title: Evaluation of a modular palatal lift prosthesis with a silicone velar lamina for hypernasal patients.
abstract: BACKGROUND
  Speech bulbs and palatal lift prostheses are used to improve oral-nasal balance in speakers with hypernasality resulting from velopharyngeal dysfunction. Fabricating such speech prostheses is often a protracted process, and the nasopharyngeal impression can be uncomfortable for the client.
  
  
  OBJECTIVE
  The purpose of this study was to develop and test a modular palatal lift prosthesis with a silicone velar lamina that can be fabricated without a nasopharyngeal impression.
  
  
  METHODS
  Six adult participants with different etiologies were treated with both a conventional palatal lift prosthesis and the new prosthesis. The outcome measures were nasalance scores, speech acceptability ratings, and participant responses on a questionnaire. Inferential statistical analyses were conducted with nonparametric Friedman tests and 2-tailed paired Wilcoxon signed ranks tests. The probability was set at P<.1.
  
  
  RESULTS
  Among the 3 speaking conditions (no prosthesis, acrylic resin prosthesis, modular silicone palatal lift prosthesis), no differences were found in nasalance scores for the oral stimuli. For the nasal sentences, a numerically greater reduction was observed for the silicone than for the acrylic resin prosthesis. Speech acceptability was better with the modular silicone palatal lift prosthesis (z=2.032, P<.05) and the acrylic resin prosthesis (z=1.753, P<.1) than with no prosthesis. The questionnaire showed better subjective speech acceptability with the acrylic resin prosthesis (z=1.706, P<.05) and the modular silicone palatal lift prosthesis (z=1.706, P<.05) than with no prosthesis. Swallowing comfort was also numerically better for the acrylic resin prosthesis than for the modular silicone palatal lift prosthesis.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility of a new design for a flexible and modular palatal lift prosthesis. The functional outcomes were comparable to those of the traditional design. Although the overall results in this study favored the traditional prosthesis, the new design may be viable for patients who require alternative treatment solutions.
authors.affiliation: Postgraduate student, Department of Prosthodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Ayliffe
authors.affiliation: Associate Professor, Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada. Electronic address: tim.bressmann@utoronto.ca.
authors.forename: Tim
authors.initials: T
authors.lastname: Bressmann
authors.affiliation: Director, Ocular and Maxillofacial Prosthetics Unit, Department of Dental Oncology, Princess Margaret Hospital, Toronto, Canada.
authors.forename: Majd
authors.initials: M
authors.lastname: Al Mardini
authors.affiliation: Professor, Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Asbjørn
authors.initials: A
authors.lastname: Jokstad
mesh_terms: D000180:Acrylic Resins / Q000737:chemistry; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000737:chemistry*; D003679:Deglutition / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011474:Prosthesis Design; D012828:Silicones / Q000737:chemistry*; D013060:Speech / Q000502:physiology; D013064:Speech Disorders / Q000534:rehabilitation*; D013065:Speech Intelligibility / Q000502:physiology; D013070:Speech Therapy / Q000295:instrumentation*; D013499:Surface Properties; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000534:rehabilitation; D014831:Voice / Q000502:physiology
chemical_list: D000180:Acrylic Resins; D001672:Biocompatible Materials; D012828:Silicones