Effects of orthognathic surgery on speech and breathing of subjects with cleft lip and palate: acoustic and aerodynamic assessment.
OBJECTIVE
To evaluate the impact of orthognathic surgery on acoustic nasalance of subjects with cleft and investigate the causes of possible changes by analyzing velopharyngeal function and nasal patency.


METHODS
Nasalance was measured in 29 subjects with operated cleft palate +/- lip before (PRE) and 45 days (POST1) and 9 months (POST2) after surgery, on average. In 19 of the patients, the minimum velopharyngeal (VP) and nasal cross-sectional (N) areas were also determined.


METHODS
Le Fort I osteotomy with maxillary advancement in combination with procedures involving the nose, maxilla, mandible or all three.


METHODS
Nasalance, VP area, N area.


RESULTS
We observed: (1) a significant (p < .05) increase in mean nasalance at POST1 and POST2, compared with PRE during the reading of oral sentences and nasal sentences; at POST2, high nasalance on the oral sentences was observed in 45% of the patients with normal nasalance at PRE, and 57% of patients with low nasalance on the nasal sentences at PRE no longer presented abnormal nasalance; (2) a significant increase in mean VP area at POST1; two borderline patients demonstrated deterioration of VP closure at POST2, compared with PRE; and (3) a significant increase in mean N area at POST2, with 73% of patients no longer presenting subnormal areas seen at PRE.


CONCLUSIONS
On a long-term basis, orthognathic surgery modifies speech nasalance of some subjects with cleft, perhaps because of an increase in internal nose size. This may also improve nasal patency for breathing.
Trindade
Inge E K
IE
Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, and Department of Biological Sciences, School of Dentistry, University of São Paulo at Bauru, São Paulo, Brazil. ingetrin@usp.br
Yamashita
Renata P
RP
Suguimoto
Roberto M
RM
Mazzottini
Reinaldo
R
Trindade
Alceu S
AS
D000162:Acoustics / Q000295:instrumentation; D000293:Adolescent; D000328:Adult; D000388:Air; D000704:Analysis of Variance; D002971:Cleft Lip / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002972:Cleft Palate / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008437:Maxilla / Q000601:surgery*; D015508:Nasal Obstruction / Q000503:physiopathology; D009666:Nose / Q000473:pathology / Q000503:physiopathology; D010160:Palate, Soft / Q000473:pathology / Q000503:physiopathology; D010614:Pharynx / Q000473:pathology / Q000503:physiopathology; D012119:Respiration; D013060:Speech / Q000502:physiology*; D013061:Speech Acoustics; D013223:Statistics as Topic; D014681:Velopharyngeal Insufficiency / Q000503:physiopathology