de Oliveira Branco Anete Antunes, de Castro Corrêa Camila, de Souza Neves Daniela, Huehara Tais, Theresa Weber Silke Anna
Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department Botucatu Medical School State University São Paulo UNESP Brazil.
Pediatr Investig. 2019 Sep 26;3(3):153-158. doi: 10.1002/ped4.12142. eCollection 2019 Sep.
Hypertrophy of the pharyngeal and palatine tonsils can interfere with breathing, physical and cognitive development, and quality of life, including sleep quality. There are important relationships between the muscles of the airways, the anatomy, and the pattern of breathing and swallowing.
The aims of the present study were to evaluate the swallowing process in children after adenotonsillectomy undertaken to treat obstructive breathing disorders.
Subjects were 85 children or adolescents who underwent adenotonsillectomy in a reference hospital between 2003 and 2007. For the clinical evaluation of swallowing, the protocol of orofacial myofunctional evaluation with scores (OMES) was used, videofluoroscopy of deglutition was performed, and the Dysphagia Outcome and Severity Scale (DOSS) and Classification for Severity of Dysphagia to Videofluoroscopy Scale were applied for analysis.
Out of the 85 evaluated children, 43 were male (50.59%), the average age at evaluation was 12.11 years, the average age at the time of surgery was 6.73 years, and post-surgery time was 3.00-8.00 years. In the clinical evaluation of swallowing, half the sample (50.59%) recorded the poorest score for lip and tongue behavior. A score of 1 was observed in 67.06% of subjects for other behaviors, and in 15.30% of subjects for efficiency of swallowing. Videofluoroscopic analysis demonstrated that the most frequent swallowing alterations were labial sealing (50.59%), residue in vallecula (51.76%), and use of compensatory maneuvers (61.18%). Analysis of DOSS showed that normal swallowing was attributed to 48.31% of subjects at level 7, 44.95% at level 6, and 6.74% at level 5. For the Classification for Severity of Dysphagia to Videofluoroscopy, 75.28% were classified as having mild dysphagia.
Alterations in the dynamics of swallowing are common in children who have undergone surgery of the tonsils, even at late follow-up.
咽扁桃体和腭扁桃体肥大可干扰呼吸、身体和认知发育以及生活质量，包括睡眠质量。气道肌肉、解剖结构以及呼吸和吞咽模式之间存在重要关系。
本研究的目的是评估因阻塞性呼吸障碍接受腺样体扁桃体切除术的儿童的吞咽过程。
研究对象为2003年至2007年间在一家参考医院接受腺样体扁桃体切除术的85名儿童或青少年。对于吞咽的临床评估，采用带评分的口面部肌功能评估方案（OMES），进行吞咽的视频荧光透视检查，并应用吞咽结果与严重程度量表（DOSS）和视频荧光透视吞咽障碍严重程度分类量表进行分析。
在85名接受评估的儿童中，43名是男性（50.59%），评估时的平均年龄为12.11岁，手术时的平均年龄为6.73岁，术后时间为3.00至8.00年。在吞咽的临床评估中，一半的样本（50.59%）在唇部和舌部行为方面得分最差。67.06%的受试者在其他行为方面得分为1分，15.30%的受试者在吞咽效率方面得分为1分。视频荧光透视分析表明，最常见的吞咽改变是唇部密封（50.59%）、会厌谷残留（51.76%）和使用代偿动作（61.18%）。DOSS分析显示，48.31%的受试者在7级时吞咽正常，44.95%在6级，6.74%在5级。对于视频荧光透视吞咽障碍严重程度分类，75.28%被归类为轻度吞咽困难。
即使在术后晚期随访时，接受扁桃体手术的儿童中吞咽动力学改变也很常见。
