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        "titulo" => "Influ&#234;ncia do modo de respira&#231;&#227;o sobre o desenvolvimento craniofacial e a postura da cabe&#231;a"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Marcos cefalom&#233;tricos&#44; &#226;ngulos e planos de refer&#234;ncia&#46; Padr&#227;o de crescimento&#58; 1&#46; &#194;ngulo do PF&#8208;PM formado pelo plano facial &#40;n&#8208;Pg&#41; e pelo plano mandibular &#40;Gn&#8208;Go&#41;&#46; O plano facial &#233; formado por n&#225;sio &#40;N&#41; e pogonion &#40;Pg&#41;&#46; O plano mandibular &#233; formado por gnation &#40;Gn&#41; e gonion &#40;Go&#41;&#59; Altura facial&#58; 2&#46; FCNA &#194;ngulo formado pelo ponto central facial &#40;FC&#41; e linha FC&#8208;nasion e linha FC&#8208;subespinhal &#40;A&#41;&#59; 3&#46; Xi&#8208;ENA&#8208;Pm &#194;ngulo formado pelo centro do ponto ramus &#40;Xi&#41; e pela linha Xi&#8208;espinha nasal anterior &#40;ENA&#41; e pela linha Xi&#8208;suprapogonio &#40;Pm&#41;&#59; Maxila&#58; 4&#46; SNA &#194;ngulo formado pela linha de base do cr&#226;nio &#40;SN&#41; e pela linha N&#8208;subespinhal &#40;A&#41;&#46; A base do cr&#226;nio &#233; um plano desde a sela &#40;S&#41; at&#233; nasion &#40;N&#41;&#59; 5&#46; ENA&#8208;ENP Dist&#226;ncia entre a espinha nasal anterior &#40;ENA&#41; e a espinha nasal posterior &#40;ENP&#41;&#59; 6&#46; ENA&#8208;ENP&#8208;FhP &#194;ngulo formado pelo plano palatino b &#40;ENA&#8208;ENP&#41; e pelo plano Frankfurt &#40;FhP&#41;&#46; O plano Frankfurt &#233; formado pelo orbitale b &#40;Or&#41; e porion &#40;Po&#41;&#59; Mand&#237;bula&#58; 7&#46; SNB &#194;ngulo formado pela linha de base do cr&#226;nio &#40;SN&#41; e pela linha N&#8208;supramentale &#40;B&#41;&#59; 8&#46; MP&#8208;FhP &#194;ngulo formado pelo plano mandibular &#40;PM&#41; e pelo plano Frankfurt &#40;FhP&#41;&#59; 9&#46; Go&#8208;FC Dist&#226;ncia do gonion &#40;Go&#41; at&#233; o centro facial &#40;FC&#41;&#59; 10&#46; Xi&#8208;Pm Dist&#226;ncia de Xi a suprapogonion &#40;Pm&#41;&#59; Maxila&#8208;Mand&#237;bula&#59; 11&#46; ANB &#194;ngulo formado pela linha subespinhal &#40;A&#41; e nasion &#40;N&#41; e linha N&#8208;supramentale &#40;B&#41;&#59; Osso hioide&#58; 12&#46; H&#8208;MP Dist&#226;ncia do ponto mais anterior e superior do osso hioide &#40;H&#41; perpendicular ao plano mandibular &#40;PM&#41;&#59; Postura craniocervical&#59; 13&#46; OPT&#8208;SN &#194;ngulo formado por &#40;SN&#41; e odontoides &#40;OPT&#41;&#46; O OPT &#233; formado por uma linha por meio do ponto posterossuperior e posteroinferior do odontoides&#59; 14&#46; CVT&#8208;SN &#194;ngulo formado por &#40;SN&#41; e cervical &#40;CVT&#41;&#46; O CVT &#233; formado por uma linha por meio do ponto posterossuperior e posteroinferior da cervical&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A respira&#231;&#227;o fisiol&#243;gica &#233; comumente afetada por problemas anat&#244;micos ou funcionais&#44; faz com que o ciclo respirat&#243;rio seja iniciado n&#227;o apenas pelo nariz&#44; mas tamb&#233;m pela boca&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1&#44;2</span></a> Em compara&#231;&#227;o com crian&#231;as com respira&#231;&#227;o nasal &#40;RN&#41;&#44; as crian&#231;as com respira&#231;&#227;o bucal &#40;RB&#41; apresentam maior risco de sono agitado&#44; diaforese&#44; enurese noturna e&#44; em alguns casos&#44; at&#233; mesmo s&#237;ndrome de apneia do sono&#46; O sono de baixa qualidade significa sonol&#234;ncia diurna&#44; irritabilidade e dores de cabe&#231;a<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> com probabilidade de afetar negativamente o desempenho acad&#234;mico&#46; Al&#233;m disso&#44; a presen&#231;a de fala hiponasal ou altera&#231;&#245;es na fala<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> aumenta a probabilidade de a crian&#231;a ser classificada com dificuldades de aprendizagem&#46; De fato&#44; muitas dessas crian&#231;as s&#227;o erroneamente diagnosticadas com Transtorno de D&#233;ficit de Aten&#231;&#227;o e Hiperatividade &#40;TDAH&#41; e&#44; &#224;s vezes&#44; medicadas de forma errada&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">V&#225;rios estudos postulam que as crian&#231;as com RB mostram caracter&#237;sticas das &#8220;f&#225;cies adenoideanas&#8221; t&#237;picas&#58; redu&#231;&#227;o no prognatismo facial&#44; nariz e narinas pequenas&#44; l&#225;bio superior curto e postura de boca aberta que pode ser a fonte de rota&#231;&#227;o para tr&#225;s e para baixo da mand&#237;bula&#44; que causa aumento no desenvolvimento vertical da face anterior inferior e dimens&#227;o anteroposterior mais estreita das vias a&#233;reas&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1&#44;6&#8208;8</span></a> O desequil&#237;brio muscular desses pacientes&#44; devido a recondicionamento anat&#244;mico&#44; pode levar a hiperextens&#227;o cr&#226;nio&#8208;cervical e cifose postual&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#44;10</span></a> H&#225; ainda relatos de diferentes tipos de m&#225; oclus&#227;o&#44; como mordidas abertas&#44; mordidas cruzadas anteriores e&#47;ou posteriores&#44; m&#225; oclus&#227;o Classe II&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> constri&#231;&#227;o do palato e sorrisos gengivais&#44; que resultam em caracter&#237;sticas faciais n&#227;o atrativas&#46; Al&#233;m disso&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> as crian&#231;as com RB normalmente sofrem de gengivite cr&#244;nica&#44; periodontite&#44; infec&#231;&#245;es por c&#226;ndida&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a> eros&#227;o dent&#225;ria e c&#225;ries&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a> Devido &#224; dificuldade de respira&#231;&#227;o e mastiga&#231;&#227;o simultaneamente por longos per&#237;odos&#44; a efici&#234;ncia mastigat&#243;ria reduz&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Isso&#44; por sua vez&#44; faz com que a crian&#231;a prefira por alimentos moles e&#44; comumente&#44; n&#227;o nutritivos aumente que aumentam a possibilidade de m&#225; oclus&#227;o e c&#225;ries nas crian&#231;as com RB&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Uma comprova&#231;&#227;o publicada &#233; inconclusiva&#44; em parte&#44; devido aos padr&#245;es de crescimento n&#227;o terem sido considerados&#44; devido ao fato de algumas caracter&#237;sticas f&#237;sicas serem compartilhadas por indiv&#237;duos com padr&#227;o de crescimento vertical predominante&#44; que&#44; por sua vez&#44; s&#227;o mais propensos a ser crian&#231;as com RB&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> Al&#233;m disso&#44; adenoides menores e matura&#231;&#227;o oclusal n&#227;o foram usados como par&#226;metros de classifica&#231;&#227;o na compara&#231;&#227;o entre os indiv&#237;duos&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> Ademais&#44; diferentes ferramentas de diagn&#243;stico foram usadas para classificar as formas de respira&#231;&#227;o&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">O principal objetivo desta pesquisa foi avaliar as diferen&#231;as cefalom&#233;tricas nas estruturas craniofaciais &#40;ou seja&#44; a forma e a posi&#231;&#227;o da maxila&#44; da mand&#237;bula&#44; das vias a&#233;reas superiores e do osso hioide&#41; e na postura da cabe&#231;a entre crian&#231;as e adolescentes com respira&#231;&#227;o nasal &#40;RN&#41; e respira&#231;&#227;o bucal &#40;RB&#41; com um padr&#227;o de crescimento facial normal&#44; com uma ferramenta de diagn&#243;stico mensur&#225;vel do tipo de respira&#231;&#227;o e crit&#233;rios rigorosos de sele&#231;&#227;o de pacientes&#46; Hipotetizamos que h&#225; diferen&#231;as anat&#244;micas nas estruturas craniofaciais em crian&#231;as e adolescentes com RB em compara&#231;&#227;o com RN&#44; mesmo em pacientes com padr&#227;o de crescimento facial normal&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participantes</span><p id="par0025" class="elsevierStylePara elsevierViewall">Os participantes foram recrutados durante consulta cl&#237;nica de rotina na Faculdade de Odontologia Infantil Integrada na Universidade de Sevilha&#46; Os crit&#233;rios de inclus&#227;o foram&#58; meninos e meninas brancos entre sete e 16 anos&#59; apar&#234;ncia de padr&#227;o de crescimento normal e n&#227;o apresentarem altera&#231;&#245;es neurol&#243;gicas ou cong&#234;nitas&#44; doen&#231;as gen&#233;ticas&#44; malforma&#231;&#245;es craniofaciais&#44; doen&#231;a sist&#234;mica grave&#44; alergias respirat&#243;rias&#44; S&#237;ndrome da Apneia Obstrutiva do Sono &#40;SAOS&#41; ou asma&#46; Os crit&#233;rios de exclus&#227;o foram&#58; terem sido submetidos a qualquer cirurgia nas vias a&#233;reas superiores&#44; procedimentos ortod&#244;nticos ou ortop&#233;dicos&#44; uso prolongado de chupeta &#40;mais de seis meses&#41; e&#47;ou mamadeira &#40;mais de dois anos&#41;&#44; quaisquer h&#225;bitos como chupar dedos ou os l&#225;bios ou posi&#231;&#227;o anterior evidente da l&#237;ngua&#46; Das 180 crian&#231;as &#40;11&#44;3 &#177; 0&#44;2 anos&#41;&#44; 58&#44;3&#37; meninas e 41&#44;7&#37; meninos&#44; avaliados para elegibilidade&#44; 98 atenderam aos crit&#233;rios de inclus&#227;o&#46; Um dos pais e&#47;ou respons&#225;vel de todos os pacientes assinou o formul&#225;rio de consentimento informado&#46; O estudo e seu protocolo foram aprovados pelo Comit&#234; de &#201;tica em Pesquisa da Universidade Hospitals Virgen Macarena&#8208;Virgen del Rocio &#40;Sevilha&#44; Espanha&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Medidas</span><p id="par0030" class="elsevierStylePara elsevierViewall">O padr&#227;o de crescimento facial normal foi confirmado por &#237;ndice craniano e facial e par&#226;metros cefalom&#233;tricos &#40;PF&#8208;PM&#41; &#40;N &#61; 68 &#177; 3&#44;5&#41; para excluir as crian&#231;as com predisposi&#231;&#227;o a padr&#227;o de crescimento&#46; O &#237;ndice craniano mede os di&#226;metros transversais e anteroposteriores do cr&#226;nio com base na seguinte f&#243;rmula&#58; di&#226;metro transversal m&#225;ximo <span class="elsevierStyleBold">x</span> 100&#47;di&#226;metro anteroposterior m&#225;ximo&#46; Os escores s&#227;o classificados como segue&#58; dolicoc&#233;falo &#40;&#60; 76&#41;&#44; mesoc&#233;falo &#40;76&#8208;81&#41; ou braquic&#233;falo &#40;&#62; 81&#41;&#46; O &#237;ndice facial mede os par&#226;metros verticais e transversais das f&#225;cies&#46; A altura da face &#233; determinada a partir do plano superciliar &#40;linha de uni&#227;o das sobrancelhas&#41; e medida verticalmente at&#233; o ponto gn&#225;tio &#40;ou seja&#44; o ponto inferior do queixo&#41;&#46; A largura da face &#233; medida com base na largura bizigom&#225;tica como segue&#58; di&#226;metro vertical m&#225;ximo <span class="elsevierStyleBold">x</span> 100&#47;di&#226;metro transversal m&#225;ximo&#46; Os escores classificam as f&#225;cies como&#58; braquic&#233;falo &#40;&#62; 97&#41;&#44; mesoc&#233;falo &#40;97&#8208;104&#41; ou dolicoc&#233;falo &#40;&#60; 104&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A forma de respira&#231;&#227;o &#40;bucal ou nasal&#41; foi avaliada por um Sensor de Fluxo de Ar da Plataforma e&#8208;Health&#44; projetado pela Cooking Hacks &#40;Libelium&#174;&#44; Libelium Comunicaciones Distribuidas S&#46;L&#44; Zaragoza&#44; Espanha&#41;&#46; O sensor mediu a frequ&#234;ncia respirat&#243;ria nasal de forma precisa por meio da detec&#231;&#227;o de mudan&#231;as de temperatura no fluxo de ar&#46; Esse dispositivo consiste em um conjunto de dois pinos posicionados nas narinas e fixo por um fio flex&#237;vel&#44; que se encaixa atr&#225;s da orelha&#46; A respira&#231;&#227;o &#233; medida pelos sensores localizados dentro dos pinos&#46; Duas medi&#231;&#245;es foram feitas em diferentes hor&#225;rios para evitar flutua&#231;&#245;es substanciais circunstanciais que possam afetar os resultados&#46; Os pacientes foram submetidos a um exame cl&#237;nico completo e seu hist&#243;rico e seus dados cl&#237;nicos foram coletados por meio de um question&#225;rio respondido pelos pais&#46; Com base nessas informa&#231;&#245;es&#44; os participantes foram classificados em pacientes com RB ou RN&#46; As crian&#231;as com RB foram definidas por uma frequ&#234;ncia respirat&#243;ria nasal menor &#40;abaixo de 17 respira&#231;&#245;es por minuto&#41;&#44; conforme medido por nossa equipe e com base nos relatos dos pais que nos informaram de uma respira&#231;&#227;o predominante bucal&#44; mostrava uma postura de boca aberta durante o dia e&#47;ou durante o sono &#40;a mudan&#231;a de posi&#231;&#227;o vertical para uma posi&#231;&#227;o supina pode causar mudan&#231;a na forma de respira&#231;&#227;o&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> Al&#233;m disso&#44; foram exclu&#237;das as crian&#231;as que apresentassem frequentemente tr&#234;s ou mais destes sintomas&#58; ronco&#44; pieira&#44; baba no travesseiro&#44; acordar durante a noite com falta de ar ou acordar cansado de manh&#227;&#46; As crian&#231;as foram classificadas como respira&#231;&#227;o nasal caso apresentassem alta frequ&#234;ncia respirat&#243;ria nasal &#40;acima de 18 respira&#231;&#245;es por minuto&#41;&#44; boca fechada durante o dia e &#224; noite e aus&#234;ncia dos sintomas descritos anteriormente&#46; Nossa classifica&#231;&#227;o foi assistida por um otorrinolaringologista por meio de rinomanometria&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Radiografias laterais foram tiradas na posi&#231;&#227;o de p&#233; com o corpo relaxado e na posi&#231;&#227;o natural da cabe&#231;a &#40;posi&#231;&#227;o de autoequil&#237;brio&#41;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> pelo equipamento de raios X Planmeca Promax &#40;Planmeca Oy&#41;&#44; na Faculdade de Odontologia da Universidade de Sevilha&#44; Espanha&#46; O cefalostato foi posicionado sem colocar press&#227;o para n&#227;o afetar a postura da crian&#231;a&#46; Marcos cefalom&#233;tricos tradicionais foram tra&#231;ados manualmente e radiografias digitais foram importadas para o sistema de um <span class="elsevierStyleItalic">software</span> comercialmente dispon&#237;vel &#40;Ortho TP&#174;&#44; Vimercate MicroLab&#44; Vimercate&#44; It&#225;lia&#41; e analisado novamente&#46; Os par&#226;metros cefalom&#233;tricos foram escolhidos com base em publica&#231;&#245;es anteriores<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;17&#8208;19</span></a> &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1 e 2</a>&#41;&#46; Contudo&#44; novas medi&#231;&#245;es foram feitas e acrescentaram as dimens&#245;es das vias a&#233;reas&#58;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">USP&#58; Dist&#226;ncia entre o ponto do palato mole &#40;5<span class="elsevierStyleHsp" style=""></span>mm abaixo do ponto superior do palato mole&#41; &#40;USP&#41; e o contraponto horizontal na parede posterior da faringe paralela ao Plano Frankfurt &#40;FhP&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">IT&#58; Dist&#226;ncia entre o ponto posterior e inferior da am&#237;gdala &#40;T&#41; &#40;5<span class="elsevierStyleHsp" style=""></span>mm acima do ponto inferior da amigdala&#41; at&#233; a contraponto horizontal na parede posterior da faringe paralela ao FhP&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">MPP&#58; Dist&#226;ncia dos pontos de interse&#231;&#227;o na parede anterior e posterior da faringe do meio do USP e da IT paralelos ao FhP&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">MP<span class="elsevierStyleInf">P</span>&#58; Dist&#226;ncia dos pontos de interse&#231;&#227;o na parede anterior e posterior da faringe do plano mandibular &#40;PM paralelo ao FhP&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">C3P&#58; Dist&#226;ncia entre a faringe posterior&#44; do ponto mais anterior e inferior no corpo da terceira v&#233;rtebra cervical &#40;C3&#41; e da faringe anterior &#40;P&#41; paralelas ao FhP&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para detectar erros na identifica&#231;&#227;o e nas medi&#231;&#245;es dos marcos&#44; 20 radiografias cefalom&#233;tricas laterais foram aleatoriamente selecionadas e comparadas pelo mesmo investigador duas semanas depois&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Por fim&#44; os pacientes foram divididos em duas faixas et&#225;rias &#40;G1 &#61; 7&#8208;9 anos&#41; &#40;7&#44;8 &#177; 0&#44;5 anos&#41; e &#40;G2 &#61; 10&#8208;16 anos&#41; &#40;12&#44;3 &#177; 1&#44;0 anos&#41; por tr&#234;s principais motivos&#58; 1&#46; Para evitar confundir a influ&#234;ncia do tipo de respira&#231;&#227;o sobre o desenvolvimento craniofacial com altera&#231;&#245;es normais no crescimento&#59; 2&#46; Para considerar o processo de matura&#231;&#227;o oclusal &#8211; associado a altera&#231;&#245;es na dimens&#227;o vertical da face &#8211; com base na varia&#231;&#227;o na erup&#231;&#227;o dos dentes permanentes para substituir a denti&#231;&#227;o mista&#59; e 3&#46; Para considerar a redu&#231;&#227;o das adenoides que inicia entre sete e 10&#44; que aumenta as diferen&#231;as nas dimens&#245;es nasofar&#237;ngeas&#46; Em crian&#231;as com menos de sete anos&#44; as adenoides ainda n&#227;o est&#227;o fisicamente presentes em um tamanho consider&#225;vel em crian&#231;as com RN e RB&#44; assim pode ser dif&#237;cil encontrar diferen&#231;as na zona de adenoides&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lises estat&#237;sticas</span><p id="par0080" class="elsevierStylePara elsevierViewall">Os dados foram analisados com os modelos estat&#237;sticos descritivos&#46; As vari&#225;veis quantitativas foram descritas com m&#233;dias e desvios&#8208; padr&#227;o e as diferen&#231;as foram testadas para relev&#226;ncia com o teste <span class="elsevierStyleItalic">t</span> de Student para amostras independentes&#46; As diferen&#231;as nas var&#225;veis n&#227;o param&#233;tricas foram testadas para relev&#226;ncia com o teste U de Mann&#8208;Whitney para amostras independentes&#46; A relev&#226;ncia estat&#237;stica foi estabelecida em p &#60; 0&#44;05&#46; A corre&#231;&#227;o de Bonferroni &#233; usada como o m&#233;todo de ajuste para manter a probabilidade do erro tipo I abaixo de 5&#37; &#40;0&#44;05&#41;&#46; Dessa forma&#44; o valor de p para considerar as diferen&#231;as estatisticamente significativas observadas ser&#225; 0&#44;05&#47;22 &#61; 0&#44;002&#46; Os testes estat&#237;sticos foram feitos com o <span class="elsevierStyleItalic">software</span> SPSS &#40;SPSS para Windows&#44; Vers&#227;o 16&#46;0&#46; Chicago&#44; EUA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">A m&#233;dia da frequ&#234;ncia respirat&#243;ria foi 18 respira&#231;&#245;es por minuto&#59; a menor frequ&#234;ncia respirat&#243;ria detectada foi de 12 respira&#231;&#245;es por minuto e maior frequ&#234;ncia foi de 25 respira&#231;&#245;es por minuto&#46; A m&#233;dia dos escores do &#205;ndice Craniano e Facial foi de 79&#44;3 &#177; 2&#44;4 e 101&#44;5 &#177; 1&#44;7&#44; respectivamente&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">As m&#233;dias e os desvios&#8208;padr&#227;o para vari&#225;veis cefalom&#233;tricas &#8211; craniofaciais&#44; posi&#231;&#227;o do osso hioide&#44; postura da cabe&#231;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41; e par&#226;metros das vias a&#233;reas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41; &#8211; de 56 pacientes com RB &#40;64&#44;6&#37;&#41; e de 42 pacientes com RN &#40;35&#44;4&#37;&#41; foram comparados por faixa et&#225;ria&#46; De acordo com a an&#225;lise cefalom&#233;trica lateral&#44; no G1 a dist&#226;ncia nas vias a&#233;reas na regi&#227;o das am&#237;dalas &#40;MPP&#41; foi menor em crian&#231;as com RB &#40;8&#44;0 &#177; 0&#44;7 anos&#41; do que em crian&#231;as com RN &#40;7&#44;6 &#177; 0&#44;9 anos&#41; &#40;<span class="elsevierStyleItalic">P</span> &#61; 0&#44;03&#41;&#46; N&#227;o foram constatadas diferen&#231;as estatisticamente significativas nas vias a&#233;reas do G2&#46; Contudo&#44; no G2&#44; a menor altura facial anterior &#40;Xi&#8208;ENA&#8208;Pm&#41; e o comprimento do palato &#40;ENA&#8208;ENP&#41; foram maiores nas crian&#231;as com RB &#40;12&#44;3 &#177; 2&#44;0 anos&#41; do que em crian&#231;as com RN &#40;12&#44;5 &#177; 1&#44;9 anos&#41; &#40;<span class="elsevierStyleItalic">P</span> &#61; 0&#44;015 e <span class="elsevierStyleItalic">P</span> &#61; 0&#44;049&#44; respectivamente&#41;&#46; Al&#233;m disso&#44; o osso hioide foi localizado em uma posi&#231;&#227;o mais baixa em rela&#231;&#227;o ao plano mandibular &#40;H&#8208;PM&#41; em adolescentes com RB do que o de adolescentes com RN&#46; Por fim&#44; n&#227;o foram encontradas diferen&#231;as estatisticamente significativas na postura da cabe&#231;a entre os pacientes com RB e RN em qualquer faixa et&#225;ria &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discuss&#227;o</span><p id="par0095" class="elsevierStylePara elsevierViewall">Estudos anteriores relatam que crian&#231;as com RB t&#234;m um padr&#227;o facial hiperdivergente<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">21&#8208;24</span></a> e uma altura facial anterior menor&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;11</span></a> observada em nossa pesquisa em adolescentes com RB &#40;G2&#41; com padr&#227;o facial normal&#44; por&#233;m n&#227;o no G1&#46; Foi observada que uma maior inclina&#231;&#227;o do plano mandibular&#44;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">22&#44;23</span></a> juntamente com uma rota&#231;&#227;o posterior do plano palatino&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> pode indicar a dire&#231;&#227;o vertical do crescimento mandibular<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">11&#44;26</span></a> e o desenvolvimento de uma m&#225; oclus&#227;o esquel&#233;tica classe II&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> Contudo&#44; nossos pacientes com RB &#40;63&#44;9&#37;&#41; apresentam oclus&#227;o esquel&#233;tica classe I&#46; De acordo com achados anteriores&#44; a maxila e a mand&#237;bula dos pacientes com RB mostraram&#8208;se mais retrusivas com rela&#231;&#227;o &#224; sua base esquel&#233;tica&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> Contudo&#44; Ucar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> observaram que apenas a maxila mostrou&#8208;se mais retrognata&#44; ao passo que outros constaram que apenas a mand&#237;bula mostrou&#8208;se mais retrusiva&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Nossos resultados mostram baixa posi&#231;&#227;o do osso hioide com rela&#231;&#227;o ao plano mandibular em pacientes com RB no G2&#44; o que corrobora achados anteriores de Cuccia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">As dimens&#245;es transversais nasofar&#237;ngeas aumentam com o restante dos tecidos do corpo durante o per&#237;odo de crescimento&#44; por&#233;m o tecido das adenoides come&#231;a a diminuir entre sete e 10 anos&#44; para desaparecer apenas na vida adulta&#46; Nossas medi&#231;&#245;es do espa&#231;o das vias a&#233;reas superiores foram menores nas crian&#231;as com RB do que nas com RN &#40;G1&#41; na regi&#227;o das am&#237;gdalas &#40;MPP&#41;&#44; por&#233;m n&#227;o bo G2&#44; corroborou o trabalho anterior&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> Portanto&#44; as am&#237;gdalas s&#227;o mais hipertr&#243;ficas em crian&#231;as do que em adolescentes&#46; Esse resultado pode ser afetado pela possibilidade de que as adenoides dos pacientes do G1 ainda n&#227;o estavam no est&#225;gio de iniciar sua redu&#231;&#227;o&#44; ao passo que as adenoides dos pacientes do G2 j&#225; haviam reduzido&#46; Al&#233;m disso&#44; as novas medi&#231;&#245;es das vias a&#233;reas em nosso estudo podem afetar nossa capacidade de compara&#231;&#227;o&#44; devido ao fato de que elas estavam paralelas ao Plano de Frankfurt &#40;um plano constante&#41; para evitar resultados comparativos incorretos com base em um plano vari&#225;vel&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">V&#225;rios estudos relatam pacientes com RB com hiperextens&#227;o cr&#226;nio&#8208;cervical&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> apesar de os problemas posturais serem significativamente mais comuns entre essas crian&#231;as&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> Nossa pesquisa mostrou altera&#231;&#227;o na postural da coluna cervical em 90&#44;3&#37; dos pacientes com RB&#44; por&#233;m&#44; como ambos os grupos apresentaram altos percentuais de hiperextens&#227;o craniofacial&#44; as diferen&#231;as n&#227;o foram estatisticamente significativas&#46; Especulamos que o uso intenso de novos dispositivos tecnol&#243;gicos pela popula&#231;&#227;o jovem&#44; como celulares e tablets&#44; pode contribuir para essa falta de diferen&#231;as substanciais na hiperextens&#227;o craniofacial&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Um estudo anterior constatou altera&#231;&#245;es miofuncionais e craniofaciais entre as crian&#231;as com RB entre 7&#8208;10 anos&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> ao passo que encontramos essas altera&#231;&#245;es em crian&#231;as com RB com idade m&#233;dia de 12&#44;3 &#177; 2&#44;0 &#40;G2&#41;&#46; A discrep&#226;ncia pode resultar do fato de esses estudos n&#227;o considerarem os padr&#245;es de crescimento&#46; Em nosso estudo&#44; exclu&#237;mos os pacientes com padr&#245;es diferentes de crescimento normal&#44; com base no &#237;ndice facial e nos par&#226;metros cefalom&#233;tricos&#44; pois os pacientes com padr&#227;o de crescimento vertical t&#234;m caracter&#237;sticas esquel&#233;ticas comuns&#44; ou seja&#44; dimens&#227;o anteroposterior mais estreita das vias a&#233;reas&#44; retrus&#227;o da maxila e da mand&#237;bula&#44; excesso maxilar vertical e maior discrep&#226;ncia esquel&#233;tica Classe II&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">19&#44;28</span></a> As caracter&#237;sticas desses pacientes podem ser um mecanismo compensat&#243;rio que pode gerar a transi&#231;&#227;o de RN para RB&#46; Por outro lado&#44; o padr&#227;o de crescimento horizontal normalmente &#233; caracterizado por mand&#237;bula mais anterior&#46; Isso resulta em via a&#233;rea far&#237;ngea inferior mais ampla&#44; que favorece a respira&#231;&#227;o nasal&#46; Portanto&#44; pode&#8208;se concluir que os padr&#245;es de crescimento podem afetar ou beneficiar a fun&#231;&#227;o respirat&#243;ria fisiol&#243;gica&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">&#201; importante conseguir detectar os pacientes com predomin&#226;ncia de RB&#46; Um encaminhamento antecipado para corre&#231;&#227;o dessa fun&#231;&#227;o patol&#243;gica &#233; essencial para a preven&#231;&#227;o de irregularidades no desenvolvimento craniofacial e de problemas ortod&#244;nticos&#46; Ao eliminar o padr&#227;o de crescimento de confus&#227;o em nosso estudo e comparar os pacientes de acordo com seu est&#225;gio de crescimento&#44; podemos detectar se h&#225; de fato diferen&#231;as entre as crian&#231;as &#40;G1&#41; e adolescentes &#40;G2&#41; com RN e RB&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Este estudo tem certas limita&#231;&#245;es&#46; Primeiro&#44; em um estudo transversal&#44; as associa&#231;&#245;es n&#227;o indicam rela&#231;&#245;es causais&#46; De fato&#44; Shanker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> constataram que v&#225;rias crian&#231;as mudaram entre modo de respira&#231;&#227;o bucal e nasal durante os quatro anos de sua investiga&#231;&#227;o&#46; Contudo&#44; como com qualquer doen&#231;a trat&#225;vel ou evit&#225;vel&#44; a possibilidade de um estudo longitudinal observacional sem interveniente assim que a RB &#233; detectada &#233; evitada por motivos &#233;ticos&#46; Segundo&#44; o pequeno tamanho da amostra resultante de nossos crit&#233;rios de sele&#231;&#227;o rigorosos pode ter limitado o poder das an&#225;lises para detectar diferen&#231;as adicionais&#46; Terceiro&#44; como n&#227;o recrutamos participantes com RN e RB&#44; o poder de nossas an&#225;lises pode ter sido afetado por essa diferen&#231;a substancial nos tamanhos dos subgrupos comparados&#46; Apesar dessas limita&#231;&#245;es&#44; nossos achados podem ajudar os profissionais de sa&#250;de no melhor manejo dos pacientes com altera&#231;&#245;es da respira&#231;&#227;o&#44; sabe&#8208;se que isso pode indicar um desequil&#237;brio de desenvolvimento&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">O estudo tamb&#233;m tem seus pontos fortes&#46; Nossos crit&#233;rios de sele&#231;&#227;o altamente precisos&#44; ao incluir apenas pacientes com padr&#227;o de crescimento normal&#44; reduziram o poss&#237;vel vi&#233;s&#44; inclusive crian&#231;as com predisposi&#231;&#227;o gen&#233;tica para RB&#46; Al&#233;m disso&#44; a matura&#231;&#227;o oclusal e a redu&#231;&#227;o fisiol&#243;gica das adenoides foram consideradas ao comparar nossos resultados&#46; Por fim&#44; usamos um sensor que forneceu dados mensur&#225;veis para melhor classificar o modo de respira&#231;&#227;o dos pacientes&#46; At&#233; onde sabemos&#44; esse dispositivo de mensura&#231;&#227;o nunca havia sido usado nesse contexto&#46; Isso&#44; em associa&#231;&#227;o ao fato de que usamos um plano constante como refer&#234;ncia para medi&#231;&#245;es das vias a&#233;reas&#44; pode provar que nossos dados s&#227;o mais precisos do que os usados na maior parte das pesquisas anteriores&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Ap&#243;s examinar as crian&#231;as e os adolescentes com padr&#227;o de crescimento normal&#44; nosso estudo mostra que h&#225; diferen&#231;as cefalom&#233;tricas entre indiv&#237;duos com os modos de respira&#231;&#227;o bucal e nasal&#46; Em compara&#231;&#227;o com aqueles com respira&#231;&#227;o nasal&#44; constatamos menor dimens&#227;o anteroposterior das vias a&#233;reas nas crian&#231;as com respira&#231;&#227;o bucal&#59; ao passo que&#44; em adolescentes com respira&#231;&#227;o bucal&#44; constatamos maior altura facial anterior inferior&#44; palato mais longo e posi&#231;&#227;o inferior do osso hioide com rela&#231;&#227;o ao plano mandibular&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Esses achados s&#227;o de interesse pr&#225;tico para os m&#233;dicos no diagn&#243;stico&#44; tratamento e&#47;ou encaminhamento de pacientes a especialistas para tratamento de problemas relacionados a altera&#231;&#245;es de respira&#231;&#227;o&#46; Como esses problemas podem indicar desequil&#237;brio no desenvolvimento&#44; o diagn&#243;stico antecipado &#233; importante para corrigir ou melhorar quaisquer efeitos negativos com tratamento oportuno&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Uma pesquisa future que examine maiores amostras de pacientes com os mesmos crit&#233;rios de sele&#231;&#227;o do que os usados aqui &#233; necess&#225;ria para examinar seu desenvolvimento craniofacial de acordo com o modo de respira&#231;&#227;o&#44; ao mesmo tempo em que considere o padr&#227;o de crescimento&#44; a idade e o sexo&#46; Esse estudo pode fornecer uma comprova&#231;&#227;o adicional da influ&#234;ncia substancial da respira&#231;&#227;o sobre o desenvolvimento craniofacial e a postura da cabe&#231;a&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflitos de interesse</span><p id="par0150" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incidence of abnormal breathing and its consequences on craniofacial development is increasing&#44; and is not limited to children with adenoid faces&#46; The objective of this study was to evaluate the cephalometric differences in craniofacial structures and head posture between nasal breathing and oral breathing children and teenagers with a normal facial growth pattern&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ninety&#8208;eight 7&#8211;16 year&#8208;old patients with a normal facial growth pattern were clinically and radiographically evaluated&#46; They were classified as either nasal breathing or oral breathing patients according to the predominant mode of breathing through clinical and historical evaluation&#44; and breathing respiratory rate predomination as quantified by an airflow sensor&#46; They were divided in two age groups &#40;G1&#58; 7&#8211;9&#41; &#40;G2&#58; 10&#8211;16&#41; to account for normal age&#8208;related facial growth&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Oral breathing children &#40;8&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7 years&#41; showed less nasopharyngeal cross&#8208;sectional dimension &#40;MPP&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;030&#41;&#44; whereas other structures were similar to their nasal breathing counterparts &#40;7&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9 years&#41;&#46; However&#44; oral breathing teenagers &#40;12&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;0 years&#41; exhibited a greater palate length &#40;ANS&#8208;PNS&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#41;&#44; a higher vertical dimension in the lower anterior face &#40;Xi&#8208;ANS&#8208;Pm&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#41;&#44; and a lower position of the hyoid bone with respect to the mandibular plane &#40;H&#8208;MP&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41; than their nasal breathing counterparts &#40;12&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9 years&#41;&#46; No statistically significant differences were found in head posture&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Even in individuals with a normal facial growth pattern&#44; when compared with nasal breathing individuals&#44; oral breathing children present differences in airway dimensions&#46; Among adolescents&#44; these dissimilarities include structures in the facial development and hyoid bone position&#46;</p></span>"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A incid&#234;ncia da respira&#231;&#227;o anormal e de suas consequ&#234;ncias no desenvolvimento craniofacial aumenta e n&#227;o &#233; limitada a crian&#231;as com f&#225;cies adenoideanas&#46; O objetivo deste estudo foi avaliar as diferen&#231;as cefalom&#233;tricas nas estruturas craniofaciais e na postura da cabe&#231;a entre crian&#231;as e adolescentes com respira&#231;&#227;o nasal e respira&#231;&#227;o bucal com padr&#227;o de crescimento facial normal&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">98 pacientes com idades entre 7-16 anos com padr&#227;o de crescimento facial normal foram avaliados de forma cl&#237;nica e radiol&#243;gica&#46; Eles foram classificados como pacientes com respira&#231;&#227;o nasal ou respira&#231;&#227;o bucal de acordo com a predomin&#226;ncia do modo de respira&#231;&#227;o por meio da avaliac&#184;&#227;o cl&#237;nica e hist&#243;rica e da predomin&#226;ncia da frequ&#234;ncia respirat&#243;ria conforme qualificado por um sensor de fluxo de ar&#46; Os pacientes foram divididos em duas faixas et&#225;rias &#40;G1&#58; 7 a 9&#41; &#40;G2&#58; 10 a 16&#41; para contabilizar o crescimento normal facial relacionado &#224; idade&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">As crian&#231;as com respira&#231;&#227;o bucal &#40;8&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;7 anos&#41; mostraram menor dimens&#227;o transversal nasofar&#237;ngea &#40;MPP&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;030&#41;&#44; ao passo que outras estruturas foram semelhantes a seus pares com respira&#231;&#227;o nasal &#40;7&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;9 anos&#41;&#46; Contudo&#44; os adolescentes com respira&#231;&#227;o bucal &#40;12&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;0 anos&#41; mostraram maior comprimento do palato &#40;espinha nasal anterior&#8208;espinha nasal posterior &#91;ENA&#8208;ENP&#93;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#44; maior dimens&#227;o vertical na menor face anterior &#40;Xi&#8208;ENA&#8208;Pm&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41; e menor posi&#231;&#227;o do osso hioide a respeito do plano mandibular &#40;H&#8208;PM&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41; do que seus pares com respira&#231;&#227;o nasal &#40;12&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9 anos&#41;&#46; N&#227;o foram constatadas diferen&#231;as estatisticamente significativas na postura da cabe&#231;a&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Mesmo em indiv&#237;duos com padr&#227;o de crescimento facial normal&#44; em compara&#231;&#227;o com indiv&#237;duos com respira&#231;&#227;o nasal&#44; as crian&#231;as com respira&#231;&#227;o bucal apresentam diferen&#231;as nas dimens&#245;es das vias a&#233;reas&#46; Entre os adolescentes&#44; essas dissimilaridades incluem estruturas no desenvolvimento facial e na posi&#231;&#227;o do osso hioide&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Como citar este artigo&#58; Chambi&#8208;Rocha A&#44; Cabrera&#8208;Dom&#237;nguez ME&#44; Dom&#237;nguez&#8208;Reyes A&#46; Breathing mode influence on craniofacial development and head posture&#46; J Pediatr &#40;Rio J&#41;&#46; 2018&#59;94&#58;123&#8211;130&#46;</p>"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Marcos cefalom&#233;tricos&#44; &#226;ngulos e planos de refer&#234;ncia&#46; Padr&#227;o de crescimento&#58; 1&#46; &#194;ngulo do PF&#8208;PM formado pelo plano facial &#40;n&#8208;Pg&#41; e pelo plano mandibular &#40;Gn&#8208;Go&#41;&#46; O plano facial &#233; formado por n&#225;sio &#40;N&#41; e pogonion &#40;Pg&#41;&#46; O plano mandibular &#233; formado por gnation &#40;Gn&#41; e gonion &#40;Go&#41;&#59; Altura facial&#58; 2&#46; FCNA &#194;ngulo formado pelo ponto central facial &#40;FC&#41; e linha FC&#8208;nasion e linha FC&#8208;subespinhal &#40;A&#41;&#59; 3&#46; Xi&#8208;ENA&#8208;Pm &#194;ngulo formado pelo centro do ponto ramus &#40;Xi&#41; e pela linha Xi&#8208;espinha nasal anterior &#40;ENA&#41; e pela linha Xi&#8208;suprapogonio &#40;Pm&#41;&#59; Maxila&#58; 4&#46; SNA &#194;ngulo formado pela linha de base do cr&#226;nio &#40;SN&#41; e pela linha N&#8208;subespinhal &#40;A&#41;&#46; A base do cr&#226;nio &#233; um plano desde a sela &#40;S&#41; at&#233; nasion &#40;N&#41;&#59; 5&#46; ENA&#8208;ENP Dist&#226;ncia entre a espinha nasal anterior &#40;ENA&#41; e a espinha nasal posterior &#40;ENP&#41;&#59; 6&#46; ENA&#8208;ENP&#8208;FhP &#194;ngulo formado pelo plano palatino b &#40;ENA&#8208;ENP&#41; e pelo plano Frankfurt &#40;FhP&#41;&#46; O plano Frankfurt &#233; formado pelo orbitale b &#40;Or&#41; e porion &#40;Po&#41;&#59; Mand&#237;bula&#58; 7&#46; SNB &#194;ngulo formado pela linha de base do cr&#226;nio &#40;SN&#41; e pela linha N&#8208;supramentale &#40;B&#41;&#59; 8&#46; MP&#8208;FhP &#194;ngulo formado pelo plano mandibular &#40;PM&#41; e pelo plano Frankfurt &#40;FhP&#41;&#59; 9&#46; Go&#8208;FC Dist&#226;ncia do gonion &#40;Go&#41; at&#233; o centro facial &#40;FC&#41;&#59; 10&#46; Xi&#8208;Pm Dist&#226;ncia de Xi a suprapogonion &#40;Pm&#41;&#59; Maxila&#8208;Mand&#237;bula&#59; 11&#46; ANB &#194;ngulo formado pela linha subespinhal &#40;A&#41; e nasion &#40;N&#41; e linha N&#8208;supramentale &#40;B&#41;&#59; Osso hioide&#58; 12&#46; H&#8208;MP Dist&#226;ncia do ponto mais anterior e superior do osso hioide &#40;H&#41; perpendicular ao plano mandibular &#40;PM&#41;&#59; Postura craniocervical&#59; 13&#46; OPT&#8208;SN &#194;ngulo formado por &#40;SN&#41; e odontoides &#40;OPT&#41;&#46; O OPT &#233; formado por uma linha por meio do ponto posterossuperior e posteroinferior do odontoides&#59; 14&#46; CVT&#8208;SN &#194;ngulo formado por &#40;SN&#41; e cervical &#40;CVT&#41;&#46; O CVT &#233; formado por uma linha por meio do ponto posterossuperior e posteroinferior da cervical&#46;</p>"
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Dimens&#245;es das vias a&#233;reas&#46; Nasofaringe&#58; 1&#46; ad1&#8208;Ba Dist&#226;ncia de &#40;ad1&#41; a basion &#40;Ba&#41;&#59; Ad1 &#233; o ponto de interse&#231;&#227;o da parede posterior da faringe e a linha da espinha nasal posterior &#40;ENP&#41; at&#233; basion &#40;Ba&#41;&#59; 2&#46; ad2&#8208;So Dist&#226;ncia de &#40;ad2&#41; a &#40;So&#41;&#46; Ad2 &#233; o ponto de interse&#231;&#227;o da parede posterior da faringe e da linha do ponto m&#233;dio &#40;SD&#41; da linha da sela &#40;S&#41; at&#233; basion &#40;Ba&#41; at&#233; a espinha nasal posterior &#40;ENP&#41;&#59; 3&#46; PtV&#8208;Ad Dist&#226;ncia do ponto &#40;PtV&#41; at&#233; adenoide &#40;Ad&#41;&#46; PtV &#233; uma linha vertical perpendicular ao FhP que passa pelo ponto mais posterior da fossa pterigomaxilar&#46; O ponto PtV est&#225; localizado 5<span class="elsevierStyleHsp" style=""></span>mm acima da ENP&#46; Orofaringe&#58; 4&#46; USP Dist&#226;ncia de um ponto do palato mole &#40;5<span class="elsevierStyleHsp" style=""></span>mm acima do ponto superior do palato mole&#41; &#40;USP&#41; at&#233; o contraponto horizontal na parede posterior da faringe at&#233; o Plano Frankfurt &#40;FhP&#41;&#46; 5&#46; MPP Dist&#226;ncia dos pontos de interse&#231;&#227;o na parede anterior e posterior da faringe do meio de &#40;USP&#41; e &#40;IT&#41; paralelos ao FhP 6&#46; IT Dist&#226;ncia do ponto posterior e inferior da amigdala &#40;T&#41; &#40;5<span class="elsevierStyleHsp" style=""></span>mm acima do ponto inferior da amigdala&#41; at&#233; o contraponto horizontal na parede posterior da faringe paralelo ao FhP&#46; 7&#46; MPP Dist&#226;ncia dos pontos de interse&#231;&#227;o na parede anterior e posterior da faringe do plano mandibular &#40;PM&#41;&#44; paralela ao FhP&#59; Hipofaringe&#58; 8&#46; C3P Dist&#226;ncia entre a faringe posterior&#44; do ponto mais anterior e inferior no corpo da terceira v&#233;rtebra cervical &#40;C3&#41; e faringe anterior&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;733<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;222mm &#177;2&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#44;269mm &#177;3&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;049<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Mand&#237;bula</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>7&#46; SNA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;500&#176; &#177;4&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;353&#176; &#177;3&#44;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;892<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;688&#176; &#177;2&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&#44;250&#176; &#177;3&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;082<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>8&#46; PM&#8208;FhP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;563&#176; &#177; 2&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;000&#176; &#177;5&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;788<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;000&#176; &#177;4&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;192&#176; &#177;3&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;911<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>9&#46; Go&#8208;FC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#44;000 mm &#177;4&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;528 mm &#177;4&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;797<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;167 mm &#177;3&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;077 mm &#177;6&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;706<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10&#46; Xi&#8208;Pm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;875 mm &#177; 4&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#44;722 mm &#177;1&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;81<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#44;833 mm &#177;3&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#44;769 mm &#177; 6&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;979<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Maxila&#8208;mand&#237;bula</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>11&#46; ANB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;063&#176; &#177;2&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;250&#176; &#177;2&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;60<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;833&#176; &#177;1&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;192&#176; &#177;3&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;757 <a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Osso hioide</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>12&#46; H&#8208;PM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;500 mm &#177;1&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;765 mm &#177;3&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;683<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;563 mm &#177;3&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;100 mm &#177;6&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;017<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Postural craniocervical</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>13&#46; OPT&#8208;SN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#44;813&#176; &#177;9&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#44;361&#176; &#177;12&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;928<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;944&#176; &#177;9&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#44;808&#176; &#177; 9&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;172<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>14&#46; CVT&#8208;SN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">105&#44;875&#176; &#177;7&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">106&#44;194&#176; &#177;10&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;941<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">101&#44;444&#176; &#177;7&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&#44;115&#176; &#177;10&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo I</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo II</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Vias a&#233;reas nasofaringe</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#46; ad1&#8208;Ba&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;833 mm &#177; 5&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;529 mm &#177; 7&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;261<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;611 mm &#177; 3&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;192 mm &#177; 5&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;789<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#46; ad2&#8208;S0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;750 mm &#177; 3&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;417 mm &#177; 3&#44;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;358<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;625 mm &#177; 4&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;800 mm &#177; 6&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;647<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#46; PtV&#8208; Ad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;500 mm &#177; 3&#44;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;000 mm &#177; 3&#44;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;724<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;556 mm &#177; 6&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;692 mm &#177; 4&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;717<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Orofaringe</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4&#46; USP&nbsp;\t\t\t\t\t\t\n
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Artigo Original
Breathing mode influence on craniofacial development and head posture
Influência do modo de respiração sobre o desenvolvimento craniofacial e a postura da cabeça
Annel Chambi‐Rocha
Autor para correspondência
anncharoc@alum.us.es
annel2302@gmail.com

Autor para correspondência.
, Ma Eugenia Cabrera‐Domínguez, Antonia Domínguez‐Reyes
Universidad de Sevilla, Facultad de Odontología, Sevilla, Espanha
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Marcos cefalom&#233;tricos&#44; &#226;ngulos e planos de refer&#234;ncia&#46; Padr&#227;o de crescimento&#58; 1&#46; &#194;ngulo do PF&#8208;PM formado pelo plano facial &#40;n&#8208;Pg&#41; e pelo plano mandibular &#40;Gn&#8208;Go&#41;&#46; O plano facial &#233; formado por n&#225;sio &#40;N&#41; e pogonion &#40;Pg&#41;&#46; O plano mandibular &#233; formado por gnation &#40;Gn&#41; e gonion &#40;Go&#41;&#59; Altura facial&#58; 2&#46; FCNA &#194;ngulo formado pelo ponto central facial &#40;FC&#41; e linha FC&#8208;nasion e linha FC&#8208;subespinhal &#40;A&#41;&#59; 3&#46; Xi&#8208;ENA&#8208;Pm &#194;ngulo formado pelo centro do ponto ramus &#40;Xi&#41; e pela linha Xi&#8208;espinha nasal anterior &#40;ENA&#41; e pela linha Xi&#8208;suprapogonio &#40;Pm&#41;&#59; Maxila&#58; 4&#46; SNA &#194;ngulo formado pela linha de base do cr&#226;nio &#40;SN&#41; e pela linha N&#8208;subespinhal &#40;A&#41;&#46; A base do cr&#226;nio &#233; um plano desde a sela &#40;S&#41; at&#233; nasion &#40;N&#41;&#59; 5&#46; ENA&#8208;ENP Dist&#226;ncia entre a espinha nasal anterior &#40;ENA&#41; e a espinha nasal posterior &#40;ENP&#41;&#59; 6&#46; ENA&#8208;ENP&#8208;FhP &#194;ngulo formado pelo plano palatino b &#40;ENA&#8208;ENP&#41; e pelo plano Frankfurt &#40;FhP&#41;&#46; O plano Frankfurt &#233; formado pelo orbitale b &#40;Or&#41; e porion &#40;Po&#41;&#59; Mand&#237;bula&#58; 7&#46; SNB &#194;ngulo formado pela linha de base do cr&#226;nio &#40;SN&#41; e pela linha N&#8208;supramentale &#40;B&#41;&#59; 8&#46; MP&#8208;FhP &#194;ngulo formado pelo plano mandibular &#40;PM&#41; e pelo plano Frankfurt &#40;FhP&#41;&#59; 9&#46; Go&#8208;FC Dist&#226;ncia do gonion &#40;Go&#41; at&#233; o centro facial &#40;FC&#41;&#59; 10&#46; Xi&#8208;Pm Dist&#226;ncia de Xi a suprapogonion &#40;Pm&#41;&#59; Maxila&#8208;Mand&#237;bula&#59; 11&#46; ANB &#194;ngulo formado pela linha subespinhal &#40;A&#41; e nasion &#40;N&#41; e linha N&#8208;supramentale &#40;B&#41;&#59; Osso hioide&#58; 12&#46; H&#8208;MP Dist&#226;ncia do ponto mais anterior e superior do osso hioide &#40;H&#41; perpendicular ao plano mandibular &#40;PM&#41;&#59; Postura craniocervical&#59; 13&#46; OPT&#8208;SN &#194;ngulo formado por &#40;SN&#41; e odontoides &#40;OPT&#41;&#46; O OPT &#233; formado por uma linha por meio do ponto posterossuperior e posteroinferior do odontoides&#59; 14&#46; CVT&#8208;SN &#194;ngulo formado por &#40;SN&#41; e cervical &#40;CVT&#41;&#46; O CVT &#233; formado por uma linha por meio do ponto posterossuperior e posteroinferior da cervical&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A respira&#231;&#227;o fisiol&#243;gica &#233; comumente afetada por problemas anat&#244;micos ou funcionais&#44; faz com que o ciclo respirat&#243;rio seja iniciado n&#227;o apenas pelo nariz&#44; mas tamb&#233;m pela boca&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1&#44;2</span></a> Em compara&#231;&#227;o com crian&#231;as com respira&#231;&#227;o nasal &#40;RN&#41;&#44; as crian&#231;as com respira&#231;&#227;o bucal &#40;RB&#41; apresentam maior risco de sono agitado&#44; diaforese&#44; enurese noturna e&#44; em alguns casos&#44; at&#233; mesmo s&#237;ndrome de apneia do sono&#46; O sono de baixa qualidade significa sonol&#234;ncia diurna&#44; irritabilidade e dores de cabe&#231;a<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> com probabilidade de afetar negativamente o desempenho acad&#234;mico&#46; Al&#233;m disso&#44; a presen&#231;a de fala hiponasal ou altera&#231;&#245;es na fala<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> aumenta a probabilidade de a crian&#231;a ser classificada com dificuldades de aprendizagem&#46; De fato&#44; muitas dessas crian&#231;as s&#227;o erroneamente diagnosticadas com Transtorno de D&#233;ficit de Aten&#231;&#227;o e Hiperatividade &#40;TDAH&#41; e&#44; &#224;s vezes&#44; medicadas de forma errada&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">V&#225;rios estudos postulam que as crian&#231;as com RB mostram caracter&#237;sticas das &#8220;f&#225;cies adenoideanas&#8221; t&#237;picas&#58; redu&#231;&#227;o no prognatismo facial&#44; nariz e narinas pequenas&#44; l&#225;bio superior curto e postura de boca aberta que pode ser a fonte de rota&#231;&#227;o para tr&#225;s e para baixo da mand&#237;bula&#44; que causa aumento no desenvolvimento vertical da face anterior inferior e dimens&#227;o anteroposterior mais estreita das vias a&#233;reas&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1&#44;6&#8208;8</span></a> O desequil&#237;brio muscular desses pacientes&#44; devido a recondicionamento anat&#244;mico&#44; pode levar a hiperextens&#227;o cr&#226;nio&#8208;cervical e cifose postual&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#44;10</span></a> H&#225; ainda relatos de diferentes tipos de m&#225; oclus&#227;o&#44; como mordidas abertas&#44; mordidas cruzadas anteriores e&#47;ou posteriores&#44; m&#225; oclus&#227;o Classe II&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> constri&#231;&#227;o do palato e sorrisos gengivais&#44; que resultam em caracter&#237;sticas faciais n&#227;o atrativas&#46; Al&#233;m disso&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> as crian&#231;as com RB normalmente sofrem de gengivite cr&#244;nica&#44; periodontite&#44; infec&#231;&#245;es por c&#226;ndida&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a> eros&#227;o dent&#225;ria e c&#225;ries&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a> Devido &#224; dificuldade de respira&#231;&#227;o e mastiga&#231;&#227;o simultaneamente por longos per&#237;odos&#44; a efici&#234;ncia mastigat&#243;ria reduz&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Isso&#44; por sua vez&#44; faz com que a crian&#231;a prefira por alimentos moles e&#44; comumente&#44; n&#227;o nutritivos aumente que aumentam a possibilidade de m&#225; oclus&#227;o e c&#225;ries nas crian&#231;as com RB&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Uma comprova&#231;&#227;o publicada &#233; inconclusiva&#44; em parte&#44; devido aos padr&#245;es de crescimento n&#227;o terem sido considerados&#44; devido ao fato de algumas caracter&#237;sticas f&#237;sicas serem compartilhadas por indiv&#237;duos com padr&#227;o de crescimento vertical predominante&#44; que&#44; por sua vez&#44; s&#227;o mais propensos a ser crian&#231;as com RB&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> Al&#233;m disso&#44; adenoides menores e matura&#231;&#227;o oclusal n&#227;o foram usados como par&#226;metros de classifica&#231;&#227;o na compara&#231;&#227;o entre os indiv&#237;duos&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> Ademais&#44; diferentes ferramentas de diagn&#243;stico foram usadas para classificar as formas de respira&#231;&#227;o&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">O principal objetivo desta pesquisa foi avaliar as diferen&#231;as cefalom&#233;tricas nas estruturas craniofaciais &#40;ou seja&#44; a forma e a posi&#231;&#227;o da maxila&#44; da mand&#237;bula&#44; das vias a&#233;reas superiores e do osso hioide&#41; e na postura da cabe&#231;a entre crian&#231;as e adolescentes com respira&#231;&#227;o nasal &#40;RN&#41; e respira&#231;&#227;o bucal &#40;RB&#41; com um padr&#227;o de crescimento facial normal&#44; com uma ferramenta de diagn&#243;stico mensur&#225;vel do tipo de respira&#231;&#227;o e crit&#233;rios rigorosos de sele&#231;&#227;o de pacientes&#46; Hipotetizamos que h&#225; diferen&#231;as anat&#244;micas nas estruturas craniofaciais em crian&#231;as e adolescentes com RB em compara&#231;&#227;o com RN&#44; mesmo em pacientes com padr&#227;o de crescimento facial normal&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participantes</span><p id="par0025" class="elsevierStylePara elsevierViewall">Os participantes foram recrutados durante consulta cl&#237;nica de rotina na Faculdade de Odontologia Infantil Integrada na Universidade de Sevilha&#46; Os crit&#233;rios de inclus&#227;o foram&#58; meninos e meninas brancos entre sete e 16 anos&#59; apar&#234;ncia de padr&#227;o de crescimento normal e n&#227;o apresentarem altera&#231;&#245;es neurol&#243;gicas ou cong&#234;nitas&#44; doen&#231;as gen&#233;ticas&#44; malforma&#231;&#245;es craniofaciais&#44; doen&#231;a sist&#234;mica grave&#44; alergias respirat&#243;rias&#44; S&#237;ndrome da Apneia Obstrutiva do Sono &#40;SAOS&#41; ou asma&#46; Os crit&#233;rios de exclus&#227;o foram&#58; terem sido submetidos a qualquer cirurgia nas vias a&#233;reas superiores&#44; procedimentos ortod&#244;nticos ou ortop&#233;dicos&#44; uso prolongado de chupeta &#40;mais de seis meses&#41; e&#47;ou mamadeira &#40;mais de dois anos&#41;&#44; quaisquer h&#225;bitos como chupar dedos ou os l&#225;bios ou posi&#231;&#227;o anterior evidente da l&#237;ngua&#46; Das 180 crian&#231;as &#40;11&#44;3 &#177; 0&#44;2 anos&#41;&#44; 58&#44;3&#37; meninas e 41&#44;7&#37; meninos&#44; avaliados para elegibilidade&#44; 98 atenderam aos crit&#233;rios de inclus&#227;o&#46; Um dos pais e&#47;ou respons&#225;vel de todos os pacientes assinou o formul&#225;rio de consentimento informado&#46; O estudo e seu protocolo foram aprovados pelo Comit&#234; de &#201;tica em Pesquisa da Universidade Hospitals Virgen Macarena&#8208;Virgen del Rocio &#40;Sevilha&#44; Espanha&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Medidas</span><p id="par0030" class="elsevierStylePara elsevierViewall">O padr&#227;o de crescimento facial normal foi confirmado por &#237;ndice craniano e facial e par&#226;metros cefalom&#233;tricos &#40;PF&#8208;PM&#41; &#40;N &#61; 68 &#177; 3&#44;5&#41; para excluir as crian&#231;as com predisposi&#231;&#227;o a padr&#227;o de crescimento&#46; O &#237;ndice craniano mede os di&#226;metros transversais e anteroposteriores do cr&#226;nio com base na seguinte f&#243;rmula&#58; di&#226;metro transversal m&#225;ximo <span class="elsevierStyleBold">x</span> 100&#47;di&#226;metro anteroposterior m&#225;ximo&#46; Os escores s&#227;o classificados como segue&#58; dolicoc&#233;falo &#40;&#60; 76&#41;&#44; mesoc&#233;falo &#40;76&#8208;81&#41; ou braquic&#233;falo &#40;&#62; 81&#41;&#46; O &#237;ndice facial mede os par&#226;metros verticais e transversais das f&#225;cies&#46; A altura da face &#233; determinada a partir do plano superciliar &#40;linha de uni&#227;o das sobrancelhas&#41; e medida verticalmente at&#233; o ponto gn&#225;tio &#40;ou seja&#44; o ponto inferior do queixo&#41;&#46; A largura da face &#233; medida com base na largura bizigom&#225;tica como segue&#58; di&#226;metro vertical m&#225;ximo <span class="elsevierStyleBold">x</span> 100&#47;di&#226;metro transversal m&#225;ximo&#46; Os escores classificam as f&#225;cies como&#58; braquic&#233;falo &#40;&#62; 97&#41;&#44; mesoc&#233;falo &#40;97&#8208;104&#41; ou dolicoc&#233;falo &#40;&#60; 104&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A forma de respira&#231;&#227;o &#40;bucal ou nasal&#41; foi avaliada por um Sensor de Fluxo de Ar da Plataforma e&#8208;Health&#44; projetado pela Cooking Hacks &#40;Libelium&#174;&#44; Libelium Comunicaciones Distribuidas S&#46;L&#44; Zaragoza&#44; Espanha&#41;&#46; O sensor mediu a frequ&#234;ncia respirat&#243;ria nasal de forma precisa por meio da detec&#231;&#227;o de mudan&#231;as de temperatura no fluxo de ar&#46; Esse dispositivo consiste em um conjunto de dois pinos posicionados nas narinas e fixo por um fio flex&#237;vel&#44; que se encaixa atr&#225;s da orelha&#46; A respira&#231;&#227;o &#233; medida pelos sensores localizados dentro dos pinos&#46; Duas medi&#231;&#245;es foram feitas em diferentes hor&#225;rios para evitar flutua&#231;&#245;es substanciais circunstanciais que possam afetar os resultados&#46; Os pacientes foram submetidos a um exame cl&#237;nico completo e seu hist&#243;rico e seus dados cl&#237;nicos foram coletados por meio de um question&#225;rio respondido pelos pais&#46; Com base nessas informa&#231;&#245;es&#44; os participantes foram classificados em pacientes com RB ou RN&#46; As crian&#231;as com RB foram definidas por uma frequ&#234;ncia respirat&#243;ria nasal menor &#40;abaixo de 17 respira&#231;&#245;es por minuto&#41;&#44; conforme medido por nossa equipe e com base nos relatos dos pais que nos informaram de uma respira&#231;&#227;o predominante bucal&#44; mostrava uma postura de boca aberta durante o dia e&#47;ou durante o sono &#40;a mudan&#231;a de posi&#231;&#227;o vertical para uma posi&#231;&#227;o supina pode causar mudan&#231;a na forma de respira&#231;&#227;o&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> Al&#233;m disso&#44; foram exclu&#237;das as crian&#231;as que apresentassem frequentemente tr&#234;s ou mais destes sintomas&#58; ronco&#44; pieira&#44; baba no travesseiro&#44; acordar durante a noite com falta de ar ou acordar cansado de manh&#227;&#46; As crian&#231;as foram classificadas como respira&#231;&#227;o nasal caso apresentassem alta frequ&#234;ncia respirat&#243;ria nasal &#40;acima de 18 respira&#231;&#245;es por minuto&#41;&#44; boca fechada durante o dia e &#224; noite e aus&#234;ncia dos sintomas descritos anteriormente&#46; Nossa classifica&#231;&#227;o foi assistida por um otorrinolaringologista por meio de rinomanometria&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Radiografias laterais foram tiradas na posi&#231;&#227;o de p&#233; com o corpo relaxado e na posi&#231;&#227;o natural da cabe&#231;a &#40;posi&#231;&#227;o de autoequil&#237;brio&#41;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> pelo equipamento de raios X Planmeca Promax &#40;Planmeca Oy&#41;&#44; na Faculdade de Odontologia da Universidade de Sevilha&#44; Espanha&#46; O cefalostato foi posicionado sem colocar press&#227;o para n&#227;o afetar a postura da crian&#231;a&#46; Marcos cefalom&#233;tricos tradicionais foram tra&#231;ados manualmente e radiografias digitais foram importadas para o sistema de um <span class="elsevierStyleItalic">software</span> comercialmente dispon&#237;vel &#40;Ortho TP&#174;&#44; Vimercate MicroLab&#44; Vimercate&#44; It&#225;lia&#41; e analisado novamente&#46; Os par&#226;metros cefalom&#233;tricos foram escolhidos com base em publica&#231;&#245;es anteriores<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;17&#8208;19</span></a> &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1 e 2</a>&#41;&#46; Contudo&#44; novas medi&#231;&#245;es foram feitas e acrescentaram as dimens&#245;es das vias a&#233;reas&#58;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">USP&#58; Dist&#226;ncia entre o ponto do palato mole &#40;5<span class="elsevierStyleHsp" style=""></span>mm abaixo do ponto superior do palato mole&#41; &#40;USP&#41; e o contraponto horizontal na parede posterior da faringe paralela ao Plano Frankfurt &#40;FhP&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">IT&#58; Dist&#226;ncia entre o ponto posterior e inferior da am&#237;gdala &#40;T&#41; &#40;5<span class="elsevierStyleHsp" style=""></span>mm acima do ponto inferior da amigdala&#41; at&#233; a contraponto horizontal na parede posterior da faringe paralela ao FhP&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">MPP&#58; Dist&#226;ncia dos pontos de interse&#231;&#227;o na parede anterior e posterior da faringe do meio do USP e da IT paralelos ao FhP&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">MP<span class="elsevierStyleInf">P</span>&#58; Dist&#226;ncia dos pontos de interse&#231;&#227;o na parede anterior e posterior da faringe do plano mandibular &#40;PM paralelo ao FhP&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">C3P&#58; Dist&#226;ncia entre a faringe posterior&#44; do ponto mais anterior e inferior no corpo da terceira v&#233;rtebra cervical &#40;C3&#41; e da faringe anterior &#40;P&#41; paralelas ao FhP&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para detectar erros na identifica&#231;&#227;o e nas medi&#231;&#245;es dos marcos&#44; 20 radiografias cefalom&#233;tricas laterais foram aleatoriamente selecionadas e comparadas pelo mesmo investigador duas semanas depois&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Por fim&#44; os pacientes foram divididos em duas faixas et&#225;rias &#40;G1 &#61; 7&#8208;9 anos&#41; &#40;7&#44;8 &#177; 0&#44;5 anos&#41; e &#40;G2 &#61; 10&#8208;16 anos&#41; &#40;12&#44;3 &#177; 1&#44;0 anos&#41; por tr&#234;s principais motivos&#58; 1&#46; Para evitar confundir a influ&#234;ncia do tipo de respira&#231;&#227;o sobre o desenvolvimento craniofacial com altera&#231;&#245;es normais no crescimento&#59; 2&#46; Para considerar o processo de matura&#231;&#227;o oclusal &#8211; associado a altera&#231;&#245;es na dimens&#227;o vertical da face &#8211; com base na varia&#231;&#227;o na erup&#231;&#227;o dos dentes permanentes para substituir a denti&#231;&#227;o mista&#59; e 3&#46; Para considerar a redu&#231;&#227;o das adenoides que inicia entre sete e 10&#44; que aumenta as diferen&#231;as nas dimens&#245;es nasofar&#237;ngeas&#46; Em crian&#231;as com menos de sete anos&#44; as adenoides ainda n&#227;o est&#227;o fisicamente presentes em um tamanho consider&#225;vel em crian&#231;as com RN e RB&#44; assim pode ser dif&#237;cil encontrar diferen&#231;as na zona de adenoides&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lises estat&#237;sticas</span><p id="par0080" class="elsevierStylePara elsevierViewall">Os dados foram analisados com os modelos estat&#237;sticos descritivos&#46; As vari&#225;veis quantitativas foram descritas com m&#233;dias e desvios&#8208; padr&#227;o e as diferen&#231;as foram testadas para relev&#226;ncia com o teste <span class="elsevierStyleItalic">t</span> de Student para amostras independentes&#46; As diferen&#231;as nas var&#225;veis n&#227;o param&#233;tricas foram testadas para relev&#226;ncia com o teste U de Mann&#8208;Whitney para amostras independentes&#46; A relev&#226;ncia estat&#237;stica foi estabelecida em p &#60; 0&#44;05&#46; A corre&#231;&#227;o de Bonferroni &#233; usada como o m&#233;todo de ajuste para manter a probabilidade do erro tipo I abaixo de 5&#37; &#40;0&#44;05&#41;&#46; Dessa forma&#44; o valor de p para considerar as diferen&#231;as estatisticamente significativas observadas ser&#225; 0&#44;05&#47;22 &#61; 0&#44;002&#46; Os testes estat&#237;sticos foram feitos com o <span class="elsevierStyleItalic">software</span> SPSS &#40;SPSS para Windows&#44; Vers&#227;o 16&#46;0&#46; Chicago&#44; EUA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">A m&#233;dia da frequ&#234;ncia respirat&#243;ria foi 18 respira&#231;&#245;es por minuto&#59; a menor frequ&#234;ncia respirat&#243;ria detectada foi de 12 respira&#231;&#245;es por minuto e maior frequ&#234;ncia foi de 25 respira&#231;&#245;es por minuto&#46; A m&#233;dia dos escores do &#205;ndice Craniano e Facial foi de 79&#44;3 &#177; 2&#44;4 e 101&#44;5 &#177; 1&#44;7&#44; respectivamente&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">As m&#233;dias e os desvios&#8208;padr&#227;o para vari&#225;veis cefalom&#233;tricas &#8211; craniofaciais&#44; posi&#231;&#227;o do osso hioide&#44; postura da cabe&#231;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41; e par&#226;metros das vias a&#233;reas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41; &#8211; de 56 pacientes com RB &#40;64&#44;6&#37;&#41; e de 42 pacientes com RN &#40;35&#44;4&#37;&#41; foram comparados por faixa et&#225;ria&#46; De acordo com a an&#225;lise cefalom&#233;trica lateral&#44; no G1 a dist&#226;ncia nas vias a&#233;reas na regi&#227;o das am&#237;dalas &#40;MPP&#41; foi menor em crian&#231;as com RB &#40;8&#44;0 &#177; 0&#44;7 anos&#41; do que em crian&#231;as com RN &#40;7&#44;6 &#177; 0&#44;9 anos&#41; &#40;<span class="elsevierStyleItalic">P</span> &#61; 0&#44;03&#41;&#46; N&#227;o foram constatadas diferen&#231;as estatisticamente significativas nas vias a&#233;reas do G2&#46; Contudo&#44; no G2&#44; a menor altura facial anterior &#40;Xi&#8208;ENA&#8208;Pm&#41; e o comprimento do palato &#40;ENA&#8208;ENP&#41; foram maiores nas crian&#231;as com RB &#40;12&#44;3 &#177; 2&#44;0 anos&#41; do que em crian&#231;as com RN &#40;12&#44;5 &#177; 1&#44;9 anos&#41; &#40;<span class="elsevierStyleItalic">P</span> &#61; 0&#44;015 e <span class="elsevierStyleItalic">P</span> &#61; 0&#44;049&#44; respectivamente&#41;&#46; Al&#233;m disso&#44; o osso hioide foi localizado em uma posi&#231;&#227;o mais baixa em rela&#231;&#227;o ao plano mandibular &#40;H&#8208;PM&#41; em adolescentes com RB do que o de adolescentes com RN&#46; Por fim&#44; n&#227;o foram encontradas diferen&#231;as estatisticamente significativas na postura da cabe&#231;a entre os pacientes com RB e RN em qualquer faixa et&#225;ria &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discuss&#227;o</span><p id="par0095" class="elsevierStylePara elsevierViewall">Estudos anteriores relatam que crian&#231;as com RB t&#234;m um padr&#227;o facial hiperdivergente<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">21&#8208;24</span></a> e uma altura facial anterior menor&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;11</span></a> observada em nossa pesquisa em adolescentes com RB &#40;G2&#41; com padr&#227;o facial normal&#44; por&#233;m n&#227;o no G1&#46; Foi observada que uma maior inclina&#231;&#227;o do plano mandibular&#44;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">22&#44;23</span></a> juntamente com uma rota&#231;&#227;o posterior do plano palatino&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> pode indicar a dire&#231;&#227;o vertical do crescimento mandibular<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">11&#44;26</span></a> e o desenvolvimento de uma m&#225; oclus&#227;o esquel&#233;tica classe II&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> Contudo&#44; nossos pacientes com RB &#40;63&#44;9&#37;&#41; apresentam oclus&#227;o esquel&#233;tica classe I&#46; De acordo com achados anteriores&#44; a maxila e a mand&#237;bula dos pacientes com RB mostraram&#8208;se mais retrusivas com rela&#231;&#227;o &#224; sua base esquel&#233;tica&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> Contudo&#44; Ucar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> observaram que apenas a maxila mostrou&#8208;se mais retrognata&#44; ao passo que outros constaram que apenas a mand&#237;bula mostrou&#8208;se mais retrusiva&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Nossos resultados mostram baixa posi&#231;&#227;o do osso hioide com rela&#231;&#227;o ao plano mandibular em pacientes com RB no G2&#44; o que corrobora achados anteriores de Cuccia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">As dimens&#245;es transversais nasofar&#237;ngeas aumentam com o restante dos tecidos do corpo durante o per&#237;odo de crescimento&#44; por&#233;m o tecido das adenoides come&#231;a a diminuir entre sete e 10 anos&#44; para desaparecer apenas na vida adulta&#46; Nossas medi&#231;&#245;es do espa&#231;o das vias a&#233;reas superiores foram menores nas crian&#231;as com RB do que nas com RN &#40;G1&#41; na regi&#227;o das am&#237;gdalas &#40;MPP&#41;&#44; por&#233;m n&#227;o bo G2&#44; corroborou o trabalho anterior&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> Portanto&#44; as am&#237;gdalas s&#227;o mais hipertr&#243;ficas em crian&#231;as do que em adolescentes&#46; Esse resultado pode ser afetado pela possibilidade de que as adenoides dos pacientes do G1 ainda n&#227;o estavam no est&#225;gio de iniciar sua redu&#231;&#227;o&#44; ao passo que as adenoides dos pacientes do G2 j&#225; haviam reduzido&#46; Al&#233;m disso&#44; as novas medi&#231;&#245;es das vias a&#233;reas em nosso estudo podem afetar nossa capacidade de compara&#231;&#227;o&#44; devido ao fato de que elas estavam paralelas ao Plano de Frankfurt &#40;um plano constante&#41; para evitar resultados comparativos incorretos com base em um plano vari&#225;vel&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">V&#225;rios estudos relatam pacientes com RB com hiperextens&#227;o cr&#226;nio&#8208;cervical&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> apesar de os problemas posturais serem significativamente mais comuns entre essas crian&#231;as&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> Nossa pesquisa mostrou altera&#231;&#227;o na postural da coluna cervical em 90&#44;3&#37; dos pacientes com RB&#44; por&#233;m&#44; como ambos os grupos apresentaram altos percentuais de hiperextens&#227;o craniofacial&#44; as diferen&#231;as n&#227;o foram estatisticamente significativas&#46; Especulamos que o uso intenso de novos dispositivos tecnol&#243;gicos pela popula&#231;&#227;o jovem&#44; como celulares e tablets&#44; pode contribuir para essa falta de diferen&#231;as substanciais na hiperextens&#227;o craniofacial&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Um estudo anterior constatou altera&#231;&#245;es miofuncionais e craniofaciais entre as crian&#231;as com RB entre 7&#8208;10 anos&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> ao passo que encontramos essas altera&#231;&#245;es em crian&#231;as com RB com idade m&#233;dia de 12&#44;3 &#177; 2&#44;0 &#40;G2&#41;&#46; A discrep&#226;ncia pode resultar do fato de esses estudos n&#227;o considerarem os padr&#245;es de crescimento&#46; Em nosso estudo&#44; exclu&#237;mos os pacientes com padr&#245;es diferentes de crescimento normal&#44; com base no &#237;ndice facial e nos par&#226;metros cefalom&#233;tricos&#44; pois os pacientes com padr&#227;o de crescimento vertical t&#234;m caracter&#237;sticas esquel&#233;ticas comuns&#44; ou seja&#44; dimens&#227;o anteroposterior mais estreita das vias a&#233;reas&#44; retrus&#227;o da maxila e da mand&#237;bula&#44; excesso maxilar vertical e maior discrep&#226;ncia esquel&#233;tica Classe II&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">19&#44;28</span></a> As caracter&#237;sticas desses pacientes podem ser um mecanismo compensat&#243;rio que pode gerar a transi&#231;&#227;o de RN para RB&#46; Por outro lado&#44; o padr&#227;o de crescimento horizontal normalmente &#233; caracterizado por mand&#237;bula mais anterior&#46; Isso resulta em via a&#233;rea far&#237;ngea inferior mais ampla&#44; que favorece a respira&#231;&#227;o nasal&#46; Portanto&#44; pode&#8208;se concluir que os padr&#245;es de crescimento podem afetar ou beneficiar a fun&#231;&#227;o respirat&#243;ria fisiol&#243;gica&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">&#201; importante conseguir detectar os pacientes com predomin&#226;ncia de RB&#46; Um encaminhamento antecipado para corre&#231;&#227;o dessa fun&#231;&#227;o patol&#243;gica &#233; essencial para a preven&#231;&#227;o de irregularidades no desenvolvimento craniofacial e de problemas ortod&#244;nticos&#46; Ao eliminar o padr&#227;o de crescimento de confus&#227;o em nosso estudo e comparar os pacientes de acordo com seu est&#225;gio de crescimento&#44; podemos detectar se h&#225; de fato diferen&#231;as entre as crian&#231;as &#40;G1&#41; e adolescentes &#40;G2&#41; com RN e RB&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Este estudo tem certas limita&#231;&#245;es&#46; Primeiro&#44; em um estudo transversal&#44; as associa&#231;&#245;es n&#227;o indicam rela&#231;&#245;es causais&#46; De fato&#44; Shanker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> constataram que v&#225;rias crian&#231;as mudaram entre modo de respira&#231;&#227;o bucal e nasal durante os quatro anos de sua investiga&#231;&#227;o&#46; Contudo&#44; como com qualquer doen&#231;a trat&#225;vel ou evit&#225;vel&#44; a possibilidade de um estudo longitudinal observacional sem interveniente assim que a RB &#233; detectada &#233; evitada por motivos &#233;ticos&#46; Segundo&#44; o pequeno tamanho da amostra resultante de nossos crit&#233;rios de sele&#231;&#227;o rigorosos pode ter limitado o poder das an&#225;lises para detectar diferen&#231;as adicionais&#46; Terceiro&#44; como n&#227;o recrutamos participantes com RN e RB&#44; o poder de nossas an&#225;lises pode ter sido afetado por essa diferen&#231;a substancial nos tamanhos dos subgrupos comparados&#46; Apesar dessas limita&#231;&#245;es&#44; nossos achados podem ajudar os profissionais de sa&#250;de no melhor manejo dos pacientes com altera&#231;&#245;es da respira&#231;&#227;o&#44; sabe&#8208;se que isso pode indicar um desequil&#237;brio de desenvolvimento&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">O estudo tamb&#233;m tem seus pontos fortes&#46; Nossos crit&#233;rios de sele&#231;&#227;o altamente precisos&#44; ao incluir apenas pacientes com padr&#227;o de crescimento normal&#44; reduziram o poss&#237;vel vi&#233;s&#44; inclusive crian&#231;as com predisposi&#231;&#227;o gen&#233;tica para RB&#46; Al&#233;m disso&#44; a matura&#231;&#227;o oclusal e a redu&#231;&#227;o fisiol&#243;gica das adenoides foram consideradas ao comparar nossos resultados&#46; Por fim&#44; usamos um sensor que forneceu dados mensur&#225;veis para melhor classificar o modo de respira&#231;&#227;o dos pacientes&#46; At&#233; onde sabemos&#44; esse dispositivo de mensura&#231;&#227;o nunca havia sido usado nesse contexto&#46; Isso&#44; em associa&#231;&#227;o ao fato de que usamos um plano constante como refer&#234;ncia para medi&#231;&#245;es das vias a&#233;reas&#44; pode provar que nossos dados s&#227;o mais precisos do que os usados na maior parte das pesquisas anteriores&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Ap&#243;s examinar as crian&#231;as e os adolescentes com padr&#227;o de crescimento normal&#44; nosso estudo mostra que h&#225; diferen&#231;as cefalom&#233;tricas entre indiv&#237;duos com os modos de respira&#231;&#227;o bucal e nasal&#46; Em compara&#231;&#227;o com aqueles com respira&#231;&#227;o nasal&#44; constatamos menor dimens&#227;o anteroposterior das vias a&#233;reas nas crian&#231;as com respira&#231;&#227;o bucal&#59; ao passo que&#44; em adolescentes com respira&#231;&#227;o bucal&#44; constatamos maior altura facial anterior inferior&#44; palato mais longo e posi&#231;&#227;o inferior do osso hioide com rela&#231;&#227;o ao plano mandibular&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Esses achados s&#227;o de interesse pr&#225;tico para os m&#233;dicos no diagn&#243;stico&#44; tratamento e&#47;ou encaminhamento de pacientes a especialistas para tratamento de problemas relacionados a altera&#231;&#245;es de respira&#231;&#227;o&#46; Como esses problemas podem indicar desequil&#237;brio no desenvolvimento&#44; o diagn&#243;stico antecipado &#233; importante para corrigir ou melhorar quaisquer efeitos negativos com tratamento oportuno&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Uma pesquisa future que examine maiores amostras de pacientes com os mesmos crit&#233;rios de sele&#231;&#227;o do que os usados aqui &#233; necess&#225;ria para examinar seu desenvolvimento craniofacial de acordo com o modo de respira&#231;&#227;o&#44; ao mesmo tempo em que considere o padr&#227;o de crescimento&#44; a idade e o sexo&#46; Esse estudo pode fornecer uma comprova&#231;&#227;o adicional da influ&#234;ncia substancial da respira&#231;&#227;o sobre o desenvolvimento craniofacial e a postura da cabe&#231;a&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflitos de interesse</span><p id="par0150" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incidence of abnormal breathing and its consequences on craniofacial development is increasing&#44; and is not limited to children with adenoid faces&#46; The objective of this study was to evaluate the cephalometric differences in craniofacial structures and head posture between nasal breathing and oral breathing children and teenagers with a normal facial growth pattern&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ninety&#8208;eight 7&#8211;16 year&#8208;old patients with a normal facial growth pattern were clinically and radiographically evaluated&#46; They were classified as either nasal breathing or oral breathing patients according to the predominant mode of breathing through clinical and historical evaluation&#44; and breathing respiratory rate predomination as quantified by an airflow sensor&#46; They were divided in two age groups &#40;G1&#58; 7&#8211;9&#41; &#40;G2&#58; 10&#8211;16&#41; to account for normal age&#8208;related facial growth&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Oral breathing children &#40;8&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7 years&#41; showed less nasopharyngeal cross&#8208;sectional dimension &#40;MPP&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;030&#41;&#44; whereas other structures were similar to their nasal breathing counterparts &#40;7&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9 years&#41;&#46; However&#44; oral breathing teenagers &#40;12&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;0 years&#41; exhibited a greater palate length &#40;ANS&#8208;PNS&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#41;&#44; a higher vertical dimension in the lower anterior face &#40;Xi&#8208;ANS&#8208;Pm&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#41;&#44; and a lower position of the hyoid bone with respect to the mandibular plane &#40;H&#8208;MP&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41; than their nasal breathing counterparts &#40;12&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9 years&#41;&#46; No statistically significant differences were found in head posture&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Even in individuals with a normal facial growth pattern&#44; when compared with nasal breathing individuals&#44; oral breathing children present differences in airway dimensions&#46; Among adolescents&#44; these dissimilarities include structures in the facial development and hyoid bone position&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A incid&#234;ncia da respira&#231;&#227;o anormal e de suas consequ&#234;ncias no desenvolvimento craniofacial aumenta e n&#227;o &#233; limitada a crian&#231;as com f&#225;cies adenoideanas&#46; O objetivo deste estudo foi avaliar as diferen&#231;as cefalom&#233;tricas nas estruturas craniofaciais e na postura da cabe&#231;a entre crian&#231;as e adolescentes com respira&#231;&#227;o nasal e respira&#231;&#227;o bucal com padr&#227;o de crescimento facial normal&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">98 pacientes com idades entre 7-16 anos com padr&#227;o de crescimento facial normal foram avaliados de forma cl&#237;nica e radiol&#243;gica&#46; Eles foram classificados como pacientes com respira&#231;&#227;o nasal ou respira&#231;&#227;o bucal de acordo com a predomin&#226;ncia do modo de respira&#231;&#227;o por meio da avaliac&#184;&#227;o cl&#237;nica e hist&#243;rica e da predomin&#226;ncia da frequ&#234;ncia respirat&#243;ria conforme qualificado por um sensor de fluxo de ar&#46; Os pacientes foram divididos em duas faixas et&#225;rias &#40;G1&#58; 7 a 9&#41; &#40;G2&#58; 10 a 16&#41; para contabilizar o crescimento normal facial relacionado &#224; idade&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">As crian&#231;as com respira&#231;&#227;o bucal &#40;8&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;7 anos&#41; mostraram menor dimens&#227;o transversal nasofar&#237;ngea &#40;MPP&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;030&#41;&#44; ao passo que outras estruturas foram semelhantes a seus pares com respira&#231;&#227;o nasal &#40;7&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;9 anos&#41;&#46; Contudo&#44; os adolescentes com respira&#231;&#227;o bucal &#40;12&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;0 anos&#41; mostraram maior comprimento do palato &#40;espinha nasal anterior&#8208;espinha nasal posterior &#91;ENA&#8208;ENP&#93;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#44; maior dimens&#227;o vertical na menor face anterior &#40;Xi&#8208;ENA&#8208;Pm&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41; e menor posi&#231;&#227;o do osso hioide a respeito do plano mandibular &#40;H&#8208;PM&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41; do que seus pares com respira&#231;&#227;o nasal &#40;12&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9 anos&#41;&#46; N&#227;o foram constatadas diferen&#231;as estatisticamente significativas na postura da cabe&#231;a&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Mesmo em indiv&#237;duos com padr&#227;o de crescimento facial normal&#44; em compara&#231;&#227;o com indiv&#237;duos com respira&#231;&#227;o nasal&#44; as crian&#231;as com respira&#231;&#227;o bucal apresentam diferen&#231;as nas dimens&#245;es das vias a&#233;reas&#46; Entre os adolescentes&#44; essas dissimilaridades incluem estruturas no desenvolvimento facial e na posi&#231;&#227;o do osso hioide&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Como citar este artigo&#58; Chambi&#8208;Rocha A&#44; Cabrera&#8208;Dom&#237;nguez ME&#44; Dom&#237;nguez&#8208;Reyes A&#46; Breathing mode influence on craniofacial development and head posture&#46; J Pediatr &#40;Rio J&#41;&#46; 2018&#59;94&#58;123&#8211;130&#46;</p>"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Marcos cefalom&#233;tricos&#44; &#226;ngulos e planos de refer&#234;ncia&#46; Padr&#227;o de crescimento&#58; 1&#46; &#194;ngulo do PF&#8208;PM formado pelo plano facial &#40;n&#8208;Pg&#41; e pelo plano mandibular &#40;Gn&#8208;Go&#41;&#46; O plano facial &#233; formado por n&#225;sio &#40;N&#41; e pogonion &#40;Pg&#41;&#46; O plano mandibular &#233; formado por gnation &#40;Gn&#41; e gonion &#40;Go&#41;&#59; Altura facial&#58; 2&#46; FCNA &#194;ngulo formado pelo ponto central facial &#40;FC&#41; e linha FC&#8208;nasion e linha FC&#8208;subespinhal &#40;A&#41;&#59; 3&#46; Xi&#8208;ENA&#8208;Pm &#194;ngulo formado pelo centro do ponto ramus &#40;Xi&#41; e pela linha Xi&#8208;espinha nasal anterior &#40;ENA&#41; e pela linha Xi&#8208;suprapogonio &#40;Pm&#41;&#59; Maxila&#58; 4&#46; SNA &#194;ngulo formado pela linha de base do cr&#226;nio &#40;SN&#41; e pela linha N&#8208;subespinhal &#40;A&#41;&#46; A base do cr&#226;nio &#233; um plano desde a sela &#40;S&#41; at&#233; nasion &#40;N&#41;&#59; 5&#46; ENA&#8208;ENP Dist&#226;ncia entre a espinha nasal anterior &#40;ENA&#41; e a espinha nasal posterior &#40;ENP&#41;&#59; 6&#46; ENA&#8208;ENP&#8208;FhP &#194;ngulo formado pelo plano palatino b &#40;ENA&#8208;ENP&#41; e pelo plano Frankfurt &#40;FhP&#41;&#46; O plano Frankfurt &#233; formado pelo orbitale b &#40;Or&#41; e porion &#40;Po&#41;&#59; Mand&#237;bula&#58; 7&#46; SNB &#194;ngulo formado pela linha de base do cr&#226;nio &#40;SN&#41; e pela linha N&#8208;supramentale &#40;B&#41;&#59; 8&#46; MP&#8208;FhP &#194;ngulo formado pelo plano mandibular &#40;PM&#41; e pelo plano Frankfurt &#40;FhP&#41;&#59; 9&#46; Go&#8208;FC Dist&#226;ncia do gonion &#40;Go&#41; at&#233; o centro facial &#40;FC&#41;&#59; 10&#46; Xi&#8208;Pm Dist&#226;ncia de Xi a suprapogonion &#40;Pm&#41;&#59; Maxila&#8208;Mand&#237;bula&#59; 11&#46; ANB &#194;ngulo formado pela linha subespinhal &#40;A&#41; e nasion &#40;N&#41; e linha N&#8208;supramentale &#40;B&#41;&#59; Osso hioide&#58; 12&#46; H&#8208;MP Dist&#226;ncia do ponto mais anterior e superior do osso hioide &#40;H&#41; perpendicular ao plano mandibular &#40;PM&#41;&#59; Postura craniocervical&#59; 13&#46; OPT&#8208;SN &#194;ngulo formado por &#40;SN&#41; e odontoides &#40;OPT&#41;&#46; O OPT &#233; formado por uma linha por meio do ponto posterossuperior e posteroinferior do odontoides&#59; 14&#46; CVT&#8208;SN &#194;ngulo formado por &#40;SN&#41; e cervical &#40;CVT&#41;&#46; O CVT &#233; formado por uma linha por meio do ponto posterossuperior e posteroinferior da cervical&#46;</p>"
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Dimens&#245;es das vias a&#233;reas&#46; Nasofaringe&#58; 1&#46; ad1&#8208;Ba Dist&#226;ncia de &#40;ad1&#41; a basion &#40;Ba&#41;&#59; Ad1 &#233; o ponto de interse&#231;&#227;o da parede posterior da faringe e a linha da espinha nasal posterior &#40;ENP&#41; at&#233; basion &#40;Ba&#41;&#59; 2&#46; ad2&#8208;So Dist&#226;ncia de &#40;ad2&#41; a &#40;So&#41;&#46; Ad2 &#233; o ponto de interse&#231;&#227;o da parede posterior da faringe e da linha do ponto m&#233;dio &#40;SD&#41; da linha da sela &#40;S&#41; at&#233; basion &#40;Ba&#41; at&#233; a espinha nasal posterior &#40;ENP&#41;&#59; 3&#46; PtV&#8208;Ad Dist&#226;ncia do ponto &#40;PtV&#41; at&#233; adenoide &#40;Ad&#41;&#46; PtV &#233; uma linha vertical perpendicular ao FhP que passa pelo ponto mais posterior da fossa pterigomaxilar&#46; O ponto PtV est&#225; localizado 5<span class="elsevierStyleHsp" style=""></span>mm acima da ENP&#46; Orofaringe&#58; 4&#46; USP Dist&#226;ncia de um ponto do palato mole &#40;5<span class="elsevierStyleHsp" style=""></span>mm acima do ponto superior do palato mole&#41; &#40;USP&#41; at&#233; o contraponto horizontal na parede posterior da faringe at&#233; o Plano Frankfurt &#40;FhP&#41;&#46; 5&#46; MPP Dist&#226;ncia dos pontos de interse&#231;&#227;o na parede anterior e posterior da faringe do meio de &#40;USP&#41; e &#40;IT&#41; paralelos ao FhP 6&#46; IT Dist&#226;ncia do ponto posterior e inferior da amigdala &#40;T&#41; &#40;5<span class="elsevierStyleHsp" style=""></span>mm acima do ponto inferior da amigdala&#41; at&#233; o contraponto horizontal na parede posterior da faringe paralelo ao FhP&#46; 7&#46; MPP Dist&#226;ncia dos pontos de interse&#231;&#227;o na parede anterior e posterior da faringe do plano mandibular &#40;PM&#41;&#44; paralela ao FhP&#59; Hipofaringe&#58; 8&#46; C3P Dist&#226;ncia entre a faringe posterior&#44; do ponto mais anterior e inferior no corpo da terceira v&#233;rtebra cervical &#40;C3&#41; e faringe anterior&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;733<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;222mm &#177;2&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#44;269mm &#177;3&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;049<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Mand&#237;bula</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>7&#46; SNA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;500&#176; &#177;4&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;353&#176; &#177;3&#44;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;892<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;688&#176; &#177;2&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&#44;250&#176; &#177;3&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;082<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>8&#46; PM&#8208;FhP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;563&#176; &#177; 2&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;000&#176; &#177;5&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;788<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;000&#176; &#177;4&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;192&#176; &#177;3&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;911<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>9&#46; Go&#8208;FC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#44;000 mm &#177;4&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;528 mm &#177;4&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;797<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;167 mm &#177;3&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;077 mm &#177;6&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;706<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10&#46; Xi&#8208;Pm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;875 mm &#177; 4&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#44;722 mm &#177;1&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;81<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#44;833 mm &#177;3&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#44;769 mm &#177; 6&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;979<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Maxila&#8208;mand&#237;bula</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>11&#46; ANB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;063&#176; &#177;2&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;250&#176; &#177;2&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;60<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;833&#176; &#177;1&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;192&#176; &#177;3&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;757 <a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Osso hioide</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>12&#46; H&#8208;PM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;500 mm &#177;1&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;765 mm &#177;3&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;683<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;563 mm &#177;3&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;100 mm &#177;6&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;017<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Postural craniocervical</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>13&#46; OPT&#8208;SN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#44;813&#176; &#177;9&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#44;361&#176; &#177;12&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;928<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;944&#176; &#177;9&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#44;808&#176; &#177; 9&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;172<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>14&#46; CVT&#8208;SN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">105&#44;875&#176; &#177;7&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">106&#44;194&#176; &#177;10&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;941<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">101&#44;444&#176; &#177;7&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&#44;115&#176; &#177;10&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo I</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo II</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Vias a&#233;reas nasofaringe</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#46; ad1&#8208;Ba&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;833 mm &#177; 5&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;529 mm &#177; 7&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;261<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;611 mm &#177; 3&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;192 mm &#177; 5&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;789<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#46; ad2&#8208;S0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;750 mm &#177; 3&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;417 mm &#177; 3&#44;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;358<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;625 mm &#177; 4&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;800 mm &#177; 6&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;647<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#46; PtV&#8208; Ad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;500 mm &#177; 3&#44;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;000 mm &#177; 3&#44;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;724<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;556 mm &#177; 6&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;692 mm &#177; 4&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;717<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Orofaringe</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4&#46; USP&nbsp;\t\t\t\t\t\t\n
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2021 Setembro 16 13 29
2021 Agosto 13 12 25
2021 Julho 12 6 18
2021 Junho 15 16 31
2021 Maio 21 18 39
2021 Abril 43 22 65
2021 Março 18 18 36
2021 Fevereiro 52 19 71
2021 Janeiro 21 27 48
2020 Dezembro 25 34 59
2020 Novembro 14 34 48
2020 Outubro 18 14 32
2020 Setembro 23 22 45
2020 Agosto 16 14 30
2020 Julho 24 13 37
2020 Junho 18 6 24
2020 Maio 25 4 29
2020 Abril 21 14 35
2020 Março 19 5 24
2020 Fevereiro 21 16 37
2020 Janeiro 35 24 59
2019 Dezembro 23 5 28
2019 Novembro 20 12 32
2019 Outubro 25 18 43
2019 Setembro 32 10 42
2019 Agosto 35 14 49
2019 Julho 29 8 37
2019 Junho 37 21 58
2019 Maio 30 11 41
2019 Abril 41 14 55
2019 Março 28 16 44
2019 Fevereiro 27 12 39
2019 Janeiro 34 16 50
2018 Dezembro 37 14 51
2018 Novembro 44 4 48
2018 Outubro 68 32 100
2018 Setembro 38 12 50
2018 Julho 1 0 1
2018 Maio 88 20 108
2018 Abril 201 48 249
2018 Março 106 29 135
2018 Fevereiro 1 3 4
2018 Janeiro 1 1 2
2017 Dezembro 2 2 4
2017 Novembro 4 1 5
2017 Outubro 2 2 4
2017 Setembro 0 1 1
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