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Kinter S, Susarla S, Delaney JC, Chapman K, Kapadia H, Weiss N. Does Distraction Lower Risk of VPI Compared to Conventional Maxillary Advancement? A Retrospective Cohort Study of Adolescents with Cleft Palate. Cleft Palate Craniofac J 2024; 61:422-432. [PMID: 36373608 PMCID: PMC10752384 DOI: 10.1177/10556656221138895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE To determine whether method of maxillary advancement in adolescents with cleft palate with or without cleft lip (CP ± L) influences post-operative velopharyngeal function. DESIGN Retrospective cohort. SETTING Pediatric Tertiary Care Hospital. PARTICIPANTS One hundred and ninety-nine patients with CP ± L after LeFort I osteotomy for maxillary advancement at our institution between January 2007 and June 2019. INTERVENTIONS LeFort I osteotomy via distraction osteogenesis (DO) or conventional osteotomy (CO). MAIN OUTCOME MEASURES Patients who underwent DO or CO were compared for the presence of new velopharyngeal insufficiency (VPI), as measured by perceptual rating by a craniofacial speech-language pathologist. Of the 199 patients who underwent maxillary advancement, 126 were available for analysis. The DO group was younger, male, and had more severe maxillary hypoplasia. Following surgery, 17/41 (41.5%) of the DO group had new VPI, compared to just 23/85 (27.1%) of the CO group. After adjusting for cleft type and predicted maxillary advancement, however, there was not sufficient evidence to reject the null hypothesis of no difference in risk of post-operative VPI between the two surgical groups (prevalence ratio [PR] 1.40, 95% CI 0.68-2.90). Increased prevalence of VPI after DO versus CO was primarily observed among patients with a pre-operative velopharyngeal need ratio < 0.8 (PR = 2.01, 95% CI 0.79-5.10) and patients with normal velopharyngeal function pre-operatively (PR = 2.86, 95% CI 0.96-8.50). Our results suggest an increased rather than decreased risk of VPI following DO relative to CO. This association is primarily seen among those with a smaller velopharyngeal ratio or perceptually normal velopharyngeal function pre-operatively.
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Affiliation(s)
- Sara Kinter
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA, USA
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA, USA
| | - Srinivas Susarla
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Oral & Maxillofacial Surgery, University of Washington, Seattle, WA, USA
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Joseph Christopher Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Kathy Chapman
- Department of Communication Sciences & Disorders, University of Utah, Salt Lake City, UT, USA
| | - Hitesh Kapadia
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA, USA
- Department of Orthodontics, University of Washington, Seattle, WA, USA
| | - Noel Weiss
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Denegri MA, Silva PP, Pegoraro-Krook MI, Ozawa TO, Yaedu RYF, Dutka JDCR. Cephalometric predictors of hypernasality and nasal air emission. J Appl Oral Sci 2021; 29:e20210320. [PMID: 34644782 PMCID: PMC8523092 DOI: 10.1590/1678-7757-2021-0320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/18/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND During times of increasingly recognized importance of interprofessional practices, professionals in Medicine, Dentistry, and Speech Pathology areas cooperate to optimize treatment of velopharyngeal dysfunction (VPD), after primary palatoplasty for correction of cleft palate. OBJECTIVE Our study aims to compare velar length, velar thickness, and depth of the nasopharynx of patients with unilateral cleft lip and palate (UCLP) with the presence, or absence, of hypernasality and nasal air emission; and to verify if the depth:length ratio, between nasopharynx and velum, would be predictive of consistent hypernasality and nasal air emission (speech signs of VPD). METHODOLOGY Cephalometric radiographs and outcome of speech assessment were obtained from 429 individuals, between 6 and 9 years of age, with repaired unilateral cleft lip and palate. Velar length, velar thickness, depth of the nasopharynx, depth:length ratio, scores of hypernasality, and scores of nasal air emission were studied and compared; grouping the radiographs according to presence or absence of hypernasality and nasal air emission. RESULTS For the group with speech signs of velopharyngeal dysfunction (those with consistent hypernasality and nasal air emission), the velums were shorter and thinner; the nasopharynx was deeper and the depth:length ratio was larger than the group without hypernasality and nasal air emission. Velar length was significantly shorter in individuals with consistent hypernasality and nasal air emission (p<0.001) and with history of palatal fistula (p=0.032). Depth of nasopharynx was significantly greater in individuals with consistent hypernasality and nasal air emission (p<0.001). Depthlength ratio was significantly larger in individuals with consistent hypernasality and nasal air emission (p<0.001). A depth:length ratio larger than 0.93 was always associated with speech signs of VPD. CONCLUSION Estimated with cephalometric radiographs, a depth:length ratio greater than 0.93, between the nasopharyngeal space and the velum, was 100% accurate in predicting hypernasality and nasal air emission after primary repair of unilateral cleft lip and palate.
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Affiliation(s)
- María Alicia Denegri
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Programa de Pós-Doutorado, Bauru, SP, Brasil.,Universidad Nacional de Cuyo. Facultad de Odontologia. Cátedra de Cirugía Bucomaxilofacial, Mendoza, Argentina
| | - Patrick Pedreira Silva
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru-SP, Programa de Pós-Graduação em Ciências da Reabilitação, Bauru, SP, Brasil
| | - Maria Inês Pegoraro-Krook
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru-SP, Programa de Pós-Graduação em Ciências da Reabilitação, Bauru, SP, Brasil.,Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Fonoaudiologia, Bauru, SP, Brasil.,Universidade de São Paulo, Faculdade de Odontologia de Bauru, Programa de Pós-Graduação em Fonoaudiologia, Bauru, SP, Brasil
| | - Terumi Okada Ozawa
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru-SP, Programa de Pós-Graduação em Ciências da Reabilitação, Bauru, SP, Brasil.,Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Divisão de Odontologia, Setor de Ortodontia, Bauru, SP, Brasil
| | - Renato Yassutaka Faria Yaedu
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru-SP, Programa de Pós-Graduação em Ciências da Reabilitação, Bauru, SP, Brasil.,Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Cirurgia, Estomatologia, Patologia e Radiologia, Bauru, SP, Brasil
| | - Jeniffer de Cássia Rillo Dutka
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru-SP, Programa de Pós-Graduação em Ciências da Reabilitação, Bauru, SP, Brasil.,Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Fonoaudiologia, Bauru, SP, Brasil.,Universidade de São Paulo, Faculdade de Odontologia de Bauru, Programa de Pós-Graduação em Fonoaudiologia, Bauru, SP, Brasil
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Medeiros-Santana MNLD, Araújo BMAM, Fukushiro AP, Trindade IEK, Yamashita RP. Surgical maxillary advancement and speech resonance: comparison among cleft types. Codas 2020; 32:e20190152. [PMID: 32401996 DOI: 10.1590/2317-1782/20202019152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/09/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose This study investigated the influence of the cleft type on the appearance of hypernasality after surgical maxillary advancement (MA). Methods Nasality was determined by measurement of nasalance (acoustic correlate of nasality) by nasometry. The study involved analysis of the nasalance scores of 17 individuals with isolated cleft palate (CP), 118 with unilateral cleft lip and palate (UCLP) and 69 with bilateral cleft lip and palate (BCLP), of both sexes, aged 18 to 28 years, after MA. Only individuals with normal nasalance scores indicating balanced resonance before MA were included in this study. Nasometry was performed 3 days before and 15 months after MA, on average. The proportion of patients who presented nasalance scores indicating hypernasality after surgery was calculated by the ANOVA test, and comparison among the different cleft types was evaluated by the chi-square test (p < 0.05). Results No significant difference was found in the proportions of individuals with hypernasality among the cleft types. Conclusion Nasometry showed that the appearance of hypernasality after MA in individuals with cleft palate with or without cleft lip occurred in similar proportions, regardless of the cleft type.
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Affiliation(s)
| | | | - Ana Paula Fukushiro
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brasil
| | - Inge Elly Kiemle Trindade
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brasil
| | - Renata Paciello Yamashita
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brasil
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de Medeiros-Santana MNL, Perry JL, Yaedú RYF, Trindade-Suedam IK, Yamashita RP. Predictors of Velopharyngeal Dysfunction in Individuals With Cleft Palate Following Surgical Maxillary Advancement: Clinical and Tomographic Assessments. Cleft Palate Craniofac J 2019; 56:1314-1321. [DOI: 10.1177/1055665619852562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate whether morphofunctional velopharyngeal aspects may be considered predictors of appearance or worsening of hypernasality in patients with cleft palate after surgical maxillary advancement (MA). Design: Prospective. Setting: National referral center for cleft lip and palate rehabilitation. Participants: Fifty-two patients with repaired cleft palate, skeletal class III malocclusion, and normal speech resonance completed speech audio recordings and cone-beam computed tomography examination before (T1) and, on average, 14 months after (T2) MA. Interventions: Hypernasality was rated by 3 experienced speech-language pathologists using a 4-point scale and morphofunctional aspects on a 3-point scale. Cone-beam computed tomography image measurements were performed using Amira and Dolphin 3D software. For each velopharyngeal morphofunctional aspect analyzed, patients were compared according to the absence (G1) and presence (G2) of postoperative hypernasality. Main Outcome Measures: Comparison of hypernasality scores between T1 and T2 and association between hypernasality and each velopharyngeal morphofunctional aspect. Results: Significant difference was observed between T1 and T2 for hypernasality ( P = .031) and between G1 and G2 ( P = .015) for velar mobility, with significant association between this variable and hypernasality on T2 ( P = .041). Conclusions: Levator veli palatini mobility influenced the appearance of hypernasality after MA.
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Affiliation(s)
| | - Jamie L. Perry
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, East Carolina University, Greenville, NC, USA
| | - Renato Yassutaka Faria Yaedú
- Department of Oral Surgery, Bauru School of Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Sao Paulo, Brazil
| | - Ivy Kiemle Trindade-Suedam
- Department of Biological Sciences, Bauru School of Dentistry and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Sao Paulo, Brazil
| | - Renata Paciello Yamashita
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Sao Paulo, Brazil
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Medeiros MNLD, Ferlin F, Fukushiro AP, Yamashita RP. Ressonância da fala após tratamento cirúrgico da insuficiência velofaríngea secundária à cirurgia ortognática. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201511514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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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