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Doctoral Thesis
DOI
https://doi.org/10.11606/T.61.2018.tde-06102020-123408
Document
Author
Full name
Flavia Ferlin
Institute/School/College
Knowledge Area
Date of Defense
Published
Bauru, 2018
Supervisor
Committee
Fukushiro, Ana Paula (President)
Berti, Larissa Cristina
Brandão, Giovana Rinalde
Trindade, Inge Elly Kiemle
Title in Portuguese
Influência do tipo de fissura labiopalatina sobre os resultados de fala após a palatoplastia primária
Keywords in Portuguese
Fala
Fissura de palato
Insuficiência velofaríngea
Nasometria
Rinomanometria
Abstract in Portuguese
Objetivo: Verificar a influência do tipo de fissura labiopalatina sobre os resultados de fala, após a palatoplastia primária, comparando-se os três tipos de fissuras mais incidentes: fissura de lábio e palato unilateral (FLPU), fissura de lábio e palato bilateral (FLPB) e fissura isolada de palato (FP). Metodologia: Foram avaliados 69 indivíduos (FLPU=28, FLPB=15 e FP=26), ambos os sexos, idades entre 5 e 25 anos, submetidos à palatoplastia primária entre 12 e 18 meses de idade no HRAC-USP. Amostras de fala compostas por sentenças contendo sons de alta pressão intraoral (AP) e baixa pressão intraoral (BP) e conversa espontânea foram gravadas em sistema audiovisual e analisadas por três avaliadores experientes quanto à nasalidade (1=ausente, 2=leve, 3=moderada e 4=grave) e erros ativos (1=ausente e 2=presente). A nasometria foi utilizada para a determinação da nasalância durante a produção de sílabas orais e nasais e sentenças AP e BP. O fechamento velofaríngeo foi estimado pela medida da área seccional velofaríngea, durante a produção de sílabas orais e nasais, vocábulo e sentença, por meio da técnica fluxo-pressão. A hipernasalidade e os erros ativos foram descritos para FLPU, FLPB e FP e comparados entre si por meio dos testes Kruskal Wallis e Qui-quadrado. Os escores médios de nasalância e área do orifício velofaríngeo foram comparados entre FLPUxFLPBxFP e aos valores normativos (ANOVA). As correlações entre os métodos foi verificada por meio dos testes de Correlação de Spearman e Correlação de Pearson, p<0,05. Resultados: As proporções de pacientes quanto à ausência de nasalidade e erros ativos foram, respectivamente: FLPU=61 e 82%, FLPB=53 e 60% e FP=62 e 81%. Para escores de nasalância sugestivos de normalidade, as proporções foram de FLPU=57%, FLPB=60% e FP=50%, e para valores de área velofaríngea sugestivos de fechamento velofaríngeo adequado, FLPU=54%, FLPB=53% e FP=58%. Não houve diferença significativa entre os três tipos de fissuras labiopalatinas. Houve correlação entre nasalidade e nasalância nas amostras AP e BP e entre nasalância e a área velofaríngea em três sílabas (/pi/, /sa/ e /ma/). Conclusão: Os resultados do presente estudo permitem concluir que o tipo de fissura labiopalatina (FLPU, FLPB, FP) não influencia os resultados de fala após a palatoplastia primária
Title in English
Influence of cleft lip and palate type on speech outcomes after primary palatoplasty
Keywords in English
Cleft palate
Nasometry
Rhinomanometry
Speech
Velopharyngeal insufficiency
Abstract in English
Objective: To verify the influence of cleft lip and palate type on speech outcomes after primary palatoplasty, comparing three cleft types: unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP) and isolated cleft palate (CP). Methods: Sixty-nine subjects (UCLP=28, BCLP=15, CP=26), both genders, aged from 5 to 25 years, undergoing primary palatoplasty between 12 to 18 months of age at HRAC-USP were evaluated. Speech samples composed of sentences containing high (HP) and low (LP) intraoral pressure sounds and spontaneous speech were recorded in an audiovisual system and analyzed by three experienced examiners regarding nasality (1=absent, 2=mild, 3=moderate, 4=severe) and active errors (1=absent or 2=present). Nasometry was used to determine nasalance scores during the production of oral and nasal syllables and reading of HP and LP sentences. In addition, the velopharyngeal function was estimated by measuring the velopharyngeal sectional area, during the production of oral syllables, word and sentence, by means of pressure-flow technique. Hypernasality and active errors were described for UCLP, BCLP and CP and compared to each other using Kruskal Wallis and Chi-square tests. Mean nasalance scores and velopharyngeal orifice areas werecompared between FLPUxFLPBxFP and normative data (ANOVA). Correlation between methods was verified by Spearman Correlation and Pearson Correlation tests, p<0.05. Results: The proportions of patients regarding the absence of nasality and active errors were, respectively: UCLP=61 and 82%, BCLP=53 and 60% and CP=62 and 81%. For normal nasalance scores the rates were: UCLP=57%, BCLP=60% and CP=50%, and for velopharyngeal area suggesting adequate velopharyngeal closure: UCLP=54%, BCLP=53% and CP=58%. There was no significant difference between the three types of cleft lip and palate. There was a correlation between nasality and nasalance in HP and LP samples and between nasalance and velopharyngeal area in three syllables studied (/pi/, /sa/ e /ma/). Conclusion: The results of the present study concluded that cleft lip and palate type (UCLP, BCLP, CP) does not influence speech outcomes after primary palatoplasty
 
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Publishing Date
2020-10-14
 
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