A Preoperative Appliance for a Newborn with Cleft Palate

2009 ◽  
Vol 46 (1) ◽  
pp. 53-57 ◽  
Author(s):  
Banu Karayazgan ◽  
Yumushan Gunay ◽  
Bahadir Gurbuzer ◽  
Mustafa Erkan ◽  
Arzu Atay
Keyword(s):  
Oral Cavity ◽  
Cleft Palate ◽  
Negative Pressure ◽  
Posterior Pharyngeal Wall ◽  
Surgical Correction ◽  
Nutritional Intake ◽  
Clinical Report ◽  
Modified Technique ◽  
Pharyngeal Wall ◽  
Affected Infant

Cleft palate is a commonly observed congenital maxillofacial defect. One of the most important problems with clefts is the interference with feeding. An affected infant cannot produce negative pressure in the oral cavity and therefore cannot move the bolus backward to the pharynx. To obtain better nutritional intake prior to surgical correction, a palatal lift obturator is recommended. In this clinical report, a modified technique of obturator fabrication is presented. The new method uses a piece of tulle, a flexible and durable material that is frequently used in theater attire. With the help of this material, the bulb part is connected to the plate as a labile piece, and this connection acts like a natural velopharyngeal extension. Additionally, because of the softer property of the silicone elastomer, the posterior pharyngeal wall is less irritated.

Compensatory Tongue-Palate-Posterior Pharyngeal Wall Relationships in Cleft Palate

1965 ◽  
Vol 30 (2) ◽  
pp. 166-173 ◽  
Author(s):  
Alta R. Brooks ◽  
Ralph L. Shelton ◽  
Karl A. Youngstrom
Keyword(s):  
Cleft Palate ◽  
Posterior Pharyngeal Wall ◽  
Pharyngeal Wall

Relationships between the Perception of Nasalization and Speech Movements in Speakers with Cleft Palate

1985 ◽  
Vol 28 (1) ◽  
pp. 63-72 ◽  
Author(s):  
Michael P. Karnell ◽  
John W. Folkins ◽  
Hughlett L. Morris
Keyword(s):  
Cleft Palate ◽  
High Speed ◽  
Posterior Pharyngeal Wall ◽  
The Other ◽  
Pharyngeal Wall ◽  
Acoustic Target ◽  
Temporal Measures ◽  
Target Syllable ◽  
Over Time

The purpose of this study was to examine the relationships between several temporal measures of speech movements and perceived nasalization in speakers with cleft palate. Four adult subjects with repaired cleft palate were filmed using high-speed (100 frames/s) cinefluorography as they produced target syllables embedded in a carrier phrase. Perceived nasalization of each extracted acoustic target syllable was rated by 18 trained judges. Movements of the tongue tip, tongue dorsum, jaw, velar knee, velar tip, and posterior pharyngeal wall were plotted over time. Time of movement onsets and movement offsets was identified from the plots. Voice onset and offset times were identified from the synchronized acoustic recordings. The findings indicate that normally expected velopharyngeal movements occurred near the time of jaw-lowering onset during nasalized CVC and CVN productions in two subjects who were judged to exhibit high levels of nasalization. The other two subjects showed no velopharyngeal movements during the CVC production. It is speculated that velopharyngeal movements normally expected in CVC utterances may be avoided by some speakers with cleft palate in order to minimize perceptible nasalization.

Management of Speech and Swallowing Disorders in Children with Oral Clefts

2019 ◽  
Author(s):  
Ravi K. Garg ◽  
Delora L Mount
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Treatment Options ◽  
Posterior Pharyngeal Wall ◽  
Diagnostic Tools ◽  
Pharyngeal Wall ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft. This review contains 1 figure, 3 videos, and 58 references.  Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Augmentation of Oral Tissues in Rabbit Using Autogenous Fat

1995 ◽  
Vol 32 (1) ◽  
pp. 1-6 ◽  
Author(s):  
John W. Canady ◽  
Sue Ann Thompson ◽  
Jerald B. Moon ◽  
Richard L. Glowacki
Keyword(s):  
Oral Cavity ◽  
Speech Therapy ◽  
Donor Site ◽  
Posterior Pharyngeal Wall ◽  
Donor Site Morbidity ◽  
Speech Disorders ◽  
Pharyngeal Wall ◽  
Synthetic Materials ◽  
Velopharyngeal Incompetence ◽  
The Stability

Patients with mild velopharyngeal incompetence (VPI) may have speech disorders, which are not sufficiently severe to warrant extensive surgical intervention, yet may not be amenable to correction by speech therapy alone. Augmentation of the posterior pharyngeal wall to aid in closure of the velopharyngeal sphincter may be beneficial in establishing better speech patterns, especially when combined with speech therapy. A variety of materials and techniques have been used in the past for this purpose. In this setting, autogenous fat may be transplanted without the risks incurred by augmentation with synthetic materials and involves very little donor site morbidity. The literature is somewhat contradictory, however, regarding the stability of the augmentation achieved using autogenous fat and there are no histologic studies describing the fate of fat injected into tissues of the oral cavity. Prior to introduction of this technique into clinical practice, this study was designed to investigate the fate of autogenous fat injected submucosally in the oropharyngeal region. Autogenous fat was injected into the anterior soft palate using the rabbit as a model. Histologic and gross inspections were performed at 2 days, 1, 2, and 4 weeks after injections. At the end of 4 weeks, at least 50% of the injection sites had visible evidence of augmentation, and 90% had histologic evidence of submucosal fat. In some instances most of the fat was resorbed; however, there were no instances of clinical infection or necrosis of the injection site. We conclude that submucosal injection of autogenous fat is a feasible alternative to using synthetic or other biologic materials for augmentation in the oral cavity.

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.

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

1997 ◽  
Vol 34 (6) ◽  
pp. 466-474 ◽  
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.

The Effect of Preoperative Use of an Orthopedic Plate on Articulatory Function in Children with Cleft Lip and Palate

2006 ◽  
Vol 43 (4) ◽  
pp. 406-414 ◽  
Author(s):  
Keiko Suzuki ◽  
Yasuharu Yamazaki ◽  
Kouichiro Sezaki ◽  
Nobuaki Nakakita
Keyword(s):  
Oral Cavity ◽  
Cleft Palate ◽  
Outcome Measures ◽  
Negative Pressure ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Control Group ◽  
Bilateral Cleft Lip ◽  
Tongue Movements ◽  
Continuous Use

Objective To evaluate the effect of preoperative use of an orthopedic plate (OP) on postoperative articulatory function in children with cleft lip and palate. Subjects The subjects had complete unilateral or bilateral cleft lip and palate and were scheduled for a one-stage palatoplasty. Main Outcome Measures Tongue movements during sucking were analyzed by ultrasonography. Postoperative articulatory behavior was also assessed at 5 years 4 months of age. Results There was an excessive downward excursion of the rear portion of the tongue during sucking regardless of the use or nonuse of the OP. This indicated that infants with cleft palate could not create negative pressure in the oral cavity, even with the OP. However, the OP appeared effective for preventing irregular movements of the tongue during sucking. The proportion of subjects obtaining excellent articulation was significantly higher in the group using the OP until palatoplasty than in the group who did not continue using the OP. The proportion of subjects with disturbed articulatory function in the latter group was comparable with that in the control group, who never used the OP. Conclusions Continuous use of the OP up to the time of palatoplasty appeared to be effective for the postoperative articulatory function in children with complete cleft lip and palate. Inhibiting irregular movements of the tongue, the OP might assist in preventing “palatalized articulation.”

Sign in / Sign up

Export Citation Format

Share Document