• Speech Sciences
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• v.3
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• pp.18-25
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• 1998

Background: The results of treatment in functional velopharyngeal insufficiency (VPI) was not good compared to physician's common practice. Objectives: Authors conducted this study to evaluate the efficacy of fat injection on posterior pharyngeal wall in the functional velopharyngeal insufficiency as the supportive treatment. Materials and Methods: The preoperative assessment includes history of patients, the perceptual analysis of patient's voice, nasopharyngoscopic finding of velopharyngeal movements, nasometer, movement findings of soft palate during phonation and swalling. Fat which was taken from umbilical area was injected in 5 patients with conducted functional velopharyngeal insufficiency. Results: All 5 patients had good results in voice quality after fat injection. Conclusions: Fat injection is a good treatment method in functional velopharyngeal insufficiency as a supportive method.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.375-380
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• 2005

Furlow palatoplasty has been favored by many plastic surgeons as the primary treatment for the velopharyngeal insufficiency associated with submucous cleft palate. The purpose of this article is to introduce an efficacy of Furlow palatoplasty and speech therapy performed on patients who were diagnosed belatedly as having submucous cleft palates. From 2002 to 2004, four submucous cleft palate patients over 5 years of age with velopharyngeal insufficiency received Furlow palatoplasty. The patients were evaluated through the preoperative perceptual speech assessment, nasometry, and videonasopharyngoscopy. Postoperatively, two patients achieved competent velopharyngeal function in running speech. One of the remaining two could achieve competent velopharyngeal function with visual biofeedback speech therapy and the other could not use her new velopharyngeal function in running speech because of her age. Speech therapy can correct the articulation errors and thus improve the velopharyngeal function to a certain extent by eliminating some compensatory articulations that might have an adverse influence on velopharyngeal function. This study shows that Furlow palatoplasty can successfully correct the velopharyngeal insufficiency in submucous cleft palate patients and speech therapy has a role in reinforcing surgical result. But age is still a restrictive factor even though surgery was well done.

• The Journal of Advanced Prosthodontics
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• v.4 no.4
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• pp.243-247
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• 2012

The velopharynx is a tridimensional muscular valve located between the oral and nasal cavities, consisting of the lateral and posterior pharyngeal walls and the soft palate, and controls the passage of air. Velopharyngeal insufficiency may take place when the velopharyngeal valve is unable to perform its own closing, due to a lack of tissue or lack of proper movement. Treatment options include surgical correction, prosthetic rehabilitation, and speech therapy; though optimal results often require a multidisciplinary approach for the restoration of both anatomical and physiological defect. We report a case of 56 year old male patient presenting with hypernasal speech pattern and velopharyngeal insufficiency secondary to cleft palate which had been surgically corrected 18 years ago. The patient was treated with a combination of speech therapy and palatal lift prosthesis employing interim prostheses in various phases before the insertion of definitive appliance. This phase-wise treatment plan helped to improve patient's compliance and final outcome.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.1
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• pp.51-53
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• 2003

Amyotrophic lateral sclerosis Is an unusual pattern of distal muscular atrophy with permanent bulbar sign. Vocal fold paralysis and velopharyngeal insufficiency(VPI) due to soft palate paralysis Is occasionally associated with distal muscular atrophy. Recently we experienced a case of amyotrophic lateral sclerosis whose symptom was initially expressed with hoarseness and VPI. So we report a case with review of literature.

• Archives of Craniofacial Surgery
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• v.19 no.3
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• pp.163-167
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• 2018

Velopharyngeal insufficiency (VPI) is a common complication after primary palatoplasty. Although the several surgical treatments of VPI have been introduced, there is no consensus guide to select the optimal surgical treatment for VPI patients. The selection of surgical treatment for VPI depends on a multimodal patient evaluation, such as perceptual speech evaluation, nasometery and nasoendoscopy. We can provide more adequate treatment for VPI through the deeper understanding of anatomy and physiology in VPI.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.5
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• pp.454-458
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• 2010

Velopharyngeal insufficiency is defined as a status in which nasal cavity and oral cavity can not be sepa-rated when speaking, swallowing by any reason. It has been treated by palatorrhaphy, pharyn-geal flap, local flap, free flap etc. When the size of the defect is small, it can be restored by palatorrhaphy, pharyngeal flap etc. But they are not proper for treatment of the large size of defect. In that case, local flap and free flap are more beneficial. Although large defect can be restored by free flap technique, but it is very complex, time-consuming and may bring about esthetical, functional complications of donor site. Buccinator myomucosal flap is a kind of local flap and reported for the first time by Bozola et al in 1989 and it has become a useful way for reconstruction of large intraoral defect. Authors experienced the use of buccinators myomucosal flap for treating secondary velopharyngeal insufficiency with large soft palate defect and obtained good result. So we report the case with literature reviews.

• Archives of Plastic Surgery
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• v.38 no.2
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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.

• Archives of Plastic Surgery
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• v.32 no.5
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• pp.660-662
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• 2005

It is well documented that adenoidectomy is attributed to hypernasality in certain cases, but not clear that the enlarged tonsils affect the quality of speech. Hypertrophied tonsils may cause and complicate the problem of velopharyngeal incompetency. The huge tonsils prevent lateral pharyngeal walls from a medial movement and interfere velar elevation, being hypernasality. Hyponasality developes as the tonsils encroach in nasopharyngeal space. Voluminous tonsils also interfere airflow in the oropharyneal passage and produce the phenomenon of cul-de-sac resonance or muffled sound. The authors and et al. present a case of velopharyngeal insufficiency accompanied with hypertrophic tonsils. Improving the lateral constricting pharyngeal wall and velar elevation after tonsillectomy minimized the velopharyngeal gap. Accordingly, the procedures of sphincter pharyngoplasty and palatal lengthening resolved the problem of hypernasality instead of pharyngeal flap. Tonsillectomy prior to pharyngeal flap surgery tends to reduce the postoperative airway problems. Sometimes, however, only tonsillectomy does without pharyngeal flap. Surgical approach by stages and intermittent evaluation are recommended at intervals of at least six weeks.

• The Journal of Korean Academy of Prosthodontics
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• v.51 no.4
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• pp.353-360
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• 2013

Cleft lip and palate is congenital deformity in oral and maxillofacial area. Normal soft palate has velopharyngeal closure action by connecting oral cavity and nasal cavity at rest and moving upward at swallowing and specific pronunciation. Cleft palate patients with velopharyngeal insufficiency have difficulty in mastication, swallowing and pronunciation because velopharyngeal closure is incomplete. At this time, a prosthetic device used to cover palate defects is called a palatal obturator. A palatal obturator separates oral cavity and nasal cavity and recovers pronunciation, mastication, swallowing and esthetic function. The purpose of this case study is to report the results because it reaches a satisfactory result in functional and esthetic aspects through functional impression procedures using modeling compound and tissue conditioner for restoration of a cleft palate patient with velopharyngeal insufficiency.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.2
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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.