Movimentos mandibulares durante a fala após tratamento do câncer de cavidade oral e orofaringe / Mandibular movements during speech after oral and oropharyngeal cancer treatment

Introdução: Alterações na fala após tratamento do câncer de cavidade oral e orofaringe podem estar relacionadas ao comprometimento dos movimentos mandibulares. Contudo, os parâmetros quantitativos desses movimentos ainda são desconhecidos nessa população. Objetivo: Descrever a amplitude, simetria e velocidade dos movimentos mandibulares durante a fala após tratamento do câncer de cavidade oral e orofaringe. Metodologia: Estudo de corte transversal, no qual pacientes submetidos a tratamento de câncer de cavidade oral e orofaringe no Hospital de Câncer de Pernambuco foram convocados para triagem no período de março de 2016 a maio de 2018. Os pacientes elegíveis compareceram ao Laboratório de Pesquisa de Patofisiologia do Sistema Estomatognático, da Universidade Federal de Pernambuco, para obtenção das medidas de movimentos mandibulares (amplitude vertical no plano frontal e sagital, simetria em lateralidade para esquerda e direita, velocidade de abertura e fechamento) através do exame de eletrognatografia e responderam a versão em português brasileiro do Índice de Desvantagem de Fala (IDF). Os dados foram analisados de forma descritiva e para verificar a diferença de médias entre as categorias das variáveis independentes foram aplicados os testes U de Mann-Whitney e Kruskal-Wallis. Para o cruzamento entre variáveis quantitativas foi aplicado o teste de correlação de Spearman. O nível de significância foi de 5%. Resultados: Foram incluídos 32 indivíduos com idade entre 33 e 70 anos (média de 55,44±10,04 anos), sendo a maioria do sexo masculino (78,1%). Os valores médios de amplitude vertical no plano frontal (6,69±3,74 mm) e sagital (8,62±4,90 mm) simetria em lateralidade para esquerda (0,32±0,41 mm), velocidade de abertura (70,69±45,03 mm/seg.) e fechamento (69,34±53,63 mm/seg.) ficaram abaixo dos valores de referência para normalidade. As variáveis que apresentaram relação significativa (p<0,05) com medidas de movimentos mandibulares foram idade, tamanho do tumor, história de tabagismo, queixa de mucosite, queixa de alteração gustativa, queixa de redução da abertura de boca, trismo e queixa de estalos na ATM ao abrir a boca. Houve elevada proporção de auto-avaliação negativa da fala (47%) e de desvantagem de fala no dia a dia (75%), porém sem relação significativa com as medidas dos movimentos mandibulares. Nenhum dos escores do IDF se correlacionou com as medidas de movimentos mandibulares. Na análise individual dos itens do IDF, pacientes que referiram dificuldades para serem compreendidos pelas pessoas tiveram menor simetria lateral à esquerda (p=0,03) e os que relataram não ter dicção clara tiveram menor velocidade de abertura (p=0,03) e fechamento (p=0,01) mandibular. Conclusão: Pacientes tratados do câncer de cavidade oral e orofaringe apresentammedidas de amplitude, velocidade e simetria mandibulares, em sua maioria, mais baixas que os valores de referência para normalidade; existe relação entre as medidas de movimentos mandibulares e variáveis sócio-demográficas e clínicas; os desfechos do IDF não se relacionam com as medidas de movimentos mandibulares investigadas neste estudo, porém, há relação entre algumas dessas medidas e aspectos de desvantagem na inteligibilidade de fala (AU)

Introduction: Speech disorders after oral and oropharyngeal cancer treatment may be related to impairment of mandibular movements. However, the quantitative parameters of these movements are still unknown in this population. Objective: To describe the amplitude, symmetry and speed of mandibular movements during speechafter oral and oropharyngeal cancer treatment. Methods:A cross-sectional study in which patients submitted to oral and oropharyngeal cancer treatment at the Hospital de Câncer de Pernambuco were screened in the period from March 2016 to May 2018. The eligible patients attended the Pathophysiology of the Stomatognathic System Research Laboratory, Federal University of Pernambuco, to obtain measures of mandibular movements (vertical amplitude in the frontal and sagittal plane, lateral symmetry for the left andright, opening and closing velocity) through the electrognatography examination and answered the Brazilian Portuguese version of the Speech Handicap Index (SHI). The data were analyzed in a descriptive way and the U Mann-Whitney and Kruskal-Wallis tests were applied to verify the mean difference between categories of the independent variables. The level of significance was 5%. Results: Thirty-two individuals aged 33-70 years (mean of 55.44 ± 10.04 years) were included, the majority being male (78.1%). The mean values of vertical amplitude in the frontal plane (6.69 ± 3.74 mm) and sagittal (8.62 ± 4.90 mm), lateral symmetry to the left (0.32 ± 0.41 mm), opening velocity (70.69 ± 45.03 mm / sec) and closing velocity (69.34 ± 53.63 mm / sec) were below the standardreferencefor normality. Significant related variables (p <0.05) with measures of mandibular movements were age, tumor size, history of smoking, mucositis complaint, gustatory impairment, complaint of reduction of mouth opening, trismus and complaint of cracking in the ATM when opening the mouth. There was a high proportion of negative speech self-assessment (47%) and speech handicap in a daily life (75%), but no significant relation with mandibular movements. None of the SHI scores correlated with measures of mandibular movement. In the individual analysis of the SHI items, patients who reported difficulties to understand the patients had less lateral symmetry to the left (p = 0.03) and those who reported not having clear diction had lower opening velocity (p = 0.03) and mandibular closure (p = 0.01). Conclusion: Patients treated for oral and oropharynx cancer have lower measures of amplitude, velocity and mandibular symmetry than the standard reference for normality; there is a relationship between mandibular movement measurements and sociodemographic and clinical variables;the SHI outcomes are not related to the measures of mandibular movements investigated in this study, however, there is a relation between some of these measures and handicap aspects associated with speech intelligibility (AU)

Autoavaliação de aspectos respiratórios e vocais após uso do umidificador de traqueostomia em laringectomizados totais / Breathing and voice self-assessments after the use of a heat and moisture exchange in total laryngectomyzed patients

RESUMO Introdução O umidificador de traqueostomia é um dispositivo permutador de calor e umidade que pode interferir nas condições respiratórias e vocais de laringectomizados totais. Objetivo Verificar a autoavaliação de aspectos respiratórios e vocais antes e após o uso do umidificador de traqueostomia, em pacientes submetidos à laringectomia total. Métodos A amostra foi composta por 15 indivíduos acompanhados no serviço de Fonoaudiologia de um hospital oncológico, sendo uma mulher e 14 homens, com idade entre 49 e 76 anos, submetidos à laringectomia total. Foi aplicado um questionário de autoavaliação, relacionado a aspectos respiratórios e vocais antes e após o uso do umidificador de traqueostomia, durante duas semanas. Resultados Permaneceram no estudo 13 indivíduos que referiram melhora da tosse, diminuição do acúmulo de secreção e melhor qualidade respiratória e de voz esofágica, após uso do umidificador de traqueostomia. Conclusão Pacientes laringectomizados totais perceberam melhora na autoavaliação de aspectos respiratórios e vocais após duas semanas de uso do umidificador de traqueostomia.

ABSTRACT Introduction A heat and moisture exchange device could modify respiratory and vocal conditions in patients who received a total laryngectomy. Purpose To verify breathing and voice self-assessments before and after the use of a heat and moisture exchange device in patients who had received a total laryngectomy. Methods The sample included 15 subjects of the Speech Therapy department of a cancer hospital; subjects included 1 woman and 14 men aged 49 to 76 years who had undergone a total laryngectomy. Patients completed a self-assessment questionnaire about breathing and voice before and after two weeks of use of a heat and moisture exchange device. Results Thirteen individuals completed the study and reported improvement in cough, secretion accumulation, sleep, breathing, and esophageal voice after use of a heat and moisture exchange device. Conclusion Patients who had received a total laryngectomy perceived improvements in breathing and voice after two weeks of the use of a heat and moisture exchange device, as measured by self-assessment.

Quality of life and deglutition after total laryngectomy

Introduction: Total laryngectomy creates deglutition disorders and causes a decrease in quality of life Aim: To describe the impact of swallowing and quality of life of patients after total laryngectomy. Method: A case series study. Patients completed a Swallowing and Quality of Life questionnaire composed of 44 questions assessing 11 domains related to quality of life (burden, eating duration, eating desire, frequency of symptoms, food selection, communication, fear, mental health, social functioning, sleep, and fatigue). The analysis was performed using descriptive statistics, including measures of central tendency and variability. Results: The sample comprised 15 patients who underwent total laryngectomy and adjuvant radiotherapy. Of these, 66.7% classified their health as good and 73% reported no restrictions on food consistency. The domains "communication" and "fear" represented severe impact and "eating duration" represented moderate impact on quality of life. The items with lower scores were: longer time to eat than others (domain "eating duration"), cough and cough to remove the liquid or food of the mouth when they are stopped (domain "symptom frequency"), difficulties in understanding (domain "communication") and fear of choking and having pneumonia (domain "fear"). Conclusion: After total laryngectomy, patients report that swallowing issues have moderate to severe impact in "communication," "fear," and "eating duration" domains...

Quality of life and deglutition after total laryngectomy.

INTRODUCTION: Total laryngectomy creates deglutition disorders and causes a decrease in quality of life Aim: To describe the impact of swallowing and quality of life of patients after total laryngectomy. METHOD: A case series study. Patients completed a Swallowing and Quality of Life questionnaire composed of 44 questions assessing 11 domains related to quality of life (burden, eating duration, eating desire, frequency of symptoms, food selection, communication, fear, mental health, social functioning, sleep, and fatigue). The analysis was performed using descriptive statistics, including measures of central tendency and variability. RESULTS: The sample comprised 15 patients who underwent total laryngectomy and adjuvant radiotherapy. Of these, 66.7% classified their health as good and 73% reported no restrictions on food consistency. The domains "communication" and "fear" represented severe impact and "eating duration" represented moderate impact on quality of life. The items with lower scores were: longer time to eat than others (domain "eating duration"), cough and cough to remove the liquid or food of the mouth when they are stopped (domain "symptom frequency"), difficulties in understanding (domain "communication") and fear of choking and having pneumonia (domain "fear"). CONCLUSION: After total laryngectomy, patients report that swallowing issues have moderate to severe impact in "communication," "fear," and "eating duration" domains.