Publicação
Insuficiência velofaríngea em doentes portadores de fenda lábio palatina
| Resumo: | Introduction: Cleft lip and palate (CLP) is the most common congenital malformation of the head and neck. After surgical palate closure, velopharyngeal dysfunction (VPD) can arise due to scarring processes of the lip and palate. VPD has implications for phonation, sucking, swallowing, middle ear function, and interpersonal well-being. The treatment of VPD can comprise speech therapy, prosthetic devices, and/or surgery. Prosthetic treatment can be performed with palate elevators in the presence of velopharyngeal incompetence and with pharyngeal obturators in the presence of velopharyngeal insufficiency. The purpose of this study is to evaluate the efficacy of the velopharyngeal obturator in the treatment of VPD.Materials and Methods: After the diagnosis of VPD, individualized pharyngeal obturators were made for each patient. As these patients were undergoing orthodontic treatment, a change was made in the obturator design with the replacement of the Adams hooks by ball hooks. Resonance, audible air emission, the presence of vocal alterations and compensatory articulation disorders were evaluated using an auditory perceptual evaluation method, prior to and at least 1 month after the placement of the pharyngeal obturator.Results: This pilot study included 7 patients, aged between 14 and 20 years old, with cleft lip and palate previously surgically closed. No significant differences were found between the parameters assessed prior and after obturator placement.Discussion: Pharyngeal obturators should be used in the following situations: contraindicated surgical approach, patients who refuse surgical approach and previous surgical failure. Factors such as the follow-up period, patient compliance, the phase of orthodontic treatment and the concomitant implementation of a speech therapy program during the use of the appliance may influence the results of the pharyngeal obturator. Conclusion: The use of pharyngeal obturators in cleft lip and palate patients with velopharyngeal insufficiency and during orthodontic treatment does not show short-term improvements in resonance, nasal air emission, voice and compensatory articulation disorders. However, the new obturator design makes it possible to retain the obturator during the use of fixed appliances. |
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| Autores principais: | Reis, Joana Patrícia Gonçalves Silva |
| Assunto: | Insuficiência Velofaríngea Fenda Palatina Obturadores Palatinos Fonação Ortodontia Velopharyngeal Insufficiency Cleft Palate Palatal Obturators Speech Orthodontics |
| Ano: | 2021 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Coimbra |
| Idioma: | português |
| Origem: | Estudo Geral - Universidade de Coimbra |
| Resumo: | Introduction: Cleft lip and palate (CLP) is the most common congenital malformation of the head and neck. After surgical palate closure, velopharyngeal dysfunction (VPD) can arise due to scarring processes of the lip and palate. VPD has implications for phonation, sucking, swallowing, middle ear function, and interpersonal well-being. The treatment of VPD can comprise speech therapy, prosthetic devices, and/or surgery. Prosthetic treatment can be performed with palate elevators in the presence of velopharyngeal incompetence and with pharyngeal obturators in the presence of velopharyngeal insufficiency. The purpose of this study is to evaluate the efficacy of the velopharyngeal obturator in the treatment of VPD.Materials and Methods: After the diagnosis of VPD, individualized pharyngeal obturators were made for each patient. As these patients were undergoing orthodontic treatment, a change was made in the obturator design with the replacement of the Adams hooks by ball hooks. Resonance, audible air emission, the presence of vocal alterations and compensatory articulation disorders were evaluated using an auditory perceptual evaluation method, prior to and at least 1 month after the placement of the pharyngeal obturator.Results: This pilot study included 7 patients, aged between 14 and 20 years old, with cleft lip and palate previously surgically closed. No significant differences were found between the parameters assessed prior and after obturator placement.Discussion: Pharyngeal obturators should be used in the following situations: contraindicated surgical approach, patients who refuse surgical approach and previous surgical failure. Factors such as the follow-up period, patient compliance, the phase of orthodontic treatment and the concomitant implementation of a speech therapy program during the use of the appliance may influence the results of the pharyngeal obturator. Conclusion: The use of pharyngeal obturators in cleft lip and palate patients with velopharyngeal insufficiency and during orthodontic treatment does not show short-term improvements in resonance, nasal air emission, voice and compensatory articulation disorders. However, the new obturator design makes it possible to retain the obturator during the use of fixed appliances. |
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