Professor and Head, Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Consultant, Audiologist and Speech Pathologist, Private practice, Mumbai, India.
J Prosthet Dent. 2020 Feb;123(2):355-363. doi: 10.1016/j.prosdent.2019.03.005. Epub 2019 Jul 12.
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.
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.
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).
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.
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.
各种阶段的修复干预有助于患者从美观和功能障碍中恢复。然而，关于它们在治疗的各个阶段对患者生活质量（QOL）的影响，知之甚少。
本临床研究的目的是评估在接受上颌骨切除术的患者在不同阶段使用修复体进行康复后，QOL 和语音声学参数的变化。
共纳入 30 例连续接受上颌骨切除术且成功完成所有修复体康复阶段的患者。研究分 4 个阶段进行。在术前阶段，对患者的 QOL 和语音进行评估，并进行牙印模。在术后即刻阶段，患者在术后第 5 天使用延迟手术阻塞器进行康复，并在术后第 12 天评估 QOL 和语音。在临时阻塞器阶段，患者在术后第 12 天至第 15 天之间使用临时上颌阻塞器进行康复，并在使用修复体至少 1 周后评估 QOL 和语音。在确定阶段，非放射患者在第 6 周使用固定修复体进行康复，放射患者在第 6 个月使用固定修复体进行康复。患者在第 1 周后评估 QOL 和语音参数。在每个阶段，通过 EORTC QLQ-C30 和 EORTC QLQ-H&N35 问卷评估 QOL。通过声学语音软件测量语音参数，包括强度、基频、习惯频率、抖动、颤动、最大发音时间和 S/Z 比。通过重复测量方差分析评估阻塞器康复各个阶段 QOL 的变化，通过 Friedman 检验（α=.05）分析语音参数的变化。
EORTC QLQ-C30 的身体功能、角色功能、疲劳、恶心、呕吐、呼吸困难、睡眠和食欲丧失以及 EORTC QLQ-H&N35 的言语、社交进食、社交接触、张口度、口干、粘性唾液、使用止痛药和喂养管等领域均观察到统计学意义上的显著差异（P<.05）。语音参数分析还显示强度、抖动、颤动、最大发音时间和 S/Z 比显著改善，这表明使用不同类型的阻塞器可以改善语音。
使用手术阻塞器、即刻阻塞器和最终阻塞器的患者整体 QOL 和语音均逐渐改善，依次为手术阻塞器、即刻阻塞器和最终阻塞器。术后即刻阶段的疾病症状和口腔功能恶化，但随着最终阻塞器义齿的使用，逐渐稳定改善并接近术前水平。
