Técnica de correção de hipernasalidade causada por adenoidectomia

Abstract

A tonsila faríngea quando aumentada, pode causar obstrução nas vias aéreas superiores e levar à respiração bucal de suplência 1 . Em alguns casos adenoidectomia e/ou adenoamigdalectomia são indicadas para remoção do fator obstrutivo, possibilitando a respiração nasal. Temos observado que algumas crianças mesmo sem apresentar queixas e/ou alterações vocais no período pré-operatório, desenvolvem uma qualidade vocal hipernasal após adenoidectomia 12 . Este artigo tem como objetivo descrever um caso de hipernasalidade após adenoidectomia e relatar o tratamento fonoaudiológico, bem como, os possíveis riscos e seqüelas após o procedimento cirúrgico.

Aspectos do sistema estomatognático pré e pós-adenotonsilectomia

“…In the presence of agents that difficult air passage through upper airways, it is common the mouth substitute respiration (2,7,16) . Phonoarticulatory structures of the stomatognathic system (lips, tongue, and soft palate) and some functions (respiration, swallowing, speech, and phonation) can be susceptible to changes in participants diagnosed with hypertrophy of palatine and adenoid tonsils.…”

“…Change of the respiratory mode can be understood as a possible consequence of hypertrophy of tonsils, with predominance of the oral respiration (4,7) . After surgical intervention, it is possible to observe changes in the previous adopted respiratory mode, becoming, in most cases, the nasal mode, which is physiologically expected (2,17) . Inappropriate respiratory pattern may provide several retinues of postural adjustments and alterations of functions from the stomatognathic system.…”

“…Data regarding the post-adenotonsillectomy evaluation indicated appropriate tongue rest posture, that is, inside the oral cavity, in most of the sample. The new tongue positioning is a consequence of the respiratory mode adaptation from the larger oropharyngeal space due to tonsil exeresis (2,6,17) . Speech therapy evaluation of resting tongue posture showed an improvement between moments before (predominance of changed posture) and after adenotonsillectomy (predominance of appropriate tongue posture) ( Table 3).…”

“…The changed respiratory pattern may provide facial deformities, which are characterized by alterations in the maxilla, hard palate, malocclusion, tonicity, and posture of structures from the stomatognathic system in the pattern of swallowing (2,3) and speech (4) . Soft palate mobility can also be damaged and change vocal resonance peculiarities.…”

“…Reevaluation, from 1 to 6 months beginning at surgery (2,5,6) , may evidence spontaneous improvement of the respiratory, vocal, and swallowing patterns and readjustment of stomatognathic system structures, which happens due to the increase of space in the oropharynx associated with clearance of the upper airways, enabling nasal respiration. As a consequence of a new stimulus, a redefinition of the articulators and of the vocal resonance is possible.…”