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At least 19 recordsLinked to original sources
PubMed1991

Cleft palate and velopharyngeal dysfunction.

Surgical and prosthetic interventions are effective means of managing cleft palate and velopharyngeal dysfunction. Most patients are managed surgically because usually there is life-long benefit from that type of intervention and an operation does not require continued cooperation from the patient. In selected cases, prosthetic intervention is preferred. Over the past century, the efficacy of such interventions has increased markedly. Not all of the factors responsible for these improved results are understood. Disagreement among care providers persists regarding the specific criteria for intervention, the use of ancillary tools beyond perceptual speech evaluation for both pre-intervention and postintervention assessments, the technical details of intervention, and the ideal age for intervention. In spite of general success of interventions for cleft palate and velopharyngeal dysfunction, much fertile ground remains to be tilled and harvested by current and future students of the problem.

Child↗
PubMed1988

Laryngeal/voice findings in patients with velopharyngeal dysfunction.

It is reported frequently that individuals with palatal clefts have a high occurrence of laryngeal/voice symptoms. It has been speculated that vocal pathology in this population is the result of laryngeal compensation for abnormal velopharyngeal valving. This paper describes the prevalence of laryngeal/voice findings in a group of 85 patients referred for multimethod evaluation of velopharyngeal dysfunction. Forty-one percent of the patients had auditorily perceived voice symptoms and/or observable laryngeal abnormalities. Twenty-one percent of the patients had vocal fold nodules or thickened vocal folds. There was no clear relationship between laryngeal/voice findings and nasoendoscopic or aerodynamic assessments of velopharyngeal dysfunction. However, there was a significant relationship between laryngeal/voice findings and estimated subglottal pressure. Patients with laryngeal/voice findings (with or without nodules) had average estimated subglottal pressure values which were outside the normal range more often than patients without laryngeal/voice findings. These results suggest patients referred for assessment of velopharyngeal dysfunction should receive a comprehensive evaluation which includes screening laryngeal structure and function.

Auditory Perception↗
PubMed1987

Velopharyngeal dysfunction: recommendations for use of nomenclature.

A review of literature relating to velopharyngeal dysfunction reveals that there is no consensus regarding the precise definition of the terms "velopharyngeal incompetence," "velopharyngeal inadequacy," or "velopharyngeal insufficiency." Since this represents an obstacle to communication among members of multidisciplinary teams concerned with rehabilitation of velopharyngeal problems, current usage of these terms is reviewed and recommendations for clarification of the nomenclature are provided.

Humans↗
PubMed1991

Velopharyngeal function and dysfunction.

The concepts regarding velopharyngeal function, the production of disordered nasalization, and the management of velopharyngeal dysfunction can be summarized as follows: 1. Although the function of the velopharyngeal mechanism is critical to the control of oral-nasal balance, the configuration and function of the speech articulatory system as a whole will determine the degree of nasalized speech that is produced. 2. Velopharyngeal dysfunction can be related to one or a combination of structural and motor limitations within the velopharyngeal mechanism. 3. There are two perceptual manifestations of velopharyngeal dysfunction. One is acoustic (nasality); the other is aerodynamic (nasal emission). For any given speaker, it is possible to hear both, and it is possible to hear one and not the other. 4. Velopharyngeal dysfunction can be treated in a variety of ways. The method of treatment should be determined by the structural characteristics of the velopharyngeal mechanism and the speech-motor abilities of the patient.

Child↗
PubMed1992

Navigation of the nose with flexible fiberoptic endoscopy.

The introduction of flexible fiberoptics into medicine revolutionized the evaluation and treatment of velopharyngeal dysfunction. In this paper, rigid endoscopy and flexible fiberoptic scopes are discussed, including their respective advantages and disadvantages. Anesthetic and anatomic considerations relative to the endoscopic procedure are presented. Transnasal endoscopy permits documentation of static and dynamic anatomy, information that may be fundamental for the understanding and treatment of patients with velopharyngeal dysfunction.

Anesthesia, Local↗
PubMed2026

A Genetic Study of 66 Individuals With Syndromic Velopharyngeal Insufficiency.

ObjectiveVelopharyngeal insufficiency (VPI) is a form of velopharyngeal dysfunction caused by anatomical anomalies in the velopharyngeal sphincter. Although genetic causes such as 22q11 deletion syndrome are recognised, the broader genetic basis remains poorly understood. This study investigated the genetic aetiology of VPI.DesignWe conducted a phenotypic search on the DECIPHER database using the term 'Velopharyngeal Insufficiency' and identified genetic variants in these patients. These were classified using ACMG guidelines. Literature searches and network analyses examined gene roles and their contribution to sphincter development.PatientsWe identified 66 patients on DECIPHER with VPI.ResultsNinety-five percent of patients presented with syndromic VPI, commonly observed phenotypes included neurodevelopmental abnormalities and facial dysmorphology. Five patients (7.6%) had cleft palate. Pathogenic or likely pathogenic variants were identified in 56.1% of those with reported genetic variants (32/57); 26.3% through copy number variants and 29.8% through sequence variants (SVs). Chromosome 22q11.2 aberrations were the most frequently observed finding in the cohort; 7 patients carried deletions and 2 carried duplications. Independent truncating SVs in KMT2A and CAMTA1 were observed in multiple individuals. Network analyses and literature review of 26 genes prioritised for potential relevance to VPI revealed 2 broad functions: regulating gene expression and signalling pathways, contributing to palatogenesis and cranial-base development.ConclusionThis study demonstrates a high rate of pathogenic or likely pathogenic genetic findings in a syndromic VPI cohort. The findings highlight several recurrent genomic regions and biologically plausible genes that may contribute to VPI beyond the well-known 22q11 deletion syndrome.

development↗
PubMed1988

Screening of velopharyngeal closure based on nasal airflow rate measurements.

Although sophisticated techniques for estimating velopharyngeal port area during speech are available, clinicians continue to seek approaches for screening patients with suspected velar inadequacy. The aim of the present study is to determine the sensitivity and specificity of predicting velopharyngeal dysfunction based on nasal airflow measurements. The pressure-flow technique was used to measure velopharyngeal orifice area and nasal airflow rate in 211 subjects with cleft palate or velar dysfunction, or both. The data demonstrate that nasal airflow rates above 125 cc/sec are almost always associated with velar dysfunction. Sensitivity and specificity of this index were high (0.85 and 0.96, respectively). A correct diagnosis was made in 93% of the cases. As expected, errors in judgment occurred most frequently in subjects with borderline velopharyngeal inadequacy.

Adolescent↗
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↗
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↗
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↗
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↗