Alterações fonéticas, oclusão dentária e suas relações nos indivíduos com fissura labiopalatina submetidos à cirurgia ortognática
Phonetic changes, dental occlusion and their relationships in individuals with cleft lip and palate undergoing orthognathic surgery
Melissa Picinato-Pirola; Andressa Sharllene Carneiro da Silva; Bruna Mara Adorno Marmontel Araújo; Ana Paula Fukushiro
Resumo
Objetivo: Verificar as modificações dos aspectos fonéticos, nasométricos e aerodinâmicos da fala em indivíduos com fissura labiopalatina e a influência da oclusão sobre essas variáveis, antes e após a cirurgia ortognática (CO) de avanço de maxila. Método: Estudo retrospectivo, observacional, transversal e analítico. Participaram 51 pacientes com fissura labiopalatina previamente reparada, 26 homens e 25 mulheres (x̅=31 anos), submetidos à CO de avanço maxilar. Foram realizados: avaliação dos aspectos fonéticos e oclusais, nasometria e avaliação aerodinâmica da função velofaríngea (técnica fluxo-pressão), antes e após a CO. Os aspectos fonéticos foram avaliados por 3 juízes experientes. Resultados: Houve alta concordância intra e inter juízes. Observou-se melhora significativa na produção fonética, após a CO: na interposição de língua ([d], [t], [l], [n], [ʎ]), distorção ([f], [v]) e ceceio anterior ([s], [z], [ʃ]). Nos aspectos oclusais, o trespasse horizontal atingiu, em média, os valores de normalidade após a CO e houve melhora oclusal da mordida cruzada anterior, mordida aberta e sobremordida. Os valores de nasalância encontraram-se dentro dos valores de normalidade após CO para o texto nasal e houve aumento da nasalância, sugestiva de hipernasalidade, no texto oral. Não houve modificação no fechamento velofaríngeo, na produção do vocábulo “rampa”, sugestivo de adequado fechamento velofaríngeo. A oclusão não influenciou a nasalância e o fechamento velofaríngeo antes ou após a CO de avanço de maxila. Conclusão: Houve melhora significativa dos aspectos fonéticos, oclusais e nasométricos após a CO. Entretanto, em nenhum fone se obteve 100% de adequação, reforçando a importância da fonoterapia após a CO.
Palavras-chave
Abstract
Purpose: To verify changes in phonetic, nasometric and aerodynamic aspects of speech in individuals with cleft lip and palate and the influence of occlusion on these variables, before and after orthognathic surgery (OC) for maxillary advancement. Methods: Retrospective, observational, cross-sectional and analytical study. Fifty-one patients with previously repaired cleft lip and palate participated, 26 men and 25 women (x̅=31 years), who underwent maxillary advancement OC. The following were performed: assessment of phonetic and occlusal aspects, nasometry and aerodynamic assessment of velopharyngeal function (flow-pressure technique), before and after OC. The phonetic aspects were evaluated by 3 experienced judges. Results: There was high intra and inter judge agreement. There was a significant improvement in phonetic production after OC: in tongue interposition ([d], [t], [l], [n], [ʎ]), distortion ([f], [v]) and anterior lisp ([s], [z], [ʃ]). In the occlusal aspects, the overjet reached, on average, the normal values after the OC and there was an occlusal improvement in the anterior crossbite, openbite and overbite. Nasalance values were within the normal range after CO for the nasal text and there was an increase in nasalance, suggestive of hypernasality, in the oral text. There was no change in velopharyngeal closure, in the production of the word “rampa”, suggestive of adequate velopharyngeal closure. Occlusion did not influence nasalance and velopharyngeal closure before or after maxillary advancement OC. Conclusion: There was a significant improvement in phonetic, occlusal and nasometric aspects after OC. However, none of the phones obtained 100% adequacy,reinforcing the importance of speech therapy after OC.
Keywords
Referências
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Submetido em:
04/08/2024
Aceito em:
12/05/2025
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