Kanchan P Dholam1, Gurmit Bachher2, Sandeep V Gurav3. 1. Professor and Head, Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India. 2. Consultant, Audiologist and Speech Pathologist, Private practice, Mumbai, India. 3. Professor, Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India. Electronic address: drsandeepgurav@gmail.com.
Abstract
STATEMENT OF PROBLEM: Prosthetic interventions at various stages help patients recover from esthetic and functional disabilities. However, little is known regarding their impact on patient quality of life (QOL) during various phases of treatment. PURPOSE: The purpose of this clinical study was to evaluate changes in the QOL and acoustic speech parameters of patients rehabilitated by using a prosthesis at various stages after undergoing maxillectomy. MATERIAL AND METHODS: A total of 30 consecutive patients who underwent maxillectomy resection and successfully completed all phases of rehabilitation with obturator prostheses were included. The study was conducted in 4 phases. In the preoperative phase, patients were evaluated for QOL and speech, and dental impressions were made. In the immediate postoperative phase, patients were rehabilitated with a delayed surgical obturator on the fifth postoperative day and were evaluated for QOL and speech on the 12th postoperative day. In the interim obturator phase, patients were rehabilitated with an interim maxillary obturator between the 12th and 15th postoperative days and were evaluated for QOL and speech after using the prosthesis for a minimum of 1 week. In the definitive phase, nonradiated patients were rehabilitated with a definitive prosthesis in the sixth week, and radiated patients were rehabilitated with a definitive prosthesis in the sixth month. The QOL and speech parameters of the patients were evaluated after 1 week. QOL evaluation in each phase was performed by using the EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires. Speech parameters, namely intensity, fundamental frequency, habitual frequency, jitter, shimmer, maximum phonation time, and the S/Z ratio, were measured by using acoustic speech software. The change in QOL over various phases of rehabilitation with an obturator was analyzed by using repeated measures analysis of variance, whereas changes in acoustic speech parameters were analyzed by using the Friedman test (α=.05). RESULTS: A statistically significant difference (P<.05) was observed in the physical function, role function, fatigue, nausea, vomiting, dyspnea, sleep, and appetite loss domains of the EORTC QLQ-C30 and in the speech, social eating, social contact, mouth opening, dry mouth, sticky saliva, use of painkillers, and feeding tube domains of the EORTC QLQ-H&N35. The analysis of speech parameters also revealed significant improvement in intensity, jitter, shimmer, maximum phonation time, and the S/Z ratio, suggesting improvement in speech with the use of different types of obturators. CONCLUSIONS: The overall QOL and speech of the patients showed increasing improvement with the use of surgical obturators, immediate obturators, and definitive obturators in that order. The disease symptoms and oral functions deteriorated in the immediate postoperative phase but improved steadily and approached the preoperative level with definitive obturator prostheses.
STATEMENT OF PROBLEM: Prosthetic interventions at various stages help patients recover from esthetic and functional disabilities. However, little is known regarding their impact on patient quality of life (QOL) during various phases of treatment. PURPOSE: The purpose of this clinical study was to evaluate changes in the QOL and acoustic speech parameters of patients rehabilitated by using a prosthesis at various stages after undergoing maxillectomy. MATERIAL AND METHODS: A total of 30 consecutive patients who underwent maxillectomy resection and successfully completed all phases of rehabilitation with obturator prostheses were included. The study was conducted in 4 phases. In the preoperative phase, patients were evaluated for QOL and speech, and dental impressions were made. In the immediate postoperative phase, patients were rehabilitated with a delayed surgical obturator on the fifth postoperative day and were evaluated for QOL and speech on the 12th postoperative day. In the interim obturator phase, patients were rehabilitated with an interim maxillary obturator between the 12th and 15th postoperative days and were evaluated for QOL and speech after using the prosthesis for a minimum of 1 week. In the definitive phase, nonradiated patients were rehabilitated with a definitive prosthesis in the sixth week, and radiatedpatients were rehabilitated with a definitive prosthesis in the sixth month. The QOL and speech parameters of the patients were evaluated after 1 week. QOL evaluation in each phase was performed by using the EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires. Speech parameters, namely intensity, fundamental frequency, habitual frequency, jitter, shimmer, maximum phonation time, and the S/Z ratio, were measured by using acoustic speech software. The change in QOL over various phases of rehabilitation with an obturator was analyzed by using repeated measures analysis of variance, whereas changes in acoustic speech parameters were analyzed by using the Friedman test (α=.05). RESULTS: A statistically significant difference (P<.05) was observed in the physical function, role function, fatigue, nausea, vomiting, dyspnea, sleep, and appetite loss domains of the EORTC QLQ-C30 and in the speech, social eating, social contact, mouth opening, dry mouth, sticky saliva, use of painkillers, and feeding tube domains of the EORTC QLQ-H&N35. The analysis of speech parameters also revealed significant improvement in intensity, jitter, shimmer, maximum phonation time, and the S/Z ratio, suggesting improvement in speech with the use of different types of obturators. CONCLUSIONS: The overall QOL and speech of the patients showed increasing improvement with the use of surgical obturators, immediate obturators, and definitive obturators in that order. The disease symptoms and oral functions deteriorated in the immediate postoperative phase but improved steadily and approached the preoperative level with definitive obturator prostheses.
Authors: Dominik Medyński; Tomasz Gredes; Mariusz Glapiński; Damian Dudek; Beniamin Oskar Grabarek; Ewa Niewiadomska; Agata Czajka-Jakubowska; Agnieszka Przystańska Journal: Int J Environ Res Public Health Date: 2022-05-07 Impact factor: 4.614