Cases reported "Speech Disorders"

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11/27. Changes in articulation and resonance after tongue flap closure of palatal fistulas: case reports.

    This paper describes speech changes in three patients after tongue flap closure of various sized palatal fistulas. In all three patients articulation and lingual mobility appeared to be unaffected by excision of tongue tissue for the procedure. However, a large protruding tongue flap was noted to interfere with the articulation of sibilants in one patient. All patients showed a reduction in overall hypernasal resonance and nasal emission, although one patient developed nasal turbulence postoperatively and another required a pharyngeal flap for total elimination of hypernasality. This paper points out the need for a systematic investigation into the effects of this surgery on speech.
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12/27. giant cell arteritis of the tongue presenting as macroglossia.

    While the tongue has been noted to be involved in giant cell arteritis, there are no recorded instances in which the disease has been confined to the tongue. We describe a patient who presented with macroglossia and was found to have a necrotizing vasculitis with giant cells on lingual biopsy. No other evidence for systemic vasculitis was detected. This is the first case report of an isolated vasculitis of the tongue.
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13/27. An interim prosthesis for the glossectomy patient.

    The use of a simple patient-held prosthesis for improving speech in a patient with mandible and tongue resections has been described. As subjectively perceived and objectively verified, speech intelligibility improved in a test patient. There were no apparent risks or lengthy therapy. The ease of fabrication and low cost indicate that this prosthesis may be of value in aiding the speech of glossectomy patients.
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14/27. A syndrome with painful lipomas, familial dysarthria, abnormal eye-movements and clumsiness.

    A syndrome of dysarthria, clumsiness and abnormal ocular movements are described in a man and his 3 children. His father, who died when our patient was born, also had the same speech abnormality. Our patient also had multiple painful lipomas suggesting a probable diagnosis of adipositas dolorosa Dercum. Although he looked muscular he complained of muscular weakness and fatigue. Oral treatment with a local anesthetic, mexiletin, inhibited the pain in the lipomas. Analysis of the speech disorder in our patient and his children revealed disturbances in the coordination of jaws, larynx and tongue with a poor control of pitch and volume and impaired intelligibility. The poor fine coordination of hands, clumsiness when walking, dysarthria and disturbance of eye-movements could be due to a familial malformation in the pons or cerebellum. Computer tomography and X-ray of head were normal but the grooves on the surface of the cerebellum were more marked than usual.
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15/27. The use of a prosthetic speech aid for a laryngectomized esophageal speaker with right hemiparesis of the tongue: a case report.

    A dental-palatal prosthetic device, which had been demonstrated to aid laryngectomees who use the glossal press method of esophageal speech, was used on a patient whose primary method of air charging was bilabial plosive injection and who had a right hemiparesis of the tongue. Cointervention of a prosthodontist and a speech pathologist is described.
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16/27. Electropalatographic analysis of apraxia of speech in a left hander and in a right hander.

    Two cases with 'pure' apraxia of speech are reported. The articulatory disturbances were quite similar. One of the two cases was a left-handed male with a subcortical haemorrhage and the other a right-handed male with a cerebral infarct. The MRI and CT scans showed that the first case had a lesion that mainly involved the right precentral gyrus and its deep white matter, and that the second had a lesion mainly affecting the lower parts of the left precentral and postcentral gyri and their deep white matter. These findings and a literature review suggest that a corticosubcortical lesion of the lower part of the left precentral gyrus in most right handers and a lesion of the symmetric region in the right hemisphere in some left handers cause apraxia of speech. The omission errors for sounds articulated by the tongue and the hard palate were analysed using electropalatography, which records visually the dynamics of the palatolingual contact. The results demonstrated that there were three kinds of omission errors: true omissions (no palatolingual contact); omissions with incorrect contact (palatolingual contact for a different sound or undifferentiated sound); and omissions with correct contact (correct palatolingual contact for a target sound). The latter two types of omission error were observed for initial consonants and they were probably caused by a delay in air flow. The patients also showed a tendency to substitute one of the two consonants/t, t/for other sounds, which suggested that they had difficulty in the inhibition of tongue activity.
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17/27. Progressive speech deterioration and dysphagia in amyotrophic lateral sclerosis: case report.

    amyotrophic lateral sclerosis (ALS) is a degenerative neurologic disease having both upper and lower motor neuron signs and symptoms. When the speech musculature is involved, a mixed dysarthria and dysphagia usually result. In a 49-year-old man with ALS, dysarthria and dysphagia progressed from mild to severe forms over 17 months. Eleven months after the patient first experienced symptoms, neurologic examination showed fasciculations of the extremities and tongue, limb weakness, and hyperreflexia of the limbs and velopharyngeal mechanism. tongue strength was one-fourth that of normal. Lingual alternate motions rates for consonant-vowel syllables were also reduced. To enhance lingual strength and swallowing, a tongue-strengthening program was developed for use with articulation training; to augment velopharyngeal function, a palatal lift was fitted; and to increase extremity strength, physical therapy was initiated. Six months after the initial neurologic examination, medical and speech reevaluation showed progressive weakness of the body parts affected initially; continued decline in tongue strength and lingual alternate motion rate; hypoactive reflex activity, indicative of progressive involvement of the lower motor neuron system; and continued deterioration of articulation and phonation owing to the progressive nature of the disease.
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18/27. dysarthria--clumsy hand syndrome produced by capsular infarct.

    A 64-year-old hypertensive man presented with the dysarthria--clumsy hand syndrome, manifested by dysarthria, dysphagia, central facial weakness, deviation of the tongue on protrusion, incoordination of the affected hand, and mild imbalance on walking. A computed tomograpphic scan demonstrated a resolving acute infarction in the vicinity of the genu of the internal capsule.
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19/27. EMG feedback and recovery of facial and speech gestures following neural anastomosis.

    A case report is presented of an attempt to increase muscle activity during nonspeech and speech activities through surface electromyographic feedback. The subject, a 25-year-old male, had a surgical anastomosis of the seventh cranial to the twelfth cranial nerve five years prior to the initiation of this therapy. The right side of the face was immobile. Frequency analogs of muscle action potentials from the right lower lip during pressing, retraction, eversion, and speech were presented to the subject. His task was to increase the frequency of the tone thereby increasing muscle activity. The subject made substantial improvement in the gestures listed above. electrodes also were placed in various infraorbital positions for an upper lip lifting task. This gesture was unimproved. Pre- and posttherapy independence of facial gestures from conscious tongue contraction was found. Possible explanations were proposed for (1) increases of muscle activity in the lower lip, (2) lack of change of maps in the upper lip, (3) independence of the facial muscle activity from conscious tongue contraction, and (4) effectiveness of this feedback training.
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20/27. Paroxysmal dysarthria and Raynaud's phenomenon in the tongue.

    Three patients suffering from systemic scleroderma and Raynaud's phenomenon in the digits as well as the tongue are reported. Following exposure to cold, a vasospasm was observed in the digits and the tongue accompanied by severe dysarthria. These striking oral symptoms had been overlooked for years in the medical ward. It is recommended to question all patients with Raynaud's phenomenon about visceral manifestations during the digital attacks.
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