Background Nutritional deterioration in patients with head and neck cancer (HNC) has a multifactorial etiology mainly associated with tumor and treatment related factors. The objective of the present thesis was to investigate the impact of the disease and treatment on body weight and eating in patients with HNC treated with radiation therapy (RT) as the single modality treatment or as preoperative RT by analyzing body weight and body mass index (BMI) over time, predictive factors for weight loss and BMI, weight loss and BMI as prognostic factors for survival, and by studying the patients’ own experience of food and eating. Methods ARTSCAN is a randomized prospective multicenter trial conducted between the years of 1998 - 2006. Data were collected during and after RT with a total follow-up time of five years. Nutritional data from the whole study cohort (n = 712), from patients with oropharyngeal cancer (n = 232) and from two of the participating treatment centers (n = 101) were retrospectively analyzed in the present thesis. In addition, interviews (n = 13) were conducted nine months after the termination of RT as part of a care development project. Results On a group level, the patients lost weight during and after RT with a nadir at five months after the termination of RT. Factors related to a higher weight loss were oropharyngeal cancer, a high BMI at the start of RT, post-treatment aspiration, no tube feeding at the start of RT, and larger treated volumes. Furthermore, a high BMI at the start of RT was shown to be significantly related to a better five-year overall survival in patients with oropharyngeal cancer, whereas weight loss was not. The patients’ own narratives showed that all aspects of food, eating and meals were affected by the remaining sequelae, and that the patients found ways to accept and cope with the changes that had to be done to facilitate eating. Conclusions and clinical implications The disease and treatment gave persistent effects on the HNC patients’ weight and BMI which calls for a prolonged nutritional follow-up. The predictive factors found for weight loss can be used during patient history to find patients at risk for nutritional deterioration. In oropharyngeal cancer, patients with a high BMI at the start of RT had the best survival. This finding indicates that patients with a low BMI should be encouraged to gain weight before RT start. All aspects of food, eating and meals were affected during and after RT, and therefore the nutritional treatment should be given with a holistic approach to meet the multifaceted need patients with HNC experience.

No description available.

Head and neck cancer patients often experience swallowing disorders placing them at risk for aspiration and malnutrition. This study examined the effects of electrical stimulation to the pharyngeal wall on swallowing function in post-surgical head and neck cancer patients. Swallowing of liquid, pudding, and cookie consistencies was examined using videofluoroscopy before, and 30 minutes after, a ten minute application of electrical stimulation the pharyngeal wall in 5 male patients experiencing moderate-severe dysphagia. A total of ten measures of swallowing function were obtained from pre- and post-videofluoroscopy studies. Changes were observed post-stimulation in duration of posterior pharyngeal wall to base of tongue contact, total number of swallows, cricopharyngeal opening durations, and pharyngeal transit time. Preliminary findings indicate that electrical stimulation of the pharynx may impact certain features of swallowing in head and neck cancer patients who experience dysphagia. However, further studies are required to confirm the present findings, explore the mechanisms responsible for these changes, and investigate the effect on swallowing function as a result of manipulating stimulus frequencies, intensities and durations. / Speech-Language Pathology

Linha de pesquisa: Epidemiologia e controle das doen?as bucais. / ?rea de concentra??o: Odontopediatria. / Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-01-09T17:58:21Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) debora_souto_souza.pdf: 1070377 bytes, checksum: 562fbb6f4882bd48d44c79a12642d975 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-01-10T13:23:52Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) debora_souto_souza.pdf: 1070377 bytes, checksum: 562fbb6f4882bd48d44c79a12642d975 (MD5) / Made available in DSpace on 2017-01-10T13:23:52Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) debora_souto_souza.pdf: 1070377 bytes, checksum: 562fbb6f4882bd48d44c79a12642d975 (MD5) Previous issue date: 2016 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / Funda??o de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG) / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq) / Objetivo: Avaliar a associa??o entre condi??es bucais, limiar de degluti??o e performance mastigat?ria de crian?as pr?-escolares. Metodologia: Um estudo transversal foi realizado com uma amostra composta por 127 crian?as entre tr?s e cinco anos de idade. O fluxo salivar, a presen?a de c?rie cavitada na regi?o posterior, o n?mero de dentes presentes e o n?mero de unidades oclusais foram as condi??es bucais avaliadas. Al?m disso, foram analisados o n?mero de ciclos mastigat?rios at? a degluti??o, o tamanho mediano da particular no limiar de degluti??o e na performance mastigat?ria. Essas avalia??es foram conduzidas utilizando um material teste (Optocal), que foi processado pela t?cnica de peneiragem e o tamanho mediano da part?cula (X50) foi avaliado pela equa??o de Rosin-Rammler. A an?lise dos dados foi realizada utilizando-se o programa Statistical Package for the Social Sciences (SPSS) para Windows, vers?o 22.0 e incluiu a descri??o de frequ?ncia das vari?veis, teste de correla??o de Spearman, an?lise de regress?o linear simples e m?ltipla. Resultados: Considerando o n?mero de ciclos como vari?vel dependente, somente o tamanho mediano das part?culas no limiar de degluti??o permaneceu associado a esta vari?vel (p<0,001). O tamanho mediano das part?culas na performance mastigat?ria (p<0,001) e o n?mero de ciclos (p<0,001) foram associados ao tamanho mediano das part?culas no limiar de degluti??o quando esta vari?vel foi considerada dependente. Utilizando o tamanho mediano das part?culas na performance mastigat?ria como vari?vel dependente, o n?mero de dentes (p<0,001) e o tamanho mediano das part?culas no limiar de degluti??o (p<0,001) foram as vari?veis que permaneceram associadas. Conclus?o: Um maior n?mero de ciclos mastigat?rios foi associado a um menor tamanho mediano da part?cula no limiar de degluti??o e o tamanho mediano da part?cula no limiar de degluti??o foi associado ? performance mastigat?ria e ao n?mero de ciclos mastigat?rios. Um arco dent?rio mais completo e um menor tamanho mediano da part?cula no limiar de degluti??o foram associados a uma melhor performance mastigat?ria. / Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Odontologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / Aim: Assess the association between oral conditions swallowing threshold and masticatory performance of preschool children. Methods: A cross-sectional study was performed with 127 children between three and five years old. The oral conditions evaluated were salivary flow, the presence of cavitated caries in posterior teeth, the number of teeth and the number of occlusal units. In addition, we analyzed the number of masticatory cycles to swallowing, particularly the median size in the threshold swallowing and masticatory performance. These evaluations were conducted using a test material (Optocal), which was processed by sieving technique and the median particle size (X50) was evaluated by the equation of Rosin-Rammler. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) for Windows, version 22.0 and included a description of variables frequency, Spearman correlation test, analysis of simple and multiple linear regression. Results: Considering the number of cycles as the dependent variable, only the median particle size in the swallowing threshold remained associated with this variable (p <0.001). The median particle size in the masticatory performance ( p <0.001) and the number of cycles (p <0.001) were associated with median particle size in swallowing threshold when this variable was considered to be dependent. Using the median particle size of the masticatory performance as the dependent variable, the number of teeth (p <0.001) and the median particle size in swallowing threshold (p <0.001) were the variables that remained associated. Conclusion: A larger number of masticatory cycles was associated with a lower median particle size in the swallowing threshold, the median particle size in the swallowing threshold was associated with masticatory performance and the number of masticatory cycles. A fuller dental arch and a lower median particle size in the swallowing threshold were associated with a better masticatory performance.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Craniocervical posture can interfere directly on the mandibular and hyoid bone position as well as on the masticatory and swallowing functions. On the other hand a stomatognathic alteration such as temporomandibular disorder (TMD) can be a harmful factor on the alimentaires functions. This study aimed to investigate the craniocervical posture and TMD relation on the masticatory and swallowing functions. 70 women were divided according to TMD diagnostic evaluated by the Research Diagnostic Criteria (RDC/TMD): 34 with TMD and 36 without signs and symptoms of TMD. Craniocervical posture and mandibular and hyoid bone variables were measured by cephalometric analysis. Masticatory and swallowing function evaluation was performed according to a protocol of orofacial myofunctional evaluation with Scores (OMES). It was observed significant correlations between craniovertebral angle and hyoid bone position variables: linear distance from the hyoid bone to the menton (p=0,02) and to the mandible (p=0,03). The angle which measured the anterior position of the head also demonstrated a significant correlation with the linear distance between hyoid bone and jaw (p=0,00). Degree of cervical curvature showed a correlation between the linear distance from hyoid bone to the third cervical vertebra (p=0,01). An important craniocervical postural change was observed in the group although there was no association between them and a higher frequency of atypical behaviors evaluated during masticatory and swallowing functions. TMD subjects showed a significant difference on tongue (p=0,03) and lip (p=0,04) posture during swallowing. Chronic unilateral chewing pattern was also observed in the TMD group (p=0,03). In spite of the anatomical relation between craniocervical posture and mandibular and hyoid bone position it was not possible to confirm that the postural alterations observed could be associated to damages on masticatory and swallowing functions. Nonetheless, TMD presence resulted on a higher frequency of myofunctional alterations during these functions. / A postura craniocervical pode interferir diretamente na posição da mandíbula e do osso hióide e conseqüentemente na realização das funções de mastigação e deglutição. Outro fator que pode repercutir nocivamente sobre as funções alimentares seria uma alteração do próprio sistema, como por exemplo, a presença de uma Desordem Temporomandibular (DTM). Este estudo teve como objetivo investigar a relação da postura craniocervical e da DTM com as funções de mastigação e deglutição. 70 indivíduos do gênero feminino foram divididos em dois grupos quanto à presença de DTM segundo o instrumento Critérios de Diagnóstico para Pesquisa de Desordem Temporomandibular (RDC/TMD): 34 indivíduos com DTM e 36 sem DTM. A postura craniocervical e a posição mandibular e do osso hióide foram aferidas pela análise cefalométrica. A avaliação das funções de mastigação e deglutição foi baseada no Protocolo de Avaliação Miofuncional Orofacial com Escores (AMIOFE). Foram observadas correlações significativas entre o ângulo crânio-vertebral e as variáveis referentes à posição do osso hióide: distância do osso hióide ao mento (p=0,02) e à mandíbula (p=0,03). O ângulo referente à anteriorização da cabeça também apresentou uma correlação significativa com a medida relativa à distância do osso hióide à mandíbula (p=0,00). O grau de curvatura cervical demonstrou uma correlação moderada em relação à distância do osso hióide à terceira vértebra cervical (p=0,01). Foram observadas alterações posturais importantes, porém estas não foram associadas à maior freqüência de comportamentos atípicos durante as funções de mastigação e deglutição. Os indivíduos com DTM apresentaram uma diferença significativa quanto à postura de língua (p=0,03) e lábios (p=0,04) durante a função de deglutição, bem como a adoção de um padrão mastigatório unilateral crônico (p=0,03) mais freqüentemente observado. Os achados cefalométricos confirmaram a relação anatômica entre a postura craniocervical, mandíbula e osso hióide. No entanto, não foi possível associar a presença dos desvios posturais craniocervicais observados com a ocorrência de alterações nas funções de mastigação e deglutição. Por outro lado, a presença da DTM repercutiu na maior freqüência de alterações nas funções alimentares.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Swallowing is considered a dynamic and complex process that needs the integrity of distinct neuronal systems for suitable operation, and in the the inadequacy has dysphagia. In pulmonary diseases such as bronchiectasis, there may be impairment of swallowing, especially by compromised respiratory function. Objective: To characterize qualitatively and quantitatively by videofluoroscopy the parameters of the biomechanics of swallowing in bronchiectasis. Method: exploratory research, field, descriptive, quantitative and cross. Participated in this study nine subjects diagnosed with bronchiectasis, the average age was 47.89 years with a standard deviation (± 16.54), minimum 21 years and maximum 73 years. Videofluoroscopy was performed to characterize the biomechanics of swallowing in this population. The analysis of these data was done by three judges blinded in relation to the research objectives and is used to evaluate the temporal and visual-spatial parameters. Results: The agreement between the judges varied from moderate to almost perfect, being statistically significant (P<0.001). There was an early escape later; residue in valecule in consistency honey and pudding; absence of residue in piriform sinuses of all consistencies; percentage predominance absence of penetration and or aspiration, though, has been observed penetration in all consistencies and aspiration consistency nectar; the beginning of the pharyngeal phase was in position between the tongue base and valecule; on average the oral transit times were 1,93s to liquid consistency; 2,07s to nectar; 1,9s for honey and 2,04s for pudding. The pharyngeal transit time on average was 0,87s to liquid consistency; 0,87s to nectar; 0,79s to honey 0,78s and for pudding. The number of swallowing a liquid consistency for on average was 1.93 swallowing; for nectar was 2.56 swallowing; for swallowing honey was 2.89 and the pudding was 2.33 swallows. It can be seen that there was a correlation between variables penetration and aspiration and early escape (r=0.69087) and later beginning of the pharyngeal phase consistency nectar (r=0.67854). Conclusion: biomechanical characterization of swallowing was observed that several parameters were found changed, even with the presence of penetration and aspiration. This fact shows the importance to performing a clinical and objective speech assessment of swallowing for the conduct to be established early, avoiding the worsening of the patology. / A deglutição é considerada um processo dinâmico e complexo que precisa da integridade de distintos sistemas neuronais para o adequado funcionamento, na inadequação tem-se a disfagia. Em doenças pulmonares, como a bronquiectasia, pode haver o comprometimento da deglutição, principalmente pelo comprometimento da função respiratória. Objetivo: caracterizar qualitativa e quantitativamente através da videofluoroscopia os parâmetros da biomecânica da deglutição na bronquiectasia. Método: pesquisa exploratória, de campo, descritivo, quantitativo e transversal. Participaram desta pesquisa nove sujeitos com diagnóstico de bronquiectasia, a média de idade foi de 47,89 anos com desvio padrão (±16,54), mínima 21 anos e máxima 73 anos. Foi realizada avaliação videofluoroscópica a fim de caracterizar a biomecânica da deglutição nessa população. A análise dos exames foi realiza por três juízes cegados em relação aos objetivos da pesquisa, sendo utilizado para avaliar os parâmetros temporais e visuoespaciais. Resultados: a concordância entre os avaliadores variou de moderada a quase perfeita, sendo estatisticamente significante (P<0.001). Houve escape posterior precoce; resíduo em valécula nas consistências mel e pudim; ausência de resíduo em recessos piriformes em todas as consistências; predomínio percentual de ausência de penetração e ou aspiração, embora, tenha sido observada penetração em todas as consistências e aspiração na consistência néctar; o início da fase faríngea foi na posição entre base de língua e valécula; em média os tempos de trânsito oral foram 1,93s para a consistência líquida; 2,07s para a néctar; 1,9s para mel e 2,04s para a pudim. O tempo de trânsito faríngeo em média foi 0,87s para a consistência líquida; 0,87s para a néctar; 0,79s para mel e 0,78s para a pudim. O número de deglutição para a consistência líquida, em média, foi de 1,93 deglutições; para a néctar foi de 2,56 deglutições; para a mel foi de 2,89 deglutições e para a pudim foi de 2,33 deglutições. Pode-se observar que houve correlação entre as variáveis penetração e aspiração e escape posterior precoce (r=0.69087) e início da fase faríngea na consistência néctar (r=0.67854). Conclusão: na caracterização da biomecânica da deglutição observou-se que vários parâmetros se encontraram alterados, inclusive, com presença de penetração e aspiração. Tal fato demonstra a importância de realizar avaliação fonoaudiológica clínica e objetiva da deglutição para que a conduta seja precocemente estabelecida evitando o agravamento da patologia.

Orientador: Marco Antonio Compagnoni / Banca: Francisco de Assis Mollo Junior / Banca: Claudio Rodrigues Leles / Resumo: O ato de deglutir tem sido empregado, clinicamente, durante a reabilitação protética, principalmente na etapa de determinação e registro das relações intermaxilares por se considerar que a deglutição de saliva levaria a mandíbula a uma posição que coincidiria com a relação central (RC) e com a dimensão vertical de oclusão (DVO) do paciente. O objetivo deste trabalho foi analisar quantitativamente, em indivíduos dentados e portadores de próteses totais bimaxilares, três medidas associadas à posição mandibular durante a deglutição de água:1) separação intermaxilar no eixo vertical; 2) desvio ântero-posterior; 3) desvio lateral. Dois grupos foram formados: GI - composto por 40 indivíduos (22 homens e 18 mulheres) dentados naturais com média de idade de 45,27 anos; e GII - composto por 40 indivíduos (29 homens e 11 mulheres) desdentados totais bimaxilares, portadores de próteses totais, com idade média de 63,92 anos. A análise foi realizada empregando-se um sistema eletrônico K6 I Diagnostic System (Myotronics Research, Inc., Seattle, WA, EUA) acoplado a um sistema operacional (Microsoft Windows 4.1) que fornece registros tridimensionais dos movimentos e posições mandibulares. Os indivíduos foram avaliados pela deglutição de um volume reduzido de água (20 mL), e a posição de maior fechamento durante a deglutição foi registrada em três eixos (vertical, lateral e ântero-posterior). Esse registro foi executado três vezes, e o valor médio foi utilizado para este estudo. Com base nos resultados obtidos, foi possível concluir que, durante a deglutição: 1) a separação intermaxilar vertical e os desvios horizontais foram semelhantes em ambos os grupos; 2) em média, houve separação intermaxilar significativa no sentido vertical; 3) nos eixos ântero-posterior e lateral, os resultados demonstraram um desvio moderado em relação à MI. / Abstract: The act of swallowing has been used as a clinical method in prosthodontics, specially for determining and recording jaw relationship, considering that swallowing saliva guides the mandible to a position coincident with centric relation (CR) and vertical dimension of occlusion (VDO). The aim of this study was to evaluate, quantitatively, in dentate subjects and complete dentures wearers, three measurements associated to mandibular position during water swallowing: 1) intermaxillary distance on vertical axis; 2) anteroposterior deviation; and 3) lateral deviation. Two groups were selected: GI - composed by 40 subjects with complete dentition (22 males and 18 females - mean age 45,27 years); e GII - composed by 40 bimaxillary edentate subjects, complete denture weares (29 males and 11 females - mean age 63,92 years). A kinesiograph instrument (K6 I Diagnostic System(Myotronics Research, Inc., Seattle, WA, EUA) connected to a computer operational system (Microsoft Windows 4.1) was used for analysis, providing tridimensional records of mandibular movement and position. Each subject was tested during swallow of a small amount of water (29 mL), and the closest mandibular opening was recorded on vertical, lateral and anteroposterior axis. Three records were taken for each measurement and a mean value were obtained, these mean value was considered for this study. It was conclude that, during deglutition: 1) intermaxillary distance on vertical axis and horizontal deviation were similar for both groups; 2) there was a significant intermaxillary distance, on vertical axis; 3) for anteroposterior and lateral axis, results showed moderate deviation in relation to MI. / Mestre

The Occupational Therapist's Intervention for Adult Patients with Neurogenic Dysphagia Abstract of the Thesis: Dysphagia is a serious disorder, often caused by a cerebrovascular accident; in many cases it may be its only or primary symptom, and even the cause of death. The main objective of this thesis is to raise awareness of swallowing disorders among occupational therapists. Despite the fact that the occupational therapist's intervention for patients with swallowing disorder is common practice among occupational therapists abroad, this issue still is not well known among occupational therapists in the Czech Republic. There is also a considerable lack of Czech literature dealing with swallowing disorders from the occupational therapy point of view. This thesis therefore not only presents theoretical findings in this field but also recommends practical procedures for occupational therapists. The theoretical part of the thesis describes functional anatomy of the swallowing structures and swallowing physiology and pathophysiology. It analyses different causes of dysphagia with a focus on neurological disorders, defines the term dysphagia and other related terms, and briefly explains several classification methods of dysphagia. While the first part of the thesis looks primarily into the diagnostics and...

A estimulação elétrica neuromuscular (EENM) é uma recente técnica terapêutica no tratamento das disfagias orofaríngeas. Poucos estudos utilizaram a EENM em casos oncológicos, havendo muitas dúvidas sobre o método de aplicação e os resultados de diferentes condições de estimulação nessa população. Este trabalho teve por objetivo verificar o efeito imediato da EENM sensorial e motora, nas fases oral e faríngea da deglutição, em pacientes após tratamento do câncer de cabeça e pescoço. Para isso foi realizado um estudo transversal intervencional que incluiu 11 pacientes adultos e idosos (mediana de 59 anos) acometidos por câncer de cabeça e pescoço. Todos os indivíduos foram submetidos ao exame de videofluoroscopia da deglutição, no qual, de modo randomizado, foram solicitadas deglutições de 5 ml de alimentos nas consistências líquida, mel e pudim em três condições distintas: sem estimulação, com EENM sensorial, com EENM motora. Foi classificado o grau da disfunção da deglutição por meio da escala DOSS (Dysphagia Outcome and Severity Scale), a presença de estase de alimentos (escala de Eisenhuber), de penetração laríngea, aspiração laringotraqueal (Penetration and Aspiration Scale - PAS), além da medida do tempo de trânsito oral e faríngeo (em segundos). Para a comparação dos resultados, considerando os três estímulos aplicados, na escala de resíduos, na escala de penetração aspiração, na escala DOSS e no tempo de trânsito oral e faríngeo foi aplicado o teste de Friedman ou a análise de variância para medidas repetidas (de acordo com a distribuição dos dados). Para todos os testes foi adotado nível de significância de 5%. Os resultados demonstraram que houve melhora com a estimulação sensorial e motora na escala DOSS e na escala PAS para um paciente tratado de câncer de boca e outro de laringe e piora, em ambas as escalas, para dois pacientes (câncer de boca), sendo um para a estimulação motora e outro na sensorial. A aplicação da escala de Eisenhuber permitiu verificar que a EENM, tanto em nível sensorial como motor, modificou de forma variável a presença de resíduos para os casos de câncer de boca, enquanto para o paciente com câncer de laringe houve redução de resíduos em valécula/raiz da língua para a estimulação sensorial e motora, além de aumento de resíduos em parede posterior da faringe com o estímulo motor. Além disso, não foi encontrada diferença estatisticamente significante para o tempo de trânsito oral e faríngeo nas diferentes estimulações para todas as consistências testadas (p>0,05). Diante desses achados, concluiu-se que a EENM, em nível sensorial e motor, apresentou variável impacto imediato nas fases oral e faríngea da deglutição, podendo melhorar a função de deglutição de pacientes com significante disfagia após o tratamento para o câncer de cabeça e pescoço, no que se diz respeito ao grau da disfagia e à presença de penetração e aspiração. / Neuromuscular electrical stimulation (NMES) is a recent therapeutic technique for the treatment of oropharyngeal dysphagia. Few studies have used NMES in cancer cases; there are many questions about the application method and the results of different stimulation conditions in this population. This study aimed to verify the immediate effect of sensory and motor NMES in the swallowing oral and pharyngeal phases in head and neck cancer patients after head and neck cancer treatment. Thus, an interventional transversal study was carried out including 11 adult and elderly patients (average of 59 years) with head and neck cancer. All subjects underwent a videofluoroscopic swallowing test, in which they were randomly requested to swallow 5 ml of food in the consistencies of liquid, honey and pudding in three distinct conditions: without stimulation, with sensorial NMES and with motor NMES. The degree of swallowing dysfunction was classified through the DOSS scale (dysphagia outcome and severity scale), the presence of stasis of food (Eisenhuber scale), laryngeal penetration, laryngotracheal aspiration (Penetration and Aspiration Scale - PAS scale), besides the measure of the oral pharyngeal transit time (in seconds).The comparison of results, considering the three stimuli applied, at residues scale, penetration aspiration scale, DOSS scale and the oral pharyngeal transit time it was applied the Friedman test or analysis of variance for repeated measures (according to the data distribution),for all tests was level adopted significance level of 5%. The results showed an improvement with the sensory and motor stimulation in the DOSS scale and PAS scale for the one patient treaty of mouth and other laryngeal cancer, and a deterioration in both scales, for two patients (mouth cancer), one for motor stimulation and the other for sensory stimulation. The application of Eisenhuber scale has shown that NMES has changed variably the presence of residues in mouth cancer cases in both sensory and motor levels, while patients with laryngeal cancer it happened a waste reduction in valecule/tongue root to the sensory and motor stimulation, besides the increase in the of residues in posterior pharyngeal wall with motor stimulation. In addition, there was no statistically significant difference for the oral and pharyngeal transit time in the different stimulations for all consistencies tested (p>0.05). Given these findings, it was possible to conclude that NMES, in sensory and motor level, showed variable immediate impact on the oral and pharyngeal phases of swallowing and may improve the swallowing function in patients with significant dysphagia after the treatment for head and neck cancer, regarding the degree of dysphagia and the presence of penetration and aspiration.

Objetivos: descrever as características dos lactentes com Sequência de Robin (SR) atendidos no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP) e identificar as variáveis associadas a um protocolo terapêutico: documentar as síndromes associadas; verificar o tipo de obstrução respiratória, os sintomas clínicos e intervenções terapêuticas; verificar a ocorrência de disfagia, complicações, comorbidades e óbitos. Material e Métodos: Foram avaliados retrospectivamente 223 lactentes com SR, menores de um ano de idade, internados no HRAC-USP no período de julho de 2003 a junho de 2008. Resultados: 52% dos lactentes eram do sexo masculino, 121 (54%) apresentavam provável Sequência de Robin isolada (SRI) e102 (46%) apresentavam Sequência de Robin associada à síndrome ou associada a outras anomalias (SRS). As síndromes mais freqüentes foram síndrome de Stickler e síndrome de Moebius. 45% dos lactentes internaram antes de um mês de idade e o tempo médio de hospitalização foi de 20 dias. O tipo de obstrução respiratória mais freqüente, diagnosticado pela nasofaringoscopia, foi tipo 1, presente em 68% dos casos. A maioria dos lactentes (81%) foi tratada conservadoramente e a intubação nasofaríngea foi o tratamento mais utilizado (48%). A traqueostomia foi realizada em 19% dos lactentes e destes a maioria era do grupo SRS. A quase totalidade dos lactentes apresentava disfagia, a qual foi mais grave nos que apresentavam obstrução tipo 3 e 4, nos submetidos à traqueostomia e nos do grupo SRS. A gastrostomia foi realizada em 25% dos lactentes e a doença de refluxo gastroesofágico ocorreu em 54% do total de lactentes estudados. A complicação mais freqüente foi pneumonia e a mortalidade foi 5,38%, sendo que todos os pacientes que evoluíram para óbito eram sindrômicos. Conclusões: A maioria dos lactentes com SR pode ser tratada conservadoramente e a intubação nasofaríngea foi o método mais empregado. As dificuldades alimentares foram universais e relacionadas ao grau de obstrução respiratória. / Objectives: to describe the characteristics of infants with Robin Sequence (SR) treated at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP) and identify the variables associated with a therapeutic protocol; record the associated syndromes; verify the type of respiratory obstruction, clinical symptoms and therapeutic interventions; and to verify the occurrence of dysphagia, complications, comorbities and death. Material and Methods: A total of 223 infants with SR were retrospectively evaluated, all younger than one month of age, hospitalized at HRAC-USP in the period July 2003 to June 2008. Results: 52% of the infants were males, 121 (54%) presented probable Isolated Robin Sequence (SRI) and 102 (46%) exhibited Robin Sequence with associated syndrome or anomalies (SRS). The most frequent syndromes were Stickler syndrome and Moebius syndrome. Among the infants, 45% were hospitalized before one month of age and the mean time of hospitalization was 20 days. The most frequent respiratory obstruction diagnosed through nasopharyngoscopy was type 1, present in 68% of cases. Most of the infants were treated conventionally and nasopharyngeal intubation was the most used procedure (48%). Tracheostomy was performed in only 19% of infants, most of whom were syndromic. Nearly all infants presented dysphagia, which was more severe in infants with obstruction type 3 and type 4, submitted to tracheostomy, and in the SRS group. Gastrostomy was performed in 25% of infants and gastroesophageal reflux occurred in 54% of SR infants. The most frequent complication was pneumonia and the mortality rate was 5.38%; all cases of death occurred among syndromic children. Conclusions: Most of the SR infants were treated conventionally and nasopharyngeal intubation was the most used procedure. Feeding difficulties were universal and related to the degree of respiratory obstruction.