Morphological Evaluation of Changes in Velopharyngeal Function following Maxillary Distraction in Patients with Repaired Cleft Palate during Mixed Dentition

2004 ◽  
Vol 41 (4) ◽  
pp. 355-363 ◽  
Author(s):  
Koichi Satoh ◽  
Junko Nagata ◽  
Kenji Shomura ◽  
Takeshi Wada ◽  
Takashi Tachimura ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Morphological Changes ◽  
Mixed Dentition ◽  
Velopharyngeal Insufficiency ◽  
Pharyngeal Wall ◽  
Lateral Cephalograms ◽  
Before And After ◽  
Velopharyngeal Function ◽  
Maxillary Distraction ◽  
Pharyngeal Depth

Objective To describe the morphological changes of nasopharyngeal components after maxillary distraction and clarify whether the morphological characteristics are related to velopharyngeal function (VPF). Design Perceptual judgments of hypernasality and nasendoscopy were performed before and after treatment. Lateral cephalograms were obtained to describe the morphological changes. Setting Department of Oral and Maxillofacial Surgery, Miyazaki Medical College, Miyazaki, Japan. Participants Nine patients with repaired cleft palate in the mixed dentition stage underwent maxillary distraction using a face mask and an intraoral fixed appliance system. Outcome Measures The severity of hypernasality, velopharyngeal insufficiency, and measurements such as pharyngeal depth, velar length, and the rotation of the palatal plane were evaluated. Results Increase in pharyngeal depth was not always proportional to the amount of advancement. It depended on the posture of the posterior pharyngeal wall and the rotation of palatal plane. Conclusion Cephalometric measurements of the nasopharynx before and after surgery confirmed subsequent changes in VPF. These were suggested to be useful in predicting future VPF. When performing maxillary distraction in patients with cleft palate in the mixed dentition stage, and when velopharyngeal closure is found to occur by velar contact against the hypertrophied adenoid, patients should be counseled about risks of subsequent deterioration in their speech before surgery.

Changes in Speech following Maxillary Distraction Osteogenesis

2001 ◽  
Vol 38 (3) ◽  
pp. 199-205 ◽  
Author(s):  
Thomas W. Guyette ◽  
John W. Polley ◽  
Alvaro Figueroa ◽  
Bonnie E. Smith
Keyword(s):  
Outcome Measures ◽  
Distraction Osteogenesis ◽  
Care Center ◽  
Velopharyngeal Insufficiency ◽  
Clinical Report ◽  
Health Care Center ◽  
Before And After ◽  
Velopharyngeal Function ◽  
Maxillary Distraction

Objective: The purpose of this study was to describe changes in articulation and velopharyngeal function following maxillary distraction osteogenesis. Design: This is a descriptive, post hoc clinical report comparing the performance of patients before and after maxillary distraction. The independent variable was maxillary distraction while the dependent variables were resonance, articulation errors, and velopharyngeal function. Setting: The data were collected at a tertiary health care center in Chicago. Patients: The data from pre- and postoperative evaluations of 18 maxillary distraction patients were used. Outcome Measures: The outcome measures were severity of hypernasality and hyponasality, velopharyngeal orifice size as estimated using the pressure-flow technique, and number and type of articulation errors. Results: At the long-term follow-up, 16.7% exhibited a significant increase in hypernasality. Seventy-five percent of patients with preoperative hyponasality experienced improved nasal resonance. Articulation improved in 67% of patients by the 1-year follow-up. Conclusions: In a predominately cleft palate population, the risk for velopharyngeal insufficiency following maxillary distraction is similar to the risk observed in Le Fort I maxillary advancement. Patients being considered for maxillary distraction surgery should receive pre- and postoperative speech evaluations and be counseled about risks for changes in their speech.

Long-term Morphological Changes of the Velum and the Nasopharynx in Patients With Cleft Palate

2021 ◽  
pp. 105566562110452
Author(s):  
Takeshi Harada ◽  
Tadashi Yamanishi ◽  
Takayuki Kurimoto ◽  
Setsuko Uematsu ◽  
Yuri Yamamoto ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Cleft Lip ◽  
Morphological Changes ◽  
Morphological Development ◽  
Depth Ratio ◽  
Lateral Cephalograms ◽  
Velopharyngeal Closure ◽  
Pharyngeal Depth

Objective To investigate long-term morphological changes in the soft palate length and nasopharynx in patients with cleft palate. We hypothesized that there would be differences in the morphological development of the soft palate and nasopharynx between patients with and without cleft palate and that these developmental changes would negatively affect the soft palate length to pharyngeal depth ratio involved in velopharyngeal closure for patients with cleft palate. Design Retrospective, case-control study. Setting Institutional practice. Patients Ninety-two patients (Group F) with unilateral cleft lip, alveolus, and palate and 67 patients (Group CLA) with unilateral cleft lip and alveolus not requiring palatoplasty were included. Main Outcome Measures The soft palate length, nasopharyngeal size, and soft palate length to pharyngeal depth ratio were measured via lateral cephalograms obtained at three different periods. Results Group F showed a shorter soft palate length and smaller nasopharyngeal size than Group CLA at all periods. Both these parameters increased with age, but the increase in amount was significantly less in Group F compared with that in Group CLA. The soft palate length to pharyngeal depth ratio in Group F decreased with age. Conclusions In patients with cleft palate, the soft palate length to pharyngeal depth ratio, which is involved in velopharyngeal closure, can change with age. Less soft palate length growth and unfavorable relationship between the soft palate and nasopharynx may be masked in early childhood but can manifest later on with age.

scholarly journals Speech Outcomes after Tonsillectomy in Patients with Known Velopharyngeal Insufficiency

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
L. M. Paulson ◽  
C. J. MacArthur ◽  
K. B. Beaulieu ◽  
J. H. Brockman ◽  
H. A. Milczuk
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Speech Intelligibility ◽  
Velopharyngeal Insufficiency ◽  
Speech Evaluation ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Before And After ◽  
History Of

Introduction. Controversy exists over whether tonsillectomy will affect speech in patients with known velopharyngeal insufficiency (VPI), particularly in those with cleft palate.Methods. All patients seen at the OHSU Doernbecher Children's Hospital VPI clinic between 1997 and 2010 with VPI who underwent tonsillectomy were reviewed. Speech parameters were assessed before and after tonsillectomy. Wilcoxon rank-sum testing was used to evaluate for significance.Results. A total of 46 patients with VPI underwent tonsillectomy during this period. Twenty-three had pre- and postoperative speech evaluation sufficient for analysis. The majority (87%) had a history of cleft palate. Indications for tonsillectomy included obstructive sleep apnea in 11 (48%) and staged tonsillectomy prior to pharyngoplasty in 10 (43%). There was no significant difference between pre- and postoperative speech intelligibility or velopharyngeal competency in this population.Conclusion. In this study, tonsillectomy in patients with VPI did not significantly alter speech intelligibility or velopharyngeal competence.

Skeletal Response to Maxillary Protraction in Patients with Cleft Lip and Palate before Age 10 Years

1994 ◽  
Vol 31 (4) ◽  
pp. 295-308 ◽  
Author(s):  
Rolf S. Tindlund
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Poor Response ◽  
Mixed Dentition ◽  
Forward Movement ◽  
Maxillary Protraction ◽  
Face Height ◽  
Lateral Cephalograms ◽  
Before And After ◽  
Maxillary Dentition

Over the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP Team have received interceptive orthopedic treatment to correct anterior and posterior crossbites during the deciduous and mixed dentition periods. The present study comprises 72 subjects of various cleft types with anterior crossbite, treated to an acceptable positive overjet by maxillary protraction using a facial mask (Delaire). Lateral cephalograms were taken immediately before and after the active treatment periods. Individuals exhibiting a favorable (fair) skeletal response to the protraction were compared with those who revealed little, (poor) skeletal response. Two cephalometric variables were chosen for the evaluation of the sagittal skeletal treatment changes: (1) the sagittal maxillomandibular change (change of angle ss-n-sm [ANB]); and (2) the forward movement of the maxilla (change of distance NSP-maxp), where maxp (maxillary point) represents the anterior contour of maxilla and NSP is the perpendicular to the naslon-sella-line (NSL) through sella. A numerical change greater than or equal to the value 1.5 (degrees or mm, respectively) was classified as fair versus poor response revealing a change less than 1.5. Fair-response (favorable response) of sagittal maxillomandibular change was found in 63 % of the cases (mean increase of angle ANB was 3.3 degrees), more often when protraction started early. The length of maxilla was increased, the skeletal maxilla was moved forward 1.8 mm, the upper dentition advanced 3.6 mm, the occlusal line was clockwise rotated, and the anterior face height was increased. Similarly, fair-response of forward movement of maxilla was found in 44% of the cases (mean increase of distance NSP-maxp was 2.4 mm), more often when protraction was started early and after long treatment duration. The maxillary prognathism increased 1.8 degrees, the angle ANB increased 3 degrees, the length of maxilla increased 1.5 mm, and the upper dentition was advanced 3.7 mm. The anterior face height increased with counterclockwise rotation of the nasal line, whereas the occlusal line was clockwise rotated. A paired fair-response of both skeletal maxillomandibular change and skeletal forward movement of maxilla was found in 35% of the cases. During protraction the mean increase of maxillary prognathism was 2.1 degrees, the maxilla moved forward 3.1 mm, the maxillary dentition advanced 4.3 mm, the maxillary length increased 1.9 mm, the ANB angle increased 3.7 degrees, and the lower anterior facial height increased 3.4 mm.

Treatment of Asymmetric Velopharyngeal Insufficiency with Skewed Pharyngeal Flap

1994 ◽  
Vol 31 (4) ◽  
pp. 287-294 ◽  
Author(s):  
Ravelo V. Argamaso ◽  
Gerald J. Levandowski ◽  
Karen J. Golding-Kushner ◽  
Robert J. Shprintzen
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Tumor Resection ◽  
Velocardiofacial Syndrome ◽  
Velopharyngeal Insufficiency ◽  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Wall Movement ◽  
Hypernasal Speech

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.

Velopharyngeal Function in Nonsyndromic Cleft Palate: Relevance of Surgical Technique, Age at Repair, and Cleft Type

1998 ◽  
Vol 35 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Eileen M. Marrinan ◽  
Richard A. Labrie ◽  
John B. Mulliken
Keyword(s):  
Surgical Technique ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Velopharyngeal Insufficiency ◽  
Significant Variable ◽  
Muscle Complex ◽  
Cleft Lip Palate ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function ◽  
Repair Group

Objective The goal of this study was to determine the relative importance of surgical technique, age at repair, and cleft type for velopharyngeal function. Design This was a retrospective study of patients operated on by two surgeons using different techniques (von Langenbeck and Veau-Wardill-Kilner [VY]) at Children's Hospital, Boston, MA. Patients We included 228 patients who were at least 4 years of age at the time of review. Patients with identifiable syndromes, nonsyndromic Robin sequence, central nervous system disorders, communicatively significant hearing loss, and inadequate speech data were excluded. Main Outcome Measure Need for a pharyngeal flap was the measure of outcome. Results Pharyngeal flap was necessary in 14% of von Langenbeck and 15% of VY repaired patients. There was a significant linear association (p = .025) between age at repair and velopharyngeal insufficiency (VPI). Patients with an attached vomer, soft cleft palate (SCP), and unilateral cleft lip/palate (UCLP) had a 10% flap rate, whereas those with an unattached vomer, hard/soft cleft palate (HSCP), and bilateral cleft lip/palate (BCLP) had a 23% flap rate (p = .03). Age at repair was critical for the unattached-vomer group (p = .03) but was not statistically significant for the attached-vomer group (p = .52). Conclusions Surgical technique was not a significant variable either in aggregate or for the Veau types. Patients in the earliest repair group (8-10 months) were the least likely to require a pharyngeal flap. Early repair was more critical for HSCP and BCLP patients. There was no correlation between velopharyngeal insufficiency and Veau hierarchy. The attached vomer/levator muscle complex may be a more important predictor of surgical success than the anatomic extent of cleft.

Velopharyngeal Morphology of Patients with Persistent Velopharyngeal Incompetence following Repushback Surgery for Cleft Palate

2003 ◽  
Vol 40 (6) ◽  
pp. 612-617 ◽  
Author(s):  
Norifumi Nakamura ◽  
Yuko Ogata ◽  
Kyoko Kunimitsu ◽  
Akira Suzuki ◽  
Masaaki Sasaguri ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cervical Vertebrae ◽  
Posterior Pharyngeal Wall ◽  
Cranial Base ◽  
Normal Children ◽  
Pharyngeal Wall ◽  
Velopharyngeal Incompetence ◽  
Posterior Maxilla ◽  
Dental Hospital ◽  
Pharyngeal Depth

Objective To characterize the velopharyngeal morphology of patients with persistent velopharyngeal incompetence (VPI) following repushback surgery for cleft palate. Participants Seven patients with moderate to severe VPI following repushback surgery for secondary correction of cleft palate, and 14 patients who had already obtained complete velopharyngeal closure function (VPF) were enrolled. Control data were obtained from the longitudinal files of 20 normal children in Kyushu University Dental Hospital. Main Outcome Measures Skeletal landmarks and measurements were derived from tracing of lateral roentgenographic cephalograms. The measurements included velar length, pharyngeal depth, and pharyngeal height and the ratio of velar length to pharyngeal depth. Additionally, the configuration of the upper pharynx (pharyngeal triangle) involving the cranial base, cervical vertebrae, and the posterior maxilla and also the position of posterior pharyngeal wall (PPW) in the pharyngeal triangle were analyzed. Results The VPI group had a significantly shorter velar length and greater pharyngeal depth, resulting in a smaller length/depth ratio than the controls. The points of PPW and cervical vertebrae of the VPI group were located more posteriorly and inferiorly than those in the group with complete VPF after the primary operation and the controls. The positions of cranial base and maxilla were not significantly different. Additionally, the position of PPW in the pharyngeal triangle was located significantly posteriorly and superiorly in the VPI group, compared with the controls. Conclusions The craniopharyngeal morphology of patients with persistent VPI was characterized by a short palate, wide-based and counterclockwise-rotated pharyngeal triangle, and posteriorly and superiorly positioned PPW. These might be contributory factors for the prediction of VPF before repushback surgery for cleft palate.

Sign in / Sign up

Export Citation Format

Share Document