Comparing the Unaided Visual Exam to Lateral Cinefluorography in Estimating Several Parameters of Velopharyngeal Function

1984 ◽  
Vol 49 (2) ◽  
pp. 136-139 ◽  
Author(s):  
C. R. Eisenbach ◽  
W. N. Williams
Keyword(s):  
Medical Records ◽  
Velopharyngeal Insufficiency ◽  
Poor Agreement ◽  
Connected Speech ◽  
Visual Examination ◽  
Management Decisions ◽  
Form And Function ◽  
Velopharyngeal Closure ◽  
Velopharyngeal Function ◽  
And Function

Retrospectively, the medical records of patients with known velopharyngeal insufficiency (VPI) were reviewed for comments based on an unaided visual examination regarding their velopharyngeal function. These comments were compared to objective findings obtained from the cinefluorographic evaluations performed on each of the patients. A total of 68 recorded comments (47 patients) were identified and fell into four broad categories: (1) velar length, (2) depth of the nasopharynx, (3) velopharyngeal closure, and (4) velar mobility. The results revealed an agreement level of 60% between judgments made from visual examinations and cinefluorographic evaluations. This relatively poor agreement suggests that management decisions concerning VPI must include some method of objectively assessing velopharyngeal form and function during connected speech.

scholarly journals Current Controversies in Diagnosis and Management of Cleft Palate and Velopharyngeal Insufficiency

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Pablo Antonio Ysunza ◽  
Gabriela M. Repetto ◽  
Maria Carmen Pamplona ◽  
Juan F. Calderon ◽  
Kenneth Shaheen ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Speech Pathology ◽  
Imaging Diagnosis ◽  
Diagnosis And Management ◽  
Velopharyngeal Closure ◽  
Articulation Disorders ◽  
Recent Method ◽  
Genetics And Genomics ◽  
Velopharyngeal Function

Background. One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI).Objective. This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate.Materials and Methods. An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy.Results. Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented.Conclusion. This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management.

Velar Closing Ratio As a Predictor for the Verlopharyngeal Function After Double Opposing Z-Plasty for Postpalatoplasty Velopharyngeal Insufficiency in Patients With Cleft Palate

2020 ◽  
pp. 105566562095408
Author(s):  
Cheng-Chun Wu ◽  
Faye Huang ◽  
Ching-Hua Hsieh ◽  
Chih-Pin Fu ◽  
Yi-Lin Tsai ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Surgical Outcome ◽  
Medical Records ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Velopharyngeal Insufficiency ◽  
Stepwise Logistic Regression ◽  
Receiver Operating Characteristic Curves ◽  
Surgical Methods ◽  
Velopharyngeal Function

Background: This study was designed to identify the potential predictors of postoperative velopharyngeal function after double opposing Z-plasty (DOZP) for the treatment of velopharyngeal insufficiency (VPI) in patients who had prior palatoplasty for cleft palate. Methods: This retrospective study reviewed the medical records of consecutive patients who received DOZP for VPI after receiving a prior palatoplasty treating cleft palate between 2004 and 2017. The speech outcome of patient was measured using the Pittsburgh Weighted Speech Scale (PWSS) at 6 months following surgery and determined the outcome suggests velopharyngeal competence (PWSS ≤2) or incompetence (PWSS >2). Stepwise logistic regression was used to identify the variables for the prediction of competent surgical outcome. The specific receiver operating characteristic curves with an area under the curve (AUC) was used to evaluate the predictor related to the surgical outcome as competence. Results: The study included 93 patients. Age, relative velar length, velar lengthening, and closure pattern were not significantly associated with postoperative competence status of the patient. The only variable that predicted a successful surgical outcome was preoperative velar closing ratio. However, the accuracy of velar closing ratio in predicting a competent surgical outcome is only moderate (AUC = 70.37). Conclusion: The results of this study showed that preoperative velar closing ratio may predict, with moderate accuracy, a successful surgical outcome in patients with postpalatoplasty VPI who undergo DOZP. Therefore, in patients with a low preoperative velar closing ratio, some alternative surgical methods other than DOZP may be considered to avoid unsatisfactory surgical outcome.

Integrated Endoscopic/Photodetector Evaluation of Velopharyngeal Function

1993 ◽  
Vol 30 (3) ◽  
pp. 337-342 ◽  
Author(s):  
Michael P. Karnell ◽  
Earl J. Seaver
Keyword(s):  
Speech Disorder ◽  
Velopharyngeal Insufficiency ◽  
Velopharyngeal Closure ◽  
Nasal Consonant ◽  
Velopharyngeal Function ◽  
New System ◽  
Normal Speaking

A new integrated videoendoscopic/photodetection system, including an endoscope with an internal instrument channel used for photodetection, was applied to the evaluation of velopharyngeal closure in a subject with marginal velopharyngeal insufficiency (VPI) and in a subject with no speech disorder. Acoustic and aerodynamic speech assessments were used to establish the severity of velopharyngeal impairment in the marginal VPI patient. A light-out condition was used to establish the photodetector criterion for closure. The new system was effective for providing detailed phonetic assessment of velopharyngeal closure. Variations in degree of closure during select oral and nasal consonant productions were identified in the VPI subject but not in the normal speaking subject. The data show that important details of velopharyngeal insufficiency can be identified using the integrated endoscopic/photodetection system.

The Basics of Velopharyngeal Function: A Brief Review for the Practicing Clinician

2012 ◽  
Vol 22 (2) ◽  
pp. 25-35 ◽  
Author(s):  
David L. Jones
Keyword(s):  
Cleft Palate ◽  
Gross Anatomy ◽  
Normal Anatomy ◽  
Anatomy And Physiology ◽  
Key Points ◽  
Velopharyngeal Closure ◽  
Velopharyngeal Function ◽  
And Function ◽  
Abnormal Anatomy

In this article, I will provide a basic overview of the normal anatomy and physiology of velopharyngeal function. I will address topics such as the gross anatomy of the velopharyngeal mechanism, identification of the anatomy and function of the velopharyngeal musculature, and patterns of velopharyngeal closure that occur. I will also summarize the role of the velopharyngeal mechanism as it relates to aero-acoustic aspects of speech. Although the focus of this article is normal anatomy, I do include references to abnormal anatomy (e.g. cleft palate). I will include key points to an oral mechanism examination as it pertains to velopharyngeal function.

Nasendoscopic Evaluation of Stress Velopharyngeal Insufficiency in Wind Musicians: A Pilot Study

2015 ◽  
Vol 30 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Alison Evans ◽  
Tim Driscoll ◽  
Jonathan Livesey ◽  
David Fitzsimons ◽  
Bronwen Ackermann
Keyword(s):  
Soft Palate ◽  
Objective Assessment ◽  
Velopharyngeal Insufficiency ◽  
Air Leak ◽  
Speech Language Pathologist ◽  
Wind Instrument ◽  
Velopharyngeal Closure ◽  
Before And After ◽  
And Function

OBJECTIVE: To investigate the anatomy and function of the velopharyngeal mechanism in musicians who experience symptoms of stress velopharyngeal insufficiency (VPI) compared to musicians who do not. METHODS: The velopharyngeal mechanism of 13 musicians, 8 with reported symptoms of stress VPI and 5 without, were evaluated using video nasendoscopy before and after 30 minutes of playing. All nasendoscopic recordings were rated by an external speech-language pathologist and ear, nose and throat surgeon for maintenance of velopharyngeal closure, type of velopharyngeal closure pattern, and velopharyngeal gap. RESULTS: Six out of 8 cases with stress VPI had nasal air leak during the assessment, 2 of whom had fatigue-related increased symptoms. Three controls had mild nasal air leak without affecting the consistency of soft palate seal nor quality of playing, suggesting that evidence of nasal air leak is not always symptomatic of stress VPI. All cases had unusual anatomical characteristics, such as the soft palate closing against an irregular surface on the posterior nasopharyngeal wall, which may cause insufficient velopharyngeal closure. Typically the soft palate contacted the nasopharyngeal wall higher when playing a wind instrument compared to during speech. CONCLUSION: Specific anatomical features and factors such as fatigue and stress may affect maintenance of velopharyngeal closure in persons with stress VPI. It is important that musicians with stress VPI are evaluated while playing their instrument. Future studies into stress VPI would benefit by including objective assessment components and some degree of quantifiable measurements.

scholarly journals Surgical outcome of pharyngeal flap surgery and intravelar veloplasty on the velopharyngeal function

CoDAS ◽  
2013 ◽  
Vol 25 (5) ◽  
pp. 451-455 ◽  
Author(s):  
Daniela Aparecida Barbosa ◽  
Rafaeli Higa Scarmagnani ◽  
Ana Paula Fukushiro ◽  
Inge Elly Kiemle Trindade ◽  
Renata Paciello Yamashita
Keyword(s):  
Surgical Treatment ◽  
Surgical Outcome ◽  
Velopharyngeal Insufficiency ◽  
Cutoff Score ◽  
Flap Surgery ◽  
Orifice Area ◽  
Velopharyngeal Closure ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function ◽  
Intravelar Veloplasty

PURPOSE: To investigate the postoperative outcomes of pharyngeal flap surgery (PF) and secondary palatoplasty with intravelar veloplasty (IV) in the velopharyngeal insufficiency management regarding nasalance scores and velopharyngeal area. METHODS: Seventy-eight patients with cleft palate±lips submitted to surgical treatment for velopharyngeal insufficiency, for 14 months on an average, were evaluated: 40 with PF and 38 with IV, of both genders, aged between 6 and 52 years old. Hypernasality was estimated by means of nasalance scores obtained by nasometry with a cutoff score of 27%. The measurement of velopharyngeal orifice area was provided by the pressure-flow technique and velopharyngeal closure was classified as: adequate (0.000-0.049 cm2), adequate/borderline (0.050-0.099 cm2), borderline/inadequate (0.100-0.199 cm2), and inadequate (≥0.200 cm2). RESULTS: Absence of hypernasality was observed in 70% of the cases and adequate velopharyngeal closure was observed in 80% of the cases, in the PF group. In the IV group, absence of hypernasality was observed in 34% and adequate velopharyngeal closure was observed in 50% of the patients. Statistically significant differences were obtained between the two techniques for both evaluations. CONCLUSION: PF was more efficient than the secondary palatoplasty with IV to reduce hypernasality and get adequate velopharyngeal closure.

Scanning tunneling microscopy (STM) of DNA and RNA

1989 ◽  
Vol 47 ◽  
pp. 34-35
Author(s):  
Patricia G. Arscott ◽  
Gil Lee ◽  
Victor A. Bloomfield ◽  
D. Fennell Evans
Keyword(s):  
Molecular Structures ◽  
Inorganic Materials ◽  
Resolving Power ◽  
Scanning Tunneling ◽  
Tunneling Microscopy ◽  
Form And Function ◽  
Dna And Rna ◽  
Calf Thymus ◽  
And Function ◽  
The Relationship

STM is one of the most promising techniques available for visualizing the fine details of biomolecular structure. It has been used to map the surface topography of inorganic materials in atomic dimensions, and thus has the resolving power not only to determine the conformation of small molecules but to distinguish site-specific features within a molecule. That level of detail is of critical importance in understanding the relationship between form and function in biological systems. The size, shape, and accessibility of molecular structures can be determined much more accurately by STM than by electron microscopy since no staining, shadowing or labeling with heavy metals is required, and there is no exposure to damaging radiation by electrons. Crystallography and most other physical techniques do not give information about individual molecules.We have obtained striking images of DNA and RNA, using calf thymus DNA and two synthetic polynucleotides, poly(dG-me5dC)·poly(dG-me5dC) and poly(rA)·poly(rU).

Instrumental Assessment in Cleft Palate Care

2013 ◽  
Vol 23 (2) ◽  
pp. 49-61 ◽  
Author(s):  
Jamie Perry ◽  
Graham Schenck
Keyword(s):  
Cleft Palate ◽  
New Developments ◽  
Perceptual Evaluation ◽  
Advantages And Disadvantages ◽  
Instrumental Assessment ◽  
Speech Language Pathologist ◽  
Hypernasal Speech ◽  
Perceptual Assessment ◽  
Velopharyngeal Function ◽  
And Function

Despite advances in surgical management, it is estimated that 20–30% of children with repaired cleft palate will continue to have hypernasal speech and require a second surgery to create normal velopharyngeal function (Bricknell, McFadden, & Curran, 2002; Härtel, Karsten, & Gundlach, 1994; McWilliams, 1990). A qualitative perceptual assessment by a speech-language pathologist is considered the most important step of the evaluation for children with resonance disorders (Peterson-Falzone, Hardin-Jones, & Karnell, 2010). Direct and indirect instrumental analyses should be used to confirm or validate the perceptual evaluation of an experienced speech-language pathologist (Paal, Reulbach, Strobel-Schwarthoff, Nkenke, & Schuster, 2005). The purpose of this article is to provide an overview of current instrumental assessment methods used in cleft palate care. Both direct and indirect instrumental procedures will be reviewed with descriptions of the advantages and disadvantages of each. Lastly, new developments for evaluating velopharyngeal structures and function will be provided.

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