• Korean Journal of Cleft Lip And Palate
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• v.10 no.1
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• pp.23-32
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• 2007

The classic triad of diagnostic signs of submucosal cleft palate which may be present are: 1) bifid uvula 2) short palate with no muscle in the midline and 3) hard palate with a submucous notching defect in the posterior midline. The treatment of submucous cleft palate are V-Y push back palatorrhaphy, and superior based pharyngoplasty implant in the posterior pharynx. The best speech results were in those children operated upon in the younger age group (especially at or before 2 years of age), thus pointing up the importance of early diagnosis.

• Archives of Plastic Surgery
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• v.33 no.2
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• pp.144-148
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• 2006

The velopharyngeal dysfunction usually occurs in patients with previous operation of the cleft palate or with submucosal cleft palate. In case of velopharyngeal dysfunction without cleft palate, no study has been made when it comes to operative method and postoperative results. Here, we would like to present the operative methods and the postoperative results with the cases we've experienced. This study is based on seven cases of velopharyngeal dysfunction without cleft palate from 1999 to 2004. Analysis of age, sex, etiology, operative methods, satisfaction rate and speech evaluation was done. The patients were 3 males and 4 females, with an age ranged from 10 to 28 at the time of surgery. The follow-up period was more than six months. One case had bifid uvula, another had atypical anomaly in palate, and five cases had no anatomical abnormality. The palatal lengthening was done on one patient, the levator muscle repositioning on another patient and to the rest of them, the superiorly based posterior pharyngeal flap was done. It was difficult to determine the etiology of the velopharyngeal dysfunction without cleft palate. The speech improvement and the satisfaction rate of the patients and parents were diverse. Although the authors had a problem with statistical analysis between the operative age and the speech improvement, it was reasonable to perform a surgical operation because postoperative speech improvement was observed in most cases regardless of age. There is little statistical correlation, but significantly higher outcomes were observed in palatal lengthening and levator muscle repositioning than in pharyngeal flap.

• Archives of Plastic Surgery
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• v.44 no.3
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• pp.202-209
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• 2017

Background No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). Methods This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ${\geq}17$ years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Results Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001). In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%-17% of the patients exhibited increased nasalance scores, assessed through nasometry. Conclusions The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.

• Archives of Plastic Surgery
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• v.51 no.4
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• pp.378-385
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• 2024

Background The best timing of closure of the hard palate in individuals with cleft lip, alveolus, and palate (CLAP) to reach the optimal speech outcomes and maxillary growth is still a subject of debate. This study evaluates changes in compensatory articulatory patterns and resonance in patients with unilateral and bilateral CLAP who underwent simultaneous closure of the hard palate and secondary alveolar bone grafting (ABG). Methods A retrospective study of patients with nonsyndromic unilateral and bilateral CLAP who underwent delayed hard palate closure (DHPC) simultaneously with ABG at 9 to 12 years of age from 2013 to 2018. The articulatory patterns, nasality, degree of hypernasality, facial grimacing, and speech intelligibility were assessed pre- and postoperatively. Results Forty-eight patients were included. DHPC and ABG were performed at the mean age of 10.5 years. Postoperatively hypernasal speech was still present in 54% of patients; however, the degree of hypernasality decreased in 67% (p < 0.001). Grimacing decreased in 27% (p = 0.015). Articulation disorders remained present in 85% (p = 0.375). Intelligible speech (grade 1 or 2) was observed in 71 compared with 35% of patients preoperatively (p < 0.001). Conclusion This study showed an improved resonance and intelligibility following DHPC at the mean age of 10.5 years, however compensatory articulation errors persisted. Sequential treatments such as speech therapy play a key role in improvement of speech and may reduce remaining compensatory mechanisms following DHPC.

• Speech Sciences
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• v.4 no.2
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• pp.69-89
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• 1998

The aim of this study is to develop an objectively method of speech evaluation for children with cleft palates. To assess velopharyngeal function, Visi-Pitch, Computerized Speech Lab. (CSL), Nasometer and Palatometer were used for this study. Acoustic parameters were measured depending on the diagnostic instruments: Pitch (Hz), sound pressure level (dB), jitter (%) and diadochokinetic rate by Visi-Pitch, VOT and vowels formant ($F_1\;&\;F_2$) by a Spectrography and the degree of hypernasality by Nasometer. In addition, Palatometer was used to find the lingual-palatal patterns of cleft palate. Ten children with cleft palates and fifty normal children participated in the experiment. The results are as follows: (1) Higher nasalance of children with cleft palates showed the resonance disorder. (2) The cleft palate showed palatal misarticulation and lateral misarticulation on the palatogram. (3) Children with cleft palates showed the phonatory and respiratory problems. The duration of sustained vowels in children with cleft palates was shorter than in the control groups. The pitch of children with cleft palates was higher than in the control groups. However, intensity, jitter and diadochokinetic rate of children with cleft palates were lower than in the control group. (4) On the Spectrogram, the VOT of children with cleft palates was longer than control group. $F_1\;&\;F_2$ were lower than in the control group.

• Korean Journal of Cleft Lip And Palate
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• v.8 no.1
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• pp.45-52
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• 2005

Velopharyngeal Insufficiency(VPI); the failure of velum, the lateral wall and the posterior pharyngeal wall to separate the nasal cavity from pharyngeal cavity during speech, can be caused by congenital conditions include cleft palate, submucous cleft palate and congenital palatal insufficiency. Speech problems of VPI are characterized by hypernasality, nasal air emission, increased nasal air flow and decreased intelligibility. These speech problems of VPI can be treated with the surgical procedure, the application of temporary prosthesis and speech therapy. Biofeedback technique with Nasometer is a speech treatment method of VPI that commonly used as one component of a comprehensive procedure for improvement of speech in patients with VPI. In this article describes a case of VPI treated by biofeedback technique with Nasometer; which showed satisfactory result in nasalance and formant analysis after the speech therapy during 9 months.

• Korean Journal of Cleft Lip And Palate
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• v.9 no.2
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• pp.79-84
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• 2006

Cleft palate is one of the most devastating congenital facial deformities frequently accompanied by cleft lip. In many cases, it causes phonetic and swallowing difficulties although surgical interventionwas applied. Among the surgical methods, Veau-Wardill-Kilner pushback palatoplasty (V-Y reposition) is widely used in the most cleft palate cases. It is designed to lengthen the palate posteriorly, hence to overcome the speech and swallowing problems, but broad postoperative palatal scar might interfere the normal maxillary growth. If the velar muscles were not reoriented, it could result in incomplete speech recovery. In this case report, the modified two-flap palatoplasty with minimal pushback was successfully applied to a 21 month-old girl who has had incomplete cleft palate extended to the posterior third of hard palate. The speech evaluation was confirmed as functional reconstruction of cleft palate was achieved.

• Korean Journal of Cleft Lip And Palate
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• v.10 no.1
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• pp.33-38
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• 2007

Team approach for the management of cleft lip & palate patients is very important. Plastic surgeon, oral-maxillofacial surgeon, orthodontist, otolaryngologist, and speech therapist should be included in the team. Main role of the ENT surgeon may be variable and is up to the team characteristics. Main topics of ENT surgeons' interesting fields are evaluation and management of hearing impairment due to SOM, voice disorder, and velopharyngeal incompetency due to submucous cleft palate & still remained VPI after curative palatoplasty. Basic review of anatomy & physiology related with otolaryngologic aspect of velopharyngeal system was done. Diseases related with hyponasality as well as hypernasality were discussed. Diagnostic and therapeutic methods were discussed. Proper management of hearing impairment and speech disorders are important.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.19.1-19.6
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• 2019

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.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.5
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• pp.483-488
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• 2006

Velopharyngeal function refers to the combined activity of the soft palate and pharynx in closing and opening the velopharyngeal port to the required degree. In normal speech, various muscles of palate & pharynx function as sphincter and occlude the oropharynx from the nasopharynx during the production of oral consonant sounds. Inadequate velopharyngeal function caused by neurologic disorder - cerebral apoplexy, regressive diseases - disseminated sclerosis, Parkinson's disease, congenital deformity - cleft palate, cerebral palsy and etc. may result in abnormal speech characterized by hypernasality, nasal emission and decreased intelligibility of speech due to weak consonant production. In our study, we constructed speech aids prosthesis - Speech bulb in the incomplete cleft palate VPI patient with hypernasality and assessed velopharyngeal function with nasometer which can evaluate the speech characteristics objectively.