ASSESSMENT OF THE EFFECT OF PUSHBACK Z-PLASTY METHOD ON THE FUNCTION OF VELOPHARYNGEAL AND ARTICULATION IN POST-RECONSTRUCTION CLEFT PALATE PATIENTS IN HARAPAN KITA CHILDREN AND MATERNITY HOSPITAL JAKARTA

2017 ◽  
Vol 20 (1) ◽  
pp. 1-7
Author(s):  
Olivia Avriyanti Hanafiah ◽  
Kasman Manullang ◽  
Mantra Firman ◽  
Muhammad Syafrudin Hak
Keyword(s):  
Cleft Palate ◽  
Nasal Mucosa ◽  
Speech Intelligibility ◽  
Maternity Hospital ◽  
Speech Articulation ◽  
Articulation Disorder ◽  
Cephalometric Radiograph ◽  
Velopharyngeal Function ◽  
Patients Experience ◽  
Nasal Emission

Cleft palate patients experience various problems, especially those affecting their speech intelligibility, such as speech articulation disorder. The aim of this research was to prove the effect of cleft palate reconstruction with modified pushback z–plasty technique at the nasal mucosa on velopharyngeal function and articulation function in speaking. A research has been conducted on post-reconstruction cleft palate patients by using modified pushback z-plasty technique at the nasal mucosa. The methods were examining velopharyngeal components with cephalometric radiograph, assessing airflow released from the nose when the patients pronounce vowel ‘a’ using nasal emission device and assessing speech articulation results through Sehati Program at Harapan Kita Children and Maternity Hospital, Jakarta. The research results showed that there was a statistically significant effect of cleft palate reconstruction with pushback z-plasty technique at the nasal mucosa on velopharyngeal function, and there was a statistically significant effect of cleft palate reconstruction with pushback z-plasty technique at the nasal mucosa on articulation function in speaking. In addition, there was also a statistically significant correlation between velopharyngeal function and speech articulation function of post-reconstruction cleft palate patients with pushback z-plasty technique at the nasal mucosa based on the cephalometric radiograph, but the result was not significant statistically based on nasal emission assessment.

Nasalance Scores in Wearers of a Palatal Lift Prosthesis in Comparison with Normative Data for Japanese

2004 ◽  
Vol 41 (3) ◽  
pp. 315-319 ◽  
Author(s):  
Takashi Tachimura ◽  
Yasuko Kotani ◽  
Takeshi Wada
Keyword(s):  
Cleft Palate ◽  
Outcome Measures ◽  
Normative Data ◽  
Normal Limits ◽  
Velopharyngeal Incompetence ◽  
The Mean ◽  
Velopharyngeal Function ◽  
Normative Score ◽  
Nasal Emission ◽  
Normal Controls

Objective This study was designed to examine whether nasalance score is changed in association with placement of a palatal lift prosthesis (PLP) and whether normative data previously reported are applicable to evaluate the effect of a PLP on velopharyngeal function as it relates to nasality. Design Nasalance scores were obtained as subjects read the Kitsutsuki Passage three times with the PLP in place and then removed. Participants Forty-three children (mean age 9.0 years, SD = 3.6 years) with repaired cleft palate who were treated with a PLP were selected as subjects. Their speech was characterized by nasal emission of air, slight hypernasality without a PLP but within normal limits with a PLP in place, or both. Main Outcome Measures Comparisons were made between normative scores and the average mean nasalance score of subjects with and without the PLP. Results Average values of the mean nasalance score for subjects were 17.3% (SD 7.6%) with the PLP in place and 33.5% (SD 13.3%) without the PLP in place. These scores were greater than the mean score of 9.1% (SD 3.9%) obtained from normal controls previously reported. Conclusion A PLP can decrease nasalance scores for speakers with repaired cleft palate who exhibit velopharyngeal incompetence. It was suggested that the normative score obtained from normal adult speakers is not applicable to evaluate the effect of a PLP to improve velopharyngeal function for children wearing the PLP.

scholarly journals Evaluación perceptual de la insuficiencia velofaríngea en personas con fisura del paladar: una revisión integradora de literatura

2021 ◽  
pp. 1
Author(s):  
Felipe Inostroza-Allende ◽  
Gustavo Baeza-Pavez ◽  
Paula Del-Valle-Román ◽  
Jason Fernández-Antifil ◽  
Constanza Yáñez-Pavez ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Speech Production ◽  
Speech Intelligibility ◽  
Velopharyngeal Insufficiency ◽  
Speech Language Pathology ◽  
Speech Articulation ◽  
Cleft Palate Speech ◽  
Language Pathology ◽  
Production Measurement

La insuficiencia velofaríngea (IVF) secundaria de fisura del paladar corresponde al cierre incompleto del mecanismo velofaríngeo durante el habla, debido a una falta de tejido en el paladar blando o las paredes de la faringe, lo cual genera una resonancia hipernasal y una emisión nasal de aire en los sonidos orales. Al respecto, en la literatura existen diversas propuestas para la evaluación perceptual de la IVF. Por esto, el objetivo del presente estudio es describir la evaluación perceptiva auditiva de la insuficiencia velofaríngea, mediante una revisión integradora de literatura. Para ello, en mayo de 2020 las bases de datos electrónicas PUBMED, LILACS, SciELO y Cochrane, fueron consultadas utilizando las palabras claves en inglés: “Velopharyngeal Sphincter”, “Velopharyngeal Insufficiency”, “Cleft Palate”, “Speech Intelligibility”, “Speech Production Measurement”, “Speech Articulation Tests” y “Speech-Language Pathology” y sus respectivos equivalentes en portugués y español. Se seleccionaron artículos originales relacionados al tema, y se creó un protocolo específico para la extracción de los datos. En total se encontraron 2.385 artículos. De ellos, 2.354 fueron excluidos por el título, 13 por el resumen y 3 luego de la lectura del texto completo. Finalmente, a partir de la metodología desarrollada, en esta revisión fueron utilizados 33 artículos. A partir de la revisión realizada se concluye que los parámetros más utilizados en la evaluación son la hipernasalidad, la emisión nasal y la articulación compensatoria asociada a IVF. Estos parámetros son evaluados principalmente en oraciones, habla espontánea y palabras, por un fonoaudiólogo experto, en vivo y mediante grabaciones de audio.

Instrumental Assessment in Cleft Palate Care

2013 ◽  
Vol 23 (2) ◽  
pp. 49-61 ◽  
Author(s):  
Jamie Perry ◽  
Graham Schenck
Keyword(s):  
Cleft Palate ◽  
New Developments ◽  
Perceptual Evaluation ◽  
Advantages And Disadvantages ◽  
Instrumental Assessment ◽  
Speech Language Pathologist ◽  
Hypernasal Speech ◽  
Perceptual Assessment ◽  
Velopharyngeal Function ◽  
And Function

Despite advances in surgical management, it is estimated that 20–30% of children with repaired cleft palate will continue to have hypernasal speech and require a second surgery to create normal velopharyngeal function (Bricknell, McFadden, & Curran, 2002; Härtel, Karsten, & Gundlach, 1994; McWilliams, 1990). A qualitative perceptual assessment by a speech-language pathologist is considered the most important step of the evaluation for children with resonance disorders (Peterson-Falzone, Hardin-Jones, & Karnell, 2010). Direct and indirect instrumental analyses should be used to confirm or validate the perceptual evaluation of an experienced speech-language pathologist (Paal, Reulbach, Strobel-Schwarthoff, Nkenke, & Schuster, 2005). The purpose of this article is to provide an overview of current instrumental assessment methods used in cleft palate care. Both direct and indirect instrumental procedures will be reviewed with descriptions of the advantages and disadvantages of each. Lastly, new developments for evaluating velopharyngeal structures and function will be provided.

Perceptual Speech Outcomes After Early Primary Palatal Repair in Ugandan Patients With Cleft Palate

2020 ◽  
pp. 105566562098024
Author(s):  
Kim Bettens ◽  
Laura Bruneel ◽  
Cassandra Alighieri ◽  
Daniel Sseremba ◽  
Duncan Musasizib ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Control Group ◽  
English Speaking ◽  
And Gender ◽  
Early Primary ◽  
Velopharyngeal Function ◽  
Normal Speech

Objective: To provide speech outcomes of English-speaking Ugandan patients with a cleft palate with or without cleft lip (CP±L). Design: Prospective case–control study. Setting: Referral hospital for patients with cleft lip and palate in Uganda. Participants: Twenty-four English-speaking Ugandan children with a CP±L (15 boys, 9 girls, mean 8.4 years) who received palatal closure prior to 6 months of age and an age- and gender-matched control group of Ugandan children without cleft palate. Interventions: Comparison of speech outcomes of the patient and control group. Main Outcome Measures: Perceptual speech outcomes including articulation, resonance, speech understandability and acceptability, and velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary surgery. Results: Normal speech understandability was observed in 42% of the patients, and 38% were judged with normal speech acceptability. Only 16% showed compensatory articulation. Acceptable resonance was found in 71%, and 75% of the patients were judged perceptually to present with competent velopharyngeal function based on the VPC-sum. Additional speech intervention was recommended in 25% of the patients. Statistically significant differences for all these variables were still observed with the control children ( P < .05). Conclusions: Overall, acceptable speech outcomes were found after early primary palatal closure. Comparable or even better results were found in comparison with international benchmarks, especially regarding the presence of compensatory articulation. Whether this approach is transferable to Western countries is the subject for further research.

Nasal Emission as a Component of the Misarticulation of Sibilants and Affricates

1975 ◽  
Vol 40 (1) ◽  
pp. 106-114 ◽  
Author(s):  
Sally J. Peterson
Keyword(s):  
Cleft Palate ◽  
Visual Cues ◽  
Acoustic Target ◽  
Nasal Emission

Nasal emission confined solely to the sibilants or sibilants and affricates may be encountered as an articulatory phenomenon in speakers who do not demonstrate velopharyngeal incompetency. This phenomenon may occur both in patients who previously had an incompetent mechanism and in patients in whom such incompetency has never been documented. In the latter case, the patient may be referred to a cleft palate clinic on suspicion of a submucous cleft or other form of palatopharyngeal incompetency. Typically the nasal emission is combined with incorrect tongue placement. The persistent oral-nasal misarticulation may be viewed simplistically as a residual of earlier velopharyngeal incompetency, documented or undocumented. The speaker’s own acoustic target for these consonants is grossly deviant, perhaps owing to such factors as malocclusion and earlier compensatory articulation gestures. Many such cases prove impervious to extensive articulation therapy, yet physical management may constitute “over-correction” with undesirable sequelae. Inventive approaches to articulation therapy may be required in these cases, since correction of the combined oral-nasal distortion requires the speaker to make many simultaneous changes in articulator placement without benefit of visual cues.

Cleft Palate in Kabuki Syndrome: A Report of Six Cases

2006 ◽  
Vol 43 (6) ◽  
pp. 756-761 ◽  
Author(s):  
Takuya Iida ◽  
Susam Park ◽  
Kogo Kato ◽  
Ichiko Kitano
Keyword(s):  
Cleft Palate ◽  
Clinical Features ◽  
Congenital Anomalies ◽  
Kabuki Syndrome ◽  
Characteristic Appearance ◽  
Submucous Cleft Palate ◽  
Velopharyngeal Function

Kabuki syndrome is a syndrome of rare congenital anomalies that was named after its characteristic appearance, a face resembling that of an actor in a Kabuki play. Although cleft palate is a feature that is sometimes observed in patients with Kabuki syndrome, there are few clinical reports of cleft palate associated with Kabuki syndrome. This report presents six cases of Kabuki syndrome with cleft palate and reviews their clinical features. Our results suggest that (1) patients with cleft palate in Kabuki syndrome tend to fail in acquiring normal velopharyngeal function and (2) submucous cleft palate might be more common in patients with Kabuki syndrome than previously was reported.

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.

scholarly journals Five surgical maneuvers on nasal mucosa movement in cleft palate repair: A cadaver study

2016 ◽  
Vol 69 (6) ◽  
pp. 789-795 ◽  
Author(s):  
Dennis C. Nguyen ◽  
Kamlesh B. Patel ◽  
Rajiv P. Parikh ◽  
Gary B. Skolnick ◽  
Albert S. Woo
Keyword(s):  
Cleft Palate ◽  
Nasal Mucosa ◽  
Cadaver Study ◽  
Cleft Palate Repair ◽  
Palate Repair

Greater Palatal Cleft Width Predicts an Increased Risk for Unfavorable Outcomes in Cleft Palate Repair

2021 ◽  
pp. 105566562110295
Author(s):  
Åsa C. Okhiria ◽  
Fatemeh Jabbari ◽  
Malin M. Hakelius ◽  
Monica M. Blom Johansson ◽  
Daniel J. Nowinski
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Velopharyngeal Insufficiency ◽  
Secondary Surgery ◽  
Increased Risk ◽  
Cleft Palate Repair ◽  
The Impact ◽  
Nasal Emission

Objective: To investigate the impact of cleft width and cleft type on the need for secondary surgery and velopharyngeal competence from a longitudinal perspective. Design: Retrospective, longitudinal study. Setting: A single multidisciplinary craniofacial team at a university hospital. Patients: Consecutive patients with unilateral or bilateral cleft lip and palate and cleft palate only (n = 313) born from 1984 to 2002, treated with 2-stage palatal surgery, were reviewed. A total of 213 patients were included. Main Outcome Measures: The impact of initial cleft width and cleft type on secondary surgery. Assessment of hypernasality, audible nasal emission, and glottal articulation from routine follow-ups from 3 to 16 years of age. The assessments were compared with reassessments of 10% of the recordings. Results: Cleft width, but not cleft type, predicted the need for secondary surgery, either due to palatal dehiscence or velopharyngeal insufficiency. The distribution of cleft width between the scale steps on a 4-point scale for hypernasality and audible nasal emission differed significantly at 5 years of age but not at any other age. Presence of glottal articulation differed significantly at 3 and 5 years of age. No differences between cleft types were seen at any age for any speech variable. Conclusions: Cleft width emerged as a predictor of the need for secondary surgery as well as more deviance in speech variables related to velopharyngeal competence during the preschool years. Cleft type was not related to the need for secondary surgery nor speech outcome at any age.

The Effect of Tongue-Tie Release on Speech Articulation and Intelligibility

2021 ◽  
pp. 014556132110640
Author(s):  
Jonathan Melong ◽  
Michael Bezuhly ◽  
Paul Hong
Keyword(s):  
Speech Intelligibility ◽  
Developmentally Appropriate ◽  
Speech Sound ◽  
Speech Errors ◽  
Speech Articulation ◽  
Speech Language Pathologist ◽  
Audio Recordings ◽  
Before And After ◽  
Consistent Manner ◽  
Age Appropriate

Objective The relationship between ankyloglossia and speech is controversial. The objective of this study was to determine the effect of tongue-tie release on speech articulation and intelligibility. Methods A prospective cohort study was conducted. Pediatric patients (>2 years of age) being referred for speech concerns due to ankyloglossia were assessed by a pediatric otolaryngologist, and speech articulation was formally assessed by a speech language pathologist using the Goldman-Fristoe Test of Articulation 2 (GFTA-2). Patients then underwent a tongue-tie release procedure in clinic. After 1 month, speech articulation was reassessed with GFTA-2. Audio-recordings of sessions were evaluated by independent reviewers to assess speech intelligibility before and after tongue-tie release. Results Twenty-five participants were included (mean age 3.7 years; 20 boys). The most common speech errors identified were phonological substitutions (80%) and gliding errors (56%). Seven children (28%) had abnormal lingual-alveolar and interdental sounds. Most speech sound errors (87.9%) were age/developmentally appropriate. GFTA-2 standard scores before and after tongue-tie release were 85.61 (SD 9.75) and 87.54 (SD 10.21), respectively, (P=.5). Mean intelligibility scores before and after tongue-tie release were 3.15 (SD .22) and 3.21 (SD .31), respectively, (P=.43). Conclusion The majority of children being referred for speech concerns thought to be due to ankyloglossia had age-appropriate speech errors at presentation. Ankyloglossia was not associated with isolated tongue mobility related speech articulation errors in a consistent manner, and there was no benefit of tongue-tie release in improving speech articulation or intelligibility.

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