Valera Fabiana C P, Trawitzki Luciana V V, Anselmo-Lima Wilma T
Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
Int J Pediatr Otorhinolaryngol. 2006 Feb;70(2):221-5. doi: 10.1016/j.ijporl.2005.06.005. Epub 2005 Jul 21.
To evaluate the myofunctional status in children submitted to adenoidectomy or adenotonsillectomy, correlating the pre and post-surgical patterns throughout a 24-month-period. To correlate the myofunctional alterations to the sort of surgery performed (adenoidectomy versus adenotonsillectomy) and to the predominant post-surgical breathing pattern (predominantly nasal versus allergic rhinitis).
Forty children were assessed by the otorhinolaryngologist and speech therapist before and 1-24 months after surgery. In order to evaluate myofunctional status, a pre-structured protocol was designed, which included observations regarding facial posture, tonicity, mastication, deglutition and respiration. A score from 0 (normal pattern) to 12 (highly altered) was set.
There was a partial, but progressive decrease of the score after surgery (p < 0.001). This decrease was markedly observed during the first 6 months following surgical procedure (p < 0.001), after which it was no longer significant. There was no correlation between the myofunctional progress and the sort of surgery performed. The myofunctional improvement was more accentuated in nasal breathers when compared to those with allergic rhinitis.
Improvement of myofunctional status seems to be observed in children after surgery. In this study, the improvement was predominantly accomplished during the first 6 months following surgical procedure. Persistent pattern of mouth breathing due to allergic rhinitis may difficult recovery of the myofunctional status. The most adequate post-surgical moment for the otorhinolaryngologist to refer the patient to speech therapist for myofunctional therapy seems to be crucial, as well as the recognition by the speech therapist of the persistence of the obstructive symptoms, re-referring this patient to the physician.
评估接受腺样体切除术或腺样体扁桃体切除术的儿童的肌功能状态，在24个月的时间里对比手术前后的模式。将肌功能改变与所进行的手术类型（腺样体切除术与腺样体扁桃体切除术）以及主要的术后呼吸模式（主要为鼻呼吸与变应性鼻炎）相关联。
40名儿童在手术前以及术后1至24个月由耳鼻喉科医生和言语治疗师进行评估。为了评估肌功能状态，设计了一个预先制定的方案，其中包括对面部姿势、张力、咀嚼、吞咽和呼吸的观察。设定了从0（正常模式）到12（高度改变）的评分。
术后评分有部分但呈渐进性下降（p < 0.001）。在手术后的前6个月明显观察到这种下降（p < 0.001），之后不再显著。肌功能进展与所进行的手术类型之间没有相关性。与有变应性鼻炎的儿童相比，鼻呼吸儿童的肌功能改善更为明显。
术后儿童似乎出现了肌功能状态的改善。在本研究中，这种改善主要在手术后的前6个月完成。由于变应性鼻炎导致的持续口呼吸模式可能会使肌功能状态难以恢复。耳鼻喉科医生将患者转介给言语治疗师进行肌功能治疗的最合适的术后时机似乎至关重要，言语治疗师识别阻塞性症状的持续存在并将该患者转回给医生也同样重要。
