• Korean Journal of Cleft Lip And Palate
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• v.15 no.1
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• pp.39-50
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• 2012

A submucous cleft palate(SMCP) is characterized by a midline deficiency or lack with/without incorrect positioning of muscular tissues in the soft palate, and by a bony defect in the midline or the center of the hard palate. Velopharyngeal incompetence(VPI) related to this SMCP has been managed by various surgical and prosthetic techniques. Because the individual diagnosis and treatment of SMCP patients was not easy to the speech pathologist and to the maxillofacial reconstructive surgeons, and for the better understanding and for the ideal approaches to the SMCP patients, we reviewed several recent articles about grading system in the SMCP caused by VPI, and summarized in this review article.

• Speech Sciences
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• v.9 no.3
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• pp.133-140
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• 2002

The purpose of this study was to investigate any changes in acoustic qualities of voice as ,a function of nasalance, in order to determine the relationship between vocal quality and nasalance. Twenty normal subjects (10 males and 10 females) vocalized /a/, /$\tilde{a}$/, and /a $\eta$/. The changes in nasalance and acoustic characteristics of the voice were analyzed by Nasometer (Model 6200-3, Kay Elemetrics, co) and Dr, Speech 4.0 (Tiger Electronics, Co), respectively. One-way ANOVA was used to examine any changes in jitter, shimmer, harmonics-to-noise ratio, and normalized noise energy relative to the nasalance in 3 types of vocalization. The Person r correlation coefficient was used to identify the relationship between the nasalance and the vocal quality. There was no statistically significant changes in jitter, shimmer, HNR and NNE. The jitter, however, tended to increase as the nasalance socre increased, compared to the other vocal parameters. In addition, the NNE showed an increase on / $\tilde{a}$/, and /a $\eta$/, more on the /a $\eta$/. Thus, it was speculated that NNE could be used to identify or screen resonant disorders with hypernasality

• Archives of Craniofacial Surgery
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• v.9 no.2
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• pp.72-76
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• 2008

Purpose: Authors evaluated results of palatoplasty by speech analysis in bilateral, unilateral complete, and unilateral incomplete and submucous cleft palate patients. Methods: The speech outcomes were studied in 15 bilateral, 28 unilateral complete, and 46 unilateral incomplete and submucous cleft palate patients who underwent push-back palatoplasties from January 1998 to July 2004. The patients were divided into 2 groups as 3 to 6, 7 to 10-year-old and compared with 20 normal children(control groups were divided into 10 children on each side). Nasal emission test, hypernasality test, and articulation test were done by speech evaluation table which was composed of 39 different words. Results: In all speech evaluation tests, the group of bilateral cleft palate patients got the worst score. And 7 to 10-year-old groups got better score when compared to the same type cleft palate. Conclusion: Bilateral cleft palate patients have many more speech problems than other patients. In cleft palate patients, the speech problem was improved with ages, postoperatively. And the speech therapy can improve the operative outcomes.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.67-74
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• 2006

Palatoplasty using Furlow's double-opposing Z-plasty has been performed from June, 1995 to September, 1999 at Seoul National University Children's Hospital. The goal of this study is to determine the optimal timing of repair and cleft severity affecting velopharyngeal function. This is the retrospective study of patients operated by the second author. The mean age of patients was 10.53 months. The patients could be divided into three groups-isolated cleft palate(n=70), unilateral cleft lip and palate(n=88), and bilateral cleft lip and palate(n=42). To evaluate the velopharyngeal function, we used two parameters, speech evaluation and cineofluorography using DSR(digital subtraction radiography). Also, to determine the relevance between cleft severity and speech development, we measured the distance between maxillary tuberosities and cleft margins. Among 200 patients, about 96% had no or minimal hypernasality and 87% had no or mild nasal emission. The cleft width and length of soft palate seemed not to be related with the speech development. Palatoplasty at the age under 12 months resulted in less 'nasal emission' and better 'articulation' of the parameters that were assessed at the age of 7 years. It can be concluded Furlow palatoplasty shows satisfactory results and also it seems that it is better to perform the operation before the age of 12 months.

• 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.

• Phonetics and Speech Sciences
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• v.1 no.3
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• pp.133-144
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• 2009

Pharyngeal flap surgery changes the space and shape of the oral cavity and vocal tract, and these changing conditions bring resonance change. The purpose of this study was to determine the most reliable and valuable parameters for evaluating hypernasality to distinguish two patients before and after pharyngeal flap surgery. Each patient was asked to clearly speak the vowels /a/, /i/, /u/, /e/, /o/ for voice recording. There were nine parameters: Formant (F1, F2, F3), Bandwidth (BW1, BW2, BW3), LPC energy slope ($\Delta$ |A2-A1/F2-F1|), and Band Energy (0-500 Hz, 500-1000 Hz) by each vowel. From the results of discrimination analyses on acoustic parameters, the vowels /a/, /e/ appeared to be insignificant but vowels /i/, /u/, /o/ appeared to be efficient in the separation. A 95%, 100%, and 100% recognition score could be reached when vowels /i/, /u/, and /o/ were analyzed. The results showed that F2, BW3, and LPC slope are more important parameters than the others. Finally, there is a relation between perceptual evaluation score and LPC energy slope of acoustic parameters by least square slope.

• Korean Journal of Cleft Lip And Palate
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• v.15 no.2
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• pp.89-96
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• 2012

Le Fort 1 osteotomy or maxillary advancement with distraction osteogenesis (DO) is main treatment strategy for cleft palate patients with maxillary hypoplasia. Maxillary DO allows greater maxillary advancement within physiological limit than Le Fort 1 osteotomy. Moreover, it is better for velopharyngeal function. However, there is a greater tendency for an increase in nasal sound when maxilla is advanced excessively. Therefore, the advancement of anterior maxillary segment using DO has been utilized. It offers advantages such as an increase in the length of the palate, a prevention of the change in palatopharyngeal depth, and a preservation of the velopharyngeal function. Moreover, it will obliterate the necessity of bone graft, and it prevents the occurrence of oronasal or oroantral fistula. Finally, it stimulates the regeneration of the soft and hard tissue of alveolus, and subsequently makes possible to place implant.

• Speech Sciences
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• v.5 no.1
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• pp.105-119
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• 1999

Cleft palate patients have general speech problems with resonance disorders and articulation disorders. The aim of this study is to find the aerodynamic and acoustic characteristics of the nasalization in cleft palate speakers. Thirteen control groups and three cleft palate patients pre- and post operation were selected for these studies. The test words are composed by polysyllabic words: consonants between high vowel /i/ analysis. The cleft palate patients repeated test words pre- and post-operation from one, three and six month periods. The subjects repeated test words on Macquirer and on Nasometer Model 6200-3. The aerodynamic and acoustic results of nasalization show as follows: (1) The nasal rate in overall airflow of aspirated consonant for cleft palate patients shows higher levels than that of the control group. It had decreased since one month after operation. (2) The overall airflow of cleft palate patients is higher than in the control group, however oral air pressure is lower than control group. (3) The nasal airflow and the nasal rate in overall airflow of cleft palate patients has higher than the control group, however its decreased after operation. (4) The nasalance scores of cleft palate patients were 40% higher than that of the control group. The scores did not decrease after operation. The nasalance score of lateral and fricative sounds did not decrease after operation.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.33 no.3
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• pp.188-192
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• 2022

Velopharyngeal insufficiency (VPI) is a phenomenon that can occur due to anatomical or neurological causes of the soft palate. VPI can make the patient difficult to articulate through hypernasality and nasal emission. There has been needed the customized treatment, as VPI can occur for many causes. We present the case of 21-year-old male who took palate plastic surgery 20 years ago for congenital submucosal cleft palate. As he had poor contraction of both lateral side of velopharynx, he was diagnosed with coronal type VPI. Through sphincter pharyngoplasty, he can obtain improvement of articulation accuracy. We would like to share this challenged case.

• Archives of Plastic Surgery
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• v.34 no.6
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• pp.741-747
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• 2007

Purpose: In order to determine the differences in speech outcome based on timing of operation in submucous cleft palate, we have reviewed our experiences in the Furlow palatoplasty over the last 11 years. Methods: From March 1996 to March 2006, 38 submucous cleft palate patients received Furlow palatoplasty. 10 developmentally delayed patients were excluded and 5 patients were lost to follow up. The rest 23 patients were reviewed. Speech was evaluated preoperatively and postoperatively, and speech therapy was performed accordingly. Perceptual speech assessment included hypernasality, nasal emission and articulation disorder. Cinefluorography was performed to aid perceptual assessment. Based on timing of operation, the patients were divided into 3 groups as following: Group A under 24 months(8 patients), Group B from 25 to 48 months(6 patients), and Group C over 49 months (9 patients). Except 1 patient under speech therapy yet, resultant speech was compared. 200707Results: The rate of abnormal speech was higher in Group C(3/9, 33.3%) than in Group A(0%) or B(0%). All 3 patients who had been discontinued of speech therapy from the parent's judgment had abnormal speech. The reason for the discontinuation was that the regular speech therapy was a burden at school age. Any patients who had continued speech therapy had normal speech. Conclusion: The results of our study shows that operative timing is associated with speech development. Maintenance of speech therapy was an important factor for normal speech development. It will be helpful to perform a palatoplasty before 48 months of age to complete speech therapy before the school age.