Journal articles: 'Velopharyngeal inadequacy'

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Dalston, Rodger M., and Donald W. Warren. "The Diagnosis of Velopharyngeal Inadequacy." Clinics in Plastic Surgery 12, no. 4 (October 1985): 685–95. http://dx.doi.org/10.1016/s0094-1298(20)31647-3.

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Conley, Stephen F., Arun K. Gosain, Susan M. Marks, and David L. Larson. "Identification and assessment of velopharyngeal inadequacy." American Journal of Otolaryngology 18, no. 1 (January 1997): 38–46. http://dx.doi.org/10.1016/s0196-0709(97)90047-8.

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Mayo, Robert, Donald W. Warren, and David J. Zajac. "Intraoral Pressure and Velopharyngeal Function." Cleft Palate-Craniofacial Journal 35, no. 4 (July 1998): 299–303. http://dx.doi.org/10.1597/1545-1569_1998_035_0299_ipavf_2.3.co_2.

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Objective The objective of this study was to determine the influence of velopharyngeal (VP) inadequacy on respiratory speech compensations. Design The pressure-flow technique was used to measure pressure, airflow, and timing variables associated with VP closure during the production of the initial plosive consonant /p/ in a series of the utterance “papa.” Setting The study was conducted in the speech and breathing laboratory of the UNC Craniofacial Center. Participants Eighty-two subjects with cleft lip and/or palate were assessed. The subjects were divided into two groups, those with adequate VP closure (VP size <.010 cm2) and those with inadequate VP closure (VP size >0.10 cm2). The adequate group was comprised of 62 subjects, and 20 subjects were categorized as inadequate. Results Peak intraoral pressure decreased in the inadequate group, but the difference was not significant. Nasal airflow increased (p < .01), but duration of the pressure pulse was the same for both groups. The area under the pressure curve decreased for the inadequate group (p = .04). Conclusion These data contrast with previously reported published data using /p/ in the utterance “hamper.” This suggests that phonetic context influences the compensatory response to velopharyngeal inadequacy. Additionally, while the findings are somewhat similar to studies that involved noncleft subjects whose oral airway was suddenly vented during the production of /p/, there is enough difference to suggest that learning also affects the compensatory outcome.

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Warren, Donald W., Rodger M. Dalston, Kathleen E. Morr, W. Michael Hairfield, and Lynn R. Smith. "The Speech Regulating System." Journal of Speech, Language, and Hearing Research 32, no. 3 (September 1989): 566–75. http://dx.doi.org/10.1044/jshr.3203.566.

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Temporal and respiratory responses to a loss of velar resistance were measured in 107 subjects demonstrating varying degrees of velopharyngeal inadequacy. The subject data were compared to data generated by a mechanical model representing a passive system. The pressure-flow technique was used to estimate velopharyngeal orifice size and measure respiratory and temporal characteristics of aerodynamic events associated with the production of the nasal-plosive blend/mp/in the word "hamper". Subjects were categorized as having adequate closure (<0.05 cm 2 ), adequate/borderline closure (0.05–0.09 cm 2 ), borderline/ inadequate closure (0.10–0.19 cm 2 ) and inadequate closure (⩾ 0.20 cm 2 ). The data revealed that intraoral pressure fell 10-fold in the model as velopharyngeal orifice area changed from adequate closure to inadequate. The subject data demonstrated only a 1.4-fold drop in pressure. Airflow data indicated that there was a 10-fold increase in respiratory volume in the subject data corresponding to the change from adequacy to inadequacy. When respiratory and temporal responses were assessed together, the findings revealed that airflow and temporal changes minimized the fall of pressure as velar resistance declined across groups.

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Rikihisa, Naoaki, Akikazu Udagawa, Shinya Yoshimoto, Masaharu Ichinose, Tomoe Kimura, and Sara Shimizu. "Treatment of Velopharyngeal Inadequacy in a Patient with Submucous Cleft Palate and Myasthenia Gravis." Cleft Palate-Craniofacial Journal 46, no. 5 (September 2009): 558–62. http://dx.doi.org/10.1597/08-049.1.

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Objective: To describe the clinical course and management of a patient with submucous cleft palate who developed myasthenia gravis (MG) as an adult and suffered recurrent hypernasality. Few reports have described MG patients undergoing pharyngeal flap surgery for velopharyngeal incompetence, and these have described only slight speech improvement in such patients. Design: Case report. Patient: The patient underwent primary pushback palatoplasty and superiorly based pharyngeal flap surgery for submucous cleft and short palate at age 7. Hypernasality showed major improvement after initial surgery. At age 19, the patient developed MG that triggered the recurrence of velopharyngeal incompetence. Intervention: After MG was treated, revision pushback palatoplasty was performed for velopharyngeal incompetence when the patient was 24 years old. Preoperatively and postoperatively, the patient was evaluated by the same speech-language-hearing therapists, each with at least 5 years of clinical experience in cleft palate speech. Results: After the second pushback palatoplasty, hypernasality and audible nasal air emission during speech decreased to mild. Conclusion: Primary pushback palatoplasty and pharyngeal flap surgery were performed for the submucous cleft palate. Revision pushback palatoplasty improved velopharyngeal inadequacy induced by MG. Decreased perceived nasality positively influenced the patient's quality of life. Combined pushback palatoplasty and pharyngeal flap surgery is thus an option in surgical treatment for velopharyngeal inadequacy to close the cleft and the velopharyngeal orifice in cases of cleft palate and MG.

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Baylis, Adriane L., Jamie Perry, Kristina Wilson, Scott Dailey, Anne Bedwinek, Judith Trost-Cardamone, Richard E. Kirschner, and Steven Goudy. "Team Management of Velopharyngeal Inadequacy: Practical Suggestions for Speech-Language Pathologists and Surgeons." Perspectives of the ASHA Special Interest Groups 4, no. 5 (October 31, 2019): 850–56. http://dx.doi.org/10.1044/2019_pers-sig5-2019-0003.

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Purpose This article aims to provide a set of guiding principles for interdisciplinary team care of velopharyngeal inadequacy (VPI) for speech, regardless of the etiology. Method A working group of practitioners with advanced training and experience in the management of patients with cleft palate/velopharyngeal disorders, including representatives from speech-language pathology, otolaryngology, and plastic surgery, was formed. Pertinent literature was reviewed, and practical suggestions for clinicians were developed through consensus discussion. Results Seven key principles were identified as being integral to the provision of interdisciplinary team care for VPI. Conclusion Collaborative interdisciplinary team care for persons with velopharyngeal disorders is key to optimal management and outcomes. Practical suggestions for implementing an interdisciplinary team care model for management of cleft-related and noncleft VPI are described.

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Napoli, Joseph A., and Linda D. Vallino. "Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty." Perspectives of the ASHA Special Interest Groups 4, no. 5 (October 31, 2019): 878–92. http://dx.doi.org/10.1044/2019_pers-sig5-2019-0005.

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Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

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Sell, D. "The role of the speech pathologist in velopharyngeal inadequacy." British Journal of Oral and Maxillofacial Surgery 32, no. 5 (October 1994): 336. http://dx.doi.org/10.1016/0266-4356(94)90085-x.

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Karnell, Michael P., Kara Schultz, and John Canady. "Investigations of a Pressure-Sensitive Theory of Marginal Velopharyngeal Inadequacy." Cleft Palate-Craniofacial Journal 38, no. 4 (July 2001): 346–57. http://dx.doi.org/10.1597/1545-1569_2001_038_0346_ioapst_2.0.co_2.

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Purpose: This two-part project was designed to test a pressure-sensitive theory of marginal velopharyngeal inadequacy (MPVI). Specifically, are select subgroups of children with MPVI perceived as hypernasal because they fail to achieve consistent closure during vowels and semivowels while demonstrating adequate closure during pressure consonants? Methods: In part one, 36 children with cleft palate and other craniofacial anomalies were examined using a clinical assessment protocol that included nasometry and perceived ratings of hypernasal resonance. Children with nasalance percentages above threshold during low-pressure (LP) productions and below threshold for high-pressure (HP) productions were placed in one group (group 1), while children with nasalance percentages below threshold for both LP and HP sentences were placed in another (group 2). Children in the two groups were age- and sex-matched. In part two, endoscopic data were examined for 10 additional children who received nasometry, perceived hypernasal resonance scores, and videoendoscopy on the same day and who received higher mean nasalance measures during production of LP sentences than during production of HP sentences. Results: The results of part one confirmed that children in group 1 were perceived as being significantly more hypernasal than children in group 2 (meangroup 1 = 2.17, meangroup 2 = 1.50; t = 2.75, p = .01). However, results of endoscopic testing failed to demonstrate a consistent observable physiologic pattern of velopharyngeal inadequacy that would confirm the theory that some patients with MVPI are perceived as being hypernasal because of difficulty achieving velopharyngeal closure during vowels and semivowels. Conclusions: The findings provide partial support for a pressure-sensitive theory of MVPI and demonstrate the value of using both HP and LP sentences to evaluate patients with MVPI.

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Dzioba, Agnieszka, Murad Husein, Anne Dworschak-Stokan, and Philip C. Doyle. "An Evaluation of Communication Apprehension in Adolescents with Velopharyngeal Inadequacy." Cleft Palate-Craniofacial Journal 49, no. 3 (May 2012): 17–24. http://dx.doi.org/10.1597/10-139.

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Karnell, Michael P., Kara Schultz, and John Canady. "Investigations of a Pressure-Sensitive Theory of Marginal Velopharyngeal Inadequacy." Cleft Palate-Craniofacial Journal 38, no. 4 (July 2001): 346–57. http://dx.doi.org/10.1597/1545-1569(2001)038<0346:ioapst>2.0.co;2.

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Smith, Marshall E., Steven D. Gray, and Harlan R. Muntz. "Surgical treatment of adenoidectomy complications: Velopharyngeal inadequacy and nasopharyngeal stenosis." Operative Techniques in Otolaryngology-Head and Neck Surgery 13, no. 1 (March 2002): 98–102. http://dx.doi.org/10.1053/otot.2002.30534.

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Laine, Tellervo, Donald W. Warren, Rodger M. Dalston, W. Michael Hairfield, and Kathleen E. Morr. "Intraoral Pressure, Nasal Pressure and Airflow Rate in Cleft Palate Speech." Journal of Speech, Language, and Hearing Research 31, no. 3 (September 1988): 432–37. http://dx.doi.org/10.1044/jshr.3103.432.

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We have suggested that compensatory behaviors associated with cleft palate may be strategies developed for the purpose of satisfying the requirements of a speech regulating system. The purpose of the present study was to test this hypothesis in subjects demonstrating various degrees of velopharyngeal inadequacy. The pressure-flow technique was used to assess aerodynamic responses to a loss of velar resistance in 74 subjects compared to a control group of 137 subjects with adequate velopharyngeal closure. The results of this study demonstrate that as degree of inadequacy increased, airflow rate also increased. Although intraoral pressure fell as inadequacy increased, many subjects were able to maintain pressures above 3.0 cm H 2 0 by increasing airflow rate. Nasal pressure increased in proportion to the decrease in intraoral pressure While combined nasal plus oral pressure remained constant across groups. These findings suggest that a loss of resistance at the velar port is compensated by an increase in resistance at the nasal port. Airflow rate appears to be adjusted to total upper airway resistance. These findings support our contention that the speech system is constrained to meet aerodynamic requirements.

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Dalston, Rodger M., Donald W. Warren, and Eileen T. Dalston. "The Modified Tongue-Anchor Technique as a Screening Test for Velopharyngeal Inadequacy." Journal of Speech and Hearing Disorders 55, no. 3 (August 1990): 510–15. http://dx.doi.org/10.1044/jshd.5503.510.

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Pressure-flow assessment of velopharyngeal (v-p) orifice size was used to test the accuracy with which tongue-anchor task results categorize patients differing in v-p adequacy status. The results indicate that this screening task was fairly accurate in identifying patients with v-p adequacy as defined by aerodynamic assessment (specificity=0.85). It was not quite as accurate in correctly categorizing patients with inadequacy (sensitivity=0.78). The predictive power of this screening test and its utility in a school setting are discussed.

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Ruscello, Dennis. "An Examination of Nonspeech Oral Motor Exercises for Children with Velopharyngeal Inadequacy." Seminars in Speech and Language 29, no. 04 (November 2008): 294–303. http://dx.doi.org/10.1055/s-0028-1103393.

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Jones, David L., Hughlett L. Morris, and Duane R. Van Demark. "A Comparison of Oral-Nasal Balance Patterns in Speakers who are Categorized as “Almost but Not Quite” and “Sometimes but Not Always”." Cleft Palate-Craniofacial Journal 41, no. 5 (September 2004): 526–34. http://dx.doi.org/10.1597/03-075.1.

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Objective The purpose of this study was to determine whether amplitude or temporal patterns of oral-nasal balance differentiate speakers with cleft palate who are classified as belonging to the “almost but not quite” (ABNQ) and “sometimes but not always” (SBNA) subgroups of marginal velopharyngeal inadequacy. Design The nasal accelerometric vibrational index (NAVI) was used to measure amplitude and temporal aspects of oral-nasal balance during the productions of oral and nasal syllables, words, and sentences. NAVI measures obtained include mean amplitude, time integral (area under the curve), duration, rise time, and fall time. Setting Tertiary care center for patients with cleft palate–craniofacial anomalies. Participants Seventeen patients with repaired cleft palate who were assigned by perceptual assessment to the ABNQ subgroup and 17 patients who were assigned to the SBNA subgroup. Results No differences were found between the ABNQ and SBNA subgroups with regard to patterns of nasalization. Further analysis as a function of level of production and phonetic context revealed no differences between the subgroups. Conclusions Although clinicians may report perceived differences in the resonance patterns of speakers who fall within the category of marginal velopharyngeal inadequacy, further division into the ABNQ and SBNA subgroups has yet to be validated.

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Zajac, David J., Robert Mayo, Ryuta Kataoka, and James Y. Kuo. "Aerodynamic and Acoustic Characteristics of a Speaker with Turbulent Nasal Emission: A Case Report." Cleft Palate-Craniofacial Journal 33, no. 5 (September 1996): 440–44. http://dx.doi.org/10.1597/1545-1569_1996_033_0440_aaacoa_2.3.co_2.

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Aerodynamic and acoustic characteristics were determined from the speech of an adult female with mild mental retardation and severe velopharyngeal inadequacy. The speaker's productions of /s/ were characterized by consistent nasal grimacing and turbulent air emission. Aerodynamic assessment estimated the size of the velopharyngeal orifice to exceed 200 mm2 during plosive production. Nasal cross-sectional area was estimated to be 35 mm2 during quiet breathing. Nasometric evaluation indicated nasalance of 63% associated with the “Zoo” passage. Acoustic analysis of the separately recorded oral and nasal speech signals indicated spectral energies in the region of approximately 2.5 to 7.0 kHz associated with nasal emission during /s/ production. The occurrence of these frequencies suggested an acoustic/perceptual function of the nasal grimace. Pressure-flow evidence also suggested that the nasal grimace, perhaps with lingual assistance, functioned to enhance speech aerodynamics.

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Leeper, H. A. "Speech Motor Control and Predicting Disordered Speech." Perspectives on Speech Science and Orofacial Disorders 9, no. 1 (November 1999): 3–6. http://dx.doi.org/10.1044/ssod9.1.3.

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Abstract There are numerous theories of speech production that focus on motor control for regulation of speech output. One of the more prominent is the “pressure regulation-control” model that was developed from studies of the aerodynamic speech activities of normal speakers and individuals with cleft lip and palate and accompanying resonance and speech disorders. This theory aid in understanding the nature of maladaptive speech production related to velopharyngeal inadequacy (VPI). Descriptions of experimental research will be employed to relate this theory to effective strategies of speech management for individuals with VPI.

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Baylis, Adriane L., Benjamin Munson, and Karlind T. Moller. "Factors Affecting Articulation Skills in Children with Velocardiofacial Syndrome and Children with Cleft Palate or Velopharyngeal Dysfunction: A Preliminary Report." Cleft Palate-Craniofacial Journal 45, no. 2 (March 2008): 193–207. http://dx.doi.org/10.1597/06-012.1.

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Objective: To examine the influence of speech perception, cognition, and implicit phonological learning on articulation skills of children with velocardiofacial syndrome (VCFS) and children with cleft palate or velopharyngeal dysfunction (VPD). Design: Cross-sectional group experimental design. Participants: Eight children with VCFS and five children with nonsyndromic cleft palate or VPD. Methods and Measures: All children participated in a phonetic inventory task, speech perception task, implicit priming nonword repetition task, conversational sample, nonverbal intelligence test, and hearing screening. Speech tasks were scored for percentage of phonemes correctly produced. Group differences and relations among measures were examined using nonparametric statistics. Results: Children in the VCFS group demonstrated significantly poorer articulation skills and lower standard scores of nonverbal intelligence compared with the children with cleft palate or VPD. There were no significant group differences in speech perception skills. For the implicit priming task, both groups of children were more accurate in producing primed nonwords than unprimed nonwords. Nonverbal intelligence and severity of velopharyngeal inadequacy for speech were correlated with articulation skills. Conclusions: In this study, children with VCFS had poorer articulation skills compared with children with cleft palate or VPD. Articulation difficulties seen in the children with VCFS did not appear to be associated with speech perception skills or the ability to learn new phonological representations. Future research should continue to examine relationships between articulation, cognition, and velopharyngeal dysfunction in a larger sample of children with cleft palate and VCFS.

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Yeow, Vincent, Selena Ee-Li Young, Philip Kuo-Ting Chen, Seng Tiek Lee, David Machin, and Qingshu Lu. "Techniques and timings for cleft palate surgery: a randomised controlled trial." Australasian Journal of Plastic Surgery 2, no. 1 (March 14, 2019): 44–54. http://dx.doi.org/10.34239/ajops.v2i1.82.

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Background: There is a lack of reliable information on outcomes following cleft surgery. Options for timing and choice of primary cleft surgery had not been compared in randomised trials. Methods: Non-syndromic infants, aged six months, with isolated cleft of the secondary palate without associated lip deformity, were included in this prospective randomised controlled trial to one of four options: Veau-Wardill-Kilner palatoplasty at six (VWK06) or 12 months of age (VWK12), or two-flap palatoplasty with intra-velar veloplasty at six (2F-IVV06) or 12 months of age (2F-IVV12). Results: Of the 76 infants included in the trial, 90.8 per cent received surgery: VWK06 (n=18), VWK12 (n=16), 2F-IVV06 (n=18) and 2F-IVV12 (n=17). Early postoperative complications occurred in two VWK infants (6.1%) and three 2F-IVV infants (8.8%). With surgery planned at six (T06) and 12 months of age (T12) respectively, there were three VWK infants (8.6%) and two 2F-IVV infants (6.3%). At age three, speech assessments were conducted for 62 (84%) children. Velopharyngeal inadequacy symptoms were detected in 4/30 VWK children (13.3%) and 3/30 2F-IVV children (10.0%). With T06 and T12, there were three VWK infants (9.4%) and four 2F-IVV infants (14.3%). Otitis media was documented in 40/61 of children (65.6%) hyper- and/or hyponasality in 27/61 of children (44%) and articulation errors in 53/60 of children (88%). Conclusion: Postsurgical complication rates differ little between VWK and 2F-IVV. At three years, there were no demonstrable differences in velopharyngeal inadequacy symptoms, nasality, articulation and otitis media between the two surgical techniques at two different times.

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Witsell, David L., Amelia F. Drake, and Donald W. Warren. "Preliminary Data on the Effect of Pharyngeal Flaps on the Upper Airway in Children With Velopharyngeal Inadequacy." Laryngoscope 104, no. 1 (January 1994): 12???15. http://dx.doi.org/10.1288/00005537-199401000-00004.

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Lof, Gregory L., and Dennis Ruscello. "Don't Blow This Therapy Session!" Perspectives on Speech Science and Orofacial Disorders 23, no. 2 (October 2013): 38–48. http://dx.doi.org/10.1044/ssod23.2.38.

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Blowing exercises and other nonspeech oral motor exercises (NSOMEs) are commonly used therapeutic techniques for children with repaired cleft palate and velopharyngeal inadequacy. Blowing exercises have a long history in the field, dating back to the early days of speech-language pathology when clinicians relied upon expert opinion to influence clinical practice. However, for more than 60 years, NSOMEs such as blowing have been questioned and many empirical studies have been conducted that demonstrate the ineffectiveness of these exercises. This article provides reasons why NSOMEs, mainly blowing, should not be used in therapy. It also traces the history of blowing exercises and then summarizes some of the seminal research articles that show that they do not work. Effective evidence-based treatments for compensatory errors are also reviewed.

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Gilbert, Harvey R., and Carole T. Ferrand. "A Respirometric Technique to Evaluate Velopharyngeal Function in Speakers with Cleft Palate, with and without Prostheses." Journal of Speech, Language, and Hearing Research 30, no. 2 (June 1987): 268–75. http://dx.doi.org/10.1044/jshr.3002.268.

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There is a paucity of respirometric quotient (RQ) data on individuals with velopharyngeal inadequacy. Paesani (1964) reported data using a technique that involved separate productions of the same task to obtain the RQ. The RQ values obtained were greater than unity, which is theoretically impossible. In the present study, respirometric quotients, the ratio of oral air volume expended to total volume expended, were obtained using separate but simultaneous productions of oral and nasal airflow. RQ values were calculated for 10 speakers with cleft palate, with and without their prosthetic appliances, and 10 normal speakers. As a group, those with cleft palate and without their appliances exhibited RQ values that were significantly lower than values obtained from the normal speakers and from speakers with the appliances in place. These findings indicated that there were no statistically significant differences in RQ values when comparing sentence repetition and counting tasks. These values were lower than those obtained for the nonnasal syllable repetition tasks, with the/m/ syllable repetition task generally being associated with the lowest RQ value of any of the speech tasks. The correlation between RQ values and perceptual judgments was -.60, indicating that there was modest agreement between the two measures. As RQ values decreased, perceptual judgments of nasality increased.

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Carneol, Susan Oliff, Susan M. Marks, and LuAnn Weik. "The Speech-Language Pathologist." American Journal of Speech-Language Pathology 8, no. 1 (February 1999): 23–32. http://dx.doi.org/10.1044/1058-0360.0801.23.

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Velocardiofacial syndrome (VCF) is a genetic condition involving palate abnormalities, cardiac anomalies, characteristic facies, and learning disabilities. This autosomal dominant malformation pattern is one of the most common syndromes associated with clefting (Shprintzen, Goldberg, Young, & Wolford, 1981), yet it can easily go undiagnosed. Velopharyngeal inadequacy is one of the key features. Because of the high incidence of speech, voice, and language disorders found in this population, the speech-language pathologist plays an integral role in the diagnosis of the syndrome and assists in management decisions related to medical and/or educational issues. The purposes of this paper are to: (a) inform the reader of the expanding phenotype of velocardiofacial syndrome, (b) inform the reader of the ramifications of an accurate and early diagnosis, and (c) highlight the role the speech-language pathologist plays in the diagnosis of this genetic syndrome. This will be accomplished with a review of current literature and a case study presentation of a family with VCF who was evaluated at the Masters Family Speech and Hearing Center and Cleft Palate Center at Children’s Hospital of Wisconsin.

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Vallino-Napoli, Linda D. "A Profile of the Features and Speech in Patients with Mandibulofacial Dysostosis." Cleft Palate-Craniofacial Journal 39, no. 6 (November 2002): 623–34. http://dx.doi.org/10.1597/1545-1569_2002_039_0623_apotfa_2.0.co_2.

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Purpose To present a profile of the features and speech in patients with mandibulofacial dysostosis (MFD). Data were collected on occlusion, palatal condition, hearing, resonance, voice, and articulation. Patients Thirty patients with MFD ranging in age from 1.6 to 21.0 years. Study Design Retrospective and prospective cross-sectional designs. Setting Pediatric tertiary care hospital. Results Sixty percent of the patients had an open bite. Isolated cleft palate was found in 37% with other types of cleft conditions occurring less frequently. Twenty-three percent underwent tracheostomy. All patients demonstrated hearing loss, 93% were conductive and 7% were mixed. Resonance, voice, and articulation were also affected. Seventy-seven percent had aberrant resonance including hypernasality, hyponasality, mixed hyper- and hyponasality or muffled resonance, which was found in 40% of the patients. Voice quality was abnormal in 63%. All patients had articulation errors. Although overlap between categories occurred, results showed that 60% had errors related to malocclusion, 30% demonstrated errors usually associated with velopharyngeal inadequacy and 50% had general articulatory or phonological errors that could be attributed to other causes. Conclusions The features and speech of patients with MFD are complex. The speech disorders may have multiple overlapping etiologies that require careful differential diagnosis. This is imperative to establish appropriate treatment regimens and evaluate clinical outcomes.

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Driscoll, Deborah A., Torrey Boland, Beverly S. Emanuel, Richard E. Kirschner, Don LaRossa, Jeanne Manson, Donna McDonald-McGinn, et al. "Evaluation of Potential Modifiers of the Palatal Phenotype in the 22q11.2 Deletion Syndrome." Cleft Palate-Craniofacial Journal 43, no. 4 (July 2006): 435–41. http://dx.doi.org/10.1597/05-070.1.

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Objective To evaluate potential modifiers of the palatal phenotype in individuals with the 22q11.2 deletion syndrome. Design Data from 356 subjects enrolled in a study of the 22q11.2 deletion syndrome were used to evaluate potential modifiers of the palatal phenotype. Specifically, subjects with and without velopharyngeal inadequacy and/or structural malformations of the palate were compared with respect to gender, race, and genotype for variants of seven genes that may influence palatal development. Methods The chi-square test or Fisher exact test was used to evaluate the association between palatal phenotype and each potential modifier. Odds ratios and their associated 95% confidence intervals were used to measure the magnitude of the association between palatal phenotype, subject gender and race, and each of the bi-allelic variants. Results The palatal phenotype observed in individuals with the 22q11.2 deletion syndrome was significantly associated with both gender and race. In addition, there was tentative evidence that the palatal phenotype may be influenced by variation within the gene that encodes methionine synthase. Conclusions Variation in the palatal phenotype observed between individuals with the 22q11.2 deletion syndrome may be related to personal characteristics such as gender and race as well as variation within genes that reside outside of the 22q11.2 region.

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D'antonio, Linda L., Reginald D. Rice, and Sandra C. Fink. "Evaluation of Pharyngeal and Laryngeal Structure and Function in Patients with Oculo-Auriculo-Vertebral Spectrum." Cleft Palate-Craniofacial Journal 35, no. 4 (July 1998): 333–41. http://dx.doi.org/10.1597/1545-1569_1998_035_0333_eopals_2.3.co_2.

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Objective This study described the occurrence and expression of pharyngeal and laryngeal anomalies in a population of patients with oculo-auriculo-vertebral spectrum (OAVS). Design Cross-sectional study using chart review, physical examination, and endoscopic evaluation of the pharynx and larynx, and perceptual and aerodynamic evaluation of speech for assessment of vocal tract function. Setting Academic tertiary referral center. Patients Chart review of 41 patients with a diagnosis of OAVS and clinical evaluation of 23 of the patients identified in the initial chart review, ranging in age from 9 months to 17 years. Main outcome Measures Data from chart review pertaining to airway and speech symptoms. Physical examination and endoscopic studies of pharyngeal and laryngeal structure and function and perceptual and aerodynamic evaluation of speech, resonance, and voice. Results Chart review showed a high occurrence of indicators of pharyngeal and laryngeal abnormalities such as velopharyngeal inadequacy and airway obstruction. Clinical evaluations documented a variety of abnormalities in pharyngeal and laryngeal structure and function as well as impairment in speech articulation, resonance, and voice. Presence and severity of pharyngeal and laryngeal abnormalities were not correlated with the severity of expression of the spectrum based on mandibular morphology. Conclusions Oculo-auriculo-vertebral spectrum appears to be associated with a high occurrence of structural and functional abnormalities of the pharynx and larynx that may contribute to increased risk of airway obstruction, communication impairment, and morbidity.

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Van Doorn, Jan, and Alison Purcell. "Nasalance Levels in the Speech of Normal Australian Children." Cleft Palate-Craniofacial Journal 35, no. 4 (July 1998): 287–92. http://dx.doi.org/10.1597/1545-1569_1998_035_0287_nlitso_2.3.co_2.

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Objective Nasalance scores have been shown to depend on the regional dialect of English spoken. Australian cleft palate clinics are increasingly making use of the Nasometer as part of their evaluation of velopharyngeal inadequacy. There are, however, no normative data for Australian English available as reference information. The objective of this study, therefore, was to obtain comprehensive nasalance data for a large group of Australian children, aged 4 to 9 years, for two standard nasalance passages (Zoo Passage and Nasal Sentences) and to investigate any gender or age differences within that age range. Participants The participants were 245 children (123 female, 122 male) ranging in age from 4 years, 0 months, to 9 years, 3 months. The children were recruited from a variety of schools and preschools across the Sydney metropolitan region. The children all spoke Australian English, and their hearing, articulation skills, and speech resonance were within normal limits. Method Mean nasalance scores were obtained for two speech passages that are used as standards for Nasometer testing (Zoo Passage and Nasal Sentences). In addition, the nasalance data were analyzed for any gender and age dependence, using separate analyses of variance for each speech passage. Five consecutive age groups were used to examine age dependence (4-, 5-, 6-, 7-, and 8-year-old children). Results A mean score of 13.1 (SD, 5.9) was obtained for the Zoo Passage, and a mean of 59.6 (SD, 8.1) for the Nasal Sentences. The analysis of variance results indicated that, at a probability level of p < 0.01, there was no statistically significant age or gender dependence for either speech passage. Conclusion These normative nasalance data for children who speak Australian English will provide important reference information for clinicians who assess nasality disorders in cleft palate clinics in Australia.

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Barbosa, Daniela Aparecida, Rafaeli Higa Scarmagnani, Ana Paula Fukushiro, Inge Elly Kiemle Trindade, and Renata Paciello Yamashita. "Surgical outcome of pharyngeal flap surgery and intravelar veloplasty on the velopharyngeal function." CoDAS 25, no. 5 (October 2013): 451–55. http://dx.doi.org/10.1590/s2317-17822013000500009.

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PURPOSE: To investigate the postoperative outcomes of pharyngeal flap surgery (PF) and secondary palatoplasty with intravelar veloplasty (IV) in the velopharyngeal insufficiency management regarding nasalance scores and velopharyngeal area. METHODS: Seventy-eight patients with cleft palate±lips submitted to surgical treatment for velopharyngeal insufficiency, for 14 months on an average, were evaluated: 40 with PF and 38 with IV, of both genders, aged between 6 and 52 years old. Hypernasality was estimated by means of nasalance scores obtained by nasometry with a cutoff score of 27%. The measurement of velopharyngeal orifice area was provided by the pressure-flow technique and velopharyngeal closure was classified as: adequate (0.000-0.049 cm2), adequate/borderline (0.050-0.099 cm2), borderline/inadequate (0.100-0.199 cm2), and inadequate (≥0.200 cm2). RESULTS: Absence of hypernasality was observed in 70% of the cases and adequate velopharyngeal closure was observed in 80% of the cases, in the PF group. In the IV group, absence of hypernasality was observed in 34% and adequate velopharyngeal closure was observed in 50% of the patients. Statistically significant differences were obtained between the two techniques for both evaluations. CONCLUSION: PF was more efficient than the secondary palatoplasty with IV to reduce hypernasality and get adequate velopharyngeal closure.

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Scarmagnani, Rafaeli Higa, Daniela Aparecida Barbosa, Ana Paula Fukushiro, Manoel Henrique Salgado, Inge Elly Kiemle Trindade, and Renata Paciello Yamashita. "Relationship between velopharyngeal closure, hypernasality, nasal air emission and nasal rustle in subjects with repaired cleft palate." CoDAS 27, no. 3 (June 2015): 267–72. http://dx.doi.org/10.1590/2317-1782/20152014145.

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PURPOSE: To investigate the correlation among velopharyngeal closure, hypernasality, audible nasal air emission (NAE) and nasal rustle (NR), in individuals with repaired cleft palate. METHODS: One hundred patients with repaired cleft palate and lip, submitted to pressure-flow study for measurement of velopharyngeal orifice area (velopharyngeal area) and speech sample recordings. Velopharyngeal area was estimated during the production of the sound /p/ inserted in a sentence, and the velopharyngeal closure was classified as adequate, borderline or inadequate. Hypernasality was rated using a 4-point scale, NAE and NR were rated as absent or present, by three speech language pathologists, using recorded speech samples. Inter and intra-judge agreements were established. Statistical analysis was performed using the Spearman correlation coefficient considering p<0.05. An ordinal logistic regression model was developed to investigate whether the characteristics of speech can predict velopharyngeal closure. For this, the speech samples included in this analysis were those that obtained 100% agreement among raters as to the degree of hypernasality (43 out of 100). RESULTS: Significant correlation was found between hypernasality and velopharyngeal area; audible NAE and velopharyngeal area. A negative correlation was observed between the NR and velopharyngeal area. The regression analysis showed that the perceptual speech characteristics contributed significantly to predict the velopharyngeal closure. CONCLUSION: There is significant correlation between velopharyngeal closure and hypernasality, NAE and NR. It suggests that the perceptual speech characteristics can predict velopharyngeal closure, favoring the diagnosis and the definition of treatment conduct of velopharyngeal dysfunction.

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Huang, Hanyao, Xu Cheng, Yang Wang, Dantong Huang, Yuhao Wei, Heng Yin, Bing Shi, and Jingtao Li. "Analysis of Velopharyngeal Functions Using Computational Fluid Dynamics Simulations." Annals of Otology, Rhinology & Laryngology 128, no. 8 (April 8, 2019): 742–48. http://dx.doi.org/10.1177/0003489419842217.

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Objectives: Competent velopharyngeal (VP) function is the basis for normal speech. Understanding how VP structure influences the airflow during speech details is essential to the surgical improvement of pharyngoplasty. In this study, we aimed to illuminate the airflow features corresponding to various VP closure states using computed dynamic simulations. Methods: Three-dimensional models of the upper airways were established based on computed tomography of 8 volunteers. The velopharyngeal port was simulated by a cylinder. Computational fluid dynamics simulations were applied to illustrate the correlation between the VP port size and the airflow parameters, including the flow velocity, pressure in the velopharyngeal port, as well as the pressure in oral and nasal cavity. Results: The airflow dynamics at the velopharynx were maintained in the same velopharyngeal pattern as the area of the velopharyngeal port increased from 0 to 25 mm2. A total of 5 airflow patterns with distinct features were captured, corresponding to adequate closure, adequate/borderline closure (Class I and II), borderline/inadequate closure, and inadequate closure. The maximal orifice area that could be tolerated for adequate VP closure was determined to be 2.01 mm2. Conclusion: Different VP functions are of characteristic airflow dynamic features. Computational fluid dynamic simulation is of application potential in individualized VP surgery planning.

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Deshmukh, Mazin M., and Gaurav Deshpande. "Musculomucosal Flap: A Technique for Correction of Velopharyngeal Insufficiency by Palate Lengthening." Journal of Contemporary Dentistry 7, no. 3 (2017): 174–77. http://dx.doi.org/10.5005/jp-journals-10031-1209.

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ABSTRACT A small but significant percentage of patients have inadequate velopharyngeal closure, or secondary velopharyngeal incompetence, following primary palatoplasty. The use of the buccinator musculomucosal (MM) flap has been described for both primary palate repair with lengthening and secondary palate lengthening for the correction of insufficient velopharyngeal closure. The MM flap was first described in 1969 for the primary repair of a wide cleft palate by Mukherji, and it was Bozola et al in 1989 who first formally described it and gave first description of its anatomy. The first report on its use to lengthen the palate in secondary velopharyngeal insufficiency (VPI) was published by Hill et al in 1999. This case report presents a patient who had correction of secondary velopharyngeal incompetence using bilateral buccinator MM flaps used as a sandwich and also gives a brief review of the literature regarding its application in cases of secondary VPI. How to cite this article Deshmukh MM, Deshpande G. Musculomucosal Flap: A Technique for Correction of Velopharyngeal Insufficiency by Palate Lengthening. J Contemp Dent 2017;7(3):174-177.

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Hill, C., C. Hayden, M. Riaz, and A. G. Leonard. "Buccinator Sandwich Pushback: A New Technique for Treatment of Secondary Velopharyngeal Incompetence." Cleft Palate-Craniofacial Journal 41, no. 3 (May 2004): 230–37. http://dx.doi.org/10.1597/02-146.1.

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Objective A small percentage of patients have inadequate velopharyngeal closure, or secondary velopharyngeal incompetence, following primary palatoplasty. Use of the buccinator musculomucosal flap has been described for primary palate repair with lengthening, but its use in secondary palate lengthening for the correction of insufficient velopharyngeal closure has not been described. This study presents the results of a series of patients who had correction of secondary velopharyngeal incompetence using bilateral buccinator musculomucosal flaps used as a sandwich. Patients In this prospective study between 1995 and 1998, a group of 16 patients with insufficient velopharyngeal closure as determined by speech assessment and videoradiography were selected. Nasopharyngoscopy was carried out in addition in a number of cases. Case selection was a result of these investigations and clinical examination in which the major factor in velopharyngeal insufficiency was determined to be short palatal length. Design The patients underwent palate lengthening using bilateral buccinator musculomucosal flaps as a sandwich. All patients were assessed 6 months postoperatively. The operative technique, postoperative course, and recorded postoperative complications including partial/total flap necrosis and residual velopharyngeal insufficiency were evaluated. Preoperative and postoperative speech samples were rated by an independent speech therapist. Results Ninety-three percent (15 of 16) had a significant improvement in velopharyngeal insufficiency, and 14 patients had no hypernasality postoperatively. Both cases of persistent mild hypernasality had had a recognized postoperative complication. Conclusion The sandwich pushback technique for the correction of persistent velopharyngeal incompetence was successful in achieving good speech results.

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Broen, Patricia A., Shirley S. Doyle, and Catherine K. Bacon. "The Velopharyngeally Inadequate Child: Phonologic Change with Intervention." Cleft Palate-Craniofacial Journal 30, no. 5 (September 1993): 500–507. http://dx.doi.org/10.1597/1545-1569_1993_030_0500_tvicpc_2.3.co_2.

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Diagnostic therapy is often recommended for children before physical management of the velopharyngeal structures. There Is, however, limited Information about the effectiveness of such intervention programs. This study describes the changes that occurred In a 3-year-old child's production of speech during a period of diagnostic therapy, and the changes that occurred following the fitting of a prosthesis. The mother served as the primary Intervener, guided by a speech-language pathologist. The mother was able to change the child's speech so that more of her productions were at a correct place of articulation. After structural management, nasal and glottalized productions disappeared from the child's speech, but glottal stops did not.

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Broen, Patricia A., Shirley S. Doyle, and Catherine K. Bacon. "The Velopharyngeally Inadequate Child: Phonologic Change with Intervention." Cleft Palate-Craniofacial Journal 30, no. 5 (September 1993): 500–507. http://dx.doi.org/10.1597/1545-1569(1993)030<0500:tvicpc>2.3.co;2.

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Marrinan, Eileen M., Richard A. Labrie, and John B. Mulliken. "Velopharyngeal Function in Nonsyndromic Cleft Palate: Relevance of Surgical Technique, Age at Repair, and Cleft Type." Cleft Palate-Craniofacial Journal 35, no. 2 (March 1998): 95–100. http://dx.doi.org/10.1597/1545-1569_1998_035_0095_vfincp_2.3.co_2.

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Objective The goal of this study was to determine the relative importance of surgical technique, age at repair, and cleft type for velopharyngeal function. Design This was a retrospective study of patients operated on by two surgeons using different techniques (von Langenbeck and Veau-Wardill-Kilner [VY]) at Children's Hospital, Boston, MA. Patients We included 228 patients who were at least 4 years of age at the time of review. Patients with identifiable syndromes, nonsyndromic Robin sequence, central nervous system disorders, communicatively significant hearing loss, and inadequate speech data were excluded. Main Outcome Measure Need for a pharyngeal flap was the measure of outcome. Results Pharyngeal flap was necessary in 14% of von Langenbeck and 15% of VY repaired patients. There was a significant linear association (p = .025) between age at repair and velopharyngeal insufficiency (VPI). Patients with an attached vomer, soft cleft palate (SCP), and unilateral cleft lip/palate (UCLP) had a 10% flap rate, whereas those with an unattached vomer, hard/soft cleft palate (HSCP), and bilateral cleft lip/palate (BCLP) had a 23% flap rate (p = .03). Age at repair was critical for the unattached-vomer group (p = .03) but was not statistically significant for the attached-vomer group (p = .52). Conclusions Surgical technique was not a significant variable either in aggregate or for the Veau types. Patients in the earliest repair group (8-10 months) were the least likely to require a pharyngeal flap. Early repair was more critical for HSCP and BCLP patients. There was no correlation between velopharyngeal insufficiency and Veau hierarchy. The attached vomer/levator muscle complex may be a more important predictor of surgical success than the anatomic extent of cleft.

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Hirschberg, Jenő. "Results and Complications of 1104 Surgeries for Velopharyngeal Insufficiency." ISRN Otolaryngology 2012 (April 11, 2012): 1–10. http://dx.doi.org/10.5402/2012/181202.

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Velopharyngeal insufficiency (VPI) means that the velopharyngeal closure is inadequate or disturbed. VPI may be organic or functional, congenital or acquired and is caused by structural alterations or paresis. The symptoms are primarily to be found in speech (hypernasality), more rarely in swallowing and hearing. The management types are as follows: speech therapy, surgery, speech bulb, and others. Surgery is indicated if the symptoms of VPI cannot be improved by speech therapy. Among the operative methods, velopharyngoplasty constitutes the basis of the surgery. The pharyngeal flap was incorporated and survived in 98.1% of the cases, hyperrhinophony disappeared or became minimal in 90% after surgery in our material (1104 cases). The speech results seemed to be the same with superiorly or inferiorly based pharyngeal flap. The Furlow technique, push-back procedure, the sphincteroplasty, and the augmentation were indicated by us if the VP gap was less than 7 mm; these methods may also be used as secondary operation. We observed among 1104 various surgeries severe hemorrhage in 5 cases, aspiration in 2 cases, significant nasal obstruction in 68 patients, OSAS in 5 cases; tracheotomy was necessary in 2 cases. Although the complication rate is rare, it must always be considered that this is not a life-saving but a speech-correcting operation. A tailor-made superiorly based pharyngeal flap is suggested today, possibly in the age of 5 years.

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Sommerlad, Brian C., Felicity V. Mehendale, Malcolm J. Birch, Debbie Sell, Caroline Hattee, and Kim Harland. "Palate Re-Repair Revisited." Cleft Palate-Craniofacial Journal 39, no. 3 (May 2002): 295–307. http://dx.doi.org/10.1597/1545-1569_2002_039_0295_prrr_2.0.co_2.

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Objective: To analyze the results of a consecutive series of palate re-repairs performed using the operating microscope and identify predictive factors for outcome. Design: Prospective data collection, with blind assessment of randomized recordings of speech and velar function on lateral videofluoroscopy and nasendoscopy. Patients: One hundred twenty-nine consecutive patients with previously repaired cleft palates and symptomatic velopharyngeal incompetence (VPI) and evidence of anterior insertion of the levator veli palatini underwent palate re-repairs by a single surgeon from 1992 to 1998. Syndromic patients, those who had significant additional surgical procedures at the time of re-repair (23 patients), and all patients with inadequate pre- or postoperative speech recordings were excluded, leaving a total of 85 patients in the study. Interventions: Palate re-repairs, with radical dissection and retropositioning of the velar muscles, were performed using the operating microscope with intraoperative grading of anatomical and surgical findings. Main Outcome Measures: Pre- and postoperative perceptual speech assessments using the Cleft Audit Protocol for Speech (CAPS) score, measurement of velar function on lateral videofluoroscopy, and assessment of nasendoscopy recordings. Results: There were significant improvements in hypernasality, nasal emission, and nasal turbulence and measures of velar function on lateral videofluoroscopy, with improvement in the closure ratio, velopharyngeal gap at closure, velar excursion, velar movement angle, and velar velocity. Conclusions: Palate re-repair has been shown to be effective in treating VPI following cleft palate repair, both in patients who have not had an intravelar veloplasty and those who have had a previous attempt at muscle dissection and retropositioning. Palate re-repair has a lower morbidity and is more physiological than a pharyngoplasty or pharyngeal flap.

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Scarmagnani, Rafaeli Higa, Adriana Cristina de Almeida Santos Furlan de Oliveira, Ana Paula Fukushiro, Manoel Henrique Salgado, Inge Elly Kiemle Trindade, and Renata Paciello Yamashita. "Impact of inter-judge agreement on perceptual judgment of nasality." CoDAS 26, no. 5 (October 2014): 357–59. http://dx.doi.org/10.1590/2317-1782/20142014068.

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Purpose:To investigate the effect of perceptual inter-judge agreement of hypernasality on velopharyngeal (VP) closure prediction.Methods:Two logistic regression models were developed aiming to verify the possibility of predicting the VP closure using the following characteristics: rating of VP closure (adequate, borderline, inadequate), determined by the pressure-flow technique, degree of hypernasality (absent, mild, moderate, severe), and the presence/absence of nasal air emission and nasal rustle determined perceptually by three experienced speech language pathologists. In the first model, 100 speech samples with a moderate agreement rate of hypernasality (kappa coefficient: 0.41) were used. In the second model, 43 speech samples with a perfect agreement among judges were included. The χ2-test was used to compare the models (p≤0.05).Results:In the first model, 65 of the 100 samples were rated in the correct VP closure category, with 42 adequate and 23 inadequate. The borderline VP closure was not predicted. The second model rated 31 of the 43 samples in the correct category, with 21 adequate VP closure, 5 in the borderline VP closure, and 5 inadequate. There was no difference (p=0.526) between the two models. However, the second model showed a higher proportion of accuracy (7%) than the first one, and it has also predicted the borderline VP closure.Conclusion:These results showed the importance of high index of inter-judge agreement when using subjective parameters of speech evaluation, especially when compared to an instrumental evaluation. This suggests the need for strategies for training and calibration of judges in the perceptual judgment to improve the reliability of auditory-perceptual assessment.

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Bohle, George, Jana Rieger, Joseph Huryn, David Verbel, Freeman Hwang, and Ian Zlotolow. "Efficacy of speech aid prostheses for acquired defects of the soft palate and velopharyngeal inadequacyâclinical assessments and cephalometric analysis: A Memorial Sloan-Kettering Study." Head & Neck 27, no. 3 (March 2005): 195–207. http://dx.doi.org/10.1002/hed.10360.

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Journal articles on the topic 'Velopharyngeal inadequacy'

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