Introduction. In classical singing techniques, it is common to manipulate the vocal tract to channel airflow to increase voice quality and volume. Technique varies according to the style of the music, the voice type, and range of a given singer. Although these practices are intentional, fixed physiological aspects of a singer's vocal instrument also play an extremely impactful role in determining voice quality. Objectives. In the present study, the relationship between the dimensions of the maxillary dental arch and voice quality were examined in professional singers. Methods. The dimensions of the palate were measured from the maxillary dental casts of 14 female singers. Audio recordings were made for the same participants while singing a sustained /a/ singing vowel, a glissando, the song "Are You Sleeping", and a selected song from their personal repertoire. The dimensions of the palate were measured from maxillary dental casts. From the recordings, two parameters were calculated: (1) the Singing Power Ratio (SPR) and (2) A(2) A(1) ratio. Higher SPR values indicate a stronger ring in the voice, typical of operatic singing style, while higher A(2) A(1) ratio values are associated with the belting singing style. Results. Singers with larger frontal palate depth, smaller posterior palate depth, larger frontal palate width, and smaller posterior palate width seem to be more suitable for an operatic singing style. Singers who had larger overall depth and width of the palate measurements produced an increased second harmonic, typical of the belting style. Conclusions. When considering a singer's ability to produce vocalizations successfully, physiological structure is an increasingly important factor. The present study discovered that palate depth and width are associated with statistically significant differences in SPR and A(2)/A(1) parameters. These parameters correlate with two styles of singing, operatic, and belting respectively.

Trismus is a well-known complication of head and neck cancer treatment. It is defined as a progressive tonic contraction of the muscles of mastication that results in decreased mouth opening. This condition can lead to impairment of speech and eating, malnutrition, poor oral hygiene, and difficulty with dental treatment. Its prevalence in patients with head and neck cancer ranges from 5% to 38%. Different treatments are available to improve muscle length and function. Mouth opening devices along with exercising of the mandible immediately after surgery and/or radiation therapy have been found to be effective in reducing the trismus induced by cancer therapy. Presently, only limited defined guidelines are available for initiating or monitoring trismus therapy in this patient population. This clinical report presents a patient with head and neck cancer and a history of progressive recurrent trismus as a sequela of extensive surgery and chemoradiation, who experienced a pathological fracture of the mandible during treatment with a mouth opening device.

An analysis of risk factors predictive of severe mandibular osteoradionecrosis (ORN) is needed to aid prophylaxis and management of this condition.

Patients with a diagnosis of mucosal malignant melanoma involving the maxilla or paranasal sinuses requiring surgery are referred to the maxillofacial prosthodontist for treatment. The standard protocol of surgical, interim, and definitive obturator treatment is usually anticipated. Depending upon the stage and presence or absence of metastasis, it is generally accepted that the prognosis for cure of this disease is poor. This clinical report reviews the current literature regarding treatment and the overall guarded prognosis for this disease, and reports the prosthodontic treatment intervention for 8 patients. Prosthodontic treatment strategies are recommended that are consistent with the reality of the diagnosis to achieve optimal function and quality of life for these patients. (J Prosthet Dent 2009;101:85-91)

This letter updates changes in the status of the osteonecrosis and final prosthodontic treatment outcome for the patient presented in the article “Prosthodontic Treatment During Active Osteonecrosis Related to Radiation and Bisphosphonate Therapy: A Clinical Report” (J Prosthet Dent 2006;96:7-12). Two years have elapsed since publication and 3 years from completion of treatment described in the article. At the time of submission of the manuscript the patient had been followed for 2 months post insertion of a maxillary denture only and the osteonecrosis persisted on the lingual aspect of the posterior right mandible. This area of exposed bone healed 7 months following insertion of the maxillary denture and 11 months post completion of hyperbaric oxygen (HBO) treatment (30 HBO treatments followed by surgical debridement followed by an additional 10 HBO treatments) and 10 months following discontinuation of bisphosphonate, alendronate 10 mg per day orally for 9 years.

Osteonecrosis of the jaws following the use of bisphosphonate drugs has been reported in the literature. Presently, there is limited evidence to establish guidelines for the prosthodontic management of patients with active osteonecrosis, a history of osteonecrosis, or medical history of using these medications. This clinical report reviews the current literature regarding bisphosphonate use, and reports the prosthodontic treatment of an edentulous patient with active osteonecrosis who had a history of oral bisphosphonate use and jaw irradiation.

Osteonecrosis of the jaws following the administration of bisphosphonate class drugs, both intravenous and oral, has recently been reported in the literature. A case series of five patients is presented. The clinical presentation, management, and proposed etiology of this adverse reaction are reviewed. Recommendations for identifying patients who may be at risk via medical history, present and past medications, specific drugs involved and recommended precautions involving various dental interventions are also discussed.

A removable partial denture (RPD) for the restoration of maxillary defects must incorporate sound design principles to reduce potential damage to the abutment teeth and supporting periodontal tissue, while enabling acceptable functional levels of speech, mastication, and deglutition. These functional demands and potential stresses on the abutment teeth may exceed those encountered by patients without maxillary defects. This article describes the indications and design considerations for a hybrid gate design framework that incorporates both conventional cast direct retainers and the gate design concept in the same framework.

This tutorial addresses the complex pathophysiology; various structural and neurologic causes; methods of clinical appraisal; and alternative behavioral, prosthetic, and medicosurgical treatments of velopharyngeal dysfunction. To balance the primary focus of this review on hypernasal resonance and articulation disorders, discussions concerning hyponasal speech characteristics and underlying etiologies are also rendered.

Velopharyngeal dysfunction is a common pathophysiological condition that can significantly affect speech production and speech intelligibility. A wide variety of anatomic and physiologic processes, including iatrogenic interventions, can adversely impact the velopharyngeal mechanism and affect the ability of individuals to effectively communicate with others. While a number of these abnormalities are congenital and developmental in origin, many sources of dysfunction can occur later in life as a result of surgery, nasal obstruction, maxillofacial trauma, and other processes.

This article provides a review of the literature to assist the clinician in determining the efficacy of palatal augmentation prosthesis regarding speech and swallowing for the patient undergoing glossectomy. A MEDLINE search was conducted. Peer-reviewed articles published from 1966 to July 2002 that addressed the question of the efficacy of this prosthesis to improve speech and swallowing after partial or total glossectomy were included. Studies reviewed had to incorporate an objective evaluation of one or both functions. Nine of 130 studies met the selection criteria (4 retrospective, 1 case control, and 4 case reports). A total of 50 subjects were studied, 42 for swallowing and 37 for speech. In 36/42 subjects, treatment was advantageous for swallowing and in 32/37 subjects, it was advantageous for speech. On the basis of the limited evidence available, the functional efficacy of the palatal augmentation prosthesis is supported.

This tutorial addresses the complex pathophysiology; various' structural and, neurologic causes; methods of clinical appraisal; and alternative behavioral, prosthetic, and medicosurgical treatments of velopharyngeal dysfunction. To balance the primary focus of this review on hypernasal resonance and articulation disorders, discussions concerning hyponasal speech characteristics and underlying etiologies are also rendered.

In this report, we document the histologic and clinical features of a previously undefined spindle cell variant of ameloblastoma that eventually behaved in a malignant fashion during a protracted course. The predominant histologic pattern was a well-differentiated, cellular, spindled epithelial proliferation arising in the maxilla of a 14-year-old African American girl. Over 19 years, the patient experienced numerous local recurrences, metastases to distant bones after 15 years, and finally bulky local recurrence with intracranial extension resulting in death. This ameloblastic malignancy histologically simulates a low-grade true sarcoma or an ameloblastic sarcoma, but differs in that the extensive spindle cell proliferation is epithelial, characterized by strong cytokeratin immunoreactivity and negative vimentin staining.

This pilot study evaluated maxillary dental arch form dimensions and volume to determine if these parameters could be predictors for or related to voice classification. Nine white female professional singers ranging in age from 26 years to 53 years were studied. A maxillary dental impression and stone dental casts were made using standard dental procedures. Measurements were made from 10 points on each cast to determine the depth of the palate measured from first molar (depth A) and from first bicuspid (depth B), the width measured from cuspid-to-cuspid (width A) and from second molar to second molar (width B), and the length of the palate. An impression of the palatal arch of each cast was made to determine the volume of the palate using fluid displacement methods. Audio recordings were made for each subject, and based on speaking fundamental frequency, spectral analysis, voice profile, and tessitura confirmation, the actual voice classification of each subject in soprano, mezzo, and alto was achieved. Correlation and discriminant analysis tests were performed on the data. The discriminant analysis revealed that no single measurement is a predictor for voice classification. However, the discriminant analysis applied to the predictors depth A, depth B, and volume gives optimal results, ie, each subject was classified in her true group.