ABSTRACT
BACKGROUND: One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI). OBJECTIVE: This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate. MATERIALS AND METHODS: An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy. RESULTS: Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented. CONCLUSION: This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management.
Subject(s)
Cleft Palate/diagnosis , Cleft Palate/therapy , Diagnostic Errors/prevention & control , Speech Disorders/diagnosis , Velopharyngeal Insufficiency/diagnosis , Velopharyngeal Insufficiency/therapy , Cleft Palate/complications , Diagnosis, Differential , Humans , Speech Disorders/etiology , Speech Disorders/prevention & control , Symptom Assessment/methods , Velopharyngeal Insufficiency/complicationsABSTRACT
BACKGROUND: Adenoid hypertrophy is a common cause of upper airway obstruction in children. Traditionally, adenoid size has been evaluated using a conventional lateral skull film. Flexible endoscopy is now the gold standard for the evaluation of the upper airway. In small children, this study is not always adequately tolerated. OBJECTIVE: Determine specificity and sensitivity of videofluoroscopy for evaluating adenoid size and velopharyngeal closure during speech, as compared with lateral skull film, using videonasopharyngoscopy as gold standard. METHODS: Prospective study analyzing 70 patients with clinical data of upper airway obstruction, ages 5-10 years old. Videofluoroscopy, videonasopharyngoscopy, and lateral skull film were performed in all cases. Patients were divided into children with and without adenoid hypertrophy. Specificity, sensitivity, and predictive values were calculated. Also, data concerning comfort during the three procedures were obtained. RESULTS: Videofluoroscopy showed sensitivity of 100% and specificity of 93%. Lateral skull film showed sensitivity of 70% and specificity of 52%. A Spearman correlation coefficient demonstrated a significant correlation (p < 0.05) between videofluoroscopy and videonasopharyngoscopy. A non-significant correlation was found between lateral skull film and videonasopharyngoscopy. Parents or legal guardians considered the lateral skull film as a comfortable procedure. Seventy-one percent of the parents considered videofluoroscopy as a comfortable procedure and 29% reported "mild discomfort". Ten percent evaluated videonasopharyngoscopy as "extremely uncomfortable". The rest reported "minor" and "moderate" discomforts. CONCLUSIONS: Videofluoroscopy seems a reliable method without serious complications for evaluating adenoid hypertrophy and velopharyngeal closure in children,besides being a well-tolerated procedure.
Subject(s)
Adenoids/pathology , Laryngoscopy/methods , Phonation/physiology , Velopharyngeal Sphincter/physiopathology , Airway Obstruction/etiology , Child , Child, Preschool , Fluoroscopy/methods , Humans , Hypertrophy/physiopathology , Prospective Studies , Sensitivity and SpecificityABSTRACT
BACKGROUND: Several pathologies can involve muscles that control vocal folds. The abnormality can affect peripheral nerves or central nervous system centers. Clinically, muscle function can be assessed by observing the movement of structures themselves or by recording electrical activity of these muscles using (electromyography-EMG). Since EMG is an invasive technique, its use is not very widespread in the diagnosis and management of voice disorders, Laryngeal EMG can be helpful in those patients with voice problems of suspected neurological or neuromuscular etiology. OBJECTIVE: Assess the role of laryngeal EMG in the clinical evaluation of unilateral vocal cord immobility. METHODS: Twenty-five patients with unilateral vocal cord paralysis were studied. Twenty-five patients with unilateral arytenoid dislocation were studied as controls. The sensitivity and specificity of the EMG as a diagnostic marker for vocal fold paralysis were obtained. RESULTS: Laryngeal EMG showed a 100% sensitivity and 92% specificity. Only two patients displaying arytenoid dislocation displayed abnormal EMG recordings. CONCLUSIONS: EMG constitutes a safe and reliable tool to aid the evaluation of patients with vocal fold immobility. EMG recordings were helpful in differentiating vocal cord paralysis from arytenoid dislocation. Moreover, EMG can provide useful data regarding denervation and reinnervation of laryngeal muscles. Aside from its diagnostic usefulness, serial EMG can help to monitor recovery and establish a reliable prognosis. Hence, an adequate treatment plan can be determined.
Subject(s)
Vocal Cord Paralysis/physiopathology , Adolescent , Adult , Electromyography , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
Antecedentes: Existen patologías que pueden involucrar a los músculos que controlan la movilidad de las cuerdas vocales, por afección de la función periférica o del sistema nervioso central. La función muscular puede evaluarse mediante observación directa de la laringe o por electromiografía (EMG), la cual por ser invasiva ha tenido un uso limitado en el diagnóstico y manejo de los trastornos de la voz. Objetivo: El propósito de este estudio fue evaluar la utilidad de la EMG laríngea en la evaluación de la parálisis cordal unilateral. Métodos: Se estudiaron 25 sujetos con parálisis cordal y 25 controles con dislocación unilateral del aritenoides. Se obtuvieron los valores de sensibilidad y especificidad de la EMG como prueba diagnóstica. Resultados: La EMG mostró sensibilidad de 100% y especificidad de 92%. Solo dos pacientes con dislocación de aritenoides mostraron anormalidades en la EMG. Conclusiones: La EMG parece una prueba confiable y segura para complementar la evaluación de alteraciones de la movilidad de una cuerda vocal y diferenciar parálisis cordal de dislocación de aritenoides. Puede proveer evidencia de la denervación muscular y la reinervación, y los datos en serie pueden contribuir a establecer un pronóstico más confiable para delinear un plan de tratamiento adecuado a cada caso.
BACKGROUND: Several pathologies can involve muscles that control vocal folds. The abnormality can affect peripheral nerves or central nervous system centers. Clinically, muscle function can be assessed by observing the movement of structures themselves or by recording electrical activity of these muscles using (electromyography-EMG). Since EMG is an invasive technique, its use is not very widespread in the diagnosis and management of voice disorders, Laryngeal EMG can be helpful in those patients with voice problems of suspected neurological or neuromuscular etiology. OBJECTIVE: Assess the role of laryngeal EMG in the clinical evaluation of unilateral vocal cord immobility. METHODS: Twenty-five patients with unilateral vocal cord paralysis were studied. Twenty-five patients with unilateral arytenoid dislocation were studied as controls. The sensitivity and specificity of the EMG as a diagnostic marker for vocal fold paralysis were obtained. RESULTS: Laryngeal EMG showed a 100% sensitivity and 92% specificity. Only two patients displaying arytenoid dislocation displayed abnormal EMG recordings. CONCLUSIONS: EMG constitutes a safe and reliable tool to aid the evaluation of patients with vocal fold immobility. EMG recordings were helpful in differentiating vocal cord paralysis from arytenoid dislocation. Moreover, EMG can provide useful data regarding denervation and reinnervation of laryngeal muscles. Aside from its diagnostic usefulness, serial EMG can help to monitor recovery and establish a reliable prognosis. Hence, an adequate treatment plan can be determined.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Middle Aged , Vocal Cord Paralysis/physiopathology , ElectromyographyABSTRACT
INTRODUCTION: Superiorly based pharyngeal flaps and sphincter pharyngoplasties are the two main possibilities for the surgical treatment of hypernasality in velopharyngeal dysfunction. Videonaspharyngoscopy and multi-view videofluoroscopy can provide anatomical and physiological data for planning these surgical procedures for correcting hypernasality. AIM: This study was undertaken to assess the planning and outcome of pharyngeal flaps and sphincter pharyngoplasties for correcting velopharyngeal insufficiency. The surgical techniques were customized according to the findings of videonasopharyngoscopy and multiview videofluoroscopy. MATERIALS AND METHODS: Seventy patients with repaired palate clefts and residual velopharyngeal dysfunction were studied. The patients were randomly divided into two groups. The first group received a pharyngeal flap. The second group received a sphincter pharyngoplasty. Both procedures were individually customized according to the findings of videonasopharyngoscopy and multi-view videofluoroscopy. RESULTS: There was a non-significant difference (P >0.05) between the mean size of preoperative velopharyngeal closure gap between the two groups of patients (mean=27.5%; S.D.=7.7% versus mean=28.3%; S.D.=5.9%). Postoperatively, velopharyngeal dysfunction was completely corrected in 89% of the cases from group 1, and in 85% of the cases from group 2. There was a non-significant difference (P >0.05) between the success rate for correcting VPI in both groups of patients. CONCLUSIONS: Pharyngeal flap and sphincter pharyngoplasty seem to be safe and reliable procedures for treating residual velopharyngeal dysfunction. Although not all the patients studied for this paper achieved complete closure after the surgical procedures, all of them showed a reduction of the size of the velopharyngeal closure defect. The planning of the surgical procedure, in order to match the postoperative structure to the preoperative velopharyngeal dimensions and movements visualized through Videonasopharyngoscopy and videofluoroscopy, seems to be the most important aspect of the surgery for correcting residual velopharyngeal dysfunction.
Subject(s)
Cleft Palate/surgery , Speech Disorders/surgery , Child , Child, Preschool , Cleft Palate/complications , Hospitals , Humans , Prospective Studies , Plastic Surgery Procedures/methods , Speech Disorders/etiology , Surgical Flaps , Treatment Outcome , Velopharyngeal Insufficiency/complications , Velopharyngeal Insufficiency/surgeryABSTRACT
Introducción: El paladar hendido submucoso (PHSM) es una malformación congénita definida. El tratamiento quirúrgico está indicado cuando se asocia con insuficiencia velofaríngea (IVF). Objetivo: Comparar la palatofaringoplastía (PFP) de incisiones mínimas (PFIM) en dos modalidades: única y con cirugía adicional individualizada (colgajo faríngeo o faringoplastía de esfínter). La cirugía individualizada fue seleccionada y realizada de acuerdo a los hallazgos de la video-naso-faringoscopía (VNF) y la video-fluoroscopía de vistas múltiples (VFVM). Material y Métodos: 72 pacientes se dividieron aleatoriamente en dos grupos. El primer grupo fue tratado con PFP. El segundo grupo se sometió a la PFP más colgajo faríngeo o de plastía de esfínter. Resultados: 37 pacientes conformaron el primer grupo y 35 pacientes el segundo. La edad media en ambos grupos no fue significativamente diferente (p > 0.5). La IVF residual después del cierre del paladar no fue significativamente diferente (14 por ciento y 11 por ciento, p > 0.5). El tamaño relativo promedio del defecto en el esfínter velofaríngeo durante el habla no fue significativamente diferente antes de la cirugía (23 por ciento vs 22 por ciento: p > 0.5). No existió diferencia significativa en el tamaño residual del defecto después de la cirugía. en los casos con IVF de ambos grupos (7 por ciento vs 8 por ciento p > 0.5). Conclusiones: Los resultados sugieren que la PFIM es una técnica confiable para el cierre palatino en pacientes con PHFM. El uso de la cirugía adicional, no parece disminuir la frecuencia de IVF residual. Además, el tamaño residual del defecto no varió significativamente después de la cirugía adicional.
Subject(s)
Humans , Male , Female , Child, Preschool , Cleft Palate , Velopharyngeal Insufficiency/surgery , Oral Surgical Procedures/rehabilitationABSTRACT
Propósito: Estudiar el uso de la videonasofaringoscopía como un instrumento para la retro-alimentación visual durante el habla en pacientes con paladar hendido reparado quirúrgicamente y con insuficiencia velofaríngea residual. Material y Métodos: Diecisiete pacientes con paladar hendido fueron seleccionados al azar para el estudio. Todos los pacientes mostraron insuficiencia velofaríngea (IVF), articulación compensatoria (AC) y movimiento negativo de las paredes faríngeas laterales (MNPFL) durante el habla. Nueve pacientes recibieron terapia del lenguaje para corregir la AC. Ocho pacientes recibieron terapia del lenguaje y videonasofaringoscopía como un instrumento para retro-alimentación visual del esfinter velofaríngeo. Resultados: Después de 12 semanas, el MNPFL se modificó en los pacientes que recibieron terapia del lenguaje y retro-alimentación visual. En contraste, el MNPFL se encontró presente en ocho de nueve pacientes que recibieron terapia del lenguaje. Posteriormente, estos pacientes también recibieron retro-alimentación visual y el MNPFL se corrigió en todos los caos. Después de seis meses, todo los diecisiete pacientes habían corregido al AC durante el habla aislada. A todos los pacientes se les practicó un colgajo faríngeo hecho a la medida. La IVF se corrigió en forma completa en quince casos. En los dos casos restantes en los que la IVF continuó presente en forma postoperatoria, el tamaño del defecto esfinter velofaríngeo se redujo significativamante. En estos dos pacientes, la retro-alimentación visual fue posterior a la cirugía para mejorar el movimiento de las paredes faríngeas laterales (PFL) hacia el borde del colgajo. Después de dieciocho meses desde el inicio de la terapia de lenguaje, todos los pacientes presentaban resonancia nasal y articulación normal durante el habla conectada. Conclusiones: La videonasofaringoscopía es una herramienta útil para mejorar la IVF en pacientes con MNPFL
