Impacto de um programa de intervenção fisioterapêutica baseado em orientação postural em crianças com diagnóstico de respiração oral submetidas à adenotonsilectomia: um ensaio clínico controlado

Abstract

Mouth breathing is an adaptive physical change with multifactorial etiology. There are some reports in the literature of a clinical entity known as Mouth Breather Syndrome (MB) characterized by a predominance of oral access of air for a period longer than six months. It is also characterized by the absence of lip closure associated with compensatory adjustments of the head position, leading topostural disorders, changes in dentocraniofacial morphology, sleep disorders, speech and chewing. Despite reports that mouth breathing can cause postural abnormalities involving the head and cervical spine, the association between postural abnormalities and mouth breathing in children is unclear. The aim of the first study of this thesis was to describe and critically analyze studies that evaluated postural disorders in MB children.The results of this systematic review reported that the most common postural deviation found in MB children was forward head position, scapular elevation and abduction. In addition, the reviewshowed the lack of standardized terminology, bony landmarks, and reference values and reports of the reliability and validity of the measurement techniques used to evaluate posture in mouth-breathing children. Adenotonsillectomy and physiotherapy interventions are indicated to relieve symptoms of MB children. The post-adenotonsilectomy benefits, as well as therapeutic monitoring posture, have not yet been described. The objectives of the second study was to investigate the kinematics of the shoulder girdle, cervical and thoracic spine in children with mouth breathing at pre- and post-adenotonsillectomy and to evaluate the effects of rehabilitation programs based on booklet with health education and exercise withand without supervision. Forty-nine mouth breathing children (6.3 ± 1.8 years) of both sexes participated in the study. The measures of thoracic kyphosis, forward head position, shoulders protrusion and abduction, elevation, anterior tilt and internal rotation of the scapula were evaluated before and after surgery and after the physical therapy intervention programs. Afterwards, the children were blindly divided into three groups: control, booklet with unsupervised exercise and physica therapy intervention and after 3 months re-evaluated again.The kinematic datawere obtained using the system Qualysis ProReflex®. The results of the second study confirm that the MB children benefits of surgery with improved forward head posture, shoulders protrusion and elevation and anterior tilt of the scapula. The physical therapy was effective in improving the thoracic kyphosis and treatment via booklet was effective in improving the scapular abduction and shoulders protrusion. The results support the hypothesis of the importance of surgery and physical therapy in improving posture and consequently the quality of life of oral breathing children.