ABSTRACT
http://dx.doi.org/10.1590/1678-775720150421
Analysis of speech and t ongue m ot ion in norm al
and post- glossect om y speaker using cine MRI
Jinhee HA1, Iel-yong SUNG2, Jang-ho SON2, Maureen STONE3, Robert ORD4, Yeong-cheol CHO2
1- University of Ulsan, Ulsan University Hospital, College of Medicine, Department of Dentistry, Ulsan, South Korea.
2- University of Ulsan, Ulsan University Hospital, College of Medicine, Department of Oral and Maxillofacial Surgery, Ulsan, South Korea. 3- University of Maryland, Department of Oral and Craniofacial Biological Science, Baltimore, United States of America.
4- University of Maryland, Department of Oral and Maxillofacial Surgery, Baltimore, United States of America.
Corresponding address: Yeong-cheol Cho - Department of Oral and Maxillofacial Surgery - College of Medicine - Ulsan University Hospital - University of Ulsan - 290-3, Ulsan University Hospital - Jeonha-dong - Dong-gu - Ulsan City - South Korea - Phone: 82-52-250-7230 - Fax: 82-52-250-7236 - e-mail: cyc73200@naver.com
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bj ect ive: Since t he t ongue is t he oral st ruct ure responsible for m ast icat ion, pronunciat ion, and swallowing funct ions, pat ient s who undergo glossect om y can be affect ed in various aspect s of t hese funct ions. The vow el / i/ uses t he t ongue shape, w hereas / u/ uses t ongue and lip shapes. The purpose of t his st udy is t o invest igat e t he m orphological changes of t he t ongue and t he adapt at ion of pronunciat ion using cine MRI for speech of pat ient s w ho undergo glossect om y. Mat erial and Met hods: Twent y- t hree cont rols ( 11 m ales and 12IHPDOHVDQGSDWLHQWVHLJKWPDOHVDQG¿YHIHPDOHVYROXQWHHUHGWRSDUWLFLSDWHLQWKH
experim ent . The pat ient s underwent glossect om y surgery for T1 or T2 lat eral lingual t um ors. The speech t asks “ a souk” and “ a geese” w ere spoken by all subj ect s providing dat a for t he vowels / u/ and / i/ . Cine MRI and speech acoust ics were recorded and m easured t o com pare t he changes in t he t ongue w it h vow el acoust ics aft er surgery. 2D m easurem ent s w ere m ade of t he int erlip dist ance, t ongue- palat e dist ance, t ongue posit ion ( ant erior- post erior and superior- inferior) , t ongue height on t he left and right sides, and pharynx size. Vow el
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a great er effect seen in / u/ t han / i/ . Conclusion: The pat ient s show ed com plex adapt at ion
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cavit y size relat ionships t o m aint ain t he value of t he form ant frequencies.
Ke yw or ds: Glossect om y. Cine MRI . Tongue. Speech.
I N TROD UCTI ON
I n r ecent year s, speech adapt at ion has been st udied in pat ient s w ho have received glossect om y su r g e r y f o r o r a l ca n ce r1 5. Po st - g l o sse ct o m y
ar t iculat ion m ay be poor because of ir r egular it y
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from irregular deform at ions of t he t ongue. Pat ient s m ay also have lim it ed t ongue range of m ot ion, d ef or m at ion ab ilit y, an d f ib r osis, all of w h ich can reduce speech qualit y. St udies have isolat ed several m aj or fact or s t hat affect speech qualit y aft er glossect om y surgery. Larger t um or size has a m ore negat ive im pact on pat ient art iculat ion and
swallowing funct ion aft er surgery14,23. Tum or locat ion
also im pact s art iculat ion qualit y w it h t he ant erior t ongue having t he biggest im pact on art iculat ion qualit y and t he t ongue base hav ing t he biggest im p act on sw allow in g1 0 , 2 1. Tu m or in v asion an d
radiat ion t reat m ent also affect post - glossect om y sp eech . Pat ien t s w h o u n d er w en t su r g er y p lu s radiat ion t herapy also show ed w orse funct ion t han pat ient s w ho only underw ent surgery13.
I n order t o rest ore t he ext ensive t issue losses of t he oral cavit y w hen m id and large size t um ors are rem oved, reconst ruct ion m ay be perform ed using
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t he best way t o im prove t he qualit y of life of pat ient s aft er surgery based on an assessm ent of funct ion in
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Chen, et al.7 ( 2002) , however, report ed t hat pat ient s
w h o u n d er w en t h em i g l o ssect o m y an d p ar t i al
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in t erm s of speech. They found t hat scar t issue
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m ov em en t of t h e t on g u e, an d t h at a p r im ar y cl o su r e m ad e t h e ar t i cu l at i o n m o r e accu r at e aft er hem iglossect om y and par t ial glossect om y. However, Sun, et al.21 ( 2007) report ed no difference
in t he speech degradat ion of pat ient s w ho w ere UHFRQVWUXFWHG ZLWK IUHH ÀDS YV DQ DGMDFHQW ÀDS and Nicollet t i, et al.13 ( 2004) found no difference
EHWZHHQ SULPDU\ DQG ÀDS FORVXUH ,QVWHDG WKH\ f ou n d t h at pr eser v at ion of t h e t ip w as k ey t o ret ent ion of speech qualit y, and t hat loss of t he t ip was as disrupt ive as a hem it ongue glossect om y.
The present paper uses F1 and F2 values for v ow els, alon g w it h t on gu e m ot ion pat t er n s, t o evaluat e t ongue funct ion in pat ient s who underwent p a r t i a l l a t er a l g l o ssect o m y. Cen t r a l i za t i o n o f v o w e l s h a s b e e n o b se r v e d i n sp e a k e r s w i t h glossect om y using F1- F2 plot s4,22, w hich im plies
poor er ar t iculat ion accuracy and a r educt ion in int elligibilit y. Dist inct iveness am ong vow els m ay be m or e im por t an t t h an global v ow el space in GHWHUPLQLQJ YRZHO LQWHOOLJLELOLW\ VLQFH VLJQL¿FDQW expansion of vow el space area can be a product of acoust ic changes in j ust one vow el12. The vow el / i/
LVRIWHQFRQVLGHUHGYHU\GLI¿FXOWIRUJORVVHFWRP\ speakers t o execut e because it requires considerable ant er ior t ongue elevat ion and a for war d t ongue body2 2. I n an ex am inat ion of / i/ , Whit ehill and
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values of F1 bet w een glossect om y pat ient s and cont rols, but pat ient s had low er F2 values.
Kaj i, et al.9 ( 2007) found differences bet w een
post- glossect om y gender differences in t he form ant frequencies of / i/ . I n fem ales, F2 and F3 values were reduced for pat ient s regarding cont rols. I n m ales, F1 values w ere higher in pat ient s t han in cont rols. They hypot hesized t hat m en and w om en process speech different ly aft er a part ial glossect om y.
I n recent years, im proved im aging m et hodology h as allow ed t h e com b in ed st u d y of st r u ct u r e a n d m o v em en t o f t h e t o n g u e. I n t h e 1 9 5 0 s
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m ovem ent2, and m or e r ecent ly cineradiography
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t h er e a r e l i m i t a t i o n s i n cl i n i ca l u se o f X- r ay because of t he risk of radiat ion exposure8. Ot her
alt er nat iv es t o X- ray include ult rasound, w hich provides represent at ions of t he t ongue in m ot ion18
and in 3D19. The ult rasound wave does not pose
any healt h risks and can ident ify t he m orphological changes of t he t ongue during speech or swallowing. Rast adm ehr, et al.17 ( 2008) used ult rasound t o
ex am in e t on gu e v elocit y du r in g t h e speech of lat eral part ial glossect om y pat ient s and report ed t h a t a co m p e n sa t o r y m e ch a n i sm w o r k e d t o increase velocit y of t he residual t ongue14. Magnet ic
Resonance I m aging ( MRI ) has also been used t o obser ve soft t issue clinically. The use of MRI in speech research began wit h t he recording of st eady st at e vow els using st at ic MRI3. St at ic MRI reveals
t he anat om y of st ruct ures in t he vocal t ract such as t he t ongue surface and t he vocal t ract airway. But , st at ic MRI is lim it ed t o quant ifying and m odeling st at ic feat ures, and cannot be used t o t rack t ongue m ot ion during speech20. The int roduct ion of cine
MRI , w hich produces a t im e series of MR im ages, great ly enhanced t he in vivo visualizat ion of t he t ongue’s m ot ion during speech.
The purpose of t his st udy is t o invest igat e t he m or p h olog ical ch an g es of t h e t on g u e an d t h e adapt at ion of pr onunciat ion using cine MRI for speech of pat ient s w ho undergo glossect om y.
M ATERI AL AN D M ETH OD S
This was a ret rospect ive st udy, w hich exam ined d at a t h at h ad b een collect ed t o st u d y sp eech pr oduct ion in glossect om ies. The pr esent st udy focused on vowels t o ascert ain whet her sounds t hat appear t o sound norm al can show com pensat ory ar t iculat or y st rat egies, w hich ar e differ ent fr om cont r ols. This st udy used a 2x 2 fact or ial design w it h repeat ed m easures, in w hich t he t w o fact ors w ere subj ect group ( glossect om ies, cont rols) and vow el ( / i/ , / u/ ) . The repeat ed m easures w ere t he dependent variables indicat ed in “ Dat a analysis” sect ion. Occasionally, gender ( m ale, fem ale) was used as a t hird fact or, or independent variable, for som e of t he com parisons.
Su bj e ct s a n d spe e ch m a t e r ia ls
Tw en t y t h r ee n or m al con t r ols an d 1 3 p ost -glossect om y pat ient s ( Figure 1) served as volunt eers for t he st udy. All w ere nat ive speakers of Am erican English. The cont rol group consist ed of 11 m ales and 12 fem ales. The pat ient group consist ed of eight
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cont rol group and pat ient group w ere 39.75 years old and 45.3 years old, respect ively. All pat ient s r eceiv ed a par t ial lat er al glossect om y w it h n o subsequent radiat ion or chem ot herapy. Two pat ient s
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or by head and neck surgeons at Johns Hopkins Hospit al. Subj ect s signed approved consent form s of t he I nst it ut ional Review Board in each locat ion.
Speech t ask s w er e “ a geese,” and “ a souk .” These t asks w ere chosen for several reasons. They can be repeat ed in less t han 1 second, w hich is w it hin t he lim it s of our MRI recording syst em . The
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neut ral t ongue posit ion. For “ souk ”, t he t ongue m oves int o t he / s/ and t hen prim arily backwards int o / u/ and / k/ . For “ geese”, t he t ongue m oves int o t he / g/ and t hen prim arily forwards int o / i/ and / s/ . The w ords use very lit t le j aw opening, so t ongue deform at ion is t he m ain com ponent of m ot ion and bot h vowels are bounded by a velar st op ( / k/ or / g/ ) and a linguo- alveolar fricat ive ( / s/ ) . One pat ient
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had no dat a at all for / i/ , since he only recorded “ a souk”. One cont rol did not have acoust ic dat a for
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did have MRI dat a. These dat aset s w ere excluded from t he relat ed st at ist ical analyses.
I n st r u m e n t s a n d r e cor din g pr oce du r e
Subj ect s w ere posit ioned in a supine posit ion in t he MRI scanner w it h t he neck coil posit ioned t o im age t he area from t he low er nasal cavit y t o t he upper t rachea.
Au dio r e cor din gs
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m ade prior t o t he MRI scan t o provide good qualit y acoust ic dat a for form ant analysis. The subj ect was posit ioned supine in a dent al chair t o sim ulat e t he MRI recording posit ion. The subj ect repeat ed each MRI w ord seven t im es and t hese recordings w ere
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vow els / i/ and / u/ . The recording was m ade w it h a head m ount ed short- range, unidirect ional, dynam ic m icrophone (Audiot echnica, I nc, Model AT857AMa, Tokyo, Japan) connect ed t o an Olym pus WS- 500M digit al voice recorder. The second recording was m ade inside t he MRI scanner. Subj ect s spoke t he speech t asks t o a m et ronom e before and during MRI scanning. This recording was used t o segm ent t he vowels and ident ify t he MRI t im e- fram es of int erest .
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Or Yeh u d a , I sr a el ) ca p t u r ed t h e sp eech a n d passively subt ract ed t he MRI noise before recording t he waveform ont o an Olym pus WS- 500M digit al voice recorder. Bot h t he m et ronom e beat s and t he speech w ere recorded.
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t w o w ere used for t he t w o syllables of t he t ask ( a souk or a geese) and t he second t w o w ere used t o t im e an inhalat ion and exhalat ion. This cont rolled all m ot ion during t he MRI recording. The m et ronom e was also used t o t rigger t he MRI scanner so t he
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syst em was based on t he one developed by Masaki, et al.11 ( 1999) .
Cin e M RI r e cor din gs
Cine MRI dat aset s w er e collect ed in m ult iple plan es, w h ile t h e su bj ect r epeat ed t h e speech t asks t o t he beat of t he m et ronom e. Because soft t issue produces a w eak signal and t he t im e fram es ar e shor t ( 38 m sec) , m ult iple r epet it ions of t he w ord w ere collect ed and averaged t o produce a single m ovie. To collect a com plet e dat aset , t he su b j ect r ep eat ed each sp eech t ask f iv e t im es
per slice. A 3-Tesla MR syst em ( Magnet om Tr io, Siem ens Medical Solut ions, Er langen, Ger m any ) was used w it h an eight channel head and neck
Name Age Sex Tumor stage Follow-up Closure method
1 46 WF T1(RT) 8mo pc
2 29 WM T1(RT) 3yrs3mo pc
3 43 WM T1(LT) 1yr ÀDS
4 50 WM T2(LT) 2yr8mo pc
5 44 WM T1(LT) 33mo pc
6 31 WF T1(LT) 1yr10mo pc
7 61 WM T2(LT) 8yrs ÀDS
8 44 WM T1(LT) 8mo pc
9 37 WF T2(RT) 20mo pc
10 40 WF T2(RT) 4yrs1mo pc
11 60 WF T1(LT) 6mo pc
12 59 WM T2(LT) 8mo pc
13 45 WM T2(RT) 9mo pc
Figure 1- Summary of patient data
coil. The param et ers w ere: FOV= 240 m m , voxel size= 1.87x1.87x6.0 m m , t im e- fram es= 26. St acks of Cine MRI im ages w ere recorded in t he sagit t al, coronal and axial planes ( Figure 2) . Depending on t he size of t he subj ect ’s t ongue, t he sagit t al st ack
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axial st ack cont ained bet w een 10 and 14 slices. Measur em ent s w er e m ade fr om t he m idsagit t al slice and t he cor onal slice t hat int er sect ed t he second m olar, since t his was encom passed by t he resect ed region.
Acou st ic a n a lyse s
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m easured for t he / i/ and / u/ in each subj ect using t he form ant t racker of Wavesurfer program . The aut om at ically ext ract ed form ant t raj ect ories w ere visually com pared wit h spect rogram s and m anually correct ed if any errors w ere det ect ed. The linear
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t r ack in g w as 1 2 an d t h e an aly sis w in dow size was 50 m s w it h a shift size of 10 m s. The m iddle w indow in each vow el segm ent was used for t he form ant m easurem ent . Each subj ect produced “ a geese” and “ a souk” seven t im es, and t he average form ant values for each subj ect and vow el w ere used in t he analyses.
Cin e M RI a n a lyse s
Th e t ar get v ow el fr am e for / i/ an d / u / w as
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fram e w it h t he sm allest t ongue palat e const rict ion occurring wit hin t he acoust ic durat ion of t he vowel. A coronal slice locat ed at t he second m andibular PRODUPHVLDOHGJHZDVLGHQWL¿HGIRUHDFKYRZHO and t he t im e- fram e com parable w it h t he sagit t al slice was chosen for m easur em ent . The second m olar was chosen because lat eral t ongue cancers occur in t his region and it is also t he locat ion of t he high part of t he palat al vault . Measurem ent s were m ade fr om landm ar ks in Figur e 2 using cust om soft ware w rit t en in Mat lab.
Fr om t he landm ar k point s in Figur e 3A, t he follow ing dist ances and lengt hs w ere m easured:
APt ng: ant erior- t o- post erior t ongue lengt h on t he PP’ line: a – c;
APTOT: d ist an ce f r om t h e t on g u e t ip t o t h e post erior pharyngeal wall on t he PP’ line: a – d;
Dpha: dist ance bet w een ant erior and post erior pharyngeal walls on t he PP’ line: c – d;
SIt ng: superior- t o- inferior t ongue height : b – e; Dlip: dist ance bet w een upper and low er lip at m inim um const rict ion;
DTP: dist ance bet w een t ongue and palat e at t he m inim um const rict ion for / i/ and / u/ . For / u/ t he const rict ion locat ion was m ore post erior t han for / i/ .
From t he coronal landm arks ( Figure 3B) , t he follow ing dist ances w ere com put ed:
Sm : t he dist ance bet w een palat al m ucosa and t he m ost upper point of t ongue perpendicular t o t he PPline, m ade on t he side w it h t he sm aller t ongue-palat e dist ance;
Lg: t he dist ance bet w een palat al m ucosa and t he m ost upper point of t ongue at perpendicular t o t he PPline, m ade on t he side w it h t he lar ger t ongue- palat e dist ance.
I n som e st at ist ical analyses, rat ios w ere used t o represent im port ant relat ionships. These w ere:
Dlip/ DTP.: The rat io of lip const rict ion t o t ongue-palat e const rict ion was st udied t o see if t radeoffs w ere m ade in const rict ion size, especially during t he / u/ , w hich uses t w o const rict ions;
Dlip/ Dpha: The rat io of lip dist ance t o pharynx size was st udied t o see if t radeoffs w ere m ade bet w een t he lip and pharynx regions of t he vocal t ract ;
SIt n g/ APt n g: Th e r at i o b et w een v er t i cal an d horizont al t ongue shape was com put ed t o det erm ine w h et h er p at ien t t on g u e sh ap es in d icat ed t h at d if f er en t m u scles w er e u sed f or t on g u e b od y elevat ion from cont rols;
APt ng/ APTOT: The rat io bet w een AP t ongue lengt h and t ongue- plus- pharynx lengt h was m easured t o det erm ine w het her pat ient s had a m ore post erior t ongue posit ion due t o t he m issing t issue;
Sm / Lg: Sym m et ry of sm all- t o- large side t ongue-palat e dist ances was m easured t o corroborat e t hat t he left / right t ongue size asym m et ry creat ed by t he surgical resect ion was absent in t he cont rols.
D a t a a n a lysis
St a t i st i ca l a n a l y si s w a s p e r f o r m e d u si n g SPSS. Gr oup, gender, and vow el w er e assigned
as in d ep en d en t v ar iab les, an d t h e d ep en d en t variables w ere F2/ F1, F3/ F2, F3/ F1, Dlip/ DTP, APTOT/ APt n g, SI / APt n g, Dlip/ Dph a, an d Sm / Lg r at io. Tw o-way Analyses of Variance ( ANOVA) w ere used t o com pare t he effect of group and w ord, in form ant values and int er lip dist ance. Thr ee- way ANOVAs w ere perform ed t o see t he effect s of group, w ord, an d gen der on t on gu e posit ion , t on gu e sh ape,
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Dlip, Dpha, DTP, SIt ng, APt ng, and APTOT.
RESULTS
Ef f ect of su b j ect g r ou p an d v ow el t y p e on form ant values
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( F= 5.911, p= 0.018) , and low er F3/ F1 rat ios t hat
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Tables 1, 2) . The rat io differences occurred because t he F2 and F3 values w ere slight ly sm aller in t he p at ien t s t h an t h e con t r ols ( see Tab le 2 ) . Th is difference was seen prim arily in t he / u/ dat a. Vowel
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( p< .05) due t o t he low er F2 and F3 for / u/ . The
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F1 ( p= 0.849) or F3/ F1 ( p= 0.204) .
Effe ct of su bj e ct gr ou p, w or d, a n d ge n de r on t on gu e posit ion a n d sh a pe
Le ft t o r igh t t on gu e - pa la t e r a t ios ( Sm / Lg)
For pat ient s, t he side in w hich t he glossect om y was perform ed had t he bigger dist ance t o t he palat e in t he coronal plane, alt hough som e asym m et ry was seen in t he cont rols as w ell. Sm / Lg rat ios for / u/ w ere 0.8± 0.31 and 0.5± 0.22 in cont rols and
Group- Vowel
F1 (Hz) F2 (Hz) F3 (Hz) DLip/DTP Sm/Lg* APtng/ APTOT
SI/APtng DLip/Dpha
CL - u mean 359 1746 2561 1.31 0.8 0.8 0.33 0.28 sd 52 265 263 0.68 0.31 0.06 0.07 0.15 PT - u mean 355 1541 2470 1.28 0.5 0.82 0.29 0.33 sd 39 226 189 0.48 0.22 0.05 0.05 0.42 CL - i mean 298 2497 3106 4.58 0.51 0.78 0.38 0.47 sd 41 272 255 3.33 0.42 0.05 0.07 0.78 PT - i mean 310 2388 2928 3.93 0.46 0.77 0.35 0.39 Sd 39 251 268 3.13 0.3 0.03 0.06 0.62
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Table 1- Results of the formants and anatomical measurements in controls (CL) and patients (PT) for the vowels /u/ and /i/
A B
Figure 3- Landmarks in (A) the midsagittal plane and (B) the coronal plane at the second molar. Landmarks are based on the palatal plane (PP) and a line parallel to PP intersecting tongue tip (PP’). Tissue points used as landmarks include
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of tongue on the PP’ line (c), the intersection point of the pharynx with the PP’ line (d), the most upper point of tongue (e),
pat ient s, respect ively. For / i/ , Sm / Lg rat ios w ere 0.51± 0.42 and 0.46± 0.3 in cont rols and pat ient s, r esp ect iv ely. Th e / u / w as m or e sy m m et r ic in cont rols during / u/ t han / i/ ; pat ient s w ere equally asym m et ric for bot h vowels. These differences were
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p= 0.039) and w ord ( Sm / Lg, F= 4,253, p= 0.043) ( Table1) .
Ton gu e sh a pe ( SI / APt n g)
Lar ger SI / AP rat ios indicat ed a m or e ver t ical t ongue shape t han sm aller rat ios. The rat ios w ere slight ly higher for cont rols t han pat ient s in bot h
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p= 0.087) . For / u/ , m eans and st andard deviat ions w e r e 0 . 3 3 ± 0 . 0 7 i n co n t r o l s a n d 0 . 2 9 ± 0 . 0 5 in pat ien t s. For / i/ , t h ey w er e 0 . 3 8 ± 0 . 0 7 an d 0.35± 0.06, respect ively. The rat io difference was
prim arily due t o a low er b – e dist ance ( SIt ng) in
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w ord ( F= 8.086, p= 0.006) . Gender did not show
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( Table 2) .
Effe ct of su bj e ct gr ou p, w or d, a n d ge n de r on voca l t r a ct a ir w a y m e a su r e m e n t s
Ph a r yn x siz e ( APt n g/ APTOT, Dlip/ Dph a)
To evaluat e t he Pharynx size, APt ng/ APTOT and Dpha w ere obt ained. Pharynx size show ed t he relat ive evaluat ion about ant erior and post erior m ovem ent of t ongue upon pronunciat ion. Upon pronunciat ion of / u/ , APt ng/ APTOT was 0.80± 0.06 and 0.82± 0.05 i n co n t r o l s a n d p a t i e n t s, r e sp e ct i v e l y. Up o n pronunciat ion of / i/ , APt ng/ APTOT was 0.78± 0.05 and 0.77± 0.03 in cont rols and pat ient s, respect ively. I n
Group F2/F1 F3/F2 F3/F1 Dlip/DTP Sm/Lg APtng/
APTOT
SItng/APtng Dlip/Dpha
groupxword Group 0.018 0.195 0.067 0.555 0.039 0.448 0.087 0.739 word 0 0 0 0 0.043 0.008 0.006 0.006 Group word 0.849 0.09 0.204 0.589 0.139 0.206 0.177 0.121 groupxwordxgender group 0.701 0.499 0.087 0.892 word 0 0.009 0.006 0.004
Table 2- Statistical analyses and p values
DliP Dpha DTP SItng APtng
Dlip pearson correlaton 1 .294* .-306** .454** -0.076 Sig.(2-tailed) 0.013 .010* .000* 0.531
N 71 71 71 71 71
Dpha pearson correlaton 294* 1 -0.059 0.022 -0.177 Sig.(2-tailed) 0.013 0.623 0.858 0.141
N 71 71 71 71 71
DTP pearson correlaton .-306** -0.059 1 -.258* 0.07 Sig.(2-tailed) 0.01 0.623 0.03 0.563
N 71 71 71 71 71
SItng pearson correlaton 454** 0.022 -0.258 1 .242* Sig.(2-tailed) 0 0.858 0.03 0.042
N 71 71 71 71 71
APtng pearson correlaton -0.076 -0.177 0.07 .242* 1 Sig.(2-tailed) 0.531 0.141 0.563 0.042
N 71 71 71 71 71
APTOT pearson correlaton 0.118 475** 0.025 0.23 .782** Sig.(2-tailed) 0.326 0 0.837 0.054 0
N 71 71 71 71 71
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pat ient s, APt ng/ APTOT was som ewhat bigger, because APTOT was shown short ly and it im plied t hat ant erior an d post er ior m ov em en t of t on gu e w as sm all.
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ZDVQRVWDWLVWLFDOVLJQL¿FDQFHLQJURXS$3t ng/ APTOT,
) S EXW WKHUH ZDV VLJQL¿FDQW LQ
word ( APt ng/ APTOT, F= 7.602, p= 0.008) . There was no
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APTOT, F= 0 . 3 5 9 , p= 0 . 5 5 7 ) . Upon pr on u n ciat ion of / u / , Dlip/ Dph a w as 0 . 2 8 ± 0 . 1 5 an d 0 . 3 3 ± 0 . 4 2 i n co n t r o l s a n d p a t i e n t s r e sp e ct i v e l y. Up o n pronunciat ion of / i/ , Dlip/ Dpha was 0.47± 0.78 and 0.39± 0.62 in cont rols and pat ient s, respect ively.
,Q VWDWLVWLFDO VLJQL¿FDQFH DQDO\VLV WKHUH ZDV QR
VWDWLVWLFDOVLJQL¿FDQFHLQJURXS'lip/ Dpha, F= 0.112,
S EXWWKHUHZDVVLJQL¿FDQWLQZRUG'lip/
Dpha, F= 8.164, p= 0.006) ( Tables 1 and 2) .
Dlip a n d t on gu e m idsa git t a l dist a n ce s ( Dlip/ DTP)
Dlip and DTP w ere m easured in t he m idsagit t al p l a n e a n d t h e m e a n w a s c a l c u l a t e d . Up o n pr onunciat ion of / u/ , t he values of Dlip and DTP in con t r ols w er e 3 . 9 1 ± 1 . 4 9 m m an d 3 . 2 1 ± 0 . 9 m m , r espect iv ely. The values of Dlip and DTP in pat ient s w ere 3.6± 1.15 m m and 3.05± 0.93 m m , respect ively. Upon pronunciat ion of / i/ , t he values of Dlip and DTP in cont rols w ere 7.64± 2.6 m m and 2.06± 0.86 m m , respect ively. The values of Dlip and DTP in pat ient s w ere 6.4± 2.26 m m and 2.0± 0.69 m m , r espect ively. I n general, values of Dlip and DTP show ed a slight ly higher value in cont rols, but
WKHUHZDVQRVWDWLVWLFDOO\VLJQL¿FDQWYDOXHV'lip/ DTP,
F= 0.352, p= 0.555) in group. How ever, in t erm s of
ZRUGWKHUHZDVVWDWLVWLFDOO\VLJQL¿FDQWYDOXH'lip/
DTP) S UHÀHFWLQJDVPDOOHUOLS
opening for / u/ ( Tables 1 and 2) .
D I SCUSSI ON
When t he part of t ongue was rem oved due t o t ongue cancer, t he shape of t ongue was changed and volum e of t ongue, w hich account ed for oral cavit y, would be changed. The changed t ongue will affect t he pr onunciat ion. Som e st udies r epor t ed t hat t he dam aged t issues induced t he change of
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reconst ruct ion got bet t er in order t o com pensat e
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m ovem ent7. I n t his st udy, t hese w er e only t w o
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w orse t han t he prim ary closure pat ient s, alt hough p h y sically, t h e lon g b ack cav it y an d sh or t lip
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upper surface of t he t ongue, as was t he case w it h bot h pat ient s, t he t ongue occupies m ore vert ical
space an d m ay len gt h en t h e or al cav it y. Bot h
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four cont rols and one prim ary closure pat ient had equivalent or longer back cavit y lengt hs. How ever,
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conclusively det erm ine differences in t he effect s of closure procedure.
For st udies on pr onunciat ion of pat ient s w ho u n d er w en t g lossect om y, sp eech in t ellig ib ilit y, a r t i cu l a t i o n , f o r m a n t , a n d v o w el sp a ce w er e prim arily used. However, because t hese approaches w ere evaluat ions on pronunciat ion funct ion aft er t h e su r ger y, t h er e w er e lim it at ion s f or st u dies on how t he shape of t ongue was changed aft er t h e su r g er y or h ow t h e t on g u e w as ch an g ed upon t he pronunciat ion. The present st udy uses Cine MRI , in w hich k- space dat a is collect ed over m ult iple repet it ions of t he speech ut t erance and an ensem ble com binat ion of t he dat a produces a cine series of im ages. From m idsagit t al Cine MRI , one can m easure t he progression of t ongue, lip, laryngeal, and velar m ot ion by t racking t he edges of t hese vocal t ract st ruct ures. From t hese prim ary 2D m easurem ent s ot her useful quant it ies can be calculat ed, such as cavit y lengt hs and m idsagit t al
FRQVWULFWLRQGLVWDQFHV9RZHOVSHFL¿FWLPHIUDPHV
select ed from Cine MRI sequences should reveal t he st rat egies and effect iveness of t ongue m ot ion adapt at ions in post - glossect om y pat ient s, w hen com pared w it h t he acoust ic out put .
I n t his st udy, Cine MRI was used in order t o invest igat e t he changed shape of t ongue and how t he com pensat ory m echanism of t ongue occurred upon pronunciat ion. The subj ect s w ere induced t o m ake pronunciat ion and Cine MRI was recorded. The part icular pronunciat ion was capt ured and t he t hr ee- dim ensional st r uct ur e of t ongue occur r ed upon pr onunciat ion. We supposed t hat phar y nx size was different bet w een t w o groups in analysis of MRI , but t here was alm ost no change in fact . Changes caused by glossect om y w ere Sm / Lg and SIt ng of t ongue. Changes of Sm / Lg w ere, of course, caused by glossect om y and SIt ng was show n less in t he group of pat ient s. Less SIt ngLPSOLHGÀDWWHU t ongue. Therefore, in form ant analysis, F2 and F3 of group of pat ient s showed low and t he pronunciat ion of v ow el w as dist or t ed. Th er e w as st at ist ically
VLJQL¿FDQFH LQ )) DQG )) YDOXHV EHWZHHQ
groups ( p= 0.018, p= 0.067) . Upon pronunciat ion of / i/ in group of pat ient s, t he t ongue t ended t o be
ÀDWDQGOLSWHQGHGWREHFORVHG
of m ale pat ient s, F1 w as incr eased m or e upon pr onunciat ion of / i/ and it w as consist ent w it h st udies of Kaj i, et al.9 ( 2007) . I n pr onunciat ion
of / u / , Dlip, SIt n g, an d DTP d id n ot sh ow m u ch differences bet w een group of pat ient s and cont rol gr oup, but in pr onunciat ion of / i/ , Dlip and SIt ng were different . Since t he t ongue should m ove m ore upon pronunciat ion of / i/ , a group of pat ient s was m ore affect ed. Pronunciat ion and shape of t ongue w as ch an ged du e t o glossect om y in t h e gr ou p of pat ien t s. Th er ef or e, t h er e w er e st at ist ically
VLJQL¿FDQFHVLQ))))6P/JDQG6,t ng/ APt ng
bet w een t w o groups.
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t o quant ify t he r elat ionship am ong t ongue, lip, an d p h ar y n x u p o n p r o n u n ci at i o n . I n Pear so n correlat ion analysis, Dlip, DTP, SIt ng, and Dpha show ed
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w as cor r elat ion in Dlip an d DTP ( p = 0 . 0 1 ) , SIt n g and DTP ( p= 0.030) , Dlip and SIt ng ( p= 0.000) , and Dlip an d Dph a ( p= 0 . 0 1 3 ) . As Dlip w as in cr eased, DTP w as decr eased. As SIt ng w as incr eased, Dpha was decr eased. As SIt ng was incr eased, DTP was decreased. As DTP was increased in group of pat ient , SIt ng had a t endency t o be decreased. I t im plied t hat a group of pat ient s had adapt at ion funct ion upon pr onunciat ion, and changes of anat om ical st ruct ures affect ed t he form ant .
The front vow el / i/ and t he back vow el / u/ bot h r equir e t ongue body elevat ion, but t he cont act w it h t he palat e is furt her forward for / i/ t han / u/ ,
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post - glossect om y pat ient s t o produce. The / i/ also requires m ore lat eral cont act bet w een t he t ongue and palat e and lat eral glossect om y pat ient s ar e m issing one side of t he t ongue, m aking t his t ask
PRUH GLI¿FXOW 7KH K\SRJORVVDO QHUYH HQWHUV WKH
t ongue from t he rear, and divides int o branches t hat course ant eriorly. I f a branch is cut , t he funct ion an t er ior t o t h e cu t is disabled. For / i/ a m or e ant erior part of t he t ongue is elevat ed t han for / u/ . I n addit ion, t he / i/ ut ilizes m ore palat al coverage t h an / u / as sh ow n in it s t y pical t on gu e- palat e cont act pat t ern. Since lat eral glossect om y pat ient s ar e m issin g t issu e on on e side of t h e t on gu e,
DGHTXDWHFRYHUDJHPD\EHPRUHGLI¿FXOWIRUL 7KHPLGOLQHGDWHFDQQRWUHÀHFWJURXSGLIIHUHQFHV
t hat result from lat eral feat ures, such as degree of elevat ion in t he lat eral port ions of t he t ongue, and lat eral t ongue- palat e cont act . I t can, how ever, present differences in lip closure bet w een t he t w o vow els. The sound / i/ uses an open lip posit ion and t he sound / u/ uses prot ruded lips. The prot ruded lips cause a const r ict ion t hat is an int egral par t of t he / u/ gest ure and cont rolled t o alt er t he F2 frequency. The lips and t ongue can t rade off in such a way t hat m ore prot ruded lips can com pensat e for a less high t ongue body in / u/ . The result s show ed
t hat lip prot rusion was t he only m idline variable t hat dist inguished pat ient s from cont rols. Therefore,
LW LV SRVVLEOH WKDW SDWLHQWV KDYH PRUH GLI¿FXOW\
w it h / i/ because t hey are unable t o use t he lips t o com pensat e for inadequat e t ongue body height . This st udy is int erest ed in t he t rade- offs bet w een t he lips and t ongue during t hese t w o vow els.
Alt hough t he st udy was lim it ed by t he sm all
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r econ st r u ct ion p at ien t s, it p r ov id ed n ew d at a
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glossect om y sur ger y, and t he adapt at ion of t he t ongue and vocal t ract during speech.
CON CLUSI ON
Ch an ges in lip con st r ict ion an d back cav it y len gt h ar e lik ely t o be com pen sat or y, w h er eas m idline t ongue shape could be com pensat ory or due t o post - surgical lim it at ions. Form ant changes
ZHUH VLJQL¿FDQW EXW LQDXGLEOH VXJJHVWLQJ WKDW FRPSHQVDWLRQ ZDV VXI¿FLHQW &ORVXUH SURFHGXUH
appeared t o have an effect on back cavit y lengt h.
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DQGVZDOORZLQJDIWHURUDOPLFURYDVFXODUIUHHÀDSUHFRQVWUXFWLRQ
Eur Arch Ot orhinolaryngol. 2010; 267: 1771- 7.
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