Cerrahi Destekli Hızlı Üst Çene Genişletmesi Yapılan Hastalarda Ses Değişikliklerinin İncelenmesi
AuthorErdur, Onur Erdem
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The sound is basically formed by the simultaneous function of three distinct components; the respiratory, vibratory and resonator chambers. The airflow issuing from the respiratory system vibrates the vocal cords, called the vibratory field, and the sound gains its characteristic in the resonator area, including the oral cavity. Various studies showed changes in voice due to hormonal effects or changes in the position and the size of anatomical structures caused by orthognatic surgery or growth-development. Maxillary transverse deficiency is a common malocclusion in patients with or without syndrome. Increase of the volume of the nasal cavity, decrease of the palate depth and some dental changes are observed following maxillary base expansion with surgically assisted or conventional rapid maxillary expansion. In addition to morphological changes in the base of the nasal cavity and the ceiling of the oral cavity, the position of the tongue changes and it is positioned more anteriorly. Therefore, it is assumed that maxillary expansion has an effect on the characters of the voice. The number of studies in the literature on the changes in sound related to rapid maxillary expansion is limited. Some studies investigated the effects of rapid maxillary expansion on voice, but as these were carried out on individuals at young ages, the voice changes that could occur due to growth and related to hormones were neglected. Based on our review, the only study that investigated the effects of surgically assisted rapid maxillary expansion among adult individuals was carried out on only 6 individuals. The aim of our study is to investigate the effects of surgically assisted rapid maxillary expansion on the acoustic characteristics of all vowel sounds in the Turkish language in adult patients. Only adult patients were included in the study to eliminate potential effects of growth-development could have on the voice. Our hypothesis is that there would be changes in the acoustic characteristics of the voice in relation to the changing vocal tract anatomy following surgically assisted rapid maxillary expansion. 5 male and 14 female patients aged between 17-31 years with maxillary transverse deficiency were included in the study. Voice records were taken before applying the appliance (T0), immediately after applying the expander (T1), 5 days after surgery (T2), after retention period (average 5.2 months) (T3), immediately after the debonding the appliance (T4) and an average of 5.8 weeks after the debonding the appliance (T5). The voice samples obtained at 6 different treatment times were analyzed using the program Praat version 6.0.43 (Paul Boersma University of Amsterdam, Netherlands). The isolated vowels were pronounced for 3 seconds and words containing those vowels were also recorded. Voice samples were analyzed with F0, F1, F2, F3, Shimmer, Jitter and NHR parameters and the data recorded at 6 different treatment periods were compared. In addition, these data were compared with the voice recordings collected from a control group of 19 subjects who didn't have orthodontic treatment. In conclusion, no statistically significant difference was observed between T0 and T5 recording times for the isolated vowels [a], e [ɛ], i [ɯ], i [i], o [ɔ], ö [œ] u [u] and ü [y] in any of the parameters; F0, F1, F2, F3, Shimmer, Jitter and NHR. The isolated a [a] sound F1 parameter showed a decrease immediately after applying the expansion device, but adaptation to the initial values occurred over time. Higher F2 frequency values were recorded for the isolated u [u] and ü [y] sounds immediately after the removal of the expansion device. Similarly, higher NHR parameter values were recorded for the isolated i [i] sound. However, adaptation to the initial values was observed over time. The F2 frequency values of the sounds i, o, ö in the word and the F3 frequency values of the i, o sounds after applying the expansion device. However, there was no difference between the initial and final records which indicates an adaptation over time. Isolated recorded F1 frequency of a [a] sound, F2 frequency of e [ɛ] sound, Jitter and NHR parameters of i [i] sound, NHR parameter of o [ɔ] sound and F0 and F1 values of u [u] sound showed more changes compared to the control group. The changes in the NHR parameter of the sound of e [ɛ] and the Shimmer parameter of the sound of i [i] were similarly higher than the control group.
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