Influência do retalho faríngeo sobre a nasalidade e a nasalância na produção de sons nasais em indivíduos com fissura labiopalatina

Ana Paula Fukushiro,Flávia Ferlin,Renata Paciello Yamashita,Inge Elly Kiemle Trindade

doi:10.1590/2317-1782/20152014088

Ana Paula Fukushiro, Flávia Ferlin + Show 2 more

Open Access

https://doi.org/10.1590/2317-1782/20152014088

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Abstract

To verify the influence of pharyngeal flap surgery on the management of velopharyngeal insufficiency on nasality and speech nasalance on nasal sound production in individuals with cleft lip and palate. Prospective study in 159 individuals with repaired cleft palate ± lip, of both genders, aged 6 to 57 years old. All the participants presented residual velopharyngeal insufficiency and were submitted to pharyngeal flap surgery. Perceptual speech evaluation and nasometric assessment were performed before and after (14 months on average) the pharyngeal flap surgery. Hyponasality was rated as absent or present, and nasalance scores were determined by means of nasometer using nasal stimuli, with a cutoff score of 43% used as the lowest limit of normality. Nasality and nasalance were compared before and after surgery (p < 0.05). On the basis of correlation between both the methods used, perceptual hyponasality was observed in 14% of the individuals, whereas nasalance scores indicating hyponasality (< 43%) were obtained in 25% of the patients after surgery. Pharyngeal flap surgery influenced the production of nasal sounds, causing hyponasality in a significant proportion of individuals. The presence of this speech symptom can also be an indicator of upper airway obstruction caused by pharyngeal flap, which should be investigated objectively and prudently postoperatively.

Highlights

The pharyngeal flap surgery has been one of the methods used in the correction of residual velopharyngeal insufficiency (VPI) from the primary surgical closure of the cleft palate
Prior to the pharyngeal flap surgery, the perceptual evaluation found that no patient had hyponasality in speech
Among the objective methods to evaluate the results of the procedures used for the correction of VPI is nasometry, applied to quantify the perceptual judgments of hypernasality and hyponasality[22,23,24] and complement the diagnosis obtained by evaluation of speech[25,26]

Summary

Introduction

The pharyngeal flap surgery has been one of the methods used in the correction of residual velopharyngeal insufficiency (VPI) from the primary surgical closure of the cleft palate. The technique involves the construction of a myomucous flap between the posterior pharyngeal wall and the soft palate, which allows, by the reduction of the nasopharyngeal space, the adequacy of the velopharyngeal closure. With respect to the respiratory aspect, the pharyngeal flap may be associated, in some cases, with the occurrence of obstruction of the upper airway, causing deleterious symptoms such as obstructive sleep apnea, oral breathing, and hyponasality, all arising from an overcorrection of the velopharyngeal dysfunction[3]. In a previous study by the same group of researchers, the high incidence of hyponasality in speech, associated with respiratory complaints after pharyngeal flap surgery, had already been identified[3]. International research found symptoms of nasal obstruction and hyponasality after pharyngeal flap surgery[7,10]. A retrospective study compared the speech results after pharyngeal flap surgery and noted that the perceptual and auditory evaluation of speech detected hyponasality in 22% of the sample studied after surgery, in addition to the symptoms of obstructive sleep apnea[12]

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