Speech resonance in orthognathic surgery in subjects with cleft lip and palate

Abstract

he main purpose of this study was to investigate the impact of maxillary advancement on speech resonance in subjects with cleft lip and palate. The study sample was composed of 42 subjects aged 16 to 41 years old with operated cleft palate ± lip submitted to maxillary advancement. Resonance was evaluated before and 3 to 12 months after surgery by perceptual analysis and graduated from absent to severe. It was observed that 47.5% of the subjects presented impairment of resonance after orthognathic surgery, with a confidence interval (at 95%) from 31.5% to 63.9%. These results suggest that orthognathic surgery in individuals with cleft palate may interfere in resonance, causing, or increasing the degree of hypernasality. Therefore, this highlights the importance of the orientation about the risks and benefits of maxillary advancement surgery and follow-up of these patients. Uniterms: Cleft palate; Orthognathic surgery; Resonance.propósito deste estudo foi verificar o impacto do avanço de maxila na ressonância de fala em sujeitos com fissura labiopalatina. A amostra do presente estudo foi composta por 42 sujeitos, entre 16 e 41 anos de idade, com fissura de palato associada ou não à de lábio submetidos ao avanço da maxila. A ressonância foi avaliada entre 3 e 12 meses após a cirurgia por análise e perceptual e graduada de ausente a severa. Observou-se que 47.5% dos sujeitos apresentaram prejuízo da ressonância após a cirurgia ortognática, com um intervalo de confiança (a 95%) de 31.5% a 63.9%. Esses resultados sugerem que a cirurgia ortognática, em sujeitos com fissura palatina, pode interferir na ressonância, causando ou aumentando o grau de hipernasalidade. Portanto, isso elucida a importância da orientação sobre os riscos e benefícios da cirurgia de avanço da maxila e acompanhamento desses pacientes.

The effects of Le Fort I osteotomy on velopharyngeal function in cleft patients

“…However, when the maxilla is advanced surgically, the hard palate and the attached soft palate are advanced as well, which can affect velopharyngeal function. According to several studies, correcting maxillary retrusion may have a negative effect on cleft patients' speech (Witzel and Munro, 1977;Epker and Wolford, 1976;Watzke et al, 1990;Haapanen et al, 1997;Maegawa et al, 1998;Trindade et al, 2003;Heli€ ovaara et al, 2004;Janulewicz et al, 2004;Niemeyer et al, 2005;Pereira et al, 2013) and trigger or worsen velopharyngeal incompetence and/or insufficiency (VPI). VPI is defined as a dysfunction of the velum and/or the pharyngeal wall at the level of the nasopharynx that results in inadequate velopharyngeal closure (Peterson-Falzone et al, 2010).…”

Ressonância da fala após tratamento cirúrgico da insuficiência velofaríngea secundária à cirurgia ortognática

“…induced by the procedure 3,6,7,23 . In a previous study 8 conducted at the Laboratory of Physiology, the same manifestation was revealed.…”

“…When orthodontics is not sufficient to correct this alteration, as in cases of great dentofacial deformities, orthognathic surgery becomes necessary 6,7 . Orthognathic surgery, specifically advancing the maxilla, provides balance between orofacial functions and harmony between the face and skull by repositioning the dental arches.…”

“…However, despite the countless benefits this surgery provides for esthetics and for orofacial functions, manipulation of velopharyngeal structures, which occurs with this procedure, may lead to speech impairment in individuals with cleft lip and palate 3,[6][7][8]10 . As the posterior edge of the hard palate and the soft palate joined to it are anteriorized, orthognathic surgery with the advancing of the maxilla may have a deleterious effect on the velopharyngeal mechanism responsible for isolating oral and nasal cavities during speech, increasing the anteroposterior and laterolateral diameter of the velopharyngeal orifice, leading to velopharyngeal insufficiency (VPI) and, consequently, to the appearance, or the worsening, when already existing, of hypernasality and other symptoms of speech 3,7,10,11 .…”

Avaliação das dimensões da nasofaringe através da tomografia computadorizada e pela rinomanometria anterior modificada em indivíduos com fissura labiopalatina submetidos à cirurgia ortognática

“…Celikoglu e colaboradores 2014 WOLFORD, 1976;MUNRO;SALYER, 1990;WITZEL;VALLINO, 1992;JAQUES et al, 1997;TRINDADE et al, 2003). (JAQUES et al, 1997;NIEMEYER et al, 2005;PEREIRA;SELL;TUOMAINEN, 2013;MEDEIROS et al, 2015).…”