Cephalometric predictors of hypernasality and nasal air emission.

María Alicia Denegri,Terumi Okada Ozawa,Maria Inês Pegoraro-Krook,Renato Yassutaka Faria Yaedu,Jeniffer De Cássia Rillo Dutka,Patrick Pedreira Silva

doi:10.1590/1678-7757-2021-0320

Abstract

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.

Highlights

During times of increasingly recognized importance of interprofessional practices, the interdisciplinary care of craniofacial anomalies is essential to improve quality of life and to reduce burden of care for patients and families
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
307 (72%) cephalometric radiographs belonged to patients without hypernasality and nasal air emission, whereas 122 (28%) belonged to patients with consistent hypernasality and nasal air emission as indicated by the Test of Hypernasality (THYPER) and Test of Nasal Air Emission (TNAE) tests

Summary

Introduction

During times of increasingly recognized importance of interprofessional practices, the interdisciplinary care of craniofacial anomalies is essential to improve quality of life and to reduce burden of care for patients and families. Not all cleft palate team worldwide, have access to imaging assessment of velopharyngeal function, such as videofluoroscopy or nasoendoscopy.. According to the authors, conducting a videofluoroscopic or nasoendoscopic evaluation “would have been a better approach”, but it is not always available, leading the authors to propose a clinical judgment regarding velopharyngeal competency, based in the intraoral examination combined to the outcome of speech assessment. Some cleft palate teams may lack equipment for videofluoroscopy or nasoendoscopy, most institutions have access or partnerships that deliver the cephalometric radiographs required during orthodontic follow-up to monitor growth, position, and size of skeletal and dental structures — as proposed in the Parameters for Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Differences.. If parameters from the American Cleft Palate-Craniofacial Association (ACPA) are followed, typical orthodontic evaluation should include cephalometric radiographs for all patients with cleft lip and palate (CLP). Measures of velopharyngeal structures, such as velar length (VL), velar thickness (VT) and depth of the nasopharynx (DN), can be obtained, routinely, for all patients (with and without signs of VPD), using cephalometric radiographs

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