Summary
Introduction
Patients undergoing maxillectomies may present alterations in the stomatognathic functions
involved in oral communication. Rehabilitative treatment should favor the rescue of
these functions, through surgical flaps, obturator prostheses or both.
Objectives
The present study aims to present the impact of the use of the palatal obturator on
the oropharyngeal geometry and on the voice of patients undergoing maxillectomies,
after adaptation to trans-surgical palatine obturators (TPO).
Methods
Twelve patients treated at a Cancer Hospital, submitted to maxillectomy and rehabilitated
during surgery were evaluated. The oropharyngeal geometry was measured by acoustic
pharyngometry and the vocal parameters were evaluated through auditory-perceptual
and acoustic analyses. The comparison between the results with and without TPO was
analyzed using the Wilcoxon test and the correlation between oropharyngeal measurements
and acoustic parameters using Spearman's correlation coefficient, all with a significance
level of 5%.
Results
There was a decrease in the following oropharyngeal measurements with the use of TPO:
length of the pharyngeal cavity and vocal tract, volume of the oral cavity, pharyngeal
and vocal tract and area of the oropharyngeal junction. There was no difference
in the length of the oral cavity and in the glottic area between situations with and
without TPO. In the vocal evaluation, changes in intelligibility and resonance were
observed in the situation without TPO and, in only one case, mild hypernasality was
detected in the situation with TPO.
Conclusions
It is concluded that the use of TPO brought the oropharyngeal measurements closer
to normal values and provided an improvement in speech intelligibility and vocal
resonance in maxilectomized individuals.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Fatores associados ao câncer de lábio e cavidade oral.Rev Bras Epidemiol. 2015; 18: 618-629https://doi.org/10.1590/1980-5497201500030008
- Atlas de Mortalidade por Câncer.SIM, Rio de Janeiro2019: 2020
- Estimativa 2020: Incidência de Câncer no Brasil.INCA, Rio de Janeiro2020
- Delayed diagnosis of oral squamous cell carcinoma: a case series (Case study).J Med Case Rep. 2011; 5: 291https://doi.org/10.1186/1752-1947-5-291
- A saúde oral e a radioterapia de cabeça e pescoço.ACM Arq Catarin Med. 2011; 40: 12-16
- Dysphagia, speech, voice, and trismus following radiotherapy and/or chemotherapy in patients with head and neck carcinoma: review of the literature.Biomed Res Int. 2016; 6086894https://doi.org/10.1155/2016/6086894
- Diagrama de desvio fonatório e análise perceptivoauditiva pré e pós-terapia vocal.in: SENISE AT Manual de Reabilitação em Oncologia do ICESP. ICESP, São Paulo2014
- Assessment of quality of life in phase III trials of radiotherapy in localized or locally advanced head and neck cancer over the past 17 years.Ann Palliat Med. 2017; 6: 73-80https://doi.org/10.21037/apm.2016.11.09
- Avaliação das tensões geradas nos componentes protéticos de próteses obturadoras maxilares classe I, II e IV de Aramany por meio de análise de elementos finitos. 2003. 126 f. Tese (Doutorado) – Faculdade de Odontologia.Universidade de São Paulo, São Paulo2013
- Oral câncer preventive campaigns: are we reaching the real target?.Braz J Otorhinolaryngol. 2015; 81: 44-49https://doi.org/10.1016/j.bjorl.2014.03.002
- Reabilitação protética de paciente maxilectomizados: relato de caso.Rev Odontol Araçatuba. 2016; 37 (Available at:) (Accessed March 25, 2021): 9-16
- Manual Prático de Disfagia.Thieme Revinter Publicações, Rio de Janeiro2017
- Reabilitação Protética Craniomaxilofacial.Santos, São Paulo2013
- Patients with maxillary defects in the oral and maxillofacial prosthesis service.Rev Cienc Med Pinar Del Rio. 2018; 22: 270-280
- Obturator protheses versus free tissue transfers: a systematic review of the optimal approach to improving the quality of life for patients with maxillary defects.J Prosthet Dent. 2016; 115: 247-253https://doi.org/10.1016/j.prosdent.2015.08.002
- Reabilitação com prótese obturadora após maxilectomia parcial: relato de caso.Rev Odontol Araçatuba. 2016; 37: 52-66https://doi.org/10.21270/archi.v5i0.1334
- Accuracy of acoustic analysis measurements in the evaluation of patients with different laryngeal diagnoses.J Voice. 2017; 31: e15-e26https://doi.org/10.1016/j.prosdent.2015.08.002
- Performance of phonatory deviation diagrams in synthesized voice analysis.Folia Phoniatr Logop. 2017; 69: 246-260https://doi.org/10.1159/000487941
- The usefulness of auditory perceptual assessment and acoustic analysis as a screening test for voice problems.Folia Phoniatr Logop. 2019; 73 (34-4)https://doi.org/10.1159/000504220
- Interferência das deformidades dentofaciais nas características acústicas dos sons da fala.Rev CEFAC. 2019; 21: e.19118https://doi.org/10.1590/1982-0216/201921419118
- The reliabity of oral and pharyngeal dimensions captured with acoustic pharyngometry.Dysphagia. 2016; 31: 555-559https://doi.org/10.1007/s00455-016-9713-y
- A faringometria acústica: correlações clínico-instrumentais nos distúrbios do sono.Rev. Bras. Otorrinolaringol. 2007; 73: 257-265https://doi.org/10.1590/S0034-72992007000200018
- Normative standards for vocal tract dimensions by race as measured by acoustic pharyngometry.J Voice. 2006; 20: 391-400https://doi.org/10.1016/j.jvoice.2005.05.001
- Oropharyngeal geometry and the singing voice: immediate effect of two semi-Occluded Vocal tract exercises.J Voice 1997. 2020; : 30244-30247https://doi.org/10.1016/j.jvoice.2020.06.027
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Auditory-perceptual evaluation of rough and breathy voices: correspondence between analogical visual and numerical scale.CoDAS. 2016; 28: 163-167https://doi.org/10.1590/2317-1782/20162015098
- Auditory-perceptual evaluation of the degree of vocal deviation: correlation between the Visual Analogue Scale and Numerical Scale.CoDAS. 2015; 27: 279-284https://doi.org/10.1590/2317-1782/20152014167
- Reabilitação protética de pacientes maxilectomizados. uma contribuição da odontologia e um convite à reflexão.Pesqui Bras Odontopediatria Clín Integr. 2004; 4: 125-130
- Tratamento reabilitador em paciente submetido a maxilectomia.Rev Odontol. 2013; 42 (Available at:) (Accessed March 25, 2021))
- Comparação de próteses obturadoras fabricadas com diferentes técnicas e seu efeito no manejo de um paciente com hemipalatomaxilectomia.Case Rep. 2014; 1https://doi.org/10.1136/bcr-2014-204088
- Função da prótese obturadora após maxilectomia e reabilitação protética obturadora.Braz J Otorhinolaryngoly. 2016; 82: 177-183https://doi.org/10.1016/j.bjorl.2015.10.006
- Palatal obturator designed by 3-dimensional prototyping for a patient with a large ameloblastoma: a case.Gen Dent. 2018; 66: e12-e17
- The effect of immediate obturator reconstruction after radical maxillary resections on speech and other functions.Dent J 2018. 2018; 6: 22https://doi.org/10.3390/dj6030022
- Perfil epidemiológico de casos incidentes de câncer de boca e faringe.RGO Rev Gaúch Odontol. 2010; 58 (Available at:) (Accessed 25 mar. 2021): 351-355
- Percepção dos acadêmicos sobre o câncer de boca.Rev Bras Cancerol. 2013; 59: 211-218https://doi.org/10.21270/archi.v6i7.2077
- Hollow Bulb One Piece Maxillary Definitive Obturator - A Simplified Approach.Contemp Clin Dent. 2017; 8: 167-170https://doi.org/10.4103/ccd.ccd_887_16
- Oropharyngeal dimensions in adults: effect of ethnicity, gender, and sleep apnea.J Clinical Sleep Med. 2005; 1: 257-263https://doi.org/10.5664/jcsm.26340
- Vocal tract dimensional development of adolescents: an acoustic reflection study.Int J Pediatr Otorhinolaryngol. 2010; 74: 907-912https://doi.org/10.1016/j.ijporl.2010.05.010
- Vocal tract dimensional characteristics of professional male and female singers with different types of singing voices.Int J Speech-Language Pathol. 2013; 15: 484-491https://doi.org/10.3109/17549507.2012.744429
- Voice classification and vocal tract of singers: a study of x-ray images and morphology.J Acoust Soc Am. 2009; 125: 503https://doi.org/10.1121/1.30263.26
- Rehabilitation after maxillectomy in patients with implant-retained obturator: a preliminary report.Oral Maxillofac Surg. 2020; 129: 8-13https://doi.org/10.1016/j.jvoice.2008.04.006
- The effectiveness of the glottal to noise excitation ratio for the screening of voice disorders.J Voice. 2010; 24: 47-56https://doi.org/10.1016/j.jvoice.2008.04.006
- Refinement of the free radial forearm flap reconstructive technique after resection of large oropharyngeal malignancies with excellent functional results.Head Neck;. 2003; 25: 772-777https://doi.org/10.1002/hed.10295
- Functional evaluation of cancer surgery in oral and maxillofacial region: speech function.Int J Clin Oncol. 2003; 8: 1-17https://doi.org/10.1007/s101470300000
- Análise Funcional e Qualidade de vida Relacionada à voz e à Deglutição de Pacientes Tratados por Câncer de Orofaringe [Tese].Fundação Antônio Prudente, São Paulo2008: 133p
- Análise acústica da voz do idoso: caracterização da frequência fundamental.Rev CEFAC. 2007; 9: 238-247https://doi.org/10.1590/S1516-18462007000200013
- Implicações do efeito Lombard sobre a intensidade, freqüência fundamental e estabilidade da voz de indivíduos com doença de Parkinson.Rev Bras Otorrinolaringol. 2007; 73: 675-683https://doi.org/10.1590/S0034-72992007000500014
- The effect of smoking on the fundamental frequency of the speaking voice.J Voice. 2018; 33 (802.e11-802.e16)https://doi.org/10.1016/j.voice.2018/04.001
- The harmonic and noise information of the glottal pulses in speech.Biomedic Signal Process Control. 2014; 10: 137-143https://doi.org/10.1016/j.bspc.2013.12.004
- Diagrama de desvio fonatório e análise perceptivoauditiva pré e pós-terapia vocal.CoDAS. 2013; 25 (Available at:) (Accessed March 25, 2021): 140-147
- Performance of the phonatory deviation diagram in the evaluation of rough and breathy synthesized voices.Braz J Otorhinolaryngol. 2018; 84https://doi.org/10.1016/j.bjorl.2017.05.012
- Sensitivity of source-filter interaction to specific vocal tract shapes.IEEE Trans Audio Speech Lang Process. 2016; 24: 2507-2515
- Accuracy of traditional and formant acoustic measurements in the evaluation of vocal quality.CoDAS. 2018; 30e20170282
- Comparison of fundamental frequency and formants frequency measurements in two speech tasks.Rev CEFAC. 2019; 21: e12819
- the interaction of formant frequency and pitch in the perception of voice category and jaw opening in female singers.J Voice. 2004; 18: 24-37
- Musical theater and opera singing – why so different (int) A study of subglottal pressure, voice source, and formante frequency characteristics.J Voice;. 2008; 22: 533-540
Article info
Publication history
Published online: April 06, 2022
Accepted:
March 8,
2022
Publication stage
In Press Corrected ProofFootnotes
Funding: Financial Suport by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001
Identification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
