title: Influence of pharyngeal flap surgery on nasality and nasalance scores of nasal sounds production in individuals with cleft lip and palate.
abstract: OBJECTIVE
  To verify the influence of pharyngeal flap surgery on the management of velopharyngeal insufficiency on nasality and speech nasalance on nasal sound production in individuals with cleft lip and palate.
  
  
  METHODS
  Prospective study in 159 individuals with repaired cleft palate ± lip, of both genders, aged 6 to 57 years old. All the participants presented residual velopharyngeal insufficiency and were submitted to pharyngeal flap surgery. Perceptual speech evaluation and nasometric assessment were performed before and after (14 months on average) the pharyngeal flap surgery. Hyponasality was rated as absent or present, and nasalance scores were determined by means of nasometer using nasal stimuli, with a cutoff score of 43% used as the lowest limit of normality. Nasality and nasalance were compared before and after surgery (p < 0.05).
  
  
  RESULTS
  On the basis of correlation between both the methods used, perceptual hyponasality was observed in 14% of the individuals, whereas nasalance scores indicating hyponasality (< 43%) were obtained in 25% of the patients after surgery.
  
  
  CONCLUSIONS
  Pharyngeal flap surgery influenced the production of nasal sounds, causing hyponasality in a significant proportion of individuals. The presence of this speech symptom can also be an indicator of upper airway obstruction caused by pharyngeal flap, which should be investigated objectively and prudently postoperatively.
authors.affiliation: Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Fukushiro
authors.affiliation: Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Flávia
authors.initials: F
authors.lastname: Ferlin
authors.affiliation: Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Renata Paciello
authors.initials: RP
authors.lastname: Yamashita
authors.affiliation: Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Inge Elly Kiemle
authors.initials: IE
authors.lastname: Trindade
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002971:Cleft Lip / Q000503:physiopathology*; D002972:Cleft Palate / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000503:physiopathology; D015508:Nasal Obstruction / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D013064:Speech Disorders / Q000209:etiology / Q000503:physiopathology; D018709:Statistics, Nonparametric; D013524:Surgical Flaps / Q000009:adverse effects*; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000503:physiopathology* / Q000601:surgery*; D014832:Voice Disorders / Q000209:etiology / Q000503:physiopathology*; D014833:Voice Quality; D055815:Young Adult