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Neiva P.D.1,2, Becker H.G.3, Franco L.P.3, Kirkwood R.1,4, Resende R.5
1Universidade Federal de Minas Gerais, Physical Therapy, Belo Horizonte, Brazil, 2Pontificia Universidade Católica de Minas Gerais, Physical Therapy, Belo Horizonte, Brazil, 3Universidade Federal de Minas Gerais, Pediatric Otohinolaringology, Belo Horizonte, Brazil, 4Wilfrid Laurier University, Kinesiology and Physical Education, Waterloo, Canada, 5Federal University of Minas Gerais, Physical Therapy, Belo Horizonte, Brazil
Background: The clinical decision for surgical treatment of children diagnosed with mouth breathing depends on the percentage of mechanical obstruction correlated with exacerbation of upper respiratory tract infections and systemic changes. The benefits of adenotonsillectomy include changes in the nasopharyngeal space, the mandibular plane and myofunctional alterations. However, post-adenotonsilectomy postural benefits have not yet been described. In addition, physical therapy is indicated for the improvement of posture in children with mouth breathing syndrome. However, the direct effects of physical therapy interventions in children post-adenotonsillectomy are yet to be determined.
Purpose: To investigate the kinematics of the shoulder complex, cervical and thoracic spine in children with mouth breathing condition before and after adenotonsillectomy. The second goal was to evaluate the effects of two rehabilitation programs, compared to a control group, based on health education and exercise with and without supervision.
Methods: 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 using the motion capture system Qualysis ProReflex®. Children were divided into three groups: control, booklet with unsupervised exercises and supervised physical therapy. Kinematic postural evaluations occurred before and after the 8-week physical therapy interventions.
Results: There was a significant decrease in forward head position (-1.9°), shoulders protrusion (-5.2°), elevation of the scapula (-2,1 mm) and anterior tilt of the scapula (-1.8°) after surgery compared to the pre-operative phase. The physical therapy group presented significant lower thoracic kyphosis (29.1°±10.5°) relative to the non-supervised group (37.9°±8.0°). The non-supervised group presented significant lower scapular abduction than the control group (77.9 ± 10.8 mm x 91.5 ± 6.3 mm) and the physical therapy group (77.9 ± 10.8 mm x 86.7 ± 16, 4 mm), and lower shoulder protrusion (124.4 ± 7.6) compared to the control group (132.6°±11.3°).
Conclusion(s): The posture of mouth breathing children improved significantly with adenotonsillectomy. The literature supports that forward head posture is a strategy adopted by mouth breathing children to facilitate and accelerate airflow. Forward head is a combination of extension of the upper cervical spine, flexion of the lower cervical and thoracic spine leading to an increase in cervical lordosis . Prolonged head forward posture causes increased strain on the extensor muscles of the head and stretches the infrahyoid muscles creating an inferior and posterior traction the hyoid bone. As a consequence, the mandible is pulled in a direction of retraction and depression A decrease in forward head posture might help facilitate the air flow mechanism of those children. Both the supervised and unsupervised physical therapy programs improved other postural measurements not observed with the surgical intervention. Therefore, physical therapy should be indicated to maintain or even improve posture in children that went adenotonsillectomy.
Implications: The consequences of mouth breathing syndrome in children is severe. Clinically these findings are important and will contribute to improving the quality of life of mouth breathing children.
Funding acknowledgements: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes)
Topic: Human movement analysis
Ethics approval: CAAE: 08516312.9.0000.5149
All authors, affiliations and abstracts have been published as submitted.
