Speech Evaluation After Palatal Augmentation in Patients Undergoing Glossectomy

Abstract

Objective: To assess, in patients undergoing glossectomy, the influence of the palatal augmentation prosthesis on the speech intelligibility and acoustic spectrographic characteristics of the formants of oral vowels in Brazilian Portuguese, specifically the first 3 formants (F1 [/a,e,u/], F2 [/o,ó,u/], and F3 [/a,ó/]).Design: Speech evaluation with and without a palatal augmentation prosthesis using blinded randomized listener judgments.Setting: Tertiary referral center.Patients: Thirty-six patients (33 men and 3 women) aged 30 to 80 (mean [SD], 53.9 [10.5]) years underwent glossectomy (14, total glossectomy; 12, total glossectomy and partial mandibulectomy; 6, hemiglossectomy; and 4, subtotal glossectomy) with use of the augmentation prosthesis for at least 3 months before inclusion in the study.Main Outcome Measures: Spontaneous speech intel-ligibility (assessed by expert listeners using a 4-category scale) and spectrographic formants assessment.Results: We found a statistically significant improvement of spontaneous speech intelligibility and the average number of correctly identified syllables with the use of the prosthesis (P Ͻ .05). Statistically significant differences occurred for the F1 values of the vowels /a,e,u/; for F2 values, there was a significant difference of the vowels /o,ó,u/; and for F3 values, there was a significant difference of the vowels /a,ó/ (PϽ .001). Conclusions:The palatal augmentation prosthesis improved the intelligibility of spontaneous speech and syllables for patients who underwent glossectomy. It also increased the F2 and F3 values for all vowels and the F1 values for the vowels /o,ó,u/. This effect brought the values of many vowel formants closer to normal.

Speech and Swallowing Data in Individual Patients Who Underwent Glossectomy after Prosthetic Rehabilitation

“…Twenty-five studies were case reports: 23 studies on 1 patient [5, 15, 16, 19–38] and 2 articles with 2 patients [39] and 3 patients [40]. Seven studies were case series (between 4 and 36 patients) [4, 41–46], and 1 study was a case-control study with 5 patients in each group [18]. …”

“…The main types of evaluation were perceptual [4, 5, 16, 18, 20–22, 24, 25, 28–31, 36, 38, 41, 43–46], acoustic [4, 18, 21, 31, 35], and subjective (nonstandardized assessment of speech) [20, 23, 26, 27, 32, 37, 39]. Only 5 studies used a combination of perceptual and acoustic analyses [4, 5, 18, 22, 31]. Ninety-six patients demonstrated improvement in speech/voice parameters, 7 patients demonstrated worsening, and 12 patients each demonstrated no changes or these changes were not evaluated.…”

“…Speech outcomes showed that there was an improvement in the intelligibility scores for vowels [21, 22], consonants [18, 22, 25, 29, 30], sentences [24], and spontaneous conversation with a prosthesis [4, 24, 29, 30, 44, 45]. Spontaneous conversational intelligibility varied from markedly unintelligible to nearly normal [16, 18, 20, 26, 29, 41, 46], but there was a reduction in the speech rate and an improvement in the intonation and articulation of sounds [5, 31].…”

“…The tongue is an organ with specific, accurate, and particular functions related to speech, voice, swallowing, and chewing. Its excision implies articulatory prejudice in most consonants and vowels [3], unbalanced resonance with predominant hypernasality [4], alterations in vocal quality [5], swallowing impairments that lead to dysphagia in all phases of swallowing [6, 7], and the impossibility or difficulty of performing mastication [7]. …”

Pectoralis Major Myocutaneous Flap in Primary and Salvage Head and Neck Cancer Surgery

“…Considering the latter, a four-grade scale was used as described previously. 5 Four aesthetic features at the donor site were considered: position of the nipple, bulk over the clavicle, depression in the upper chest because of pectoral major muscle transposition, and M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 5 appearance of the upper chest skin. When all four features were assessed as satisfying, the cosmetic effect was considered excellent; in other cases, it was deemed good (3 features recognised as satisfying) or poor (<3 features recognised as satisfying).…”