Chua HD, Whitehill TL, Samman N, Cheung LK. Maxillary distraction versus orthognathic surgery in cleft lip and palate patients: effects on speech and velopharyngeal function. Int J Oral Maxillofac Surg. 2010 Jul;39(7):633-40.
This article which is at http://www.sciencedirect.com/science/article/pii/S0901502710001050 contains text directly copied and/or closely paraphrased from a Master's thesis submitted by Dr. Nattharee Chanchareonsook to the University of Hong Kong in 2004 titled "Speech outcome and velopharyngeal function in Cantonese cleft patients : comparison of le fort I maxillary osteotomy and distraction osteogenesis: a pilot study". Following my complaint to the VC this thesis which was previously available for downloading at http://hub.hku.hk/bitstream/10722/40700/1/FullText.pdf has been blocked.
Nevertheless a side by side comparison of these documents reveals the amount of similarity. Please note that Dr. Chanchareonsook's dissertation has not been cited in this article.
All patients underwent a nasoendoscopy examination preoperatively and at 3, 12 and 24 months postoperatively to determine their velopharyngeal status.
|
Part II -Page 8
|
All subjects enrolled in the study received nasoendoscopy examination preoperatively and at 3 months postoperatively to determine their velopharyngeal status.
|
All patients were examined using a flexible nasoendoscope (Kay Rhino-Laryngeal Stroboscope RLS 9100B, KayPentax, Lincoln Park, NJ; Olympus ENF type P-4, Olympus America Inc., Melville, NY) (Fig. 10a).
|
Part II- Page 8
|
All patients were examined with a flexible nasoendoscope (Rhino-Laryngeal Stroboscope RLS 9100B KAY (Figure B), Olympus ENF type P-4 (Figure C).
|
The scope was connected to a cold light supply to allow visualization.
|
Part II-Page 8
|
The scope is connected to a cold light supply to allow visualization..............
|
The image obtained from the scope was visualized on a colored monitor.....
|
Part II-Page 8
|
The image obtained from the scope was visualized on a color monitor..........
|
......patients were asked to sit with their heads extended and tilted backward about 15 degrees .......
|
Part II-Page 9
|
.....patients were placed in a sitting position and their heads were extended about 15 degrees .......
|
Topical anaesthesia using 4% cocaine was sprayed into the nasal cavity in order to maximize patient comfort and cooperation and to diminish secretion. The nasoendoscopy was performed using the same nostril in each subject at the preoperative and postoperative examinations
|
Part II-Page 9
|
Topical anesthesia using 4% Cocaine spray was used to maximize patient comfort and cooperation and minimize secretions. The nasoendoscopy was performed using the same nostril in each subject at the preoperative and postoperative examinations
|
The boundary of the velopharyngeal orifice is defined by the posterior border of the soft palate (velum), left and right lateral pharyngeal walls and the posterior pharyngeal wall.
|
Part II-Page 9
|
Velopharyngeal orifice boundaries (the velum posterior border and velar point, left and right lateral pharyngeal walls and the posterior pharyngeal wall).............
|
The 'Cantonese Nasendoscopy Speech Protocol', developed by Whitehill23 was used. The protocol asks patients to pronounce their name, age, count from 1 to 20, and requires sustained production of two vowels, consonant-vowel repetitions (e.g. 'pa pa pa', 'ti ti ti'), sustained/s/, sentences loaded with plosives, fricatives and nasals, and non-speech activities such as blowing, whistling and swallowing.
|
Part II-Page 8 & 9
|
The 'Cantonese Nasoendoscopy Speech Protocol' which was developed by T. Whitehill of the Department of Speech & Hearing Sciences, University of Hong Kong (January 2000) was used in this examination. The protocol includes the client's name, age, counting from 1 to 20, sustained vowel products, consonant vowel (CV) repetitions, sustained /s/, connected speech (sentence repetition) and non-speech activities such as blowing and whistling.
|
Each speech assessment took about 3-5 min.
|
Part II-Page 8
|
Each assessment took 3-5 minutes to complete.
|
For patients presenting with pharyngeal flap, both pharyngeal orifices were included in the assessment so that all borders could be seen in a single view. Each portal was also examined individually.
|
Part II-Page 9
|
For patients presenting with pharyngeal flap, both pharyngeal orifices were included so that all borders could be seen in a single view. Each portal was also examined individually.
|
The clinical nasoendoscopy findings were evaluated on completion of each examination and the diagnosis was noted in the clinical record. This included: classification of VF (adequate closure, borderline competence, mild, moderate or severe incompetence), the consistency of the VF.....
|
Part II-Page 9
|
The clinical nasoendoscopy data was analyzed by both investigators upon completion of each examination and a judgment noted in the clinical record, including classification of velopharyngeal function (adequate velopharyngeal function, borderline competence, mild, moderate or severe VPI). The consistency of velopharyngeal function was also noted.
|
all the nasoendoscopy data were retrieved and transferred to a mini-digital video tape (Sony Corporation, Tokyo, Japan) by a technician not involved in the study.
|
Part II-Page 10
|
All nasoendoscopic data were transferred randomly to compact discs by a technician not associated with the study.
|
The videos were randomized across groups (CO and DO) and the time of evaluation (preoperative and postoperative) ....
|
Part II-Page 10
|
The digital samples were randomized across groups (conventional osteotomy and distraction), patients and time of evaluation (preoperatively or postoperatively).
|
The analysis design was a randomized blind evaluation of the velopharyngeal gap closure.
|
Part II-Page 10
|
The analysis thus entailed a randomized blind estimation of the velopharyngeal gap closure.
|
If the pattern of velopharyngeal closure was inconsistent, the maximum velopharyngeal closure during the entire protocol was used to represent the
final rating. |
Part II-Page 10
|
If the pattern of velopharyngeal closure was inconsistent, the maximum velopharyngeal closure during the entire protocol was used to represent the final rating.
|
During each session, an experienced speech-language pathologist examined each patient to evaluate resonance (hypernasality and hyponasality) nasal emission, and articulation.
|
Part II-Page 12
|
During each session, an experienced speech language pathologist (a doctoral student) assessed the patient for hypernasality, nasal emission, and articulation.
|
The speech examination was conducted in a quiet room.
|
Part II-Page 12
|
The examination was conducted in a quiet room.
|
Speech samples were recorded using a Sony TCD-D3 Digital (DAT) tape recorder.
A Sony ECM-909 microphone was used, with a mouth to microphone distance maintained at approximately 10 cm.
|
Part II-Page 12
|
Speech samples were recorded using a Sony TCD-D3 Digital (DAT) tape recorder.
A Sony ECM-909 microphone was used and a mouth to microphone distance of 10 cm was maintained.
|
The audiorecordings were re-named as numbers, randomized (across surgical groups and time of evaluation)....
|
Part II-Page 10
|
The digital samples were randomized across groups (conventional osteotomy and distraction), patients and time of evaluation (preoperatively or postoperatively).
|
Nasality was assessed using a Nasometer (Kay Elemetrics, Model 6200, KayPENTAX, New Jersey, USA).
The Nasometer was calibrated according to the manufacturer's instructions, and the headset device was adjusted by the speech language pathologist ....
|
Part II-Page 15
|
Key Elemetrics Model 6200 Nasometer (Figure F) was used for data collection.
The Nasometer was calibrated, and the headgear was adjusted by the examiner, a qualified speech language pathologist, according to the manufacturer's instructions.
|
Calibration was made before the assessment of each subject. Each patient read an oral passage aloud23, which contained no nasal phonemes. If an error occurred during reading, the subject was asked to repeat the test.
|
Part II-Page 15
|
The calibration was made before assessment in each subject. Subjects read the speech stimuli aloud. If an error occurred during reading, the subject was asked to repeat the stimulus.
|
The mean percentage nasalance was calculated for each patient at each time period.
Previous studies have recommended various cut-off points for nasalance values such as 32%6 and 26%9.
In this study, a nasalance value higher than 30% was considered to be indicative of hypernasality23.
A 2-point nasalance scale was thus derived, where 1 is above/outside normal limits (nasalance above 30%), 0 iswithin normal limits (30% nasalance or below).
|
Part II-Page 16
|
The mean percentage nasalance was collected for each speaker.
The previous studies reported the cutoff point nasalance values; for example 32% (Dalston et al, 1991) and 26% (Hardin et al., 1992.
Based on the average of these two values, nasalance values higher than 30%, were considered to be suggestive of increased hypernasality.
A 2-point nasalance scale was thus derived, 1= Hypernasality (nasalance above 30%), 0= No hypernasality (30% nasalance or below).
|
The nasoendoscopy results were further classified into patients who showed an improvement, no change, and deterioration in velopharyngeal status according to the types of surgery
An exact χ2 test showed no significant difference between the number of subjects who showed 'improvement', 'deterioration', and 'no change' in their velopharyngeal status between the two types of surgery .....
|
Part II- Page 21
|
The nasoendoscopy results were classified into subjects who showed an improvement in velopharyngeal status, subjects who showed no change, and those who showed deterioration in velopharyngeal status.
An Exact Chi-square test showed no significant difference between number of subjects who showed ''improvement'', "deterioration", and ''no change" of the velopharyngeal status between the 2 types of surgery.
|
Patients were classified into those who 'deteriorated', 'improved' or had 'no change'.
A χ2 test showed no significant difference between number of patients who showed 'improvement', 'deterioration' and 'no change' of velopharyngeal status between the two types of surgery
|
Part II- Page 21
|
......were classified into subjects who showed an improvement in velopharyngeal status, subjects who showed no change, and those who showed deterioration in velopharyngeal status.
An Exact Chi-square test showed no significant difference between number of subjects who showed ''improvement'', "deterioration", and ''no change" of the velopharyngeal status between the 2 types of surgery.
|
Table 1- even though the authors have cited one of Dr. Chanchareonsook's past publications in the table title, they need to get copyright clearance from the publisher when reproducing a table (A simple citation alone may not be sufficient).
|
Part II-Page 40
|
Identical to Table 1
|
Table 2
|
Part II-Page 41
|
Identical to Table 2
|
No comments:
Post a Comment