Advances in classification and reconstruction of palatal fistula after cleft palate operation / 口腔疾病防治

@#Postoperative fistulae are one of the most significant complications of cleft palate repair. They usually has an adverse effect on patients’ oral hygiene, speech and even mental health. There has been a wide range of rates of fistula occurrence, from 0.8%-60%, with the classification and definition of fistulae differing from one author to the next. In this paper, the definition and classification of palatal fistulae and their reconstruction method are reviewed. At present, there is a lack of a consistent definition of palatal fistulae and a classification that can fully reflect the characteristics of palatal fistula. Adjacent flap is mainly used for repairing small fistulae with an adequate amount of surrounding tissue; anteriorly based dorsal tongue flaps are a safe and reliable method for large fistulae; free flap is beneficial for refractory and complicated palatal fistulae that are difficult to repair by the local and pedicle flap; and different synthetic materials are used in multilayer repair of fistulae; among them, composite polymer membrane is highly biocompatible, promoting cell attachment and proliferation in animal models, but its security in the human body needs further research.

Velopharyngeal closure pattern and speech characteristics of patients congenital velopharyngeal insufficiency / 华西口腔医学杂志

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.

Abordagem fonoaudiológica nas fissuras orofaciais não sindrômicas: revisão de literatura / Speech pathology treatment on nonsyndromic orofacial clefts: literature review

A fi ssura labiopalatina é uma malformação comum que ocorre em virtude da falta de fusão dos processos embrionários que formam a face e o palato. A avaliação e o tratamento voltados à fi ssura labiopalatina envolvem uma equipe multidisciplinar que contempla, entre outras especialidades, cirurgião-plástico, fonoaudiólogo, ortodontista, cirurgião-bucomaxilofacial, cirurgião-dentista, odontopediatra, otorrinolaringologista e psicólogo. Desse modo, por meio da assistência com profi ssionais especializados, é possível alcançar resultados estéticos e funcionais satisfatórios, proporcionando interações sociais mais efetivas e consequentemente melhor qualidade de vida ao fi ssurado. O objetivo deste trabalho é apresentar alguns dos princípios da ação do fonoaudiólogo nas fi ssuras orofaciais não sindrômicas, destacando-se a avaliação e terapia voltadas à função alimentar, mecanismo velofaríngeo e aspectos articulatórios da fala. Para tanto, procedeu-se a uma revisão narrativa da literatura. Como critério de inclusão dos trabalhos, consideraram-se publicações em coletâneas de repercussão na área fonoaudiológica e manuscritos que contemplassem os seguintes temas: aleitamento, orientações pré e pós-cirúrgicas, articulações compensatórias, função velofaríngea e terapia fonoaudiológica.

Cleft lip and palate is a common defect that occurs due to the lack of fusion of embryonic processes that form the face and the palate. Evaluation and treatment for cleft lip and palate involve an interdisciplinary team that includes, among other specialties, plastic surgeon, speech-language therapist, otorhinolaryngology, audiologist, orthodontist, maxillofacial surgeon and psychologist. Thus, through assistance with specialized professionals, it is possible to achieve satisfactory results, providing more effective social interactions and consequently better quality of life to subject with cleft lip and palate. The aim of this paper is to present some of the speech-language therapist's action principles on typical orofacial clefts, emphasizing the evaluation and therapy focused on food function, velopharyngeal mechanism and articulatory aspects of speech. Therefore, we proceeded to a literature review. For the inclusion of the papers, the following topics were considered: breastfeeding, pre and post-surgical guidelines, compensatory articulation, velopharyngeal function and speech-language therapy

Velopharyngeal closure pattern and speech performance among submucous cleft palate patients / 华西口腔医学杂志

<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>

The assessment of the nasality of cleft palate speech with the linguistic approach.

Nasality, an abnormal voice quality, is generally considered the major deviation in cleft palate speech. The assessment of this problem is necessary for the appropriate management. The study aimed to design the standard speech test to measure nasality : hypernasality, hyponasality (cul-de-sac) and nasal emission. The test was directed to the production of the phonetic criterion for selecting words that evidence the problem. The hypernasality and hyponasality are judged in three levels : sound, word, and connected speech. But the nasal emission is separately judged from nasality in only two levels : sound and word. The speech test was also analyzed by nasometer to check whether it could measure nasality of cleft palate speech and the result agreed well with purpose of the test. This suggests that test can be clinically used as a standard pattern to identify nasality.

The Study of Electropalatographic patterns in Cleft Palate Patients

Speech characteristics of cleft palate have been reported previously by hypernasality disorders. However, some cleft palate patients suffered from articulation disorders although they were taken surgery at an early time. Misarticulations of cleft palate patients are caused by abnormal lingual-palatal contacts. Traditionally, the Palatograpy has been used to see the lingual-palatal patterns. However, on this study, the Electropalatography(Palatometer) was used to investigate the comparison with lingual-palatal patterns between normal adult and cleft palate adult. The Nasometer model 6200-3 was used separately to measure the nasalance for cleft palate patient. The acoustic characteristics of cleft palate patients with respect to the palatographic patterns were examined by Computerized Speech Lab(IBM). The dental reflector was applied to measure the nasal airflow when cleft palate patient uttered. Test words were composed of meaningless mono syllabic words VCV (V: low center vowel /a/, C: alveolar stop, velar stop, affricate, fricative and lateral sounds). The subjects repeated the test words 10 times for statistic analysis. As a result of the palatographic patterns and the burst durations for stop consonants and the durations for fricative consonants, the cleft palate patients showed broader contact area, longer burst durations and fricative consonant durations than normal. It means that the cleft palate speech showed more tenseness of consonants than normal. By palatographic patterns, the misarticulation of cleft palate patient showed as follows : (1) Lingual-palatal contact of alveolar stop showed the palatalized misarticulation. (2) Lingual -palatal contact of velar stop moved forward in comparison with normal. However, posterior lateral contact areas were broader than normal contact area. (3) Lingual-palatal contact of affricate moved backward with narrower constriction than normal. (4) Fricative consonant showed lateral misarticulation.