Caracterização da respiração oral: avaliação multidisciplinar

Abstract

In the presence of nasal obstruction, nasal patency may be reduced, and nasal breathing is replaced by mouth breathing (MB). Orofacial, and otorhinolaringologic changes are present in this breathing mode, as well as head posture misalignment, as a compensatory mechanism for the nasal airflow impairment. Some characteristics are typically found, but MB diagnosis is still controversial among multidisciplinary assessments. This study was conduct to identify variables associated with mouth breathing diagnosis in children, based on multidisciplinary domains, including anamnesis, speech therapy, otorhinolaryngologic, occlusal and physiotherapeutic assessments. It also aimed to compare nasal patency and otorhinolaryngologic-orofacial features and craniocervical posture in children. Six-12 year-old children, both sexes underwent muldisciplinary evaluation constituted by: anamnesis; speech therapy evaluation, according to MBGR protocol; clinical and endoscopic otorhinolaryngologic (OTRL) examination; occlusal and physical therapy assessments (nasal patency and body posture). Nasal patency was measured, by means of Peak Nasal Inspiratory Flow absolute (PNIF) values and Nasal Obstruction Symptom Evaluation (NOSE) scale. Craniocervical posture was evaluated with biophotogrametric measures (software SAPO, v.0.68), such as: Cervical Distance (CD); Head Horizontal Alignment (HHA), Flexion-Extension Head Position (FE) and Lumbar Distance (LD). Mann-Whitney, Kruskal-Wallis, Spearman Correlation Coefficient and Multiple Logistic Regression were used for data analysis. One hundred thirty three children took part in the study. Significant lower values of PNIF and %PNIF in children with restless sleep (p=0.006 and p=0.002), nasal obstruction report (p=0.027 and p=0.023) and runny nose (p=0.004 and p=0.012), unsystematic lip closure during mastication (p=0.040 and 0.026), masticatory speed reduced (p=0.006 and p= 0.008) and altered solid food swallowing (p=0.006 and p=0.001) were found. Significant lower PNIF was found in children with pale inferior turbinate (p=0.040). PNIF and %PNIF was significantly higher in children with mild everted lip (p=0.008 and p=0.000). PNIF was significantly higher in children with tongue width increased (p=0.027) and lower in children with hard palate width reduced (p=0.037). PNIF was significantly lower in children with altered speech (p=0.004). FE was significantly higher in children with nasal patency decreased (p=0.023). Negative and weak correlation between FE and %PNIF (r=-0.266; p=0.002) and positive and weak correlation between CD and PNIF (r=0.209; p=0.016) were found. NOSE scores were negatively correlated with PNIF (r= -0.179; p=0.039). It was found association of MB diagnosis in each professional domain with: nasal obstruction report (OR =5.55), time of pacifier sucking (OR=1.25), convex facial type (OR=3.78), obtuse nasal angle (OR=4.30), half-open or open lip posture (OR=4.13), tongue positioned on the mouth floor (OR=5.88), hard palate width reduced (OR=2.99), unexpected contraction of orbicularis and mentalis muscles during mastication (OR= 2.97), obstructive pharyngeal tonsills (OR=8.37), Angle Class II malocclusion (OR= 10.85) and regular gingival maintenance (OR=2.89). Nasal patency was lower in children with restless sleep, rhinitis signs and symptoms, hard palate width reduced and with changes in mastication, deglutition and speech functions. Children with decreased nasal patency presented greater head extension and, this postural deviation is prone to increase as nasal airflow decreases, indicating the relationship between craniocervical posture and nasal patency. Nasal obstruction report, time of pacifier sucking, convex facial type, obtuse nasal angle, half-open or open lip posture, tongue positioned on the mouth floor, hard palate width reduced, unexpected contraction during mastication, obstructive pharyngeal tonsils, Angle Class II malocclusion and regular gingival maintenance were associated with MB diagnosis