A profile of the features and speech in patients with mandibulofacial dysostosis

PURPOSE

To present a profile of the features and speech in patients with mandibulofacial dysostosis (MFD). Data were collected on occlusion, palatal condition, hearing, resonance, voice, and articulation.

PATIENTS

Thirty patients with MFD ranging in age from 1.6 to 21.0 years.

STUDY DESIGN

Retrospective and prospective cross-sectional designs.

SETTING

Pediatric tertiary care hospital.

RESULTS

Sixty percent of the patients had an open bite. Isolated cleft palate was found in 37% with other types of cleft conditions occurring less frequently. Twenty-three percent underwent tracheostomy. All patients demonstrated hearing loss, 93% were conductive and 7% were mixed. Resonance, voice, and articulation were also affected. Seventy-seven percent had aberrant resonance including hypernasality, hyponasality, mixed hyper- and hyponasality or muffled resonance, which was found in 40% of the patients. Voice quality was abnormal in 63%. All patients had articulation errors. Although overlap between categories occurred, results showed that 60% had errors related to malocclusion, 30% demonstrated errors usually associated with velopharyngeal inadequacy and 50% had general articulatory or phonological errors that could be attributed to other causes.

CONCLUSIONS

The features and speech of patients with MFD are complex. The speech disorders may have multiple overlapping etiologies that require careful differential diagnosis. This is imperative to establish appropriate treatment regimens and evaluate clinical outcomes.

[Surgical reconstruction of velopharyngeal incompetence in postoperative cleft palate patients]

OBJECTIVE

To explore the clinical result of velopharyngeal cerclage in repairing velopharyngeal incompetence of postoperative cleft palate patients.

METHODS

From 1987 to 2000, 25 cases of velopharyngeal incompetence due to postoperative cleft palate were given the velopharyngeal cerclage. The mucosa flap of palate was pushed back, the autogenous free grafts of denervated skeletal muscle were selectively used for velopharyngeal cerclage. All the patients were followed up for 2 and a half years on average.

RESULTS

All the patients achieved good results with velopharyngeal competence and good articulation. The patients' sound of voices was clear.

CONCLUSION

This method can be used to repair velopharyngeal incompetence of postoperative cleft palate patients; the operation is simple and the results are satisfactory.

[Schizophrenia and the 22q11 deletion syndrome]

In 10-30% of the patients with the 22q11 deletion syndrome (22q11DS), a psychosis develops in adulthood, often schizophrenia. 22q11DS is a common genetic syndrome which is associated with an interstitial deletion at chromosome 22q11. The syndrome is characterised by a variable phenotype which includes cognitive and behavioural problems, in addition to congenital heart and facial anomalies. The presence of 22q11DS represents one of the highest risk factors for the development of schizophrenia. The study of 22q11DS offers a unique opportunity to increase the understanding of the pathogenesis of schizophrenia.

Complete denture with a removable palatal lift prosthesis: a case report and clinical evaluation

The palatal lift prosthesis is used to alleviate rhinopharyngeal closure dysfunction. It is generally problematical to use in edentulous patients, because the palatal lift prosthesis requires secure retention of the denture base and is difficult for the patient to retain while eating. This article describes the fabrication of a complete denture with a removable palatal lift prosthesis and a clinical evaluation of the denture's stability. A sprue pin and tube were used as a connecting attachment between the removable palatal lift prosthesis and the denture base. The force required for lifting the soft palate and the denture's stability were measured in the clinical evaluation. The prosthesis required an average retentive force of 0.26 N for each 1 mm of soft palate lift. The force required to dislodge the denture was measured with and without the palatal lift prosthesis in place. The force required to dislodge the conventional complete dentures of five healthy individuals was also measured as a reference. The denture was 24.4% less stable when the palatal lift prosthesis was in place and was generally easier to dislodge than were conventional dentures. This denture with a removable palatal lift prosthesis is useful for patients with dysfunction of the soft palate involving hypernasal speech who have difficulty in retaining the prosthesis while eating.

Impact of malocclusion and orthognathic reconstruction surgery on resonance and articulatory function: an examination of variability in five cases

Articulatory patterns and nasal resonance were assessed before and 6 months after orthognathic reconstruction surgery in five patients with dentofacial deformities. Perceptual and physiological assessments showed disorders of nasality and articulatory function preoperatively, two patients being hyponasal, and one hypernasal. Four patients had mild articulatory deficits, and four had reduced maximal lip or tongue pressures. Operation resulted in different patterns of change. Nasality deteriorated in three patients and articulatory precision and intelligibility improved in only one patient and showed no change in the other four. Operation improved interlabial pressures in three patients, while its impact on tongue pressures varied, being improved in one case, deteriorating in one, and remaining unchanged in the other three. The variability in the results highlights the need for routine assessment of speech and resonance before and after orthognathic reconstruction.

Effect of a speech prosthesis on electromyographic activity levels of the levator veli palatini muscle activity during syllable repetition

OBJECTIVES

To examine whether repeated production of a syllable effects levator veli palatini muscle activity for speakers with velopharyngeal incompetence and whether the effect can be changed by a speech prosthesis.

DESIGN

Repeated-measures analysis; each subject produced the speech sample /pu/ more than 200 times in each of 2 experimental conditions.

SETTING

Graduate dental school in Japan.

PARTICIPANTS

Four patients with operated cleft palate with a speech prosthesis.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Electromyographic traces were highband-pass filtered at 30 Hz, rectified, and smoothed with a time constant of 30 ms. Electromyographic traces were made of each production in 2 conditions: (1) without the prosthesis and (2) with the prosthesis. The regression slope of the linear regressor line, when smoothed levator activity was the criterion variable and the number of productions was the explanatory variable, was calculated in each condition.

RESULTS

The mean value of levator activity was significantly smaller with the prosthesis in than without it (P<.10, t test). With the prosthesis, the regression slope was significant for all 4 subjects, whereas it was insignificant without the prosthesis for 3 of 4 subjects (P<.10, t test). Absolute values of the regression slope were significantly smaller with the prosthesis than without it for all subjects (P<.10, t test). Comparison of the regression slopes for the 2 conditions identified a significant difference in slopes between the 2 conditions (P<.10, t test).

CONCLUSION

In operated cleft palate patients with velopharyngeal incompetence, a speech prosthesis can stabilize both temporal changes in levator muscle activity and connected speech, such as conversation.

Change in levator veli palatini muscle activity for patients with cleft palate in association with placement of a speech-aid prosthesis

OBJECTIVE

The purpose of this study was to examine whether a speech-aid prosthesis normalizes the activity of the levator veli palatini muscle for patients with cleft palate who exhibit velopharyngeal incompetence.

DESIGN

Each subject was instructed to produce repetitions of /mu/, /u/, /pu/, /su/, and /tsu/ and to blow with maximum possible effort. Electromyographic (EMG) activity of the levator veli palatini muscle was recorded with and without a hybrid speech-aid prosthesis in place.

PARTICIPANTS

The participants were five patients with repaired cleft palate who were routinely wearing a hybrid speech-aid prosthesis.

RESULTS

With the prosthesis in place, the mean value of levator activity changed positively in relation to oral air-pressure change during blowing. Differences in levator activity in relation to speech samples were similar to those in normal speakers. With the prosthesis in place, levator activity for speech tasks was less than 50% of the maximum levator activity for all subjects. The findings were similar to those reported previously for normal speakers.

CONCLUSION

Placement of the prosthesis changed EMG activity levels of the levator veli palatini muscle to levels that are similar to normal speakers. It is possible that, with the increase in the differential levator activity between speech and a maximum force task, the velopharyngeal mechanism has a greater reserve capacity to maintain velopharyngeal closure compared with the no-prosthesis condition.

Palatal adhesion: the treatment of unilateral palatal paralysis after high vagus nerve injury

BACKGROUND

Resection of skull base tumors commonly necessitates intraoperative sacrifice of lower cranial nerves at the level of the jugular foramen. Sequelae of unilateral vagus nerve loss include ipsilateral laryngeal paralysis, ipsilateral palatal and pharyngeal paralysis, and velopharyngeal incompetence (VPI) marked by hypernasal speech and nasopharyngeal reflux of liquids during swallowing.

METHODS

Palatal adhesion (PA), a procedure whereby the unilaterally paralyzed palate is attached to the posterior pharyngeal wall, decreases the size of the velopharyngeal port and minimizes the symptoms. This study assessed the outcome of PA in 31 patients with VPI secondary to proximal vagus nerve injury.

RESULTS

PA decreased postoperative nasality in 96% of patients. Nasopharyngeal reflux was significantly improved in 83%. Three patients (11%) had minor wound breakdown postoperatively, all of which healed completely with conservative management.

CONCLUSION

PA offers a favorable result with minimal concomitant morbidity and is recommended for patients with VPI secondary to unilateral proximal vagus nerve paralysis.

Speech outcomes in isolated cleft palate: impact of cleft extent and additional malformations

OBJECTIVE

The purpose of the study was to study the speech outcome in a series of 5-year-old children born with an isolated cleft palate and compare the speech with that of noncleft children and to study the impact of cleft extent and additional malformation on the speech outcome.

DESIGN

A cross-sectional retrospective study.

SETTING

A university hospital serving a population of 1.5 million inhabitants.

SUBJECTS

Fifty-one patients with an isolated cleft palate; 22 of these had additional malformations. Thirteen noncleft children served as a reference group.

INTERVENTIONS

A primary soft palate repair at a mean of 8 months of age and a hard palate closure at a mean age of 4 years and 2 months if the cleft extended into the hard palate.

MAIN OUTCOME MEASURES

Perceptual judgment of seven speech variables assessed on a five-point scale by three experienced speech pathologists.

RESULTS

The cleft palate group had significantly higher frequency of speech symptoms related to velopharyngeal function than the reference group. There were, however, no significant differences in speech outcome between the subgroup with a nonsyndromic cleft and the reference group. Cleft extent had a significant impact on the variable retracted oral articulation while the presence of additional malformations had a significant impact on several variables related to velopharyngeal function and articulation errors.

CONCLUSION

Children with a cleft in the soft palate only, with no additional malformations, had satisfactory speech, while children with a cleft palate accompanied by additional malformations or as a part of a syndrome should be considered to be at risk for speech problems.

A comparison of three methods of repairing the hard palate

OBJECTIVE

To compare growth, speech, and nasal symmetry outcomes of three methods of hard palate repair.

PATIENTS

Consecutive available records of children born with unilateral bony complete cleft lip and palate over the period 1972 to 1992.

INTERVENTIONS

Identical management of lip, nose, alveolus, and soft palate. Hard palate repair by Cuthbert Veau (CV) from 1972 to 1981, von Langenbeck (vL) from 1982 to 1989, or medial Langenbeck (ML) from 1989 to 1991.

OUTCOME MEASURES

For growth: GOSLON yardstick or 5-year model index. For speech: articulation test. Nasal anemometry. For nasal symmetry: Coghlan computer-based assessment. All these measures were developed during the period of data collection but not for this project.

RESULTS

There was a strong trend toward more favorable anteroposterior maxillary growth with the change from CV to vL to ML techniques. This fell short of statistical significance because of the small sample size. There was a significant reduction in cleft-related articulation faults (p =.01) considered to be related to improved arch form. In the absence of improved rates of velopharyngeal insufficiency or nasal symmetry, increased surgical experience was discounted as a significant contribution to improved growth and articulation outcomes.

CONCLUSIONS

Reduced periosteal undermining and residual exposed palatal shelf from CV to vL to ML improved incisor relationships and articulation.

Gross unilateral abnormalities of the velum and pharynx

OBJECTIVE

Velopharyngeal incompetence because of gross unilateral velopharyngeal hypoplasia is rare, particularly in patients with no significant hemifacial microsomia or facial asymmetry. We describe the abnormal anatomy and treatment of three patients with gross congenital velopharyngeal asymmetry.

RESULTS AND CONCLUSIONS

Following surgery, all three patients showed a good improvement in velopharyngeal function and speech. Nasendoscopy and lateral videofluoroscopy were important in confirming the abnormal anatomy and pathology and in evaluating the degree of movement of the affected side of the velum and pharyngeal walls as well as the size and location of the defect. Muscles from the normal side were radically dissected and mobilized across the midline to reconstruct the hypoplastic hemivelum. Mucosal lengthening was achieved by suturing the normal mucosa to the mucosa of the hypoplastic hemivelum and the lateral pharyngeal wall or by insetting a posterolateral pharyngeal flap (modified Moore pharyngoplasty) into the nasal surface of the hypoplastic side.

Perceptual evaluation of speech and velopharyngeal function in children with and without cleft palate and the relationship to nasal airflow patterns

OBJECTIVES

The aim was to study the relationship between perceptual evaluation of speech variables related to velopharyngeal function and the pattern of nasal airflow during the velopharyngeal closing phase in speech in children with and without cleft palate.

PARTICIPANTS

Fourteen children with cleft lip and palate or cleft palate only and 15 controls aged 7 and 10 years. All were native Swedish speakers.

METHOD

Three experienced listeners performed a blinded perceptual speech evaluation. Nasal airflow was transduced with a pneumotachograph attached to a nasal mask. The duration from peak to 5% nasal airflow, maximum flow declination rate, and nasal airflow at selected points in time during the transition from nasal to stop consonants in bilabial and velar articulatory positions in sentences were estimated. The analysis was focused on the perceptual ratings of "velopharyngeal function" and "hypernasality."

RESULTS

A strong association was found between ratings of "velopharyngeal function" and "hypernasality" and the pattern of nasal airflow during the bilabial nasal-to-stop combination /mp/. Both the sensitivity and specificity were 1.00 for the bilabial temporal airflow measure in relation to ratings of "velopharyngeal function." The nasal airflow rate during /p/ in /mp/ had a sensitivity of 1.00 and specificity of 0.92 to 0.96 in relation to ratings of "hypernasality."

CONCLUSION

Assessment of the nasal airflow dynamics during the velopharyngeal closing phase in speech presents quantitative, objective data that appear to distinguish between perceptually normal and deviant velopharyngeal function with high sensitivity and specificity.

Velopharyngeal function after microsurgical reconstruction of lateral and superior oropharyngeal defects

OBJECTIVES/HYPOTHESIS

Defects of the lateral and superior oropharyngeal wall are difficult to reconstruct because of their complicated anatomy and the possibility of causing velopharyngeal incompetence. The objective was to investigate problems of reconstruction and postoperative velopharyngeal function.

STUDY DESIGN

Defects were classified into three types (I, II, and III) according to their extent. Four operative procedures were performed: the Patch, Jump, Denude, and Gehanno methods, which include a lateral-posterior pharyngeal advancement flap. Speech intelligibility, velopharyngeal function, and wound dehiscence between the flap and the remaining soft palate were evaluated.

METHODS

Forty patients who had undergone resection of the lateral and superior oropharyngeal walls and subsequent reconstruction were reviewed.

RESULTS

Most patients with type I or II defects had satisfactory velopharyngeal function. However, in patients with type III defects, speech function was worse and severe velopharyngeal incompetence was more common. The type of defect and the presence of wound dehiscence were related to postoperative function. The rates of wound dehiscence were lower with the Patch and Gehanno methods.

CONCLUSIONS

Postoperative function in patients with type III defects can be affected by various factors. We suggest that the Gehanno method be the treatment of choice for reconstruction of extensive defects of the oropharynx. However, patients in whom more than two-thirds of the superior and posterior oropharyngeal walls has been resected are poor candidates for reconstruction because of the difficulty of maintaining both nasal airway patency and velopharyngeal function.

Evaluation and treatment of velopharyngeal insufficiency: the University of Florida experience

This retrospective study spans the years 1988 to 2000 and looks specifically at the treatment procedures and outcomes for the correction of velopharyngeal insufficiency (VPI). Ninety-eight patients underwent preoperative assessment by speech pathologists that included perceptual speech evaluation, videofluoroscopy, and, for some, nasendoscopy. Based on this evaluation protocol, a specific surgical procedure was chosen to serve the patients' needs. The four procedures of choice were the palatal pushback with a pharyngeal flap lining, sphincter pharyngoplasty, a superiorly based obturating pharyngeal flap, and Furlow palatoplasty. The criteria for selecting these procedures are reviewed. The results revealed VPI resolution and the establishment of normal nonnasal speech in more than 95% of the 75 patients for whom outcomes were determined. This study reiterates the importance of thorough preoperative evaluation and the individualization of the secondary corrective procedure.

Craniofacial characteristics and velopharyngeal function in cleft lip/palate children with and without adenoidectomy

The association between velopharyngeal function, craniofacial morphology and adenoidectomy was investigated using 27 craniofacial and nasopharyngeal variables taken from lateral cephalograms. The sample consisted of 96 boys with cleft palates with or without cleft lips. They were examined at 6 years of age when cephalograms were obtained and perceptual speech assessments were performed. The subjects were divided into three groups: (1) velopharyngeal competence (VPC, n = 45); (2) mild incompetence not requiring velopharyngoplasty (VPI, n = 36); and (3) previous incompetence operated on with velopharyngoplasty ad modum Hoenig (VPP, n = 15) before the 6-year examination. The groups were further divided into two subgroups according to previous adenoidectomy (Ad+, Ad-). The cranial base, size and interrelationship of the maxilla and mandible and their relationship to the cranial base or the bony nasopharynx did not differ among the VPC, VPI and VPP groups. The sagittal depth of the nasopharyngeal airway (Pm-ad1, Pm-ad2, Pm-ad3) was significantly wider in the VPP group than in the the VPC and VPI groups. The previous adenoidectomy decreased the thickness of the posterior pharyngeal wall (ad1-Ba, ad2-so) and thus increased airway size. The length of the velum did not differ between the three groups or their subgroups with and without adenoidectomy. The results showed that adenoidectomy is a risk to velopharyngeal function by widening the nasal airway, but velopharyngeal incompetence cannot definitely be attributed to adenoidectomy.

[Pseudohypoparathyroidism or hypoparathyroidism? A misleading clinical presentation]

We report the case of a 27-year old woman who presented hypocalcemia and hyperphosphoremia during her first pregnancy. Her phenotype was in favor of Albright's hereditary osteodystrophy: short stature, obesity, round face, brachymetacarpy and mental retardation. However, the diagnosis of pseudohypopara thyroidism type Ia was ruled out due to low PTH level (10 pg/ml). The patient's 22q11 microdeletion was suspected and identified because of the association of severe neonatal hypocalcemia, abnormal face and renal malformation in her children. Deletion 22q11 leads to various syndromes, including Di George syndrome, also referred to as CATCH 22 syndrome (Cardiac defect (C), Abnormal face (A), Thymic hypoplasia (T), Cleft palate (C) and Hypocalcemia (H)). Retrospectively, the patient presented with symptoms suggestive of CATCH 22: abnormal face, hypernasal voice suggestive of velopharyngeal insufficiency, mental retardation, recurrent otitis in childhood. It is also noteworthy that there was an idiopathic thrombocytopenic purpura. In conclusion, while the phenotype was suggestive of Albright's hereditary osteodystrophy, the constatation of a low PTH level would cast doubt on this diagnosis. Furthermore, the 22q11 microdeletion should be searched by FISH (Fluorescence In Situ Hybridization) in all patients with hypopara thyroidism of unknown origin, even in the absence of cardiac malformations. Finally, it seems that patients with CATCH 22 would be predisposed to auto-immune disease as a result of thymic dysfunction.

[Wavy incision of the soft palate. Modification of intravelar veloplasty]

PURPOSE

The problem with primary soft palate repair is shortness of the soft palate and a soft tissue deficit in this region. The authors introduce a modification of the intravelar veloplasty allowing lengthening of the soft palate at the time of primary closure.

METHODS

The "soft palate wavy incision procedure" combines a wavy or undulating type of incision at the velar cleft margins with intravelar veloplasty. In 12 patients with complete clefts of the palate, postoperative breathing and speech was analyzed 3 years later. The investigator did not know whether a modification of the common procedure had been performed in these patients or not.

RESULTS

It was found that the soft palate wavy line procedure is easy to perform and closure in three layers is possible even in wide clefts of the soft palate. No postoperative fistula was observed. An average lengthening of the soft palate of about 56% (24-83%) was achieved, measured immediately at the end of surgery. Three years later the patients have good speech results following this technique.

CONCLUSIONS

Experience has shown that the soft palate wavy incision procedure is straightforward, safe, and easy. It seems that this technique leads to better results than classic intravelar veloplasty. This paper is only a first report, and further investigations are necessary.

Reconstruction of palatal defect using mucoperiosteal hinge flap and pushback palatoplasty

This article describes a simple, new surgical technique to provide a complete two-layer closure of palatal defect resulting from a surgical complication of trans palatal resection of skull base chordoma. The nasal layer was reconstructed with triangular shape oral mucoperiosteal turn over hinge flap based on anterior margin of palatal defect and rectangular shaped lateral nasal mucosal hinge flaps. The oral layer was reconstructed with conventional pushback V-Y advancement 2-flaps palatoplasty. Each layer of the flaps were secured with two key mattress suture for flap coaptation. This technique has some advantages: simple, short operation time, one-stage procedure, no need of osteotomy. It can close small- to medium-sized palatal defect of palate or wide cleft palate and can prevent common complication of oronasal fistula, which could be caused by tension.

Investigations of a pressure-sensitive theory of marginal velopharyngeal inadequacy

PURPOSE

This two-part project was designed to test a pressure-sensitive theory of marginal velopharyngeal inadequacy (MPVI). Specifically, are select subgroups of children with MPVI perceived as hypernasal because they fail to achieve consistent closure during vowels and semivowels while demonstrating adequate closure during pressure consonants?

METHODS

In part one, 36 children with cleft palate and other craniofacial anomalies were examined using a clinical assessment protocol that included nasometry and perceived ratings of hypernasal resonance. Children with nasalance percentages above threshold during low-pressure (LP) productions and below threshold for high-pressure (HP) productions were placed in one group (group 1), while children with nasalance percentages below threshold for both LP and HP sentences were placed in another (group 2). Children in the two groups were age- and sex-matched. In part two, endoscopic data were examined for 10 additional children who received nasometry, perceived hypernasal resonance scores, and videoendoscopy on the same day and who received higher mean nasalance measures during production of LP sentences than during production of HP sentences.

RESULTS

The results of part one confirmed that children in group 1 were perceived as being significantly more hypernasal than children in group 2 (mean(group 1) = 2.17, mean(group 2) = 1.50; t = 2.75, p =.01). However, results of endoscopic testing failed to demonstrate a consistent observable physiologic pattern of velopharyngeal inadequacy that would confirm the theory that some patients with MVPI are perceived as being hypernasal because of difficulty achieving velopharyngeal closure during vowels and semivowels. CONCLUSIONS; The findings provide partial support for a pressure-sensitive theory of MVPI and demonstrate the value of using both HP and LP sentences to evaluate patients with MVPI.

[Modified uvula flap in therapy of sleep-related breathing disorders]

BACKGROUND/OBJECTIVE

Velopharyngeal incompetence is a well described complication of uvulopalatopharyngoplasty (UPPP) for snoring or obstructive sleep apnea. A new uvulopalatal flap technique (UPF), first presented by Powell in 1996 was now modified by our team. The new technique intends to lateralize the posterior faucial pillars as the UPPP, entirely sparing uvulopalatal muscles.

RESULTS

No statistical difference existed in change of AHI before and after surgery in all patients even though 14 patients had a statistically significant decrease in AHI (pre 19.2 +/- 19.6; after 8.2 +/- 9.8; p < 0.05). Snoring decreased clearly (p < 0.05) from 49.4% to 25.9%.

Changes in speech following maxillary distraction osteogenesis

OBJECTIVE

The purpose of this study was to describe changes in articulation and velopharyngeal function following maxillary distraction osteogenesis.

DESIGN

This is a descriptive, post hoc clinical report comparing the performance of patients before and after maxillary distraction. The independent variable was maxillary distraction while the dependent variables were resonance, articulation errors, and velopharyngeal function.

SETTING

The data were collected at a tertiary health care center in Chicago.

PATIENTS

The data from pre- and postoperative evaluations of 18 maxillary distraction patients were used.

OUTCOME MEASURES

The outcome measures were severity of hypernasality and hyponasality, velopharyngeal orifice size as estimated using the pressure-flow technique, and number and type of articulation errors.

RESULTS

At the long-term follow-up, 16.7% exhibited a significant increase in hypernasality. Seventy-five percent of patients with preoperative hyponasality experienced improved nasal resonance. Articulation improved in 67% of patients by the 1-year follow-up.

CONCLUSIONS

In a predominately cleft palate population, the risk for velopharyngeal insufficiency following maxillary distraction is similar to the risk observed in Le Fort I maxillary advancement. Patients being considered for maxillary distraction surgery should receive pre- and postoperative speech evaluations and be counseled about risks for changes in their speech.

Superiorly based flap pharyngoplasty: the degree of postoperative "tubing" and its effect on speech

It is recognised that superiorly based pharyngeal flaps tend to contract resulting in narrowing and lowering of the flaps. If lateral pharyngeal-wall motion is unable to close against the "tubed" flap or if the flap migrates below the level of medial displacement of the lateral pharyngeal walls, velopharyngeal insufficiency will result. The extent of this phenomenon of flap contracture or shrinkage has not been previously quantified. A consecutive series of 120 superior flap pharyngoplasty operations were assessed critically and carefully. The mean width of the harvested flap measured 89% of the width of the pharyngeal posterior wall and shrank over 6 months to 45% of the lateral pharyngeal diameter. The relations between speech results, complication rate and remaining flap width are analysed. All flaps shrink but to a varying degree.

Retropharyngeal autologous fat transplantation for congenital short palate: a nasometric assessment of functional results

Seventeen patients (4 to 24 years old; mean, 9.7 years) with mild velopharyngeal insufficiency were treated in our department during the period 1996 to 1999 with augmentation of the posterior pharyngeal wall with autologous fat. The main disorder was a congenital short palate without a cleft, in most cases revealed by adenoidectomy. Four patients had previously undergone pharyngoplasty, and 1 had already been injected in the posterior pharyngeal wall with Teflon paste. All patients had been exhaustively treated with speech therapy, and the result remained unsatisfactory. The functional outcome of the surgical procedure was quantified by acoustic nasometry. The decrease of the nasalance percentage for a standardized spoken passage was significant 1 to 3 months after the fat transplantation, and there was a slight tendency to further reduction of nasality at the late follow-up visit, more than 6 months (average, 9.4 months) after the intervention. The mean value of the nasalance score for the "normal passage" (running speech) then reached the limit of normal values. A long-term follow-up (average, 24.3 months) by telephone questionnaire confirmed the persistence of the beneficial results. Autologous fat seems an excellent alternative for Teflon in this indication. Acoustic nasometry allows a precise quantitative assessment of functional velopharyngeal surgery.