Central tongue reduction for macroglossia.

Unhappy with our postoperative results from standard tongue reduction methods, we have developed a central tongue reduction technique. This technique allows for alteration of the tongue base as well as tongue height and width while minimizing postoperative scarring. Although the technique and its associated surgical complications are in some ways comparable with the standard tongue reduction methods, our postoperative polysomnographic and tongue functioning results are improved. It is noteworthy that none of our patients had worse speech postoperatively and that our one Down syndrome patient had improved speech. Our indication for central tongue reduction is macroglossia of any sort in appropriate patients.

Effects of aerosol corticosteroids on the voice: triamcinolone acetonide and beclomethasone dipropionate.

The present investigation compared the effects of triamcinolone acetonide (Aristocort Aerosol) and beclomethasone dipropionate (Vanceril Inhaler) on the vocal functioning of 11 chronic asthmatics. Using conventional aero-acoustic techniques, subjects' vocal fundamental frequency, maximum phonation time, and oral air volume velocity were sampled at baseline (oral corticosteroid use) and at the end of the first and second year of aerosol triamcinolone acetonide use. At the end of the second year of aerosol triamcinolone acetonide use, all subjects discontinued use of this compound and began use of aerosol beclomethasone dipropionate. Subjects' vocal performance then was sampled after 1 year of aerosol beclomethasone dipropionate use. Results of this study suggest that aerosol triamcinolone acetonide reduced the vocal dysfunction observed during the baseline period. When aerosol beclomethasone dipropionate was used, however, subjects' vocal performance was similar to that observed during the baseline period (oral steroid use).

The magnum procedure: surgical salvage of end-stage velopharyngeal incompetence.

One of the most difficult problems in cleft palate surgery is the patient who remains velopharyngeally incompetent after previous attempts at surgical correction. The magnum procedure was employed as a method of surgically salvaging these problem patients. The magnum flap is a procedure involving the use of a single or double hemipalatal flap based on the greater palatine vessels and inserted posterior to the hard palate to provide a maximum pushback in these patients. Eleven cases of severe and persistent velopharyngeal incompetence secondary to cleft palate after prior palatoplasty and secondary procedures are presented. All these patients had had at least two previous palatal procedures and were not considered good candidates for significant improvement by further speech therapy, based on evaluation in the Speech Pathology Department. All patients had preoperative and postoperative speech evaluations, including nasal airway studies and cineradiography. Postoperative follow-up was between 12 and 66 months. Speech evaluations and results and operative details and complications were investigated. All patients had mild to marked improvement in their velopharyngeal function, articulation, and resonant voice quality. There were two perioperative complications, one of which was a delayed bleeding episode requiring no treatment and the other of which was a case of cellulitis of the cheek requiring additional antibiotics. Based on this initial series of patients, we feel that the magnum procedure offers considerable promise in the salvage of those patients previously falling into the category of end-stage velopharyngeal incompetence.

A technique for temporary obturation of fistulae.

We devised a simple technique to differentiate the contribution of the oronasal fistula from that of the velopharyngeal port when abnormal nasal air flow is present. Temporary obturators were constructed from a thin sheet of dental wax and retained by a dental adhesive. Speech samples collected for aerodynamic analysis, both with and without the appliance, included both fricatives and plosives in single words and connected speech. Our results indicate that this temporary obturator, used in conjunction with aerodynamic studies, can be used to determine the etiology of abnormal nasal flows in speakers with oronasal fistulae.

The effects of triamcinolone acetonide on the voice.

With the exception of the pioneering work by Damsté in the mid 1960s and early '70's, no long term quantitative research on voice changes subsequent to drug therapy has been reported. This study reports the effects of a specific cortico-steroid, triamcinolone acetonide, on selected aerodynamic and acoustic parameters reflecting the vocal performance of twenty-one chronic asthmatic steroid dependent individuals. Measurements of the subjects' vocal fundamental frequency, maximum phonation time, oral air volume velocity, and peak intra-oral air pressure during production of selected speech stimuli were made before the introduction of triamcinolone and following the first and second years of drug use. After two years of triamcinolone therapy, significant changes were noted in parameters reflecting laryngeal functioning. Respiratory performance remained unchanged for most subjects. The results are discussed in terms of the possible physiological changes that might have occurred and their implications for the speech-language pathologist and speech scientist in medical management.

Determination of lateral pharyngeal wall motion during connected speech by use of pulsed ultrasound.

Variations in the position of a point on the lateral pharyngeal wall relative to the external neck wall can be monitored by time-motion display of pulsed ultrasound. Such a portrayal is used to evaluate the lateral pharyngeal wall motion in normal and pathologic speakers during connected discourse.