• Archives of Plastic Surgery
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• 제37권2호
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• pp.175-177
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• 2010

Ppupose: Velopharyngeal insufficiency (VPI) during articulation development period can cause compensatory articulation like glottal stop, which can maintain VPI symptoms such as hypernasality and nasal emission despite of recovered velopharyngeal function. Methods: A girl visited our department with speech problems such as hypernasality, compensatory articulation patterns, and nasal air emission. She had history of postpalatoplasty fistula which was repaired after 1 year follow-up. Results: After treated with speech therapy without surgery, her hypernasal speech problem was corrected. From this, we could assume that the fistula during articulation development period induced VPI, which leads to glottal substitution and this compensatory articulation maintained VPI though the fistula was repaired. Conclusion: In this report, we could observe that palatal fistula in articulation development period can have detrimental effect on articulation, and also we could confirm that evaluation of soft palate mechanism with using speech sample without compensatory articulations prevent the patient from unnecessary operation.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.867-870
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• 2011

Purpose: The authors would like to introduce two patients who presented with velopharyngeal inadequacy. We emphasize the importance of nasaopharyngeal endoscopy in evaluating the velopharyngeal function and the usefulness of biofeedback trial therapy. Methods: Two patients visited our clinic due to velopharyngeal inadequacy. Both of the patients showed hypernasality, nasal emission and compensatory articulation such as glottal stop. During oral examination and nasopharyngeal endoscopy both showed no evidence of structural deformities. One inconsistently showed a small gap during articulation. The other showed a rather large gap during compensatory articulation. Both received a simultaneous biofeedback trial therapy using the nasopharyngeal endoscope. Results: Both patients were successfully diagnosed and treated at once using biofeedback trial therapy with nasopharyngeal endoscopy. By giving direct visual feedback to the patient, they were both able to achieve complete velopharyngeal closure during production of 2~3 nonsence syllables and hypernasality was not detected in both of them. Conclusion: The authors were able to help patients with velopharyngeal inadequacy to have velopharyngeal closure through biofeedback trial therapy. The accurate evaluation of velopharyngeal function and the possibility of closure prevented unnecessary operations.

• Archives of Plastic Surgery
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• 제38권2호
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• pp.203-206
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• 2011

Purpose: Kabuki syndrome is a multiple malformation syndrome that was first reported in Japan. It is characterized by distinctive Kabuki-like facial features, skeletal anomalies, dermatoglyphic abnormalities, short stature, and mental retardation. We report two cases of Kabuki syndrome with the surgical intervention and speech evaluation. Methods: Both patients had velopharyngeal insufficiency and had a superior based pharyngeal flap operation. The preoperative and postoperative speech evaluations were performed by a speech language pathologist. Results: In case 1, hypernasality was reduced in spontaneous speech, and the nasalance scores in syllable repetitions were reduced to be within normal ranges. In case 2, hypernasality in spontaneous speech was reduced from severe level to moderate level and the nasalance scores in syllable repetitions were also reduced to be within normal ranges. Conclusion: The goal of this article is to raise awareness among plastic surgeons who may encounter such patients with unique facial features. This study shows that pharyngeal flap operation can successfully correct the velopharyngeal insufficiency in Kabuki syndrome and post operative speech therapy plays a role in reinforcing surgical result.

• 대한구순구개열학회지
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• 제15권2호
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• pp.97-108
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• 2012

Velopharyngeal insufficiency (VPI) is improper closure of velopharynx during the phonation and swallowing due to various causes, especially appeared in cleft palate patients. The several surgical techniques and speech therapy can be considered in treatment of VPI. The surgical techniques such as Furlow's double opposing Z-plasty, pharyngeal flap, push-back palatoplasty, etc. have been widely used when the speech therapy is not so much effective. However, there is considerable variability in the methods for evaluation and in success criteria making difficult to compare among surgical techniques. This article reviewed the recent articles about comparing the surgical techniques in treatment of VPI. Although there is no significant difference in speech assessment by speech pathologist, Furlow's double opposing Z-plasty is a useful technique especially diminishing hypernasality and nasal emission.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제14권1_2호
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• pp.22-39
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• 1992

The purpose of this study was to evaluate hypernasality, nasal air emission, glottal stop, articulation disorder in patients with velopharyngeal incompetency(V.P.I.) and to analyze speech improvement after pharyngoplasty. In this study 61 patients with velopharyngeal incompetency were tested, and in patents with pharyngoplasty speech problems before pharyngoplasty were compared with those after pharyngoplasty. The results obtained are as follows : 1. There are few speech problems in pronouncing the vowel sounds. 2. There are many speech problems in pronouncing the pressure sounds and few speech problems in non-pressure sounds. 3. Speech problems in patients with cleft palate are influenced not by anatomical defect but by severity of velopharyngeal incompetence after palatorrhaphy. 4. Operation methods which decrease the velopharygeal incompetence must be considered for reducing the speech problems. 5. Among the 61 cases with V.P.I. 19 cases(31%) showed nasal air emission and 24 cases(39%) showed glottal stop. 6. Pharyngoplasty is of benefit to primary precipitating components such as hypernasality, nasal air emission but of no benefit to secondary compensating component such as glottal stop. 7. There as no significant difference in speech improvement between pre-and post-pharyngoplasty(p<0.05).

• 대한구순구개열학회지
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• 제12권1호
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• pp.1-6
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• 2009

Oronasal fistula are a well-known complication of surgical treatment of cleft palate, occurring most frequently in the alveolus and hard palate. Previous reports have demonstrated that oronasal fistulas, particularly if greater than l cm in diameter, had an adverse effect on speech. The aim of this study was to demonstrate the relationship between the size of the fistula and the influence on velopharyngeal function. The site and size of the fistula were indicated on graph paper with calipers and measured in $mm^2$. Speech assessment was carried out using a Nasometer, VPI articulation differential test, spectrography. Patient whose fistulas affected their speech had significantly larger fistulas than those whose fistulas did not. The study shows that the larger the fistula, the greater the risk of hypernasality and nasal emission, but even small fistulas can cause speech problems. If obstruction of the nasal passage is eliminated in a patient with a previously asymptomatic fistula, it may result in a fistula becoming symptomatic, resulting in hypernasality and nasal emission. In conclusion, even small fistulas can influence speech production and should be considered before any treatment is planned. The study lends support to early closure of oronasal fistulas, particularly before pharyngeal flap surgery is contemplated.

• 대한음성언어의학회:학술대회논문집
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• 대한음성언어의학회 1998년도 제10회 학술대회 심포지움
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• pp.189-189
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• 1998

점막하 구개열(submucous cleft palate)은 특징적인 임상적 해부학적 기형을 나타내는데 이분 구개수(bifid uvula), 근육의 분리(muscular diastasis), 경구개 후연의 절흔(frank notching of the posterior hard palate)등이다. 결국 이러한 기형을 교정하지 않으면 과비음과 공명장애로 인한 조음장애는 사회생활에 중요한 영향을 미치고, 사람의 인상에 나쁜 영향을 주게되어 개인의 인성 형성의 장애와 삶의 질의 저하를 초래하게 된다. (중략)

• Archives of Plastic Surgery
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• 제47권6호
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• pp.542-550
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• 2020

Background This study aimed to identify the initial diagnostic characteristics and treatment status of children with submucous cleft palate (SMCP) and to examine the relationship between the timing of surgical correction and the degree of articulation and resonance improvement. Methods This retrospective study included 72 children diagnosed with SMCP between 2008 and 2016. The evaluation criteria were the age of the initial visit, total number of visits, age at the end of treatment, speech problems, resonance problems, and speech therapy. Results Children with SMCP first visited the hospital at an average age of 34.32 months, and speech problems were identified at an average age of 48.53 months. Out of 72 children, 46 underwent surgery at an average age of 49.74 months. Four of these children required secondary surgery at an average age of 83.5 months. Among the children who underwent surgery before 3 years of age, 70% exhibited articulation improvements, with mild-to-moderate hypernasality. Articulation improvements showed no statistically significant differences according to age at the time of surgery. However, children who underwent surgery before 4 years had a better hypernasality rating than those who underwent surgery after 4 years of age. Conclusions Children with SMCP tend to undergo delayed treatment because the anatomical symptoms in some children with SMCP are unclear, and surgical interventions are considered only after speech problems are clarified. Starting interventions as early as possible reduces the likelihood of receiving secondary surgery and speech therapy, while increasing expectations for positive speech function at the end.

• Archives of Plastic Surgery
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• 제39권1호
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• pp.25-30
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• 2012

Background : The soft palate functions as a valve and helps generate the oral pressure required for normal speech resonance. Speech problems and nasal regurgitation can result from a soft palatal defect. Reduction of the size of the velopharyngeal orifice is required to compensate for the lack of mobility in a reconstructed soft palate. We suggest a large volume folded free flap for reduction of the caliber and a palmaris longus tendon sling for suspension of the reconstructed palate. Methods : Six patients had total soft palate resection for tonsillar cancer and reconstruction with a large volume folded radial forearm free flap combined with a palmaris longus sling. A single surgeon and speech therapist examined the patients with three standardized speech assessment tools: nasometer test, consonant articulation test, and speech acuity test performed for speech evaluation. Results : Mean nasalance score was 76.20% for sentences with nasal sounds and 43.60% for sentences with oral sounds. Hypernasality was seen for oral sound sentences. The mean score of the picture consonant articulation test was 84% (range, 63% to 100%). The mean score of the speech acuity test was 5.84 (range, 5 to 6). These mean ratings represent a satisfactory level of speech function. Conclusions : The large volume folded free flap with a palmaris longus tendon sling for total soft palate reconstruction resulted in satisfactory prognosis for speech despite moderate hypernasality.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권1호
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• pp.92-96
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• 2001

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 - Palatal lift in acquired idiophathic VPI patient and assessed velopharyngeal function with various diagnostic instruments which can evaluate the speech characteristics objectively.