RESUMO
INTRODUCTION: Compensatory articulation disorder (CAD) severely affects speech intelligibility of cleft palate children. CAD must be treated with speech therapy. Children can manage articulation better when they use language in event contexts such as every day routines. OBJECTIVE: The purpose of this paper is to study and compare two modalities of speech intervention in cleft palate children with associated CAD. The first modality is a conventional approach providing speech therapy in 1-h sessions, twice a week. The second modality is a speech summer camp in which children received therapy 4h per day, 5 days a week for a period of 3 weeks. We were aimed to determine if a speech summer camp could significantly enhance articulation in CP children with CAD. MATERIALS AND METHODS: Forty-five children with repaired cleft palates who exhibited CAD were studied. A matched control group of 45 children with repaired cleft palate who also exhibited CAD were identified. The patients included in the first group attended a speech summer camp for 3 weeks. The matched control subjects included in the second group received speech therapy aimed to correct CAD twice per-week in 1-h sessions. RESULTS: At the onset of either the summer camp or the speech therapy period, the severity of CAD was evenly distributed with non-significant differences across both groups of patients (p > 0.05). After the summer camp (3 weeks) or 12 months of speech therapy sessions at a frequency of twice per-week, both groups of patients showed a significant decrease in the severity of their CAD (p < 0.05). However, when the distribution of the severity of CAD was compared at the end of the summer camp or the speech therapy period, non-significant differences were found between both groups of patients (p > 0.05). CONCLUSIONS: A speech summer camp is a valid and efficient method for providing speech therapy in cleft palate children with compensatory articulation disorder.
Assuntos
Transtornos da Articulação/etiologia , Transtornos da Articulação/terapia , Fissura Palatina/complicações , Estações do Ano , Meio Social , Fonoterapia/métodos , Transtornos da Articulação/diagnóstico , Criança , Pré-Escolar , Fissura Palatina/cirurgia , Feminino , Humanos , Masculino , Índice de Gravidade de DoençaRESUMO
INTRODUCTION: Superiorly based pharyngeal flaps and sphincter pharyngoplasties are the two main possibilities for the surgical treatment of hypernasality in velopharyngeal dysfunction. Videonaspharyngoscopy and multi-view videofluoroscopy can provide anatomical and physiological data for planning these surgical procedures for correcting hypernasality. AIM: This study was undertaken to assess the planning and outcome of pharyngeal flaps and sphincter pharyngoplasties for correcting velopharyngeal insufficiency. The surgical techniques were customized according to the findings of videonasopharyngoscopy and multiview videofluoroscopy. MATERIALS AND METHODS: Seventy patients with repaired palate clefts and residual velopharyngeal dysfunction were studied. The patients were randomly divided into two groups. The first group received a pharyngeal flap. The second group received a sphincter pharyngoplasty. Both procedures were individually customized according to the findings of videonasopharyngoscopy and multi-view videofluoroscopy. RESULTS: There was a non-significant difference (P >0.05) between the mean size of preoperative velopharyngeal closure gap between the two groups of patients (mean=27.5%; S.D.=7.7% versus mean=28.3%; S.D.=5.9%). Postoperatively, velopharyngeal dysfunction was completely corrected in 89% of the cases from group 1, and in 85% of the cases from group 2. There was a non-significant difference (P >0.05) between the success rate for correcting VPI in both groups of patients. CONCLUSIONS: Pharyngeal flap and sphincter pharyngoplasty seem to be safe and reliable procedures for treating residual velopharyngeal dysfunction. Although not all the patients studied for this paper achieved complete closure after the surgical procedures, all of them showed a reduction of the size of the velopharyngeal closure defect. The planning of the surgical procedure, in order to match the postoperative structure to the preoperative velopharyngeal dimensions and movements visualized through Videonasopharyngoscopy and videofluoroscopy, seems to be the most important aspect of the surgery for correcting residual velopharyngeal dysfunction.
Assuntos
Fissura Palatina/cirurgia , Distúrbios da Fala/cirurgia , Criança , Pré-Escolar , Fissura Palatina/complicações , Hospitais , Humanos , Estudos Prospectivos , Procedimentos de Cirurgia Plástica/métodos , Distúrbios da Fala/etiologia , Retalhos Cirúrgicos , Resultado do Tratamento , Insuficiência Velofaríngea/complicações , Insuficiência Velofaríngea/cirurgiaRESUMO
INTRODUCTION: Sleep apnea is one of the most frequent manifestations of respiratory obstruction. Historically this clinical entity has stimulated the production of numerous valuable contributions with one purpose in mind: the improvement of airway permeability. A multi-disciplinary approach is required to define the problem in anatomic and functional terms to avoid a tracheostomy and prevent long-term sequels. We decided on an approach that focuses on improving the projection of the tongue in the posterior pharynx; by lengthening the mandible and bringing the muscular insertions of the floor of the mouth forward, the antero-posterior dimensions of the airway are increased. OBJECTIVE: To evaluate mandibular distraction osteogenesis as a simple mandibular lengthening procedure useful as a definite treatment in patients with obstructive sleep apnea. MATERIAL AND METHODS: The series consisted of 15 consecutive patients, divided in four groups. Patients with acute upper airway obstruction who required endotracheal intubation, patients with no acute upper airway obstruction but with severe respiratory distress, patients with milder degrees of airway obstruction, and patients with long-term tracheostomies. Therapeutic interventions were performed according to the findings of each group. RESULTS: The patients were evaluated according to cephalometric analysis, polysomnograms, nasopharyngoscopy, and clinical data. Significant changes were seen in the cephalometric studies. There were no postoperative episodes of apnea; clinical improvement occurred in all patients and decannulation was possible in all patients. CONCLUSION: Mandibular distraction is a safe and reliable procedure for treating patients with obstructive sleep apnea.