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https://www.audiolcommres.org.br/article/doi/10.1590/2317-6431-2025-3067pt
Audiology - Communication Research
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Possíveis tratamentos para a microstomia em pacientes com esclerose sistêmica: revisão de escopo

Possible treatments for microstomy in patients with systemic sclerosis: scoping review

Carla Patrícia Hernandez Alves Ribeiro César; Aline Santana de Carvalho; Ericka Rafaella Batista Matias; Raphaela Barroso Guedes-Granzotti; Kelly da Silva

http://dx.doi.org/10.1590/2317-6431-2025-3067pt Audiol. Commun. Res., vol.30, e3067, 2025
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Resumo

Objetivo: mapear, por meio de revisão de escopo, as intervenções disponíveis para o tratamento da microstomia na esclerose sistêmica, descrevendo suas características e principais resultados clínicos.

Estratégia de pesquisa: a revisão seguiu as diretrizes PRISMA Extension for Scoping Reviews, utilizando a estratégia População (pacientes com esclerose sistêmica); Conceito (intervenções terapêuticas para microstomia) e Contexto (estudos clínicos e experimentais). A busca foi realizada em sete bases de dados, em maio de 2025, utilizando descritores controlados e não controlados, combinados por operadores booleanos. Dois revisores independentes conduziram a triagem e seleção dos estudos, sendo um terceiro acionado em caso de divergências.

Critérios de seleção: foram incluídos estudos clínicos realizados em pacientes adultos ou idosos com diagnóstico confirmado de esclerose sistêmica e excluídos artigos de revisão, comentários, monografias, diretrizes, livros, recomendações e estudos com duas ou mais comorbidades. Não houve restrições quanto ao ano de publicação, idioma ou tipo de estudo. A análise dos resultados foi qualitativa.

Resultados: foram recuperados 263 artigos e 24 incluídos na amostra. As intervenções descritas incluíram: mioterapia orofacial (exercícios de alongamento, de contração isotônica e isométrica), radiação eletromagnética (luz ultravioleta, luz intensa pulsada e laser de CO2 fracionado), procedimentos cirúrgicos (como comissuroplastia e enxertos) e aplicações de toxina botulínica, ácido hialurônico e enzimas.

Conclusão: a revisão de escopo mostrou que existem diferentes estratégias terapêuticas para a microstomia em pacientes com esclerose sistêmica, variando desde exercícios miofuncionais até procedimentos invasivos. Apesar da diversidade de estudos, a evidência científica ainda é limitada e heterogênea, ressaltando a necessidade de estudos clínicos robustos que avaliem a efetividade comparativa dessas intervenções e apoiem protocolos baseados em evidências.

Palavras-chave

Esclerose sistêmica; Sistema estomatognático; Microstomia; Doenças autoimunes; Fonoaudiologia

Abstract

Purpose: This scoping review systematically mapped the available interventions for the management of microstomia in systemic sclerosis, characterizing their features and reported clinical outcomes.

Search strategy: The review followed PRISMA-ScR guidelines, using the Population (patients with systemic sclerosis), Concept (therapeutic interventions for microstomia), and Context (clinical and experimental studies) strategy. The search was conducted in seven databases in May 2025, utilizing both controlled and uncontrolled descriptors combined with Boolean operators. Two independent reviewers performed the screening and selection of studies, with a third reviewer consulted in case of disagreements.

Selection criteria: Clinical studies involving adult or older adults patients with a confirmed diagnosis of systemic sclerosis were included. Review articles, commentaries, monographs, guidelines, books, recommendations, and studies involving two or more comorbidities were excluded. No restrictions were applied regarding year, language, or study type. The analysis of results was qualitative.

Results: A total of 263 articles were retrieved, of which 24 were included in the final sample. The described interventions included orofacial myotherapy (stretching, isotonic, and isometric contraction exercises), electromagnetic radiation (ultraviolet light, intense pulsed light, and fractional CO2 laser), surgical procedures (such as commissuroplasty and grafts), and applications of botulinum toxin, hyaluronic acid, and enzymes.

Conclusion: The review identified a range of therapeutic approaches for microstomia in systemic sclerosis, from myofunctional exercises to invasive procedures. Despite this variety, the current scientific evidence is limited and heterogeneous, underscoring the need for well-designed clinical studies to assess the comparative effectiveness of these interventions and to inform evidence-based clinical protocols.

Keywords

Systemic sclerosis; Stomatognathic system; Microstomy; Autoimmune diseases; Speech-language pathology

Referências

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55 Türk İ, Cüzdan N, Çiftçi V, Arslan D, Ünal İ. Correlations between clinical features and mouth opening in patients with systemic sclerosis. Arch Rheumatol. 2020;35(2):196-204. https://doi.org/10.46497/ArchRheumatol.2020.7434. PMid:32851368.
 

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