• Archives of Plastic Surgery
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• v.33 no.1
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• pp.67-74
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• 2006

Palatoplasty using Furlow's double-opposing Z-plasty has been performed from June, 1995 to September, 1999 at Seoul National University Children's Hospital. The goal of this study is to determine the optimal timing of repair and cleft severity affecting velopharyngeal function. This is the retrospective study of patients operated by the second author. The mean age of patients was 10.53 months. The patients could be divided into three groups-isolated cleft palate(n=70), unilateral cleft lip and palate(n=88), and bilateral cleft lip and palate(n=42). To evaluate the velopharyngeal function, we used two parameters, speech evaluation and cineofluorography using DSR(digital subtraction radiography). Also, to determine the relevance between cleft severity and speech development, we measured the distance between maxillary tuberosities and cleft margins. Among 200 patients, about 96% had no or minimal hypernasality and 87% had no or mild nasal emission. The cleft width and length of soft palate seemed not to be related with the speech development. Palatoplasty at the age under 12 months resulted in less 'nasal emission' and better 'articulation' of the parameters that were assessed at the age of 7 years. It can be concluded Furlow palatoplasty shows satisfactory results and also it seems that it is better to perform the operation before the age of 12 months.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.4 no.1
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• pp.24-32
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• 1991

Cleft palate or velopharyngeal incompetence shows many disorders and disabilities affecting speech transmission. including distortion. substitution. and the nasalization of the vowels. The nasalized vowels are produced primarily by lowering of the velum. resulting in opening a side passage for the air flow through the nasal cavity. These abnormal movements give rise to complex modification of the physical property of the sound or in the sound spectrum. The authors employed Sonagraph$^{\circledR}$ as a sound analyzer in order to ascertain the features which characterize the nasalization of vowels. Twenty healthy Korean male adult voluteers were analyzed in artificial conditions of anterior and posterior nasal obstruction. and velo-pharyngeal incompetence. The results were as follows : 1) Fundamental frequency was not changed by nasal obstruction or velopharyngeal incompetence. 2) There was no significant difference of the formant intensity between normal and nasal vowels. 3) In VPI, a decrease of the frequency of $F_2$ was observed in /e/ and /i/ vowels(p<0.001). 4) In VPI, the $F_2$ was frequently missed in /o/ and /u/ vowels. 5) In the consonant spectra of VPI, the 'release burst' was usually not observed.

• Speech Sciences
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• v.7 no.3
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• pp.219-228
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• 2000

Assessment of speech nasality provides important information for the treatment of velopharyngeal incompetence. Objective procedures may be used to assess velopharyngea1 function, in examples Nasometer, Aerodynamics, x-ray, Electromyography, Nasoendoscopy and Videofluoroscopy etc. The aim of this study was to obtain comprehensive nasalance data for Korean adults, aged 20 years and to investigate any gender differences within that age group using Nasometer II. The results were as follow: (1) The nasalance of the vowels(/a/, /i/, /e/, /o/, /u/, /ja/, /je/, /wi/) in the group of adults was higher in females than in males (p<0.05). (2) The nasalance of the plosives (/p/, /$p^h$/, /p'/, /t/, /$t^h$/, /t'/, /k/, /$k^h$/, /k'/) in the group of adults was higher in females than in males (p<0.05). (3) The nasalance of the affricatives (/c/, /$c^h$/, /c'/) in the group of adults was higher in females than in males (p<0.05). (4) The nasalance of the fricatives (/s/, /s'/, /$\int$/) in the group of adults was higher in female than in males (p<0.05). (5) There was no statistically significant effect for the nasalance of nasal consonants (/m/, /n/, /$a{\eta}$/).

• 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.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.23.1-23.6
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• 2018

Background: Velopharyngeal insufficiency that accompanies speech resonance and articulation disorders can be managed through several intervention methods such as speech-language therapy, prosthetic aids, and surgery. However, for patients with severe hypernasality, surgical interventions are highly recommended. Among available surgical techniques, the posterior pharyngeal flap is most common. Case presentation: Two adult males with high nasalance scores underwent superiorly based posterior pharyngeal flap surgery, followed by speech testing by an expert speech-language therapist. Nasalance scores and articulation accuracy were assessed up until 1 year after the surgery. Nasalance scores were measured five times using a nasometer, after which the average value was calculated. Conclusions: Consistent declines in hypernasality over time are not easy to explain since the pedicled pharyngeal flap narrowed over time, secondary to cicatrization. However, scar tethering of the soft palate in a posterior direction could reduce the velopharyngeal port size over time. Therefore, long-term follow-up with intensive speech therapy is suggested for patients with severe hypernasality.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.3
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• pp.165-171
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• 2020

The congenital long QT syndrome (LQTS) is an inherited cardiac disorder characterized by increased QT intervals and a tendency to experience ventricular tachycardia, which can cause fainting, heart failure, or sudden death. A 4-year-old female patient undergoing velopharyngeal correction surgery under general anesthesia suddenly developed Torsades de pointes. Although the patient spontaneously resolved to sinus rhythm without treatment, subsequent QT prolongation persisted. Here, we report a case of concealed LQTS with a literature review.

• 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 korean academy of Pediatric Dentistry
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• v.31 no.4
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• pp.721-728
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• 2004

Velopharyngeal closure is a sphincter mechanism between the activities of the soft palate, lateral pharyngeal wall and the posterior pharyngeal wall, which divides the oral and nasal cavity. It participates in physiological activities such as swallowing, breathing and speech. It is called a velopharyngeal dysfunction when this mechanism malfunctions. The causes of this dysfunction are defects in (1) length, function, posture of the soft palate, (2) depth and width of the nasopharynx and (3) activity of the posterior and lateral pharyngeal wall. The purposes of this study are to analyze the nasopharynx of cleft palate patients using cephalometry and to evaluate the degree of hypernasality using nasometry to find its relationship with velopharyngeal dysfunction. The following results were obtained : 1. In cephalometry, there were significant differences in soft palate length, soft palate thickness, nasopharyngeal depth, nasopharyngeal area, and adequate ratio between two groups. 2. In nasometry, there were significant differences between two groups in vowel /o/ and sentences including oral consonants. 3. In cleft palate patients, though no general correlation was found between Anatomic VPI and nasalance scores, vowel /i/ and sentences including oral consonants were slightly correlated. In conclusion, cephalometry and nasometer results were significantly different between the two groups. Though in the cleft palate group, Anatomic VPI and nasalance scores, which are indices for velopharyngeal closure, excluding the vowel /i/ and sentences including oral consonants show generally no significance.

• Proceedings of The Korean Cleft Lip And Palate Association
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• 1997.06a
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• pp.36-36
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• 1997

• Archives of Plastic Surgery
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• v.43 no.3
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• pp.254-257
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• 2016

Background The postoperative speech outcomes of submucous cleft palate (SMCP) surgery are known to be poorer than those of other types of cleft palate. We attempted to objectively characterize the postoperative complications and speech outcomes of the surgical treatment of SMCP through a comparison with the outcomes of incomplete cleft palate (ICP). Methods This study included 53 SMCP patients and 285 ICP patients who underwent surgical repair from 1998 to 2015. The average age of the patients at the time of surgery was $3.9{\pm}1.9years$ for the SMCP patients and $1.3{\pm}0.9years$ for the ICP patients. A retrospective analysis was performed of the complications, the frequency of subsequent surgical correction for velopharyngeal dysfunction (VPD), and speech outcomes. Results In both the SMCP and ICP patients, no cases of respiratory difficulty, bleeding, or wound disruption were noted. Delayed wound healing and fistula occurred in 18.9% and 5.7% of the SMCP patients and in 14% and 3.2% of the ICP patients, respectively. However, no statistically significant difference in either delayed wound healing or fistula occurrence was observed between the two groups. The rate of surgical correction for VPD in the SMCP group was higher than in the ICP group. In the subset of 26 SMCP patients and 62 ICP patients who underwent speech evaluation, the median speech score value was 58.8 in the SMCP group and 66 in the ICP group, which was a statistically significant difference. Conclusions SMCP and ICP were found to have similar complication rates, but SMCP had significantly worse speech outcomes.