A specific protocol of myo-functional therapy in children with Down syndrome. A pilot study

Abstract

In this article the authors propose a specific myofunctional therapy protocol for children with Down syndrome. For these patients, who usually present with atypical swallowing problems, mouth breathing and lip incompetence, the use of a myofunctional therapy protocol with specific exercises has been shown to improve orofacial and nasal functions. In addition to the functional results, such as the correction of the atypical swallowing, restoration of lip competence, breathing improvement and reduction of nasal rhinorrhea, there were also aesthetic results. This protocol can be useful to improve the quality of life of these patients.

Introduction

Down syndrome is by far the most common chromosomal abnormality affecting live born children. It is primarily caused by trisomy of chromosome 21 and it is characterised by mild to moderate mental retardation and physical deficits. Affected individuals most often exhibit systemic abnormalities (cardiovascular, neurological, immunological, musculoskeletal) as well as anomalies of the orofacial complex, the most frequent ones are:-skeletal abnormalities such as deficit development of the middle third of the face resulting in mandibular prognathism, skeletal open bite, deep and narrow palate;-dental anomalies of shape, such as macrodontia or microdontia (often the upper lateral incisors, if present, are peg-shaped), number, such as agenesis of teeth (especially of the upper lateral incisors), and eruption, such as delayed eruption or teeth that erupt in a different order than in healthy children [Kumasaka et al., 1997; Mestrovic et al., 1998]. Patients with Down syndrome have periodontal disease [Shapira et al., 1991; Agholme et al., 1999; Sohoel et al., 1995; Cichon et al., 1998], with the mandibular incisors and the maxillary molars being the most commonly affected teeth. Cavities are rather less frequent than periodontal disease or functional problems. Patients with Down syndrome present mouth breathing, which is a consequence of the small size of the nasal cavity, but it is probably also due to continuous infection of the upper airways that force the patient to breathe through the mouth. Mouth breathing often causes problems of halitosis (bad breath) and dry mouth (xerostomia) as well as angular cheilitis, often also due to sialorrhoea. Patients often present with macroglossia. It is, however, an apparent macroglossia due to the small size of the palate that forces the tongue to maintain a low and forward position. Patients with Down syndrome have significant problems in sucking, swallowing, chewing and talking.

Conclusions

The results of this study treating nasal-oral atypical functions with myofunctional therapy in patients with Down syndrome has been very positive, and allow us to state that, in selected cases, it is possible to achieve proper restoration of the orofacial physiological kinetics and to normalise oral functions such as swallowing, breathing and articulation although, in the present study, speech was not a therapy goal. Myofunctional therapy should be considered not only as an adjunct to orthodontic treatment, but also as an essential support to the development of the cranio-mandibular-occlusal complex[Saccomannoetal.,2012a,2012b,2014].Amultidisciplinary approach and cooperation between the medical staff and the patient as well as his/her family is necessary to ensure compliance at home to perform the exercises that are crucial to the success of the treatment.This study showed that good results can be achieved with two specific and properly performed cycles of myofunctional therapy. With this group of patients, the number of repetitions of exercises and the length of the therapy were sufficient to allow a neuroplastic and neuromuscular result, visible in facial posture, nasal breathing and oral functions. Therefore, it is of paramount importance to begin therapy with children with Down syndrome as soon as possible in order to ensure the maximum benefit of myofunctional therapy, to establish normalised orofacial and nasal functions and thus improve their social life.

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