Ultrasonic detection of lateral pharyngeal wall movement

Twenty-two patients, with hypernasal speech and asymmetric velopharyngeal insufficiency (VPI) identified preoperatively by multi-view videofluoroscopy and nasopharyngoscopy, were managed with superiorly based pharyngeal flaps skewed to the side with reduced lateral pharyngeal wall movement. Patient age ranged from 5 to 58 years. The etiology of the VPI included cleft palate with or without cleft lip, neurogenic VPI, velocardiofacial syndrome, tumor resection or latrogenic causes, submucous cleft palate, neurofibromatosis, and hemifacial microsomia. Follow-up, at 1 year and thereafter, showed resolution of VPI in all but two patients. An auxiliary flap to augment the primary flap was added on the side of diminished lateral pharyngeal wall motion which corrected the residual VPI. Three patients developed hyponasality. One was a child whose symptoms improved with time and growth. Two were adults, but the hyponasal resonance was mild and required no further Intervention. The advantage of skewing flaps is that at least one port functions adequately for ease in respiration and for drainage of secretions, thus reducing the risk of nasal obstruction. One open port also allows access for nasoendotracheal intubation should anesthetic be required for future operations.

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The Submentovertical Projection in the Radiographic Analysis of Velopharyngeal Dynamics

Journal of Speech and Hearing Disorders ◽

10.1044/jshd.3804.473 ◽

1973 ◽

Vol 38 (4) ◽

pp. 473-477 ◽

Cited By ~ 1

Author(s):

Daniel H. Zwifman ◽

Michael T. Gyepes ◽

Frederick Sample

Keyword(s):

Normal Subjects ◽

Radiographic Analysis ◽

Lateral Pharyngeal Wall ◽

Pharyngeal Wall ◽

Lateral Projection ◽

Wall Movement ◽

Normal Individuals ◽

Pharyngeal Flap ◽

Surrounding Areas

In assessing lateral pharyngeal wall movement during routine cinefluorographic examination for velopharyngeal adequacy, the inclusion of submentovertical projection is important to the lateral projection of the velum. The main structures of the nasopharynx and surrounding areas are defined, and a method to obtain visualization of this area in normal subjects is described. The degree of lateral pharyngeal wall movement varies among normal individuals and may affect the success of pharyngeal flap operations in patients with velopharyngeal inadequacy.

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The Role of Lateral Pharyngeal Wall Movement in Pharyngeal Flap Surgery

Plastic & Reconstructive Surgery ◽

10.1097/00006534-198008000-00007 ◽

1980 ◽

Vol 66 (2) ◽

pp. 214-219 ◽

Cited By ~ 61

Author(s):

Ravelo V. Argamaso ◽

Robert J. Shprintzen ◽

Berish Strauch ◽

Michael L. Lewin ◽

Avron I. Daniller ◽

...

Keyword(s):

Lateral Pharyngeal Wall ◽

Flap Surgery ◽

Pharyngeal Wall ◽

Wall Movement ◽

Pharyngeal Flap

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Lateral Pharyngeal Wall Movement During Speech Production

Journal of Speech and Hearing Research ◽

10.1044/jshr.1303.584 ◽

1970 ◽

Vol 13 (3) ◽

pp. 584-594 ◽

Cited By ~ 29

Author(s):

Fred D. Minifie ◽

Thomas J. Hixon ◽

Charles A. Kelsey ◽

Robert J. Woodhouse

Keyword(s):

Speech Production ◽

Stop Consonants ◽

Lateral Pharyngeal Wall ◽

Pulsed Ultrasound ◽

Pharyngeal Wall ◽

Wall Movement ◽

Time Motion ◽

High Vowels ◽

Motion Method

Movement of one lateral pharyngeal wall during the production of VCVCV trisyllables was monitored via pulsed ultrasound using a time-motion method of display. Three normal speakers produced the six English stop consonants* combined with five vowels. The extent of lateral pharyngeal wall movement was found to be greatest on low vowels and least on high vowels. Pharyngeal wall movement during consonant production appeared to be dependent on the adjacent vowels.

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Multicenter Interrater Reliability in the Endoscopic Assessment of Velopharyngeal Function Using a Video Instruction Tool

Otolaryngology ◽

10.1177/0194599818822989 ◽

2019 ◽

Vol 160 (4) ◽

pp. 720-728 ◽

Cited By ~ 1

Author(s):

Craig Miller ◽

Randall Bly ◽

Shelagh Cofer ◽

John P. Dahl ◽

Lianne de Serres ◽

...

Keyword(s):

Posterior Pharyngeal Wall ◽

Interrater Agreement ◽

Categorical Variables ◽

Gap Size ◽

Lateral Pharyngeal Wall ◽

Video Instruction ◽

Pharyngeal Wall ◽

Wall Movement ◽

Before And After ◽

Endoscopic Assessment

Objective Assess interrater agreement of endoscopic assessment of velopharyngeal (VP) function before and after viewing the video instruction tool (VIT). We hypothesized improvement in interrater agreement using the Golding-Kushner scale (GKS) after viewing the VIT. Study Design Prospective study. Setting Multi-institutional. Methods Sixteen fellowship-trained pediatric otolaryngologists who treat velopharyngeal insufficiency (VPI) rated 50 video segments using the GKS before and after watching the VIT. Raters assessed gap size percentage and lateral pharyngeal wall (LPW), soft palate (SP), and posterior pharyngeal wall (PPW) movement. Intraclass correlation coefficient was estimated for these continuous measures. Raters also indicated the presence of a palatal notch, Passavant’s ridge, and aberrant pulsations (categorical variables). Fleiss κ coefficient was used for categorical variables. Wilcoxon signed-rank test was performed on the difference between the pre/post individual video ratings. Results Reliability improved for all continuous variables after watching the instructional video. The improvement was significant for PPW (0.22-0.30, P < .001), SP (left: 0.63-0.68, P < .001 and right: 0.64-0.68, P = .001), and LPW (left: 0.49-0.54, P = .01 and right: 0.49-0.54, P = .09) but not significant for gap size (0.65-0.69, P = .36). Among categorical variables, agreement on Passavant’s ridge significantly improved (0.30-0.36, P = .03). Conclusion Exposure to a video instruction tool improves interrater agreement of endoscopic assessment of VP function. Significant improvement was observed in our primary end points, specifically posterior pharyngeal wall movement, soft palate movement, and lateral pharyngeal wall movement. There was less impact of the VIT on the interrater agreement of the categorical variables, palatal notch, Passavant’s ridge, and aberrant pulsations.

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