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PubMed1991

Cleft palate. Selected case studies.

These case studies provide small, selected samples of the results of assessments of articulation skills and their phonologic applications and give some information related to velopharyngeal function during speech. These illustrations were based chiefly on perceptual assessment of speech because this type of assessment is used routinely by SLPs, and does not require instrumentation. Indicators for referral and communication to a cleft palate team were derived from the perceptual evaluation. Other articles in this issue discuss procedures for evaluation in considerable detail. Early identification of possible velopharyngeal problems and early referral to a cleft palate team can help to resolve speech, language, and hearing disorders related to cleft palate and velopharyngeal dysfunction. People who comprise cleft palate and craniofacial teams are most likely to have the experience, and the special instrumentation necessary, to make a definitive diagnosis. The team's comprehensive multidisciplinary evaluation should lead to thorough consideration of the many factors that are important for treatment planning. The information and services provided by the team will assist the audiologist and SLP in the conduct of their services for these clients. In this way, the communication disorders specialist becomes an affiliate of the team. The affiliate not only acts as a referent, but also may provide the necessary longitudinal services. The best interests of the client are promoted by ongoing communication between the team and the affiliates of the team.

Child, Preschool↗
PubMed1993

Multidisciplinary treatment results for patients with isolated cleft palate.

Fifty-eight patients with cleft palate only who had received treatment in the Department of Otolaryngology-Head and Neck Surgery at the University of Iowa were examined for treatment results. Forty-one (70.7 percent) of the 58 patients showed a syndrome or suggestive factors. An unusually high percentage (36 percent) of the 58 patients required secondary surgery for velopharyngeal dysfunction or showed indications for surgery at examination. Some but not all of the relatively low success rate appears related to surgical experience. Speech proficiency, hearing acuity, and dental status were within normal limits or nearly so. The 20 patients with pharyngeal flap surgery were doing well, with minimal indications of functional obstruction.

Adolescent↗
PubMed1988

Velopharyngeal nomenclature: incompetence, inadequacy, insufficiency, and dysfunction.

Different usages of the terms velopharyngeal incompetence, velopharyngeal inadequacy, velopharyngeal insufficiency, and velopharyngeal dysfunction that are commonly found in the literature are reviewed. It is advocated that one should not attempt to use any of the terms to distinguish between neuromotor or structural causes for behavioral dysfunction. Although the terms can be used as synonyms, this is not always the case. When terms are used differently, it is important to make the specific usage clear from context.

Humans↗
PubMed1990

A child with signs of developmental apraxia of speech with whom a palatal lift prosthesis was used to manage palatal dysfunction.

A client is described who exhibited a large number of characteristics consistent with developmental apraxia of speech (DAS). The exhibited symptoms included excessive nasal resonance and nasal emission of air due to velopharyngeal port dysfunction, for which successful management was achieved by use of a palatal lift prosthesis. The results of the client's use of the lift, in conjunction with her speech and language remedial programming, is presented.

Apraxias↗
PubMedDate not supplied

Evaluation of functional positions of tongue and soft palate with MR imaging: initial clinical results.

Magnetic resonance imaging was used to analyze functional positions of the tongue and soft palate in 10 patients and 10 healthy volunteers. The patients had velopharyngeal insufficiency and/or dysfunction of the tongue. With snapshot FLASH (fast low-angle shot) sequences (data acquisition time, less than 1 second), malpositions of the articulatory apparatus were imaged and recorded for follow-up documentation.

Adult↗
PubMed2025

Current Advances in Surgical Techniques for Secondary Cleft Palate Repair: A Systematic Review.

ObjectiveTo systematically review advances in surgical techniques for secondary cleft palate repair, emphasizing their impact on velopharyngeal function, speech outcomes, and the methodological validity of speech assessments used in published studies.DesignFollowing PRISMA 2021 guidelines, six electronic databases were searched for articles from January 2012 to February 2025 using MeSH terms related to secondary cleft palate repair, velopharyngeal insufficiency, palatoplasty, and speech outcomes. Eligible studies included clinical reports with ≥10 patients undergoing secondary repair. Data on surgical methods, outcomes, and complications were extracted and qualitatively synthesized due to heterogeneity across studies.SettingAll published clinical studies evaluating secondary cleft palate repair outcomes.Patients/ParticipantsIndividuals presenting with residual velopharyngeal insufficiency, recurrent fistula, or speech dysfunction following primary palatoplasty.Main Outcome MeasuresSpeech resonance and intelligibility, velopharyngeal closure rate, fistula recurrence, donor-site morbidity, and obstructive sleep apnea risk.ResultsFourteen studies met the inclusion criteria. Palate-based re-repair with Furlow double-opposing Z-plasty and buccal myomucosal flaps improved resonance and closure in small to moderate gaps. Pharyngeal flap and sphincter pharyngoplasty achieved satisfactory closure in larger defects but increased the risk of airway obstruction. However, most studies lacked validated speech protocols or controlled for articulatory errors and fistula effects, limiting confidence in the interpretation of outcomes.ConclusionsWhile secondary repairs often improve resonance and velopharyngeal competence, evidence remains constrained by heterogeneity and non-validated assessment methods. Future multicenter research integrating standardized, speech pathologist-verified protocols is essential to establish evidence-based algorithms for secondary cleft palate repair.

Humans↗
PubMed2001

Respiratory obstruction as a sign of brainstem dysfunction in infants with Chiari malformations.

Laryngeal respiratory obstruction associated with Chiari malformations was first described in 1932. We studied this type of obstruction in six children with one or several disorders pointing to brainstem dysfunction (failure to thrive, velopharyngeal incompetence, gastroesophageal reflux, or vagal hypertonia). The nature of the laryngeal obstruction was highly variable (vocal cord paralysis, paradoxical vocal cord motion, laryngomalacia) as were the frequency and severity of associated disorders. Chiari malformations should be routinely sought in a child with laryngeal respiratory obstruction occurring at birth or later, whatever the endoscopic diagnosis, especially when signs of brainstem dysfunction are present. The best tool for diagnosing the Chiari malformation is T1- and T2-weighted MRI. Signs of brainstem dysfunction must be treated symptomatically, before treating Chiari malformations by decompressive surgery. This latter approach led to full functional recovery in all five children who underwent the procedure. Palliative surgical treatment should be reserved for patients in whom this procedure is unsuccessful.

Airway Obstruction↗
PubMed1989

[Electromagnetic articulography (EMA) studies on orofacial movement functions].

For judging the influence of orofacial motor functions on the development and function of the dentoalveolar system objective methods are required. Electromagnetic Articulography (EMA) is a new device based on an inductive measuring principle. Using miniature receiver coils placed on the tongue dorsum or the velar margin, movements of multiple points on orofacial structures in the midsagittal plane can be recorded. The application of EMA on the examination of tongue and velum motor activity during speech production and deglutition is demonstrated. First results of sagittal tongue movement during swallowing in normals are reported. Examples from current studies, using EMA in the field of tongue dysfunction, orofacial motor coordination and velopharyngeal closure are demonstrated and the possible perspective of EMA-application is discussed for dental research and functional treatment of CLP-patient.

Deglutition↗
PubMed2000

Dysphagia after radiotherapy: endoscopic examination of swallowing in patients with nasopharyngeal carcinoma.

Dysphagia is a late sequela compromising the lives of more than one fourth of patients with nasopharyngeal carcinoma (NPC) who survive long after radiotherapy. By using fiberoptic endoscopic examination of swallowing as a modality for dysphagia evaluation, we were able to easily recognize the functional and anatomic changes in 31 dysphagic NPC patients. The majority of patients were found to aspirate after the act of swallowing (77.4%). Seventeen (54.8%) had tongue atrophy, and 9 (29%) had vocal cord palsy. Dysfunctions such as dry mouth (45.2%), velopharyngeal incompetence (58%), premature leakage (41.9%), delay or absence of swallow reflex (87.1%), poor pharyngeal constriction (80.6%), pharyngeal residue retention (83.9%), penetration or aspiration (93.5%), and silent aspiration (41.9%) were noted in these patients. Multiple dysfunctions were demonstrated in each patient. Abnormality of pharyngeal constriction and/or aberrant upper esophageal sphincter function played the major role in the postswallow aspiration of these irradiated NPC patients. Clinically compromised patients (weight loss of > or =5 kg in 1 year or pneumonia) had more of the above anatomic and functional impairments. The radiation dosage and volume bore no correlation to the time of symptom onset, or to the occurrence of functional changes.

Adult↗
PubMed1993

Peritonsillar abscess as a cause of transient velopharyngeal insufficiency.

"Hot potato voice" is a characteristic sign of peritonsillar abscess and peritonsillitis. Our findings show that the hot potato voice is the result of an underlying transient velopharyngeal insufficiency combined with muffled oral resonance. The hot potato voice should be distinguished from the muffled oral voice which can be occasionally encountered in cases of severe tonsillitis. The velopharyngeal insufficiency is the result of transient dysfunction of the palatal muscles on the affected side. Transient negative middle-ear pressure indicating eustachian tube dysfunction was found in few of the patients in whom concomitant sinusitis was also present. The clinical, nasendoscopic, and radiologic findings are analyzed and discussed. We believe that this phenomenon is valuable as a research tool for the investigation of the anatomy and physiology of the velopharyngeal valve.

Acoustic Impedance Tests↗
PubMed1987

Palatopharyngeal incompetence in association with esophageal dysmotility, acquired glucocorticoid deficiency, and deficient tear production.

An 8 1/2-year-old male is described with the rare triad of acquired adrenal insufficiency, esophageal dysfunction, and alacrima. In addition, he had velopharyngeal insufficiency, which is a previously unreported feature of this syndrome. Although the pathophysiology of this disorder remains to be demonstrated, a defect may be present, linking hormone-receptor cyclic AMP-mediated processes with abnormalities in parasympathetic and voluntary neuronal innervation or transmission.

Child↗
PubMedDate not supplied

Nasopharyngoscopy in palatopharyngeal prosthetic rehabilitation: A preliminary report.

PURPOSE: Prosthetic rehabilitation of speech disorders related to palatopharyngeal dysfunction is accomplished through separation of the oral and nasal cavities. The ability to achieve this separation is challenged when the disorder or defect involves the soft palate. Prosthetic rehabilitation of soft palate disorders and defects has traditionally relied on functional contouring of a prosthesis using functionally adapted impression materials. However, there are limitations to this process, particularly in its inability to visualize function as it relates to the prosthesis in a 3-dimensional space. The aim of this study was to address this limitation by describing outcomes related to the use of nasopharyngoscopy (NPS) for visualization of the velopharyngeal port during assessment and treatment of palatopharyngeal dysfunction. MATERIALS AND METHODS: A retrospective analysis of speech data was conducted for 5 patients who were assessed before treatment, after prosthetic intervention using conventional functional impression techniques, and after prosthetic intervention using NPS. Nasalance and velopharyngeal orifice area outcome measurements were collected for each patient at clinically predetermined intervals. Perceptual assessment of speech samples was performed as well. RESULTS: Improvements in speech function were observed for all patients after treatment with a prosthesis designed via a conventional functional impression technique; however, no patient showed normal values for nasalance or velopharyngeal orifice area. With the use of NPS to adjust the wax impression-derived prosthesis, both nasalance and velopharyngeal orifice area measurements for all patients were within normal limits. Similarly, perceptual judgment of speech found that normal resonance balance was obtained after use of NPS. CONCLUSION: The addition of NPS into prosthetic treatment for palatopharyngeal disorders shows promise for improved speech results.

Adolescent↗
PubMed2005

Laryngeal and velopharyngeal sensory impairment in obstructive sleep apnea.

STUDY OBJECTIVE: To determine whether mucosal sensory dysfunction is present at multiple upper-airway sites in patients with obstructive sleep apnea (OSA). DESIGN: Physiologic testing of consecutive patients with OSA and nonsnoring controls. SETTING: University hospital sleep center. PARTICIPANTS: Thirty-nine subjects with OSA and 17 controls. INTERVENTIONS: Endoscopic testing was used to determine sensory detection thresholds for air-pressure pulses delivered to the oropharynx, velopharynx, hypopharynx, and larynx (aryepiglottic eminence). The air-pulse stimulus intensity required to elicit the protective laryngeal adductor reflex was also determined. MEASUREMENTS AND RESULTS: There was a significant impairment in sensory detection threshold for OSA versus control subjects in the oropharynx, as previously described by ourselves using other techniques, as well as at the velopharynx (median 11 mm Hg [confidence interval 9-11] for subjects with OSA vs 8 mm Hg [confidence interval 4-11] for controls, P = .03) and, at the larynx, 4 mm Hg [confidence interval 2-9] for subjects with OSA vs 2 mm Hg [confidence interval 2-3] for controls, P < .001). The threshold stimulus intensity for the laryngeal adductor reflex was also significantly higher for OSA subjects. For OSA patients with abnormal laryngeal sensation (61% of OSA subjects), there were significant correlations between laryngeal sensory values and measures of apnea severity, including apnea-hypopnea index (r = 0.82, P < .001) and nadir SaO2 (r = -0.48, P < .05). CONCLUSION: Mucosal sensory function is impaired at multiple upper-airway sites in OSA.

Adult↗
PubMed2000

Speech-aid prostheses for neurogenic velopharyngeal incompetence.

STATEMENT OF PROBLEM: When surgical treatment is not considered an option, prosthetic management of velopharyngeal insufficiency is carried out by means of a speech-aid prosthesis, whereas velopharyngeal incompetence is traditionally managed by a palatal lift prosthesis. Varying degrees of treatment success have been attributed to palatal lift prostheses. PURPOSE: This study introduces the use of nasopharyngeal obturation instead of palatal elevation for the management of velopharyngeal incompetence. METHODS: Seven patients afflicted by neurogenic velopharyngeal incompetence were treated with wire-extension speech-aid prostheses constructed to circumvent the dysfunctional soft palate. The shape of the nasopharyngeal section was functionally molded in speech and swallowing and controlled by video-nasopharyngoscopic examinations. RESULTS: Effective nasopharyngeal obturation with notable improved speech was achieved in all patients. Even though all patients ultimately tolerated the prostheses well, 2 patients denied any improvement in speech with the finalized prostheses. CONCLUSION: Wire-extension speech-aid prostheses used by the patients were an effective treatment approach for velopharyngeal incompetence. Nasopharyngoscopic control is mandatory for maximizing the effect of velopharyngeal closure around the nasopharyngeal section of the prosthesis in function, yet it allows free nasal breathing. Velopharyngeally incompetent patients should be carefully tailored for prosthetic treatment because of contingent noncompliance.

Adult↗
PubMedDate not supplied

Physiological and perceptual features of dysarthria in Moebius syndrome: directions for treatment.

The functioning of the major subsystems of the speech production apparatus of a 12 year old female with Moebius syndrome was investigated using a battery of perceptual and physiological instrumental measures. Perceptual tests administered included: The Assessment of Intelligibility of Dysarthric Speech; the Frenchay Dysarthria Assessment; and a perceptual analysis of a speech sample based on a reading of the Grandfather Passage. Instrumental procedures included: spirometric and kinematic analysis of speech breathing; electroglottographic and aerodynamic evaluation of laryngeal function; nasometric assessment of velopharyngeal function; and evaluation of lip and tongue function using a variety of strain-gauge and pressure transducers. Consistent with the pathophysiological basis of Moebius syndrome, the major dysfunctions of the speech production mechanism were found at the level of the articulatory valve. Somewhat unexpectedly, however, impaired function was also identified at the level of the velopharyngeal and laryngeal valves by both the perceptual and instrumental assessments and at the level of the respiratory system by the physiological analysis alone. The results are discussed with reference to the neurological basis and clinical features of Moebius syndrome. The implications of the findings for the treatment of congenital dysarthria associated with Moebius syndrome are also discussed. The advantage of instrumental analysis over perceptual assessments in defining treatment goals for children with congenital dysarthria is highlighted.

Child↗
PubMed1991

[Articulatory evaluation after mesopharyngeal reconstruction with the radial forearm flap].

Soft palate and tonsil (mesopharynx) play an important role on articulation and swallowing. We must take care not to restrict these physiological function when we reconstruct the mesopharyngeal defect after cancer ablation. In order not to restrict the postoperative function of mesopharynx, we take it the more important to preserve the function of the residual tissue rather than to rebuild the lost function. We took notice of pliable nature of the radial forearm flap and tried to reconstruct mesopharyngeal defect in five cases with this flap. We analyzed articulatory function and velopharyngeal closure in these cases, postoperatively. Articulatory function was assessed on the results of intelligibility test with 100 Japanese monosyllables. In four cases out of five, about 70% of syllables were accurately heard. According to the Hirose's standard of speech function after the operation of oral and/or oropharyngeal cancer, those four cases were evaluated also to be excellent. Whether the resection was done beyond the uvula or not, proved not to have anything to do with the postoperative speech intelligibility. Although speech intelligibility once went down immediately after the operation, it improved around six months later. The improvement might be due to the following facts; The forearm flap was cicatrized postoperatively, disturbing the mobility. After the softening of the cicatrix began, the flap gradually recovered flexibility, which enabled surrounding structure to move more smoothly. Articulatory dysfunction was characterized as plosives tend to be misunderstood as nasals or affricates. Concerning nasality, the velopharyngeal closure was examined by fiberscope. Perfect closure was seen in two cases, near-perfect in two cases, and insufficient in one case.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2000

Posterior pharyngeal flap and sphincter pharyngoplasty: the state of the art.

Surgical management of velopharyngeal insufficiency by attachment of posterior pharyngeal flap or construction of sphincter pharyngoplasty is reviewed. Posterior pharyngeal flap surgery is well established, with a long history dating back to the 19th century. Flaps have been based superiorly, inferiorly, or laterally. There have been reports of airway obstruction and obstructive sleep apnea associated with posterior pharyngeal flap surgery. The concept of surgical creation of a dynamic sphincter pharyngoplasty to provide velopharyngeal closure was first introduced by Hynes in 1950. Hynes and others have proposed several subsequent anatomic modifications. Airway dysfunction has also been reported following sphincter pharyngoplasty, but may not be as frequent or severe as with posterior pharyngeal flap. While several studies have compared posterior pharyngeal flap and sphincter pharyngoplasty in terms of speech outcome or complications, there is not, as yet, a consensus regarding the specific choice of one versus the other for surgical management of velopharyngeal insufficiency.

Cleft Palate↗
PubMed1979

Familial velopharyngeal incompetence caused by myasthenia gravis.

This report describes 2 cases of familial myasthenia gravis presenting as velopharyngeal incompetence. The diagnosis was made only after pharyngoplasty had been done. Symptoms suggesting possible myasthenia gravis are seen in speech therapy and cleft palate clinics, and often labeled "palatal insufficiency" without a more specific diagnosis. In spite of the fact that myasthenia gravis is usually mentioned in the differential diagnosis of velopharyngeal incompetence, it is rarely ruled out by specific studies. We urge that myasthenia gravis be ruled out by definitive tests when the cause of neuromuscular dysfunction cannot be definitely established.

Adult↗