• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.22.1-22.4
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• 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.

• 대한후두음성언어의학회지
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• 제18권2호
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• pp.129-133
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• 2007

Background and Objectives: Nasometry is an easy, noninvasive method to obtain objective data regarding the function of velopharynx. However, because articulation errors may affect the results of nasometry, the examiner should interpret the nasalance score based on appropriate speech stimuli. The purpose of this study is to examine the difference of nasalance score between glottal and oral articulations in patients with velopharyngeal insufficiency (VPI). Materials and Method: Nineteen children between 3.4 and 12.1 years of age (mean age 5.7 years) with a confirmed VPl showing hypernasality and articulation errors (glottal stops) were included. Nasalance scores were obtained for two speech patterns of glottal and oral stops. In addition, the velopharyngeal functions were analyzed in four subjects using video nasopharyngoscopy. Results: The $mean{\pm}S.D$ nasalance scores of the glottal stops and oral stops were $42.54{\pm}16.26%$ and $25.47{\pm}16.51%$ respectively (p=.000). Six of 19 patients achieved normal nasalance scores when glottal stops changed to oral stops by the trial speech therapy. Video nasopharyngoscope confirmed that large velopharyngeal gaps can be decreased into tiny gaps or complete closure when compensatory articulations were corrected for some cases. Conclusion: Compensatory articulation errors must be corrected for the reliable interpretation of the nasalance scores that are obtained in children with velopharyngeal insufficiency, which would facilitate to make a better decision for further management of these patients.

• 한국음향학회지
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• 제38권6호
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• pp.703-709
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• 2019

본 논문에서는 구개인두부전증(VeloPharyngeal Insufficiency, VPI) 환자의 음성을 효과적으로 인식하기 위해 컨볼루션 신경망 (Convolutional Neural Network, CNN), 장단기 모델(Long Short Term Memory, LSTM) 구조 신경망을 은닉 마르코프 모델(Hidden Markov Model, HMM)과 결합한 하이브리드 구조의 음성 인식 시스템을 구축하고 모델 적응 기법을 적용하여, 기존 Gaussian Mixture Model(GMM-HMM), 완전 연결형 Deep Neural Network(DNN-HMM) 기반의 음성 인식 시스템과 성능을 비교한다. 정상인 화자가 PBW452단어를 발화한 데이터를 이용하여 초기 모델을 학습하고 정상인 화자의 VPI 모의 음성을 이용하여 화자 적응의 사전 모델을 생성한 후에 VPI 환자들의 음성으로 추가 적응 학습을 진행한다. VPI환자의 화자 적응 시에 CNN-HMM 기반 모델에서는 일부층만 적응 학습하고, LSTM-HMM 기반 모델의 경우에는 드롭 아웃 규제기법을 적용하여 성능을 관찰한 결과 기존 완전 연결형 DNN-HMM 인식기보다 3.68 % 향상된 음성 인식 성능을 나타낸다. 이러한 결과는 본 논문에서 제안하는 LSTM-HMM 기반의 하이브리드 음성 인식 기법이 많은 데이터를 확보하기 어려운 VPI 환자 음성에 대해 보다 향상된 인식률의 음성 인식 시스템을 구축하는데 효과적임을 입증한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.8.1-8.5
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• 2020

Background: The cause of maxillary growth restriction in patients with cleft lip and palate remains controversial. While studies have investigated the effects surgical technique and timing have on maxillary growth, few focus on patients with isolated cleft palate (ICP). The purpose of this study was to determine the impact palate repair and its associated complications may have on maxillary growth. Methods: A retrospective chart review of ICP patients who underwent palatoplasty from 1962 to 1999 at Akron Children's Hospital was performed. Patient demographics, Veau type, age at primary repair, closure technique, presence of fistula or velopharyngeal insufficiency (VPI), number of palatal operations, maxillary hypoplasia (MH) frequency, and follow-up were recorded. Exclusion criteria included patients with cleft lip, submucous cleft, or syndromes. Results: Twenty-nine non-syndromic ICP patients were identified; 62% (n = 18) had Veau type 1 and 38% (n = 11) had Veau type 2. All patients underwent 2-flap or Furlow palatoplasty with mobilization of mucoperiosteal flaps. Vomerine flaps were used in all Veau 2 cleft palate closures. Palatoplasty was performed at a mean age of 19.9 ± 8.2 months. Average follow-up was 209 ± 66.5 months. The rate of VPI was 59% (n = 17) and the rate of oronasal fistula was 14% (n = 4). Conclusions: There was a low incidence of MH despite complications after initial palate closure. Our results seem to suggest that age at palate closure, type of cleft palate, and type of surgical technique may not be associated with MH. Additionally, subsequent procedures and complications after primary palatoplasty such as VPI and palatal fistula may not restrict maxillary growth.

• 대한후두음성언어의학회지
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• 제11권1호
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• pp.81-86
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• 2000

Submucous cleft palate is a relatively uncommon congenital anomaly accompanying velopharyngeal incompetence(VPI). Double opposing Z-plasty has many advantages including prolongation of soft palate, normal midfacial growth, midline scar. We analyzed postoperative results comparing with those of preoperative evaluation by several variables(nasometer, endoscopy, satisfactory scale) in 14 patients treated with double opposing Z-plasty due to submcous cleft palate. Nasalance score in Ah sound, Ma phrase, and Pa phrase decreased 20.23%, 3.25%, and 23.26% in the average, respectively. As a result, hypernasality improved significantly. Closure rate in velum evaluated by endoscopy was increased from 0.44 to 0.76. In objective satisfactory scale checked by each patient's guardian at the postoperative period, much improved in 3, improved in 6, minimally improved in 1, and no difference in 1 was reported. (n=11 patients) Double opposing B-plasty is a good surgical modality in patients accompanying VPI with submucous cleft palate or incomplete cleft palate and will be used more usefully and widely.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권1호
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• pp.13-20
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• 2006

The articulation disorders associated with velopharyngeal insufficiency (VPI) in cleft palate patients are interested to clinicians particularly. The purpose of this study was to investigate mainly the oropharyngeal air pressure and overall air flow in cleft palate patients. The pressure-measuring catheter was positioned at the midportion of the oropharyngeal cavity with a facial mask. Test words were composed of 9 meaningless polysyllabic words and 17 meaningful words. Aerophone II and Nasometer II were used to measure peak air pressure, mean air pressure, maximum flow rate, volume, phonatory flow rate, nasalance. The data shows that airflow of the cleft palate patient group were higher than those of the control group. Intraoral air pressure of the cleft palate patient group was lower than those of the control group. The first vowel formant and first Bandwidths of the cleft palate patient group were higher than those of the control group.

• 대한음성언어의학회:학술대회논문집
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• 대한음성언어의학회 2003년도 제19회 학술대회
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• pp.147-147
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• 2003

Recent aerodynamic and acoustic studies of VPI(velopharyngeal insufficiency) are non-invasive and safety, therefore, many researchers have used it to diagnose the hyper/hyponasality and articulation disorders of cleft palate patients. The purpose of this study was to estimate mainly the oropharyngeal air pressure and over all air flow in cleft lip and palate patients. The pressure-collecting catheter was positioned in the oropharyngel cavity around tongue base. Twelve adult control group and three cleft lip & palate patients were participated to this experimentation. Aerophone II was used to measure peak air flow, mean air flow, phonatory airflow, phonatory efficiency and resistance. The results were as follows: 1) Airflow of cleft lip ＆ palate patients group were higher than those of control group. Fricative sounds /s/ and /s'/ showed the statistic significance of mean airflow and volume data. 2) Intraoral air pressure of cleft lip ＆ palate patients was lower than those of control group.