Speech Outcomes and Velopharyngeal Function in Children Undergoing Submucous Cleft Palate Repair.

OBJECTIVE: Describe and compare the results of speech and velopharyngeal function in children with classic and occult submucous cleft palate undergoing interdisciplinary treatment at the Gantz Foundation. METHODS: The clinical history of all patients born between 2012 and 2017 with a diagnosis of classic or occult submucous cleft palate was retrospectively reviewed. Preoperative and postoperative medical, surgical, and speech and language history were collected. RESULTS: Twenty-eight cases diagnosed at the age of 44.8±23.9 months were included. Of these, 71.4% presented classic submucous cleft, and 28.6% occult. Before primary surgery, 7.1% had a diagnosis of the syndrome, and 21.4% were under study. A total of 39.3% had hearing difficulties and 21.4% used tympanic ventilation tubes. A total of 60.7% had language problems, 39.3% had compensatory articulation, 17.9% had absent hypernasality, and 21.4% had absent nasal emission. The team indicated primary palate surgery in 71.4%, of which 85% performed the surgery at the mean age of 61.7±24.7 months. The surgical technique was Furlow in 88.2% of the cases and intravelar veloplasty in the remaining 11.8%. Then, 3 cases underwent velopharyngeal insufficiency surgery; 2 of them eliminated hypernasality and reduced nasal emission. The age of diagnosis ( P =0.021) and the performance of velopharyngeal insufficiency surgery ( P =0029) of the occult submucous cleft palate group was significatively later than the classic cleft palate group. CONCLUSIONS: Language, hearing, compensatory articulation, hypernasality, and nasal emission problems were recorded. A high percentage required primary surgery. Of these, a low proportion also required a velopharyngeal insufficiency surgery, which improved the velopharyngeal function of the children but did not completely adapt it. In this regard, early diagnosis is essential, as well as an analysis of each center primary closure protocol.

International Collaboration for the Prosthetic and Surgical Intervention of Velopharyngeal Insufficiency.

Interdisciplinary teamwork is essential for the rehabilitation of patients with cleft lip and palate, and therefore, the application of treatment techniques for velopharyngeal insufficiency, both surgical and prosthetic, depends on the experience of each rehabilitation team. For this reason, the following study consisting of the cooperation between interdisciplinary cleft lip and palate teams from Chile and Argentina, which succeeded in correcting velopharyngeal insufficiency in an adolescent, initially using a pharyngeal bulb prosthesis and speech therapy, and finally through pharyngeal flap surgery, is presented. This shows that international cooperation is a valuable tool for training, implementation, and follow-up of different treatment techniques for teams in formation.

Planificación quirúrgica de colgajo faríngeo a medida para insuficiencia velofaríngea secundaria a fisura de paladar: reporte de caso y revisión de literatura / Surgical planning of a tailor-made pharyngeal flap for velopharyngeal insufficiency secondary to a cleft palate: case report and literature review

Resumen La insuficiencia velofaríngea (IVF) es una de las principales secuelas estructurales tras la palatoplastía primaria en casos de fisura de paladar. La IVF se caracteriza por la ausencia de tejido suficiente para lograr un cierre adecuado del mecanismo velofaríngeo durante el habla, lo que conlleva a una resonancia hipernasal y la emisión nasal de aire durante la producción de sonidos orales. Al respecto, el tratamiento ideal para corregir la IVF es quirúrgico, dentro de los cuales el colgajo faríngeo de pedículo superior es uno de los procedimientos más utilizados en nuestro país. Para su realización es fundamental determinar el ancho necesario, lo cual puede ser determinado mediante una videofluoroscopía multiplano (VFMP). Por esto, con el objetivo de potenciar el trabajo multidisciplinario en la corrección quirúrgica de la IVF, a continuación, se presentan los procedimientos de evaluación fonoaudiológica, videonasofaríngoscopía flexible y videofluoroscopía multiplano utilizados para la planificación quirúrgica de un colgajo faríngeo en un adolescente chileno diagnosticado con IVF secundaria a fisura palatina operada. Además, se describe el uso de la VFMP en la planificación quirúrgica del colgajo faríngeo mediante una revisión de literatura.

Abstract Velopharyngeal insufficiency (VPI) is one of the main structural sequelae after primary palatoplasty in cases of cleft palate. VPI is characterized by the absence of sufficient tissue to achieve adequate closure of the velopharyngeal mechanism (VFM) generating hyper-nasal resonance and nasal emission during the production of oral sounds. In cases of cleft palate, the ideal treatment to correct VPI is surgery. The upper pedicle pharyngeal flap is one of the most widely used procedures. To plan it, is essential to determine the appropriate width, which can be determined by means of multiplane videofluoroscopy (MPVF). For this reason, and with the aim of promoting multidisciplinary approach in the surgical correction of VPI, the following procedures such as speech and language evaluation, flexible videonasopharyngoscopy and multiplane videofluoroscopy used for the surgical planning of a pharyngeal flap, in a Chilean adolescent diagnosed with VPI secondary to operated cleft palate, will be presented. In addition, the use of MPVF in pharyngeal flap surgical planning is described through a literature review.

Valores de nasalancia para vocales, serie numérica y oraciones producidas por adultos hablantes de español chileno / Nasalance scores for vowels, number series and sentences produced by Chilean Spanish-speaking adults

Objetivo: El presente estudio tuvo como objetivo establecer y comparar valores de nasalancia en adultos de ambos sexos hablantes de español de Chile durante la producción de vocales sostenidas, una muestra de habla automática y la lectura de oraciones. Métodos: Participaron 46 adultos (25 mujeres y 21 hombres), con edad entre 18 y 29 años. Todos sin historia de tratamiento fonoaudiológico, patologías neurológicas, déficit intelectual, pérdida auditiva, síndromes u otras patologías que afectan la producción del habla. La adecuada función velofaríngea fue determinada en vivo a través de una evaluación perceptual de la resonancia. La nasalancia fue determinada con el Nasometer, modelo 6450, durante la producción sostenida de las vocales /a/, /i/, /u/, una repetición automática de la serie numérica 1-10 y la lectura de seis oraciones, cinco con consonantes orales de alta presión y una con consonantes nasales. La comparación entre ambos sexos fue realizada con el test de la U de Mann-Whitney. Resultados: La oración con sonidos nasales («Mi mamá me mima») presentó el porcentaje mayor de nasalancia, con un 66.36%, seguido de la serie numérica, con un 24.61%, y la vocal /i/, con un 23.57%. En tanto, las oraciones con sonidos orales y las vocales /a/ y /u/ sostenidas presentaron una nasalancia promedio que fluctuó entre un 10.5% (vocal /u/) y un 16.52% (oración: «Fifí fue feliz»). Por último, fue observado un promedio significativamente mayor en mujeres para tres oraciones orales: «Pipo patea la pelota» (p=.044), «Tito tapa tarros» (p=.041), y «Fifi fue feliz» (p=.027). Conclusión: Los valores de nasalancia obtenidos en adultos chilenos demostraron variaciones de acuerdo al estímulo de habla y el sexo de los hablantes.(AU)

Objective: The present study aimed to establish and compare nasalance scores in Spanish-speaking adults of both genders from Chile during the production of sustained vowels, an automatic speech sample and the reading of sentences. Methods: 46 adults participated, 25 women and 21 men, aged between 18 and 29 years. All without a history of speech therapy, neurological pathologies, intellectual deficit, hearing loss, syndromes or other pathologies that affect speech production. Adequate velopharyngeal function was determined in vivo through a perceptual evaluation of resonance. Nasalance was determined with the Nasometer, model 6450, during the sustained production of the vowels /a/, /i/ and /u/, an automatic repetition of the number series 1-10 and the reading of six sentences, five with consonants high pressure orals and one with nasal consonants. The comparison between both genders was made with the Mann-Whitney U test. Results: The sentence with nasal sounds («Mi mamá me mima») presented the highest percentage of nasalance with 66.36%, followed by the numerical series with 24.61% and the vowel /i/ with 23.57%. Meanwhile, sentences with oral sounds and sustained vowels /a/ and /u/ presented an average nasalance that fluctuated between 10.5% (vowel /u/) and 16.52% (sentence: «Fifi fue feliz»). Finally, a significantly higher average was observed in women for three oral sentences: «Pipo patea la pelota» (P=.044), «Tito tapa tarros» (P=.041), and «Fifi fue feliz» (P=.027). Conclusion: The nasalance values obtained in Chilean adults showed variations according to the speech stimulus and the gender of the speakers.(AU)

Fisiología del esfínter velofaríngeo durante la deglución. Revisión sistemática de literatura

Resumen El objetivo de este artículo es describir el funcionamiento del esfínter velofaríngeo (EVF) durante la deglución, mediante una revisión de literatura. En febrero de 2020, las bases de datos electrónicas Medline, LILACS, SciELO e IBECS, fueron consultadas retrospectivamente, usando las palabras claves en inglés: "velopharyngeal sphincter" o "pharyngeal muscles". Fueron seleccionados artículos originales que describen la fisiología del EVF en la deglución de adultos sanos. Para este estudio fue creado un protocolo que contempla lo siguiente: autor, año, país, número y características de los participantes, actividades evaluadas, metodologías e instrumentos utilizados y principales resultados. Fueron encontrados 4.124 artículos. 3.863 fueron excluidos luego de la lectura de los títulos, 239 luego de lectura de los resúmenes y 8 luego de la revisión de los textos completos. Finalmente, 14 artículos fueron analizados en esta revisión. Se discuten eventos espaciales y temporales del EVF, la actividad electromiográfica de la musculatura del EVF y la presión velofaríngea durante la deglución en adultos sanos. Se concluye que el esfínter velofaríngeo cumple un rol importante en la fase faríngea de la deglución, que debe ser profundizado en futuras investigaciones.

Abstract The aim of this article is to describe the functioning of the velopharyngeal sphincter (VPS) during swallowing, through a literature review. In February 2020, the electronic databases Medline, LILACS, SciELO and IBECS were retrospectively consulted, using the key words in English: "velopharyngeal sphincter" or "pharyngeal muscles". Original articles were selected that describe the physiology of VPS in healthy adult swallowing. For this study it was created a protocol that includes the following items: author, year, country, number and characteristics of the participants, evaluated activities, methodologies and instruments used, and main results. 4124 articles were found. 3,863 were excluded after reading the titles, 239 after reading the abstracts and 8 after reviewing the full texts. Finally, 14 articles were analyzed in this review. Spatial and temporal events of the VPS, the electromyographic activity of the VPS musculature, and velopharyngeal pressure during swallowing in healthy adults are discussed. We conclude that the velopharyngeal sphincter plays an important role in the pharyngeal phase of swallowing, which should be studied in depth in future research.

22q11.2 Deletion: Surgical and Speech Outcomes of Patients With Velopharyngeal Insufficiency Treated With a Superiorly Based Pharyngeal Flap as the Primary Surgery.

The most frequent palate diagnoses in patients with chromosome 22q11.2 deletion syndrome are a classic submucous cleft, occult, and velopharyngeal insufficiency without cleft, which generates alterations in speech that require surgery. Surgical protocols are controversial owing to syndrome characteristics that make their handling more complex. Pharyngeal flap pharyngoplasty is effective for this type of patient. The objective of this study is to examine the surgical management of velopharyngeal insufficiency in patients with chromosome 22 deletion, using a pharyngeal flap as the primary surgery. The clinical records of patients with chromosome 22 deletion and velopharyngeal insufficiency between 2015 and 2017 were analyzed retrospectively. Eight patients underwent pharyngeal flap pharyngoplasty as a primary surgery, including 1 with velopharyngeal insufficiency without a cleft, 1 with a classic submucous cleft, and 6 with occult submucous cleft. The pre- and postoperative protocol performed by speech therapists and surgeons included clinical evaluation of the oral cavity; perceptual, video recording, and nasometry speech evaluation; and videonasopharyngoscopy. All perceptual parameters and nasometry results significantly changed. Of the cases, 88% achieved a flap with the expected width and height and complete closure of the velopharyngeal sphincter. One patient required flap revision. Four of the 8 patients achieved normal resonance, and 2 of 8 showed mild hypernasality. Using the pharyngeal flap pharyngoplasty as a primary technique to correct velopharyngeal insufficiency in patients with chromosome 22 deletion provides satisfactory outcomes and decreases the number of surgeries. Preoperative planning must be conducted carefully and needs to be individualized to be successful.