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.
Cleft Lip ; Cleft Palate* ; Congenital Abnormalities ; Deglutition ; Humans ; Mastication ; Mouth ; Nasal Cavity ; Palatal Obturators* ; Palate ; Palate, Soft ; Velopharyngeal Insufficiency*

Microstomia can be occured as a result of direct injury to tissues such as chemical, thermal and electrical burns, and animal bites. It also may be secondary to contracture of burned perioral skin, or may result from scarring after reconstructive lip surgery. Narrowing of the oral aperture is not only disfiguring, but also limiting the oral access needed for introduction of food, insertion of dentures, oral hygiene, and dental treatment. Limited mouth opening may also interfere with mastication and speech. Few reports exist regarding correction of microstomia and reconstruction of the corners of the mouth. A 16-year-old girl with a bilateral cleft lip and palate presented with the limited mouth opening (approximately 20 mm), the esthetic problem due to the small lip, and the cleft lip-nasal deformity. The microstomia was corrected by bilateral commissuroplasty using "over and out" buccal mucosa flaps proposed by Converse. The intercommissure distance was increased from the preoperative 40 mm to the postoperative 60 mm. The one-year postoperative intercommissure distance was 54 mm, because the 6 mm relapse was occured. The bilateral commissuroplasty using "over and out" buccal mucosa flap could increase the width and general size of the oral aperture and improve the lip appearance.]]>
Adolescent ; Animals ; Bites and Stings ; Burns ; Cicatrix ; Cleft Lip ; Congenital Abnormalities ; Contracture ; Dentures ; Humans ; Lip ; Mastication ; Microstomia ; Mouth ; Mouth Mucosa ; Oral Hygiene ; Palate ; Recurrence ; Skin

OBJECTIVETo investigate the application of the perceptual assessment in the diagnosis of the velopharyngeal function, to provide a reference to the improvement of the velopharyngeal function diagnosis through comparing the consistency between the diagnosis of the perceptual assessment and the objective assessment.

METHODSAll subjects (254) were selected from the Department of Cleft Lip and Palate Surgery, West China School of Stomatology, Sichuan University, from 2000-2010. The results of the perceptual and the nasopharyngeal fiberscope (NPF) assessment were retrospectively analyzed, and the consistent rate between the two assessment methods was calculated. The Kappa test and the correlation analysis were performed to analyze the consistency and correlation, and the factors relating to the perceptual assessment were analyzed by the correlation coefficient.

RESULTSThere were 254 patients met the inclusion criteria. The consistent number of the patients diagnosed by the perceptual and the objective assessment as velopharyngeal competence (VPC) and velopharyngeal insufficiency (VPI) were 58 and 167 respectively. The consistent rate was 88.58% for all patients, and 66.67% for the VPC patients. The Kappa value was 0.721, Spearman's R=0.751, P<0.05. There were correlation between the hypernasality, the nasal emission and the subjective assessment, and Spearman's R=0.697, 0.590, P<0.05.

CONCLUSIONThe VPC patients and the VPI patients with moderate and severe hypernasality and nasal emission diagnosed by the perceptual assessment could be exempt from the objective examination. Patients diagnosed with mild hypernasality and nasal emission by the perceptual assessment should be further referred to NPF or other instruments.

China ; Cleft Lip ; Cleft Palate ; Humans ; Retrospective Studies ; Velopharyngeal Insufficiency

OBJECTIVETo enhance the accuracy in diagnosis and management of submucous cleft palate via a thorough analysis of its anatomical and functional details.

METHODSTwo hundred seventy-six submucous cleft palate cases from 2008 to 2014 were retrospectively investigated. Subgroup analysis were performed on the basis of preoperative velopharyngeal function, palatal morphology, cleft lip concurrence, and patient motives for treatment.

RESULTSAmong the included cases, 96 (34.78%) were presented as velopharyngeal competence (VPC), 151 (54.71%) as velopharyngeal insufficiency (VPI), and 29 (10.51%) as marginal VPI (MVPI). Eighty cases (28.99%) also demonstrated cleft lip deformity, and 196 cases (71.01%) were merely submucous cleft palate. Compared with patients with submucous cleft palate only, those with cleft lips exhibited higher rates of complete velopharyngeal closure. The pathological spectrum of submucous cleft palate varied significantly. Only 103 (37.32%) cases met all the three diagnostic criteria proposed by Calnan.

CONCLUSIONSGiven that the velopharyngeal closure rate varies among the subgroups, the factors analyzed in this study should be considered in the personalized manage-ment of submucous cleft palate.

Cleft Lip ; Cleft Palate ; Humans ; Retrospective Studies ; Velopharyngeal Insufficiency

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.
Cleft Lip ; Cleft Palate ; Humans ; Mass Screening ; Maxilla ; Osteotomy ; Osteotomy, Le Fort ; Palate ; Velopharyngeal Insufficiency

OBJECTIVETo characterize the velopharyngeal closure patterns and speech performance among submucous cleft palate patients.

METHODSPatients with submucous cleft palate visiting the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University between 2008 and 2016 were reviewed. Outcomes of subjective speech evaluation including velopharyngeal function, consonant articulation, and objective nasopharyngeal endoscopy including the mobility of soft palate, pharyngeal walls were retrospectively analyzed.

RESULTSA total of 353 cases were retrieved in this study, among which 138 (39.09%) demonstrated velopharyngeal competence, 176 (49.86%) velopharyngeal incompetence, and 39 (11.05%) marginal velopharyngeal incompetence. A total of 268 cases were subjected to nasopharyngeal endoscopy examination, where 167 (62.31%) demonstrated circular closure pattern, 89 (33.21%) coronal pattern, and 12 (4.48%) sagittal pattern. Passavant's ridge existed in 45.51% (76/167) patients with circular closure and 13.48% (12/89) patients with coronal closure. Among the 353 patients included in this study, 137 (38.81%) presented normal articulation, 124 (35.13%) consonant elimination, 51 (14.45%) compensatory articulation, 36 (10.20%) consonant weakening, 25 (7.08%) consonant replacement, and 36 (10.20%) multiple articulation errors.

CONCLUSIONSCircular closure was the most prevalent velopharyngeal closure pattern among patients with submucous cleft palate, and high-pressure consonant deletion was the most common articulation abnormality. Articulation error occurred more frequently among patients with a low velopharyngeal closure rate.

Cleft Lip ; Cleft Palate ; Endoscopy ; Humans ; Palate, Soft ; Pharynx ; Retrospective Studies ; Speech ; Surgical Flaps ; Velopharyngeal Insufficiency

Dysphasia related to oral anomaly is a common situation in oral and maxillofacial surgery. The etiology of oral anomalies causing dysphasia can be divided into congenital and acquired disease. Congenital diseases include teratoma or benign tumors and congenital defects such as cleft lip and palate. Benign tumors include cystic hygroma in the neck and hemangioma in the tongue. Certain syndromes with macroglossia and micrognathia are also related to difficulty in swallowing. The three common syndromes are Pierre-Robin syndrome, Beckwith-Widermann syndrome and ectodermal dysplasia. Taken together, these congenital diseases require a multi-discipline approach to obtain optimal results. Representative disease of acquired dysphasia is the oral cavity cancer. Cancer ablation results in tissue defect and decreased motor function. Free flap reconstruction is the choice of treatment following oral cavity caner operation; however, dysphasia after cancer operation is inevitable. In this review article, the full scopes of oral anomaly associated with dysphasia were classified and treatment was suggested.
Aphasia ; Cleft Lip ; Congenital Abnormalities ; Deglutition ; Ectodermal Dysplasia ; Free Tissue Flaps ; Hemangioma ; Lymphangioma, Cystic ; Macroglossia ; Micrognathism ; Mouth ; Mouth Neoplasms ; Neck ; Palate ; Pierre Robin Syndrome ; Surgery, Oral ; Teratoma ; Tongue

OBJECTIVETo investigate the correlation between articulation, velopharyngeal function, and surgical age by comparing the changes in articulation after velopharyngeal closure is performed. This study is also conducted to investigate the influencing factors of omission change between pre- and post-operation.

METHODSA total of 48 patients, including 18 males and 30 females, mean age (13.3 ± 5.8) years, with non-syndromic cleft lips and palates were selected from January 2011 to December 2011. Their speech data and articulation between pre- and post-operation were retrospectively analyzed using non-parametric tests. Correlation study was performed to analyze the influencing factors of the changes in articulation. P < 0.05 was considered statistically significant.

RESULTSThe difference in articulation after velopharyngeal closure occurred was significant (Z = -3.796, P = 0.000). A negative correlation between the ratio of post-operative normal articulation and surgical age (R = -0.487, P = 0.000) was observed. The change in omission was positively correlated with surgical age (R = 0.589, P = 0.000) and gender (R = 0.404, P = 0.047). By comparison, the change in omission was negatively correlated with follow-up time (R = -0.235, P = 0.040).

CONCLUSIONArticulation and intelligibility are significantly improved after velopharyngeal closure is performed. These parameters are negatively correlated with surgical age to some extent. In addition, the change in omission is positively correlated with surgical age and gender, whereas the change in omission is negatively correlated with follow-up time.

Adolescent ; Articulation Disorders ; Child ; Cleft Lip ; Cleft Palate ; Female ; Humans ; Male ; Retrospective Studies ; Velopharyngeal Insufficiency ; Young Adult

OBJECTIVETo observe the mobility of levator veli palatini muscle during speech in patients with repaired cleft palate and cleft lip.

METHODSMRI of the levator veli palatini muscle was taken during speech and breathing in three groups of patients: control group (cleft lip only, 8 cases), velopharyngeal incompetence (VPI) group (7 cases), velopharyngeal competence (VPC) group (10 cases). The length and the angle of the levator veli palatini muscle were compared.

RESULTSThe changes of the length and the angle during speech were not significantly different among the three groups (P > 0.05). The ratio of length changes when speaking "a", "i", and "m" are (13.5 ± 11.7)%, (11.1 ± 10.8)%, (8.2 ± 14.3)%. Mean angle of pronouncing "a", "i", and "m" are [(43.18 ± 4.984)°, (43.08 ± 4.879)°, (39.48 ± 5.046)°]. The levator veli palatini muscle contracted progressively form "m", "i", to "a".

CONCLUSIONSThe mobility of the levator veli palatini muscle in patients with repaired cleft palate and cleft lip only is basically the same.

Cleft Lip ; surgery ; Cleft Palate ; surgery ; Humans ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Palatal Muscles ; pathology ; Speech ; Velopharyngeal Insufficiency

The deformities of micrognathia and glossoptosis in the newborn are frequently associated with a cleft palate, which is known as Pierre Robin sequence. Upper airway obstruction is the most serious problem in these patients. Treatment of Pierre Robin sequence includes either positional or surgical intervention. Mild cases are often managed in the prone position. However, when the patient fails to thrive due to chronic upper airway obstruction, or severe respiratory distress ensures despite positional treatment, surgical intervention is mandatory to relieve the obstruction. We experienced three infants with Pierre Robin sequence who showed a symptom triad of micrognathia, glossoptosis, and cleft palate. Intermittent cyanosis, depression of the chest, respiratory difficulty and feeding problems were also observed. To relieve severe upper airway obstruction caused by micrognathia and glossoptosis, we simultaneously performed modified tongue lip adhesion (TLA) and a subperiosteal release of the floor of the mouth (SRFM). Respiratory and feeding difficulties were relieved, the tongue positioned anteriorly, body weight increased, and mandibular growth improved. Simultaneous TLA and SRFM may constitute a simple and reliable method for surgical treatment of airway obstruction in patients with Pierre Robin sequence.
Airway Obstruction* ; Body Weight ; Cleft Palate ; Congenital Abnormalities ; Cyanosis ; Depression ; Humans ; Infant* ; Infant, Newborn ; Lip ; Mouth ; Pierre Robin Syndrome* ; Prone Position ; Thorax ; Tongue