Satoko Imai

Functional effects of intraoral reconstruction with a free radial forearm flap

Summary Postoperative articulation was investigated in patients who underwent glossectomy and reconstruction with free radial forearm flaps. The methods of evaluation consisted of scores for intelligibility of 100 Japanese syllables and 3 groups of glossal sounds. The glossal sounds, based on palato-lingual contact (lingogram), were useful to evaluate function of the respective parts of the tongue. One patient who had had a partial glossectomy and resection of the floor of the mouth achieved an overall score of 80.5% one year postsurgery, and his glossal sounds were also excellent. Three patients who underwent removal of the floor of the mouth and hemiglossectomy, excluding the root of the tongue, had overall scores ranging from 45.6% to 82.1%. Two of these had particularly low scores for the glossal sounds produced with the rear part of the tongue, and this suggested the necessity for suspension slings to prevent depression of the reconstructed tongue and the floor of the mouth. The hemiglossectomy with partial mandibulectomy had an acceptable score of 68.7%. Chronologically, the glossal sounds produced with the rear part and the blade of the tongue often tended to improve postsurgery.

Articulatory Function After Resection of the Tongue and Floor of the Mouth: Palatometric and Perceptual Evaluation

Linguapalatal contact patterns and the time course of changes in contacts during utterances of/asa, ata, a sa, aca/ were measured using electropalatography (EPG). The relations between these data and perceptual scores in 17 glossectomized patients after various surgical methods were examined. The linguapalatal contact patterns produced during perceptually less distorted sounds varied with the place and manner of articulation. Patterns having very few contacts or a posterior groove produced more distorted /s/ sounds; however, types of EPG patterns producing less distorted /s/ sounds were relatively frequent. Distortion of the and /c/ sounds was less often produced by variation of the EPG patterns, whereas /t/ sounds were most frequently judged to be highly distorted. Patterns that showed complete constriction along the dental arch or constriction on the anterior portion of the hard palate, as well as rapid release for plosion by the tongue tip, produced less distorted /t/ sounds. The results revealed that glossectomized patients often evidenced defective stop sounds. It was concluded that mobility rather than volume of the residual tongue is required to produce less distorted stops.

Electropalatographic investigation of abnormal lingual-palatal contact patterns in cleft palate patients

Lingual-palatal contact patterns and auditorily judged misarticulations, classed as palatalized misarticulation (PM), lateral misarticulation (LM), nasopharyngeal misarticulation (NM), and other distortions were compared in 53 Japanese cleft palate patients. Velopharyngeal function of these patients was considered within normal limits. Contact patterns were recorded by electropalatography (EPG) in an attempt to objectively categorize the misarticulations of cleft palate speakers including those previously reported in English. It is concluded that these lingual-palatal contact patterns are characterized by a broader and/or more posterior pattern than found in normal speakers, although considerable variability was noted.

Improvement of speech intelligibility by a secondary operation to mobilize the tongue after glossectomy

To prove the hypothesis that speech after glossectomy would be improved more by increasing the mobility of the remaining tongue rather than by increasing its volume, the speech intelligibility of 4 glossectomy patients was investigated before and after a secondary operation in which a split skin graft was used to mobilize the residual tongue. In each case, the postoperative speech intelligibility scores were higher than preoperative ones (case 1:83.6 to 97.2%, case 2: 76.6 to 82.5%, case 3: 51.5 to 58.5%, case 4: 30.2 to 49.3%). Sounds produced with the rear portion of the tongue were improved in 3 cases, and plosive and affricative sounds were remarkably improved in all cases. These results were considered to be due to the increased mobility, especially the mid and rear portions of the tongue.

Speech function following maxillectomy reconstructed by rectus abdominis myocutaneous flap.

Post-surgical maxillary defects have recently been reconstructed by microvascularized free flaps. However, few reports have evaluated the resulting speech function. This study compared the speech intelligibility of four maxillectomy patients who underwent reconstruction by rectus abdominis myocutaneous flaps (RAMCF) with that of four non-reconstructed patients who were treated with split-skin grafts and prostheses, to explore ways of achieving better speech function. Speech function was assessed by a Japanese language speech intelligibility test. Intelligibility scores ranged from 57.3% to 75.8% (mean, 70.4%) in the non-reconstructed group and from 66.2% to 77.2% (mean, 71.0%) in the reconstructed group. An analysis of articulatory manners and sites revealed that speech disorders resulted mainly from poor oronasal separation in the non-reconstructed group and from incorrect linguopalatal contact in the reconstructed group, especially for linguodentoalveolar and linguovelar sounds. Therefore, for higher speech function in the reconstructed group, dentoalveolar and palatal contours of the maxilla must be restored as closely as possible. This must also be done in patients whose maxillae are reconstructed by other types of microvascularized myocutaneous or cutaneous flaps that have similar postoperative palatal contours.