In various post-consonantal environments, the palatal glide /j/ has been subject to variation and change since the late 17th century. Retention, coalescence, and deletion of the glide respectively account for various pronunciations of the word due [dju:], [dʒu:], and [du:] in different dialects of English. Research in this area has often focused on internal motivations. However, the external motivations that regulate the practice of glide variants in the speech of different segments of communities have been a relatively recent area of investigation. Among other dialects, Australian English is one of the major varieties that has not been formally assessed in this area. Hence, the aim of this thesis has been to investigate possible associations between the glide variants and their emergence in the speech of 48 speakers of Australian English. The audio data for this study were 12 tokens pronounced by the speakers in wordlist, sentences, and a story, and were extracted from the AusTalk Corpus (Burnham, Cox et al., 2011). The results for separate analysis of social variables seem to indicate that the spread of different glide variants in the speech of speakers are mainly conditioned by age. The combination of the social variables shows that glide retention is most frequent in the speech of higher educated old individuals. By contrast, glide deletion seems to be almost non-existent in their speech while more frequent in the pronunciations of the young. Overall, glide coalescence is the most present and has the strongest stylistic consistency in the speech of individuals. Further details and possible reasons behind these observations are discussed in the work that follows.

The present study was undertaken to evaluate the rat as a model for middle ear re­search. The rat was chosen primarily because the gross structure of its middle ear shows several similarities to that of man. It was considered of great importance to make a thorough structural study of the rat middle ear and to compare the results with those reported for the human middle ear. The thesis therefore includes indepen­dent studies on various aspects of rat middle ear structure and function as well as a review of the literature. The most pertinent findings in the experimental part of this study were the following. The rat Eustachian tube consists of a nasopharyngeal, and a cartilaginous and bony portion. The orifice of the nasopharyngeal portion is composed of two soft tissue lips, which appear to be opened mainly by the action of the salpingopharyngeal mus­cle, but also by the levator and tensor veli palatini muscles. The cartilaginous por­tion appears to be opened solely by the tensor veli palatini muscle. The tensor tympani muscle seems to have no effect on the tube. A ciliated and secretory epithelium lines the inferomedial walls of the tube throughout its length. In the tympanic cavity these thelial cell types extend as two tracts - one anterior and the other inferoposterior to  the promontory - which communicate with the epitympanic/attic compartments. The remaining parts of the tube and the tympanic cavity are covered by a squamous/cuboidal, non-ciliated epithelium. The subepithelial loose connective tissue contains vessels, nerves, and connective tissue cells, among these mast cells. The mast cells are confined to areas covered by the ciliated epithelium, and in the floor of the bulla, in the pars flaccida, and along the manubrial vessels. Glands are restricted to the Eustachian tube. In the clearance/transport of serum-like material, from the epitympanum towards the tube, hydrostatic forces appear to be important. The tympanic membrane is vascularized from meatal and tympanal vessels. Meatal ves­sels branch in the pars flaccida and along the handle of the malleus, where they are localized directly beneath the outer, keratinizing, stratified, squamous epithelium. Furthermore, meatal vessels form a vascular network at the junction between the fi­brocartilaginous annulus and the tympanic sulcus. Tympanal vessels send branches to the periphery of the pars tensa, where they run immediately beneath the tympanal, simple, squamous epithelium. In the major portion of the pars tensa, no blood vessels were found. The rat stapedial artery is a thin-walled vessel with a wide lumen. Without branch­ing, it runs through the tympanic cavity to the extratympanal regions it supplies. In contrast to the corresponding artery in man, the rat stapedial artery persists throughout life. The artery does not seem to be affected by the fluid produced during experimentally induced otitis media with effusion. The middle ear structure in the rat and in man show both similarities and differ­ences. If the differences are kept in mind and considered, it would seem that the rat is indeed a suitable model for experimental middle ear research. / digitalisering@umu

A expansão rápida de maxila assistida cirurgicamente (ERMAC) é uma das formas de tratamento para a deficiência transversal de maxila. Essa técnica depende do uso de dispositivos expansores, os quais podem ter relação com a movimentação dos dentes superiores, não existindo estudos que apontem alterações dos dentes inferiores. O presente trabalho teve como objetivo mensurar a movimentação dos dentes superiores e inferiores, produzidas pela ERMAC, por meio de técnicas cirúrgicas com diferentes tipos de corticotomias da parede anterior da maxila. O estudo foi composto 87 exames de tomografia computadorizada por feixe cônico (TCFC), sendo esses divididos de acordo com o osteotomia realizada: Grupo I (n= 42) osteotomia do tipo Le Fort I subtotal com degrau no pilar zigomático-maxilar e Grupo 2 (n = 45) osteotomia do tipo Le Fort I subtotal com osteotomia linear descendente. Os períodos avaliados foram divididos em: pré-operatório (T0), após o término da ativação do dispositivo expansor (T1) e período de contenção ortodôntica (T2). Os dados foram tabulados, comparados entre os períodos estudados e analisados estatisticamente por meio da análise de variância para medidas repetidas (ANOVA) e Teste de Tukey para comparação entre os três tempos, nos quais foram avaliados o total de pacientes (GI+GII) e cada grupo isoladamente (GI) (GII). Os resultados demonstraram aumento estatisticamente significativo das dimensões maxilares, além a inclinação vestibular dos dentes 13, 23, 16 e 26, em ambos os grupos; observaram-se efeitos dentoesqueléticos mandibulares na largura da cortical lingual, aumento da distância entre os ápices dos dentes 46 e 36 e inclinação vestibular do dente 36. Porém, somente esse último foi estatisticamente significante (p < 0,05). Isso nos permitiu concluir que, em procedimentos de expansão rápida de maxila assistida cirurgicamente são verificados efeitos dento-esqueléticos predominantemente maxilares, mas podem ocorrer efeitos mandibulares, sendo esses sem significância estatística. / Surgically assisted rapid maxillary expansion (SARME) is the main treatment option for transverse maxillary deficiency in adults. This technique depends on the use of expanders, which are commonly related to the movement of teeth in the maxilla, however, there are no studies analyzing the occurrence of alterations in the lower teeth to this date. The aim of this study was to assess the movement of upper and lower teeth produced by SARME executed by means of two surgical techniques with different types of corticotomies on the anterior wall of the maxilla. The sample consisted of 87 cone beam computed tomography (CBCT) scans, which were divided in two groups according to the osteotomy performed: Group I (n = 42) Le Fort I subtotal osteotomy with a step on the zygomatic-buttress and Group 2 (n = 45) Le Fort I type subtotal osteotomy with a linear descending osteotomy of the maxilla. The time periods evaluated were divided into: preoperative (T0), immediately after activation of the expander device was ceased (T1) and ending of orthodontic containment period (T2). The data were tabulated and compared between the periods studied and statistically analyzed by means of analysis of variance for repeated measurements (ANOVA) and Tukey\'s test for comparison between the three time periods. The total number of individuals (GI + GII) and each isolated group (GI) (GII) were analyzed. The results showed a statistically significant increase of all the maxillary dimensions associated with buccal inclination of the teeth 13, 23, 16 and 26 in both groups; mandibular dentoskeletal effects on the width of the lingual cortex were observed, there was also an increased distance between the apexes of teeth 46 and 36, and buccal inclination of the tooth 36 were noted, however, only the latter was statistically significant (p <0.05). This has allowed us to conclude that, in procedures of surgically assisted rapid maxillary expansion, dento-skeletal effects are predominantly maxillary, but mandibular effects may also occur, mainly without statistical significance.

Objective: To determine the prevalence and odds ratios for cleft lip and/or palate (CL/P) among infants prenatally exposed to opioids with or without neonatal opioid withdrawal syndrome (NOWS). Design: This study represents an exploratory, retrospective cohort study design of newborn medical health records from 2011 to 2016. Setting: Records were drawn from a regional health system located in South Central Appalachia. Population and study sample: The original population yielded 3 cohorts of infants: (1) infants with opioid exposure (OE) but not requiring pharmacological intervention (OE; N = 168); (2) infants with NOWS requiring pharmacological intervention (N = 294); and (3) infants with no opioid exposure (NOE; N = 16 090), the primary comparison group. Main outcome: Infants in the NOWS and OE groups showed significantly increased prevalence and odds ratios for CL/P when compared to those in the NOE group. Results: Prevalence rates per 1000 live births for infants with OE (35.71) and infants with NOWS (6.80) were significantly higher than those for infants with NOE (1.37). Comparison of infants with OE to the NOE group revealed significantly increased odds for CL/P, isolated cleft palate (CP), cleft lip (CL), and cleft lip and palate (CLP) (27.05, 41.81, 19.26, 19.37, respectively; all Ps < .008). The odds ratios for infants with NOWS compared to the NOE group were significantly higher for CL/P and CP (5.00 and 10.98, respectively; Ps < .03) but not for CL and CLP. Conclusion: The results provide additional evidence that prenatal OE should be considered among the critical environmental risk factors that can contribute to CL/P.

Introduction : L’arthrite juvénile idiopathique (AJI) désigne un groupe d’arthrites hétérogènes entrainant à terme la destruction des tissus durs et mous d’une ou plusieurs articulations chez les enfants. L’articulation temporo-mandibulaire (ATM) est fréquemment concernée, ce qui peut donner lieu à des difformités dento-squelettiques sévères chez ces enfants en croissance. Les patients présentent davantage de micrognathies et rétrognathies mandibulaires avec un patron squelettique de classe II, d’asymétries faciales, de manque transverse maxillaire et de béances antérieures. L’hypoplasie maxillaire et la rétrognathie mandibulaire auront pour conséquence une restriction des voies respiratoires, que les patients vont tenter de compenser en réalisant une extension de la tête, objectivée par une posture cranio-cervicale en extension. Objectifs : L’objectif primaire de cette étude était d’évaluer l’effet de l’expansion palatine rapide (EPR) sur la posture cranio-cervicale des patients atteints d’AJI. L’objectif secondaire était d’évaluer la correction de la malocclusion antéro-postérieure. L’objectif tertiaire était de corréler ces résultats avec la correction des asymétries maxillaire et mandibulaire. Matériels et méthodes : L’échantillon était constitué de deux groupes de patients : AJI (n= 11) et contrôle (n=11). Tous étaient âgés de 8 à 15 ans et présentaient un manque transverse maxillaire. Une EPR a été réalisée au moyen d’un appareil de type Hyrax. Un questionnaire de santé, un questionnaire de respiration, un examen orthodontique et un examen radiologique ont été réalisés au temps T0 (initial) et T1 (fin de la période de rétention) pour chaque patient. Les effets de l’EPR sur la posture cranio-cervicale et sur la malocclusion squelettique antéro-postérieure ont été analysés au moyen de points et lignes céphalométriques sur une téléradiographie de profil, et les effets de l’EPR sur l’asymétrie maxillo-mandibulaire ont été évalués sur une tomodensitométrie volumique à faisceau conique (TVFC). Résultats : La réalisation d’une EPR n’a pas donné lieu à des changement significatifs de la posture cranio-cervicale, ni chez les patients AJI ni chez les patients sains. Toutefois, une tendance à une flexion de la tête sur la colonne cervicale a pu être objectivée chez les patients AJI après EPR. Concernant la malocclusion antéro-postérieure, les patients avec AJI présentaient significativement plus de malocclusion de Classe II par rétrognathie mandibulaire en comparaison avec le groupe contrôle : angle SNB diminué (p=0.01), angle ANB augmenté (p=0.02), Wits augmenté (p=0.02). Après EPR, une légère réduction de la Classe II par repositionnement de la mandibule vers l’avant a pu être observé, mais le changement n’était significatif dans aucun des deux groupes. Enfin, l’asymétrie maxillo-mandibulaire n’était pas corrigée par l’EPR ni dans le groupe contrôle, ni dans le groupe témoin. Néanmoins, l’étude a mis en évidence une ouverture de l’occlusion après expansion : l’inclinaison du plan occlusal était augmentée de 2,53° entre T0 et T1 (p=0,015). Conclusion : Les enfants atteints d'AJI présentaient significativement plus de malocclusions squelettiques de classe II que le groupe contrôle. Nos résultats n'ont pas montré d'amélioration significative après le traitement par EPR en termes de paramètres posturaux, de correction de la classe II ou de réduction de l'asymétrie par rapport au groupe contrôle. Aucun patient n'ayant signalé d’effet néfaste pendant le traitement, l'EPR pourrait être utile pour corriger la dysharmonie transversale maxillaire chez les patients souffrant d'AJI et présentant une maladie en phase latente. / Introduction : Juvenile idiopathic arthritis (JIA) refers to a group of heterogeneous arthritis, leading to the eventual destruction of the hard and soft tissues of one or more joints in children. The temporomandibular joint (TMJ) is frequently affected, which can lead to severe dento-skeletal deformities in these growing children. Patients show more mandibular micrognathia and retrognathia with a Class II skeletal pattern, more facial asymmetries and reduced transverse palatal dimension. Maxillary hypoplasia and mandibular retrognathia result in airway restriction, which the patient will attempt to compensate for by extending their heads, as evidenced by an extended cranio-cervical posture. Objectives : The primary objective of this study was to evaluate the effect of rapid palatal expansion (RPE) on the craniocervical posture of patients with JIA. The secondary objective was to assess the correction of anteroposterior malocclusion. The tertiary objective was to correlate these results with the correction of maxillary and mandibular asymmetries. Materials and methods : The sample consisted of two groups of patients: JIA (n= 11) and control (n=11). All were aged between 8 and 15 years old and had a maxillary transverse discrepancy. RPE was performed using a Hyrax-type appliance. A health questionnaire, a breathing questionnaire, an orthodontic examination and evaluation by lateral cephalometric radiographs and cone-beam computed tomography (CBCT) were performed at time T0 (initial) and at T1 (end of retention period) for each patient. The effects of RPE on craniocervical posture and skeletal malocclusion were analyzed using cephalometric landmarks on lateral teleradiography, and the effects of RPE on maxillo-mandibular asymmetry were assessed on three-dimensional radiography. Results : No significant differences in craniocervical posture could be found, neither in JIA group, nor in control group, between T0 (before RPE) and T1 (after RPE). However, a tendency toward a head flexion on the cervical spine was observed in patients with JIA after RPE. Regarding anteroposterior malocclusion, JIA patients showed significantly more Class II mandibular retrognathic malocclusion than the control group: SNB angle decreased (p=0.01), ANB angle increased (p=0.02), Wits increased (p=0.02). After RPE, a slight reduction in Class II was observed by repositioning the mandible forward, but the change was not significant in either group. Finally, maxillo-mandibular asymmetry was not corrected by RPE in either the control or the non-control groups. Nevertheless, the study did demonstrate an opening of the occlusion after expansion: the inclination of the occlusal plane was increased by 2.53° between T0 and T1 (p=0.015). Conclusions : Children with JIA had significantly more Class II skeletal malocclusion than the control group. Our results didn’t show any significant improvement after RPE treatment in terms of postural parameters, Class II correction or asymmetry reduction when compared to control group. Since no patient reported any inconvenience during treatment, RPE could be helpful to correct maxillary transverse discrepancy in JIA patient with latent disease.

Introduction : L’expansion palatine rapide assistée chirurgicalement (EPRAC) est une option de traitement privilégiée chez les patients ayant atteint la maturité squelettique et présentant une déficience transverse du maxillaire. L’effet bénéfique de l’EPRAC sur la fonction respiratoire est régulièrement mentionné, toutefois, encore peu d’études ont évalué son impact sur les voies aériennes supérieures. L’objectif de cette étude clinique prospective comparative consistait à évaluer les effets tridimensionnels de l’EPRAC sur la cavité nasale, le nasopharynx et l’oropharynx à l’aide de la tomodensitométrie. Méthodologie : L’échantillon était constitué de 14 patients (5 hommes, 9 femmes) dont l’âge moyen était de 23,0 ± 1,9 ans (16 ans 4 mois à 39 ans 7 mois). Tous ont été traités avec un appareil d’expansion de type Hyrax collé et l’expansion moyenne a été de 9,82 mm (7,5 - 12,0 mm). Tous ont eu une période de contention d’une année avant le début de tout autre traitement orthodontique. Une évaluation par tomodensitométrie volumique à faisceau conique a été réalisée aux temps T0 (initial), T1 (6 mois post-expansion) et T2 (1an post-expansion) et le volume des fosses nasales, du nasopharynx et de l’oropharynx ainsi que les dimensions de la zone de constriction maximale de l’oropharynx ont été mesurés sur les volumes tridimensionnels obtenus. Résultats : Les résultats radiologiques ont démontré une augmentation significative du volume des fosses nasales et du nasopharynx ainsi qu’une augmentation de la zone de constriction maximale de l’oropharynx à 6 mois post-expansion. Par la suite, une portion du gain enregistré pour ces trois paramètres était perdue à un an post-EPRAC sans toutefois retourner aux valeurs initiales. Aucun effet significatif sur le volume de l’oropharynx n’a été observé. De plus, aucune corrélation significative entre la quantité d’expansion réalisée et l’ensemble des données radiologiques n’a été observée. L’analyse de la corrélation intra-classe a démontré une excellente fiabilité intra-examinateur. Conclusions : L’EPRAC entraîne un changement significatif du volume de la cavité nasale et du nasopharynx. L’EPRAC ne modifie pas le volume de l’oropharynx, par contre, un effet significatif sur la zone de constriction maximale de l’oropharynx est noté. Les effets observés n’ont pas de corrélation avec le montant d’activation de la vis d’expansion. / Introduction: Surgically assisted rapid palatal expansion (SARPE) is a treatment of choice for patients who have reached skeletal maturity and present a maxillary transverse deficiency. It is often mentioned that SARPE has the benefit to improve respiratory function, however, only a few research projects have investigated the effects of SARPE on the upper airways. The objective of this clinical prospective comparative study was to evaluate the three-dimensional effects of SARPE on the nasal cavity, the nasopharynx and the oropharynx using computed tomography. Materials and Methods: The sample consisted of 14 subjects (5 males, 9 females) whose mean age was 23.0 ± 1.9 years (range: 16 y. 4 mo. to 39 y. 7 mo.). All patients were treated using a bonded Hyrax expander and the mean expansion was 9.82 mm (7.5-12.0 mm). A one-year retention period was undertaken before the beginning of any other orthodontic treatment. A cone-beam computed tomography (CBCT) evaluation was performed at T0 (initial), T1 (6 months post-expansion) and T2 (1 year post-expansion), and then the nasal cavity, nasopharyngeal and oropharyngeal volumes and the oropharyngeal minimal cross-sectional area were measured on the three-dimensional volumes that were obtained. Results: Radiological results have demonstrated a significant increase of the nasal and nasopharyngeal volumes and also an increase of the oropharyngeal minimal cross-sectional area at 6 months post-expansion. At one year post-SARPE, for these three parameters, a part of the gain was lost but did not return to the initial values. No significant effect on oropharyngeal volume was found. No significant correlation between expansion screw activation and radiological parameters were noted. Intra-class correlation analysis showed excellent intra-examiner reliability. Conclusions: SARPE causes significant changes of the nasal cavity and nasopharyngeal volumes. SARPE does not modify the oropharyngeal volume, but induces significant changes of the oropharyngeal minimal cross-sectional area. The observed effects do not have a correlation with the amount of expansion screw activation.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Introduction : Le bruxisme du sommeil est un désordre du mouvement décrit comme un mouvement involontaire de la mastication durant le sommeil. Cette parafonction est observée dans 14-38% de la population pédiatrique. Un lien a été trouvé entre les événements respiratoires et les épisodes de bruxisme. L’expansion palatine rapide (EPR) est un traitement orthopédique effectué chez les enfants en croissance pour régler un manque transverse squelettique du maxillaire supérieur. Quelques études ont observé que l’apnée obstructive du sommeil a été diminuée par un traitement d’expansion palatine rapide. Objectifs : Étant donné que le bruxisme est en lien avec des événements respiratoires et que l’expansion palatine rapide augmente la dimension des cavités nasales, l’objectif de la présente étude est d’évaluer la possible réduction du bruxisme après le traitement d’expansion rapide. Méthodes : Ce projet pilote est une étude clinique randomisée contrôlée de patients consécutifs qui a inclus 27 enfants (8-14 ans, 8 garçons et 19 filles) avec ou sans bruxisme du sommeil. Tous ces patients sont venus à la clinique d’orthodontie de l’Université de Montréal et présentaient un manque transverse du maxillaire supérieur (au moins 5 mm). Dans le cadre de l’étude, les patients devaient passer un enregistrement polysomnographique ambulatoire avant le traitement d’expansion palatine (T0) et après l’activation de l’appareil d’expansion (T1). Résultats : Les résultats démontrent une diminution du bruxisme chez 60% (9 patients) de nos patients bruxeurs. L’interaction entre le traitement et les groupes (Br et Ctl) s’est avérée significative (p=0,05 ANOVA mesures répétées), et démontre une diminution du bruxisme chez les bruxeurs (p=0,04, t-test paire). Les médianes (min, max) du groupe avec bruxisme sont passées de 3,11 (2,06; 7,68) à 2,85 (0,00; 9,51). Les paramètres de sommeil sont restés stables (Stade N1/N2/N3, REM, efficacité du sommeil), ainsi que les paramètres respiratoires et le ronflement. Conclusion : Une réduction du bruxisme a été observée lors de cette étude, mais un échantillonnage plus grand est nécessaire pour conclure. / Introduction: Sleep bruxism (SB) is a movement disorder described as an involuntary mastication movement during sleep. This parafunction is observed in 14-38% of the child population. A link was found between respiratory events and episodes of bruxism. Rapid palatal expansion (RPE) in children is an orthopedic treatment that is effective in correcting maxillary transverse deficiency and in reducing obstructive apnea syndrome (OAS) by increasing airway capacity. Objectives : Since bruxism is related to respiratory events and RPE increases respiratory capacity, the objective of this study is to evaluate the possible reduction of bruxism after RPE therapy. Material and Methods : This prospective randomized controlled clinical pilot study recruited 27 children (8-14 years old, 8 boys, 19 girls) with or without sleep bruxism. These patients were seeking treatment for transverse maxillary deficiency (5 mm or more) at the orthodontics department of the University of Montreal. Patients underwent an ambulatory polysomnography before (T0) and after expansion (T1). Sleep parameters, rhythmic muscular masticatory activity index were evaluated. Results : The results show a reduction of bruxism in 60% of bruxer patients (9 participants). The interaction between the treatment and the groups (Br and ctl) was significant (p=0,05, repeated measures ANOVA). A reduction of bruxism is shown for bruxers (p=0,04, paired t-test). The sleep parameters stayed stable after RPE (Stage N1/N2/N3, REM, sleep efficiency) as well as the breathing parameters and snoring data. The medians (min, max) of bruxism group went from 3,11 (2,06; 7,68) to 2,85 (0,00; 9,51). Conclusion : During this study, a reduction of bruxism was observed but a larger sample size is needed to conclude on the subject.

INTRODUÇÃO: A literatura confirma a relação existente entre os Distúrbios Respiratórios do Sono (DRS) e os sintomas do Transtorno do Déficit de Atenção/Hiperatividade (TDAH). Há estudos que mostram o efeito dos tratamentos para DRS no comportamento, observando-se, após adenotonsilectomia, melhora nos índices dos testes de comportamento, assim como no desempenho escolar das crianças com TDAH. Considerando-se a relação existente entre a Respiração Oral (RO) e os DRS e entre estes e o TDAH, pretende-se avaliar se ocorrem interferências sintomáticas entre a RO e o TDAH, quando se obtém a reversão da RO em respiração nasal fisiológica, através da utilização do tratamento ortopédico funcional (utilização de placas ortopédicas, orientação para o fechamento labial, ginástica respiratória) e terapia fonoaudiológica. MÉTODOS: Neste estudo longitudinal, realizado entre janeiro de 2004 e janeiro de 2007, acompanhando pacientes com TDAH e RO, de 7 a 13 anos de idade, por 18 meses, no ambulatório de TDAH do Hospital das Clínicas/ FMUSP, comparamos os escores de testes comportamentais para TDAH (Conners e SNAP IV) em dois grupos de pacientes que estavam sendo tratados com metilfenidato, um dos quais recebeu tratamento ortopédico funcional e fonoaudiológico para a RO. RESULTADOS: 1) Não houve diferenças entre o grupo tratado e não tratado para a RO com respeito à idade; 2) Os escores dos questionários no grupo tratado para RO foram significantemente diminuindo (indicando melhora) em todas as variáveis (exceto Conners Pais -conduta anti-social), ao longo do tempo; 3) Os escores dos questionários no grupo tratado para RO foram significantemente menores (indicando melhora) do que os escores do grupo não tratado, para todas as variáveis estudadas, quando se comparam os dois grupos; 4) Esta melhora dos sintomas ocorreu após 12 meses de tratamento para RO e persistiu aos 18 meses; 5) dois dos oito pacientes do grupo tratado puderam interromper o metilfenidato, sendo que todos os pacientes do grupo não tratado ainda utilizam o medicamento. CONCLUSÕES: O Tratamento Ortopédico Funcional para RO, em conjunto com a terapia fonoaudiológica, foi efetivo para a melhora dos sintomas de TDAH em pacientes em tratamento com metilfenidato; a RO e os DRS devem ser investigados e tratados em pacientes com diagnóstico ou suspeita de TDAH, pois podem contribuir para a piora dos sintomas. / INTRODUCTION: A number of studies demonstrate the relationship between Sleep Respiratory Disorders (SRD) and symptoms of the Attention Deficit Hyperactivity Disorder (ADHD). Some of them assess the effect of the treatments for SRD on the behavior; for example, an improvement of the scores in the behavior tests, as well as in the school performance of children with TDAH is observed after adenotonsillectomy Considering the relation between mouth breathing (MB) and SRD and between these and the ADHD, we aimed to evaluate symptomatic interferences between MB and ADHD, through the reversion of MB in physiological nasal breath, by means of functional orthopedics treatment (use of orthopedics plates, orientation for labial closing, respiratory gymnastics) and speech therapy. METHODS: In this longitudinal study, performed between January of 2004 and January of 2007, 16 patients with ADHD and MB, aged 7 to 13 years, and who were being treated with methylphenidate, were followed-up for 18 months, in the outpatient clinic for ADHD at the Hospital das Clínicas da FMUSP. We compared the scores in ADHD tests (Conners and SNAP IV) of two groups of eight patients, one of which received functional orthopedics treatment and speech therapy for MB and the other did not. RESULTS: 1) The two groups were statistically equivalent by age; 2) The scores of the questionnaires in the group of patients treated for MB were significantly lowering (indicating improvement) regarding all the variables (except Conners Parents - antisocial behavior), along the follow-up period; 3) The scores of the questionnaires in the treated group were significantly lower (indicating improvement) of the scores in no treated group, for all the studied variables, when the two groups are compared; 4) This improvement of the symptoms occurred 12 months after the beginning of the treatment for MB and persisted at 18 months; 5) two of the eight patients from the treated group were indicated for interrupting the methylphenidate; however, all patients of the group not treated were still utilizing the medication. CONCLUSIONS: Functional the Orthopedics Treatment for MB, associated with speech therapy, was effective for the improvement of the symptoms of ADHD in patients who were being treated with methylphenidate; MB and SRD must be investigated and treated in patients with diagnosis or suspicion of ADHD, as they can contribute for the worsening of the symptoms.

Introdução- Obstrução das vias aeríferas superiores associadas a mudanças nos padrões de sono, estão diretamente relacionados a problemas de crescimento e aprendizagem, o que interfere com a qualidade de vida das crianças com este quadro. Métodos de expansão maxilar já mostraram efeito favorável sobre a função respiratória. Aparelhos removíveis intra-orais têm sido usados no tratamento do ronco e apneia do sono, buscando reequilibrar a postura da mandíbula e da língua para melhorar a função respiratória. O objetivo deste trabalho é avaliar as dimensões da faringe, o crescimento craniofacial e os sintomas respiratórios obstrutivos em crianças com ronco e aumento das tonsilas faríngeas e palatinas em tratamento com um aparelho ortodôntico e ortopédico bucal. Métodos- Quarenta crianças de 6 a 9 anos de idade com tonsilas faríngeas e palatinas graus 3 e 4 e apresentando maxila atrésica e sobressaliência anterior foram divididos em dois grupos aleatórios: 24 pacientes tratados com o aparelho oral e 16 controles não tratados. As dimensões da faringe foram medidas por faringometria acústica. Cefalometria avaliou o crescimento facial, incluindo os valores relacionados com a apnéia do sono. Os pais preencheram questionários sobre os sintomas respiratórios da criança. Os pacientes foram reavaliados após 6 meses, em ambos os grupos. Resultados: A faringometria acústica confirmou um aumento volumétrico de 3,1 cm3 (d.p. ± 2,5) na faringe, no grupo de estudo e uma redução volumétrica de -1,2 cm3 (d.p. ± 1,3) no não tratado (p <0,001). A área mínima de colapsibilidade no grupo de estudo apresentou incremento de 1,1 cm2 (dp ± 0,2) para 1,3 cm2 (d.p. ± 0,2) e uma redução no grupo controle de 1,5 cm2 (dp ± 0,3) para 1,3 cm2 (d.p. ± 0,3) estatisticamente significante (p <0,001). A cefalometria comprovou crescimento craniofacial mais favorável no grupo de estudo, em comparação aos controles, incluindo os valores relacionados a apnéia do sono, como ANB, MMPA e H-ML (p <0,001) . O questionário de sintomas confirmou uma melhoria no padrão de respiração e sono no grupo tratado. Conclusão- As crianças que foram submetidos a esse protocolo de tratamento apresentaram aumento de dimensões da faringe, direção de crescimento mais favorável, e uma melhora na respiração e qualidade do sono / Introduction- Airway obstruction due to associated changes in sleep patterns are directly related to problems of growth and learning, which interfer with the quality of life for these children. Maxillary expansion methods have shown favorable effect on respiratory function. Intra-oral removable appliances have been used in the treatment of snoring and sleep apnea, seeking to rebalance the posture of the jaw and tongue to improve breathing function. The purpose of this thesis is evaluate the facial growth, pharyngeal dimensions and respiratory symptoms in snoring children with enlarged tonsils and adenoids under treatment with an orthodontic and orthopedic oral appliance. Methods- Forty snoring children ages 6 to 9 years old with tonsil and adenoid enlargement grades 3 and 4 and presenting constricted maxilla were divided into two randomized groups: 24 patients treated with the oral appliance and 16 untreated controls. Pharyngeal size was measured by acoustic pharyngometry. Cephalometry evaluated the facial growth including values related to sleep apnea. Pharyngeal size was measured by acoustic pharyngometry. Parents filled out questionnaires about their child\'s respiratory symptoms. Patients were re-evaluated after 6 months, in both groups Results- Acoustic pharyngometry confirmed a volumetric gain of 3.1 cm3 (s.d. ±2.5) in the pharynx at the study group and a volumetric reduction of -1.2 cm3 (s.d. ±1.3) at the untreated (p<0.001). The minimum area on collapsibility at the study group showed an increment from1.1 cm2 (s.d.±0.2) to 1.3 cm2 (s.d.±0.2) and a reduction on the control group from 1.5 cm2 (s.d.±0.3) to 1.3 cm2 (s.d.±0.3) statistically significant (p<0.001). Cephalometry showed a more favorable facial growth on the study group compared to controls, including values related to sleep apnea prediction such as ANB, MMPA and H-ML (p<0.001). The symptoms questionnaire confirmed an improvement on the breathing pattern at the group treated. Conclusions- Children who underwent this treatment protocol presented more favorable growth direction, enlargement of pharyngeal dimensions, and an improvement in breathing and sleep