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117 records · Page 7Linked to original sources
PubMed1987

Nasal videoendoscopy in prosthetic management of palatopharyngeal dysfunction.

Application of nasal videoendoscopic procedures simplifies and objectifies design of an obturator prosthesis. Although oral videoendoscopic techniques are also valuable, the nasal perspective provides valuable information not visible from the oral perspective. Because the primary function of the obturator prosthesis is to eliminate hypernasal speech and perceived nasal emission of air associated with palatopharyngeal insufficiency, nasal videoendoscopy should be considered to verify proper soft tissue-obturator contact during speech.

Endoscopes↗
PubMed2001

The dental prosthesis used for intraoral muscle therapy in the rehabilitation of the stroke patient. A preliminary research study.

The dentist can maximize the oral rehabilitation of the stroke patient's weak or paralyzed oral musculature, resulting in dysfunctional speech, swallowing and deglutition, with the use of palatal lift and palatal augmentation prostheses. The study described here evaluates functional changes using these prostheses for three post-stroke patients with left hemiparesis. Clinical tests indicated decreased nasal emission and hypernasality, and improved speech articulation. Videofluoroscopy evaluation showed improvement in the oral phase of swallowing. Patient self-assessment indicated improved satisfaction with treatment.

Adult↗
PubMed2001

[Functional consequences of cleft palate and its management].

On the basis of the experience with 5200 various types of orofacial cleft operations performed during 42 years (1959-2000) and of the 60-70 cases with velopharyngeal insufficiency without cleft examined yearly author stresses that the surgical closure of the cleft is not enough in the care: the functional consequences (respiratory, sucking, swallowing, speech, hearing and maxillofacial developmental disorders) should also be managed. The first symptom of Robin sequent (cleft palate associated with dysgnathia) is respiratory disorder improving mostly spontaneously but worsening sometimes after palatoplasty. Polysomnography has been performed by the author routinely before all primary palatoplasties for establishing the possible surgical risks and for choice of the optimal time for surgery. On the basis of the results in 61 infants, the surgery was contraindicated and postponed in 6 cases. The various orofacial clefts may cause swallowing problems in different phase of swallowing and different types of dysphagia: the cleft lip cause sucking problems in the preparatory phase, the cleft palate in the oral transitory phase and the velopharyngeal insufficiency in the pharyngeal phase, but the sensomotor function is more decisive in the swallowing process than the cleft itself. Use of an obturator is not necessary, long-term catheter feeding is inappropriate, early closure of the soft palate (in the age of 8-10 months) is recommended. The liquid or food reflux through the nose can be established by cinefluoroscopy with contrast material and with nasoendoscopy following the way of coloured boluses. Retarded speech development, hyperrhinophony, nasal escape, facial grimacing, articulation disorders and dysphonia are the most frequent voice and speech disorders; speech therapy is in 70%, velopharyngoplasty in 20% of the cases indicated. Anatomical result was good in 98% of 1107 flap surgeries operated on by the author, hyperrhinophony ceased in 90%. The results are assessed by a 5-grade perceptual scale. Among the instrumental procedures videofluoroscopy, videoendoscopy, and nasometry seems to be the most informative. The cause of the frequent hearing disorders is mostly the eustachian tube dysfunction. Author found pathological tympanograms in 64% of their cases. The hearing slightly improves after staphylorraphy and often after flap surgery. Adenoidectomy and grommet insertion are alternative procedures in the therapy. The surgeries have an effect on the maxillofacial growth but this is not significant. Multidisciplinary co-operation in the management of cleft patients is indispensable.

Adolescent↗
PubMed1990

Di George anomaly and velocardiofacial syndrome.

The velocardiofacial syndrome is an autosomal dominant disorder characterized by cleft palate, cardiac anomalies, characteristic facies, and learning disabilities. The Di George anomaly involves developmental defects of the third and fourth pharyngeal pouches, resulting in thymic and parathyroid hypoplasia and cardiac defects. The cases of individuals in two families help substantiate the notion that the Di George anomaly occurs as a feature of the velocardiofacial syndrome. The proband in family 1 was a male infant with persistent hypocalcemia and cardiac defects consisting of truncus arteriosus, atrial septal defect, ventricular septal defect, and abnormal aortic arch vessels. Autopsy revealed absence of thymic and parathyroid tissue, and the Di George anomaly was diagnosed. His father had a submucous cleft palate, T cell dysfunction, and facial features consistent with the velocardiofacial syndrome. This is the third case of male-to-male transmission of velocardiofacial syndrome. The proband of family 2 was a 4-year-old girl with developmental delay, persistent neonatal hypocalcemia, ventricular septal defect, T cell dysfunction, and facial features of the velocardiofacial syndrome. The Di George anomaly has been reported to occur in at least 18 different disorders. The observation that the Di George anomaly is a component manifestation of the velocardiofacial syndrome in these two families provides further evidence that the Di George anomaly is not a distinct syndrome of a single origin but rather a heterogeneous developmental field defect. It is proposed that all previously reported cases of autosomal dominant Di George anomaly are examples of the velocardiofacial syndrome.

Adult↗
PubMed1991

Fluoroscopy and nasoendoscopy in designing palatal lift prostheses.

Prosthodontists frequently provide prostheses for the management of speech disorders related to palatopharyngeal dysfunction. Optimal prosthetic management of the palatopharyngeal port requires close interaction between the prosthodontist and speech pathologist in the use of videofluoroscopy and videonasoendoscopy for design, placement, and modification of the prosthesis. Function of the palatopharyngeal port during production of controlled samples of connected speech can be observed from multiview fluoroscopy, including lateral and frontal projections. Like fluoroscopy, nasoendoscopy can be used to observe and record function of the palatopharyngeal port during speech. This article provides an overview of the procedures suggested for diagnosing palatopharyngeal disorders. A method for designing and placing a prosthesis to aid in obturating the nasopharynx is also suggested.

Endoscopy↗
PubMed2003

[Idiopathic palatopharyngeal hemiparalysis].

Idiopathic velopalatine palsy is a condition of unknown etiology and is rarely seen in childhood. Consequently, diagnosis requires a high degree of suspicion. We report a case of sudden onset dysfunction of the lower cranial pairs (IX and X) in a 5-year-old girl who was previously asymptomatic. The clinical course was favorable and the results of complementary investigations were normal and the patient was diagnosed with velopalatine palsy. Based on this case, we aim to report our experience of this condition and provide a review of the literature. This disease should be suspected in patients aged between 5 and 15 years old who present a palsy of the IX and X cranial nerves of sudden onset and without any other symptoms in order to rationalize diagnostic and therapeutic tools. Treatment is based on support measures. The prognosis is excellent, with a high percentage of complete recovery and absence of recurrences.

Child, Preschool↗
PubMed2003

Vasomotor instability in neonates with chromosome 22q11 deletion syndrome.

Approximately 70% of individuals with chromosome 22q11 deletion syndrome (22q11DS) have congenital heart defects. A host of other vascular problems in these patients, such as tortuous carotid arteries, Raynaud's phenomenon, unexplained hypotension, hypertension, and hypothermia, raise the possibility that there may be abnormal autonomic regulation of the vascular system. So far, however, there has been no formal report of autonomic dysfunction in patients with 22q11 deletion. We present two infants with 22q11DS, who had profound hypotension after uncomplicated surgeries for congenital heart disease. The hypotension was not responsive to vasopressor treatment (and extracorporeal membrane oxygenation in one infant) and resulted in death, due to multiorgan system failure. Obvious causes, such as poor cardiac contractility, prolonged circulatory arrest, neurological abnormality, sepsis and blood loss were excluded. On autopsy, no abnormalities were found that could explain the hypotension. We hypothesize that these infants died of severe hypotension due to abnormal vascular tone and that this is a variable feature in individuals with 22q11 deletion. The autonomic nervous system, which is responsible for the regulation of vasomotor tone, may be variably affected in 22q11DS. This could have implications for the surgical management of patients with 22q11DS. Further studies on this topic would establish or refute the association between 22q11DS and dysautonomia.

Adult↗
PubMed1977

Potential for clinical cooperation between dentistry and speech pathology.

Clinical management of articulation dysfunctions is one area in which the joint efforts of dentistry and speech pathology are particularly beneficial. Those articulation deviations discussed result from: (1) deformities in the upper lip, teeth, mandible and the hard and soft palates; (2) introduction of dentures; (3) difficulties in adjusting to esophageal speech; and (4) special problems associated with cleft palate/cleft prepalate. Team management of the individual with cleft palate and/or cleft prepalate was also reviewed. While orthodontists and prosthodontists provide the technology for correct speech production, speech pathologists furnish therapy for cultivating speech or modifying defective articulation patterns. Speech pathologists also serve as liaisons with respect to patients and other professionals. The authors believe that, ideally, clinicians from all disciplines should assume a holistic attitude in treating organic and functional human pathologies. Such interdisciplinary clinical cooperation is especially effective between dentistry and speech pathology. The concept of team management of cleft palate/cleft prepalate is an excellent example of how concomitant treatment effects total patient care. However, joint research and educational ventures also contribute to this objective and should continue to be encouraged.

Cleft Palate↗
PubMed1998

[External vocal cord medialization: functional outcome].

BACKGROUND: Comprehensive evaluation of voice function is the precondition for indication and quality control of every phonosurgical procedure. In 53 patients presenting with glottic insufficiencies of different etiologies an external vocal fold medialisation was performed. Functional voice results obtained with this operation are presented and discussed. METHODS: The following voice parameters were measured preoperatively and postoperatively, and statistical comparison was performed: mean fundamental frequency and sound pressure level, frequency and intensity range (voice range profile), perceptual evaluation of hoarseness, and maximum phonation time. The impairment of vocal communication skills was rated on a newly developed 7-point scale. A combined parameter called "Voice Dysfunction Index" was introduced for global assessment of vocal abilities in particular for long term observations. RESULTS: Statistically significant improvement of all voice parameters was demonstrated. Interestingly, in nearly all measurements male patients yielded significantly better results than females. Glottic insufficiencies due to scarring produced poorer functional results but without statistical significance. A statistically significant correlation between the preoperative and postoperative Voice Dysfunction Index could be observed. This score was also significantly correlated with the degree of glottal gap. No significant correlation between voice results and preoperative delay or follow-up period were observed. Voice therapy was performed in 81% of the patients. Correlation of duration of voice therapy and voice results was statistically significant and negative. Analysis of this surprising result showed that it was caused by some patients with vocal fold scarring in whom outcome was poor despite a long period of voice therapy. CONCLUSIONS: Significant improvement of vocal function can be obtained by external vocal fold medialization in patients with glottic insufficiencies. Glottal gaps caused by vocal fold scarring and/or atrophy can be treated with this method, too. However, results are not as good as in paralysis and require additional long term voice therapy. Satisfying results can be expected in patients with a long history of disturbances, and in older patients. Due to the reversibility of the operation, external vocal fold medialization can be performed even in cases of palsy prior to the spontaneous recovery period. The degree of glottic gap determines the functional disturbance. The degree of the preoperative impairment correlates with the outcome. Results are stable with respect to the follow-up period (mean 66 weeks).

Adult↗