ABSTRACT Purpose: to investigate the effectiveness of a pharyngeal bulb prosthesis to eliminate hypernasality in patients with operated cleft palate presenting with diagnosis of hypodynamic velopharynx. Methods: twenty patients with cleft palate, ages 11-40 years, presenting hypodynamic velopharynx participated in the study. Patients had their speech audio recorded twice, with and without prosthesis, simultaneously with nasometry. Three speech-pathologists rated the presence and absence of hypernasality. Perceptual and nasometric data without and with prosthesis were compared, using the McNemar Test (p<0.05). Results: three (15%) patients presented hypernasality without prosthesis and normal resonance with prosthesis, 3 (15%), normal resonance without prosthesis and hypernasality with prosthesis, 9 (45%), hypernasality without and with prosthesis, and 5 (25%), normal resonance in both conditions. Nasometry (≤27% cut off): 1 (5%), presented scores >27% without prosthesis and <27% with prosthesis, 2 (10%), scores <27% without prosthesis and >27% with prosthesis, 17 (85%), scores >27% in both conditions, and 1(5%), scores <27% in both conditions. The comparisons between the results were not significant (p=1.000). Conclusion: the pharyngeal bulb prosthesis alone is insufficient to eliminate hypernasality of patients presented with hypodynamic velopharynx. To this purpose, the combination between the prosthesis and speech therapy is required.

RESUMO Objetivo: O objetivo deste trabalho é apresentar e discutir a elaboração e a avaliação de material multimídia, destinado à orientação dos cuidadores de bebês com fissura labiopalatina, mais especificamente orientação sobre a velofaringe, palatoplastia primária e fala com relação às fissuras labiopalatinas. Métodos: A elaboração do material envolveu interdisciplinarmente as áreas de Fonoaudiologia, Odontologia e Arte. Permeados por princípios da arte-educação, houve definição e execução dos seguintes aspectos: caracterização do público alvo, caracterização do conteúdo, identificação e elaboração de ilustrações didáticas, caracterização da abordagem educacional, elaboração do texto/narração, definição da sequência audiovisual e conversão em vídeo. A avaliação do material foi conduzida com a participação de 41 cuidadores de pacientes com fissura labiopalatina e envolveu a comparação dos conhecimentos dos participantes por meio de um roteiro avaliativo, aplicado antes e depois da apresentação do material. Resultados : Ocorreu aumento para as respostas corretas referentes ao papel da velofaringe e a importância da palatoplastia primária na fala. Conclusão: O material multimídia mostrou-se efetivo na otimização dos conhecimentos dos cuidadores, sugerindo a relevância de seu papel em momentos de orientação.

ABSTRACT Purpose: The objective of this study was to describe the process of elaboration and evaluation of multimedia material for caregivers about velopharynx, speech, and primary palatoplasty in babies with cleft lip and palate. Methods: The elaboration of the material involved an interdisciplinary relationship between the fields of Speech Language Pathology and Audiology, Dentistry and Arts. The definition and execution of the following activities were based on the principles of art education involving the following: characterization of audience, characterization of content, identification and elaboration of illustrations, characterization of educational approach, elaboration of text and narratives, definition of audiovisual sequence, and video preparation. The material was evaluated with the participation of 41 caregivers of patients with cleft lip and palate involving the comparison between acquired knowledge using an evaluation script applied before and after presenting the material. Results: An increase was observed in correct responses regarding the role of velopharynx and the importance of primary palatoplasty for speech. Conclusions: The multimedia was effective in optimizing the knowledge of caregivers, suggesting the importance of such material during orientation.

OBJETIVO: Comparar os achados nasoendoscópicos relacionados ao gapvelofaríngeo entre pacientes com fissura labiopalatina operados do palato pela técnica de Furlow (F) e aqueles operados pela de Von Langenbeck (vL) que permaneceram com insuficiência velofaríngea (IVF).MÉTODOS: Os dados analisados foram coletados do banco de gravações de exames de nasoendoscopia da instituição. A amostra foi constituída por 70 gravações de nasoendoscopia obtidas de 22 pacientes operados do palato pela técnica de F e de 48 pela de vL, que permaneceram com IVF e que foram submetidos à nasoendoscopia para definição de conduta para correção da IVF, entre as idades de 5e 15 anos (média: 8 anos). As imagens foram editadas em sequência aleatória em um DVD e julgadas por três fonoaudiólogas experientes quanto ao movimento e deslocamento do véu palatino; ao movimento e descolamento das paredes laterais da faringe; ao movimento e deslocamento da parede posterior da faringe; à ocorrência da prega de Passavant e ao tamanho e tipo do gapvelofaríngeo.RESULTADOS: Os resultados quanto à comparação das medidas entre as técnicas cirúrgicas (F versusvL) não foram estatisticamente significantes.CONCLUSÃO: A técnica cirúrgica utilizada na palatoplastia primária não foi relevante para determinar diferença no tamanho do gapvelofaríngeo para os pacientes que permaneceram com IVF.

PURPOSE: To compare the nasoendoscopic findings related to the velopharyngeal gap among patients with cleft palate who underwent the Furlow (F) technique and those who underwent the von Langenbeck (vL) technique for primary palatal surgery, who remained with velopharyngeal insufficiency (VPI).METHODS: The analyzed data were retrieved from the institution's data of recordings of nasoendoscopic exams. The sample comprised 70 recorded nasoendoscopic exams obtained from 22 patients who underwent the F technique and from 48 who underwent the vL technique during primary palatoplasty, who remained with VPI after surgery and were submitted to nasoendoscopy, between the ages of 5 and 15 years (mean age: 8 years), for definition of the best treatment for VPI. The images were edited into a DVD in a randomized sequence to be assessed by three experienced speech language pathologists regarding displacement and excursion of the soft palate; displacement and excursion of lateral pharyngeal's walls; displacement and excursion of the posterior pharyngeal's wall; and presence of the Passavant ridge and size and type of velopharyngeal gap.RESULTS: The results of the comparison of measurements between F and vL groups were not statistically significant.CONCLUSION: The surgical technique used in primary palatoplasty was not relevant to determine the difference in the size of the velopharyngeal gap for patients who maintained VPI.

Objetivo Verificar a concordância entre os resultados dos Testes de Emissão de Ar Nasal e de Hipernasalidade e os achados do exame de videofluorocopia no diagnóstico da disfunção velofaríngea, em indivíduos com fissura labiopalatina. Métodos A amostra foi constituída por 89 exames de videofluoroscopia e 89 escores dos Testes de Emissão de Ar Nasal e de Hipernasalidade, interpretados como fechamento velofaríngeo consistente, ou como fechamento velofaríngeo inconsistente, ou ainda, como não fechamento velofaríngeo. Foram calculadas a sensibilidade, a especificidade e a concordância entre a interpretação dos achados dos testes perceptivos e os achados da videofluoroscopia. Resultados Foram encontrados índices de sensibilidade e especificidade de 98% e 37%, respectivamente, para o Teste de Emissão de Ar Nasal e de 96% e 63%, respectivamente, para o Teste de Hipernasalidade. As porcentagens de concordância entre os escores do Teste de Emissão de Ar Nasal e os exames de videofluoroscopia e entre os escores do Teste de Hipernasalidade e os exames de videofluoroscopia, para a categoria fechamento velofaríngeo consistente, foram de 62% e 70%, respectivamente, de 43% e 47%, para a de fechamento velofaríngeo inconsistente, respectivamente, e de 68% e 77%, para a de não fechamento velofaríngeo, respectivamente. Conclusão Houve um bom nível de concordância entre os testes perceptivos e os exames de videofluoroscopia para as categorias fechamento velofaríngeo consistente e não fechamento velofaríngeo, mas não para a de fechamento velofaríngeo inconsistente.

Purpose To determine the agreement between the results of the Nasal Air Emission and Hypernasality tests and the videofluoroscopy findings in the diagnosis of velopharyngeal dysfunction in individuals with cleft lip and palate. Methods The sample consisted of 89 scores of Nasal Air Emission and Hypernasality tests and 89 judgments of videofluoroscopy recordings, which were interpreted as consistent velopharyngeal closure, or as inconsistent velopharyngeal closure, or as non velopharyngeal closure. The sensitivity, specificity and agreement between the interpretation of the results of the perceptual tests and the findings of the videofluoroscopy were calculated. Results The rates found for sensitivity of Nasal Air Emission and Hypernasality tests were 98% and 96%, respectively, and the rates for specificity of Nasal Air Emission and Hypernasality tests were 37% and 63%, respectively. Regarding the percentages of agreement between the Nasal Air Emission test scores and the videofluoroscopy judgments, it was found an agreement of 62% for the consistent velopharyngeal closure condition, 43% for the inconsistent velopharyngeal closure, and 68% for the non velopharyngeal closure. Between the scores of Hypernasality test and videofluoroscopy judgments the agreement found was 70% for the consistent velopharyngeal closure condition, 47% for the inconsistent velopharyngeal closure and 77% for the non velopharyngeal closure. Conclusion There was a good level of agreement between the perceptual tests and the videofluoroscopy judgments for the consistent velopharyngeal closure and non velopharyngeal closure conditions, but not for the inconsistent velopharyngeal closure.