• 음성과학
• /
• 제7권2호
• /
• pp.19-35
• /
• 2000

Speech evaluation and treatment planning for the patients with articulation disorders have traditionally been based on perceptual judgement by speech pathologists. Recently, various computerized speech analysis systems have been developed and commonly used in clinical settings to obtain the objective and quantitative data and specific treatment strategies. 10 dysarthric children (6 neurogenic and 4 functional dysarthria) participated in this experiment. Speech evaluation of dysarthria was performed in two ways; first, the acoustic analysis by Visi-Pitch and a Computerized Speech Lab and second, the perceptual scoring of phonetic errors rates in 100 word test. The results of the initial evaluation served as primary guidlines for the indivisualized treatment planning of each patient's speech problems. After mean treatment period of 5 months, the follow-up data of both dysarthric groups showed increased maximum phonation time, increased alternative motion rate and decreased occurrence of articulatory deviation. The changes of acoustic data and therapeutic effects were more prominent in children with dysarthria due to neurologic causes than with functional dysarthria. Three cases including their pre- and post treatment data were illustrated in detail.

• Archives of Plastic Surgery
• /
• 제34권3호
• /
• pp.330-335
• /
• 2007

Purpose: The purpose of this study is to evaluate the functional outcome and donor site morbidity of anterolateral thigh free flap(ALT) compared to Radial forearm free flap(RFFF) for the reconstruction of partial glossectomy defect. Methods: 5 ALT free flap (group I) were attempted for partial glossectomy patients. We compared patients undergone ALT flap with those(n=11) of similar size defect reconstructed with RFFF (Group II). Rating scales for articulation and swallowing function were applied and donor site morbidity have been evaluated. Results: The scales for speech function showed no difference between the two groups (average score; group I - 6.4, group II - 6.45). Swallowing function also showed no difference between the two groups(average score; Group I - 6.6, Group II - 6.27). ALT group had one patient with donor site morbidity(numbness). All of the RFFF patients(11/11) complained and suffered from hypertrophic scar, retraction, numbness or hyperpigmentation on forearm donor site. Based on our study, ALT free flap is comparable to that of RFFF in terms of functional assessment in tongue reconstruction. Conclusion: Considering the donor site morbidity, ALT flap is to be valuable to reconstruct partial glossectomy defect.

• 대한두경부종양학회지
• /
• 제25권2호
• /
• pp.119-122
• /
• 2009

Objectives : Ablation of carcinoma of the tongue leads to deficits in speech and swallowing, but none to date has provided all of the qualities of mobility and sensation to simulate the complex function of the tongue. The authors evaluated postoperative swallowing and pronouncing function in patients who underwent tongue reconstruction using free flap. Material and Methods : This is a retrospective review documenting the outcome of 42 patients between January of 1991 and August of 2008. We classified patients according to the size of resection of the tongue like as 7 partial glossectomy, 25 hemiglossectomy, 2 subtotal glossectomy, and 8 total glossectomy. Swallowing function was graded into 4 point scale and pronouncing function was analyzed using picture consonant articulation test. Aspiration was evaluated with videofluoroscopic swallowing study. Results : The average points for swallowing function were 3.43 in partial glossectomy, 3.52 in hemiglossectomy, 3 in subtotal glossectomy, and 2.63 in total glossectomy. The percentage of consonants correct showed 76.5% in partial glossectomy, 72.29% in hemiglossectomy, 47.69% in subtotal glossectomy, and 29.94% in total glossectomy. Aspiration was noted in 3 patients(1 hemiglossectomy and 2 total glossectomy) and 2 total glossectomy patients were taken permanent feeding gastrostomy. Conclusion : Free flap gave us proper volume in tongue reconstruction and showed good result in preserving swallowing function. Swallowing function difference according to the size of defect showed no statistical significance, whereas articulation function was shown to decrease in accuracy as the size of defect was larger.

• 대한치과의사협회지
• /
• 제15권5호
• /
• pp.359-364
• /
• 1977

Orthognathic surgery, ie, the surgical correction of congenital and acquaired anormalities of the jaws, is currently a field of vigorous activity among oral surgeons. Surgical correction of maxillofacial deformities benefits the patient both psychologically and functionally. Facial mutilation may precipitate adverse psychologic effects. Function is frequently impaired by malrelation of the jaws. In addition, speech, specifically articulation, is often handicapped in patient with severe jaw deformities. Therefore, in dealing with these patient, above mentioned problem should be considered deliberately. In this regard, the authors have treated 2 cases of mandible defect caused by gunshot and explosives with iliac bone graft. In both cases, the patient had Tantalum plate on defect area. But it became lose and gave functional disturbances. So, the authors have removed Tantalum plate and performed bone transplantation with autogenous soild iliac bone graft on that area with good results.

• 대한두경부종양학회:학술대회논문집
• /
• 대한두경부종양학회 2007년도 춘계학술대회 논문집
• /
• pp.80-84
• /
• 2007

Background and Objectives : The radial forearm free flap is a useful reconstructive method of surgical defects after oral and oropharyngeal tumor resection. We evaluated the swallowing and speech outcomes of radial forearm free flap reconstruction for oral and oropharyngeal cancers. Materials and Methods : We retrospectively reviewed clinical data of 84 patients who underwent reconstructive surgery for oral or oropharyngeal cancer using radial forearm free flap from August 1994 to January 2007. Modified barium swallowing (MBS) was done in 100 patients and speech-language assessment was done in 23 patients by a speech-language pathologist. Results were analyzed according to the swallowing functions and the speech-language assessments. Results : According to the results of MBS which was done postoperatively, aspiration occurred in three patients and velopharyngeal insufficiency occurred in four patients who had been reconstructed with multilobed free flap due to large mucosal defects. There was one patient who exhibited severe articulation impairment out of 23 patients. However, 19 patients out of 23 patients showed excellent intelligibility in speech. Conclusion : We concluded that the radial forearm free flap technique is an excellent reconstructive method for the restoration of palatal and pharyngeal function in oral and oropharyngeal cancer patients.

• 동의생리병리학회지
• /
• 제18권6호
• /
• pp.1585-1597
• /
• 2004

Facial palsy is a common disease in clinic, which can be classified into central and peripheral according to the causes. The central facial palsy is caused by cerebral vascular accident, brain tumor, etc. The peripheral facial palsy comes from cold stimulus on face, regional infection of virus, suppurative tympanitis, inflammation on mastoid process, pathological teeth, trauma like cranial fracture, and so forth, They have distinctive features in diagnosis. While the central facial palsy is followed by hemiplegia and articulation disorder, the peripheral one by the disappearance of wrinkles on the forehead and rising of eyeball on paralyzed side when closing the eyes. Most of the cases in this thesis are peripheral palsy. The social classes and ages of the patients are so various that the treatments must be applied from various standpoints. The statistical data shows that the functional weakness of the whole body is the fundamental condition of the facial palsy. Therefore it is very important to find and the exact pathology and treatment appropriate for Hyungsang of the patients.

• 대한기관식도과학회:학술대회논문집
• /
• 대한기관식도과학회 1982년도 제16차 학술대회연제순서 및 초록
• /
• pp.16.1-16
• /
• 1982

구순은 음식이 구강을 통과하는데 뿐만 아니라 음절을 구성 하는데도 중요한 역할을 한다. 구순을 이루고 있는 Orbicularis oris 근육이 괄약근으로 작용하여 강한 수축을 하여야 구순의 완전한 폐쇄를 이룰수 있고 구순의 모양을 형성할 수 있게 된다. 또 이 Orbicularis oris근육이 유지되기 위해서는 Orbicularis oris 근육주위의 여러 근육들이 서로 길항 혹은 협력할수 있어야만 한다. 구순재건술의 관점에서 가장 중요한 것은 안면신경과 혈관은 보존하면서도 괄약작용에 손실없이 주위근육으로부터 Orbicularis oris 근육을 분리할 수 있어야 한다는 것이다. 저자들은 교상으로 인하여 하구순 결손 환자에서 구순재건술을 시행하여 그 기능과 미용에 있어서 좋은 결과를 얻었으므로 문헌과 함께 보고하는 바이다.

• 말소리와 음성과학
• /
• 제10권4호
• /
• pp.163-171
• /
• 2018

A mixed dysarthria with combinations of hypokinetic, ataxic, and spastic components is a common clinical feature of multiple system atrophy (MSA). Due to the rapid progress of dysarthria after diagnosis, people with MSA experience difficulty with verbal communication, which eventually affects their quality of life negatively. In this study, SPEAK $OUT!^{(R)}$, an intensive 1:1 treatment of dysarthria for improving functional communicative ability, was provided to twelve people with MSA. To evaluate the efficacy of SPEAK $OUT!^{(R)}$ in people with MSA, aerodynamic, acoustic, and perceptual analyses were conducted. Pre-and post-therapy data included maximum phonation time, vocal intensity, and fundamental frequency during /a/ sustained phonation and passage reading; frequency range between high /a/ and low /a/ phonation; jitter, shimmer, and HNR for vocal quality; speech rate during passage reading; and perceptual evaluation scores for articulation precision and intonation. The participants achieved statistically significant improvement in vocal intensity, pitch range, vocal quality, speech rate, and speech intelligibility. In conclusion, SPEAK $OUT!^{(R)}$ is a feasible treatment for people with MSA to efficaciously improve their speech ability.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제22권2호
• /
• pp.191-205
• /
• 2000

The purpose of this study was undertaken to determine the effects of orthognathic surgery on speech. The hyposis stated herein is that functional behaviors of the dentofacial complex, such as speech production, may be adversely affected by deviations of a structural nature(especially, Class III malocclusion). Twenty adults with Class III malocclusion(13 female and 7 male) were studied preoperative, immediate postoperative and either 6 or 12 months postoperative lateral cephalograms. They had mandibular prognathism and had undergone mandible setback operation. The position of tongue, soft palate(Uvula), hyoid bone, respiratory track width, and pharyngeal depth were assessed on lateral cephalograms with 23 cephalometric variables, ANOVA, Paired t-tests and Pearson's product-moment correlation coefficient tests were used to evalute the operative changes in all cephalometric parameters. A experienced speech and language pathologists performed narrow phonetic transcriptions of tape-recorded words and sentences produced by each of the ninth patients and the recording tapes were analyzed by phonetic computer program(Computerized Speech Lab(CSL) Model 4300BI(U.S.A.)) These judges also recorded their ratings of each patient's overall consonants, hypernasality, hyponasality, and articulation proficiency. The results obtained are as follows; 1. There were significant changes in distance of posterior pharyngeal wall to tongue (TI-TW2, TS-TW3) after the surgery at 6 months postoperatively(each p<0.01 p<0.05). 2. The posterior tongue point(TI, TS, PPT) moved posteriorly after surgery and remained to its changed position at 6 months postoperatively(p<0.05). The displacement of tongue was correlated with the movement of mandibular setback amount(p<0.05). The hyoid bone moved posteriorly superiorly after immediate postoperative period. There was significant changes in hyoid bone movement after immediated postoperative period(p<0.05), but returned to its original position during the follow-up period(p>0.05) 3. The soft palate was displaced posteriorly superiorly after immediated operative period and remained to its changed position at 6 months postoperatively(p<0.05). ANS-PNS-SPT angle increasing, PPU-PPPo distance narrowing was showed after surgery, and remained its appearance 6 months postoperatively(p<0.05). 4. There were significant changes in formant value and squre diagram of vowel sound after the orthognathic surgery and the follow-up period. There were significant changes in /ㅅ/sound and posterior tongue sound. 5. The posterior movement of tongue and the posteriosuperior movement of soft palate was correlated with mandibular setback amount after orthognathic surgery. On the vowel squre diagram, the author found that the place of articulation after operation moved downward, backward, upward. 6. In assessing speech abnormalities, dental occlusion should be considered as a contributing factor. The vast majority of subjects with preoperative misarticulations eliminated or reduced their errors following orthognathic surgery. There was significant difference in speech impovement between pre- and postoperation.

• 대한기관식도과학회지
• /
• 제5권2호
• /
• pp.191-197
• /
• 1999

Background and Objective : Soft palate plays a great role in function of speech and swallowing. Ablation of tonsil cancer results in multi-demensional defect including soft palate in most cases and restoration of the postoperative oral cavity function is a continuing surgical challenge. Although a variety of techniques are available, radial forearm free flap has been known as an effective method for these defect, which offers a thin, pliable, and relatively hairless skin, and a long vascular pedicle. The aim of the present study is to report the speech and swallowing function test results of our 5 consecutive radial forearm free flaps used for tonsil cancers. Materials and Methods : We reviewed the medical records of 5 patients who were offered intraoral reconstruction with a radial forearm free flap after ablative surgery for tonsil cancers, from Dec. 1997 to Oct. 1998, and analyzed the surgical methods, complications, and speech and swallowing function test results. We have examined with modified barium swallow to evaluate postoperative wallowing function and articulation and resonance test for speech. Results : The tumor sizes by TNM stage(AJCC, 1997) were T1(1), T2(2), and T4(3). The paddles of flaps were tailored in multilobed designs from oval shape to pentalobed design and in variable size from 24$cm^2$ to 108$cm^2$(average size = 78.4$cm^2$), according to the defect after ablation. This procedures resulted in satisfactory flap success and functional results all but 1 case of flap contracture in 2 postoperative week, achieved early oral diet until 16-57 postoperative day(average, 28 days) and social speech. The oropharyngeal defect including soft palate reconstruction with radial forearm free flap might be an excellent method for the maximal functional results, after ablative surgery of tonsil cancer that results in multidimensional defect.