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Phippen G. Articulating the issues: speech assessment and intervention in cleft lip and palate. Br Dent J 2023; 234:912-917. [PMID: 37349440 DOI: 10.1038/s41415-023-5954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
This paper describes the impact of cleft lip and palate on speech. It provides an overview for the dental clinician of the key issues affecting speech development and clarity. The paper summarises the complex speech mechanism and cleft-related factors that affect speech, including palatal, dental and occlusal anomalies. It outlines the framework for speech assessment throughout the cleft pathway and provides a description of cleft speech disorder, as well as describing treatment approaches for cleft speech and velopharyngeal dysfunction.This is followed by a spotlight on speech prosthetics for treating nasal speech, with an emphasis on joint management by the Speech and Language Therapist and Consultant in Restorative Dentistry. This includes the core multidisciplinary approach, clinician and patient-reported outcome measures, and brief discussion of national developments in this area.The importance of multidisciplinary cleft care is highlighted and, within this, the essential interaction between speech and dental clinicians in providing routine care, as well as in delivering a highly specialist speech prosthetics service.
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Affiliation(s)
- Ginette Phippen
- Lead Speech & Language Therapist, The Spires Cleft Centre, Salisbury NHS Foundation Trust/Oxford University Hospitals NHS Foundation Trust, United Kingdom.
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Park YH, Jo HJ, Hong IS, Leem DH, Baek JA, Ko SO. Treatment of velopharyngeal insufficiency in a patient with a submucous cleft palate using a speech aid: the more treatment options, the better the treatment results. Maxillofac Plast Reconstr Surg 2019; 41:19. [PMID: 31106163 PMCID: PMC6491524 DOI: 10.1186/s40902-019-0202-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/28/2019] [Indexed: 12/01/2022] Open
Abstract
Background The submucous cleft palate (SMCP) is a type of cleft palate that may result in velopharyngeal insufficiency (VPI). Palate muscles completely separate oral and nasal cavities by closing off the velopharynx during functional processes such as speech or swallow. Also, hypernasality may arise from anatomical or neurological abnormalities in these functions. Treatments of this issue involve a combination of surgical intervention, speech aid, and speech therapy. This case report demonstrates successfully treated VPI resulted from SMCP without any surgical intervention but solely with speech aid appliance and speech therapy. Case presentation A 13-year-old female patient with a speech disorder from velopharyngeal insufficiency that was caused by a submucous cleft palate visited to our OMFS clinic. In the intraoral examination, the patient had a short soft palate and bifid uvula. And the muscles in the palate did not contract properly during oral speech. She had no surgical history such as primary palatoplasty or pharyngoplasty except for tonsillectomy. And there were no other medical histories. Objective speech assessment using nasometer was performed. We diagnosed that the patient had a SMCP. The patient has shown a decrease in speech intelligibility, which resulted from hypernasality. We decided to treat the patient with speech aid (palatal lift) along with speech therapy. During the 7-month treatment, hypernasality measured by a nasometer decreased and speech intelligibility became normal. Conclusions Surgery remains the first treatment option for patients with velopharyngeal insufficiencies from submucous cleft palates. However, there were few reports about objective speech evaluation pre- or post-operation. Moreover, there has been no report of non-surgical treatment in the recent studies. From this perspective, this report of objective improvement of speech intelligibility of VPI patient with SMCP by non-surgical treatment has a significant meaning. Speech aid can be considered as one of treatment options for management of SMCP.
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Affiliation(s)
- Yun-Ha Park
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University Dental Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea.,2Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea
| | - Hyun-Jun Jo
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University Dental Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea.,2Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea
| | - In-Seok Hong
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University Dental Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea.,2Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea
| | - Dae-Ho Leem
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University Dental Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea.,2Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea
| | - Jin-A Baek
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University Dental Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea.,2Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea
| | - Seung-O Ko
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University Dental Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea.,2Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do Republic of Korea
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Bibars ARM, Alfwaress FSD, Hamasha AAH, Al-Hourani ZA, Almhdawi K. Prosthodontic Rehabilitation of Arabic Speaking Individuals with Velopharyngeal Incompetence: A Preliminary Study. Open Dent J 2017; 11:436-446. [PMID: 28979573 PMCID: PMC5611712 DOI: 10.2174/1874210601711010436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Hypernasality is a frequently encountered problem in the speech of individuals with velopharyngeal incompetence. The use of palatal lift appliance (PLA) is the main treatment option for correction of velopharyngeal incompetence. The literature on the outcomes of using prosthetics treatment for Arabic speaking patients is scarce. Objective: The aim of this study was to investigate the effect of using PLA on hypernasality of Arabic speaking patients with velopharyngeal incompetence. Methods: Six participants with age ranging from 9 to 61 years (4 males and 2 females) were recruited between October 2013 and August 2014. Written informed consents were taken from all the adult participants/the guardians of under-aged participants. All patients exhibited hypernasality with different etiologies for velopharyngeal incompetence (head injury, cerebrovascular accident, and neurological disorders). They were treated with PLAs which were constructed to elevate the dysfunctional soft palate. Nasalance scores and perceptual speech acceptability ratings were measured/evaluated in both situations; with and without appliances. Paired t-test was used to analyze the perceptual ratings and nasalance scores in order to detect any significant change in hypernasality pre and post insertion of PLA. Results: There was a statistically significant decrease (p>0.05) in nasalance scores (Pa, Pi, Ma, Mi, a, i) after PLA insertion. The subtest /u/ showed insignificant change (p= 0.056). Perceptual ratings showed significant reduction in hypernasality which was consistent with nasalance measurements. Conclusion: PLAs can reduce hypernasality in Arabic speaking patients who suffer from velopharyngeal impairment.
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Affiliation(s)
- Abdel Rahim M Bibars
- Department of Applied Dental Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Firas S D Alfwaress
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences; Jordan University of Science and Technology, Irbid, Jordan
| | - Abed Al-Hadi Hamasha
- Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Zeid A Al-Hourani
- Department of Applied Dental Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Khader Almhdawi
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences; Jordan University of Science and Technology, Irbid, Jordan
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Abstract
PURPOSE OF REVIEW To review journal articles discussing surgery for velopharyngeal dysfunction over the past year. All articles ascertained by a PubMed search relevant to this topic were reviewed. RECENT FINDINGS Articles evaluated from the past year discussed the variations, effectiveness, and feasibility of multiple surgical techniques for velopharyngeal dysfunction, including the Furlow palatoplasty, sphincter pharyngoplasty, pharyngeal flap procedure, and other less known novel surgical options. Outcomes, comparisons, and complications were a focus of the majority of the studies. Combinations of the above procedures are also assessed. Nonsurgical options, such as prosthetic devices and pharyngeal augmentation, are mentioned. SUMMARY Multiple surgical options exist to assist patients with velopharyngeal dysfunction. The majority of the surgical options can be highly successful. A multispecialty team is critical in providing patients with the most appropriate treatment for their specific situation. Standardized speech and velopharyngeal dysfunction outcome measures are necessary to allow accurate preoperative and postoperative comparisons, intrasurgeon comparisons, and multi-institutional comparisons. Unfortunately, there is a lack of standardization in speech outcome measures among the studies published over the last year. The risk of postoperative obstructive sleep apnea must be assessed and discussed prior to surgery for any patient scheduled to undergo surgery for velopharyngeal dysfunction. Future studies promise to improve our understanding of velopharyngeal dysfunction and provide further guidance as to the best surgical options to assist these patients.
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