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.

Comparison of Nasopharyngeal Growth between Patients with Clefts and Noncleft Controls

1997 ◽  
Vol 34 (5) ◽  
pp. 405-409 ◽  
Author(s):  
Takeshi Wada ◽  
Koichi Satoh ◽  
Takashi Tachimura ◽  
Unai Tatsuta
Keyword(s):  
Soft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cervical Vertebrae ◽  
Cranial Base ◽  
Velopharyngeal Incompetence ◽  
Stage 4 ◽  
Posterior Maxilla ◽  
Lateral Cephalograms ◽  
Upper Cervical

Objective: This study was a comparison of the cephalometric growth characteristics of the nasopharyngeal structures between UCLP and noncleft controls. Method: Eighty patients with complete unilateral cleft lip and palate (UCLP group) and 82 noncleft controls (NCC group) were assigned to four develop mental stages (i.e., stage 1, at 4 years; stage 2, at 8 years; stage 3, at 12 years; and stage 4, at 17 years of age). Measurements on the anteroposterior and the vertical dimensions were derived from reference lines and points of nasopharyngeal structures on the lateral cephalograms. Results: The results showed that there were no growth differences between the two groups at any stages in the regions of cranial base and cervical vertebrae, and that growth of the posterior maxilla in the UCLP group was significantly less at any stage in both A-P and vertical dimensions than in the NCC groups. As well, the nasopharyngeal triangle (Ho-At-PMP) in the groups showed almost parallel increase with stage, though with short vertical dimension in the UCLP group, and the soft palate length in the UCLP group was significantly less at stages 2, 3, and 4 compared to that in the NCC group. The adequate ratio (soft palate length/pharyngeal depth) in the UCLP group tended to decrease and was significantly less at stage 4 compared to that in the NCC group. Conclusions: These results indicate that the growth of the cranial base and the upper cervical vertebrae is independent of the effect of clefts or of surgeries on clefts, and that the growth inhibition at the posterior maxilla results in morphologic disharmony of upper nasopharyngeal structures. This could be a potential factor for the reappearance of velopharyngeal incompetence at a later age.

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.

Treatment of Stress Velopharyngeal Incompetence With Injection of Hyaluronic Acid

2017 ◽  
Vol 55 (4) ◽  
pp. 615-618 ◽  
Author(s):  
Steven Koprowski ◽  
Michael J. VanLue ◽  
Michael E. McCormick
Keyword(s):  
Hyaluronic Acid ◽  
Posterior Pharyngeal Wall ◽  
Clinical Entity ◽  
Multidisciplinary Management ◽  
Pharyngeal Wall ◽  
Safety And Efficacy ◽  
Velopharyngeal Incompetence ◽  
Acid Compound

Stress velopharyngeal incompetence (VPI) is a challenging clinical entity that can be managed by a variety of surgical and nonsurgical approaches. We describe the case of a clarinetist who presented with nasal air escape while playing. She had successful improvement in her symptoms after targeted injection of a hyaluronic acid compound to her posterior pharyngeal wall. Our objective is to describe the safety and efficacy of this technique, to emphasize the multidisciplinary management of patients with stress VPI, and to review the importance of both nasopharyngoscopy and videofluoroscopy in their evaluation.

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.

Surgical Management of Velopharyngeal Incompetence in Velocardiofacial Syndrome

2004 ◽  
Vol 41 (2) ◽  
pp. 124-135 ◽  
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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