Research progress in evaluating velopharyngeal structures and functions by magnetic resonance imaging / 口腔疾病防治

@#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.

Intensive treatment of speech disorders in robin sequence: a case report

ABSTRACT Purpose To describe the speech of a patient with Pierre Robin Sequence (PRS) and severe speech disorders before and after participating in an Intensive Speech Therapy Program (ISTP). Methods The ISTP consisted of two daily sessions of therapy over a 36-week period, resulting in a total of 360 therapy sessions. The sessions included the phases of establishment, generalization, and maintenance. A combination of strategies, such as modified contrast therapy and speech sound perception training, were used to elicit adequate place of articulation. The ISTP addressed correction of place of production of oral consonants and maximization of movement of the pharyngeal walls with a speech bulb reduction program. Therapy targets were addressed at the phonetic level with a gradual increase in the complexity of the productions hierarchically (e.g., syllables, words, phrases, conversation) while simultaneously addressing the velopharyngeal hypodynamism with speech bulb reductions. Results Re-evaluation after the ISTP revealed normal speech resonance and articulation with the speech bulb. Nasoendoscopic assessment indicated consistent velopharyngeal closure for all oral sounds with the speech bulb in place. Conclusion Intensive speech therapy, combined with the use of the speech bulb, yielded positive outcomes in the rehabilitation of a clinical case with severe speech disorders associated with velopharyngeal dysfunction in Pierre Robin Sequence.

Podem os distúrbios de fala de crianças com fissura labiopalatina serem justificadas pelas alterações das habilidades auditivas centrais? / Can speech disorders of children with cleft palate be justified by central auditory skills?

As crianças com fissura labiopalatina geralmente apresentam alterações fonoaudiológicas com manifestações em vários aspectos, especialmente no da comunicação. No que se refere à audição, os bebês que nascem com fissura no palato tendem a apresentar acúmulo de fluido na orelha média, devido ao mau funcionamento do mecanismo de abertura e fechamento da tuba auditiva. O quadro pode evoluir para otites, que é umas das causas mais comuns de perda auditiva em crianças com fissura labiopalatina com até 10 anos. Esta perda auditiva geralmente é do tipo condutiva bilateral. Sabe-se que a audição normal é essencial para a aquisição da linguagem oral e efetiva comunicação verbal, e que déficits do sistema auditivo, congênitos ou adquiridos afetam a transmissão e a percepção do som. Qualquer perda auditiva oferece privação sensorial, podendo, assim, levar a alterações em diferentes habilidades auditivas. São crescentes os estudos científicos relacionados às habilidades auditivas em crianças com fissura labiopalatina, contudo, existe uma escassez de trabalhos relacionando habilidades auditivas centrais com as alterações de fala na fissura labiopalatina. Assim, hipotetizou-se que as habilidades auditivas centrais em crianças com fissura labiopalatina que apresentam alterações de fala seriam diferentes das habilidades das crianças com fissura labiopalatina sem alteração de fala e também que poderia existir uma relação entre as alterações de fala relacionadas à Disfunção Velofaríngea e às habilidades auditivas centrais. Este trabalho teve por objetivo verificar a associação entre as habilidades auditivas centrais e alterações de fala decorrentes da Disfunção Velofaríngea (hipernasalidade e emissão de ar nasal), e Articulações Compensatórias em crianças com fissura labiopalatina operada. Nesta pesquisa, foi realizado um estudo prospectivo de 45 pacientes, subdividos em 3 grupos. Todos matriculados no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo, com fissura labiopalatina operada. Foram averiguados inicialmente em prontuário dados quanto à Disfunção Velofaríngea e ao uso de Articulações Compensatórias a fim de compor os três grupos do estudo, sendo o G1 com alterações de fala decorrentes da Disfunção Velofaríngea e Articulações Compensatórias, o G2 com alterações de fala decorrentes da Disfunção Velofaríngea, porém sem Articulações Compensatórias, e G3 (grupo controle) sem alterações de fala decorrentes da Disfunção Velofaríngea e sem Articulações Compensatórias. Posteriormente, os sujeitos foram submetidos à avaliação audiológica periférica e a testes do processamento auditivo central. A Articulação Compensatória de maior ocorrência foi a golpe de glote, seguida pela fricativa faríngea e plosiva dorso médio palatal. O G1 foi o grupo que apresentou o maior número de sujeitos com habilidades auditivas alteradas, seguido pelo G2, e G3. Foi encontrada significância estatística na associação do grupo com alterações de fala decorrentes da DVF e AC com as habilidades de figura-fundo e ordenação temporal. A habilidade de resolução temporal esteve alterada em toda amostra estudada.(AU)

Children with cleft lip and palate usually have speech-language disorders with manifestations in various aspects of communication and supply. With regard to auditing, children with cleft palate tend to have fluid buildup in the middle ear due to malfunction of the opening and closing mechanism of the Eustachian tube. The table may develop into Otitis, which is one of the most common causes of hearing loss in children up to 10 years with cleft lip and palate. This hearing loss is usually conductive type and bilateral. Normal hearing is essential for the acquisition of oral language and effective verbal communication and that deficits of the auditory system, congenital or acquired, affect the transmission and perception of sound. Any hearing loss offers sensory deprivation and may thus lead alteration in different hearing abilities.Scientific studies related to the auditory abilities in children with cleft lip and palate are increasing, however, there is a paucity of studies linking central auditory skills with speech disorders in the cleft lip and palate. Thus hypothesized dry the central auditory skills in children with cleft lip and palate who have speech disorders would be different from the skills of children with cleft lip and palate speechless change and also that could be a relationship between speech disorders related to velopharyngeal dysfunction and central auditory skills .The objective of this study is investigate the association between central auditory skills and speech disorders resulting from the velopharyngeal dysfunction (hypernasality and nasal air emission) and compensatory articulations in children with cleft palate. In this research it performed a prospective study of 45 patients, subdivided into 3 groups. All enrolled in the Craniofacial Anomalies Rehabilitation Hospital of the University of São Paulo, with operated cleft lip and palate. They were initially investigated in medical records data on the velopharyngeal dysfunction and use of compensatory articulations in order to compose the three study groups: the G1 with speech disorders resulting from the velopharyngeal dysfunction and compensatory articulations, G2 with speech disorders resulting from the velopharyngeal dysfunction But without compensatory articulations and G3 (control group) without speech disorders resulting from the velopharyngeal dysfunction and no compensatory articulations. Later the subjects underwent a peripheral audiological evaluation and auditory processing tests. The compensatory articulation was the most frequent glottal stop, followed by pharyngeal fricative and plosive average back palatal. The G1 was the group that had the highest number of subjects with altered auditory skills, followed by G2 and G3. Found statistically significant association between the group with speech disorders resulting from VPD and CA with the figure-ground skills and temporal skills. The temporal resolution skill was altered in all groups of this study.(AU)

Successful and rapid response of speech bulb reduction program combined with speech therapy in velopharyngeal dysfunction: a case report / 대한악안면성형재건외과학회지

Velopharyngeal dysfunction in cleft palate patients following the primary palate repair may result in nasal air emission, hypernasality, articulation disorder and poor intelligibility of speech. Among conservative treatment methods, speech aid prosthesis combined with speech therapy is widely used method. However because of its long time of treatment more than a year and low predictability, some clinicians prefer a surgical intervention. Thus, the purpose of this report was to increase an attention on the effectiveness of speech aid prosthesis by introducing a case that was successfully treated. In this clinical report, speech bulb reduction program with intensive speech therapy was applied for a patient with velopharyngeal dysfunction and it was rapidly treated by 5months which was unusually short period for speech aid therapy. Furthermore, advantages of pre-operative speech aid therapy were discussed.

The Relationship between Age and Speech Improvement in the Patients Performed Pharyngeal Flap for Correction of Velopharyngeal Dysfunction

PURPOSE: The pharyngeal flap is one of the popular surgical methods to treat the problem of velopharyngeal dysfunction. This study evaluated speech outcome of patients who underwent superiorly based pharyngeal flap surgery based on timing of surgery. METHODS: A restrospective review of 50 patients who underwent pharyngeal flap surgery for velopharyngeal insufficiency from September 1996 to January 2008 was undertaken. Thirty patients with an available preoprative and postoperative speech assessments with at least 6 months of follow-up were included in this study. We checked out the significance of speech improvement after surgery analysing preoperative and postoperative scoring of speech assessment. We also investigated the direct relationship between the age at surgery and the degree of speech improvement, and the improvement score in different age groups. RESULTS: The mean score of preoperative speech was 52.6 +/- 7.4 points and postoperative speech was 58.6 +/- 6.5 points, which presented significant postoperative speech improvement with an average of 5.9 points (p<0.01). There was a significant inverse relationship between the age at operation and speech improvement degree (p<0.01, r=-0.54). Comparing the age groups, the age group of 4 to 5 years presented statistically significant speech improvement (p<0.01). CONCLUSION: we propose that all patients indicated should take pharyngeal flap irrespective of age. In this study, the younger the age at surgery, the higher degree of speech improvement, for which we suggest that surgical approach should be undertaken as early as possible, especially younger than 5 years of age.