Speech resonance after surgical management of velopharyngeal insufficiency secondary to orthognathic surgery
Ressonância da fala após tratamento cirúrgico da insuficiência velofaríngea secundária à cirurgia ortognática
Maria Natália Leite de Medeiros; Flávia Ferlin; Ana Paula Fukushiro; Renata Paciello Yamashita
Abstract
Purpose: to investigate the effect of surgical management of velopharyngeal insufficiency on the speech resonance in individuals with cleft palate that presented hypernasality after orthognathic surgery.
Methods: twenty-three cleft palate subjects underwent surgical management of velopharyngeal insufficiency were analyzed. All patients presented normal speech resonance before orthognathic surgery and underwent surgical management of velopharyngeal insufficiency due to hypernasality observed after orthognathic surgery. Patients were submitted to perceptual speech evaluation for classification of nasality in three situations: 3 days before and five months, on average, after orthognathic surgery and 13 months, on average, after surgical management of velopharyngeal insufficiency. Hypernasality was classified using a 4-point scale: 1=absence of hypernasality; 2=mild hypernasality; 3=moderate, and 4=severe. Hypernasality scores in the three situations studied were compared by Friedman test, with a significance level of 5% and then by Tukey test for multiple comparisons.
Results: from the total of 23 patients, elimination of the speech symptom after surgical management of velopharyngeal insufficiency was observed in 83% (19/23) of the cases, the mean scores of nasality before orthognathic surgery=1, after orthognathic surgery=3 and after surgical management of velopharyngeal insufficiency=1. There was a statistically significant difference among the three clinical situations studied (p<0.001).
Conclusion: surgical management of velopharyngeal insufficiency was an effective treatment in most cases of velopharyngeal insufficiency following to orthognathic surgery, reestablishing normal speech condition.
Keywords
Resumo
Objetivo: investigar o efeito da cirurgia corretiva da insuficiência velofaríngea sobre a ressonância da fala de indivíduos nascidos com fissura palatina que passaram a apresentar hipernasalidade, após a cirurgia ortognática.
Métodos: foram analisados os resultados da ressonância de 23 pacientes com fissura labiopalatina corrigida cirurgicamente que apresentavam ressonância oronasal equilibrada antes da cirurgia ortognática e foram submetidos à correção cirúrgica da insuficiência velofaríngea, devido ao aparecimento de hipernasalidade após a cirurgia ortognática. Os pacientes foram submetidos à avaliação perceptivo-auditiva da fala para classificação da hipernasalidade, em três situações: 3 dias antes e 5 meses, em média, após a cirurgia ortognática e, 13 meses, em média, após a cirurgia corretiva da insuficiência velofaríngea. A hipernasalidade foi classificada utilizando-se escala de 4 pontos: 1=ausência de hipernasalidade; 2=hipernasalidade leve; 3=moderada e 4=grave. Os escores de hipernasalidade nas três situações estudadas foram comparados por meio do teste de Friedman, com nível de significância de 5% e, posteriormente, pelo teste de Tukey para comparações múltiplas.
Resultados: do total de 23 pacientes, houve eliminação do sintoma de fala após a correção da insuficiência velofaríngea em 83% (19/23), sendo os escores médios de nasalidade antes da cirurgia ortognática=1, após a cirurgia ortognática=3 e após a correção da insuficiência velofaríngea=1. Houve diferença estatisticamente significante entre as três situações estudadas (p<0,001).
Conclusão: a cirurgia corretiva da insuficiência velofaríngea foi um tratamento efetivo na grande maioria dos casos que apresentaram hipernasalidade secundária à cirurgia ortognática, com retorno à condição de normalidade.
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Referências
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Submetido em:
02/07/2014
Aceito em:
24/07/2014
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