Palatal Prosthesis Research Articles

Endoscopic lipofilling for velopharyngeal insufficiency after transoral surgery: a technical note.

Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery, with a reported incidence of 8.1%. The main factor related to VPI is the split of the soft palate. However, dead space resulting from transoral decompression may play a pivotal role in the pathogenesis of the dysfunction. In our experience, functionally significant dead space is almost constantly present after transoral decompression. This is probably due to malformation in children and postoperative scarring, thus configuring a nosological entity that we could define as "syndrome of the nasopharyngeal dead space." Palatal prosthesis and pharyngoplasty have been proposed, though these surgical procedures are technically tricky and with possible complications, such as OSA symptoms, snoring, and nasopharyngeal stenosis. We proposed an effortless and minimally invasive procedure to treat this condition based on lipofilling the nasopharynx posterior wall endoscopically. To test the procedure's functional result, the submucosa of the nasopharynx posterior wall was initially filled with resorbable material, namely fibrin glue and autologous blood. The result was optimal but regressed after one month. Then, we repeated the procedure by lipofilling with autologous abdominal fat, resulting in a more stable anatomical and functional outcome at six months follow-up. The patient had a prompt significant improvement of his complaints (rhinolalia and oronasal regurgitation) and a correct projection of the nasopharynx posterior wall, with correct closure during phonation and absence of oronasal reflux. The "syndrome of the nasopharyngeal dead space" should be correctly identified after transoral surgery. It can be effectively treated with lipofilling of the posterior nasopharyngeal wall, a simple and minimally invasive procedure.

Personalized light-curable polyurethane palatal prosthesis designed and fabricated based on computer fluid dynamics and 3D printing to repair palatal fistula

Personalized light-curable polyurethane palatal prosthesis designed and fabricated based on computer fluid dynamics and 3D printing to repair palatal fistula

Uso de material multimídia: efeitos no conhecimento de graduandos de Odontologia e Fonoaudiologia

ABSTRACT Objective: To compare the knowledge of Dental and Speech-Language Pathology undergraduate students about prosthesis treatment of velopharyngeal dysfunction in cases of cleft lip and palate before and after using educational multimedia material. Methods: The sample comprised 58 students (38 from the Dental program, and 20 from the Speech-Language Pathology program). A questionnaire on prosthesis treatment of velopharyngeal dysfunction in cases of cleft lip and palate was administered to a group of Dental and Speech-Language Pathology undergraduate students before and after they had access to educational multimedia (video) material on the topic approached in this study. Inferential statistics were used to investigate the significance of differences in correct answers before and after the Dental and Speech-Language Pathology undergraduate students had access to the multimedia/video material. Results: Before having access to the multimedia/video material, Speech-Language Pathology students had more correct answers (Dental: 4.89±1.31; SLP: 6.30±0.57). After having access to the material, the difference in correct answers between the students of both programs decreased (Dental: 6.00±0.66; SLP: 6.45±0.51), as Dental students’ knowledge of the research topic increased. The comparison of the total sample before and after applying the multimedia/video material also demonstrated an increase in correct answers. Conclusion: Speech-Language Pathology students proved to have greater previous knowledge of palatal prostheses used for velopharyngeal dysfunction in cases of cleft lip and palate. Moreover, using the multimedia material possibly increased both Dental and Speech-Language Pathology students’ knowledge of this topic.

Mucoepidermoid carcinoma of the palate: a rare case report

<p class="abstract">The salivary glands home of several tumoral pathologies, diversified by their locations and their histological types. Described as a rare malignant tumor of the accessory salivary glands, more so in the palatine bone; the diagnosis of Mucoepidermoid carcinoma (CME) remains difficult to evoke due to the uncommonness of the clinical signs and the insidious evolution. The purpose of this case report is to discuss the clinical manifestation, diagnosis, treatment and the follow-up plan of this case. A 39-year-old patient, with no prior pathological history, presents with a painless swelling on the palate evolving for 4 years causing swallowing difficulties without any other signs, several clinical, radiographic and histopathological investigations were carried out for excision of the lesion. Biopsy of the lesion confirmed the diagnosis as mucoepidermoid carcinoma of the palate, following which wide surgical excision with adjacent free margins was performed, the additional surgical treatment consisted of bilateral functional lymph node dissection of groups I, II and III. The follow-up of the patient shows a good improvement in the local condition in the 18 months, after 36 radiotherapy sessions and without signs of recurrence. On the control CT scan with placement of an obturator palatal prosthesis to improve the quality of life awaiting a palatal flap. This case report highlights the need for diagnosis and of an appropriate treatment plan in cases of malignant tumors, as this can lead to morbidity and mortality.</p>

ORAL REPERCUSSIONS AND DENTAL MANAGEMENT OF YOUNG NASOANGIOFIBROMA TREATMENT: A CASE REPORT

This study aims to report a case of juvenile nasoangiofibroma with oral repercussions highlighting dental management. The patient is a 12-year-old boy who had a 10-day epistaxis episode. Computed tomography and magnetic resonance angiography suggested nasoangiofibroma. Embolization and surgical excision with frozen section biopsy were performed, which confirmed the diagnosis. After surgery, he developed necrosis of the palate mucosa and maxillary buccal marginal gingival and dental mobility grade III (teeth 13-23). The dentistry team instructed oral care, proceeding vestibular splinting with orthodontic wire, and made a provisional palatal prosthesis. After 2 years of constant follow-up, teeth are still splinting with mobility grade I, some of them with a positive response to pulp sensitivity test, despite the computed tomography showing areas of vertical bone loss. Dental management was essential to the maintenance of the involved teeth, improving the patient's phonation, deglutition, quality of life, and social reintegration.

Fechamento de fissura palatina com prótese total adaptada – relato de caso

In order for us to understand the objectives of treatment with a palate prosthesis, it is necessary, initially, to understand the speech production mechanism, as well as the suction mechanism performed during feeding. The palate prosthesis consists of a removable device that has a fixed extension towards the pharynx and bulb, whose function is to act on the dynamics and functionality together with the pharynx musculature, so that there is control of the oronasal air flow, being the most common the removable type, which can be total, when the patient has no teeth, or partial, when the patient has some teeth, which can be used as anchorage. Its preparation is made from a combination of acrylic resin with the appropriate steps for making a prosthesis. MDGAF patient, 67 years old, female, attended to the clinic of the Brazilian Postgraduate Institute IBPG, reporting functional and aesthetic dissatisfaction of her prosthesis, as she had teeth with wear, pigmentation throughout the prosthesis, speech difficulties, and swallowing. On clinical examination, it was found that it was not just a conventional full denture, but a conventional full denture adapted for patients with cleft palates. In the anamnesis, the patient reported that she was diagnosed in 2003 with poor basilar formation, and the main symptom was severe headaches. She sought a neurologist for such diagnosis, where three attempts were made to close the communication that were unsuccessful.

A case of improving swallow and speech function with a palatal augmentation prosthesis after operation for lingual cancer

A case of improving swallow and speech function with a palatal augmentation prosthesis after operation for lingual cancer

Use of palatal prosthesis to correct an acquired palatal cleft in a cat: a case report

Palatal malformations rarely occur in small animals. Palatal clefts can affect the upper lip, hard palate, and soft palate, and may be congenital or acquired in origin. The most common acquired forms result from the excision of oral neoplasia, teeth extraction, perforating lesions, automobile accidents, and electric accidents. Clinical signs of a fissured palate are sneezing, purulent nasal discharge, salivary secretion in nasal discharge, difficulty feeding and drinking, and pneumonia due to aspiration, which are the most severe alterations and can lead to death. The treatment of palatal clefts consists of occlusion of the oronasal communication, which can be performed using mucoperiosteal grafts, pedicled flaps, or palatal obturators. Herein, we report a case of an acquired palatal cleft treated with a palatal obturator in a feline patient who bit a high-tension wire. Two attempts of surgical correction had been unsuccessful, resulting in suture dehiscence and perpetuation of the oronasal fistula. After fixation of the obturator, the animal showed remission of all clinical signs. The animal has survived for over one year with improved quality of life.

Sensorimotor adaptation across the speech production workspace in response to a palatal perturbation.

Talkers have been shown to adapt the production of multiple vowel sounds simultaneously in response to altered auditory feedback. The present study extends this work by exploring the adaptation of speech production to a physical alteration of the vocal tract involving a palatal prosthesis that impacts both somatosensory and auditory feedback during the production of a range of consonants and vowels. Acoustic and kinematic measures of the tongue were used to examine the impact of the physical perturbation across the various speech sounds, and to assess learned changes following 20 min of speech practice involving the production of complex, variable sentences. As in prior studies, acoustic analyses showed perturbation and adaptation effects primarily for sounds directly involving interaction with the palate. Analyses of tongue kinematics, however, revealed systematic, robust effects of the perturbation and subsequent motor learning across the full range of speech sounds. The results indicate that speakers are able to reconfigure oral motor patterns during the production of multiple speech sounds spanning the articulatory workspace following a physical alteration of the vocal tract.

Adaptation to a physical alteration of the vocal apparatus: The effect of visual self-perception on speech motor plasticity

Adapting speech movements to novel or perturbed conditions relies critically on the processing of self-produced sensory information. In the context of a physical alteration of the vocal apparatus (e.g., palatal prosthesis), talkers have been shown to adapt following 10–15 min of practice to produce improved acoustic output. It is possible that additional information, such as ultrasound imaging of the tongue, may help talkers adapt even more effectively to such perturbations. Providing visual feedback of the tongue surface in real-time has shown promise in the treatment of speech-sound disorders. However, it remains unclear whether the addition of such visual information will influence speech plasticity on the timescale examined in experimental studies of speech adaptation. Here, we examine how neurotypical talkers adapt to a palatal prosthesis, relying on auditory and somatosensory feedback alone (n = 15), or with the addition of ultrasound feedback of the tongue, either in the mid-sagittal (n = 15) or coronal plane (n = 15). Differences in adaptation performance between the three feedback conditions were observed, both in the patterns of speech adaptation and the learning after-effects. The results indicate that talkers will rapidly integrate visual articulatory information into their control of oral speech movements in order to guide productions towards improved acoustic outcomes.Adapting speech movements to novel or perturbed conditions relies critically on the processing of self-produced sensory information. In the context of a physical alteration of the vocal apparatus (e.g., palatal prosthesis), talkers have been shown to adapt following 10–15 min of practice to produce improved acoustic output. It is possible that additional information, such as ultrasound imaging of the tongue, may help talkers adapt even more effectively to such perturbations. Providing visual feedback of the tongue surface in real-time has shown promise in the treatment of speech-sound disorders. However, it remains unclear whether the addition of such visual information will influence speech plasticity on the timescale examined in experimental studies of speech adaptation. Here, we examine how neurotypical talkers adapt to a palatal prosthesis, relying on auditory and somatosensory feedback alone (n = 15), or with the addition of ultrasound feedback of the tongue, either in the mid-sagittal (n = 15) or co...

Do eyeglasses and palatal prostheses affect the results of the Weber test?

<p class="abstract"><strong>Background:</strong> The aim of the study was to analyze the possible effects of eyeglasses and palatal prostheses on the results of the Weber tuning fork test.</p><p class="abstract"><strong>Methods:</strong> We enrolled 96 patients diagnosed with unilateral conductive-type hearing loss. All were aged between 18 and 65 years. Group 1 was composed of 48 patients with eyeglasses and group 2 included 48 patients with palatal prostheses. All patients underwent the weber tuning fork test with and without their eyeglasses and prostheses, and the results were compared. Weber tests were performed using 256 Hz and 512 Hz tuning forks. </p><p class="abstract"><strong>Results:</strong> No significant between-group difference was apparent (both p>0.05).</p><p class="abstract"><strong>Conclusions</strong> Neither eyeglasses nor palatal prostheses significantly affected the results of the Weber test.</p>

Enhancing speech adaptation to a palatal perturbation using ultrasound visual biofeedback

Prior clinical studies suggest that visual biofeedback of the tongue (e.g., ultrasound) may enhance the treatment of speech disorders, but outcomes have been mixed, likely due to variability in both the clinical profiles of participants and the way in which treatments have been carried out. Understanding the true potential of this clinical tool requires a clearer sense of how visual biofeedback interacts with speech motor control. Here, we present a novel experimental approach that mimics the conditions of clinical treatment for speech disorders while maintaining a high level of consistency and control over the speech-learning task. The procedure involves altering the vocal tract of typically developing talkers using a palatal prosthesis to perturb /s/-production in combination with the controlled application of ultrasound biofeedback. As participants practice and improve their speech, changes in articulatory movements are examined using acoustic and kinematic measures. The present study compared a control group (n = 10) receiving only auditory feedback during speech practice with a group receiving visual biofeedback (n = 10). Results indicate an effect of biofeedback, in particular in the retention of learned motor patterns, indicating that talkers integrate real-time visual feedback of tongue movement into the sensorimotor processes driving speech adaptation.Prior clinical studies suggest that visual biofeedback of the tongue (e.g., ultrasound) may enhance the treatment of speech disorders, but outcomes have been mixed, likely due to variability in both the clinical profiles of participants and the way in which treatments have been carried out. Understanding the true potential of this clinical tool requires a clearer sense of how visual biofeedback interacts with speech motor control. Here, we present a novel experimental approach that mimics the conditions of clinical treatment for speech disorders while maintaining a high level of consistency and control over the speech-learning task. The procedure involves altering the vocal tract of typically developing talkers using a palatal prosthesis to perturb /s/-production in combination with the controlled application of ultrasound biofeedback. As participants practice and improve their speech, changes in articulatory movements are examined using acoustic and kinematic measures. The present study compared a contro...

Speech adaptation to palatal perturbation: Evidence for sensorimotor reorganization across the workspace

Competent speakers demonstrate a high degree of precision in speech production, but also considerable flexibility in speech motor patterns used to attain speech goals. This flexibility is evident in studies examining adaptation to sensory perturbations, including physical manipulations that alter both auditory and somatosensory feedback (e.g., using a palatal prosthesis to disrupt the production of the alveolar fricative /s/). While the acoustic effects of such perturbations (and subsequent adaptation) have been well explored, their underlying articulatory basis remains poorly understood. In this study, we explored speech adaptation to a palatal perturbation in 9 adult speakers using acoustic and articulatory measures of adaptation (using electromagnetic articulography) during the production of various consonants and vowels. Acoustic measures showed effects of both the perturbation and subsequent compensation (following 15 minutes of speech practice) across the consonants and vowels. Analysis of tongue kinematics confirmed the global nature of these effects, including significant changes in sounds involving no physical interaction with the palate. Furthermore, directional analyses revealed a degree of fine-tuning in motor adaptation across phonemes. The findings indicate that even localized changes in palate shape induce complex compensatory changes in speech motor control across the articulatory workspace.

Prosthetic rehabilitation of a patient with tongue cancer using palatal augmentation prosthesis and mandibular implant-retained overdenture: A case report

Prosthetic rehabilitation of a patient with tongue cancer using palatal augmentation prosthesis and mandibular implant-retained overdenture: A case report

Evaluation of Swallowing Sound Using a Throat Microphone with an AE Sensor in Patients Wearing Palatal Augmentation Prosthesis

An increase in the population of dysphagia patients due to an aging population has led to increased attention on examination methods based on swallowing sound as simple methods of screening aspiration. However, an issue with the conventional method of cervical auscultation is that its accuracy varies based on the examiner. Previous studies examined the use of throat microphones and acceleration sensors to examine the acoustic characteristics of swallowing sound. Nevertheless, extant studies to date did not reach a level of clinical application. This study focused on using a throat microphone that is conventionally used to measure swallowing sound and an AE sensor to measurement a high-frequency range equal to and exceeding 20 kHz (upper limit 2 MHz). The study involved measuring the sounds of swallowing water of healthy subjects and patients wearing palatal augmentation prosthesis who had done surgical operation to treat head and neck cancer with the objective of using swallowing sound for screening aspiration. Acoustic characteristics of measured swallowing sound were analyzed using probability distributions using Quantile-Quantile (Q-Q) plots and spectral analysis based on wavelet transform. The findings indicated that with respect to patients with PAP, the duration time of the swallowing sound and the Q-Q plot departure rate were both significantly higher when compared with those in healthy subjects. The analysis based on wavelet transform indicated that the AE sensor allowed measurements of waveforms at a higher frequency range when compared to those in the case of the throat microphone. Additionally, an increased frequency of higher-frequency signals was associated with patients with PAP when compared to healthy subjects. The results revealed that it is possible to measure waveforms in the high-frequency range by using the AE sensor. The findings suggested the validity of analysis of the swallowing sound based on probability distributions using the Q-Q plot to evaluate the swallowing sound.

Effect of Experimental Palatal Prosthesis on Voice Onset Time.

Objective evaluation of a patient's speech is needed in prosthetic dentistry because the prostheses can affect the intelligibility of speech. Measurement of voice onset time is one evaluation method of consonant production used in phonetic science. The purpose of this study was to confirm the influence of a palatal prosthesis on consonant production by measuring voice onset time. In this study, voice onset time was measured in 10 healthy women (mean age 26.5 years) under two conditions: with and without an experimental palatal prosthesis. In this study, voice onset time of /ta/ and /ka/ were used to determine the effect of wearing a palatal prosthesis; /pa/ was tested as a control, with the null hypothesis that voice onset time of /ta/ and /ka/ would not change when wearing a palatal prosthesis. Medial voice onset time of /pa/, /ta/, and /ka/ syllables without the palatal prosthesis was 22.5 ms, 19.5 ms, and 42.5 ms, whereas that with the palatal prosthesis was 22.5 ms, 23.5 ms, and 55.0 ms. Voice onset times for /ta/ and /ka/ were prolonged when wearing the experimental palatal prosthesis, whereas /pa/ showed no significant difference. Consonant production was affected by wearing a palatal prosthesis, and this change in sound was detected by measuring voice onset time.

Prosthetic Rehabilitation for Edentulous Patient with an Acquired Palatal Defect: A Case Report

The rehabilitation of a patient with partial resection of soft palate is a challenge. Surgical management is considered one of the preferred treatment options for such cases. However, this is not possible in several clinical situations, for such situations the prosthetic management would be a valuable alternative. This clinical report describes the rehabilitation of an acquired palatal defect with palatal prosthesis to restore the physical separation between the nasopharynx and oropharynx.

A review and meta-analysis of tongue and palatal implants for post carcinoma corrections

Tongue and palatal implants, prosthesis are recently being used for improvising patients medical condition. This paper reviews recent advances and research to overcome post carcinoma treatments for aiding vital processes such as deglutition, mastication and speech, using palatal augmentation prosthesis, food guiding prosthesis and tongue replacement prosthesis. Silent speech can be overcome by using magnetic implants and sensors. Restoration of voice box post laryngectomy and glossectomy can be achieved by Electrolarynx (EL) and Transoesophageal Voice Prosthesis (TEP). The success of tongue and palatal implants are discussed in the clinical report.

Decision making for residual palatoalveolar cleft defects: a new classification.

Oral rehabilitation of adult patients with cleft lip and palate is related to the severity of the anatomical and functional alterations that hamper the proper closure of the nasopharynx. The ideal treatment is closure by bone graft and orthodontics. However, when surgery is not possible or when the patient does not wish to undergo surgery, a palatal prosthesis may offer the best solution in most clinical situations. The authors of this article propose a new classification to help the practitioner with decision making and prosthetic treatment planning for residual palatoalveolar cleft defects.

Influence of changes in the oral cavity on the performance of recorder players: A pilot study

Wind instrument players may dread dental treatment because changes in the oral cavity can affect their performance. However, few studies have investigated the influence of such changes, particularly prosthesis-induced morphologic changes, on the performance of wind instrument players. The purpose of this study was to determine the effects of prosthesis-induced morphologic changes in the oral cavity on the performance of wind instrument players. Seven women were asked to play a recorder with and without an experimental palatal appliance. Their performances were analyzed by psychoacoustic analysis, with loudness as a parameter, and by performable range analyses with Voice Range Profile software. The Wilcoxon signed rank test was used for the statistical analyses. Differences between moderately loud and very soft sounds (P=.043) and between very loud and very soft sounds (P=.027), as well as the performable range of frequency and intensity (P=.028), all decreased significantly in the presence of the palatal prosthesis. The results of this study suggest that changes in the oral cavity caused by the presence of a prosthesis affect thepsychoacoustic features and the performable range of frequency and intensity during the playing of wind instruments.