No abstract available.
Velopharyngeal Insufficiency

BACKGROUND AND OBJECTIVES: Various kinds of surgical correction have been performed for management of velopharyngeal insufficiency (VPI). This study was conducted to evaluate the efficacy of nasometer by comparing the speech evaluation with the nasalance change in patients who had undergone surgical correction of VPI. MATERIALS AND METHODS: Twelve cases of VPI, who had undergone surgical correction at Seoul National University Hospital between January 1996 and June 1999, were retrieved in this study. Nasality in all cases was evaluated by the speech evaluation and nasometer before and 3 months after the operation. RESULTS: Postoperative nasalance decreased from 49.0% to 40.9%. Seven of nine patients with decreased nasalance after the operation showed improved nasality by the speech evaluation. Three patients with increased nasalance or no change in nasalance did not show change of nasality by the speech evaluation. Seven cases of improved nasality by the speech evaluation represented significant decrease in nasalance. CONCLUSION: The speech outcome after surgical correction of VPI may be evaluated objectively with the change of nasalance.
Humans ; Seoul ; Velopharyngeal Insufficiency*

ABSTRACT Soft palate tumors pose the challenge during reconstructive and rehabilitating procedures. Surgical resection of these tumors leads to velopharyngeal insufficiency (VPI). The primary effects of VPI are hypernasality and air-flow escape, while the secondary effects are abnormalities in speech articulation. Surgical revision along with speech therapy is a common approach to the treatment of VPI. Prosthetic management by means of speech aid prosthesis helps to reduce resonance, nasal emission and consonants errors. This clinical report describes the different stages of rehabilitation of velopharyngeal insufficiency defect following resection of malignant melanoma of left posterior alveolar ridge and soft palate. The speech aid prosthesis helped to rehabilitate the velopharyngeal insufficiency defect and aided in the diagnosis of extent of speech function improvement by perceptual and objective methods.
Dental Prosthesis ; Velopharyngeal Insufficiency

A total of 35 patients with velopharyngeal incompetence were treated by surgical correction from 1995 to 2001. Twenty-six patients underwent lateral port control superior based pharyngeal flap and 9 patients underwent sphincteric pharyngoplasty. Speech analysis and fluorolaryngo-graphy was performed preoperatively and postoperatively. The nasality of open vowel, round vowel and sentence and articulation accuracy in 26 patients who underwent the pharyngeal flap improved from 37.7+/-10.71%, 49.1+/-9.54%, 50.1+/-9.03% and 68.9+/-10.11% preoperatively to 20.4+/-9.77%, 25.4+/-10.11%, 38.5+/-9.34% and 80.1+/-6.47% postoperatively, and hypernasality and articulation accuracy improved significantly (p<0.05). In case of 9 patients who underwent sphincteric pharyngoplasty, results were from 41.2+/-11.27%, 42.4+/-17.04%, 53.8+/-7.63% and 72.3+/-10.87% preoperatively to 20.7+/-8.27%, 20.8+/-14.34%, 29.7+/- 11.47% and 80.7+/-12.47% postoperatively, and hypernasality improved significantly (p<0.05). As far as postoperative fluorolaryngography is concerned, the velopharyngeal space was closed in patients with postoperative normal range of nasality. In conclusion, these results suggest that patients with velopharyngeal incompetence will improve speech dysfunction effectively if is chosen appropriately either superior based pharyngeal flap or sphincteric pharyngoplasty.
Humans ; Reference Values ; Velopharyngeal Insufficiency*

No abstract available.
Palate, Soft* ; Tuberculosis* ; Velopharyngeal Insufficiency*

Velopharyngeal insufficiency (VPI) is a common complication after primary palatoplasty. Although the several surgical treatments of VPI have been introduced, there is no consensus guide to select the optimal surgical treatment for VPI patients. The selection of surgical treatment for VPI depends on a multimodal patient evaluation, such as perceptual speech evaluation, nasometery and nasoendoscopy. We can provide more adequate treatment for VPI through the deeper understanding of anatomy and physiology in VPI.
Consensus ; Humans ; Physiology ; Velopharyngeal Insufficiency*

It is well documented that adenoidectomy is attributed to hypernasality in certain cases, but not clear that the enlarged tonsils affect the quality of speech. Hypertrophied tonsils may cause and complicate the problem of velopharyngeal incompetency. The huge tonsils prevent lateral pharyngeal walls from a medial movement and interfere velar elevation, being hypernasality. Hyponasality developes as the tonsils encroach in nasopharyngeal space. Voluminous tonsils also interfere airflow in the oropharyneal passage and produce the phenomenon of cul-de-sac resonance or muffled sound. The authors and et al. present a case of velopharyngeal insufficiency accompanied with hypertrophic tonsils. Improving the lateral constricting pharyngeal wall and velar elevation after tonsillectomy minimized the velopharyngeal gap. Accordingly, the procedures of sphincter pharyngoplasty and palatal lengthening resolved the problem of hypernasality instead of pharyngeal flap. Tonsillectomy prior to pharyngeal flap surgery tends to reduce the postoperative airway problems. Sometimes, however, only tonsillectomy does without pharyngeal flap. Surgical approach by stages and intermittent evaluation are recommended at intervals of at least six weeks.
Adenoidectomy ; Palatine Tonsil* ; Tonsillectomy ; Velopharyngeal Insufficiency*

PURPOSE: The pharyngeal flap is one of the popular surgical methods to treat the problem of velopharyngeal dysfunction. This study evaluated speech outcome 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 from September 1996 to 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 +/- 7.4 points and postoperative speech was 58.6 +/- 6.5 points, 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 5 years of age.
Follow-Up Studies ; Humans ; Velopharyngeal Insufficiency

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.
Endoscopy ; Follow-Up Studies ; Humans ; Velopharyngeal Insufficiency

PURPOSE: The goal of palatoplasty is focused on two points. One is to close the palatal defect completely, and the other to create a velopharyngeal system for normal speech. While established methods such as pushback palatoplasty or double opposing Z palatoplasty are used in wide cleft palate repair, sequelae such as maxillary hypoplasia or oronasal fistula may result. Therefore, when palatoplasty with buccinator myomucosal flap is used in the case of wide cleft palates, maxillary hypoplasia and oronasal fistula is reduced and optimal results are obtained. METHODS: From October 2005 to December 2006, four children with wide complete cleft palate underwent unilateral buccinator myomucosal flap and intravelar veloplaty. Mean age at cleft repair was 15 months, and mean cleft size was 2.15cm. The patients underwent intravelar veloplasty and palatoplasty was done using unilateral buccinator myomucosal flap. RESULTS: The patients, after mean 10 months of follow- up observation, showed no signs of oronasal fistula resulting from flap tension. The shape and color similar to normal oral mucosa was obtained, and velopharyngeal function was acquired. CONCLUSION: When intravelar veloplasty and palatoplasty with unilateral buccinator myomucosal flap is done on wide cleft palates, postoperative speech function is optimal, velopharyngeal incompetence is effectively corrected, and sequelae resulting from pushback palatoplasty and double opposing Z-plasty, such as maxillary hypoplasia and oronasal fistula, is reduced.
Child ; Cleft Palate* ; Fistula ; Humans ; Mouth Mucosa ; Velopharyngeal Insufficiency