TODENTJ-25-03-2019_TODENTJ-11-436 1553507071 Bentham Open doi@benthamopen.net Bentham Open The Open Dentistry Journal TODENTJ 1874-2106 08 30 2017 11 1 Abdel Rahim M. Bibars Firas S.D. Alfwaress Abed Al-Hadi Hamasha Zeid A. Al-Hourani Khader Almhdawi Background: Hypernasality is a frequently encountered problem in the speech of individuals with velopharyngeal incompetence. The use of palatal lift appliance (PLA) is the main treatment option for correction of velopharyngeal incompetence. The literature on the outcomes of using prosthetics treatment for Arabic speaking patients is scarce. Objective: The aim of this study was to investigate the effect of using PLA on hypernasality of Arabic speaking patients with velopharyngeal incompetence. Methods: Six participants with age ranging from 9 to 61 years (4 males and 2 females) were recruited between October 2013 and August 2014. Written informed consents were taken from all the adult participants/the guardians of under-aged participants. All patients exhibited hypernasality with different etiologies for velopharyngeal incompetence (head injury, cerebrovascular accident, and neurological disorders). They were treated with PLAs which were constructed to elevate the dysfunctional soft palate. Nasalance scores and perceptual speech acceptability ratings were measured/evaluated in both situations; with and without appliances. Paired t-test was used to analyze the perceptual ratings and nasalance scores in order to detect any significant change in hypernasality pre and post insertion of PLA. Results: There was a statistically significant decrease (p>0.05) in nasalance scores (Pa, Pi, Ma, Mi, a, i) after PLA insertion. The subtest /u/ showed insignificant change (p= 0.056). Perceptual ratings showed significant reduction in hypernasality which was consistent with nasalance measurements. Conclusion: PLAs can reduce hypernasality in Arabic speaking patients who suffer from velopharyngeal impairment. 08 30 2017 436 446 TODENTJ-11-436 1 10.2174/crossmark_policy opendentistryjournal.com benthamopen.com true Peer Reviewed Single blind Checked with iThenticate 2017-05-19 2017-07-27 2017-08-01 2017-08-30 https://creativecommons.org/licenses/by/4.0/legalcode 10.2174/1874210601711010436 1553507071 https://opendentistryjournal.com/VOLUME/11/PAGE/436/ https://opendentistryjournal.com/contents/volumes/V11/TODENTJ-11-436/TODENTJ-11-436.pdf https://opendentistryjournal.com/contents/volumes/V11/TODENTJ-11-436/TODENTJ-11-436.pdf https://opendentistryjournal.com/contents/volumes/V11/TODENTJ-11-436/TODENTJ-11-436.pdf https://opendentistryjournal.com/contents/volumes/V11/TODENTJ-11-436/TODENTJ-11-436.pdf https://opendentistryjournal.com/contents/volumes/V11/TODENTJ-11-436/TODENTJ-11-436.pdf https://opendentistryjournal.com/contents/volumes/V11/TODENTJ-11-436/TODENTJ-11-436.pdf https://opendentistryjournal.com/contents/volumes/V11/TODENTJ-11-436/TODENTJ-11-436.pdf https://opendentistryjournal.com/contents/volumes/V11/TODENTJ-11-436/TODENTJ-11-436.xml Beumer J, Curtis TA, Marunick MT, Eds. Maxillofacial rehabilitation: Prosthodontic and surgical considerations. St Louis: Ishiyaku EuroAmerica 1996; p. 541. Sprintzen R, Bardach J. Cleft palate speech management. St Louis: CV Mosby 1995; pp. 263-7. J. Prosthet. Dent. Aram A. 9 149 1959 10.1016/0022-3913(59)90111-8 Aram A, Subtelny JD. Velopharyngeal function and cleft palate prosthesis. J Prosthet Dent 1959; 9 (1) : 149-58. Cleft Palate Craniofac. J. Nakamura N. 40 612 2003 10.1597/1545-1569(2003)040<0612:VMOPWP>2.0.CO;2 Nakamura N, Ogata Y, Kunimitsu K, Suzuki A, Sasaguri M, Ohishi M. Velopharyngeal morphology of patients with persistent velopharyngeal incompetence following repushback surgery for cleft palate. Cleft Palate Craniofac J 2003; 40 (6) : 612-7. J. Appl. Oral Sci. Pinto J.H. 11 192 2003 10.1590/S1678-77572003000300007 Pinto JH, Pegoraro-Krook MI. Evaluation of palatal prosthesis for the treatment of velopharyngeal dysfunction. J Appl Oral Sci 2003; 11 (3) : 192-7. J. Prosthet. Dent. Shifman A. 83 99 2000 10.1016/S0022-3913(00)70094-1 Shifman A, Finkelstein Y, Nachmani A, Ophir D. Speech-aid prostheses for neurogenic velopharyngeal incompetence. J Prosthet Dent 2000; 83 (1) : 99-106. 10.1159/000368014 Jackson M. Prosthodontics rehabilitation in velopharyngeal insufficiency surgery for pediatric velopharyngeal insufficiency. Basel: Karger 2015; 76: pp. 41-9. J. Prosthet. Dent. La Velle W.E. 42 308 1979 10.1016/0022-3913(79)90222-1 La Velle WE, Hardy JC. Palatal lift prostheses for treatment of palatopharyngeal incompetence. J Prosthet Dent 1979; 42 (3) : 308-15. Cleft Palate Craniofac. J. Witt P.D. 32 469 1995 10.1597/1545-1569(1995)032<0469:DPLPSV>2.3.CO;2 Witt PD, Rozelle AA, Marsh JL, et al. Do palatal lift prostheses stimulate velopharyngeal neuromuscular activity? Cleft Palate Craniofac J 1995; 32 (6) : 469-75. Pathol Watanabe S. 24 119 2012 Watanabe S, Oh-Shige H, Miyachi H, Gotoh M, Ariji E, Shimozato K. Use of palatal augmentation prostheses to maintain speech and swallowing function in patients with amyotrophic lateral sclerosis. J Oral and Maxillofac Surg, Med. Pathol 2012; 24 (2) : 119-23. Mazaheri M. Palatal lifting prosthesis for the treatment of velopharyngeal incompetency and insufficiency cleft lip palate. Springer 2013; pp. 839-51. Cleft Palate Craniofac. J. Kummer A.W. 40 590 2003 10.1597/1545-1569(2003)040<0590:TRBTCO>2.0.CO;2 Kummer AW, Briggs M, Lee L. The relationship between the characteristics of speech and velopharyngeal gap size. Cleft Palate Craniofac J 2003; 40 (6) : 590-6. Cleft Palate Craniofac. J. Trindade I.E. 40 54 2003 10.1597/1545-1569(2003)040<0054:EOOSOS>2.0.CO;2 Trindade IE, Yamashita RP, Suguimoto RM, Mazzottini R, Trindade AS Jr. Effects of orthognathic surgery on speech and breathing of subjects with cleft lip and palate: acoustic and aerodynamic assessment. Cleft Palate Craniofac J 2003; 40 (1) : 54-64. Rev. Bras. Otorrinolaringol Larangeira F.R. 82 326 2016 Larangeira FR, Dutka JdeC, Whitaker ME, et al. Speech nasality and nasometry in cleft lip and palate. Rev Bras Otorrinolaringol 2016; 82 (3) : 326-33. J. Adv. Prosthodont. Raj N. 4 243 2012 10.4047/jap.2012.4.4.243 Raj N, Raj V, Aeran H. Interim palatal lift prosthesis as a constituent of multidisciplinary approach in the treatment of velopharyngeal incompetence. J Adv Prosthodont 2012; 4 (4) : 243-7. Cleft Palate Craniofac. J. Pinto J.H. 44 635 2007 10.1597/06-061.1 Pinto JH, da Silva Dalben G, Pegoraro-Krook MI. Speech intelligibility of patients with cleft lip and palate after placement of speech prosthesis. Cleft Palate Craniofac J 2007; 44 (6) : 635-41. Int. J. Prosthodont. Raju H. 22 579 2009 Raju H, Padmanabhan TV, Narayan A. Effect of a palatal lift prosthesis in individuals with velopharyngeal incompetence. Int J Prosthodont 2009; 22 (6) : 579-85. Acta Med. Acad. Aboloyoun A.I. 42 55 2013 10.5644/ama2006-124.71 Aboloyoun AI, Ghorab S, Farooq MU. Palatal lifting prosthesis and velopharyngeal insufficiency: preliminary report. Acta Med Acad 2013; 42 (1) : 55-60. J. Craniofac. Surg. Alfwaress F.S. 28 30 2017 10.1097/SCS.0000000000003167 Alfwaress FS, Bibars AR, Hamasha A, Maaitah EA. Outcomes of palatal lift prosthesis on dysarthric speech. J Craniofac Surg 2017; 28 (1) : 30-5. J. Indian Soc. Pedod. Prev. Dent. Premkumar S. 29 S70 2011 10.4103/0970-4388.90746 Premkumar S. Clinical application of palatal lift appliance in velopharyngeal incompetence. J Indian Soc Pedod Prev Dent 2011; 29 (6) (Suppl. 2) : S70-3. J. Prosthet. Dent. Esposito S.J. 83 90 2000 10.1016/S0022-3913(00)70093-X Esposito SJ, Mitsumoto H, Shanks M. Use of palatal lift and palatal augmentation prostheses to improve dysarthria in patients with amyotrophic lateral sclerosis: a case series. J Prosthet Dent 2000; 83 (1) : 90-8. J. Prosthet. Dent. Mazaheri M. 35 319 1976 10.1016/0022-3913(76)90257-2 Mazaheri M, Mazaheri EH. Prosthodontic aspects of palatal elevation and palatopharyngeal stimulation. J Prosthet Dent 1976; 35 (3) : 319-26. J. Speech Hear. Disord. Hardy J.C. 34 123 1969 10.1044/jshd.3402.123 Hardy JC, Netsell R, Schweiger JW, Morris HL. Management of velopharyngeal dysfunction in cerebral palsy. J Speech Hear Disord 1969; 34 (2) : 123-37. Cleft Palate Craniofac. J. Dalston R.M. 30 285 1993 10.1597/1545-1569(1993)030<0285:NSASAC>2.3.CO;2 Dalston RM, Neiman GS, Gonzalez-Landa G. Nasometric sensitivity and specificity: A cross-dialect and cross-culture study. Cleft Palate Craniofac J 1993; 30 (3) : 285-91. Int. J. Pediatr. Otorhinolaryngol. Hirschberg J. 70 785 2006 10.1016/j.ijporl.2005.09.017 Hirschberg J, Bók S, Juhász M, Trenovszki Z, Votisky P, Hirschberg A. Adaptation of nasometry to Hungarian language and experiences with its clinical application. Int J Pediatr Otorhinolaryngol 2006; 70 (5) : 785-98. Int. J. Lang. Commun. Disord. Sweeney T. 43 265 2008 10.1080/13682820701438177 Sweeney T, Sell D. Relationship between perceptual ratings of nasality and nasometry in children/adolescents with cleft palate and/or velopharyngeal dysfunction. Int J Lang Commun Disord 2008; 43 (3) : 265-82. Cleft Palate Craniofac. J. Brancamp T.U. 47 631 2010 10.1597/09-106 Brancamp TU, Lewis KE, Watterson T. The relationship between nasalance scores and nasality ratings obtained with equal appearing interval and direct magnitude estimation scaling methods. Cleft Palate Craniofac J 2010; 47 (6) : 631-7. Cleft Palate Craniofac. J. Nellis J.L. 29 157 1992 10.1597/1545-1569(1992)029<0157:CONALJ>2.3.CO;2 Nellis JL, Neiman GS, Lehman JA. Comparison of nasometer and listener judgments of nasality in the assessment of velopharyngeal function after pharyngeal flap surgery. Cleft Palate Craniofac J 1992; 29 (2) : 157-63. J. Speech Hear. Res. Seaver E.J. 34 715 1991 10.1044/jshr.3404.715 Seaver EJ, Dalston RM, Leeper HA, Adams LE. A study of nasometric values for normal nasal resonance. J Speech Hear Res 1991; 34 (4) : 715-21. Cleft Palate Craniofac. J. Karnell M.P. 32 145 1995 10.1597/1545-1569(1995)032<0145:NDOHAT>2.3.CO;2 Karnell MP. Nasometric discrimination of hypernasality and turbulent nasal airflow. Cleft Palate Craniofac J 1995; 32 (2) : 145-8. Cleft Palate Craniofac. J. Sweeney T. 41 168 2004 10.1597/02-094 Sweeney T, Sell D, O’Regan M. Nasalance scores for normal-speaking Irish children. Cleft Palate Craniofac J 2004; 41 (2) : 168-74. Stewart KL, Kuebker WA, Eds. S P. Removable partial dentures in maxillofacial prosthodontics. Clinical Partial Removable Prosthodontics. 2nd ed. Portland: Medico Dental Media Int 2005; pp. 651-2.