• Archives of Plastic Surgery
• /
• v.40 no.2
• /
• pp.97-103
• /
• 2013

Background Velopharyngeal insufficiency (VPI) may persist after primary repair of the cleft palate, and surgical correction is necessary in many cases. The purpose of this study is to evaluate the effect of double opposing Z-plasty (DOZ) in cleft palate patients suffering from VPI after primary two-flap palatoplasty. Methods Between March 1999 and August 2005, we identified 82 patients who underwent two-flap palatoplasty for cleft palate repair. After excluding the patients with congenital syndrome and mental retardation, 13 patients were included in the final study group. The average age of the patients who underwent DOZ at was 5 years and 1 month. Resonance, nasal emission, and articulation were evaluated by a speech pathologist. The velopharyngeal gaps were measured before and after surgery. Results Six patients attained normal speech capabilities after DOZ. The hypernasality grade was significantly improved after surgery in all of the patients (P=0.0015). Whereas nasal emission disappeared in 8 patients (61.5%), it was diminished but still persisted in the remaining 5 patients. Articulation was improved in all of the cases. In two cases, the velopharyngeal gap was measured using a ruler. The gap decreased from 11.5 to 7 mm in one case, and from 12.5 to 8 mm in the second case. Conclusions The use of DOZ as a surgical option to correct VPI has many advantages compared with other procedures. These include short surgery time, few troublesome complications, and no harmful effects on the dynamic physiological functioning of the pharynx. This study shows that DOZ can be another option for surgical treatment of patients with VPI after two-flap palatoplasty.

• Korean Journal of Cleft Lip And Palate
• /
• v.12 no.1
• /
• pp.1-6
• /
• 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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.27 no.1
• /
• pp.92-96
• /
• 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.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.37
• /
• pp.22.1-22.4
• /
• 2015

Velopharyngeal dysfunction in cleft palate patients following the primary palate repair may result in nasal air emission, hypernasality, articulation disorder and poor intelligibility of speech. Among conservative treatment methods, speech aid prosthesis combined with speech therapy is widely used method. However because of its long time of treatment more than a year and low predictability, some clinicians prefer a surgical intervention. Thus, the purpose of this report was to increase an attention on the effectiveness of speech aid prosthesis by introducing a case that was successfully treated. In this clinical report, speech bulb reduction program with intensive speech therapy was applied for a patient with velopharyngeal dysfunction and it was rapidly treated by 5months which was unusually short period for speech aid therapy. Furthermore, advantages of pre-operative speech aid therapy were discussed.

• Speech Sciences
• /
• v.3
• /
• pp.57-69
• /
• 1998

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, during the production of oral consonant sounds elevation of the soft palate, along with the superior constrictor muscle, occludes the oropharynx from the nasopharynx. Inadequate velopharyngeal function caused by congenital or acquired insufficiency or incompetency may result in abnormal speech characterized by hypernasality, nasal emission and decreased intelligibility of speech due to weak consonant production. The speech aid is often helpful in improving the speech of individuals with velopharyngeal incompetency. In this article, the pathogenesis and treatment of velopharyngeal incompetence are discussed and a speech aid appliance that was constructed for the patient is described.

• Tuberculosis and Respiratory Diseases
• /
• v.72 no.2
• /
• pp.169-172
• /
• 2012

Melanoma can occur as a metastasis within subcutaneous tissue, lymph nodes, or viscera without a detectable primary tumor. Among patients with metastatic melanoma of unknown primary lesion, those with endobronchial metastasis are exceedingly rare. Herein we report a case of an endobronchial and pulmonary metastasis in a patient with melanoma originating from an unknown primary site. The patient without a previous history of melanoma presented with blood-tinged sputum. Fiberoptic bronchoscopy revealed a black polypoid tumor obstructing the posterior basal segmental bronchus of the right lower lobe. A final diagnosis of the malignant melanoma was made based on an immunohistochemical study of the bronchoscopic biopsy specimen. Skin, ophthalmic, oral, and nasal examinations failed to identify occult primary lesions. Subsequent evaluation including positron emission tomography/computed tomography scans did not uncover any abnormalities other than the metastatic pulmonary melanoma. We also describe the characteristic bronchoscopic features of melanoma.

• Archives of Plastic Surgery
• /
• v.38 no.6
• /
• pp.867-870
• /
• 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 Craniofacial Surgery
• /
• v.9 no.2
• /
• pp.72-76
• /
• 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.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.13 no.2
• /
• pp.180-187
• /
• 2002

Background and Objectives : The operation Double Opposing Z-Plasty, has been used for improving VPI function in the submucous cleft palate. However, few reports on the effects of the speech change were presented. The purpose of this study is to compare the difference of nasality and nasalance, parents satisfaction between before and after this operation and to consider how much improvement in speech. Materials and Methods : Ten submucous cleft palate children who underwent double opposing Z-plasty were analyzed. We retrospectively studied nasalance, auditory perception (nasality) with hypernasality, patients satisfaction, speech evaluation by using charts review, video tape, telephone interview. Results : In 8 patients of 10 submucous cleft palate, hypernasality reduced and speech intelligibility was higher and mean 0.35 point was increased in the velum length after operation. After operation, nasality was improved (2.0 point) and level of nasal emission decreased. Regarding satisfaction of this operation, scale was mean 2.8 (5 point-scale) : 8 parents were satisfied in the resonance, 3 parents were satisfied articulation. The reason of dissatisfaction was mostly compensatory articulation. Conclusion : To improve of speech in the submucous cleft palate, speech therapy afterthis operation as well as successful surgery should be considered.

• Korean Journal of Cleft Lip And Palate
• /
• v.11 no.1
• /
• pp.13-22
• /
• 2008

Velopharyngeal insufficiency(VPI), characterized by hypernasal resonance and nasal air emission, is a speech disorder that can significantly compromise speech intelligibility. Cleft palate, previously repaired cleft palate and submucous cleft palate are associated with VPI. Less commonly, patients may acquire it after adenoidectomy with or without tonsillectomy or as a result of neuromuscular dysfunction. Comprehensive evaluation by a VPI team includes medical assessment focusing on airway obstructive symptoms, perceptual speech analysis, MRI and instrumental assessment. Options for intervention include speech therapy, intraoral prosthetic devices and surgery. Surgical methods can be categorized as palatal, palatopharyngeal or pharyngeal procedures. Each surgical approach has its strengths and limitations. Oro-maxillofacial surgeons are increasingly involved in the referral, evaluation, and treatment of velopharyngeal function. Therefore, understanding of physiology, anatomic structures, evaluation and treatment protocols in VPI is very important. This article presents protocol for evaluation of velopharyngeal function with a focus on indications for surgical interventions.