An Electromyographic Study of Velopharyngeal Function in Speech

Electromyographic (EMG) recordings were obtained from the levator palatini, superior pharyngeal constrictor, middle pharyngeal constrictor, palatoglossus, and palatopharyngeus muscles of three talkers of American English. Bipolar hooked-wire electrodes were used. Each subject read nonsense words composed of three vowels (/i, a, u/), six stop consonants (/p, b, t, d, k, g/), and two nasal consonants (/m, n/) to form various stop-nasal and nasal-stop contrasts. Multiple repetitions of each utterance type were recorded and subsequently processed by computer. The levator palatini was found to be the primary muscle of velopharyngeal closure for each of the subjects. The palatopharyngeus also showed consistent oralization activity for each of the subjects, although the activity of this muscle was strongly affected by vowel environment. Two subjects showed pharyngeal constrictor muscle activity related to oral articulation, but pharyngeal constrictor activity for the third subject was related to vowel quality. Nasal articulation was accomplished by suppression of oral articulation for each subject. Vowel quality affected the strength of EMG signals for lateral and posterior pharyngeal wall muscles. In those cases where activity was different for the three vowels, activity was greatest for /a/.

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Surgical Management of Velopharyngeal Incompetence in Velocardiofacial Syndrome

The Cleft Palate-Craniofacial Journal ◽

10.1597/01-110 ◽

2004 ◽

Vol 41 (2) ◽

pp. 124-135 ◽

Cited By ~ 40

Author(s):

Felicity V. Mehendale ◽

Malcolm J. Birch ◽

Louise Birkett ◽

Debbie Sell ◽

Brian C. Sommerlad

Keyword(s):

Posterior Pharyngeal Wall ◽

Velocardiofacial Syndrome ◽

Prospective Data ◽

Pharyngeal Wall ◽

Velopharyngeal Incompetence ◽

Staged Approach ◽

Velopharyngeal Function ◽

And Function ◽

Nasal Emission ◽

Results Of Surgery

Objective To analyze the results of surgery for velopharyngeal incompetence (VPI) in velocardiofacial syndrome. Design Prospective data collection, with randomized, blind assessment of speech and velopharyngeal function on lateral videofluoroscopy and nasendoscopy. Setting Two-site, tertiary referral cleft unit. Patients Forty-two consecutive patients with the 22q11 deletion underwent surgery for symptomatic VPI by a single surgeon. Interventions Intraoral examinations, lateral videofluoroscopy (± nasendoscopy) and intraoperative evaluation of the position of the velar muscles through the operating microscope. Based on these findings, either a radical dissection and retropositioning of the velar muscles (submucous cleft palate [SMCP repair]) or a Hynes pharyngoplasty (posterior pharyngeal wall augmentation pharyngoplasty) was performed. As anticipated, a proportion of patients undergoing SMCP repair subsequently required a Hynes. The aim of this staged approach was to maximize velar function, thereby enabling a less obstructive pharyngoplasty to be performed. Thus, there were three surgical groups for analysis: SMCP alone, Hynes alone, and SMCP+Hynes. Main Outcome Measures Blind perceptual rating of resonance and nasal airflow; blind assessment of velopharyngeal function on lateral videofluoroscopy and nasendoscopy; and identification of predictive factors. Results Significant improvement in hypernasality in all three groups. The SMCP+Hynes group also showed significant improvement in nasal emission. There were significant improvements in the extended and resting velar lengths following SMCP repair and a trend toward increased velocity of closure. Conclusions Depending on velopharyngeal anatomy and function, there is a role for SMCP repair, Hynes pharyngoplasty, and a staged combination of SMCP+Hynes, all of which are procedures with a low morbidity.

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Structure of the Musculus Uvulae: Functional and Surgical Implications of an Anatomic Study

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1997_034_0466_sotmuf_2.3.co_2 ◽

1997 ◽

Vol 34 (6) ◽

pp. 466-474 ◽

Cited By ~ 21

Author(s):

Martin H. S. Huang ◽

S. T. Lee ◽

K. Rajendran

Keyword(s):

Cleft Palate ◽

Posterior Pharyngeal Wall ◽

Anatomic Study ◽

Pharyngeal Wall ◽

Cleft Palate Repair ◽

Palate Repair ◽

Velopharyngeal Function ◽

Intravelar Veloplasty ◽

Anatomic Information

Objective: The role of the musculus uvulae in velopharyngeal function, its morphologic status in cleft palate, and its fate in palatoplasty procedures are subjects of controversy. The aims of this investigation were to re-examine this velar muscle to clarify its anatomic characteristics, to analyze its role in speech physiology, and to study the surgical implications of this information for cleft palate repair. Methods: Its attachments, morphology, and relations were examined in 18 fresh human adult cadavers by detailed dissection under 3.2× magnification and light microscopy. Results: The musculus uvulae was observed to be a paired midline muscle extending between the tensor aponeurosis anteriorly and the base of the uvula posteriorly along the nasal aspect of the velum. It had no attachments to the hard palate. Conclusions: These findings suggest that its action is to increase midline bulk on the nasal aspect of the velum, thus contributing to the levator eminence. It may also have an extensor effect on the nasal aspect of the velum, displacing it toward the posterior pharyngeal wall. Both of these actions would serve to maximize midline velopharyngeal contact. One clinical application of this anatomic information is that the muscle should be preserved in the dissection performed during intravelar veloplasty. Furthermore, it should be recognized that the musculus uvulae is invariably divided and reoriented incorrectly in the Furlow double opposing Z-plasty.

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Schwannoma of the posterior pharyngeal wall

The Journal of Laryngology & Otology ◽

10.1017/s0022215100131585 ◽

1995 ◽

Vol 109 (9) ◽

pp. 883-885 ◽

Cited By ~ 5

Author(s):

Bharath Singh ◽

Shanil Ramjettan ◽

Tej Prakash J. Maharaj ◽

Reena Ramsaroop

Keyword(s):

Male Patient ◽

Cervical Vertebra ◽

Posterior Pharyngeal Wall ◽

The Body ◽

Pharyngeal Wall ◽

The Third ◽

Large Size

AbstractSchwannoma of the posterior pharyngeal wall, in a 36-year-old male patient is presented demonstrating the asymptomatic nature of the tumour (which is peculiar to schwannomas). The tumour gradually increased in size, destroyed the body of the third cervical vertebra but remained asymptomatic. The patient only presented to hospital when the tumour obstructed the airway, because of its large size.

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Posterior Pharyngeal Wall Position in the Production of Speech

Journal of Speech Language and Hearing Research ◽

10.1044/1092-4388(2003/019) ◽

2003 ◽

Vol 46 (1) ◽

pp. 241-251 ◽

Cited By ~ 8

Author(s):

Harriet S. Magen ◽

A. Min Kang ◽

Mark K. Tiede ◽

D. H. Whalen

Keyword(s):

Cervical Vertebra ◽

Posterior Pharyngeal Wall ◽

Magnetic Resonance Images ◽

The Body ◽

Vowel Quality ◽

Anterior Portion ◽

Pharyngeal Wall ◽

X Ray ◽

Pharyngeal Region ◽

Wall Position

The posterior pharyngeal wall has been assumed to be stationary during speech. The present study examines this assumption in order to assess whether midsagittal widths in the pharyngeal region can be inferred from measurements of the anterior pharyngeal wall. Midsagittal magnetic resonance images and X-ray images were examined to determine whether the posterior pharyngeal wall from the upper oropharynx to the upper laryngopharynx shows anterior movement that can be attributed to variables in speech: vowel quality in both English and Japanese; vowels versus consonants as classes of speech sounds; sustained versus dynamically produced speech; and isolated words versus sentences. Measurements were made of the distance between the anterior portion of the vertebral body and the pharyngeal wall. The first measurement was on a line traversing the junction between the dens and the body of the second cervical vertebra (C2). The next three measurements were on lines at the inferior borders of the bodies of C2, C3, and C4. The measurements showed very little movement of the posterior pharyngeal wall, none of it attributable to speech variables. Therefore, the position of the posterior pharyngeal wall in this region can be eliminated as a variable, and the anterior portion of the pharynx alone can be used to estimate vocal cavities.

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Sphincter Pharyngoplasty for Velopharyngeal Dysfunction

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0052 ◽

2019 ◽

pp. 535-540

Author(s):

Donald S. Mowlds ◽

Raj M. Vyas

Keyword(s):

Sleep Apnea ◽

Upper Airway ◽

Posterior Pharyngeal Wall ◽

Upper Airway Obstruction ◽

Velopharyngeal Insufficiency ◽

Airway Compromise ◽

Lateral Pharyngeal Wall ◽

Pharyngeal Wall ◽

Velopharyngeal Closure ◽

Sphincter Pharyngoplasty

The surgical correction of velopharyngeal insufficiency (VPI) seeks to augment the deficient aspect of the velopharyngeal apparatus. The objective of the sphincter pharyngoplasty is to narrow the velopharyngeal gap transversely by addressing lateral pharyngeal wall motion. Superiorly based lateral palatopharyngeus myomucosal flaps are transposed 90 degrees and inset into the posterior pharyngeal wall mucosa. Following sphincter pharyngoplasty, the patient is monitored overnight for impending airway compromise. If symptomatic VPI persists, repeat diagnostic evaluation is performed. Success is determined by acceptable perceptual oral resonance, adequate velopharyngeal closure on endoscopy, and the absence of upper airway obstruction or sleep apnea.

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Schwannoma of the posterior pharyngeal wall: a case report

The Journal of Laryngology & Otology ◽

10.1017/s0022215100133079 ◽

1996 ◽

Vol 110 (2) ◽

pp. 170-171 ◽

Cited By ~ 10

Author(s):

Hidetoshi Haraguchi ◽

Tohru Ohgaki ◽

Hitoshi Hentona ◽

Atsushi Komatsuzaki

Keyword(s):

Case Report ◽

Posterior Pharyngeal Wall ◽

Pharyngeal Wall ◽

The Third ◽

Intraoral Approach

AbstractSchwannoma arising in the posterior pharyngeal wall is rare. We report on a 60-year-old man who complained of discomfort in his pharynx, from whom a tumour was excised via an intraoral approach. No recurrence was seen after an 11-year follow-up. The nerve origin of the tumour is most likely to be the peripharyngeal plexus. This is the third such case reported.

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A Computational Model Quantifies the Effect of Anatomical Variability on Velopharyngeal Function

Journal of Speech Language and Hearing Research ◽

10.1044/2015_jslhr-s-15-0013 ◽

2015 ◽

Vol 58 (4) ◽

pp. 1119-1133 ◽

Cited By ~ 13

Author(s):

Joshua M. Inouye ◽

Jamie L. Perry ◽

Kant Y. Lin ◽

Silvia S. Blemker

Keyword(s):

Computational Model ◽

Muscle Activation ◽

Posterior Pharyngeal Wall ◽

Speech Disorders ◽

Cross Sectional ◽

Pharyngeal Wall ◽

Large Variability ◽

Velopharyngeal Function ◽

Anatomical Parameters ◽

Outcome Metrics

Purpose This study predicted the effects of velopharyngeal (VP) anatomical parameters on VP function to provide a greater understanding of speech mechanics and aid in the treatment of speech disorders. Method We created a computational model of the VP mechanism using dimensions obtained from magnetic resonance imaging measurements of 10 healthy adults. The model components included the levator veli palatini (LVP), the velum, and the posterior pharyngeal wall, and the simulations were based on material parameters from the literature. The outcome metrics were the VP closure force and LVP muscle activation required to achieve VP closure. Results Our average model compared favorably with experimental data from the literature. Simulations of 1,000 random anatomies reflected the large variability in closure forces observed experimentally. VP distance had the greatest effect on both outcome metrics when considering the observed anatomic variability. Other anatomical parameters were ranked by their predicted influences on the outcome metrics. Conclusions Our results support the implication that interventions for VP dysfunction that decrease anterior to posterior VP portal distance, increase velar length, and/or increase LVP cross-sectional area may be very effective. Future modeling studies will help to further our understanding of speech mechanics and optimize treatment of speech disorders.

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Comparison of Cineradiographic and Photodetection Techniques for Assessing Velopharyngeal Function during Speech

Journal of Speech Language and Hearing Research ◽

10.1044/jshr.3004.564 ◽

1987 ◽

Vol 30 (4) ◽

pp. 564-569 ◽

Cited By ~ 7

Author(s):

Gerald Zimmermann ◽

Rodger M. Dalston ◽

Carolyn Brown ◽

John W. Folkins ◽

Raymond N. Linville ◽

...

Keyword(s):

High Speed ◽

Posterior Pharyngeal Wall ◽

Lateral View ◽

Two Dimensional ◽

Pharyngeal Wall ◽

Maximal Opening ◽

The Times ◽

Velopharyngeal Function ◽

Photodetector Device

This study investigated the extent to which high-speed lateral-view cineradiography and a photodetector system described by Dalston (1982) provided comparable information concerning velopharyngeal activity. We observed the production of isolated utterances and running speech for 2 subjects in three contexts. A comparison was made between the times at which the velopharyngeal port was observed by each method to begin opening, reach maximal opening, begin closing, and initially attain closure. The photodetector system was found to be sensitive to changes in velar position observed by cineradiography. The correlation between the magnitude of photodetector output and the magnitude of velar displacement from the posterior pharyngeal wall was .89 for Subject 1 and .78 for Subject 2. The lack of a perfect relation between the output of the photodetector device and movements of the velum observed by cineradiography was not unexpected given the two-dimensional limitation of lateral cineradiography and the complexity of events associated with changing port size. The significance of these findings is discussed with respect to the potential research and clinical uses of this photodetector system.

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