..............Height:................Record:.................................................................................................
By:..................................................................................................................Specialty:................................................
Nostrils configuration (with forced breathing)
Level 0 Level 1 Level 2 Level 3A Level 3B Level 4 Level 5
Both dilate Doesn’t collapse
nor dilate
Unilateral partial
closure
Bilateral partial
closure
Unilateral total
closure
Total closure and
partial closure
Bilateral total
closure
1
2
3
4
Authors: Elsa Bottini, Alberto Carrasco, Jordi Coromina, Graciela Donato, Pablo Echarri, Diana Grandi, Lyda Lapitz & Emma Vila.
Malocclusion (Angle)
Class I (Normal) Class II/1 Class II/2 Class III
Lips
Lip contact in rest
Tonsils
Level 0 Level 1 Level 2 Level 3 Level 4 Level 5
Inferior lingual frenum (Ask patient to lift his/her tongue with the completely open mouth, and to try to touch his/her palate)
Previous
tonsillectomy
Very small
tonsils (< 25%)
No visible tonsils Tonsils occupy 1/3
of pharyngeal space
(25% - 50%)
Tonsils occupy 2/3
of pharyngeal space
(50% - 75%)
Tonsils occupy 3/3
of pharyngeal space
(>75%)
6
7
8
Dry or chapped lipsNo lip contact in rest
Bite Occlusion
Anterior deep bite
Alignment
Normal Spacing Crowding
Swallowing
Tongue thrust or lip thrust while swallowing
Posture alterations
Normal position Lordosis Cyphosis
Lumbar curvature
increased
Curved back, reduced
lumbar curvature
shoulders dropped,
flat thorax and
prominent abdomen
9
10
11
12
Recommended assessment by:
ENT Orthodontist Speech therapist Odontopediatrician
14
Open bite Crossbite (uni./bilat.)Normal bite
Normal Makes faces while swallowing
Level 0 Level 1 Level 2 Level 3 Level 4 Level 5
Frenectomy Tongue tip
touches the palate
Almost touches
the palate
The distance between
the upper and lower
incisors is the same
Reaches
lower incisors
Doesn’t reach
lower incisors
5
13 Adenoids:
Phonetical test
(morning)
Positive (different)
Negative (same)
Endoscopy (only ENT)
No obstruction
Partial obstruction
Profile X-ray (only orthodontists) Severe obstruction
In this poster, we explain the results of a descriptive study involving a Sample Group (SG)
population of 185 subjects and a Control Group (CG) of 187 children, all between the ages
of 4 and 16 years, which was conducted in Catalonia (Spain) and which used this protocol.
Objectives
• Contribute to the area of OM with efficient resources for the early detection of possible
alterations and dysfunctions.
• Diffuse the use of the Interdisciplinary Orofacial Examination Protocol for Children and
Adolescents amongst the various professionals who work with the Stomatognatic System
• Unify evaluation criteria of the anomalies between the different disciplines to favour inter-
professional understanding and the use of a common terminology
• Relate alterations in respiration and swallowing, dental malocclusion, and posture in
accordance with different age groups and compare the presence of said alterations
between SG and CG, and analyse the results.
Methodology
The Sample Group consisted of young patients between 4 and 16 years who solicited aid
from an ENT, an orthodontist, or an SLP.
The Control Group consisted of ordinary primary school students the same ages as the
Sample Group who had not sought help from any of the afore mentioned professionals.
The protocol was used with the SG and the CG. The data was grouped into 3 age subgroups:
4 to 7 years, 8 to 11 years, and 12 to 16 years.
Normal. Class I Convex. Class II Concave. Class III
Yes No
INTERDISCIPLINARY OROFACIAL EXAMINATION PROTOCOL FOR CHILDREN AND ADOLESCENTS
(For ENT, Pediatricians, Dentists and Speech Therapists)
Concept:
Extra and intra-oral interdisciplinary orofacial exploration, which includes the examination to detect possible morphological
alterations and/or dysfunctions.
1.Speed (5-8 minutes)
2.Simplicity
This suggestion is an approximation to the exploration protocol which entails 2 characteristics:
Parents Anamnesis:
1- Does your child usually snore while sleeping?
2- Have you noticed that your child has difficulties in breathing
or he/she breathes with lots of effort?
3- Have you noticed in your child while sleeping:
Break or pause in breathing?
Restless or agitated sleep?
Abnormal head postures (hyperextension, etc)?
Excessive sweating?
4- Does he/she wet the bed with saliva?
5- Does he get easily tired after running or doing exercises?
6- Does your child keep his/her mouth open while watching TV or using the computer?
7- Does he/she drool during the day?
8- Does he frequently catch a cold?
9- Is he/she allergic?
10- Habits: pacifier/ thumb sucking / nail-biting/ cheilophagia / other
11- Does he/she frequently get voiceless?
12- Does he/she have pronunciation problems?
Don’t know
Breathing:
Nasal Buccal Mixed
Profile:
Patient personal data:
Name:...................................................................................Age:...................Date:......................................................
Sex:..............Weight:..............Height:................Record:.................................................................................................
By:..................................................................................................................Specialty:................................................
Nostrils configuration (with forced breathing)
Level 0 Level 1 Level 2 Level 3A Level 3B Level 4 Level 5
Both dilate Doesn’t collapse
nor dilate
Unilateral partial
closure
Bilateral partial
closure
Unilateral total
closure
Total closure and
partial closure
Bilateral total
closure
1
2
3
4
Authors: Elsa Bottini, Alberto Carrasco, Jordi Coromina, Graciela Donato, Pablo Echarri, Diana Grandi, Lyda Lapitz & Emma Vila.
Malocclusion (Angle)
Class I (Normal) Class II/1 Class II/2 Class III
Lips
Lip contact in rest
Tonsils
Level 0 Level 1 Level 2 Level 3 Level 4 Level 5
Inferior lingual frenum (Ask patient to lift his/her tongue with the completely open mouth, and to try to touch his/her palate)
Previous
tonsillectomy
Very small
tonsils (< 25%)
No visible tonsils Tonsils occupy 1/3
of pharyngeal space
(25% - 50%)
Tonsils occupy 2/3
of pharyngeal space
(50% - 75%)
Tonsils occupy 3/3
of pharyngeal space
(>75%)
6
7
8
Dry or chapped lipsNo lip contact in rest
Bite Occlusion
Anterior deep bite
Alignment
Normal Spacing Crowding
Swallowing
Tongue thrust or lip thrust while swallowing
Posture alterations
Normal position Lordosis Cyphosis
Lumbar curvature
increased
Curved back, reduced
lumbar curvature
shoulders dropped,
flat thorax and
prominent abdomen
9
10
11
12
Recommended assessment by:
ENT Orthodontist Speech therapist Odontopediatrician
14
Open bite Crossbite (uni./bilat.)Normal bite
Normal Makes faces while swallowing
Level 0 Level 1 Level 2 Level 3 Level 4 Level 5
Frenectomy Tongue tip
touches the palate
Almost touches
the palate
The distance between
the upper and lower
incisors is the same
Reaches
lower incisors
Doesn’t reach
lower incisors
5
13 Adenoids:
Phonetical test
(morning)
Positive (different)
Negative (same)
Endoscopy (only ENT)
No obstruction
Partial obstruction
Profile X-ray (only orthodontists) Severe obstruction
Malocclusion (Angle)
Class I (Normal) Class II/1 Class II/2 Class III
Lips
Lip contact in rest
Tonsils
Level 0 Level 1 Level 2 Level 3 Level 4 Level 5
Inferior lingual frenum (Ask patient to lift his/her tongue with the completely open mouth, and to try to touch his/her palate)
Previous
tonsillectomy
Very small
tonsils (< 25%)
No visible tonsils Tonsils occupy 1/3
of pharyngeal space
(25% - 50%)
Tonsils occupy 2/3
of pharyngeal space
(50% - 75%)
Tonsils occupy 3/3
of pharyngeal space
(>75%)
6
7
8
Dry or chapped lipsNo lip contact in rest
Bite Occlusion
Anterior deep bite
Alignment
Normal Spacing Crowding
Swallowing
Tongue thrust or lip thrust while swallowing
Posture alterations
Normal position Lordosis Cyphosis
Lumbar curvature
increased
Curved back, reduced
lumbar curvature
shoulders dropped,
flat thorax and
prominent abdomen
9
10
11
12
Recommended assessment by:
ENT Orthodontist Speech therapist Odontopediatrician
14
Open bite Crossbite (uni./bilat.)Normal bite
Normal Makes faces while swallowing
Level 0 Level 1 Level 2 Level 3 Level 4 Level 5
Frenectomy Tongue tip
touches the palate
Almost touches
the palate
The distance between
the upper and lower
incisors is the same
Reaches
lower incisors
Doesn’t reach
lower incisors
5
13 Adenoids:
Phonetical test
(morning)
Positive (different)
Negative (same)
Endoscopy (only ENT)
No obstruction
Partial obstruction
Profile X-ray (only orthodontists) Severe obstruction
RESULTS for AGE RANGE: 4 to 7 years
SAMPLE:
83
subjects
WITH
ALTERATIONS
WITHOUT
ALTERATIONS
BREATHING
68 : 81,92% 15 : 18,07%
MALOCLUSSION
70 : 84,33% 13 : 15,66%
SWALLOWING
53 : 63,85% 30 : 36,14%
POSTURE
18 : 21,68% 65 : 78,31%
CONTROL:
58
subjects
WITH
ALTERATIONS
WITHOUT
ALTERATIONS
BREATHING
21: 36,20% 37 : 63,79%
MALOCLUSSION
46 : 79,31% 12 : 20,68%
SWALLOWING
22 : 37,93% 36 : 62,06%
POSTURE
9 : 15,51% 49 : 84,48%
We statistically analysed data relating to: Breathing, Swallowing, Malocclusion, and posture.
• In this age range, Malocclusion is the most significant (84% in the SG and 79% in the
CG) with remarkable values.
• In the SG, Breathing presented significant alteration (82%). Dysfunctional Swallowing is
observed in a considerable percentage of children of this age (64%), but it must be kept in
mind that in terms of evolution the swallowing function may have not yet matured.
• However, in the CG, Breathing and Swallowing present a significantly lower percentage of
alteration.
• The percentage of Altered Posture in this age range is not significant (15 to 22%)
RESULTS for AGE RANGE: 8 to 11 years
SAMPLE:
68
subjects
WITH
ALTERATIONS
WITHOUT
ALTERATIONS
BREATHING
38 : 55,88% 30 : 44,11%
MALOCCLUSSION
56 : 82,35% 12 : 17,64%
SWALLOWING
40 : 58,82% 28 : 41,17%
POSTURE
25 : 36,76% 43 : 63,23%
CONTROL:
95
subjects
WITH
ALTERATIONS
WITHOUT
ALTERATIONS
BREATHING
36 : 37,89% 59 : 62,10%
MALOCCLUSION
80 : 84,21% 15 : 15,78%
SWALLOWING
57 : 60,00% 38 : 40,00%
POSTURE
29 : 30,52% 66 : 69,47%
• Malocclusion continues to be the prevalent alteration with a high percentage in
both the SG (82%) and the CG (84%).
• Altered Swallowing also presents significant presence in both groups (59% in the SG
and 60% in the CG).
• Breathing presents more alteration in the SG (56%) than the CG (38%).
• In this age range, Posture shows alteration in similar percentages that are considerable in
both groups (37% in the SG and 31% in the CG). This situation is not repeated in the
other two age ranges.
RESULTS for AGE RANGE: 12 to 16 years
SAMPLE:
34
subjects
WITH
ALTERATIONS
WITHOUT
ALT.
BREATHING
21 : 61,76 % 13 : 38,23%
MALOCCLUSION
26 : 76,47 % 8 : 23,52%
SWALLOWING
27 : 79,41 % 7 : 20,58%
POSTURE
12 : 35,29 % 22 : 64,70%
CONTROL:
34
subjects
WITH
ALTERATIONS
WITHOUT
ALT.
BREATHING
10 : 29,41 % 24 : 70,58 %
MALOCCLUSION
23 : 67,64 % 11 : 32,35 %
SWALLOWING
15 : 44,11% 19 : 55,88 %
POSTURE
6 : 17,64 % 28 : 82,35 %
• Malocclusion is significantly present in both the SG (76%) and the CG (68%).
• In this age range, dysfunctional SWALLOWING is the most altered function in the SG
(79%). Altered Respiration presents a some what lower percentage (62%), and both
values decrease in the CG.
• Altered Posture presents a not unimportant percentage (35%) in the SG; a value which
decreases by half in the CG.
CONCLUSIONS:
• MALOCCLUSION is present in high percentages in all age groups for both the SG and CG (68-84%).
• BREATHING is altered in more than 50% of the SG (max. 82% in 4-7 years), a figure that clearly declines in the CG
• SWALLOWING shows a higher percentage of alteration in the SG (64- 79%), with the exception of the intermediate age group, in which the alterations show similarity between the SG and CG
(60%).
• POSTURE shows the least percentage of alteration in the three age groups, although it must be said that even if the percentage of alterations is not significant among younger patients (15-22%),
this percentage does increase among the older subjects.
- The usefulness of the Protocol is evident as an interdisciplinary tool in the early detection and referral of not only children and adolescents who consult us with orofacial dysfunctions, but also
others who may have undetected orofacial dysfunctions.
- This way we can direct each patient to the appropriate professionals to conduct the correct diagnosis and necessary treatment at the earliest possible stage.
- Therefore, this protocol represents an essential tool for the individual evaluation if one wishes to give the diagnostic a multidisciplinary focus.
- It would be interesting to conduct further studies in different populations, in the three age ranges evaluated, to collect results regarding the prevalence of orofacial alterations and dysfunctions,
compare the results and establish lines of intervention.
81,92
36,20
84,33
79,31
63,85
37,93
21,68
15,51
0
10
20
30
40
50
60
70
80
90
100
Títulodeleje
MALOCCLUSIONBREATHING SWALLOWING POSTURE
SAMPLE GROUP CONTROL GROUP
55,88
37,89
82,35
84,21
58,82 60,00
36,76
30,52
0
10
20
30
40
50
60
70
80
90
100
BREATHING MALOCCLUSION SWALLOWING POSTURE
SAMPLE GROUP CONTROL GROUP
61,76
29,41
76,47
67,64
79,41
44,11
35,29
17,64
0
10
20
30
40
50
60
70
80
90
100
BREATHING MALOCCLUSION SWALLOWING POSTURE
SAMPLE GROUP CONTROL GROUP
Bibliographic references:
Arne&
GW,
Bergman
Rt.
Facial
Keys
to
orthodon;c
diagnosis
and
treatment
planning-­‐
Part
I.
Am
J
Orthod
Dentofacial
Orthop.
1993;
103:
299-­‐312
-­‐
Part
II.
Am
J
Orthod
Dentofacial
Orthop.
1993;
103:
395-­‐411.
Coromina
J,
Es;vill
E.
Tratamiento
del
niño
roncador
y/o
con
apnea
obstruc;va
del
sueño:
la
reducción
amigdalar
con
láser.
En:
Coromina
J,
Es;vill
E.
El
niño
roncador.
El
niño
con
síndrome
de
apnea
obstruc;va
del
sueño.
Barcelona.
2ª
Ed.
EDIMSA
2006:
41-­‐68.
Donato
G,
Lapitz
L,
Grandi
D.
Protocolo
de
exploración
Interdisciplinar
orofacial
para
niños
y
adolescentes.
Revista
Logopèdia.
Col·∙legi
de
Logopedes
de
Catalunya
(16),
gener
2009.
Durán
J.
Mul;func;on
System
“MFS”.
Las
8
claves
de
la
matriz
funcional.
Ortodoncia
clínica.
2003;
6:
10-­‐13.
Durán
J.
Técnica
MFS:
Diagnós;co
de
la
matriz
funcional:
codificación.
Ortodoncia
clínica.
2003;
6:138-­‐40.
Echarri
P,
Carrasco
A,
Vila
E,
Boini
E.
Protocolo
de
exploración
Interdisciplinar
orofacial
para
niños
y
adolescentes.
Revista
Ortod.
Esp.,
2009;
49
(2);
107-­‐115
Echarri
P,
Pérez
JJ.
Historia
clínica,
examen
clínico
y
estudio
de
modelos.
En
Echarri
P.
Diagnós;co
en
ortodoncia:
estudio
mul;disciplinario.
Barcelona.
Nexus.
2002:
57-­‐102.
Grandi
D,
Donato
G.
Terapia
Miofuncional.
Diagnós;co
y
Tratamiento.
Lebón,
Barcelona,
2006.
Ustrell
J,
Durán
J.
Diagnós;co
en
ortodoncia.
En
Ustrell
J,
Durán
J.
Ortodoncia.
Primera
edición.
Barcelona.
Ed.
Universitat
de
Barcelona.
2001:61-­‐100.
Disclosure:
D. Grandi, E. Bottini and L. Lapitz have no relevant financial or non financial relationships to disclose.
digran@telefonica.net
elsa.boini@gmail.com
lydalapitz@hotmail.com