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Cláudia Maria de Felício,1,2 Franciele Voltarelli da Silva Dias,1,2 Luciana Vitaliano Voi Trawitzki1,2 1Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; 2Craniofacial Research Support Center, University of São Paulo (USP), Ribeirão Preto, Brazil Purpose: Orofacial myofunctional therapy (OMT) is a modality of treatment for children and adults with obstructive sleep apnea (OSA) to promote changes in the musculature of the upper airways. This review summarizes and discusses the effects of OMT on OSA, the therapeutic programs employed, and their possible mechanisms of action.Methods: We conducted an online literature search using the databases MEDLINE/PubMed, EMBASE, and Web of Science. Search terms were “obstructive sleep apnea” in combination with “myofunctional therapy” OR “oropharyngeal exercises” OR “speech therapy”. We considered original articles in English and Portuguese containing a diagnosis of OSA based on polysomnography (PSG). The primary outcomes of interest for this review were objective measurement derived from PSG and subjective sleep symptoms. The secondary outcome was the evaluation of orofacial myofunctional status.Results: Eleven studies were included in this review. The studies reviewed reveal that several benefits of OMT were demonstrated in adults, which include significant decrease of apnea–hypopnea index (AHI), reduced arousal index, improvement in subjective symptoms of daytime sleepiness, sleep quality, and life quality. In children with residual apnea, OMT promoted a decrease of AHI, increase in oxygen saturation, and improvement of orofacial myofunctional status. Few of the studies reviewed reported the effects of OMT on the musculature.Conclusion: The present review showed that OMT is effective for the treatment of adults in reducing the severity of OSA and snoring, and improving the quality of life. OMT is also successful for the treatment of children with residual apnea. In addition, OMT favors the adherence to continuous positive airway pressure. However, randomized and high-quality studies are still rare, and the effects of treatment should also be analyzed on a long-term basis, including measures showing if changes occurred in the musculature. Keywords: sleep-disordered breathing, myofunctional therapy, oropharyngeal exercises, speech therapy, oral motor exercises

Purpose: To measure the nasalance scores of Brazilian Portuguese-speaking young adults from the states of Sao Paulo and Minas Gerais in order to investigate whether dialect variations and gender affect these scores., Methods: Nasalance was assessed in 36 individuals: 20 native residents of Sao Paulo state (mean age=23 y.o.) and 16 native residents of Minas Gerais state (mean age=24 y.o.), following the same criteria. Nasalance measures were taken using the Nasometer II 6400 (KayPentax) device based on the reading of three texts (nasal-1, nasal-2, and oral). Intergroup nasalance scores were compared using the unpaired Student's t test considering two experimental groups., Results: The nasalance scores in individuals from the states of Sao Paulo and Minas Gerais were 52.7% and 48.8% for the nasal-1 text, 49.6% and 49.9% for the nasal-2 text, and 14.3% and 9.8% for the oral text, respectively. Statistical analysis comparing the mean nasalance scores in both groups showed significant difference (p=0.03) only for the oral text, in which individuals from Sao Paulo state presented higher scores., Conclusion: Although nasalance scores were lower in individuals from Minas Gerais state compared with those of individuals from Sao Paulo state, both groups presented values within the normal range. The variable gender was not relevant in the nasalance assessment; however, a tendency for higher scores was observed in women compared with men from Minas Gerais state in the same group in the reading of the nasal-2 text. This study contributes to the knowledge of nasalance reference scores for two different populations of Brazilian Portuguese speakers; however, the results herein reported should be interpreted with caution due to the small study sample size.

Objectives: The purposes of this study were (1) to identify possible differences in muscular and orofacial functions between children with obstructive sleep apnea (OSA) and with primary snoring (PS); (2) to examine the standardized difference between normal values of myofunctional scores and those of subjects with OSA or PS; and (3) to identify the features associated with OSA., Methods: Participants were 39 children (mean age 8 ± 1.2 years) of which, 27 had a diagnosis of OSA and 12 had PS. All participants were examined by an otorhinolaryngologist and underwent overnight polysomnography. Orofacial characteristics were determined through a validated protocol of orofacial myofunctional evaluation with scores (OMES), surface electromyography of masticatory muscles, and measurements of maximal lip and tongue strength. Reference values in the OMES were included to quantify the standardized difference (effect size = ES) relative to the groups studied and in the regression analysis., Results: The OSA group had lower scores in breathing and deglutition, more unbalanced masticatory muscle activities than PS group (P < 0.05), but both groups had similar reductions in orofacial strength. OSA had a large ES (Cohen's d > 0.8) in all analysed OMES scores, while PS group showed small and medium differences in breathing and mastication scores, respectively. The mobility of the stomatognathic components score was the most important to contribute for group status (57%, P < 0.0001) in the regression analysis., Conclusion: Children with tonsillar hypertrophy and OSA had relevant impairments in orofacial functions and lesser muscular coordination than children with PS., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To present the measures for tongue pressure in Brazilian young adults, considering specific tasks, and to verify the differences regarding gender and according to the tasks., Methods: Fifty-one volunteers aged 18 to 28 years, of both genders with normal occlusion and without speech disorders were evaluated. We used the Iowa Oral Performance Instrument in the evaluation of tongue pressure (kilopascal) during specific tests of elevation, protrusion, swallowing, and lateralization, in addition to the endurance test (seconds). The analysis was conducted using analysis of variance, followed by the Tukey's multiple comparison test, adopting a 5% significance level., Results: The values obtained for men and women in the tests were as follows: elevation, 63.94±12.92 and 50.27±15.29; protrusion, 60.22±13.62 and 44.30±12.95; swallowing, 33.94±12.06 and 34.27±13.25; lateralization on the right, 44.15±10.47 and 31.85±8.46; lateralization on the left, 43.15±10.22 and 29.55±8.91; and endurance test: 24.85±10.95 and 17.35±6.71, respectively. The values were higher in men compared with women for the protrusion and lateralization tasks. The measures of the protrusion and elevation tasks did not differ for men but were higher in both genders than those of the lateralization and the swallowing tests. There was no difference in lateralization according to side in both the genders., Conclusion: The measures for the tongue pressure in Brazilian young adults were determined by specific tasks. Gender influenced the pressure of the tongue values for the protrusion and lateralization tasks. Elevation and protrusion tasks measures were higher than those of the lateralization and swallowing tasks.

Background: It is recognized that adenotonsillar hypertrophy leads to muscular and functional changes in face, and that adenotonsillectomy is associated to improvement in this condition. However, the ideal interval one should wait until this spontaneous recovery is not well defined, neither if this recovery is expected to be complete or partial., Objective: To compare the muscular and functional changes in face of children prior and after adenotonsillectomy in a monthly evaluation., Methods: 8 children aged from 4 to 6 years were prospectively studied. All patients underwent adenotonsillectomy, and were assessed before and monthly-after surgery up to 6 months, through the Protocol of Orofacial Myofunctional Evaluation with Scores (OMES)., Results: There was a progressive improvement in OMES score in all measured parameters, including the "mobility" and "posture" sub-tests; this improvement was significant at the first month after surgery. The sub-test "function" was not affected by surgery. Improvement continued from the first to the sixth month after surgery, although it was not significant between these two periods. Additionally, all parameters remained altered after the final evaluation at six months. There was a significant correlation between the improvement in "mobility" sub-test and in total score of OMES., Conclusion: We observed a partial recovery in facial muscular and functional changes following adenotonsillectomy, particularly during the first month after surgery. This improvement was especially observed in the "mobility" and "posture" sub-tests. We conclude that waiting for a spontaneous muscular and functional facial recovery during the first month post-operatively seems reasonable. Nevertheless, after this period, if the patient fails to achieve recovery, it may be advised that this child should undergo myofunctional therapy., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: Uvulopalatopharyngoplasty (UPPP) has been described as an option for treating obstructive sleep apnea syndrome (OSAS), with variable success rates. The main purpose of our study was to correlate UPPP success to craniofacial bony structure and orofacial muscles function., Methods: Clinical variables, including body mass index (BMI), age, and preoperative apnea-hypopnea index (AHI); cephalometric measurements of the craniofacial region and hyoid bone position; and muscle function variables including clinical protocol and tongue strength measures were evaluated in 54 patients who underwent UPPP in the last 7years. The measurements were related to the success or failure of UPPP based on the results of preoperative and postoperative polysomnography (PSG)., Results: The variables BMI, preoperative AHI, and cephalometric measurements showed no influence on surgical success. The clinical muscle protocol also was similar between groups. However, the muscle strength of the anterior portion of the tongue was significantly greater in the group that showed surgical success compared to those with surgical failure., Conclusion: OSAS is a multifactorial disease and diagnostic symptom assessments should be individualized. In addition, special attention should be given to functional muscle alterations of the airways, as they might influence the evolution of the disease., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Unlabelled: The changes in mastication and deglutition in children with adenotonsillar hypertrophy need to be better characterized., Objective: To evaluate the frequency of parent-reported myofunctional changes and to determine if there are differences in the alteration patterns of children with adenotonsillar hypertrophy and subjects with adenoid hypertrophy., Method: Questionnaire and assessment by a speech therapist of children aged between three and six years with tonsillar hypertrophy. The data reported by the parents were compared to the data obtained from the speech therapist's evaluation; additionally, data from children with adenotonsillar hypertrophy were compared to findings from subjects with adenoid hypertrophy., Study Design: cross-sectional cohort., Results: The myofunctional changes observed by the speech therapist were more frequent than the alterations reported by the parents, and there was no correlation between the two findings. The children with adenoid hypertrophy and the individuals with adenotonsillar hypertrophy had the same pattern of myofunctional alteration., Conclusion: Parents cannot clearly correlate tonsillar hypertrophy with changes in mastication and deglutition. The cause of the respiratory obstruction does not seem to interfere in the pattern of myofunctional change.

Cephalometry has been used to measure hard and soft facial tissues, as well as the pharyngeal air space for the diagnosis of obstructive sleep apnea (OSA). The changes occurring in the pharynx due to maxillo-mandibular advancement (MMA) have not been established or quantified. The objective of this study was to identify the anatomical changes of the pharynx and of hard tissues that occur in patients with OSA after MMA. 19 patients with a polysomnographic diagnosis of OSA were submitted to cephalometric analysis before and 6 months after surgery in order to evaluate the changes produced by MMA in the pharynx and soft tissues. Cephalometry was standardized in order to obtain descriptive measurements of the dimensions of the airways, the position of the hyoid bone, and maxilla-mandibular relations. The modifications of the pharynx due to MMA showed a significant relation obtained by cephalometry. For each millimeter of maxillary and mandibular bone advancement there was a 0.76mm increase in the retropalatal region and a 1.2mm increase in the pharynx in the retrolingual region. In addition, MMA promoted a significant repositioning of the hyoid bone in the cranial direction., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The objective of this study was to determine whether dentofacial deformities (class II and class III) influence maximum isometric tongue strength compared with a group without deformities. A total of 126 adult patients participated in the study. Of these, 45 had a class II diagnosis (14 men and 31 women) and 81 a class III diagnosis (35 men and 46 women), all of them with indication of orthognathic surgery. Fifty adult volunteers (17 men and 33 women) with no changes in dental occlusion (class I) and with no clinical signs of dysfunction of the temporomandibular joint represented the control group. Tongue strength (in N) was measured with a dynamometer. The maximum strength of the anterior portion was determined with the instrument positioned on the retroincisor region and the maximum strength of the dorsum with the instrument positioned in the region of the hard palate. Data were analysed statistically by analysis of variance (anova) and by the Pearson correlation test. No significant difference (P > 0·05) in tongue strength in the anterior or dorsal region was observed between the groups with dentofacial deformities or between these groups and the control. The tongue strength of the anterior and dorsal regions was not influenced by the dentofacial deformity., (© 2012 Blackwell Publishing Ltd.)

Masticatory efficiency may be impaired in individuals with dentofacial deformities. The objective of the present study was to determine the condition of masticatory efficiency in individuals with dentofacial deformities. 30 patients with class II (DG-II) and 35 patients with class III (DG-III) dentofacial deformity participated in the study, all had an indication for orthognathic surgery. 30 volunteers (CG) with no alterations of facial morphology or dental occlusion and with no signs or symptoms of temporomandibular joint dysfunction also participated. Masticatory efficiency was analysed using a bead system (colorimetric method). Each individual chewed 4 beads, one at a time, over 20s measured with a chronometer. The groups were compared in terms of masticatory efficiency using analysis of variance (ANOVA), with the level of significance set at P<0.05. Masticatory efficiency was significantly greater in CG (P<0.05) than in DG-II and DG-III in all chewing tasks tested, with no significant difference between DG-II and DG-III (P>0.05). It was observed that the presence of class II and class III dentofacial deformity affected masticatory efficiency compared to CG, although there was no difference between DG-II and DG-III., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: To verify whether the number of chewing strokes and the chewing time are influenced by dentofacial deformities in habitual free mastication., Methods: Participants were 15 patients with diagnosis of class II dentofacial deformity (GII), 15 with class III (GIII), and 15 healthy control individuals with no deformity (CG). Free habitual mastication of a cornstarch cookie was analyzed, considering the number of chewing strokes and the time needed to complete two mastications. Strokes were counted by considering the opening and closing movements of the mandible. The time needed to consume each bite was determined using a digital chronometer, started after the placement of the food in the oral cavity and stopped when each portion was swallowed., Results: There were no differences between groups regarding both the number of strokes and the chewing time. However, with regards to the number of strokes, CG and GII presented a significant concordance between the first and the second chewing situation, which was not observed in GIII. The analysis of time showed significant concordance between the first and second chewing situation in CG, reasonable concordance in GII, and discordance in GIII., Conclusion: Dentofacial deformities do not influence the number of chewing strokes or the chewing time. However, class III individuals do not show uniformity regarding these aspects.

Objective: To determine whether dentofacial deformities influence maximal isometric bite force in affected individuals compared to a control group., Design: A total of 125 volunteer adult patients attended at a hospital participated in the study. Of these, 44 had a confirmed diagnosis of class II deformity (GII: 13 men and 31 women; mean age: 27 years) and 81 had class III deformity (GIII: 35 men and 46 women; mean age 25 years), all of them with indication of orthognathic surgery and under orthodontic treatment. Fifty adult volunteers (CG: 17 men and 33 women; mean age: 22 years) with no alterations of dental occlusion or clinical signs of temporomandibular joint dysfunction participated as controls. Maximal isometric bite force was measured with an electronic gnathodynamometer alternately positioned on each side of the dental arch in the region of the molar teeth and the subjects were instructed to bite it as strongly as possible, with the value being recorded in Newtons. Individuals with good understanding of oral language and with no cognitive or neuromuscular deficits were selected. Data were analysed statistically by the mixed effects model., Results: There was no statistically significant difference (P>.05) in maximal isometric bite force between subjects with class II and class III dentofacial deformities, although the values for both groups were lower than those of control individuals., Conclusion: Dentofacial deformity affected maximal isometric bite force regardless of its pattern., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: To analyse the effect of integrated orthodontic treatment, orthognathic surgery and orofacial myofunctional therapy on masseter muscle thickness in patients with class III dentofacial deformity three years after orthognathic surgery., Design: A longitudinal study was conducted on 13 patients with class III dentofacial deformities, denoted here as group P1 (before surgery) and group P3 (same patients 3 years to 3 years and 8 months after surgery). Fifteen individuals with no changes in facial morphology or dental occlusion were assigned to the control group (CG). Masseter muscle ultrasonography was performed in the resting and biting situations in the three groups. Data were analysed statistically by a mixed-effects linear model considering a level of significance of P < 0.05., Results: Significantly higher values (P < 0.01) of masseter muscle thickness (cm) were detected in group P3 (right rest: 0.82 ± 0.16, left rest: 0.87 ± 0.21, right bite: 1 ± 0.22, left bite: 1.04 ± 0.28) compared to group P1 (right rest: 0.63 ± 0.19, left rest: 0.64 ± 0.15, right bite: 0.87 ± 0.16, left bite: 0.88 ± 0.14). Between P3 and CG (right rest: 1.02 ± 0.19, left rest: 1 ± 0.19, right bite: 1.18 ± 0.22, left bite: 1.16 ± 0.22) there was a significant difference on the right side of the muscle (P < 0.05) in both situations and on the left side at rest., Conclusion: The proposed treatment resulted in improved masseter muscle thickness in patients with class III dentofacial deformity., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The measurement of tongue strength contributes to the study of oro-facial physiology. The objective of this study was to investigate the influence of gender on tongue strength in young adults and to determine the differences in this strength between tongue regions. This study was conducted on 50 healthy volunteers (17 men and 33 women) with a mean age of 23 years, with no oro-facial myofunctional alterations. The strength of the anterior portion and of the dorsum of the tongue was analysed with a calibrated electronic dynamometer. The subjects were asked to apply maximum force. Men showed higher tongue strength values than women both in the anterior portion and in the dorsum of the tongue (P<0·05), and the strength of the anterior portion of the tongue was lower than that of the dorsum in both genders (P<0·05). We conclude that gender and region influenced tongue strength., (© 2010 Blackwell Publishing Ltd.)

Individuals with dentofacial deformities have masticatory muscle changes. The objective of the present study was to determine the effect of interdisciplinary treatment in patients with dentofacial deformities regarding electromyographic activity (EMG) of masticatory muscles three years after surgical correction. Thirteen patients with class III dentofacial deformities were studied, considered as group P1 (before surgery) and group P3 (3 years to 3 years and 8 months after surgery). Fifteen individuals with no changes in facial morphology or dental occlusion were studied as controls. The participants underwent EMG examination of the temporal and masseter muscles during mastication and biting. Evaluation of the amplitude interval of EMG activity revealed a difference between P1 and P3 and no difference between P3 and the control group. In contrast, evaluation of root mean square revealed that, in general, P3 values were higher only when compared with P1 and differed from the control group. There was an improvement in the EMG activity of the masticatory muscles, mainly observed in the masseter muscle, with values close to those of the control group in one of the analyses., (Copyright © 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: swallowing in children with neurologic disorders., Aim: to relate the data obtained in the clinical and in the videofluoroscopic evaluations of swallowing in children with neurologic disorders., Methods: a retrospective analysis of 24 protocols of speech-language evaluation and of medical records of children, of both genders, referred to clinical and videofluoroscopic evaluations of swallowing at the School of Medicine of Ribeirão Preto - University of São Paulo, from January 2001 to June 2005. The following aspects were analyzed in the clinical evaluation: diet consistency, functional aspects of the swallowing mechanism and results of the cervical auscultation. Videofluoroscopic evaluation was performed to determine the dynamic aspects of the oral and pharyngeal phases., Results: during the clinical evaluation of the oral phase, for both liquid and pasty consistencies, a greater occurrence of inadequate bolus control was observed (n = 15 e n = 14, respectively). In the pharyngeal phase, also for both consistencies, an adequate cervical auscultate was more frequently observed before swallowing (n = 16 e n = 13) followed by the inadequate cervical auscultation during swallowing (n = 15 e n = 12). In the videofluoroscopic evaluation, during the oral phase, for both consistencies, the presence of inadequate food propulsion was the most frequent finding (n = 13 e n = 13) and, in the pharyngeal phase, the most frequent finding was the absence of laryngotracheal aspiration (n = 12 e n = 17). There was a statistically significant correlation between the cervical auscultate and the excursion of the hyoid and the larynx, and between the cervical auscultate and laryngotracheal aspiration of liquid and pasty consistencies., Conclusion: both procedures are important and complementary in the diagnosis of dysphagia.

Introduction: Bruxism is characterized by repeated tooth grinding or clenching. The condition can occur in all age ranges and in both genders, being related or not to other oral habits., Objective: The objective of the present study was to investigate the occurrence of bruxism in children with nasal obstruction and to determine its association with other factors., Methods: Sixty children with nasal obstruction seen at the Otorhinolaryngology Outpatient Clinic of the University Hospital of Ribeirão Preto participated in the study. The data were obtained using a pre-established questionnaire applied to the person responsible and by orofacial evaluation of the patient. The participants were divided into two groups: group with bruxism (GB) as reported by the relatives and with the presence of tooth wear detected by clinical evaluation, and group without bruxism (GWB), consisting of children with none of the two symptoms of bruxism mentioned above., Results: The presence of bruxism exceeded its absence in the sample studied (65.22%). There was no significant difference (P<0.05) between groups regarding gender, phase of dentition, presence of hearing diseases, degree of malocclusion, or child behavior., Conclusion: Bruxism and deleterious oral habits such as biting behavior (objects, lips and nails) were significantly present, together with the absence of suction habits, in the children with nasal obstruction.

Objective: The objective of the present study was to determine the modifications in masseter muscle thickness before and after interdisciplinary orthodontic, oromyofunctional and surgical treatment of class III dentofacial skeletal deformities (DFSD)., Design: Fifteen patients with class III DFSD participated in the study, denoted P1 group before the interdisciplinary treatment and P2 group (same patients) 6-8 months after surgery. Fifteen individuals with no DFSD were used as the control group. Bilateral ultrasonography (US) of the masseter muscle under resting and biting conditions was performed in the three groups., Results: There was a significant difference (P<0.01) for all muscles tested between the control, P1 and P2 groups, with greater thickness for controls, intermediate thickness for P2, and the lowest thickness for P1 in all situations evaluated., Conclusion: We conclude that there was an increase in masseter muscle thickness after surgical correction of DFSD accompanied by interdisciplinary treatment, although the values were still lower than those observed in the control group.

Objectives: To evaluate the myofunctional status in children submitted to adenoidectomy or adenotonsillectomy, correlating the pre and post-surgical patterns throughout a 24-month-period. To correlate the myofunctional alterations to the sort of surgery performed (adenoidectomy versus adenotonsillectomy) and to the predominant post-surgical breathing pattern (predominantly nasal versus allergic rhinitis)., Methods: Forty children were assessed by the otorhinolaryngologist and speech therapist before and 1-24 months after surgery. In order to evaluate myofunctional status, a pre-structured protocol was designed, which included observations regarding facial posture, tonicity, mastication, deglutition and respiration. A score from 0 (normal pattern) to 12 (highly altered) was set., Results: There was a partial, but progressive decrease of the score after surgery (p < 0.001). This decrease was markedly observed during the first 6 months following surgical procedure (p < 0.001), after which it was no longer significant. There was no correlation between the myofunctional progress and the sort of surgery performed. The myofunctional improvement was more accentuated in nasal breathers when compared to those with allergic rhinitis., Conclusions: Improvement of myofunctional status seems to be observed in children after surgery. In this study, the improvement was predominantly accomplished during the first 6 months following surgical procedure. Persistent pattern of mouth breathing due to allergic rhinitis may difficult recovery of the myofunctional status. The most adequate post-surgical moment for the otorhinolaryngologist to refer the patient to speech therapist for myofunctional therapy seems to be crucial, as well as the recognition by the speech therapist of the persistence of the obstructive symptoms, re-referring this patient to the physician.

Individuals with dentofacial deformities present changes in masticatory muscles. The objective of the present study was to determine the influence of interdisciplinary treatment in cases of class III dentofacial deformities regarding the EMG activity of the temporal (T) and masseter (M) muscles. The study was conducted on 15 patients with class III dentofacial deformities who were submitted to orthodontic, oromyofunctional and surgical treatment and assigned to groups P1 (before surgery) and P2 (6-9 months after surgery). Fifteen individuals with no alterations in facial morphology or dental occlusion and without signs or symptoms of temporomandibular joint dysfunction were used as controls (CG). The T and M muscles were submitted to EMG bilaterally in the situations of mastication and mastication plus biting, with analysis of amplitude interval and root mean square. For all muscles tested, there was a difference between CG, P1 and P2; CG was higher than P2 and P2 higher than P1 in all situations assessed. We conclude that there was an increase in EMG activity in the T and M muscles after surgical correction of the dentofacial deformity accompanied by interdisciplinary treatment, although the values were still lower than those obtained for CG.

Aim: Breast-feeding promotes several benefits in childhood, among them favoring the nasal breathing. In the present study, the relationship between breathing pattern and the history of breast-feeding and of deleterious oral habits was determined., Study Design: clinical with transversal cohort., Material and Method: The study population consisted of 62 children ranging in age from 3 years and 3 months to 6 years and 11 months who were submitted to otorhinolaryngologic evaluation to determine nasal and mouth breathers and to a speech language pathologic interview. The otorhinolaryngologic evaluation involved the following exams: anterior rhinoscopy, oroscopy and radiologic examination. The parents of the children were questioned about the form of feeding (natural and/or artificial), the duration of breast-feeding and the presence of deleterious oral habits (suction and biting). The Fisher exact test was used to compare groups regarding the presence and absence of habits and the different periods of breast-feeding., Results: The breast-feeding period was longer among nasal breathers and was concentrated in the period between 3 and 6 months of age. Regarding the use of bottle, the results showed that most of the children in both groups used this type of feeding during the first years of life, with no significant difference between groups (p=0.58). There was a marked presence of deleterious oral habits among mouth breathers, with a statistically significant difference between groups regarding suction (p=0.004) and biting habits (p=0.0002)., Conclusion: Mouth breathing children were breast-fed for a shorter period of time and had a history of deleterious oral habits compared to nose breathers.