Review of Current Techniques of Cleft Palate Repair Concerning Palatal Innervation: A Preliminary Assumption.

OBJECTIVE: To highlight the possible surgical steps that could affect the neural supply of soft palate and velopharyngeal sphincter during Furlow palatoplasty and posteriorly-based myo-mucosal buccal flaps in patients with persistent velopharyngeal insufficiency after primary cleft palate repair. DESIGN: Institution-based retrospective study. SETTING: Academic Medical Center. PATIENTS: Non-syndromic patients with persistent hypernasality (after primary cleft palate repair) who had Furlow palatoplasty or posteriorly-based buccal myo-mucosal flaps and were followed up for at least 60 months after the secondary surgery. INTERVENTIONS: All patients were examined using a fiberoptic endoscopy, the movement of components of the velopharyngeal sphincter: soft palate, and lateral pharyngeal walls were traced on the monitor and given a score from 0-4. The pattern of VPS closure was reported whether coronal, circular, or sagittal for each case. MAIN OUTCOME MEASURES: Patients' characteristics, auditory perceptual assessment, the severity of hypernasality, intraoperative lengthening of the palate, and operative complications were recorded. RESULTS: At postoperative (at least 60 months) evaluation of the patients statistically non-significant differences were reported when comparing the pre-versus post-operative auditory perceptual assessment following both procedures (P value ≥0.05). A greater tendency towards improvement was noticed with BF but was non-significant. CONCLUSION: The nerve supply of the palate could be jeopardized by many techniques of primary or secondary repair of the cleft palate leaving behind a deceiving intact but weak poor-functioning palate. All efforts should be made to provide more neural-preservation techniques in primary/secondary repair of the cleft palate. Further wide-scale research is essential to have final clear conclusions.

Positional awake nasoendoscopic pattern-based surgical decision for correction of retropalatal obstruction in OSA.

PURPOSE: To evaluate differential surgical interventions for obstructive sleep apnea (OSA) patients with single-level retropalatal based on the preoperative topographical diagnosis using nasoendoscopy with Müller's maneuver during supine position (MM-P). SUBJECTS AND METHODS: This case series included adult patients with OSA who showed a predominant single-level retropalatal collapse on MM-P. An anteroposterior pattern of collapse was managed by an anterior advancement procedure, while a transverse pattern of collapse was managed by lateral/anterolateral advancement procedures (double suspension sutures). A combined procedure was provided to the concentric type of collapse. All patients underwent evaluation of the polysomnography, Epworth Sleepiness Scale (ESS) values and snoring scores both preoperatively and 6-8 months after surgery. RESULTS: Among 102 patients, the most commonly reported pattern of collapse at the retropalatal level was the concentric pattern (48.04%) followed by the transverse pattern (27.45%). The AP-pattern of collapse was reported in 24.51%. In the postoperative follow-up visits, no early or late complications were reported. All included groups showed significant improvement in polysomnographic data (mean AHI and lowest O2 saturation level). Significant improvement of VAS of snoring was reported. The overall success rate was ˃90%. CONCLUSION: Preoperative differential diagnosis of OSA with MM-P allows for tailored surgical management. Tailored procedures could yield good surgical outcomes when patients are properly selected and the technique is chosen according to preoperative topographical diagnostic assessment. This study might provide an available less-costly and effective preoperative planning for OSA intervention. LEVEL OF EVIDENCE: 4.

Assessment of the New L Pharyngeal Flap for Velopharyngeal Insufficiency.

OBJECTIVE: To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI). METHODS: This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation. RESULTS: Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported. CONCLUSION: The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication.

Positional Awake Endoscopy Versus DISE in Assessment of OSA: A Comparative Study.

OBJECTIVE: To compare awake endoscopy with Müller's maneuver (MM) during both sitting and supine positions, with drug-induced sleep endoscopy (DISE) as regard determination of different levels, patterns, and degrees of collapse of the upper airway in adult patients with obstructive sleep apnea (OSA). METHODS: The study included adult patients with OSA symptoms, who had apnea hypopnea index (AHI) > 15. Patients were examined by MM in a sitting position, then during supine position; DISE then followed. Site, pattern, and degree of obstruction were assessed by experienced examiners according to the nose oropharynx hypopharynx and larynx classification. RESULTS: Eighty-one adult subjects were included. The most common pattern of collapse at the retro-palatal level was the concentric pattern, while the predominant pattern at the hypopharyngeal level was the lateral wall collapse. The analysis of the pattern of collapse of the study group revealed that the individual pattern did not change (for the same patient at the same level) in the majority of patients whatever the maneuver or the position. CONCLUSION: This study demonstrates the feasibility of positional awake endoscopy for providing valuable surgical information as regard level, pattern, and degree of severity in OSA. The data of positional awake endoscopy were comparable to those gained from DISE with less morbidity and costs. The idea and results of this work provide a useful foundation for future research in this area. Multicenter studies are encouraged to obtain more reliable conclusions and more clear standards aiming at a better surgical planning. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2269-2274, 2020.

Palatal Sphincter Pharyngoplasty With Cephalic Mucosa Preservation in Selected Cases of Velopharyngeal Insufficiency.

OBJECTIVES: Sphincter pharyngoplasty is a commonly performed procedure for the treatment of velopharyngeal insufficiency and is often indicated in patients with circular or coronal closure patterns of the velopharyngeal sphincter. The authors present a modified technique of sphincter pharyngoplasty (partially mucosalized palatal sphincter pharyngoplasty [PMPSP]) in which bilateral superiorly based myomucosal palatopharyngeal flaps were elevated (in a newly designed fashion) and inserted in the palate through preformed palatal tunnels. METHODS: This case series included 14 patients (5 male, 9 female) with persistent hypernasality who were subjected to treatment by PMPSP between May 2015 and August 2018. The palatopharyngeal flap was designed to be full thickness at its caudal segment, while its cephalic segment was denuded of its mucosa. The cephalic mucosa (of the flap) was elevated off the bed muscles as a medially based mucosa flap to be used at the end of the procedure to drape the upper part of the bed. RESULTS: Pain assessed using a visual analog scale had decreased significantly at day 10 after surgery, and normal oral feeding was regained within 7 to 10 days. No major complications were recorded. Postoperative nasoendoscopic and phoniatric assessments were reported. Statistically significant improvements were reported when comparing pre- versus postoperative auditory perceptual assessment following PMPSP. CONCLUSIONS: The newly reported PMPSP might be a useful technique for correction of velopharyngeal insufficiency in patients with weak palatal motion (coronal or circular pattern of velopharyngeal sphincter closure). PMPSP had good reported surgical and phoniatric outcomes.

Cephalic de-mucosalized superiorly-based pharyngeal flap: A modified mucosa-preserving technique for velopharyngeal insufficiency.

INTRODUCTION: Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to correct velopharyngeal insufficiency (VPI). Bared posterior pharyngeal wall might prolong the period of convalescence with throat pain and discomfort. Delayed donor site healing problems and subsequent fibrosis with downward migration of the transposed flap might be one a cause of failure and might necessitate revision. AIM OF THE WORK: To present a modified technique of PF aiming at dealing with the problems of donor site defects via immediate self-mucosal covering of the cephalic portion of the bed. METHODS: This case series study was conducted on patients with persistent VPI. All patients underwent the new modified technique of cephalic de-mucosalized pharyngeal flap (CDPF). The basic premise was to harvest a laterally-based mucosal flap from the upper part of the posterior pharyngeal wall. A superiorly-based pharyngeal flap (with a bared cephalic segment and a mucosalized caudal segment) was elevated off the posterior pharyngeal wall and inserted in the soft palate. Then the laterally-based mucosal flap was spread over the superior part of donor site of the posterior pharyngeal wall. RESULTS: 13 VPI patients were included in this study. Their age ranged from 5 to 12 years with a mean of 5.6 ±â€¯1.2. The follow-up period ranged from 8 to 14 months. All flaps and beds were completely healed within 2-3 weeks and no patients showed flap dehiscence, infection or palatal fistula. Postoperative speech assessment showed significant improvement of velopharyngeal function, resonance balance, and reduction in nasal emission. CONCLUSIONS: The modified technique provides an immediate self-mucosa cover to the superior part of the posterior pharyngeal wall, thus it could promote primary healing at the donor site with a short period of convalescence. CDPF separates the two opposing raw surfaces of the flap and the posterior pharyngeal wall. The mucosal flap might guard against downward migration of the flap.

Linear Measurements of Vocal Folds and Laryngeal Dimensions in Freshly Excised Human Larynges.

INTRODUCTION: Understanding the morphology of the larynx, one of the most complex organs of the human body, is an important step toward understanding the detailed laryngeal anatomy, and physiology. Different studies have described the linear measurements of the larynx in different measuring methods, but no studies have been structured to describe vocal fold length in freshly excised larynges. OBJECTIVES: The aim of this study was to describe exact anatomical measurements of vocal folds and some laryngeal structures in freshly excised larynges, and to compare such measurements between males and females. This can help improve the diagnostic and therapeutic procedures in the laryngology field. SUBJECTS AND METHODS: This study was applied on 21 patients having different types of laryngeal carcinoma: 11 males and 10 females with the age range 41-75 years old. Every patient was assessed using laryngeal endoscopy and photography, and the length of the membranous vocal fold was measured using a millimeter-graded ruler that was photographed with focus with the same magnification used in the video laryngoscopy of the glottis. Then patients were exposed to total laryngectomy, and excised larynges were used for a direct measuring of the membranous and cartilaginous vocal folds. Then measures of men and women were compared statistically. Measures of excised larynges were also compared with those of the video endoscopy using a video-printed ruler. CONCLUSION: Freshly excised larynges can be used for accurate quantitative measuring of the vocal fold length and laryngeal dimensions. There are considerable differences in all measured dimensions between males and females.

Nasalance Changes Following Various Endonasal Surgeries

Abstract Introduction There is change in nasalance post endonasal surgery which is not permanent. Objectives The objective of this study is to evaluate the long-term nasalance changes following different types of endonasal surgeries. Methods We included in this study patients who underwent sinonasal surgery at the Otorhinolaryngology Department in Zagazig University Hospitals from February 2015 until March 2016. We divided the patients into two groups according to the surgeries they underwent: Group (A) was the FESS group and group (B), the septoturbinoplasty group.We checked nasalance using a nasometer before and after the sinonasal surgery. Results Nasalance increased at one month after the operation in both groups. However, it returned to nearly original levels within three months postoperatively. Conclusion FESS, septoplasty, and turbinate surgery may lead to hypernasal speech. This hypernasal speech can be a result of change in the shape and diameter of the resonating vocal tract. Hypernasal speech in these circumstances may be a temporary finding that can decrease with time. Surgeons should inform their patients about the possibility of hypernasality after such types of surgery, especially if they are professional voice users.

Nasalance Changes Following Various Endonasal Surgeries.

Introduction There is change in nasalance post endonasal surgery which is not permanent. Objectives The objective of this study is to evaluate the long-term nasalance changes following different types of endonasal surgeries. Methods We included in this study patients who underwent sinonasal surgery at the Otorhinolaryngology Department in Zagazig University Hospitals from February 2015 until March 2016. We divided the patients into two groups according to the surgeries they underwent: Group (A) was the FESS group and group (B), the septoturbinoplasty group. We checked nasalance using a nasometer before and after the sinonasal surgery. Results Nasalance increased at one month after the operation in both groups. However, it returned to nearly original levels within three months postoperatively. Conclusion FESS, septoplasty, and turbinate surgery may lead to hypernasal speech. This hypernasal speech can be a result of change in the shape and diameter of the resonating vocal tract. Hypernasal speech in these circumstances may be a temporary finding that can decrease with time. Surgeons should inform their patients about the possibility of hypernasality after such types of surgery, especially if they are professional voice users.

Voice and Swallowing Outcomes after Hyoid Suspension Surgery in Patients with Obstructive Sleep Apnea.

OBJECTIVE: The role of hyoidthyroidpexia (HTP) surgery in the management of patients with obstructive sleep apnea (OSA) is well described with good reported outcomes. The effect of HTP on other laryngeal functions is not well discussed. This study was designed to evaluate voice and swallowing outcomes after HTP. PATIENTS AND METHODS: This study was applied on a selected group of OSA patients. HTP (as a sole procedure) was performed in 17 patients and 14 patients had simultaneous palatal procedures (e.g., anterior palatoplasty). Pre- and postoperative assessment of voice and swallowing were done. RESULTS: Comparison between pre- and postoperative results of voice and swallowing measures revealed a nonsignificant difference. CONCLUSION: HTP (as a sole technique or as part of a multilevel intervention) could help with airway collapse and might be considered a safe, simple, and effective technique in the management of selected patients experiencing OSA. In addition, it seems to have no hazardous effect on either the voice or swallowing function of patients.

Use of autologous platelet-rich plasma in complete cleft palate repair.

OBJECTIVES/HYPOTHESIS: Evaluate the effect of topical application of autologous platelet-rich plasma (PRP) in primary repair of complete cleft palate and then compare the result with another group of patients using the same surgical technique, without application of PRP with regard to the incidence of oronasal fistula, velopharyngeal closure, and grade of nasality. STUDY DESIGN: Case control study. METHODS: This study was carried on 44 children with complete cleft palate with age range from 12 to 23 months. The children were divided into two age- and gender-matched groups: All children were subjected to the same technique of V-Y pushback repair of the complete cleft palate. In group A (22 children), the PRP prepared from the patient was topically applied between the nasal and oral mucosa layer during palatoplasty, whereas in group B (22 children) the PRP was not applied. RESULTS: All cases were recovered smoothly without problems. In group A, no oronasal fistula was reported, whereas in group B three patients (13.6%) had postoperative fistulae and two patients (9.1%) needed revision palatoplasty. At 6 months postoperative assessment, group A (with PRP application) showed significantly better grade of nasality (P = 0.024) and better endoscopic velopharyngeal closure (P = 0.016) than group B. CONCLUSION: Usage of autologous PRP in complete cleft palate repair is simple; effective; can decrease the incidence of oronasal fistula; and also significantly improves the grade of nasality and velopharyngeal closure, which decreases the need of further surgical intervention in cleft palate patients. LEVEL OF EVIDENCE: 3b. Laryngoscope, 126:1524-1528, 2016.

Voice Changes after Late Recurrent Laryngeal Nerve Identification Thyroidectomy.

OBJECTIVES: To assess voice changes in patients after thyroidectomy where the recurrent laryngeal nerve (RLN) was found late in the thyroid dissection and where the RLN was not injured (late RLN identification technique). METHODS: This study was conducted on 64 patients who underwent thyroidectomy by late RLN identification technique. Voice was assessed preoperatively, 1 week, 3 months, and 6 months after surgery using the voice assessment protocol and Voice Problem Self-Assessment Scale. The study group was divided into two subgroups (hemithyroidectomy: N = 13 and total thyroidectomy: N = 51). Voice assessments of both subgroups were then compared with a control group (N = 20) of patients who recently underwent extracervical surgeries. RESULTS: All voice analysis differences between the control group and the individual study subgroup were nonsignificant. Dysphonia in the study group was significantly worse at 1 week and 3 months postoperatively but became nonsignificant at 6 months postoperatively. The deviations from the preoperative acoustic analysis were significant only in the first week postoperative comparison for fundamental frequency, noise-to-harmonic ratio, and maximal phonation time and thereafter became nonsignificant. Significant Voice Problem Self-Assessment Scale mean score increase (worsening) was also detected only at first week postoperatively. CONCLUSION: Minimal voice changes were reported early after late RLN identification thyroidectomy in absence of RLN injury and disappeared gradually in a few months. Those changes are comparable with that of other extracervical surgeries, making thyroidectomy with late RLN identification a relatively safe technique as regard voice.

Laryngeal Compensation for Voice Production After CO2 Laser Cordectomy.

OBJECTIVES: Carbon dioxide (CO2) laser cordectomy is considered one of the modalities of choice for treatment of early glottic carcinoma. In addition to its comparable oncological results with radiotherapy and open surgical procedures, it preserves of laryngeal functions including voice production. The aim of this study was to detect how the larynx compensates for voice production after different types of CO2 laser cordectomy for early glottic carcinoma together with assessment of the vocal outcome in each compensation mechanism. METHODS: One hundred twelve patients treated with CO2 laser cordectomy were classified according to their main postoperative phonatory site. Perceptual analysis of voice samples using GRBAS (grade, roughness, breathiness, asthenia, and strain) scale was done for 88 patients after exclusion of the voice samples of all female patients to make the study population homogenous and the samples of 18 male patients due to bad quality (4 patients) or unavailability (14 patients) of their voice samples and the results were compared with those obtained from control group that included 25 age-matched euphonic male subjects. RESULTS: Five types of laryngeal compensation were defined including: vocal fold to vocal fold, vocal fold to vocal neofold, vocal fold to vestibular fold, vestibular fold, to vestibular fold, and arytenoids hyper adduction. Characters changes of voice produced by each compensation type were found to be statistically significant except for breathiness, asthenia and strain changes in vocal fold to vocal fold compensation type. CONCLUSION: The larynx can compensate for voice production after CO2 laser cordectomy by five different compensation mechanisms with none of them producing voice quality comparable with that of controls.

Voice outcome after gore-tex medialization thyroplasty

Introduction Although medialization thyroplasty utilizing Gore-Tex (Gore and Associates, Newark, Delaware, United States) has been discussed in the literature, few reports have assessed voice quality afterward, and they did not use a full assessment protocol. Objective To assess the improvement in voice quality after medialization thyroplasty utilizing Gore-Tex in patients with glottic insufficiency of variable etiology. Methods Eleven patients with glottic insufficiency of different etiologies that failed compensation were operated by type 1 thyroplasty utilizing Gore-Tex. Pre- and postoperative (1 week, 3 months, and 6 months) voice assessment was done and statistical analysis was performed on the results. Results In all postoperative assessments, there was significant improvement in the grade of dysphonia (p < 0.004) and highly significant reduction in the size of glottic gap and prolongation of maximum phonation time (p < 0.0001). The difference in voice parameters in the early (1 week) and the late (3 and 6months) postoperative period was not significant. None of the patients developed stridor or shortness of breath necessitating tracheotomy, and there was no implant extrusion in any patient during the study period. Conclusion Gore-Tex medialization provides reliable results for both subjective and objective voice parameters. It leads to a satisfactory restoration of voice whatever the etiology of glottic incompetence is. This technique is relatively easy and does not lead to major complications. Further studies with larger number of patients andmore extended periods of follow-up are still required to assess the long-term results of the technique regarding voice quality and implant extrusion.

Voice Outcome after Gore-Tex Medialization Thyroplasty.

Introduction Although medialization thyroplasty utilizing Gore-Tex (Gore and Associates, Newark, Delaware, United States) has been discussed in the literature, few reports have assessed voice quality afterward, and they did not use a full assessment protocol. Objective To assess the improvement in voice quality after medialization thyroplasty utilizing Gore-Tex in patients with glottic insufficiency of variable etiology. Methods Eleven patients with glottic insufficiency of different etiologies that failed compensation were operated by type 1 thyroplasty utilizing Gore-Tex. Pre- and postoperative (1 week, 3 months, and 6 months) voice assessment was done and statistical analysis was performed on the results. Results In all postoperative assessments, there was significant improvement in the grade of dysphonia (p < 0.004) and highly significant reduction in the size of glottic gap and prolongation of maximum phonation time (p < 0.0001). The difference in voice parameters in the early (1 week) and the late (3 and 6 months) postoperative period was not significant. None of the patients developed stridor or shortness of breath necessitating tracheotomy, and there was no implant extrusion in any patient during the study period. Conclusion Gore-Tex medialization provides reliable results for both subjective and objective voice parameters. It leads to a satisfactory restoration of voice whatever the etiology of glottic incompetence is. This technique is relatively easy and does not lead to major complications. Further studies with larger number of patients and more extended periods of follow-up are still required to assess the long-term results of the technique regarding voice quality and implant extrusion.

Powered instrumentation for transnasal endoscopic partial adenoidectomy in children with submucosal cleft palate.

OBJECTIVES: Partial adenoidectomy is the selective removal of the obstructing part of adenoid tissue, thus relieves obstruction symptoms and preserves the velopharyngeal valve action. Patients with palatal dysfunction are candidates for the technique. This study describes the use of microdebrider, transnasally (guided by the nasal endoscope) to perform partial adenoidectomy in patients with submucosal cleft palate, who presented with adenoidal hypertrophy and also it discusses its effects on nasal obstruction and speech. SUBJECTS AND METHODS: This prospective study was carried out on twenty-three submucosal cleft palate patients who were referred to the ORL-HN department; Zagazig University Hospitals complaining of respiratory obstruction and sleep disturbances due to adenoids hypertrophy. After preoperative nasoendoscopic and speech evaluation, transnasal endoscopic, power-assisted partial adenoidectomy was done for all patients. All patients were followed up at regular visits including nasoendoscopy and speech evaluation. RESULTS: The procedure insured fast, safe, reliable, under vision and well controlled steps. Intraoperatively no major complications were recorded. During follow up, nasal obstruction and respiratory obstruction symptoms were improved. Speech outcome results were reported. CONCLUSION: The study demonstrates the feasibility of using the microdebrider for performing transnasal partial adenoidectomy (under endoscopic guidance). The procedure is precise, rapid, safe and well-tolerated with the advantage of direct visualization of a traditionally difficult-to-expose area. The study reported improvement of respiratory obstruction symptoms with good speech results.

Comparison between laser- and diathermy-assisted posterior cordotomy for bilateral vocal cord abductor paralysis.

IMPORTANCE: A reliable procedure is needed to solve the problem of difficult airway in patients with bilateral vocal cord paralysis without adversely affecting patient "voice quality." OBJECTIVES: To compare the results of laser-assisted posterior cordotomy with diathermy-assisted posterior cordotomy for bilateral vocal cord paralysis in regard to dyspnea severity, voice quality, and aspiration. DESIGN: Prospective randomized clinical trial at a university medical center. SETTING: Zagazig University Hospitals, Zagazig, Egypt. PARTICIPANTS: Twenty patients randomly categorized into 2 groups; group A was treated with laser-assisted posterior cordotomy and group B was treated with diathermy-assisted posterior cordotomy. INTERVENTION: Laser-assisted posterior cordotomy for group A and diathermy-assisted posterior cordotomy for group B. MAIN OUTCOME AND MEASURE: Dyspnea severity, voice quality, and aspiration. RESULTS: A significant difference (P < .05) was found between group A and group B at all postoperative comparisons in dyspnea, whereas no significant difference (P ≥ .05) was detected at all postoperative comparisons in voice quality. CONCLUSIONS AND RELEVANCE: Laser-assisted posterior cordotomy can be considered as a reliable and superior procedure compared with diathermy-assisted posterior cordotomy in the treatment of bilateral vocal cord abductor paralysis. TRIAL REGISTRATION: clinicaltrials.gov Identifier: ISRCTN08093874.

Posterior pharyngeal flap for velopharyngeal insufficiency patients: a new technique for flap inset.

OBJECTIVES/HYPOTHESIS: To describe a modification of the originally described superiorly based pharyngeal flap as a secondary operation to correct velopharyngeal insufficiency (VPI) in patients with nonsyndromic repaired cleft palate. STUDY DESIGN: Prospective clinical trial at university medical center. METHODS: Twenty-six patients with VPI after cleft palate repair underwent a modified posterior pharyngeal flap procedure. Patients with submucous cleft palate or associated with syndromic VPI or Pierre Robin sequence were excluded from the study. Flap was harvested high up in the nasopharynx and inserted into the soft palate through a transverse full-thickness palatal incision. Lateral pharyngeal ports were determined by 45-degree nasoendoscopy. Speech assessment was done preoperatively and 3 months postoperatively. The flap integrity and lateral pharyngeal ports were evaluated with postoperative nasoendoscopy. RESULTS: Postoperative speech assessment showed significant improvement in the overall velopharyngeal function, nasal emission, resonance, and articulation defects. The pattern of velopharyngeal closure was circular in 15 patients, coronal in six patients, and sagittal in five patients. Eighteen patients received medium to wide flap, five patients had narrow flap, and three patients had near obstructing flap. Velopharyngeal function was normal or borderline insufficiency in 24 patients (92%). Partial flap dehiscence was seen in two patients and was considered as failure despite the significant improvement in their preoperative VPI. CONCLUSIONS: The minimal complication and ease of flap design with precise flap inset make this modified superior flap technique easily applicable with a high success rate for patients with VPI after cleft palate repair.

Standardization of nasometry for normal Egyptian Arabic speakers.

OBJECTIVE: The aim of this study was to collect the normative values of nasalance for Egyptian Arabic speakers in different age groups, using Arabic speech samples in order to compare patients with disturbed nasality. MATERIAL AND METHODS: This study included 300 normal Egyptian volunteers divided into three groups according to their ages: group I = children (n = 92; age 3 years, 3 months to 9 years), group II = teenagers (n = 76; age 9-18 years) and group III = adults (n = 132; age above 18 years). The Nasometer II 6400 was used for the analysis of speech samples. All subjects were asked to perform four speech tasks that were based on the MacKay-Kummer SNAP Test-R and modified to be applicable to the Arabic language, especially to the Egyptian dialect. RESULTS: The normative values for nasometric assessment in the different age groups were studied. The results demonstrated nasalance score variations according to age and gender. Most of the nasalance score norms of the Egyptian children demonstrated statistically significant differences when compared with the norms of children for the MacKay-Kummer Test-R. CONCLUSION: The Egyptian Arabic SNAP test is an easy, noninvasive and objective procedure that is suitable for all age groups.