Speech considerations in prosthodontic rehabilitation of the glossectomy patient

A knowledge of normal articulation is needed before the prosthodontist can assess the compensatory articulation used by glossectomy patients. The amount and portion of tongue resected is directly correlated with speech intelligibility. The loss of the tip of the tongue is more critical to intelligibility than a hemiglossectomy. Partial glossectomy speakers can often use the residual tongue stump to perform adaptive movements that approximate normal movements and should be treated as an articulation problem. The compensatory articulation used by the total glossectomy patient was reviewed. The prosthodontic management of patients with partial tongue resection often includes lowering the palatal vault, while the management of the total glossectomy patient usually requires a mandibular tongue prosthesis. These prostheses can be refined with the use of multiview videofluoroscopy, videotaping, and spectrographic analysis.     

Recovery of postoperative swallowing in patients undergoing partial laryngectomy

This study assessed the achievement of postoperative swallowing in patients undergoing partial laryngectomy surgery. Oropharyngeal swallow efficiency was used to predict time to achievement of outcome. Fifty-five patients were followed for up to 1 year in two hemilaryngectomy and four supraglottic laryngectomy groups. Within 10 days of healing, a videofluoroscopic evaluation enabled the measurement of swallowing efficiency. Times to achievement of oral intake, removal of feeding tube, preoperative diet, and normal swallow were analyzed using actuarial curves. Patients with hemilaryngectomies achieved swallowing rehabilitation sooner than patients with nonextended supraglottic laryngectomies (p < .05) who, in turn, achieved swallowing function sooner than did patients undergoing supraglottic laryngectomies with tongue base resection (p < .05). Median time to attainment of preoperative diet in these three groups was 28 days, 91 days, and > 335 days, respectively. Higher early postoperative oropharyngeal swallow efficiency was related to earlier achievement of oral food intake and of preoperative diet (p < .05). Results show that the time course for swallowing rehabilitation covers an extended postoperative period. In some surgical groups, functional swallowing and eating may be achieved within 3 months of surgery while for other types, significant impairment remains up to 9 months postoperatively. Early radiographic assessments of swallowing function are useful in predicting the time to swallow recovery. Recovery of swallowing ability may be delayed in patients who have not achieved oral intake before radiotherapy is started.     

Oral endoscopy in prosthodontic management of the soft palate defect

Telescopic oral endoscopy is an effective aid in the construction and modification of a speech aid prosthesis. The method is noninvasive and easy to perform, permits the prosthodontist to achieve the goal of functional effectiveness in prosthesis construction while keeping the weight and size of the pharyngeal extension at a minimum, decreases the number and length of patient visits required for modification, and when coupled to a fiberoptic teaching arm or a video camera and recording system, it becomes an excellent aid in teaching, patient education and orientation, and record keeping.     

The Effect of Castration on the Synthesis and Secretion of Proteins in 7,12-Dimethylbenz(a)anthracene-Induced Rat Mammary Tumors

The effect of castration on the incorporation of p⁵S]methionine into secreted proteins in 7,12-dimethylbenz(a)anthracene (DMBA)-induced rat mammary tumors, was investigated. Biopsy specimens were obtained from 19 tumors, 0, 24, 48, 72, and 96 h after castration. In 14 tumors, castration induced an increase in the incorporation (mean of 5-fold), reaching the maximal level after 24 h (3 tumors), 48 h (7 tumors), 72 h (3 tumors), and after 96 h (1 tumor). In three tumors castration did not alter the incorporation rate, while in two tumors incorporation declined immediately after castration. One-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) analysis of the labeled secreted protein showed that castration did not decrease or increase significantly the incorporation of [³⁵S]methionine into any of the major labeled proteins. Conclusion: tumor regression following hormonal deprivation is apparently preceded by an increased synthesis of secreted proteins. However, no qualitative differences in any major labeled proteins could be observed.     

Function of The Eustachian Tube Related to Surgical Management of Acquired Aural Cholesteatoma in Children

A group of 12 children with acquired cholesteatoma had the ventilatory function of the Eustachian tube assessed by the inflation-deflation technique. All had varying degrees of functional rather than mechanical obstruction of the Eustachian tube. In these children, the pathogenesis of acquired cholesteatoma appeared to be the result of the following sequence of events: functional Eustachian tube obstruction, high negative middle ear pressure, atelectasis of the tympanic membrane-middle ear, a retraction pocket in either the posterosuperior or attic portion of the tympanic membrane, and adhesive otitis media. Tympanoplasty in these children was not successful. It is suggested that when the middle ear-mastoidectomy cavity is allowed to remain open, then the bony portion of the Eustachian tube should be surgically closed to prevent postoperative reflux of nasopharyngeal secretions.     

Pretreatment swallowing function in patients with head and neck cancer

BACKGROUND: Few objective data characterizing the pretreatment swallow function of patients with head and neck cancer are available. METHODS: Pretreatment swallowing function in 352 patients with various lesions was evaluated with videofluoroscopy and compared with control subjects. RESULTS: Patients had significantly longer oral and pharyngeal transit times, greater amounts of oral and pharyngeal residue, shorter cricopharyngeal opening durations, and lower swallow efficiencies. Swallow function worsened significantly with increased tumor stage, and patients with oral or pharyngeal lesions had worse swallow function than patients with laryngeal lesions. Frequency of complaint of swallow difficulty before treatment was 59%. Patients with lower stage tumors had fewer complaints of swallowing, as did patients with oral cavity lesions. CONCLUSIONS: Despite demonstrating significant differences from control subjects, patients had highly functional swallows before treatment. The tendency for patients not to perceive a swallowing problem is consistent with the highly functional nature of their pretreatment swallow.     

The role of the health facilitator in community health education

A community health education program has been established by the Department of Community Health Sciences of Duke University Medical Center in two target areas of Durham County, North Carolina. The program trains unpaid lay people, health facilitators, to whom others already turn for help, to increase their competency for advising and referring community residents to appropriate community resources.Several methods for identifying potential health facilitators have been developed. Evaluation of the role of health facilitators hinges upon designing measures to demonstrate their existence in the community and the impact that they make. To be successful, the training of health facilitators should result in improving the quality of the advice they give their fellows. It is also important to assess the cultural acceptability of the facilitators' advice and to ensure that their helping role in the community is not disturbed by the possible professionalization of their role due to the training program.The authors are with the Division of Community Health Models, Department of Community Health Sciences, Duke University Medical Center, Durham, North Carolina 27710. Dr. Salber is Professor, Community Health Sciences, and Director, Community Health Models; Mr. Beery is Associate and Director, Community Health Education Program; and Ms. Jackson is Associate and Health Education Specialist, Community Health Education Program. This study was aided by a grant from the Edna McConnell Clark Foundation. The authors wish to thank Dr. David P. Phillips, Associate Professor of Sociology, University of California at San Diego, for his valuable criticisms and comments and Dr. John Cassel, Professor of Epidemiology at the University of North Carolina, School of Public Health, for his interest in and encouragement of this program.     

The influence of perennial allergic rhinitis on facial type and a pilot study of the effect of allergy management on facial growth patterns

Perennial rhinitis with an allergic component (PRAC) in association with chronic mouthbreathing has been thought to cause skeletal open-bite facial type and narrow transverse facial dimensions. The object of this study was to supply data for this theory and to determine if allergy management would alter the course of facial growth. When a group of children, aged 5 to 10 years, with PRAC was compared with a matched control sample, a significantly larger palatomandibular angle and lower anterior facial height were found for the PRAC group. Transverse cephalometric measurements showed significantly narrower bilateral orbital breadth, bizygomatic, and binasal dimensions (narrower face) of the PRAC patients compared with the control sample. A pilot study of twelve PRAC patients who received 2 1/2 years of allergy management revealed no significant dento-facial dimensional change. This study suggests that PRAC with chronic mouthbreathing can alter the development of the midface. Whether allergy therapy can prevent or change this is as yet uncertain.