• Archives of Plastic Surgery
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• v.38 no.6
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• pp.867-870
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• 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 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.

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

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.4
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• pp.414-421
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• 2000

The objective evaluation of velopharyngeal closure function is the key to diagnosis and therapy control of velopharyngeal incompetency. The aim of this study is to evaluate the aerodynamic and acoustic characteristics of the velopharyngeal closure function of patients who have developed velopharyngeal incompetency after management with speech aids. The test words were composed of sustained vowels /a/, /i/, /e/, /u/, /ja/, /je/, /wi/ and polysyllabic words /p'ap'i/, /siso/, /mami/ for measuring nasalance, The data was collected before the placement of the speech aids and one to three months after. The results were as follows: The nasalance score of the velopharyngeal incompetency speakers was higher than that of the normal control group, except for nasal sounds, and was decreased after placement of the speech aids, especially in high vowels /i/ (P<.01) and /wi/ (P<.05).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.1
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• pp.92-96
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• 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
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• v.37
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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.

• 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.

• 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.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.2
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• pp.159-162
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• 1995

Five patients underwent surgery to treat velopharyngeal incompetence with an inferiorly based pharyngeal flap, and were evaluated postoperatively with a nasoendoscopy. In all patients, velopharyngeal closure occurred during speech of fricative sounds and swallowing. During speech of closed vowel sounds, patients younger than 10 years of age, compared with patients more than 20 years of age, demonstrated a grater improvement in velopharyngeal closure postoperatively. The present study supported the concept that an early pharyngoplasty should be made to obtain improved speech and articulation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.4
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• pp.555-562
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• 1996

A competent velopharyngeal sphincter is essential for intelligible speech. If the velopharyngeal incompetence exist, the seal will not be complete during speech, with a resultant hypernasal speech quality. The patient with velopharyngeal incompetence(VPI) may develope other compensatory speech problems. There are many approaches available to correct velopharyngeal incompetence, which include speech therapy, push back palatorrhaphy, pharyngeal wall implants and pharyngoplasty. This is cases report of velopharyngeal incompetence, which were successfully treated by superiorly based pharyngeal flap, covered with splitted hinge flap of nasal lining mucosa of the soft palate, named modified Hogan method. The advantages of this method are precision in the approximation of the flap due to pentagonal shaped flap design, good blood supply due to omission of the midsagittal incision on nasal lining mucosa, and simplicity than Hogan method.