Effect of maxillary advancement on velopharyngeal function in cleft lip and palate: 20 years of experience.

This retrospective study aimed to investigate the impact of orthognathic surgery with maxillary advancement (MA) on the velopharyngeal function (VF) in individuals with cleft lip and palate (CLP). The study included 651 patients with repaired CLP, both sexes, aged over 18 years who underwent MA alone or in combination with nasal procedures and/or mandibular osteotomy, operated between 2000 and 2019. The main outcome measures were nasalance (nasal text-NT and oral text-OT) and velopharyngeal orifice area measurement (VA), determined by nasometry and pressure-flow technique, respectively.

Speech Outcomes Audit for Unilateral Cleft lip and Palate After 2-Stage Palate Repair: Preliminary Results.

Primary cleft lip and palate surgeries can interfere with speech status, facial appearance, maxillary growth, and psychosocial and academic development. Therefore, different surgical protocols and techniques have been proposed, and adequate velopharyngeal function and speech is the main goal for the treatment success. The present study aimed to report preliminary speech results of the 2-stage palate repair of children with unilateral cleft lip and palate.

Models for Predicting Velopharyngeal Competence Based on Speech and Resonance Errors and Velopharyngeal Area Estimation.

Objective: To develop tools for predicting velopharyngeal competence (VPC) based on auditory-perceptual assessment and its correlation with objective measures of velopharyngeal orifice area.

Design: Methodological study.

Participants And Methods: Sixty-two patients with repaired cleft palate, aged 6 to 45 years, underwent aerodynamic evaluation by means of the pressure-flow technique and audiovisual recording of speech samples.

Effect of Orthognathic Surgery on Breathing in Patients with Cleft lip and Palate: 20-Year Experience at a Tertiary Hospital in Brazil.

Objective: To verify the effect of orthognathic surgery (OS) on nasal dimensions and its correlation with respiratory symptoms in patients operated on over the past 20 years.

Design: Retrospective study.

Setting: Tertiary level craniofacial hospital.

Facial grimace during speech in cleft lip and palate: a proposal for classification.

Purpose: To investigate the effectiveness of a proposal for classification of facial grimace (FG) and its correlation with objective evaluation of velopharyngeal closure (VPC).

Methods: Twenty individuals with repaired cleft lip and palate underwent velopharyngeal area measurement by means of rhinomanometry and speech sample recording. The FG was rated in two steps, by three speech-language pathologists.

Evaluation of the Nasopharyngeal Cannula Use After Orthognathic Surgery: Permeability of the Nasal Airways and Discomfort of the Patient With Cleft Lip and Palate.

It is believed that the use of the nasopharyngeal cannula can maintain the patent upper airway in the immediate post-operative period of orthognathic surgery. The present study is a randomized clinical trial with the objective of evaluating the difference in the use of the nasopharyngeal cannula in the post-operative period of orthognathic surgery with respect to permeability and discomfort. The sample was composed of 26 individuals with repaired cleft lip and palate randomly distributed in 2 groups with and without nasopharyngeal cannula.

Surgical maxillary advancement and speech resonance: comparison among cleft types.

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.

Borg scale: a new method for hypernasality rating.

Purpose: To investigate the reliability in auditory-perceptual assessment of hypernasality of the Borg centiMax scale and the influence of the speech material on the reliability of two scales.

Methods: Four experienced speech-language pathologists rated hypernasality of 80 audio recordings of patients with repaired cleft palate (40 single-word string and 40 sentences) using the 5-point ordinal scale and the Borg centiMax scale. Intra and inter-rater reliability were calculated for both scales and for both types of speech samples.

Predictors of Velopharyngeal Dysfunction in Individuals With Cleft Palate Following Surgical Maxillary Advancement: Clinical and Tomographic Assessments.

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.

Normative nasalance scores in the production of words and syllables for Brazilian Portuguese speakers.

The objective of this study was to determine normative nasalance scores for non-cleft children, adolescents and adults, native speakers of Brazilian Portuguese, during the production of words and syllables, for cross-linguistic comparisons in populations with and without cleft palate. Nasalance was assessed in 62 individuals, aged 6-10 years (n = 20), 11-17 years (n = 20) and 18-35 years (n = 22), using a nasometer II model 6450 (KayPENTAX), during production of one sequence of nine oral words ( and of sequences of isolated syllables (e.g.

Reliability of Hypernasality Rating: Comparison of 3 Different Methods for Perceptual Assessment.

Objective: To compare reliability in auditory-perceptual assessment of hypernasality for 3 different methods and to explore the influence of language background.

Design: Comparative methodological study.

Participants And Materials: Audio recordings of 5-year-old Swedish-speaking children with repaired cleft lip and palate consisting of 73 stimuli of 9 nonnasal single-word strings in 3 different randomized orders.

Nasalance scores of Brazilian Portuguese speakers at 5 years of age.

Purpose: To determine nasalance scores of Brazilian Portuguese speaking children without evident speech disorders, language delay and orofacial deformities, at age 5 years, and analyze differences between types of speech samples and genders.

Methods: Twenty children were analyzed, 11 males, age ranging from 4 years and 10 months to 5 years and 11 months. The Nasometer II 6450 (KayPENTAX) was used for nasalance assessment.

Nasopharyngeal dimensions in normal individuals: normative data.

Objective: To establish normative values of minimum cross-sectional nasopharyngeal area in individuals without craniofacial anomalies at different age ranges.

Material And Method: Ninety-six individuals of both genders, without craniofacial anomalies, and with normal body mass index and neck circumference were evaluated. Participants were divided into 4 age groups: children, aged 6 to 10 years (G1); adolescents, aged 11 to 17 years (G2); young adults, 18 to 39 years (G3), and middle-aged adults, 40 to 59 years (G4).

Influence of speech sample on perceptual rating of hypernasality.

Purpose: To investigate the influence of speech sample of spontaneous conversation or sentences repetition on intra and inter-rater hypernasality reliability.

Methods: One hundred and twenty audio recorded speech samples (60 containing spontaneous conversation and 60 containing repeated sentences) of individuals with repaired cleft palate±lip, both genders, aged between 6 and 52 years old (mean=21±10) were selected and edited. Three experienced speech and language pathologists rated hypernasality according to their own criteria using 4-point scale: 1=absence of hypernasality, 2=mild hypernasality, 3=moderate hypernasality and 4=severe hypernasality, first in spontaneous speech samples and 30 days after, in sentences repetition samples.

The influence of listener training on the perceptual assessment of hypernasality.

Introduction A high agreement in the perceptual assessment of hypernasality among different listeners is difficult to achieve. Prior listener training and the standardization of analysis criteria may be effective strategies to decrease the effect of perceptual assessment subjectivity and increase the agreement among listeners. Objective To investigate the influence of prior training on agreement among different listeners in the perceptual assessment of hypernasality.

Influence of pharyngeal flap surgery on nasality and nasalance scores of nasal sounds production in individuals with cleft lip and palate.

Objective: 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.

Methods: 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.

Comparative analysis of velopharyngeal activity assessed by acoustic rhinometry and rhinomanometry.

Purpose: To analyze the velopharyngeal (VP) activity of subjects with velopharyngeal dysfunction (VPD) by acoustic rhinometry, as compared to rhinomanometry.

Methods: This was a prospective clinical study conducted in 41 adults, both genders, with repaired cleft palate, with or without a previously repaired cleft lip, and residual VPD on clinical assessment, without compensatory articulations for [p], [t], and [k]. The outcome measures were as follows: (1) on acoustic rhinometry, nasopharyngeal volumetric change (ΔV) during [p], [t], and [k], relatively to rest condition (decreases by <3 cm3 considered as absence of VP activity); (2) on modified anterior rhinomanometry, VP orifice area (areas ≥0.

Relationship between velopharyngeal closure, hypernasality, nasal air emission and nasal rustle in subjects with repaired cleft palate.

Purpose: To investigate the correlation among velopharyngeal closure, hypernasality, audible nasal air emission (NAE) and nasal rustle (NR), in individuals with repaired cleft palate.

Methods: One hundred patients with repaired cleft palate and lip, submitted to pressure-flow study for measurement of velopharyngeal orifice area (velopharyngeal area) and speech sample recordings. Velopharyngeal area was estimated during the production of the sound /p/ inserted in a sentence, and the velopharyngeal closure was classified as adequate, borderline or inadequate.

Obstructive Sleep Apnea Following Pharyngeal Flap Surgery for Velopharyngeal Insufficiency: A Prospective Polysomnographic and Aerodynamic Study in Middle-Aged Adults.

Objective: To compare the frequency and severity of obstructive sleep apnea (OSA) in middle-aged adults who underwent pharyngeal flap surgery for velopharyngeal insufficiency (VPI) with matched subjects who did not undergo pharyngeal flap surgery and to verify the relationship between OSA severity and internal pharyngeal dimensions.

Setting: National referral care center for cleft lip and palate.

Method: Prospective study on 42 nonsyndromic subjects with repaired cleft palate with flap (F group, n = 22) and without flap (NF group, n = 20), aged 40 to 58 years.

Impact of inter-judge agreement on perceptual judgment of nasality.

Purpose: To investigate the effect of perceptual inter-judge agreement of hypernasality on velopharyngeal (VP) closure prediction.

Methods: Two logistic regression models were developed aiming to verify the possibility of predicting the VP closure using the following characteristics: rating of VP closure (adequate, borderline, inadequate), determined by the pressure-flow technique, degree of hypernasality (absent, mild, moderate, severe), and the presence/absence of nasal air emission and nasal rustle determined perceptually by three experienced speech language pathologists. In the first model, 100 speech samples with a moderate agreement rate of hypernasality (kappa coefficient: 0.

Surgical outcome of pharyngeal flap surgery and intravelar veloplasty on the velopharyngeal function.

Purpose: To investigate the postoperative outcomes of pharyngeal flap surgery (PF) and secondary palatoplasty with intravelar veloplasty (IV) in the velopharyngeal insufficiency management regarding nasalance scores and velopharyngeal area.

Methods: Seventy-eight patients with cleft palate±lips submitted to surgical treatment for velopharyngeal insufficiency, for 14 months on an average, were evaluated: 40 with PF and 38 with IV, of both genders, aged between 6 and 52 years old. Hypernasality was estimated by means of nasalance scores obtained by nasometry with a cutoff score of 27%.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: institutional outcomes assessment and the role of the Laboratory of Physiology.

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.

Speech outcomes and velopharyngeal function after surgical treatment of velopharyngeal insufficiency in individuals with signs of velocardiofacial syndrome.

Objective: The objective of the study was to analyze if individuals with velocardiofacial syndrome (VCFS) present the same characteristics of speech and velopharyngeal function (VPF) compared with patients with nonsyndromic submucous cleft palate, as well as to compare the effectiveness of palate surgery on the speech function and VPF between groups.

Methods: This was a prospective study performed at the Speech Therapy Sector and Physiology Laboratory, Hospital for Rehabilitation of Craniofacial Anomalies/University of São Paulo.The procedure performed was primary palatoplasty associated or not to superiorly based pharyngeal flap surgery.

Long-term effects of pharyngeal flaps on the upper airways of subjects with velopharyngeal insufficiency.

Objectives: To investigate the long-term effects of pharyngeal flap surgery (PFS) on nasal and nasopharyngeal dimensions of patients with velopharyngeal insufficiency (VPI) and to correlate the findings with the onset of respiratory complaints after surgery.

Design/participants: Prospective study in 58 nonsyndromic patients with repaired cleft palate and VPI, evaluated 2 days before and 5 months (POST1) and 1 year (POST2) after PFS, on average. Patients were divided into two groups: one consisting of patients with postoperative respiratory complaints (RC group) and the other without complaints (NRC group).

Short- and long-term effect of surgically assisted maxillary expansion on nasal airway size.

Transverse maxillary deficiency (TMD) may reduce nasal dimensions and lead to oral breathing. The objective of the present study was to investigate the short- and long-term effects of surgically assisted maxillary expansion on nasal airway size of patients with TMD. Eleven subjects with TMD and skeletal maturity were submitted to posterior rhinomanometry to determine the minimum nasal cross-sectional area (CSA) before and 3, 6, and 12 months after surgery.