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.

Velopharyngeal Incompetence in Dysarthria：Pathogenesis, Evaluation and Treatment (review) / 中国康复理论与实践

Dysarthric patients often present velopharyngeal incompetence (VPI), characterized nasalization articulation for hypernasali-ty, which seriously impaired their communication. Research of evaluation of VPI is mainly about cleft palate and postoperative, few about the dysarthria. Some approaches, such as physiologic approach to rehabilitation, have been used to correct hypernasality, and prosthesis, such as palatal lift prosthesis (PLP) and nasal speaking valve (NSV), are also proved effectively. PLP has been widely used for hypernasality oversea, but fewer in China.

Interim palatal lift prosthesis as a constituent of multidisciplinary approach in the treatment of velopharyngeal incompetence

The velopharynx is a tridimensional muscular valve located between the oral and nasal cavities, consisting of the lateral and posterior pharyngeal walls and the soft palate, and controls the passage of air. Velopharyngeal insufficiency may take place when the velopharyngeal valve is unable to perform its own closing, due to a lack of tissue or lack of proper movement. Treatment options include surgical correction, prosthetic rehabilitation, and speech therapy; though optimal results often require a multidisciplinary approach for the restoration of both anatomical and physiological defect. We report a case of 56 year old male patient presenting with hypernasal speech pattern and velopharyngeal insufficiency secondary to cleft palate which had been surgically corrected 18 years ago. The patient was treated with a combination of speech therapy and palatal lift prosthesis employing interim prostheses in various phases before the insertion of definitive appliance. This phase-wise treatment plan helped to improve patient's compliance and final outcome.

A Case of Velopharyngeal Incompetence due to Unexplained Myopathy in a Patient with Terminal-Staged Breast Cancer / 대한이비인후과학회지

Velopharyngeal incompetence is rare and difficult to diagnose, especially if there is no structural or neurologic cause for it. The authors have recently experienced a case of unexplained velopharyngeal incompetence in a 67-year old female patient with terminal-staged breast cancer (T4N2M1), who had received surgery before but failed. During her hospitalization for palliative treatment, the patient was referred to our department for hypernasality, nasal regurgitation and poor oral intake. Although clinical evaluations were completed to find the causes of velopharyngeal incompetence, no definite causes were found. Authors performed a palatopharyngoplasty with the superiorly based pharyngeal flap and her symptoms were cured. We report our case with a brief review of the literatures.

Reconstruction of Velopharyngeal Function after Resection of Lateral and Superior Oropharyngeal Cancer

PURPOSE: The reconstruction of oropharyngeal defect after cancer surgery is very difficult because of their complicated structure and the functional importance to prevent velopharyngeal incompetence. In this article we investigated affecting factors of velopharyngeal function after reconstruction and a fundamental rule of reconstruction for saving their functions such as swallowing, speeching and breathing. METHODS: We classified 18 patients into three group under Kimata's grouping. Type I defect(6 patients) was healed by primary closure or secondary intention. In Type II or III defect, two operation methods were used - the folded flap(8 patients) and modified Gehanno method(4 patients), which include a lateral-posterior pharyngeal rotation-advancement flap. We evaluated wound dehiscence between the flap and the soft palate, speech intelligibility using Hirose's method, regurgitation during oral feeding, and hypernasality. RESULTS: Most of type I or II defects patients recovered satisfactory velopharyngeal function. But, in patients with type III defects we found wound dehiscence, worse speech function, and common velopharyngeal incompetence. CONCLUSION: The large defect size and presence of wound dehiscence are major factors of postoperative velopharyngeal function. We conclude that folded flap or modified Gehanno method is a good reconstructive operation method for broad contact between the flap and defect site, preventing wound problem.

Speech Analysis in Patients with Velopharyngeal Incompetence Following Surgical Correction

A total of 35 patients with velopharyngeal incompetence were treated by surgical correction from 1995 to 2001. Twenty-six patients underwent lateral port control superior based pharyngeal flap and 9 patients underwent sphincteric pharyngoplasty. Speech analysis and fluorolaryngo-graphy was performed preoperatively and postoperatively. The nasality of open vowel, round vowel and sentence and articulation accuracy in 26 patients who underwent the pharyngeal flap improved from 37.7+/-10.71%, 49.1+/-9.54%, 50.1+/-9.03% and 68.9+/-10.11% preoperatively to 20.4+/-9.77%, 25.4+/-10.11%, 38.5+/-9.34% and 80.1+/-6.47% postoperatively, and hypernasality and articulation accuracy improved significantly (p<0.05). In case of 9 patients who underwent sphincteric pharyngoplasty, results were from 41.2+/-11.27%, 42.4+/-17.04%, 53.8+/-7.63% and 72.3+/-10.87% preoperatively to 20.7+/-8.27%, 20.8+/-14.34%, 29.7+/- 11.47% and 80.7+/-12.47% postoperatively, and hypernasality improved significantly (p<0.05). As far as postoperative fluorolaryngography is concerned, the velopharyngeal space was closed in patients with postoperative normal range of nasality. In conclusion, these results suggest that patients with velopharyngeal incompetence will improve speech dysfunction effectively if is chosen appropriately either superior based pharyngeal flap or sphincteric pharyngoplasty.

Evaluation of velopharyngeal function using nasopharyngeal fiberoscope and image processing program / 实用口腔医学杂志

0.05). Conclusion: RVPI and RSVPI of can be used as a measure to assess VPF and speech articulation of CP patients after operation.