ABSTRACT
ABSTRACT Objective Since the tongue is the oral structure responsible for mastication, pronunciation, and swallowing functions, patients who undergo glossectomy can be affected in various aspects of these functions. The vowel /i/ uses the tongue shape, whereas /u/ uses tongue and lip shapes. The purpose of this study is to investigate the morphological changes of the tongue and the adaptation of pronunciation using cine MRI for speech of patients who undergo glossectomy. Material and Methods Twenty-three controls (11 males and 12 females) and 13 patients (eight males and five females) volunteered to participate in the experiment. The patients underwent glossectomy surgery for T1 or T2 lateral lingual tumors. The speech tasks “a souk” and “a geese” were spoken by all subjects providing data for the vowels /u/ and /i/. Cine MRI and speech acoustics were recorded and measured to compare the changes in the tongue with vowel acoustics after surgery. 2D measurements were made of the interlip distance, tongue-palate distance, tongue position (anterior-posterior and superior-inferior), tongue height on the left and right sides, and pharynx size. Vowel formants Fl, F2, and F3 were measured. Results The patients had significantly lower F2/Fl ratios (F=5.911, p=0.018), and lower F3/F1 ratios that approached significance. This was seen primarily in the /u/ data. Patients had flatter tongue shapes than controls with a greater effect seen in /u/ than /i/. Conclusion The patients showed complex adaptation motion in order to preserve the acoustic integrity of the vowels, and the tongue modified cavity size relationships to maintain the value of the formant frequencies.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pharynx/pathology , Speech/physiology , Tongue/physiopathology , Tongue/pathology , Glossectomy/rehabilitation , Pharynx/physiopathology , Postoperative Period , Reference Values , Speech Acoustics , Tongue Neoplasms/surgery , Tongue Neoplasms/physiopathology , Tongue Neoplasms/pathology , Case-Control Studies , Retrospective Studies , Analysis of Variance , Treatment Outcome , Magnetic Resonance Imaging, Cine , Anatomic Landmarks , Neoplasm StagingABSTRACT
O tratamento primário do câncer de cavidade oral consta de cirurgia e/ou radioterapia manifestando sequelas de fala e de deglutiçäo em graus variados. O comprometimento da inteligibilidade de fala geralmente está à extensäo da remoçäo da língua, à localizaçäo e aspecto do retalho e à habilidade de movimentaçäo da porçäo remanescente. A proposta deste traalho é avaliar a inteligibilidade de fala após as glossectomias parciais e totais no início e término da reabilitaçäo fonoaudiológica. Foram avaliados 10 pacientes glossectomizados - 6 parciais e 4 totais - após a cirurgia, e destes, 4 pacientes - 2 parciais e 2 totais - foram avaliados pré e pós-terapia. Os pacientes foram submetidos a uma gravaçäo de um protocolo constando de 14 emissöes vogal/consoante/vogal. As emissöes foram editadas aleatoriamente e analisadas por 61 estudantes de Fonoaudiologia. Nas glossectomias parciais, na fase pré-terapia observou-se uma variaçäo entre 15,71 (por cento) e 66,33 (por cento) de emissöes inteligíveis e nas totais entre 25,64 (por cento) e 35,83 (por cento). No término de 2 meses de terapia observou-se uma porcentagem de melhora de 12,17(por cento) e 6,01(por cento) nos dois casos de glossectomias parciais avaliados e de 10,78(por cento) e 22,08(por cento) nos casos de glossectomias totais, sendo que o melhor resultado foi o de uma criança de 10 anos. O trabalho demonstra a efetividade da intervençäo fonoaudiológica na melhora da inteligibilidade de fala de pacientes glossectomizados