• Archives of Plastic Surgery
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• v.51 no.3
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• pp.284-289
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• 2024

Background Velopharyngeal insufficiency (VPI) is a major complication of cleft palate repair. The purpose of this study was to evaluate the incidence and predictive factors of VPI after cleft palate repair based on 27 years of one surgeon's experience. Methods Medical records were retrospectively reviewed for 652 patients who underwent cleft palate repair between 1995 and 2021. After exclusion of those with other syndromes or developmental disorders, the study included 374 patients with sufficient follow-up until the age of 4 years, when language evaluation was possible. VPI status was categorized through subjective and objective tests into normal, VPI, and borderline. We analyzed potential differences in VPI incidence by multiple factors. Factors with significance were analyzed to confirm the relationships between subvariables. Results Of the 374 patients, 311 (83.2%) exhibited normal pronunciation, 51 (13.6%) had VPI, and 12 (3.2%) were borderline. Primary cleft palate repair performed after 18 months was associated with a higher incidence of VPI than repair conducted before 18 months (p = 0.005). The incidence of VPI was higher in cases of submucous cleft palate than in the other types based on the Veau classification (p = 0.011). However, in the multivariable analysis, only the submucous type showed statistically significant results (p = 0.026). Conclusion A total of 374 people underwent primary cleft palate repair, and 13.6% of those with VPI required secondary therapy. The incidence of VPI was relatively high among patients with primary cleft palate repair after 18 months and patients with submucous cleft palate.

• Archives of Plastic Surgery
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• v.33 no.2
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• pp.144-148
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• 2006

The velopharyngeal dysfunction usually occurs in patients with previous operation of the cleft palate or with submucosal cleft palate. In case of velopharyngeal dysfunction without cleft palate, no study has been made when it comes to operative method and postoperative results. Here, we would like to present the operative methods and the postoperative results with the cases we've experienced. This study is based on seven cases of velopharyngeal dysfunction without cleft palate from 1999 to 2004. Analysis of age, sex, etiology, operative methods, satisfaction rate and speech evaluation was done. The patients were 3 males and 4 females, with an age ranged from 10 to 28 at the time of surgery. The follow-up period was more than six months. One case had bifid uvula, another had atypical anomaly in palate, and five cases had no anatomical abnormality. The palatal lengthening was done on one patient, the levator muscle repositioning on another patient and to the rest of them, the superiorly based posterior pharyngeal flap was done. It was difficult to determine the etiology of the velopharyngeal dysfunction without cleft palate. The speech improvement and the satisfaction rate of the patients and parents were diverse. Although the authors had a problem with statistical analysis between the operative age and the speech improvement, it was reasonable to perform a surgical operation because postoperative speech improvement was observed in most cases regardless of age. There is little statistical correlation, but significantly higher outcomes were observed in palatal lengthening and levator muscle repositioning than in pharyngeal flap.

• Korean Journal of Cleft Lip And Palate
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• v.12 no.1
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• pp.7-20
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• 2009

Orthodontic treatment planning of cleft lip and palate requires consideration of the characteristic features, growth pattern and functional disorders related to cleft lip and palate patients. Tissue deficiencies and constriction of the scar tissue in surgically treated cleft lip and palate results in disturbance of maxillary growth and deficiency of midfacial region with anterior and posterior crossbite. These patients often present congenital missing of teeth, supernumerary teeth, malformed teeth, or ectopic position of teeth, which should be treated by orthodontic treatment by expanding upper arch followed by fixed appliance. Proper use of retainer and continuous follow-up is needed to prevent relapse after orthodontic treatment has finished. Also we have to pay attention to correct speech disorder which is caused by the velopharyngeal insufficiency.

• Archives of Craniofacial Surgery
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• v.22 no.4
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• pp.209-213
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• 2021

Primary palatoplasty for cleft palate places patients at high risk for scarring, altered vascularity, and persistent tension. Palatal fistulas are a challenging complication of primary palatoplasty that typically form around the hard palate-soft palate junction. Repairing palatal fistulas, particularly wide fistulas, is extremely difficult because there are not many choices for closure. However, a few techniques are commonly used to close the remaining fistula after primary palatoplasty. Herein, we report the revision of a palatal fistula using a pedicled buccal fat pad and palatal lengthening with a buccinator myomucosal flap and sphincter pharyngoplasty to treat a patient with a wide palatal fistula. Tension-free closure of the palatal fistula was achieved, as well as velopharyngeal insufficiency (VPI) correction. This surgical method enhanced healing, minimized palatal contracture and shortening, and reduced the risk of infection. The palate healed with mucosalization at 2 weeks, and no complications were noted after 4 years of follow-up. Therefore, these flaps should be considered as an option for closure of large oronasal fistulas and VPI correction in young patients with wide palatal defects and VPI.

• Journal of the Korea Institute of Information and Communication Engineering
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• v.18 no.7
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• pp.1740-1748
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• 2014

This paper focuses on listening test and acoustic analysis of patients' speech with velopharyngeal insufficiency (VPI) and normal speakers' simulation speech. In this research, a set consisting of 50-words, vowels and single syllables is determined for speech database construction. A web-based listening evaluation system is developed for a convenient/automated evaluation procedure. The analysis results show the trend of incorrect recognition for VPI speech and the one for simulation speech are similar. Such similarity is also confirmed by comparing the formant locations of vowel and spectrum of consonant sounds. These results show that the simulation method for VPI speech is effective at generating the speech signals similar to actual VPI patient's speech. It is expected that the simulation speech data can be effectively employed for our future work such as acoustic model adaptation.

• 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.

• Archives of Plastic Surgery
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• v.36 no.3
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• pp.294-298
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• 2009

Purpose: The pharyngeal flap is one of the popular surgical method to treat the problem of velopharyngeal dysfunction. This study evaluated speech outcomes of patients who underwent superiorly based pharyngeal flap surgery based on timing of surgery. Methods: A restrospective review of 50 patients who underwent pharyngeal flap surgery for velopharyngeal insufficiency between September 1996 and January 2008 was undertaken. Thirty patients with an available preoprative and postoperative speech assessments with at least 6 months of follow-up were included in this study. We checked out the significance of speech improvement after surgery analysing preoperative and postoperative scoring of speech assessment. We also investigated the direct relationship between the age at surgery and the degree of speech improvement, and the improvement score in different age groups. Results: The mean score of preoperative speech was $52.6{\pm}7.4points$ and postoperative speech was $58.6{\pm}6.5points$, which presented significant postoperative speech improvement with an average of 5.9 points(p<0.01). There was a significant inverse relationship between the age at operation and speech improvement degree(p<0.01, r = -0.54). Comparing the age groups, the age group of 4 to 5 years presented statistically significant speech improvement(p<0.01). Conclusion: we propose that all patients indicated should take pharyngeal flap irrespective of age. In this study, the younger the age at surgery, the higher degree of speech improvement, for which we suggest that surgical approach should be undertaken as early as possible, especially younger than age 5 years.

• Archives of Plastic Surgery
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• v.39 no.3
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• pp.198-202
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• 2012

Background : Maxillary hypoplasia refers to a deficiency in the growth of the maxilla commonly seen in patients with a repaired cleft palate. Those who develop maxillary hypoplasia can be offered a repositioning of the maxilla to a functional and esthetic position. Velopharyngeal dysfunction is one of the important problems affecting speech after maxillary advancement surgery. The aim of this study was to investigate the impact of maxillary advancement on repaired cleft palate patients without preoperative deterioration in speech compared with non-cleft palate patients. Methods : Eighteen patients underwent Le Fort I osteotomy between 2005 and 2011. One patient was excluded due to preoperative deterioration in speech. Eight repaired cleft palate patients belonged to group A, and 9 non-cleft palate patients belonged to group B. Speech assessments were performed preoperatively and postoperatively by using a speech screening protocol that consisted of a list of single words designed by Ok-Ran Jung. Wilcoxon signed rank test was used to determine if there were significant differences between the preoperative and postoperative outcomes in each group A and B. And Mann-Whitney U test was used to determine if there were significant differences in the change of score between groups A and B. Results : No patients had any noticeable change in speech production on perceptual assessment after maxillary advancement in our study. Furthermore, there were no significant differences between groups A and B. Conclusions : Repaired cleft palate patients without preoperative velopharyngeal dysfunction would not have greater risk of deterioration of velopharyngeal function after maxillary advancement compared to non-cleft palate patients.

• Journal of the Korea Institute of Information and Communication Engineering
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• v.19 no.5
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• pp.1243-1250
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• 2015

This paper presents an effective recognition method of VPI patient's speech for a VPI speech reconstruction system. Speaker adaptation technique is employed to improve VPI speech recognition. This paper proposes to use simulated speech for generating an initial model for speaker adaptation, in order to effectively utilize the small size of VPI speech for model adaptation. We obtain 83.60% in average word accuracy by applying MLLR for speaker adaptation. The proposed speaker adaptation method using simulated speech model brings 6.38% improvement in average accuracy. The experimental results demonstrate that the proposed speaker adaptation method is highly effective for developing recognition system of VPI speech which is not suitable for constructing large-size speech database.

• Journal of the Korea Institute of Information and Communication Engineering
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• v.23 no.1
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• pp.33-38
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• 2019

This paper proposes an effective recognition method of VPI patient's speech employing DNN-HMM-based speech recognition system, and evaluates the recognition performance compared to GMM-HMM-based system. The proposed method employs speaker adaptation technique to improve VPI speech recognition. This paper proposes to use simulated VPI speech for generating a prior model for speaker adaptation and selective learning of weight matrices of DNN, in order to effectively utilize the small size of VPI speech for model adaptation. We also apply Linear Input Network (LIN) based model adaptation technique for the DNN model. The proposed speaker adaptation method brings 2.35% improvement in average accuracy compared to GMM-HMM based ASR system. The experimental results demonstrate that the proposed DNN-HMM-based speech recognition system is effective for VPI speech with small-sized speech data, compared to conventional GMM-HMM system.