ABSTRACT
Abstract Introduction Velopharyngeal insufficiency (VPI) is a controversial pathology with many surgical options. Objectives To compare pharyngoplasty and retropharyngeal fat grafting and to build a prognostic tool to achieve perfect speech. Methods Retrospective observational cohort study of 114 patients operated for VPI from 1982 to 2019 in a single tertiary center. The instrumental assessment was made using an aerophonoscope and nasofibroscopy. The variables sex, age, genetic syndromes, and type of diagnosis were analyzed with logistic regression model adjusted with propensity score. To generalize results and to build a surgical predictive tool, a marginal analysis concludes the study. Results Among the patients (median [range] age 7 [4-48]), 63 (55.26%) underwent pharyngoplasty and 51 (44.74%) graft. The graft group had no complication, but it had a failure rate of 7.84%. The pharyngoplasty group had no failure, but one patient had postoperative obstructive sleep apnea. The marginal analysis demonstrated that age lower than 7 years, cleft lip and palate, absence of syndrome, and intermittent VPI were important predictive factors of good result regardless of surgical technique. Conclusions Without a statistical demonstration of the superiority of pharyngoplasty over graft, and in the uncertainty of literature background, our perfect-speech patient profile represents an important tool for a postoperative forecast of results in which, like in the Master Mind game, every feature has to be considered not individually but as a pattern of characteristics whose association contributes to the outcome.
ABSTRACT
OBJECTIVE@#To analyze velopharyngeal closure patterns and speech characteristics of patients with congenital velopharyngeal insufficiency.@*METHODS@#Patients visiting the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University between 2009 and 2017 were reviewed. Outcomes of subjective speech evaluation, including resonance, consonant articulation, and correction rate, were analyzed. Furthermore, the mobility of soft palate and pharyngeal walls under nasopharyngeal fiberscope were analyzed retrospectively.@*RESULTS@#A total of 47 cases were retrieved and subjected to nasopharyngeal fiberscopic examination. Among them, 29 (61.7%) demonstrated a circular closure pattern, 16 (34.0%) showed a coronal pattern, and 2 (4.3%) had a sagittal pattern. Furthermore, 25 (53.2%) presented medium soft-palate mobility, 22 (46.8%) had weak lateral pharyngeal wall mobility, and 41 (87.2%) had no posterior pharyngeal wall mobility. Among all of the patients, 23 (48.9%) presented medium hypernasality, accounting for the highest proportion. Consonant misarticulation occurred in 89.4% of the cases. The articulation manners with the highest correction rate were in the following order: nasal, lateral, fricatives, stops, and affricates. The articulation places with the highest correction rate were in the following order: bilabial, alveolar, velar, and linguadental.@*CONCLUSIONS@#Circular closure was the most prevalent velopharyngeal closure pattern among patients with congenital velopharyngeal insufficiency, and consonant omission was the most common articulation abnormality.
Subject(s)
Humans , China , Cleft Palate/surgery , Palate, Soft , Pharynx , Retrospective Studies , Speech , Treatment Outcome , Velopharyngeal InsufficiencyABSTRACT
@#Normal development of the velopharyngeal structures is key to obtaining good velopharyngeal closure. In the assessment of velopharyngeal closure and normal pronunciation, a variety of instruments can be used to detect and assist in the diagnosis of velopharyngeal dysfunction. In the past, the assessment of velopharyngeal closure often used two-dimensional imaging or relied solely on the subjective assessment of the phonetician. With the development of science and technology, magnetic resonance imaging (MRI) has become widely used in the evaluation of velopharyngeal structures and functions as an ideal examination method. This article reviews the current capabilities and limitations in evaluating velopharyngeal closure, as well as recent research on the structures and functions of the velopharyngeal using static MRI, dynamic MRI, three-dimensional MRI reconstructions and diffusion tensor imaging (DTI) techniques; in addition, this work explores the role and significance of MRI technology in evaluating the structures and functions of the velopharyngeal. A review of the literature shows that static MRI is simple in terms of the scanning mode, has easily adjustable parameters, and clearly shows the anatomical structures of palatopharyngeal in resting or transient vocal states. Dynamic MRI can capture the anatomical changes of the palatopharyngeal in a more complex pronunciation state and obtain accurate dynamic images of the velopharyngeal closure process for the study of speech pathology. Three-dimensional MRI reconstructions are usually used in fine scanning of the velopharyngeal structures in a resting state; although this method takes a long time, the images obtained are clear and reliable. This approach can be used for three-dimensional reconstruction analysis and three-dimensional finite element analysis, and it can be used to help plan an operation and evaluate the effect of the surgery. DTI is a new method for observing the contractile function of muscles by observing the locus of water molecules in muscles. DTI can be used to analyze and study many muscles involved in velopharyngeal closure.
ABSTRACT
Background: Digital Lateral Cephalograms are the most commonly used radiographs for evaluating morphological variations of soft palate. It is a relatively inexpensive method and provides a good assessment of the soft-tissue elements that define the soft palate and its surrounding structures. The present study was conducted to investigate the morphological variations of the soft palate and influence of age on it. Materials and methods: The present study consisted of 150 digital cephalograms of subjects aged between 20 to 60 years taken from the department of oral medicine and radiology, Sri Sai College of Dental Surgery, Vikarabad. The subjects were categorized into five groups, group A: 20- 30 years, group B: 31- 40 years, group C: 41- 50 years, group D: 51- 60 years and group E: 61- 70 years. Digital lateral cephalograms were obtained and analyzed to categorize the soft palate into six morphological types, based on the classification by You, et al. Results: Type 1: leaf shaped soft palate was the most common type, type 4 and 6 varieties were the least common among all age groups. Type 5: S-shaped soft palate was found in considerable proportions among all the age groups (6.7% - 25.8%). There was no significant correlation found between the different age groups and the type of soft palate. Conclusion: Radiographic analysis of morphological variations of soft palate can help us better understand the velar morphology and may assist in success of surgical procedures aimed for correcting deformities of soft palate.
ABSTRACT
<p><b>OBJECTIVE</b>To characterize the velopharyngeal closure patterns and speech performance among submucous cleft palate patients.</p><p><b>METHODS</b>Patients with submucous cleft palate visiting the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University between 2008 and 2016 were reviewed. Outcomes of subjective speech evaluation including velopharyngeal function, consonant articulation, and objective nasopharyngeal endoscopy including the mobility of soft palate, pharyngeal walls were retrospectively analyzed.</p><p><b>RESULTS</b>A total of 353 cases were retrieved in this study, among which 138 (39.09%) demonstrated velopharyngeal competence, 176 (49.86%) velopharyngeal incompetence, and 39 (11.05%) marginal velopharyngeal incompetence. A total of 268 cases were subjected to nasopharyngeal endoscopy examination, where 167 (62.31%) demonstrated circular closure pattern, 89 (33.21%) coronal pattern, and 12 (4.48%) sagittal pattern. Passavant's ridge existed in 45.51% (76/167) patients with circular closure and 13.48% (12/89) patients with coronal closure. Among the 353 patients included in this study, 137 (38.81%) presented normal articulation, 124 (35.13%) consonant elimination, 51 (14.45%) compensatory articulation, 36 (10.20%) consonant weakening, 25 (7.08%) consonant replacement, and 36 (10.20%) multiple articulation errors.</p><p><b>CONCLUSIONS</b>Circular closure was the most prevalent velopharyngeal closure pattern among patients with submucous cleft palate, and high-pressure consonant deletion was the most common articulation abnormality. Articulation error occurred more frequently among patients with a low velopharyngeal closure rate.</p>
Subject(s)
Humans , Cleft Lip , Cleft Palate , Endoscopy , Palate, Soft , Pharynx , Retrospective Studies , Speech , Surgical Flaps , Velopharyngeal InsufficiencyABSTRACT
El objetivo fue identificar los patrones de Cierre Velofaríngeo (CVF) en pacientes con Paladar Hendido (PH) y Labio y Paladar Hendido (LPH) que acuden a la Clínica de Atención Integral de Pacientes con Labio y Paladar Hendido (CAIPLPH) de la Escuela Nacional de Estudios Superiores, Unidad León (ENES, León). Estudio transversal, con una muestra por conveniencia de 79 pacientes entre 4 y 10 años de edad. Las variables incluidas fueron el patrón de CVF, tipo de hendidura, edad del paciente y el antecedente de intervención quirúrgica previa para el cierre de la hendidura palatina. A los pacientes se les realizó valoración clínica y nasofibroscopía por examinadores previamente estandarizados para conocer si existe una relación entre edad y patrón de CVF, entre el tipo de hendidura y patrón de CVF y una relación entre el patrón de CVF y el antecedente quirúrgico, utilizando una prueba bivariada de Chi cuadrada. Se examinaron 46 hombres y 33 mujeres con una media de edad 6,6 años. La frecuencia de los patrones de CVF fueron coronal 8,86%, sagital 67,08%, circular 13,92% y circular con rodete de Passavant 10,12%. Se observó una diferencia estadística significativa entre el patrón de CVF y el tipo de hendidura (X2= 53,93, p<0,001). Las diferentes formas en que se pueden presentar las hendiduras de paladar y labiopalatinas influyen en la función del CVF ya que se puede presentar un patrón distinto en cada caso. El patrón de CVF no se ve afectado por la edad ni por el antecedente quirúrgico de cierre de la hendidura palatina.
The objective of the study was to identify patterns of velopharyngeal closure (CVF) in patients with Cleft Palate (PH) and cleft lip and palate (LPH) attending the Clinic of Comprehensive Attention of Patients with Cleft Lip and Palate (CAIPLPH) of the Escuela Nacional de Estudios Superiores, Unidad León (ENES, León). A cross-sectional study and convenience sample of 79 patients was carried out, including those aged between 4 and 10 years. The variables included were: CVF pattern, kind of cleft, the patient's age and history of previous surgery for closure of the palatal cleft. Patients underwent clinical evaluation and nasofibroscopy by examiners previously standardized to know if there is a relationship between age and CVF pattern, between kind of cleft and pattern of CVF and a relationship between the pattern of CVF and patient's history of previous surgery, using a X2 test bivariate square. Forty-six men and 33 women with a mean age 6.6 years were examined. Frequency patterns CVF: 8.86% coronal, sagittal 67.08%, circular 13.92% and a circular with Passavant ridge 10.12%. A statistically significant difference between the pattern of CVF and the kind of cleft (X2= 53.93, p <0.001) was observed. The different ways in which the PH and LPH clefts can present influence the function of CVF as it can present a different pattern in each case. CVF pattern is unaffected by age or by the previous surgical closure.
Subject(s)
Humans , Male , Female , Child , Cleft Lip , Cleft Palate , Velopharyngeal Insufficiency , Cross-Sectional Studies , Informed ConsentABSTRACT
The purpose of this study is to assess patterns of velopharyngeal closure in normal Thai subject. Ten volunteers with normal speech and no history of cranio-maxillo-facial abnormality, injury or surgery were included in this study. Their velopharyngeal closures were reviewed b y nasopharyngoscopy. Their articulation and resonation characteristics were also evaluated. The patterns of closure and related anatomy were studied. The results showed that all subjects achieved complete closure without a gap or nasal emission. Three patterns of velopharyngeal closure were found. A circular pattern was found in the majority of the subjects. More specifically, 6 subjects demonstrated circular closure patterns and 1 had a circular closure pattern with the Passavant’s ridge. The coronal pattern was found in the last 3 subjects. There was no correlation between patterns of closure and demographic data related to anatomy and resonation characteristics. In conclusion, 3 patterns of velopharyngeal closure were found and the circular type was the common. Further study was recommended with a larger group for gathering a database of Thai people.