Os objetivos do presente estudo foram: 1) mensurar e descrever as medidas de extensão e espessura do véu palatino e da profundidade da nasofaringe em indivíduos com fissura transforame unilateral operada (FTU) que apresentavam disfunção velofaríngea (DVF); 2) calcular e descrever a razão entre a profundidade da nasofaringe e a extensão do véu palatino; 3) comparar as medidas encontradas para os indivíduos deste estudo com as normas descritas por SUBTELNY (1957); 4) comparar as medidas encontradas entre os sexos masculino e feminino; 5) comparar as medidas encontradas para os indivíduos que receberam palatoplastia com procedimento de Furlow (FW) com as medidas daqueles que receberam procedimento de Von Langenbeck (VL); 6) correlacionar as medidas encontradas com as idades dos indivíduos. A casuística foi constituída de 30 indivíduos com FTU e DVF, sendo 15 meninas e 15 meninos, com média de idade de 6 anos e 11 meses. Desses 30, 10 tiveram o palato operado pela técnica de FW e 20 pela de VL, entre as idades de 9 e 18 meses. Para definição da conduta para correção da DVF, todos os indivíduos foram submetidos ao exame de videofluoroscopia. Uma imagem em tomada lateral do MVF em repouso fisiológico foi selecionada e editada em um DVD para análise e mensuração das estruturas velofaríngeas de interesse. Três fonoaudiólogas experientes em videofluoroscopia realizaram as mensurações. Os resultados indicaram média de 27,4 mm para as medidas de extensão do véu palatino, de 9,7 mm para as de espessura do véu palatino, de 22,7 mm para as de profundidade da nasofaringe e de 0,86 para a razão entre a profundidade da nasofaringe e a extensão do véu palatino. Comparando os resultados do presente estudo com os de Subtelny (1957) diferença significante foi encontrada para as medidas da espessura do véu palatino, da profundidade da nasofaringe e da razão entre a profundidade da nasofaringe e a extensão do véu palatino. Os resultados também demonstraram diferença significante entre a média das medidas de extensão do véu palatino nos sexos masculino e feminino. Não houve diferença significante entre a média das medidas das estruturas avaliadas para os indivíduos operados pela técnica de FW nem pelos operados pela VL. Não houve correlação significante entre a variável idade e as medidas obtidas. / The objectives of the present study were: 1) to measure and to describe length and thickness of the velum and depth of nasopharynx for individuals with unilateral operated cleft lip and palate (UCLP) with velopharyngeal dysfunction (VPD); 2) to calculate and describe the depth of nasopharynx to velar length ratio (D/L); 3) to compare measures found for the individuals in this study with the norms described by Subtelny (1957) for normal individuals; 4) to compare the measures between males and females; 5) to compare the measures between individuals who received palatoplasty with the Furlow (FW) procedure to those who received the Von Langenbeck (VL) procedure; 6) correlate measures between different ages. The sample included 30 individuals with UCLP and VPD, 15 girls and 15 boys, with mean age of 6y11m. Ten individuals had palatoplasty with FW procedure and 20 with VL, between the ages of 9 and 18 months. For identifying best procedure for correcting VPD all individuals were submitted to videofluoroscopy assessment. A lateral view of the velopharyngeal mechanism during rest was selected and edited into a DVD, for analysis and measurement of the velopharyngeal structures of interest. Three speech-language pathologists experienced in videofluoroscopic assessment obtained all measures studied. The results revealed a mean velar length of 27.4 mm; mean velar thickness of 9.7 mm; mean depth of nasopharynx of 22.7 mm; D/L of 0.86. Comparing these results to Subtelny\'s (1957) a significant difference was found for measures of velar thickness, depth of nasopharynx velar length and D/L. Significant difference was found between males and females only for velar length. No significant differences were found between different techniques for palatoplasty. There was no significant correlation between age and the measurements obtained.

Oral and pharyngeal cancer is commonly treated with a combination of radiotherapy and surgery. It is a clinical knowledge that patients often experience severe swallowing disorders following treatment. Since surgical sequelae are instantaneous and obvious, little attention has been paid to other concurrent effects of the treatment. To shed light on this subject, the aim of this thesis was twofold (i) to make a retrospective inventory of the sequelae following treatment and (ii) to perform a prospective, inceptive examination at diagnosis, and to follow-up after radiotherapy, six months and 12 months after surgery. The files of ninety-nine patients revealed that following treatment one-third had to use gastric fistulas and more than nine of ten patients had restricted swallowing capacity. Every second patient could only swallow puréed or liquid food. Adequate intra-oral sensation and discrimination ability is essential for bolus preparation and bolus control, for appropriate elicitation of the swallowing reflex and, hence, for the oral phase of swallowing. At the inceptive examination, the prospective part of the study demonstrated intra-oral discrimination ability in patients was equal to that in healthy controls but was impaired six months after treatment and there was no significant improvement after 12 months. It had been expected that the patient’s healthy, non-tumor side would compensate but it did not. An explanation was found when it was revealed that radiotherapy induced a delayed decline in intra-oral sensation. Sensory decline was not demonstrated within a month after radiotherapy but was manifest six months later. Since the radiotherapy field includes the neck, because of the risk for metastasis, it is highly plausible that pharyngeal sensation declines in a manner corresponding to that found intra-orally when the healthy side is irradiated. In accord with this presumption, pharyngeal swallowing function deteriorated in patents with oral tumors. Cineradiographic evaluation of oral and pharyngeal swallowing function disclosed a significant association between the degree of swallowing dysfunction and the degree of sensory decline and with the degree of impairment of shape recognition. Conclusions: Delayed intra-oral sensory decline, found to be induced by radiotherapy, can be expected to appear in the entire radiation field, including the oral cavity and the pharynx, with adverse effect on swallowing. Testing intra-oral sensation close to the last radiotherapy session is not advisable, because sensory decline does not develop immediately after radiotherapy but manifests after six months. Spontaneous sensory rehabilitation cannot be expected after six months. The significant association between degree of swallowing dysfunction and degree of intra-oral sensory decline and impaired discrimination ability must be considered in the quest for functional rehabilitation of patients treated for oral or pharyngeal cancer.