Effects of Orthognathic Surgery on Speech and Breathing of Subjects with Cleft Lip and Palate: Acoustic and Aerodynamic Assessment

Abstract

Objective To evaluate the impact of orthognathic surgery on acoustic nasalance of subjects with cleft and investigate the causes of possible changes by analyzing velopharyngeal function and nasal patency. Design/Patients Nasalance was measured in 29 subjects with operated cleft palate ± lip before (PRE) and 45 days (POST1) and 9 months (POST2) after surgery, on average. In 19 of the patients, the minimum velopharyngeal (VP) and nasal cross-sectional (N) areas were also determined. Interventions Le Fort I osteotomy with maxillary advancement in combination with procedures involving the nose, maxilla, mandible or all three. Main Outcome Measures Nasalance, VP area, N area. Results We observed: (1) a significant (p < .05) increase in mean nasalance at POST1 and POST2, compared with PRE during the reading of oral sentences and nasal sentences; at POST2, high nasalance on the oral sentences was observed in 45% of the patients with normal nasalance at PRE, and 57% of patients with low nasalance on the nasal sentences at PRE no longer presented abnormal nasalance; (2) a significant increase in mean VP area at POST1; two borderline patients demonstrated deterioration of VP closure at POST2, compared with PRE; and (3) a significant increase in mean N area at POST2, with 73% of patients no longer presenting subnormal areas seen at PRE. Conclusions On a long-term basis, orthognathic surgery modifies speech nasalance of some subjects with cleft, perhaps because of an increase in internal nose size. This may also improve nasal patency for breathing.

Nasal symptoms and clinical findings in adult patients treated for unilateral cleft lip and palate

“…In the current study, only three patients had undergone septoplasty and their outcome did not differ from the rest of the patients. An operation to expand and move the maxilla forward can also improve nasal function [11,17]. Two patients of the current study had undergone osteotomy of the maxilla with forward movement of the maxilla; however, no rapid maxillary expansion was performed.…”

Effect of maxillary osteotomy on speech in cleft lip and palate: perceptual outcomes of velopharyngeal function

“…Whilst some studies have found that maxillary osteotomy results in VPD (e.g. Trindade et al 2003), others have shown the reverse (e.g. Dalston and Vig 1984).…”

“…These post-operative datum points were aimed at capturing early and late speech changes following advancement surgery, as recognized as the typical post-operative data points in the osteotomy field (e.g. Eurocran 2003, Trindade et al 2003). Transcribe consonant production Note: In the adapted protocol, only the audio component was provided to the raters.…”

Effect of Nasal Decongestion on Nasalance Measures

“…Different cutoff points for interpretation of nasometric measures during the production of oral speech stimuli in the English language vary from 21% to 33% (Dalston et al, 1991a(Dalston et al, , 1993Paynter et al, 1991;Hardin et al, 1992;Watterson et al, 1993Watterson et al, , 1996Dutka, 1996;Trindade et al, 2003). For the Brazilian Portuguese language, Dutka (1996) has suggested the use of a cutoff value of 21% for maximally optimizing the instruments sensitivity and Trindade et al (2003) have suggested the use of a cutoff of 27%.…”

“…For the Brazilian Portuguese language, Dutka (1996) has suggested the use of a cutoff value of 21% for maximally optimizing the instruments sensitivity and Trindade et al (2003) have suggested the use of a cutoff of 27%. Although normative data for the speech stimuli used in this study have not been pub-lished yet, this study used the cutoff point of 21% suggested by Dutka (1996) for interpreting nasalance scores obtained during the production of short oral phrase with the phonetic context limited to the phoneme /b/.…”