title: Articulation and nasality changes resulting from sustained palatal fistula obturation.
abstract: OBJECTIVE
  The purpose of the study was to determine differences in articulation and nasality with obturation over time in children with a palatal fistula.
  
  
  METHODS
  Articulation and nasality were measured with the fistula open, immediately after obturation, and 4 to 7 weeks postobturation. SETTING, PATIENTS, PARTICIPANTS: Subjects were 15 patients with a palatal fistula secondary to a repaired cleft palate who were seen through the Orofacial Program, Utah Department of Health, ranging in age from 4 years 6 months to 13 years 1 month.
  
  
  METHODS
  Acrylic palatal obturators were designed to provide coverage specific to the unique shape and location of each child's fistula. Obturators were cemented to molar teeth using wire clasps for control of usage.
  
  
  METHODS
  Measurements consisted of listener judgments of hypernasality, hyponasality, and nasal emissions; instrumental ratings of nasalance using the Nasometer 6200-2; and performance on a standardized articulation test.
  
  
  RESULTS
  Significant improvement occurred only on nasal emission measures from the preobturation condition to immediate postobturation. However, significant improvement was found in articulation, listener judgments of hypernasality, nasal emissions, and Nasometric Nasal Sentence mean scores from the preobturation condition to 4 to 7 weeks postobturation and from the immediate postobturation condition to 4 to 7 weeks postobturation. No significant differences were found between conditions for listener judgments of hyponasality and Nasometric Zoo and Rainbow Passage scores. Obturation of the palatal fistula over a 4- to 7-week period resulted in no adverse effect on articulation ability, perceptual ratings of nasality, or instrumental ratings of nasalance.
  
  
  CONCLUSIONS
  Clinical management of patients with a palatal fistula can be enhanced with treatment using obturation over time. For subjects who continue to exhibit hypernasality immediately postobturation, sustained obturation is advocated prior to consideration of surgical intervention for treatment of a palatal fistula and/or velopharyngeal dysfunction.
authors.affiliation: Child Development Clinic, Utah Department of Health, Department of Communication Disorders, University of Utah, Salt Lake City 84114-4640, USA.
authors.forename: J
authors.initials: J
authors.lastname: Pinborough-Zimmerman
authors.forename: C
authors.initials: C
authors.lastname: Canady
authors.forename: D K
authors.initials: DK
authors.lastname: Yamashiro
authors.forename: L
authors.initials: L
authors.lastname: Morales
mesh_terms: D000180:Acrylic Resins; D000293:Adolescent; D001184:Articulation Disorders / Q000145:classification / Q000628:therapy*; D002484:Cementation; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D017267:Dental Prosthesis Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016155:Oral Fistula / Q000209:etiology / Q000628:therapy*; D010158:Palatal Obturators; D010159:Palate / Q000473:pathology*; D011183:Postoperative Complications / Q000628:therapy; D013060:Speech / Q000502:physiology*; D013064:Speech Disorders / Q000145:classification / Q000628:therapy*; D013065:Speech Intelligibility; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery / Q000628:therapy
chemical_list: D000180:Acrylic Resins