Yukari Yamashita

A comparison of surgical and prosthetic treatment for speech disorders attributable to surgically acquired soft palate defects

Surgical and prosthetic treatments for speech disorders attributable to surgically acquired soft palate defects were investigated. Ten patients who had undergone soft palate resection for extensive cancer served as the subjects. In four patients, the resected portion of the soft palate was confined to the anterior or middle segments, with an intact posterior band, whereas in the remaining six patients the resected portion extended into the posterior edge. An obturator with or without a speech appliance was adapted to all patients in the former group and to one patient in the latter group. The remaining five patients in the latter group underwent surgical reconstruction using a free radial forearm flap immediately after resection of the soft palate. The speech of each patient was evaluated either before and after surgery in those treated only surgically or with and without the obturator in the other patients using a standard intelligibility test of 100 Japanese syllables. These tests showed that two of the four patients with a posterior band of soft palate remaining postsurgically achieved excellent restoration of speech and improvement of velopharyngeal function following placement of a special prosthesis. The patients who had resection extending into the posterior edge of the soft palate obtained better restoration of speech and function from surgical reconstruction rather than prosthetic management. All three patients who had surgical reconstruction, in whom the special obturator was applied achieved a slight increase in speech intelligibility scores resulting from the improvement of velopharyngeal function. These results suggest that surgical reconstruction and prosthetic management may best be applied selectively based on the extent of resection of the soft palate.

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.

Misarticulation Caused by Abnormal Lingual-Palatal Contact in Patients with Cleft Palate with Adequate Velopharyngeal Function

Misarticulations produced by three patients with cleft palate (2 isolated cleft palate; 1 unilateral cleft lip, alveolus, and palate) who attained adequate velopharyngeal function and normal palatal vault by early surgical repairs were examined using electropalatography (EPG) and sound spectrography (SG). Common characteristics of lingual-palatal contact in which the contact area was broader and/or was more posterior than normal were observed. These misarticulations can be divided into three types based on the direction of the breath emission: palatalized misarticulation (in which air passes along the midline of the palate), lateral misarticulation (in which air flows laterally through the occluded dental arch), and nasopharyngeal misarticulation (in which air flows out the nose). These three are considered to be similar to intractable posterior pattern of articulation in cleft palate patients previously reported. However, these types of misarticulations can be produced by cleft patients who have achieved adequate velopharyngeal function and normal palatal vault.

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.

Analyses of speech intelligibility in patients after glossectomy and reconstruction with fasciocutaneous/myocutaneous flaps

This study analyzed the results of speech intelligibility tests in patients with tongue cancer who had undergone resection with the aim of making surgical recommendations for flap design and inset, to improve speech function. A total of 126 patients, enrolled from 13 Japanese institutions, were classified into 3 groups according to the resected site: lateral, anterior, and combined. The lateral group was further divided into 3 subgroups and the anterior group into 2 subgroups according to the size of resection. The speech intelligibility score was analyzed based on articulatory site and mode: 5 articulatory sites (linguodentoalveolar, linguopalatal, linguovelar, and their intermediates); and 7 articulatory modes (plosives, fricatives, affricatives, grids, nasals, vowels and semivowels). Low speech intelligibility scores were recorded at sites where flaps contribute directly to the pronunciation in the lateral and combined groups and at the anterior part of the reconstructed tongue in the anterior group. Plosives and glides displayed low values in general. A radial forearm flap had higher function in the lateral group than other flaps. The type of flap had no effect in the anterior and combined groups. Surgical techniques and flap selection to improve functional status in each type of resection are discussed.

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.

Primary Treatment for Cleft Lip and/or Cleft Palate in Children in Japan

Objective To investigate current trends in primary treatment for children with cleft lip and/or cleft palate in Japan. Design Nationwide, retrospective study under the direction of the Academic Survey Committee of the Japanese Cleft Palate Association based on analysis of data obtained via a booklet-style questionnaire completed by institutions providing primary treatment for cleft lip and/or palate patients. Participants, Patients Patients were 4349 children undergoing primary repair for cleft lip and/or palate at 107 participating institutions between 1996 and 2000. Main Outcome Measure(s) Cleft type, laterality; use of infant palatal plate; and timing and technique of primary repair for cleft lip and/or palate were evaluated by cleft surgeons at 107 participating institutions. Results Of a total of 2874 patients with cleft lip and palate or cleft palate only, infant palatal plates were used with 1087 (37.8%) and were not used with 1787 (62.2%). Primary unilateral lip repair was performed at the age of 2 to 6 months in more than 90% of patients. Bilateral cleft lip was treated by one-stage repair in 285 patients (44.5%) and by two-stage repair in 258 (40.2%). Primary one-stage palatal repair was performed in 2212 (76.9%) and two-stage palatal repair in 262 (9.1%) cleft palate patients. Information on treatment of the remaining 400 (14%) patients was unavailable. Conclusion This investigation clarified current trends in primary treatment for cleft lip and/or palate in Japan. The results suggest the need for an increase in regional core hospitals and greater variation in treatment options.

Quantitative evaluation of hypernasality in cleft palate patients

To quantitatively evaluate hypernasality in cleft palate patients, the Japanese vowel /i/ pronounced by six cleft palate patients and four normal children (controls) of similar ages was analyzed acoustically by cepstrum analysis. Spectrum envelopes obtained by the cepstrum method were evaluated every 1/3 octave to obtain the mean level in each band. Ten listeners evaluated a speech sample from each subject for degree of nasality on an equal interval scale ranging from 0 (no nasality) to 4 (strongest nasality). Two factors were obtained from the factor analysis of the judged scores. The first factor, which accounted for 77% of the total variance, was the consensus perception of nasality. The second factor, which accounted for 9%, was the difference among the individual listeners. The levels in two 1/3 octave bands were highly correlated with the first factor. The central frequencies of these two bands were 1 and 5 kHz.

Observation of the palato‐lingual contact in the cases after hemiglossectomy by use of dynamic palatography

The dynamic palatograph (DP) employed in this study is an electric device capable of displaying and recording constantly changing palato‐lingual contact as a function of time, utilizing a thin plastic artificial palate incorporating 63 electrodes. The DP was applied to investigate palato‐lingual contact before and after hemiglossectomy to three subjects with carcinoma of the tongue. The palatogram and speech sound were simultaneously recorded and synchronized with a sound spectrogram. The following findings were obtained: (1) Before hemiglossectomy, nearly normal patterns were observed in all cases. (2) After hemiglossectomy, abnormal patterns were found in all cases, though the results differed among the three cases according to the volume of the resection. In two cases, where less than half of the tongue was resected, contact areas tended to increase at the frontal part of the palate in one case, and at the side corresponding to the nonresected side of the tongue in the other. In the third case, where m...