• 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.

• 대한구순구개열학회지
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• 제11권1호
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• pp.13-22
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• 2008

Velopharyngeal insufficiency(VPI), characterized by hypernasal resonance and nasal air emission, is a speech disorder that can significantly compromise speech intelligibility. Cleft palate, previously repaired cleft palate and submucous cleft palate are associated with VPI. Less commonly, patients may acquire it after adenoidectomy with or without tonsillectomy or as a result of neuromuscular dysfunction. Comprehensive evaluation by a VPI team includes medical assessment focusing on airway obstructive symptoms, perceptual speech analysis, MRI and instrumental assessment. Options for intervention include speech therapy, intraoral prosthetic devices and surgery. Surgical methods can be categorized as palatal, palatopharyngeal or pharyngeal procedures. Each surgical approach has its strengths and limitations. Oro-maxillofacial surgeons are increasingly involved in the referral, evaluation, and treatment of velopharyngeal function. Therefore, understanding of physiology, anatomic structures, evaluation and treatment protocols in VPI is very important. This article presents protocol for evaluation of velopharyngeal function with a focus on indications for surgical interventions.

• Archives of Plastic Surgery
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• 제38권6호
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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.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.19.1-19.6
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• 2019

Background: The submucous cleft palate (SMCP) is a type of cleft palate that may result in velopharyngeal insufficiency (VPI). Palate muscles completely separate oral and nasal cavities by closing off the velopharynx during functional processes such as speech or swallow. Also, hypernasality may arise from anatomical or neurological abnormalities in these functions. Treatments of this issue involve a combination of surgical intervention, speech aid, and speech therapy. This case report demonstrates successfully treated VPI resulted from SMCP without any surgical intervention but solely with speech aid appliance and speech therapy. Case presentation: A 13-year-old female patient with a speech disorder from velopharyngeal insufficiency that was caused by a submucous cleft palate visited to our OMFS clinic. In the intraoral examination, the patient had a short soft palate and bifid uvula. And the muscles in the palate did not contract properly during oral speech. She had no surgical history such as primary palatoplasty or pharyngoplasty except for tonsillectomy. And there were no other medical histories. Objective speech assessment using nasometer was performed. We diagnosed that the patient had a SMCP. The patient has shown a decrease in speech intelligibility, which resulted from hypernasality. We decided to treat the patient with speech aid (palatal lift) along with speech therapy. During the 7-month treatment, hypernasality measured by a nasometer decreased and speech intelligibility became normal. Conclusions: Surgery remains the first treatment option for patients with velopharyngeal insufficiencies from submucous cleft palates. However, there were few reports about objective speech evaluation pre- or post-operation. Moreover, there has been no report of non-surgical treatment in the recent studies. From this perspective, this report of objective improvement of speech intelligibility of VPI patient with SMCP by non-surgical treatment has a significant meaning. Speech aid can be considered as one of treatment options for management of SMCP.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.871-874
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• 2011

Purpose: In some patients with velopharyngeal insufficiency (VPI), Hypernasality can persist after surgical management. Continuous Positive Airway Pressure (CPAP) is applied to these patients for treating hypernasality. The purpose of this study is to report follow-up results of postoperative CPAP therapy. Methods: After performing palatal lengthening, CPAP therapy was applied to three patients for eight weeks from July of 2008 to November of 2009. Perceptual evaluation, nasometry, and nasopharyngeal endoscopy were performed to evaluate hypernasality, nasalance and size of the gap at velopharyngeal port. Each evaluation was made before surgery, right after CPAP therapy and during follow-up of more than a year after CPAP therapy. Results: All of the patients showed improvement in hypernasality right after CPAP therapy according to the auditory perceptual evaluation, nasometry and nasopharyngeal endoscopy. But the improvement in hypernasality in these patients did not last during follow-up. Conclusion: In this study, our results suggest that CPAP therapy is effective in reducing hypernasality for postoperative VPI patients immediately after the therapy, but hypernasality may be worsen in some patients during follow-up. Therefore we recommend follow-ups after CPAP therapy to see if the efficacy of CPAP therapy lasts.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1991년도 제25차 학술대회 연제순서 및 초록
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• pp.22-22
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• 1991

구개열 및 구개근의 기능부전 등에 의한 인두문(velopharyngeal valve)의 폐쇄부전으로 인하여 발생하는 구개범인두부전증(velopharyngeal insufficiency)은 흔히 과비성으로 알려진 구음장애를 나타내는 병적현상으로 Von Langenbeck(1861)이 구개 외측 점막성 골막편을, Smith(1895) 와 Ganzer(1920)는 각각 구개 4-판 및 3-판 점막성 골막편을 이용한 수술적 치료법을 통하여 구음장애를 해결하여 주려하였고, 그외 인두후벽의 증대 및 언어보조기 등을 이용한 방법으로 구음장애를 해결하여 주려는 연구가 최근까지 활발하게 이루어지고 있으나 만족할 만한 성적을 거두지 못하고 있는 실정에 있다. 이에 저자들은 구개범인두부전증에 대한 수술적 치료후 증상의 호전정도를 관찰하고, 술후에도 증상의 호전을 보이지 않는 환자의 음성재활에 대한 향후 방향제시에 도움을 주고자 1987년 1월부터 1991년 1월까지 과비성을 주소로 본원 이비인후과에 내원하여 구개성형술을 시행받고 3개월 이상 추적 관찰이 가능하였던 14례의 환자를 분석한 결과 구개범인두부전에 대하여 1차 수술을 시행받은 14례중 5례(36%)에서 정상적인 구음이 가능하였으며 실패한 9례중 5례에 대하여는 재 수술을 시행하였으나 만족할 만한 음성회복을 거두지 못하여 그 원인과 저자들의 술식을 분석 검토함으로써 구개범인두부전증의 치료에 대한 보다 효율적인 방법을 모색하고자 문헌고찰과 함께 보고하는 바이다.

• 음성과학
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• 제9권4호
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• pp.3-14
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• 2002

VPI occurs when the velum and lateral and posterior pharyngeal wall fail to separate the nasal cavity from the oral cavity during deglutition and speech. There are a number of congenital and acquired conditions which result in VPI. Congenital conditions include cleft palate, submucous cleft palate and congenital palatal insufficiency (CPI). Acquired conditions include carcinoma of the palate or pharynx and neurologic disorders. The speech characteristics of VPI is characterized by hypernasality, nasal air emission, decreased intraoral air pressure, increased nasal air flow, decreased intelligibility. VPI can be treated with various methods that include speech therapy, surgical procedures to reduce the velopharyngeal gap, speech aid prosthesis, and combination of surgery and prosthesis. This article describes four cases of VPI treated by speech aid prosthesis and speech therapy with satisfactory result.

• 대한음성언어의학회:학술대회논문집
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• 대한음성언어학회 2012년도 제36차 학술대회
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• pp.28-28
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• 2012

• 대한치과보철학회지
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• 제54권3호
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• pp.286-290
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• 2016

최근에 열가소성 레진 클라스프를 이용한 가철성 장치의 사용이 빈번해졌다. 통상적으로 사용하는 아크릴릭 레진과 비교했을 때 열가소성 레진은 낮은 굴곡 강도와 탄성률을 가지고 있다. 그러므로 열가소성 레진으로 제작된 가철성 장치는 파절의 위험이 낮아 의치상이 얇고 가볍게 만들어져 환자들이 편하게 사용할 수 있다. 또한 장치가 치아 언더컷에 수동적으로 장착될 수 있어 지대치의 삭제가 최소이거나 거의 없다. 이 증례에서는 경도의 구개인두부전을 가진 44세 여환은 polyester 계열 열가소성 레진으로 제작된 구개거상장치로 치료를 받았다. 환자가 결손치가 없고 보존적인 치료를 원하기 때문에 열가소성 레진을 이용한 가철성 장치가 상대적으로 만족스러운 치료 결과를 보였다.

• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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• 제55권8호
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• pp.498-507
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• 2012

Background and Objectives We aimed to develop a Korean version of the velopharyngeal insufficiency (VPI) speech corpus system. Subjects and Method After developing a 3-channel simultaneous speech recording device capable of recording nasal/oral and normal compound speech separately, voice data were collected from VPI patients aged more than 10 years with/without the history of operation or prior speech therapy. This was compared to a control group for which VPI was simulated by using a french-3 nelaton tube inserted via both nostril through nasopharynx and pulling the soft palate anteriorly in varying degrees. The study consisted of three transcriptors: a speech therapist transcribed the voice file into text, a second transcriptor graded speech intelligibility and severity and the third tagged the types and onset times of misarticulation. The database were composed of three main tables regarding (1) speaker's demographics, (2) condition of the recording system and (3) transcripts. All of these were interfaced with the Praat voice analysis program, which enables the user to extract exact transcribed phrases for analysis. Results In the simulated VPI group, the higher the severity of VPI, the higher the nasalance score was obtained. In addition, we could verify the vocal energy that characterizes hypernasality and compensation in nasal/oral and compound sounds spoken by VPI patients as opposed to that characgerizes the normal control group. Conclusion With the Korean version of VPI speech corpus system, patients' common difficulties and speech tendencies in articulation can be objectively evaluated. Comparing these data with those of the normal voice, mispronunciation and dysarticulation of patients with VPI can be corrected.