Tumor de sistema nervoso central e o paciente pediátrico: alterações fonoaudiológicas / Central nervous system tumor and the pediatric patient: speech-language alterations / Tumor del sistema nervioso central y el paciente pediátrico: trastornosdelhabla y ellenguaje

Introdução: Os tumores do sistema nervoso central (SNC) constituem a segunda neoplasia mais frequente na criança. Os distúrbios tratados pela equipe de fonoaudiologia mais observados em pacientes com tumores são: disfagia, disfonia, alterações de linguagem, transtorno da articulação temporomandibular, disacusia, disartria e paralisia facial. A detecção precoce de alterações fonoaudiológicas em pacientes com tumores pediátricos, na fase do diagnóstico ou início do tratamento, é essencial para um manejo terapêutico mais adequado. Objetivo: descrever as alterações fonoaudiológicas de pacientes pediátricos com diagnóstico de tumor de sistema nervoso central em atendimento durante internação hospitalar. Método: Estudo retrospectivo, com coleta realizada através da pesquisa de dados extraídos de prontuário eletrônico, com dados dos pacientes internados de março de 2016 a agosto de 2018. Para avaliar a associação entre as variáveis categóricas, o teste Qui-quadrado de Pearson foi aplicado. O nível de significância adotado foi de 5% (p<0,05). Resultados: Verificou-se maior relevância nos dados relacionados aos distúrbios de deglutição e motricidade orofacial. Observou-se significância estatística na variável local da lesão - em fossa posterior -, com presença de alterações fonoaudiológicas. Conclusão: A amostra de pacientes oncológicos pediátricos demonstrou alterações fonoaudiológicas, principalmente nas áreas de disfagia e de motricidade orofacial.

Introduction: Central nervous system (CNS) tumors are the second most frequent neoplasm in children. The disorders treated by the speech therapy team most observed in patients with tumors are: dysphagia, dysphonia, language disorders, temporomandibular joint disorder, dysacusis, dysarthria and facial paralysis. Early detection of speech-language pathology changes in patients with pediatric tumors, at the stage of diagnosis or initiation of treatment, is essential for a more appropriate therapeutic management. Objective: to describe speech disorders in pediatric patients diagnosed with a tumor of the central nervous system in care during hospitalization. Method: Retrospective study, with collection performed through the research of data extracted from electronic medical records, with data of patients hospitalized from March 2016 to August 2018. To evaluate the association between categorical variables, Pearson's Chi-square test was applied. The level of significance adopted was 5% (p <0.05). Results: There was greater relevance in the data related to swallowing disorders and orofacial motricity. Statistical significance was observed in the local variable of the lesion - in the posterior fossa -, with the presence of speech-language disorders. Conclusion: The sample of pediatric cancer patients demonstrated speechlanguage disorders, especially in the areas of dysphagia and orofacial motricity.

Introducción: Los tumores del sistema nervioso central (SNC) son la segunda neoplasia maligna más frecuente em niños. Los trastornos tratados por el equipo de terapia del habla más observados en pacientes con tumores son: disfagia, disfonía, transtornos del lenguaje, trastorno de la articulación temporomandibular, disacusis, disartria y parálisis facial. La detección temprana de los câmbios em la patologia del habla y el linguaje en pacientes con tumores pediátricos, em la etapa de diagnóstico o inicio del tratamiento, es esencial para un manejo terapéutico más adecuado. Objetivo: describir los transtornos del habla y el lenguaje de los pacientes pediátricos diagnosticados con tumor del sistema nervioso central em la atención durante la hospitalización. Método: Estudio retrospectivo, com recopilación realizada a través de la investigación de datos extraídos de registros médicos electrónicos, com datos de pacientes hospitalizados de marzo de 2016 a agosto de 2018. Para evaluar la asociación entre variables categóricas, se aplico la prueba de Chi-cuadrado de Pearson. El nivel de significancia adoptado fue del 5% (p<0,05). Resultados: Hubo mayor relevância em los datos relacionados com los trastornos de la deglución y la motricidad orofacial. Se observo importancia estadística em la variable local de la lesión, em la fosa posterior, com la presencia de alteraciones de la patologia del habla y el lenguaje. Conclusión: La muestra de pacientes com cáncer pediátrico demostró la presencia de transtornos del habla y el lenguaje, especialmente em las áreas de disfagia y motricidad orofacial.

Comparison of simple frenotomy with 4-flap Z-frenuloplasty in treatment for ankyloglossia with articulation difficulty: A prospective randomized study.

OBJECTIVE: To compare the surgical outcomes of simple frenotomy and the 4-flap Z-frenuloplasty according to the articulation test values and tongue-tie classification in patients with ankyloglossia with articulation difficulty. STUDY DESIGN: prospective randomized study. SETTING: Tertiary academic center. SUBJECTS: and methods: Children with ankyloglossia with articulation difficulty were randomly divided into 2 groups for surgical treatment. Patients were evaluated for the tongue-tie classification and articulation test before surgery. Three months after the operation, the frenulum classification and articulation test were re-evaluated to compare the differences in surgical outcome between the two surgical methods. RESULTS: Out of 37 patients, 19 underwent the 4-flap Z-frenuloplasty and 18, the simple frenotomy. No differences were observed in the baseline characteristics of the patients assigned to both groups. Changes in the tongue-tie classification and improvement in the articulation test results were observed with both the surgical methods. Both surgical groups had significant improvement in the speech articulation test (consonants) but there was no difference in the speech outcomes between the surgical groups. CONCLUSION: Although there was no significant difference in the surgical outcome between the two surgical methods, ankyloglossia patients showed improvement in a Korean speech articulation test 3 months after undergoing surgery to release the lingual frenulum.

Longitudinal study of the development of obstruent correctness from ages 3 to 5 years in 108 Danish children with unilateral cleft lip and palate: a sub-study within a multicentre randomized controlled trial.

BACKGROUND: Speech-sound development in preschoolers with unilateral cleft lip and palate (UCLP) as a group is delayed/disordered, and obstruents comprise the most vulnerable sound class. AIMS: To evaluate the development of obstruent correctness (PCC-obs) and error types (cleft speech characteristics (CSCs) and developmental speech characteristics (DSCs)) from ages 3-5 and to investigate possible predictors (error types, velopharyngeal dysfunction (VPD) and gender) of PCC-obs at age 5 in two groups of children with UCLP. METHODS & PROCEDURES: Subgroup analysis was conducted within a multicentre randomized controlled trial (RCT) of primary surgery (Scandcleft Project). A total of 125 Danish children with UCLP received lip and soft palate repair around 4 months of age and early hard palate closure at 12 months (EHPC group) or late hard palate closure at 36 months (LHPC group). Audio and video recordings of a naming test were available for 108 children at ages 3 and 5, and recordings were transcribed phonetically by blinded raters. OUTCOMES & RESULTS: PCC-obs scores increased significantly from ages 3-5 in both groups, but with small effect sizes in the EHPC group that had higher scores at age 3 than the LHPC group. DSCs decreased in both groups whereas CSCs only decreased in the LHPC group that had more CSCs at age 3 than the EHPC group. The frequency of CSCs at age 3 was a significant predictor of PCC-obs scores at age 5 in both groups. DSCs significantly improved the logistic regression model in the EHPC group, whereas VPD and gender did not significantly improve the model in either group. CONCLUSIONS & IMPLICATIONS: Although PCC-obs developed significantly from ages 3 to 5, children with UCLP as a group did not catch up to typically developing Danish children at age 5. Furthermore, the LHPC group at age 5 did not reach the 3-year level of the EHPC group, which means that delaying hard palate closure until age 3 is detrimental to obstruent development. Both CSCs and DSCs at age 3 were important predictors of PCC-obs at age 5 and should be considered when determining need for intervention.

Pacifiers, Thumb Sucking, Breastfeeding, and Bottle Use: Oral Sucking Habits of Children with and without Phonological Impairment.

AIMS: The aim of this study was to describe the nutritive and non-nutritive oral sucking habits (breastfeeding, bottle use, pacifier/dummy/soother use, thumb/finger sucking) of preschoolers with and without phonological impairment, and to determine whether oral sucking habits are associated with the presence and severity of phonological impairment. METHODS: We conducted a cross-sectional study of 199 Australian English-speaking preschoolers with and without phonological impairment. Preschoolers' speech was directly assessed, and parents/caregivers completed a questionnaire. Chi-square (χ2) tests were used to examine relationships between oral sucking habits and the presence and severity of phonological impairment. RESULTS: Based on caregiver reports, 79.9% of participants had been breastfed (33.3% for >12 months), 58.3% had used a pacifier (74.2% for ≥12 months), 83.9% had used a bottle (73.4% for > 12 months), and 15.1% sucked their thumb/fingers. There was no association between a history of oral sucking and the presence and severity of phonological impairment. CONCLUSION: The majority of preschoolers had been breastfed and bottle-fed, and more than half had used a pacifier. The findings support an understanding that phonological impairment is not associated with a history of nutritive and non-nutritive sucking habits. Research is needed to examine the association between oral sucking habits and other types of speech sound disorders.

Investigating the effect of STN-DBS stimulation and different frequency settings on the acoustic-articulatory features of vowels.

INTRODUCTION: Parkinson's disease (PD) is the second most frequent progressive neuro-degenerative disorder. In addition to motor symptoms, nonmotor symptoms and voice and speech disorders can also develop in 90% of PD patients. The aim of our study was to investigate the effects of DBS and different DBS frequencies on speech acoustics of vowels in PD patients. METHODS: The study included 16 patients who underwent STN-DBS surgery due to PD. The voice recordings for the vowels including [a], [e], [i], and [o] were performed at frequencies including 230, 130, 90, and 60 Hz and off-stimulation. The voice recordings were gathered and evaluated by the Praat software, and the effects on the first (F1), second (F2), and third formant (F3) frequencies were analyzed. RESULTS: A significant difference was found for the F1 value of the vowel [a] at 130 Hz compared to off-stimulation. However, no significant difference was found between the three formant frequencies with regard to the stimulation frequencies and off-stimulation. In addition, though not statistically significant, stimulation at 60 and 230 Hz led to several differences in the formant frequencies of other three vowels. CONCLUSION: Our results indicated that STN-DBS stimulation at 130 Hz had a significant positive effect on articulation of [a] compared to off-stimulation. Although there is not any statistical significant stimulation at 60 and 230 Hz may also have an effect on the articulation of [e], [i], and [o] but this effect needs to be investigated in future studies with higher numbers of participants.

Deliberate Practice: Preliminary Results of a Useful Strategy for Correcting Articulation in Children With Cleft Palate.

Children with cleft palate frequently show speech and language disorders. In the related scientific literature, several reports have described the use of different strategies for treating speech disorders in children with cleft palate. However, only a few studies have addressed the use of these strategies within a meaningful linguistic context.Deliberate practice is a procedure or strategy, which proposes that the key for achieving high levels of expert performance is dedicating long time for practice. Deliberate practice has been studied mainly in the areas of sports and intellectual games. The purpose of this article is to study whether the use of a strategy originally designed for achieving expert performance in sports and intellectual games, can be useful for the speech intervention of children with cleft palate.For this project, 32 children with cleft palate were studied. The children were randomly assigned to 2 independent groups. Both groups received speech therapy based on the principles of the Whole Language Model. In addition, deliberate practice was used in the children included in the active group.After a speech intervention, although both groups of children demonstrated significant improvement in articulation placement, the active group demonstrated a significantly higher improvement as compared with the control group.In conclusion, these preliminary results seem to suggest that the use of deliberate practice can be effective for enhancing articulation in children with cleft palate.

Prevalence of communication, swallowing and orofacial myofunctional disorders in children and adolescents at the time of admission at a cancer hospital. / Prevalência de distúrbios da comunicação, deglutição e motricidade orofacial em crianças e adolescentes no momento da matrícula em um hospital oncológico.

PURPOSE: Describe the prevalence of communication, swallowing and orofacial myofunctional disorders in a group of children and adolescents at the time of registration at a cancer hospital. METHODS: A cross-sectional study conducted with children aged ≥2 and adolescents, of both genders, admitted to the Pediatric Oncology Section of the Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA) from March 2014 to April 2015 for investigation and/or treatment of solid tumors. A protocol was used to record the sociodemographic and clinical information and findings of the speech-language pathology clinical evaluation, which included aspects of the oral sensorimotor system, swallowing, speech, language, voice, and hearing. RESULTS: Eighty-eight children/adolescents (41.3%) presented some type of speech-language disorder. The most frequent speech-language disorders were orofacial myofunctional disorder, dysphonia, and language impairments, whereas the less frequent ones were dysacusis, tongue paralysis, and trismus. Site of the lesion was the clinical variable that presented statistically significant correlation with presence of speech-language disorders. CONCLUSION: High prevalence of speech-language disorders was observed in children and adolescents at the time of admission at a cancer hospital. Occurrence of speech-language disorders was higher in participants with lesions in the central nervous system and in the head and neck region.

OBJETIVO: Descrever a prevalência dos distúrbios da comunicação, deglutição e motricidade orofacial em um grupo de crianças e adolescentes, no momento da matrícula hospitalar em um instituto oncológico. MÉTODO: Estudo transversal, com a inclusão de crianças com dois anos ou mais e adolescentes de ambos os gêneros, matriculados na Seção de Oncologia Pediátrica do Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA) no período de março de 2014 a abril de 2015 para investigação e/ou tratamento de tumores sólidos. Foi utilizado um protocolo para registro das informações sociodemográficas e clínicas e os achados da avaliação clínica fonoaudiológica, que contemplava aspectos do sistema sensório-motor oral, deglutição, fala, linguagem, voz e audição. RESULTADOS: Oitenta e oito crianças/adolescentes (41,3%) avaliados apresentavam algum tipo de distúrbio fonoaudiológico. As alterações fonoaudiológicas mais frequentes foram o distúrbio miofuncional orofacial, a disfonia e os transtornos de linguagem. Os menos frequentes foram a disacusia, a paralisia de língua e o trismo. A variável clínica que teve associação estatisticamente significante com a presença de alterações fonoaudiológicas foi o local da lesão. CONCLUSÃO: O estudo demonstrou uma alta prevalência de alterações fonoaudiológicas em crianças e adolescentes no momento da matrícula hospitalar em um hospital oncológico. A ocorrência de transtornos fonoaudiológicos foi maior nos grupos de participantes com lesões localizadas no sistema nervoso central e na região da cabeça e pescoço.

Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate.

BACKGROUND: Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. AIMS: To assess the influence of different timing of hard palate closure in a two-stage procedure on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery, hearing and speech therapy. METHODS & PROCEDURES: A randomized controlled trial (RCT). Early hard palate closure (EHPC) at 12 months versus late hard palate closure (LHPC) at 36 months in a two-stage procedure was tested in a cohort of 126 Danish-speaking children born with non-syndromic UCLP. All participants had the lip and soft palate closed around 4 months of age. Audio and video recordings of a naming test were available from 113 children (32 girls and 81 boys) and were transcribed phonetically. Recordings were obtained prior to hard palate closure in the LHPC group. The main outcome measures were percentage consonants correct adjusted (PCC-A) and consonant errors from blinded assessments. Results from 36 Danish-speaking children without CP obtained previously by Willadsen in 2012 were used for comparison. OUTCOMES & RESULTS: Children with EHPC produced significantly more target consonants correctly (83%) than children with LHPC (48%; p < .001). In addition, children with LHPC produced significantly more active cleft speech characteristics than children with EHPC (p < .001). Boys achieved significantly lower PCC-A scores than girls (p = .04) and produced significantly more consonant errors than girls (p = .02). No significant differences were found between groups regarding burden of treatment. The control group performed significantly better than the EHPC and LHPC groups on all compared variables.

Prevalência de distúrbios da comunicação, deglutição e motricidade orofacial em crianças e adolescentes no momento da matrícula em um hospital oncológico / Prevalence of communication, swallowing and orofacial myofunctional disorders in children and adolescents at the time of admission at a cancer hospital

RESUMO Objetivo Descrever a prevalência dos distúrbios da comunicação, deglutição e motricidade orofacial em um grupo de crianças e adolescentes, no momento da matrícula hospitalar em um instituto oncológico. Método Estudo transversal, com a inclusão de crianças com dois anos ou mais e adolescentes de ambos os gêneros, matriculados na Seção de Oncologia Pediátrica do Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA) no período de março de 2014 a abril de 2015 para investigação e/ou tratamento de tumores sólidos. Foi utilizado um protocolo para registro das informações sociodemográficas e clínicas e os achados da avaliação clínica fonoaudiológica, que contemplava aspectos do sistema sensório-motor oral, deglutição, fala, linguagem, voz e audição. Resultados Oitenta e oito crianças/adolescentes (41,3%) avaliados apresentavam algum tipo de distúrbio fonoaudiológico. As alterações fonoaudiológicas mais frequentes foram o distúrbio miofuncional orofacial, a disfonia e os transtornos de linguagem. Os menos frequentes foram a disacusia, a paralisia de língua e o trismo. A variável clínica que teve associação estatisticamente significante com a presença de alterações fonoaudiológicas foi o local da lesão. Conclusão O estudo demonstrou uma alta prevalência de alterações fonoaudiológicas em crianças e adolescentes no momento da matrícula hospitalar em um hospital oncológico. A ocorrência de transtornos fonoaudiológicos foi maior nos grupos de participantes com lesões localizadas no sistema nervoso central e na região da cabeça e pescoço.

ABSTRACT Purpose Describe the prevalence of communication, swallowing and orofacial myofunctional disorders in a group of children and adolescents at the time of registration at a cancer hospital. Methods A cross-sectional study conducted with children aged ≥2 and adolescents, of both genders, admitted to the Pediatric Oncology Section of the Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA) from March 2014 to April 2015 for investigation and/or treatment of solid tumors. A protocol was used to record the sociodemographic and clinical information and findings of the speech-language pathology clinical evaluation, which included aspects of the oral sensorimotor system, swallowing, speech, language, voice, and hearing. Results Eighty-eight children/adolescents (41.3%) presented some type of speech-language disorder. The most frequent speech-language disorders were orofacial myofunctional disorder, dysphonia, and language impairments, whereas the less frequent ones were dysacusis, tongue paralysis, and trismus. Site of the lesion was the clinical variable that presented statistically significant correlation with presence of speech-language disorders. Conclusion High prevalence of speech-language disorders was observed in children and adolescents at the time of admission at a cancer hospital. Occurrence of speech-language disorders was higher in participants with lesions in the central nervous system and in the head and neck region.

Stroke resulting from an isolated pulmonary arteriovenous malformation.

Isolated pulmonary arteriovenous malformations (PAVM) are rare, but can be responsible for paradoxical embolic events. It is important to recognise these situations early and intervene quickly to attain the best outcome. We describe the case of a 45-year-old woman with a long-standing history of migraines with aura who presented to the emergency department with left-sided weakness and slurred speech. Work-up was unclear and she was diagnosed with cryptogenic stroke. Follow-up transoesophageal echocardiogram was suggestive of an atrial septal defect, though no clear defect was evident. Pulmonary angiography revealed an isolated PAVM arising from the right lower lung segmental artery with a 2 mm feeding artery leading into 3-4 mm of dysplastic vessel that connects to the vein. The vessel was embolised successfully using a combination of a 4 mm Amplatzer Vascular Plug in the distal feeding artery and a 4 mm Nester coil proximally.

Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 5. Speech outcomes in 5-year-olds - consonant proficiency and errors.

BACKGROUND AND AIM: Normal articulation before school start is a main objective in cleft palate treatment. The aim was to investigate if differences exist in consonant proficiency at age 5 years between children with unilateral cleft lip and palate (UCLP) randomised to different surgical protocols for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. DESIGN: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Norway, Sweden, and the UK. METHODS: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with non-syndromic UCLP. Speech audio- and video-recordings of 391 children (136 girls and 255 boys) were available and transcribed phonetically. The main outcome measure was Percent Consonants Correct (PCC) from blinded assessments. RESULTS: In Trial 1, arm A showed statistically significant higher PCC scores (82%) than arm B (78%) (p = .045). No significant differences were found between prevalences in Trial 2, A: 79%, C: 82%; or Trial 3, A: 80%, D: 85%. Across all trials, girls achieved better PCC scores, excluding s-errors, than boys (91.0% and 87.5%, respectively) (p = .01). CONCLUSIONS: PCC scores were higher in arm A than B in Trial 1, whereas no differences were found between arms in Trials 2 or 3. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed. TRIAL REGISTRATION: ISRCTN29932826.

Use of an automated mobile application to assess effects of nicotine withdrawal on verbal fluency: A pilot study.

Mild-to-moderate impairment in frontally mediated functions such as sustained attention, working memory, and inhibition have been found to occur during tobacco withdrawal and may present a barrier to successful cessation. These findings have led to studies evaluating cessation treatments that target nicotine withdrawal related cognitive impairment. The instruments currently used to assess cognitive function provide detailed and specific information but have limitations including being time consuming, cumbersome, anxiety provoking, and having poor ecological validity. The authors examined the feasibility of using a mobile computer application to test verbal fluency (VF) as a quick, easy-to-administer, and more ecologically valid method of measuring the effects of short-term smoking abstinence on frontally mediated cognitive functions. Thirty participants completed 2 assessments-1 during ad lib smoking and 1 after overnight abstinence. At each assessment, semantic and phonemic VF tests were administered using a mobile application and nicotine craving and withdrawal symptom severity was assessed. In repeated assessments, performance on both semantic and phonemic VF tests is expected to improve due to practice effects; however, significant improvements were observed only in semantic (p = .012) but not phonemic (p = .154) VF. In addition, the change between assessments in phonemic (but not semantic) score was significantly associated with withdrawal (p = .006) and craving (p = .037) severity measured postabstinence. This study demonstrates that nicotine withdrawal has differential effects on semantic versus phonemic VF suggesting impairments of working memory, attention, and inhibition. These effects were measured using methods easily used in large groups of participants, potentially with remote test administration and automated scoring. (PsycINFO Database Record

Five-year speech and language outcomes in children with cleft lip-palate.

OBJECTIVE: To investigate 5-year speech and language outcomes in children with cleft lip/palate (CLP). MATERIALS AND METHODS: Thirty-eight children aged 4-7 years and 8 months were recruited for this study. Speech abilities including articulation, resonance, voice, and intelligibility were assessed based on Thai Universal Parameters of Speech Outcomes. Language ability was assessed by the Language Screening Test. RESULTS: The findings revealed that children with clefts had speech and language delay, abnormal understandability, resonance abnormality, and voice disturbance; articulation defects that were 8.33 (1.75, 22.47), 50.00 (32.92, 67.08), 36.11 (20.82, 53.78), 30.56 (16.35, 48.11), and 94.44 (81.34, 99.32). CONCLUSIONS: Articulation errors were the most common speech and language defects in children with clefts, followed by abnormal understandability, resonance abnormality, and voice disturbance. These results should be of critical concern. Protocol reviewing and early intervention programs are needed for improved speech outcomes.

Effects of leukocyte-platelet rich fibrin on postoperative complications of direct sinus lifting.

BACKGROUND: Blood products have been widely used in soft tissue and bone regeneration in oral and maxillofacial surgery. The purpose of this study is to evaluate the effects of leukocyte-platelet rich fibrin (L-PRF) following direct sinus lifting procedure. METHODS: Twenty-eight patients were included in the study. Direct sinus lifting was performed via lateral window approach under conscious sedation and local anesthesia. Bony window and sinus floor elevation were performed using piezosurgery device. Two groups were formed. In the first group an allogenous bone graft and L-PRF mixture was used as grafting material. The L-PRF membrane was used to close the lateral window. In the second group, only allogenous bone was used for grafting and resorbable collagen membrane was used to close the lateral window. Pain, swelling, sleeping, eating, phonetics, activities of daily living, missed work days and soft tissue healing were evaluated postoperatively. RESULTS: Data of 24 patients were evaluated. Improvements were seen in the studied parameters in the L-PRF group; however, the difference was not significant between the two groups (P>0.05). CONCLUSIONS: The use of L-PRF and allogenous bone graft in combination with L-PRF membrane does not significantly improve postoperative complications following direct sinus lifting.

Articulation handicap index: an instrument for quantifying psychosocial consequences of impaired articulation.

Structural, neurological and muscular diseases can lead to impairments of articulation. These impairments can severely impact social life. To judge health status comprehensively, this impact must be adequately quantified. For this purpose, the articulation handicap index (AHI) has been developed. Psychometric analyses referring to this index are presented here. The AHI was completed by 113 patients who had undergone treatment of tumours of the head or neck. The patients also gave a general self-assessment of their impairments due to articulation problems. Furthermore, tumour size, tumour location and kind of therapy were recorded. Missing data were analysed and replaced by multiple imputation. Internal structure was investigated using principal component analysis (PCA); reliability using Cronbach's alpha. Validity was investigated by analysing the relationship between AHI and general self-assessment of impairments. Moreover, the relationships with tumour size, tumour location and kind of therapy were analysed. Only 0.12 % of the answers to the AHI were missing. The Scree test performed with the PCA results suggested one-dimensionality with the first component explaining 49.6 % of the item variance. Cronbach's alpha was 0.96. Kendall's tau between the AHI sum score and the general self-assessment was 0.69. The intervals of AHI sum scores for the self-assessment categories were determined with 0-13 for no, 14-44 for mild, 46-76 for moderate, and 77-120 for severe impairment. The AHI sum score did not systematically relate to tumour size, tumour location or kind of therapy. The results are evidence for high acceptance, reliability and validity.

[Improving the speech with a prosthetic construction]. / Een prothetische constructie ter verbetering van de spraak.

A 12-year-old boy had problems with his speech due to a defect in the soft palate. This defect was caused by the surgical removal of a synovial sarcoma. Testing with a nasometer revealed hypernasality above normal values. Given the size and severity of the defect in the soft palate, the possibility of improving the speech with speech therapy was limited. At a centre for special dentistry an attempt was made with a prosthetic construction to improve the performance of the palate and, in that way, the speech. This construction consisted of a denture with an obturator attached to it. With it, an effective closure of the palate could be achieved. New measurements with acoustic nasometry showed scores within the normal values. The nasality in the speech largely disappeared. The obturator is an effective and relatively easy solution for palatal insufficiency resulting from surgical resection. Intrusive reconstructive surgery can be avoided in this way.

Ultrasound visual feedback in articulation therapy following partial glossectomy.

UNLABELLED: Disordered speech is common following treatment for tongue cancer, however there is insufficient high quality evidence to guide clinical decision making about treatment. This study investigated use of ultrasound tongue imaging as a visual feedback tool to guide tongue placement during articulation therapy with two participants following partial glossectomy. A Phase I multiple baseline design across behaviors was used to investigate therapeutic effect of ultrasound visual feedback during speech rehabilitation. Percent consonants correct and speech intelligibility at sentence level were used to measure acquisition, generalization and maintenance of speech skills for treated and untreated related phonemes, while unrelated phonemes were tested to demonstrate experimental control. Swallowing and oromotor measures were also taken to monitor change. Sentence intelligibility was not a sensitive measure of speech change, but both participants demonstrated significant change in percent consonants correct for treated phonemes. One participant also demonstrated generalization to non-treated phonemes. Control phonemes along with swallow and oromotor measures remained stable throughout the study. This study establishes therapeutic benefit of ultrasound visual feedback in speech rehabilitation following partial glossectomy. LEARNING OUTCOMES: Readers will be able to explain why and how tongue cancer surgery impacts on articulation precision. Readers will also be able to explain the acquisition, generalization and maintenance effects in the study.

Changes in the nasalance of vowels within the first week following uvulopalatopharyngoplasty.

We conducted a retrospective study to evaluate the short-term effect of uvulopalatopharyngoplasty (UPPP) on changes in the nasalance of five vowels: /a/, /ε/, /i/, /ɔ/, and /u/. Our study group was made up of 20 patients-15 males and 5 females, aged 16 to 57 years (mean: 37.3 ± 11.5)-who had undergone UPPP as a treatment for mild to moderate obstructive sleep apnea. Nasometry was used to obtain nasalance scores in all patients on the morning of the operation (day 1) and subsequently on day 4 or 5 (mean: 4.5 ± 0.5). Preoperatively, nasalance scores were highest for /i/ (mean: 29.8 ± 12.6) and /a/ (mean: 24.1 ± 10.3). After the operation, nasalance scores for all five studied vowels increased; they were highest for /i/ (mean: 40.7 ± +17.8) and /ε/ (mean: 30.0 ± 10.8). The increases in the nasalance of /i/, /ε/, and /u/ were statistically significant (p < 0.05). Our findings indicate that UPPP has a significant impact on nasalance immediately after surgery.