Muscular and functional changes following adenotonsillectomy in children Dandara de A. Bueno a , Taı ´s H. Grechi a , Luciana V.V. Trawitzki a , Wilma T. Anselmo-Lima b , Cla ´ udia M. Felı ´cio a , Fabiana C.P. Valera b, * a Speech Therapy Course, Medical School of Ribeira˜o Preto, University of Sa ˜o Paulo, Ribeira˜o Preto, Sa ˜o Paulo State, Brazil b Otorhinolaryngology Division, Medical School of Ribeira˜o Preto, University of Sa˜o Paulo, Ribeira˜o Preto, Sa˜o Paulo State, Brazil 1. Introduction Mouth breathing during childhood is associated to sleep breathing diseases [1]. The main causes for mouth breathing are adenotonsillar hypertrophy and allergic rhinitis, and both condi- tions are frequently concomitant [2]. Adenotonsillectomy is one of the most common surgery performed in children, and its main objective is to reestablish nasal breathing, ultimately improving quality of life and, hopefully, facial myofunctional status after surgery [3]. Several craniofacial modifications have been reported in chronic mouth breathing children, such as maxillary and mandibular retraction [2,4,5], vertical rotation in mandible [6], long face [5–7], maxillary atresia [2,4,7] and posterior cross-bite [7]. In general, these changes are more apparent in older children [4–6]. In a previous study performed by our group [8], we have observed palatal atresia and dolichofacial pattern in children from three to six years, but in general the craniofacial changes were subtler in this stage than in scholar children. We suggested that craniofacial changes depended on time and amount of breathing disturbance. Myofunctional changes, however, are already evident in pre- school children [8]. The main muscular changes observed in International Journal of Pediatric Otorhinolaryngology 79 (2015) 537–540 A R T I C L E I N F O Article history: Received 28 November 2014 Received in revised form 15 January 2015 Accepted 19 January 2015 Available online 28 January 2015 Keywords: Adenotonsillectomy Myofunctional Evolution Mouth breathing Therapy Muscular A B S T R A C T Background: It is recognized that adenotonsillar hypertrophy leads to muscular and functional changes in face, and that adenotonsillectomy is associated to improvement in this condition. However, the ideal interval one should wait until this spontaneous recovery is not well defined, neither if this recovery is expected to be complete or partial. Objective: To compare the muscular and functional changes in face of children prior and after adenotonsillectomy in a monthly evaluation. Methods: 8 children aged from 4 to 6 years were prospectively studied. All patients underwent adenotonsillectomy, and were assessed before and monthly-after surgery up to 6 months, through the Protocol of Orofacial Myofunctional Evaluation with Scores (OMES). Results: There was a progressive improvement in OMES score in all measured parameters, including the ‘‘mobility’’ and ‘‘posture’’ sub-tests; this improvement was significant at the first month after surgery. The sub-test ‘‘function’’ was not affected by surgery. Improvement continued from the first to the sixth month after surgery, although it was not significant between these two periods. Additionally, all parameters remained altered after the final evaluation at six months. There was a significant correlation between the improvement in ‘‘mobility’’ sub-test and in total score of OMES. Conclusion: We observed a partial recovery in facial muscular and functional changes following adenotonsillectomy, particularly during the first month after surgery. This improvement was especially observed in the ‘‘mobility’’ and ‘‘posture’’ sub-tests. We conclude that waiting for a spontaneous muscular and functional facial recovery during the first month post-operatively seems reasonable. Nevertheless, after this period, if the patient fails to achieve recovery, it may be advised that this child should undergo myofunctional therapy. ß 2015 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +55 16 3602 2862/+55 16 3602 2863; fax: +55 16 36022860. E-mail addresses: facpvalera@uol.com.br, facpvalera@fmrp.usp.br (Fabiana C.P. Valera). Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology jo ur n al ho m ep ag e: ww w.els evier .c om /lo cat e/ijp o r l http://dx.doi.org/10.1016/j.ijporl.2015.01.024 0165-5876/ß 2015 Elsevier Ireland Ltd. All rights reserved.