CoDAS
http://www.codas.periodikos.com.br/article/doipath/10.1590/2317-1782/20202019152
CoDAS
Artigo Original

Surgical maxillary advancement and speech resonance: comparison among cleft types

Avanço cirúrgico de maxila e ressonância de fala: comparação entre os tipos de fissura

Maria Natália Leite de Medeiros-Santana; Bruna Mara Adorno Marmontel Araújo; Ana Paula Fukushiro; Inge Elly Kiemle Trindade; Renata Paciello Yamashita

Downloads: 0
Views: 6

Abstract

Purpose: This study investigated the influence of the cleft type on the appearance of hypernasality after surgical maxillary advancement (MA). Methods: Nasality was determined by measurement of nasalance (acoustic correlate of nasality) by nasometry. The study involved analysis of the nasalance scores of 17 individuals with isolated cleft palate (CP), 118 with unilateral cleft lip and palate (UCLP) and 69 with bilateral cleft lip and palate (BCLP), of both sexes, aged 18 to 28 years, after MA. Only individuals with normal nasalance scores indicating balanced resonance before MA were included in this study. Nasometry was performed 3 days before and 15 months after MA, on average. The proportion of patients who presented nasalance scores indicating hypernasality after surgery was calculated by the ANOVA test, and comparison among the different cleft types was evaluated by the chi-square test (p < 0.05). Results: No significant difference was found in the proportions of individuals with hypernasality among the cleft types. Conclusion: Nasometry showed that the appearance of hypernasality after MA in individuals with cleft palate with or without cleft lip occurred in similar proportions, regardless of the cleft type.

Keywords

Cleft Palate; Orthognathic Surgery; Velopharyngeal Insufficiency; Speech; Speech Disorders

Resumo

Objetivo: Investigar a influência do tipo de fissura sobre o aparecimento da hipernasalidade após o avanço cirúrgico da maxila (AM). Método: A nasalidade foi determinada por meio da medida de nasalância (correlato acústico da nasalidade) utilizando-se a nasometria. Foi realizada a análise dos escores de nasalância de 17 indivíduos com fissura isolada de palato (FP), 118 com fissura de lábio e palato unilateral (FLPU) e 69 com fissura de lábio e palato bilateral (FLPB), de ambos os sexos, com idades entre 18 e 28 anos, submetidos ao AM. Apenas indivíduos com escores de nasalância indicativos de ressonância equilibrada previamente ao AM foram incluídos neste estudo. A nasometria foi realizada, em média, três dias antes e 15 meses após o AM. A proporção de pacientes que apresentaram escores de nasalância indicativos de hipernasalidade após o AM foi calculada por meio do teste ANOVA e a comparação entre os diferentes tipos de fissura foi realizada utilizando-se o teste Qui-quadrado (p < 0,05). Resultados: Não foi observada diferença significante entre as proporções de indivíduos com hipernasalidade, de acordo com o tipo de fissura. Conclusão: A nasometria mostrou que o aparecimento da hipernasalidade após o AM, em indivíduos com fissura de palato envolvendo ou não o lábio, ocorreu em proporções similares independentemente do tipo de fissura

Palavras-chave

Fissura Palatina; Cirurgia Ortognática; Insuficiência Velofaríngea; Fala; Distúrbios da Fala

Referências

1 Kummer AW. Cleft palate and craniofacial anomalies: the effects on speech and resonance. 3rd ed. San Diego: Singular Thomson Learning; 2014. [ Links ]

2 Freitas JAS, Garib DG, Trindade-Suedam IK, Carvalho RM, Oliveira TM, Lauris RC, et al. Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP). Part 3: oral and Maxillofacial Surgery. J Appl Oral Sci. 2012;20(6):673-9. http://dx.doi.org/10.1590/S1678-77572012000600014. PMid:23329251. [ Links ]

3 Naqvi ZA, Ravi S, Shivalinga BM, Munawwar SS. Effect of cleft lip palate repair in craniofacial growth. J Orthod Sci. 2015;4(3):59-64. http://dx.doi.org/10.4103/2278-0203.160236. PMid:26229945. [ Links ]

4 Marrinan EM, LaBrie RA, Mulliken JB. Velopharyngeal function in nonsyndromic cleft palate: relevance of surgical technique, age at repair, and cleft type. Cleft Palate Craniofac J. 1998;35(2):95-100. http://dx.doi.org/10.1597/1545-1569_1998_035_0095_vfincp_2.3.co_2. PMid:9527305. [ Links ]

5 Yang Y, Li Y, Wu Y, Gu Y, Yin H, Long H, et al. Velopharyngeal function of patients with cleft palate after primary palatoplasty: relevance of sex, age, and cleft type. J Craniofac Surg. 2013;24(3):923-8. http://dx.doi.org/10.1097/SCS.0b013e3182587b34. PMid:23714912. [ Links ]

6 Subtelny D. Width of the nasopharynx and related anatomic structures in normal and unoperated cleft palate children. Am J Orthod. 1955;41(12):889-909. http://dx.doi.org/10.1016/0002-9416(55)90126-3. [ Links ]

7 Heliövaara A, Hukki J, Ranta R, Haapanen ML. Cephalometric pharyngeal changes after Le Fort I osteotomy in different types of clefts. Scand J Plast Reconstr Surg Hand Surg. 2004;38(1):5-10. http://dx.doi.org/10.1080/02844310310009537. PMid:15074716. [ Links ]

8 López-Giménez A, Silvestre-Rangil J, Silvestre FJ, Paredes-Gallardo V. Craniofacial cephalometric morphologies in different cleft types: a retrospective cross-sectional study of 212 patients. Oral Radiol. 2018;34(2):127-35. http://dx.doi.org/10.1007/s11282-017-0290-z. PMid:30484129. [ Links ]

9 Antonarakis GS, Tompson BD, Fisher DM. Preoperative cleft lip measurements and maxillary growth in patients with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2016;53(6):e198-207. http://dx.doi.org/10.1597/14-274. PMid:27776219. [ Links ]

10 Paradowska-Stolarz A, Kawala B. Occlusal disorders among patients with total clefts of lip, alveolar bone, and palate. BioMed Res Int. 2014;2014:583416. http://dx.doi.org/10.1155/2014/583416. PMid:24982898. [ Links ]

11 Trindade IEK, Yamashita RP, Suguimoto RM, Mazzottini R, Trindade AS Jr. Effects of orthognathic surgery on speech and breathing of subjects with cleft lip and palate: acoustic and aerodynamic assessment. Cleft Palate Craniofac J. 2003;40(1):54-64. http://dx.doi.org/10.1597/1545-1569_2003_040_0054_eoosos_2.0.co_2. PMid:12498606. [ Links ]

12 Wu Y, Wang X, Ma L, Li Z. Velopharyngeal configuration changes following Le Fort I osteotomy with maxillary advancement in patients with cleft lip and palate: a cephalometric study. Cleft Palate Craniofac J. 2015;52(6):711-6. http://dx.doi.org/10.1597/14-146.1. PMid:25259778. [ Links ]

13 Kim SK, Kim JC, Moon JB, Lee KC. Perceptual speech assessment after maxillary advancement osteotomy in patients with a repaired cleft lip and palate. Arch Plast Surg. 2012;39(3):198-202. http://dx.doi.org/10.5999/aps.2012.39.3.198. PMid:22783526. [ Links ]

14 Pereira VJ, Sell D, Tuomainen J. Effect of maxillary osteotomy on speech in cleft lip and palate: perceptual outcomes of velopharyngeal function. Int J Lang Commun Disord. 2013;48(6):640-50. http://dx.doi.org/10.1111/1460-6984.12036. PMid:24165361. [ Links ]

15 Richardson S, Seelan NS, Selvaraj D, Khandeparker RV, Gnanamony S. Paerceptual speech assessment after anterior maxillary distraction in patients with cleft maxillay hypoplasia. J Oral Maxillofac Surg. 2016;7(6):1239.e1-9. http://dx.doi.org/10.1016/j.joms.2016.02.006. [ Links ]

16 Hagberg E, Flodin S, Granqvist S, Karsten A, Neovius E, Lohmander A. The impact of maxillary advancement on consonant proficiency in patients with cleft lip and palate, lay listeners’ opinion, and patients’ satisfaction with speech. Cleft Palate Craniofac J. 2019;56(4):454-61. http://dx.doi.org/10.1177/1055665618784804. PMid:29949386. [ Links ]

17 Chanchareonsook N, Whitehill TL, Samman N. Speech outcome and velopharyngeal function in cleft palate; comparison of Le Fort I maxillary osteotomy and distraction osteogenesis: early results. Cleft Palate Craniofac J. 2007;44(1):23-32. http://dx.doi.org/10.1597/05-003. PMid:17214524. [ Links ]

18 Kudo K, Takagi R, Kodama Y, Terao E, Asahito T, Saito I. Evaluation of speech and morphological changes after maxillary advancement for patients with velopharyngeal insufficiency due to repaired cleft palate using a nasometer and lateral cephalogram. J Oral Maxillofac Surg Med Pathol. 2014;26(1):22-7. http://dx.doi.org/10.1016/j.ajoms.2013.07.006. [ Links ]

19 Medeiros-Santana MNL, Perry JL, Yaedú RYF, Trindade-Suedam IK, Yamashita RP. Predictors of velopharyngeal dysfunction in individuals with cleft palate following surgical maxillary advancement: clinical and tomographic assessments. Cleft Palate Craniofac J. 2019;56(10):1314-21. http://dx.doi.org/10.1177/1055665619852562. PMid:31213072. [ Links ]

20 Jaques B, Herzog G, Muller A, Hohlfeld J, Pasche P. Indications for combined orthodontic and surgical (orthognathic) treatments of dentofacial deformities in cleft lip and palate patients and their impact on velopharyngeal function. Folia Phoniatr Logop. 1997;49(3-4):181-93. http://dx.doi.org/10.1159/000266453. PMid:9256540. [ Links ]

21 Sweeney T, Sell D. Relationship between perceptual ratings of nasality and nasometry in children/adolescents with cleft palate and/or velopharyngeal dysfunction. Int J Lang Commun Disord. 2008;43(3):265-82. http://dx.doi.org/10.1080/13682820701438177. PMid:17852526. [ Links ]

22 Medeiros MNL, Fukushiro AP, Yamashita RP. Influence of speech sample on perceptual rating of hypernasality. CoDAS. 2016;28(3):289-94. http://dx.doi.org/10.1590/2317-1782/20162015202. PMid:27409419. [ Links ]

23 Dalston RM, Warren DW, Dalston ET. Use of nasometry as a diagnostic tool for identifying patients with velopharyngeal impairment. Cleft Palate Craniofac J. 1991;28(2):184-8. http://dx.doi.org/10.1597/1545-1569_1991_028_0184_uonaad_2.3.co_2. PMid:2069975. [ Links ]

24 Trindade IEK, Genaro KF, Dalston RM. Nasalance scores of normal Brazilian Portuguese speakers. Braz J Dysmorphol Speech Disord. 1997;1(1):23-34. [ Links ]

25 Chanchareonsook N, Samman N, Whitehill TL. The effect of cranio-maxillofacial osteotomies and distraction osteogenesis on speech and velopharyngeal status: a critical review. Cleft Palate Craniofac J. 2006;43(4):477-87. http://dx.doi.org/10.1597/05-001.1. PMid:16854207. [ Links ]

26 Haapanen ML, Kalland M, Heliövaara A, Hukki J, Ranta R. Velopharyngeal function in cleft patients undergoing maxillary advancement. Folia Phoniatr Logop. 1997;49(1):42-7. http://dx.doi.org/10.1159/000266436. PMid:9097494. [ Links ]

27 Proffit WR, Turvey TA, Phillips C. The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension. Head Face Med. 2007;3(1):21. http://dx.doi.org/10.1186/1746-160X-3-21. PMid:17470277. [ Links ]

28 Mason KN, Perry JL. Relashionship between age and diagnosis on volumetric and linear velopharyngeal measures in cleft and noncleft populations. J Craniofac Surg. 2016;27(5):1340-5. http://dx.doi.org/10.1097/SCS.0000000000002744. PMid:27391503. [ Links ]


Submetido em:
13/06/2019

Aceito em:
09/09/2019

5ec3da760e8825cb71ba8f8e codas Articles

CoDAS

Share this page
Page Sections