1
|
Mao Q, Li J, Yin X. Pearls and pitfalls in contemporary management of marginal velopharyngeal inadequacy among children with cleft palate. Front Pediatr 2023; 11:1187224. [PMID: 37609363 PMCID: PMC10440703 DOI: 10.3389/fped.2023.1187224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/29/2023] [Indexed: 08/24/2023] Open
Abstract
Marginal velopharyngeal inadequacy (MVPI) is a particular status of velopharyngeal closure after cleft palate repair. The physiological and phonological characteristics of patients with MVPI are significantly different from those with typical velopharyngeal insufficiency. The pathological mechanisms and diagnostic criteria of MVPI are still controversial, and there is limited evidence to guide the selection of surgical and non- surgical management options and a lack of recognized standards for treatment protocols. Based on a systematic study of the relevant literatures, this review identifies specific problems that are currently under-recognized in the diagnosis and treatment of MVPI and provides guidelines for further exploration of standardized and reasonable intervention protocols for MVPI.
Collapse
Affiliation(s)
- Qirong Mao
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jingtao Li
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xing Yin
- Department of Orthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| |
Collapse
|
2
|
Zeng YT, Liu WY, Torng PC, Hwu WL, Lee NC, Lin CY, Chien YH. A pilot study shows the positive effects of continuous airway pressure for treating hypernasal speech in children with infantile-onset Pompe disease. Sci Rep 2021; 11:18826. [PMID: 34552118 PMCID: PMC8458442 DOI: 10.1038/s41598-021-97877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 08/31/2021] [Indexed: 11/09/2022] Open
Abstract
Children with infantile-onset Pompe disease (IOPD) demonstrate hypernasality. This study aimed to evaluate whether continuous positive airway pressure (CPAP) training may reduce hypernasality in children with IOPD. Five children with IOPD were enrolled in a single-subject experimental design of type A-B-A′. The intervention comprised an 8-week, 6-day-per-week regimen of CPAP training at home. Participants continued traditional speech therapy once per week throughout the 24-week study duration. The outcome measurements included the degree of hypernasality (DH), the percentage of consonants correct (PCC), and the speech intelligibility score (SIS). C-statistic analysis with an α of 0.05 was used along with visual analysis to assess speech changes. Three patients completed the study. During the CPAP training phase, the DH, PCC, and SIS were significantly improved compared with the baseline (p < 0.05). At the follow-up phase, both DH and SIS were improved compared with the baseline (p < 0.05), but the PCC had returned to the baseline level. CPAP training demonstrated effectiveness in reducing nasal sounds in IOPD patients. Further studies training younger children with normal hearing may help elucidate the persistence of the effects in children with IOPD.
Collapse
Affiliation(s)
- Yin-Ting Zeng
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Wen-Yu Liu
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Chuan Torng
- Department of Speech-Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Wuh-Liang Hwu
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ni-Chung Lee
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Yi Lin
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Yin-Hsiu Chien
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
3
|
Schenck GC, Perry JL, O'Gara MM, Linde AM, Grasseschi MF, Wood RJ, Lacey MS, Fang X. Velopharyngeal Muscle Morphology in Children With Unrepaired Submucous Cleft Palate: An Imaging Study. Cleft Palate Craniofac J 2020; 58:313-323. [PMID: 32909827 DOI: 10.1177/1055665620954749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify quantitative and qualitative differences in the velopharyngeal musculature and surrounding structures between children with submucous cleft palate (SMCP) and velopharyngeal insufficiency (VPI) and noncleft controls with normal anatomy and normal speech. METHODS Magnetic resonance imaging was used to evaluate the velopharyngeal mechanism in 20 children between 4 and 9 years of age; 5 with unrepaired SMCP and VPI. Quantitative and qualitative measures of the velum and levator veli palatini in participants with symptomatic SMCP were compared to noncleft controls with normal velopharyngeal anatomy and normal speech. RESULTS Analysis of covariance revealed that children with symptomatic SMCP demonstrated increased velar genu angle (15.6°, P = .004), decreased α angle (13.2°, P = .37), and longer (5.1 mm, P = .32) and thinner (4 mm, P = .005) levator veli palatini muscles compared to noncleft controls. Qualitative comparisons revealed discontinuity of the levator muscle through the velar midline and absence of a musculus uvulae in children with symptomatic SMCP compared to noncleft controls. CONCLUSIONS The levator veli palatini muscle is longer, thinner, and discontinuous through the velar midline, and the musculus uvulae is absent in children with SMCP and VPI compared to noncleft controls. The overall velar configuration in children with SMCP and VPI is disadvantageous for achieving adequate velopharyngeal closure necessary for nonnasal speech compared to noncleft controls. These findings add to the body of literature documenting levator muscle, musculus uvulae, and velar and craniometric parameters in children with SMCP.
Collapse
Affiliation(s)
- Graham C Schenck
- Department of Rehabilitation Therapies, 20731Gillette Children's Specialty Healthcare, Saint Paul, MN, USA.,Department of Communication Sciences and Disorders, University of Wisconsin-River Falls, River Falls, WI, USA
| | - Jamie L Perry
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, 3627East Carolina University, Greenville, NC, USA
| | - Mary M O'Gara
- Department of Pediatric Plastic Surgery, 24183Shriners Hospital for Children-Chicago, Chicago, IL, USA.,Department of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy Morgan Linde
- 174539Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.,Department of Speech, Language, and Hearing Sciences, 174539Western Michigan University, Kalamazoo, MI, USA
| | - Mitchell F Grasseschi
- Department of Pediatric Plastic Surgery, 24183Shriners Hospital for Children-Chicago, Chicago, IL, USA.,Department of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert J Wood
- Department of Plastic and Craniofacial Surgery, 3605Banner Health System, Phoenix, AZ, USA
| | - Martin S Lacey
- Department of Plastic Surgery, 20731Gillette Children's Specialty Healthcare, Saint Paul, MN, USA.,Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Xiangming Fang
- Department of Biostatistics, College of Allied Health Sciences, 3627East Carolina University, Greenville, NC, USA
| |
Collapse
|