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velopharyngeal incompetence

J Pauchot, D Feuvrier, I Pluvy, F Floret, O Mauvais
INTRODUCTION: Reconstruction of the soft palate after oncologic resection remains a surgical challenge. Speech and swallowing problems are the consequences of velopharyngeal incompetence following soft palate resection. Free tissue transfer like radial forearm flaps can be used in larger defects for complex reconstruction. The conformation of the flap in order to be closer to the shape of the soft palate improves the functional outcome. In the same way, we describe an original "double-arched" flap design...
September 21, 2016: Annales de Chirurgie Plastique et Esthétique
Paul Luther Shay, Jesse A Goldstein, Jason D Wink, J Thomas Paliga, Cynthia B Solot, Marilyn A Cohen, Susan A Friedman, David W Low, Jesse A Taylor, Oksana A Jackson
BACKGROUND: International adoptees with cleft lip and palate (CLP) are a growing population in the United States. They represent a clinical challenge, presenting at various ages and stages of cleft repair. METHODS: A retrospective review of patients seen at the CLP Program at the Children's Hospital of Philadelphia (CHOP) between 1998 and 2012 with a history of international adoption was performed. Demographics, surgical histories, and long-term speech outcomes were reviewed...
October 2016: Annals of Plastic Surgery
Robert S Glade, Randolph Deal
Velopharyngeal dysfunction (VPD) describes any condition whereby the velopharyngeal valve does not properly close during the production of oral sounds. VPD contains multiple causes, including velopharyngeal mislearning (nasopharyngeal sound substitution for an oral sound), velopharyngeal incompetence (neurolophysiologic dysfunction causing poor pharyngeal movement), and velopharyngeal insufficiency (a structural or anatomic defect prevents velopharyngeal closure). Evaluation for VPD is best performed within the context of a multidisciplinary team and consists of history and physical examination, perceptual speech evaluation, and instrumental assessment of speech with either video nasoendoscopy or multiview speech fluoroscopy...
May 2016: Oral and Maxillofacial Surgery Clinics of North America
J Erdenetsogt, G N Ayanga, D Tserendulam, R Bayasgalan
INTRODUCTION: The three common complications after cleft palate repair are velopharyngeal incompetence, delayed maxillary growth, and fistula formation. Fistula formation rates are reported 0-76% in the literature. Wider palatal defects are more challenging to avoid excess tension, and recent reports suggest defects >15 mm have a significantly higher risk of fistula formation. By localization, the fistulas are divided into seven groups with Pittsburgh fistula classification system (PFCS)...
July 2015: Annals of Maxillofacial Surgery
Joseph T Hardwicke, Helen Richards, Louise Cafferky, Imogen Underwood, Britt ter Horst, Rona Slator
BACKGROUND: Pierre Robin sequence results from a cascade of events that occur during embryologic development and frequently presents with cleft palate. Some studies have shown speech outcomes to be worse in patients with Pierre Robin sequence after cleft palate repair. METHODS: A cohort of Pierre Robin sequence patients who all required an airway intervention and nasogastric feeding in the neonatal period were identified and speech outcomes assessed at 5 years of age...
March 2016: Plastic and Reconstructive Surgery
Ezzeddin Elsheikh, Mohammad Waheed El-Anwar
OBJECTIVE: To describe and assess the results of central inset L-shaped posterior pharyngeal flap (PF) for treatment of velopharyngeal incompetence. METHODS: This study included 12 patients who were diagnosed as persistent velopharyngeal insufficiency. L-shaped central inset superiorly based PF was harvested from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm behind the posterior margin of the hard palate, then the flap was spread 1 cm horizontally and 1 cm in the anteroposterior direction in soft palate...
January 2016: Journal of Craniofacial Surgery
Nikhila Raol, Gillian Diercks, Cheryl Hersh, Christopher J Hartnick
Stress velopharyngeal incompetence (SVPI) commonly affects brass and wind musicians. We present a series of two patients who presented with nasal air emission following prolonged woodwind instrument practice. Neither patient demonstrated audible nasal air emission during speech, but endoscopy revealed localized air escape/bubbling from different sites for each patient with instrument playing only. Both underwent tailored surgical treatment with resolution of symptoms during performance. Diagnosis of SVPI requires examination during the action that induces VPI to allow for directed management...
December 2015: International Journal of Pediatric Otorhinolaryngology
Valérie Bedoucha, François Boutin, Laure Frapier
AIM: Mouth breathing is a functional disorder that affects craniofacial and dento-alveolar growth and also upper airway (UA) anatomy. This is apparent mainly in dimensional abnormalities of the UA caused by hypertrophy of Waldeyer's ring and excessive vertical development of the lower part, giving rise to labial incompetence that perpetuates the functional disorder. The main aim of this study was to evaluate the development of the oropharyngeal structures in young hyperdivergent patients who had undergone functional genioplasty in the context of orthodontic treatment...
December 2015: International Orthodontics
Hidemi Yoshimasu, Yutaka Sato, Takashi Mishimagi, Akihide Negishi
BACKGROUND: Velopharyngeal function is very important for patients with cleft palate to acquire good speech. For patients with velopharyngeal insufficiency, prosthetic speech appliances and speech therapy are applied first, and then pharyngeal flap surgery to improve velopharyngeal function is performed in our hospital. The folded pharyngeal flap operation was first reported by Isshiki and Morimoto in 1975. We usually use a modification of the original method. PURPOSE: The purpose of this research was to introduce our method of the folded pharyngeal flap operation and report the results...
January 2015: Annals of Maxillofacial Surgery
Toby Macrae, Julie A G Stierwalt, Kensley A Behel
The purpose of this study was to determine the effectiveness of a motor learning guided (MLG) approach to speech treatment in a unique case of speech disturbance following surgery for stress velopharyngeal incompetence (SVPI). The patient was a 20-year-old female college student. Treatment took place over 6 sessions and focused on eliciting productions through a hierarchy of clinician support, with an emphasis on self-evaluation and -correction. Acoustic measurements and ratings from the treating clinician and unfamiliar listeners revealed a speech disturbance following surgery that was corrected following speech treatment...
2015: Clinical Linguistics & Phonetics
Kurien Varghese
Obturator is derived from the Latin verb obturate which means to close or to shut off. This definition provides an appropriate description of the objective of obturation in patients with palatal defects. The obturator is often helpful in improving the speech of individuals with partial or total velar defects i.e. cleft of soft palate. Soft palate cleft is one of the most common cause of velopharyngeal incompetence, which is the functional inability of the soft palate to effectively seal with the posterior and or lateral pharyngeal walls...
December 2014: Journal of Indian Prosthodontic Society
Riccardo F Mazzola, Giovanna Cantarella, Isabella C Mazzola
Surgical management of velopharyngeal incompetence (VPI) aims at improving voice resonance and correcting nasal air escape by restoring a competent velopharyngeal sphincter. Assessment of VPI requires the examination of multiple variables. The dynamic study of movements of the velopharyngeal port during speech and the quantification of the closure gap, using flexible videonasoendoscopy and/or videofluoroscopy, is essential. Autologous fat injection represents a minimally invasive alternative to major surgery in the management of mild to moderate VPI that minimizes the risk of complications and sequelae, and can be performed without modifying the anatomy of the velopharyngeal port...
July 2015: Clinics in Plastic Surgery
Ann Swillen, Donna McDonald-McGinn
Chromosome 22q11.2 deletion syndrome (22q11.2DS), a neurogenetic condition, is the most common microdeletion syndrome affecting 1 in 2,000-4,000 live births and involving haploinsufficiency of ∼50 genes resulting in a multisystem disorder. Phenotypic expression is highly variable and ranges from severe life-threatening conditions to only a few associated features. Most common medical problems include: congenital heart disease, in particular conotruncal anomalies; palatal abnormalities, most frequently velopharyngeal incompetence (VPI); immunodeficiency; hypocalcemia due to hypoparathyroidism; genitourinary anomalies; severe feeding/gastrointestinal differences; and subtle dysmorphic facial features...
June 2015: American Journal of Medical Genetics. Part C, Seminars in Medical Genetics
Don Varghese, Shubharanjan Datta, Annie Varghese
BACKGROUND: The purpose of this review was to assess the effectiveness of the buccal myomucosal flap in secondary repairs of cleft palate in 20 patients. PATIENTS AND METHODS: Totally, 20 patients, who underwent secondary palatoplasty between 5 years and 8 years in which a buccal myomucosal flap was used, were reviewed retrospectively. All patients had undergone at least one previous attempted repair at other institutions. Indications for the secondary repair included velopharyngeal incompetence and/or oronasal fistula...
March 2015: Contemporary Clinical Dentistry
Nikhila Raol, Christopher J Hartnick
The velopharynx is a complex structure that is responsible for separation of the oral and nasal cavities during speech production and swallowing. Incompetence of this mechanism can lead to hypernasality, with nasal air emission and incomprehensible speech, as well as nasopharyngeal regurgitation. There can be a significant social stigma associated with velopharyngeal dysfunction, and surgical treatment can be curative in many cases. Knowledge of the normal anatomy and physiology of the velopharyngeal complex is essential when planning for surgical repair...
2015: Advances in Oto-rhino-laryngology
Yang Yang, Liping Jiang, Qiong Liu, Guomin Wang, Yang Chen, Teng Wan
OBJECTIVE: To investigate the duration of speech therapy of patients with or without velopharyngeal insufficency after palatoplasty. METHODS: One hundred and one cleft-palate patients with velopharyngeal incompetence (VPI) and eighty-seven without VPI were selected in the study. The treatment times of the patients who completed the speech therapy were counted and analyzed. RESULTS: The mean treatment frequency in VPI group was 17 times, and in the group without VPI this number was 13 (P < 0...
December 2014: Zhonghua Kou Qiang Yi Xue za Zhi, Zhonghua Kouqiang Yixue Zazhi, Chinese Journal of Stomatology
Ann W Kummer, Jennifer L Marshall, Margaret M Wilson
Although a history of cleft palate is the most common cause of velopharyngeal dysfunction (VPD), there are other disorders that can also cause hypernasality and/or nasal emission. These include other structural anomalies of the velopharyngeal valve (velopharyngeal insufficiency), neurophysiological disorders that result in inadequate velopharyngeal movement (velopharyngeal incompetence), and even faulty articulation placement in the pharynx (velopharyngeal mislearning). Unfortunately, individuals with non-cleft causes of hypernasality and/or nasal emission do not typically present at a cleft palate/craniofacial center where there are professionals who specialize in the evaluation and treatment of these disorders...
March 2015: International Journal of Pediatric Otorhinolaryngology
Yael Hacohen, Leslie W Jacobson, Susan Byrne, Fiona Norwood, Abhimanu Lall, Stephanie Robb, Robertino Dilena, Monica Fumagalli, Alfred Peter Born, Debbie Clarke, Ming Lim, Angela Vincent, Heinz Jungbluth
BACKGROUND: Transient neonatal myasthenia gravis (TNMG) affects a proportion of infants born to mothers with myasthenia gravis (MG). Symptoms usually resolve completely within the first few months of life, but persistent myopathic features have been reported in a few isolated cases. METHODS: Here we report 8 patients from 4 families born to mothers with clinically manifest MG or mothers who were asymptomatic but had elevated acetylcholine receptor (AChR) antibody levels...
February 2015: Neurology® Neuroimmunology & Neuroinflammation
N Hodgins, C Hoo, P McGee, C Hill
A questionnaire designed to survey methods of assessment and management of velopharyngeal incompetence (VPI) was circulated to all surgical members of the Craniofacial Society of Great Britain and Ireland. 45 questionnaires were distributed yielding 30 respondents (66.6% response rate). 27 respondents performed surgery for both cleft and non-cleft forms of VPI. Multi-planar videofluroscopy and nasendoscopy were the most frequently used methods of assessing and diagnosing VPI. The most frequently utilised corrective surgical procedure was palatal re-repair, followed by the Hynes pharyngoplasty and the Furlow double opposing z-plasty technique...
April 2015: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Mohammad Waheed El-Anwar, Hazem Saeed Amer, Ismail Elnashar, Alaa Omar Khazbak, Ahmed Khater
OBJECTIVES/HYPOTHESIS: The aim of this study was to assess the effect of the central inset pharyngeal flap, used for correcting persistent velopharyngeal incompetence after cleft palate repair, on Eustachian tube (ET) function. METHODS: This study included 28 patients who were diagnosed with persistent velopharyngeal insufficiency following primary cleft palate repair, together with otitis media with effusion (OME) and/or ET dysfunction that failed to improve after the primary palatoplasty and extensive medical treatment...
July 2015: Laryngoscope
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