Page 20 - Read Online

by our department, analyzed objectively and subjectively professional recording system at a constant distance
the potential changes brought by closed rhinoplasty on from mouth (12 cm). All data, expressed as ± standard
many characteristics of vocal pattern, such as frequency, deviation, were analyzed with the Mann-Whitney test
tones and timbre. and values were compared before and 6 months after the
intervention. All data with a P value of 0.05 or less were
METHODS considered statistically significant for the preliminary
report.
Our preliminary evaluation was conducted from
September 2012 to May 2013. We studied 19 patients The subjective evaluation, instead, was supported by a
(7 males, 12 females), raging in ages from 19 to 56 questionnaire, translated in Italian. The questionnaire
years (mean age was 29.3 years). All of them underwent was a modified version of the Voice Handicap Index
exclusively closed rhinolplasty. An informed consent and Score [7,8] and helped us to study the subjective changes.
an accurate clinical history were obtained from all patients, It is composed by 3 legs, technical, structural and
and every single step of our evaluation was carried on perceptive: a greater handicap is reflected by a greater
through the rules of the local medical ethic committee score. Technical leg is about effects of vocal pattern
of Umbria, Italy. Our preliminary evaluation was obtained on work life. The structural leg is about any personal
with an observational study. Both the objective and the detected disorders. Perceptive leg comprises questions
subjective evaluation were realized with a time series about the personal perception of the effects on voice after
study, through a chronological sequence of data points, rhinoplasty. Patients answered this questionnaire before
consisting in several measures made over a 6 months and 6 months after surgery. Results were compared in
time interval. All data were analyzed with the Mann- total score and separately for each area of questions.
Whitney test. Inclusion criteria were the professional use
of voice and the purely aesthetic request for the surgery. RESULTS
We excluded patients affected by chronic respiratory
diseases; we also excluded secondary procedures. The The 19 patients enrolled for the study were observed
study was approved by the local ethical committee before and 6 months after surgery (this is a preliminary
under the World Medical Association Declaration of report, we will continue with a long-term evaluation
Helsinki guidelines. Of our patients, 24% used their voce in future, with more patients). For the subjective
professionally. All 19 patients were studied before and 6 evaluation, our modified version of Voice Handicap Index
months after surgery. The same surgeon performed the Scores helped us to evaluate several characteristics of
19 operations. Authors always used the closed approach the personal perception of voice. We separately scored
for the surgical procedures, performed under general and compared each area of the translated questionnaire.
anesthesia with the supplementary infiltration of a
local anesthetic with vasoconstrictor (xylocaine 1% and
epinephrine 1:100,000). The intercartilaginous incision
starts the procedure, and after the dissection of vestibular
skin, the operator reduces the dorsum. Lateral low-to-high
osteotomies and the management of the tip, performed
with a delivery approach, complete the procedure. Grafts
or additional procedures were never used.

After 1 week, we removed nasal splints. This preliminary
postoperative evaluation was performed 6 months after
surgery (we will evaluate more patients for a longer period
of time, for a stronger report). The study of the voice was
performed with both objective and subjective methods.
To compare the extracted data from preoperative and
postoperative evaluations, the results were analyzed
with the Mann-Whitney test. The objective analysis,
conducted with the study on spectrograms, allowed to
quantify the frequency levels of nasal consonants (“N” and
“M”) and vowels (“A” and “E”) before and 6 months after
surgery. It was conducted with a professional recording
system and sounds were analysed using the PRAAT open
source software. Voices were analyzed in frames of 3 s
and for every single sound we extracted a spectrogram Figure 1: Frequencies of “M” consonant sound (top), “N” consonant
and studied it through a spectrographic analysis. Every sound (middle) and “A” vowel sound (bottom) before and 6 months
recording was performed in a quiet room, using the after surgery. Data are expressed in Hertz
232 Plast Aesthet Res || Volume 3 || July 7, 2016