Singing Voice Quality: The Effects of Maxillary Dental Arch and Singing Style.

INTRODUCTION: In classical singing techniques, it is common to manipulate the vocal tract to channel airflow to increase voice quality and volume. Technique varies according to the style of the music, the voice type, and range of a given singer. Although these practices are intentional, fixed physiological aspects of a singer's vocal instrument also play an extremely impactful role in determining voice quality. OBJECTIVES: In the present study, the relationship between the dimensions of the maxillary dental arch and voice quality were examined in professional singers. METHODS: The dimensions of the palate were measured from the maxillary dental casts of 14 female singers. Audio recordings were made for the same participants while singing a sustained /a/ singing vowel, a glissando, the song "Are You Sleeping", and a selected song from their personal repertoire. The dimensions of the palate were measured from maxillary dental casts. From the recordings, two parameters were calculated: (1) the Singing Power Ratio (SPR) and (2) A2 A1 ratio. Higher SPR values indicate a stronger ring in the voice, typical of operatic singing style, while higher A2 A1 ratio values are associated with the belting singing style. RESULTS: Singers with larger frontal palate depth, smaller posterior palate depth, larger frontal palate width, and smaller posterior palate width seem to be more suitable for an operatic singing style. Singers who had larger overall depth and width of the palate measurements produced an increased second harmonic, typical of the belting style. CONCLUSIONS: When considering a singer's ability to produce vocalizations successfully, physiological structure is an increasingly important factor. The present study discovered that palate depth and width are associated with statistically significant differences in SPR and A2/A1 parameters. These parameters correlate with two styles of singing, operatic, and belting respectively.

Mandibular pathological fracture during treatment with a dynamic mouth opening device: A clinical report.

Trismus is a well-known complication of head and neck cancer treatment. It is defined as a progressive tonic contraction of the muscles of mastication that results in decreased mouth opening. This condition can lead to impairment of speech and eating, malnutrition, poor oral hygiene, and difficulty with dental treatment. Its prevalence in patients with head and neck cancer ranges from 5% to 38%. Different treatments are available to improve muscle length and function. Mouth opening devices along with exercising of the mandible immediately after surgery and/or radiation therapy have been found to be effective in reducing the trismus induced by cancer therapy. Presently, only limited defined guidelines are available for initiating or monitoring trismus therapy in this patient population. This clinical report presents a patient with head and neck cancer and a history of progressive recurrent trismus as a sequela of extensive surgery and chemoradiation, who experienced a pathological fracture of the mandible during treatment with a mouth opening device.

Factors predictive of severity of osteoradionecrosis of the mandible.

BACKGROUND: An analysis of risk factors predictive of severe mandibular osteoradionecrosis (ORN) is needed to aid prophylaxis and management of this condition. METHODS: We retrospectively analyzed 46 patients diagnosed between June 2002 and March 2009: 93% had mandibular ORN, which was staged 0 to III (Store and Boysen). Patient, tumor, treatment-related, and other variables were analyzed for association with mandibular ORN severity. RESULTS: Oral or oropharyngeal tumors comprised 85% of our primary tumors, 80% were stage IV, and 91% were squamous cell carcinomas. Most patients (87%) received 3-dimensional (3D) conformal radiation therapy (RT), with 60 Gray (Gy) median dose; 28% and 72% received primary and adjuvant RT, respectively; 78% received chemotherapy, mostly concurrent (97%) and platinum-based (96%). Median time to development of ORN was 7.5 months. White ethnicity and secondary infection correlated significantly with stage III mandibular ORN (p = .038, p = .0007, respectively). Advanced age, stage IV, RT dose, post-RT, and lack of pre-RT dental extractions appeared predictive of severe mandibular ORN. CONCLUSIONS: The above-cited factors are predictive of severity and can potentially guide prophylaxis and management.

Prosthodontic treatment considerations for patients with oral sinonasal mucosal malignant melanoma: a clinical report.

Patients with a diagnosis of mucosal malignant melanoma involving the maxilla or paranasal sinuses requiring surgery are referred to the maxillofacial prosthodontist for treatment. The standard protocol of surgical, interim, and definitive obturator treatment is usually anticipated. Depending upon the stage and presence or absence of metastasis, it is generally accepted that the prognosis for cure of this disease is poor. This clinical report reviews the current literature regarding treatment and the overall guarded prognosis for this disease, and reports the prosthodontic treatment intervention for 8 patients. Prosthodontic treatment strategies are recommended that are consistent with the reality of the diagnosis to achieve optimal function and quality of life for these patients.

Prosthodontic treatment during active osteonecrosis related to radiation and bisphosphonate therapy: a clinical report.

Osteonecrosis of the jaws following the use of bisphosphonate drugs has been reported in the literature. Presently, there is limited evidence to establish guidelines for the prosthodontic management of patients with active osteonecrosis, a history of osteonecrosis, or medical history of using these medications. This clinical report reviews the current literature regarding bisphosphonate use, and reports the prosthodontic treatment of an edentulous patient with active osteonecrosis who had a history of oral bisphosphonate use and jaw irradiation.

Adverse oral sequelae to bisphosphonate administration.

Osteonecrosis of the jaws following the administration of bisphosphonate class drugs, both intravenous and oral, has recently been reported in the literature. A case series of five patients is presented. The clinical presentation, management, and proposed etiology of this adverse reaction are reviewed. Recommendations for identifying patients who may be at risk via medical history, present and past medications, specific drugs involved and recommended precautions involving various dental interventions are also discussed.

Velopharyngeal dysfunction: speech characteristics, variable etiologies, evaluation techniques, and differential treatments.

This tutorial addresses the complex pathophysiology; various structural and neurologic causes; methods of clinical appraisal; and alternative behavioral prosthetic, and medicosurgical treatments of velopharyngeal dysfunction. To balance the primary focus of this review on hypernasal resonance and articulation disorders, discussions concerning hyponasal speech characteristics and underlying etiologies are also rendered.

Hybrid gate design frameworks for the rehabilitation of the maxillectomy patient.

A removable partial denture (RPD) for the restoration of maxillary defects must incorporate sound design principles to reduce potential damage to the abutment teeth and supporting periodontal tissue, while enabling acceptable functional levels of speech, mastication, and deglutition. These functional demands and potential stresses on the abutment teeth may exceed those encountered by patients without maxillary defects. This article describes the indications and design considerations for a hybrid gate design framework that incorporates both conventional cast direct retainers and the gate design concept in the same framework.

The efficacy of palatal augmentation prostheses for speech and swallowing in patients undergoing glossectomy: a review of the literature.

This article provides a review of the literature to assist the clinician in determining the efficacy of palatal augmentation prosthesis regarding speech and swallowing for the patient undergoing glossectomy. A MEDLINE search was conducted. Peer-reviewed articles published from 1966 to July 2002 that addressed the question of the efficacy of this prosthesis to improve speech and swallowing after partial or total glossectomy were included. Studies reviewed had to incorporate an objective evaluation of one or both functions. Nine of 130 studies met the selection criteria (4 retrospective, 1 case control, and 4 case reports). A total of 50 subjects were studied, 42 for swallowing and 37 for speech. In 36/42 subjects, treatment was advantageous for swallowing and in 32/37 subjects, it was advantageous for speech. On the basis of the limited evidence available, the functional efficacy of the palatal augmentation prosthesis is supported.

Malignant ameloblastoma, spindle cell variant.

In this report, we document the histologic and clinical features of a previously undefined spindle cell variant of ameloblastoma that eventually behaved in a malignant fashion during a protracted course. The predominant histologic pattern was a well-differentiated, cellular, spindled epithelial proliferation arising in the maxilla of a 14-year-old African American girl. Over 19 years, the patient experienced numerous local recurrences, metastases to distant bones after 15 years, and finally bulky local recurrence with intracranial extension resulting in death. This ameloblastic malignancy histologically simulates a low-grade true sarcoma or an ameloblastic sarcoma, but differs in that the extensive spindle cell proliferation is epithelial, characterized by strong cytokeratin immunoreactivity and negative vimentin staining.