Validation of the MBGR orofacial myofunctional assessment protocol for adults with temporomandibular disorders with disc displacement with reduction.
- 作者列表："Bueno MDRS","Rosa RR","Genaro KF","Berretin-Felix G
PURPOSE:This study aimed at validating the MBGR Orofacial Myofunctional Assessment Protocol (MBGR Protocol) for adults with Temporal Mandibular Disorders (TMD). METHODS:The study sample was composed of 30 adults: 15 with TMD (disc displacement with reduction according to the Research Diagnostic Criteria for Temporomandibular Disorders) and 15 control individuals. The validation process encompassed the content, criterion, and construct of the protocol, as well as its inter- and intra-rater agreement levels and sensitivity and specificity values, considering a 5% statistical significance level. RESULTS:The following validities were confirmed: of content, as the MBGR Protocol covers all functional issues present in patients with TMD; of criterion, with significant correlations between the MBGR and Orofacial Myofunctional Evaluation with Scores (OMES) protocols; of construct, differentiating individuals with and without Orofacial Myofunctional Disorders (OMD) as for pain on palpation and mandible range of motion, with significant correlation between the MBGR clinical evaluation and that using a digital algometer, as well as confirmation of the instrumental assessment for the breathing mode classification. Agreement ranged from poor to very good and from reasonable to very good for the inter- and intra-rater power analyses, respectively. High sensitivity and specificity values were observed. CONCLUSION:The MBGR Protocol proved to be valid for use in adults presented with TMD with disc displacement with reduction and controls, covering all aspects that enable the analysis of OMD in these individuals. OBJETIVO:Este estudo visou validar o Protocolo de Avaliação Miofuncional Orofacial MBGR para adultos com DTM. MÉTODO:Participaram 30 adultos, sendo 15 com DTM (deslocamento de disco com redução segundo o Research Diagnostic Criteria for Temporomandibular Disorders) e 15 Controles. O processo de validação envolveu a validade de conteúdo, de critério e de construto, além da concordância inter e intra-avaliador, sensibilidade e especificidade. Considerou-se nível de significância de 5%. RESULTADOS:Foram confirmadas as validades de conteúdo, visto que o Protocolo MBGR abarca todas as questões funcionais presentes em indivíduos com DTM; de critério, com correlações significantes entre o MBGR e AMIOFE; e de construto, diferenciando indivíduos com e sem DMO quanto à dor à palpação e mobilidade mandibular, com correlação significante entre a avaliação clínica do MBGR e o uso do algômetro digital, bem como confirmação do exame instrumental para a classificação do modo respiratório. A força de concordância variou de pobre a muito boa para a análise interavaliador e de razoável a muito boa para intra-avaliador. Os valores de sensibilidade e especificidade foram elevados. CONCLUSÃO:O Protocolo MBGR mostrou-se válido para aplicação em adultos com DTM com deslocamento de disco com redução e controles, contemplando todos os aspectos que possibilitam a análise das condições oromiofuncionais nesses indivíduos.
目的: 本研究旨在验证成人颞下颌疾患 (TMD) 的MBGR口面部肌功能评估方案 (MBGR方案)。 方法: 研究样本由 30 例成人组成: 15 例TMD (根据颞下颌关节紊乱病研究诊断标准，关节盘移位伴复位) 和 15 例对照个体。验证过程包括方案的内容、标准和结构，以及评定者间和评定者内的一致性水平以及灵敏度和特异性值，考虑了 5% 的统计学显著性水平。 结果: 证实了以下有效性: 内容，因为MBGR方案涵盖了TMD患者中存在的所有功能问题; 标准，MBGR和口面肌功能评价与评分 (OMES) 协议之间具有显著相关性; 结构，区分有和无口面肌功能障碍 (OMD) 的个体至于触诊疼痛和下颌骨活动范围，MBGR临床评价与使用数字algometer的临床评价显著相关，以及呼吸模式分类仪器评价的确认。评定者间和评定者内权力分析的一致性分别从差到非常好，从合理到非常好。观察到较高的敏感性和特异性值。 结论: MBGR方案被证明适用于伴有椎间盘移位的TMD成人患者，包括减少和对照，涵盖了能够分析这些个体中OMD的所有方面。 Objectivo: Este estudo visou validar o Protocolo de avalia ç ao Miofuncional口面MBGR para adulttos com DTM。 M é todo: Participaram 30 adultos，sendo 15 com DTM (delocamento de disco com redu ç ã o segundo o颞下颌关节紊乱病研究诊断标准) e 15 对照。O prociso de valid a ç ao envolveu a validade de conte ú do，de crit é rio e de construto，al é m da concord ância inter e intra-avalidor，sensibilidade e specifidade。Conference ou-se n í vel de patient ā ncia de 5%. 结果: Foram confirmadaas as validades de conte ú do，visto que o Protocolo MBGR abarca todas as questes funciais presentes em indiv í duos com DTM; de crit é rio，com correla ç es patititentes e o MBGR e AMIOFE; e de construto，diferenciando indiv í duos com e sem DMO quanto à dor à palpa ç ó o e mobilidade下颌，Com correla ç ã o sentiante entre a avalia ç ó o cl í nica do MBGR e o uso do alg ó metro digital，bem como confirma ç ó o do exame tools para classifica ç ó o modo respir ó rio。A forç a de concord ä ncia variou de pobre a muito boa para a an á lise interavalidor e de razou á vel A muito boa para intra-avalidor.Os valores de sensibilidade e specificidade foram elevados. Conclusao: O Protocolo MBGR mostou-se v á lido para adulem adultos com DTM com desclocatento de disco com redu ç ao e controles，conforplando to dos os aspectos que possibilitam a an á lise das condies indiasis v í duos.
METHODS:BACKGROUND:The anterior oronasal fistulae neighboring the alveolar cleft could persist or reappear after the alveolar reconstruction with cancellous bone grafting. The persistent symptomatic anterior oronasal fistulae need to be repaired, but surgery remains a challenge in cleft care. Surprisingly, this issue has rarely been reported in the literature. The purpose of this long-term study was to report a single surgeon experience with a therapeutic protocol for persistent symptomatic anterior oronasal fistula repair. METHODS:This is a retrospective study of consecutive patients with Veau type III and IV clefts and persistent symptomatic anterior oronasal fistulae managed according to a therapeutic protocol from 1997 to 2018. Depending on fistula size, patients were treated with local flaps associated with an interpositional graft or two-stage tongue flaps (small/medium or large fistulae, respectively). The surgical outcomes were classified as "good" (complete fistula closure with no symptoms), "fair" (asymptomatic narrow fistula remained), or "poor" (failure with persistent symptoms). RESULTS:Forty-four patients with persistent symptomatic anterior oronasal fistulae were reconstructed with local flaps associated with interpositional fascia or dermal fat grafting (52.3%) or two-stage tongue flaps (47.7%). Most of patients (93.2%) presented "good" outcomes, ranging from 87% to 100% (local and tongue flaps, respectively). Three (6.8%) patients presented symptomatic residual fistula ("poor" outcomes). CONCLUSIONS:For the repair of persistent symptomatic anterior oronasal fistulae, this therapeutic protocol provided satisfactory outcome with low fistula recurrence rate.
METHODS:OBJECTIVE:Methadone is a vital treatment for women with opioid use disorder in pregnancy. Previous reports suggested an association between methadone exposure and Pierre Robin sequence (PRS), a rare craniofacial anomaly. We assessed the association between gestational methadone exposure and PRS. DESIGN/SETTING:This case-malformed control study used European Surveillance of Congenital Anomalies population-based registries in Ireland, the Netherlands, Italy, Switzerland, Croatia, Malta, Portugal, Germany, Wales, Norway and Spain, 1995-2011. PATIENTS:Cases included PRS based on International Classification of Disease (ICD), Ninth Edition-British Paediatric Association (BPA) code 75 603 or ICD, Tenth Edition-BPA code Q8708. Malformed controls were all non-PRS anomalies, excluding genetic conditions, among live births, fetal deaths from 20 weeks' gestation and terminations of pregnancy for fetal anomalies. An exploratory analysis assessed the association between methadone exposure and other congenital anomalies (CAs) excluding PRS. Methadone exposure was ascertained from medical records and maternal interview. RESULTS:Among 87 979 CA registrations, there were 127 methadone-exposed pregnancies and 336 PRS cases. There was an association between methadone exposure and PRS (OR adjusted for registry 12.3, 95% CI 5.7 to 26.8). In absolute terms, this association reflects a risk increase from approximately 1-12 cases per 10 000 births. A raised OR was found for cleft palate (adjusted OR 5.0, 95% CI 2.7 to 9.2). CONCLUSIONS:These findings suggest that gestational methadone exposure is associated with PRS. The association may be explained by unmeasured confounding factors. The small increased risk of PRS in itself does not alter the risk-benefit balance for gestational methadone use. The association with cleft palate, a more common CA, should be assessed with independent data.
METHODS::Orthopedic treatment to improve deficient maxillary growth of cleft lip and palate patients is an important part of treatment. The success of this treatment is strongly dependent on the time of initiation of therapy. There has been a large controversy in the available literature regarding the skeletal age of these patients. The aim of the present study was to compare the skeletal age of cleft lip and palate patients with normal individuals.37 unilateral and 14 bilateral cleft lip and palate patients and 47 healthy individuals participated in this cross-sectional study. The patients were classified into 8 to 10 and 11 to 14-year-old individuals. Cervical vertebral maturational stage of participants was evaluated in the lateral cephalometry. The skeletal age of cleft lip and palate patients was compared with normal controls. Chi-square was used for statistical analysis. There was not a significant difference in the skeletal developmental stage of unilateral and bilateral cleft compared to their normal peers according to their age and sex. Also, significant difference in skeletal maturational stage of cleft lip and palate patients was not found between boys and girls (P = 0.8). Similarly, no significant difference was found in the skeletal age of the 3 studied groups without considering the age and sex of participants (P = 0.5). Regarding the similar skeletal maturational stage of cleft lip and palate patients with normal controls in our study, their maxillofacial orthopedic treatment can be initiated at similar time to normal peers.