1/48. Pharyngeal flap for velopharyngeal incompetence in patients with myotonic dystrophy.Velopharyngeal incompetence (VPI) has been associated with neuromuscular disorders. Only 4 patients with myotonic dystrophy (MD) who underwent pharyngeal flap elevation for VPI have been reported in the literature. In 3 patients, surgery preceded the diagnosis of MD. Cardiorespiratory complications characterized the postoperative period of 3 patients. The authors present 3 patients with VPI and an established diagnosis of MD (by molecular genetics) who underwent pharyngeal flap elevation. The operation resulted in a major improvement in speech in all patients, although some relapse was noted later in 1 patient. Contrary to previous reports, none had peri- or postoperative cardiorespiratory complications. MD, although an uncommon etiology, should be considered in cases of late-onset VPI. Owing to differences between the authors' findings and previous reports, additional studies are needed before final conclusions can be reached regarding the benefit and safety of pharyngeal flap surgery in MD patients. At present, MD should not be considered a contraindication for this procedure, although close perioperative monitoring is indicated.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
2/48. Results with sphincter pharyngoplasty and pharyngeal flap.OBJECTIVE: To evaluate speech outcomes and complications of sphincter pharyngoplasty and pharyngeal flap performed for management of velopharyngeal insufficiency (VPI). DESIGN: Case series. SETTING: Tertiary care children's hospital. patients: All patients who underwent pharyngeal flap or sphincter pharyngoplasty from 1990 to 1995. methods: Perceptual speech analysis was used to assess severity of VPI, presence of nasal air emissions and quality of nasal resonance (hyper, hypo, or normal). Pre-operative measures of velopharyngeal function were based upon nasendoscopy and videofluoroscopic speech assessment. Recommendations for management were made by the attending surgeon. Complications of hyponasality and obstructive sleep symptoms (OSS) were noted. Patient characteristics were compared using univariate analysis. RESULTS: Sixteen patients underwent sphincter pharyngoplasty and 18 patients underwent superiorly based pharyngeal flap. patients were similar in terms of lateral pharyngeal wall medial motion and palatal elevation. The groups were also similar with regard to VPI severity, though there was a trend for more severe VPI in patients undergoing sphincter pharyngoplasty than pharyngeal flap (50 vs. 33.3%, respectively). patients with pharyngoplasty had a higher rate of resolution of VPI than those who had pharyngeal flap (50 vs. 22.2%, respectively), although this was not statistically significant. Post-operative hyponasality and obstructive sleep symptoms were present in both groups. However, only patients who underwent PF and had postoperative OSS had obstructive sleep apnea (OSA). CONCLUSIONS: There were no detectable anatomic differences between treatment groups implying that treatment selection during the study period was not guided by strict anatomic criteria. Sphincter pharyngoplasty may have a higher success rate with a lower risk of OSS.- - - - - - - - - - ranking = 3keywords = speech (Clic here for more details about this article) |
3/48. An endosseous, implant-retained obturator for the rehabilitation of a recurrent central giant cell granuloma: a clinical report.The prosthodontic rehabilitation of a patient with a recurrent maxillary CGCG has been described. The patient's immense defect originally was rehabilitated with a scapular microvascular free flap, endosseous dental implants, and an ISP that became obsolete by virtue of the resection of recurrent disease and the subsequent need for velopharyngeal obturation. The patient was provided with a surgical obturator at the time of the resection of the recurrent CGCG. The surgical obturator thereafter was modified into an interim obturator to provide velopharyngeal competence while the soft tissues around the palatal defect healed. Finally, the construction of a bar-retained definitive obturator markedly improved the patient's speech, mastication, and deglutition.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
4/48. Lipoinjection augmentation of the soft palate for velopharyngeal stress incompetence.OBJECTIVES/HYPOTHESIS: Velopharyngeal stress incompetence in professional musicians is an uncommon but potentially career-ending problem. Pharyngeal flaps, V-Y palatal pushback procedures, Teflon or collagen injection of the posterior pharyngeal wall, and speech therapy have all been used to address this problem. The ideal procedure for this subset of patients with velopharyngeal incompetence (VPI) with high-pressure, mild VPI would be one that combines low morbidity and an expedient recovery for the busy musician. We describe an approach of endoscopically assisted autologous lipoinjection of the soft palate. STUDY DESIGN: A retrospective review of our experience treating high-pressure stress VPI in two professional musicians. methods: literature review and retrospective chart review. RESULTS: Two musicians underwent autologous lipoinjection of the soft palate for stress VPI. patients resumed full play within 2 weeks of the operation with no serious complications. There has been no recurrence of the VPI after 18 and 12 months of follow-up, respectively. CONCLUSIONS: Velopharyngeal stress incompetence in musicians is an uncommon disorder. Velopharyngeal incompetence in these patients may not present as in a typical manner with hypernasality but may go undiagnosed for years mistakenly rationalized as a declining performance ability rather than a curable structural problem. The performance demands of professional musicians necessitate a timely solution to their VPI. More precise and limited contouring of palatal bulk can be achieved through the lipoinjection technique than compared with traditional palatal V-Y pushback or a standard pharyngeal flap. Lipoinjection of the palate can be performed as an outpatient procedure with only minor discomfort and an expedient recovery for the career musician.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
5/48. Gross unilateral abnormalities of the velum and pharynx.OBJECTIVE: Velopharyngeal incompetence because of gross unilateral velopharyngeal hypoplasia is rare, particularly in patients with no significant hemifacial microsomia or facial asymmetry. We describe the abnormal anatomy and treatment of three patients with gross congenital velopharyngeal asymmetry. RESULTS AND CONCLUSIONS: Following surgery, all three patients showed a good improvement in velopharyngeal function and speech. Nasendoscopy and lateral videofluoroscopy were important in confirming the abnormal anatomy and pathology and in evaluating the degree of movement of the affected side of the velum and pharyngeal walls as well as the size and location of the defect. muscles from the normal side were radically dissected and mobilized across the midline to reconstruct the hypoplastic hemivelum. Mucosal lengthening was achieved by suturing the normal mucosa to the mucosa of the hypoplastic hemivelum and the lateral pharyngeal wall or by insetting a posterolateral pharyngeal flap (modified Moore pharyngoplasty) into the nasal surface of the hypoplastic side.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
6/48. Specific language impairment in children with velocardiofacial syndrome: four case studies.OBJECTIVE: To describe specific language impairment in four children with velocardiofacial syndrome (VCFS). DESIGN: A descriptive, retrospective study of four cases. SETTING: University Hospital Groningen, tertiary clinical care. patients: Of 350 patients with cleft plate, 18 children were diagnosed with VCFS. Four children are described. Interventions: In all children, cardiac and plastic surgery was carried out in the first year of life. Afterward, interventions consisted of hearing improvement, pharyngoplasty, and speech therapy. MAIN OUTCOME: Inadequate and uncharacteristic development of articulation and expressive language in four children with VCFS were observed. They differed from the majority in two ways: their nonverbal IQ was in the normal range, and their language skills were below expectations for their IQ. RESULTS: Four of 18 patients with VCFS (22%) showed poor response to therapy and did not develop language in accordance with their normal learning abilities (nonverbal learning capacities and language comprehension). Persistent hypernasal resonance and severe articulation problems remained in all four children. In two children the expressive language profile was also not in agreement with the nonverbal profile: they produced only two- and three-word utterances at the age of 6.0 and 5.3 years. The other two children at the age of 6.8 and 6.4 years produced very long sentences, but they were unintelligible. CONCLUSIONS: The speech and language impairment of the four children may be characterized as a phonological or verbal programming deficit syndrome and as such can be described as a specific language impairment in conjunction with VCFS.- - - - - - - - - - ranking = 2keywords = speech (Clic here for more details about this article) |
7/48. Complete denture with a removable palatal lift prosthesis: a case report and clinical evaluation.The palatal lift prosthesis is used to alleviate rhinopharyngeal closure dysfunction. It is generally problematical to use in edentulous patients, because the palatal lift prosthesis requires secure retention of the denture base and is difficult for the patient to retain while eating. This article describes the fabrication of a complete denture with a removable palatal lift prosthesis and a clinical evaluation of the denture's stability. A sprue pin and tube were used as a connecting attachment between the removable palatal lift prosthesis and the denture base. The force required for lifting the soft palate and the denture's stability were measured in the clinical evaluation. The prosthesis required an average retentive force of 0.26 N for each 1 mm of soft palate lift. The force required to dislodge the denture was measured with and without the palatal lift prosthesis in place. The force required to dislodge the conventional complete dentures of five healthy individuals was also measured as a reference. The denture was 24.4% less stable when the palatal lift prosthesis was in place and was generally easier to dislodge than were conventional dentures. This denture with a removable palatal lift prosthesis is useful for patients with dysfunction of the soft palate involving hypernasal speech who have difficulty in retaining the prosthesis while eating.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
8/48. cleft palate with congenital midline teratoma.A 4-year-old girl presented with hypernasal speech. On examination, in addition to velopharyngeal incompetence noted by speech examination, a palatal tumor was found in between the cleft palate. The computed tomographic and magnetic resonance imaging examinations were suspicious for midline teratoma. Total excision of the nasopalatal tumor was performed, and the pathology revealed benign teratoma. After 6 months of follow-up, no recurrence was noted. A two-flap palatoplasty with a superior-based pharyngeal flap was then performed to reconstruct the palatal defect and to correct the velopharyngeal incompetence. An anterior oronasal fistula developed after the operation, but a tongue flap was transferred to cover the defect successfully. The purpose of this case report is to present the relationship between a congenital midline nasopalatal tumor and cleft palate.- - - - - - - - - - ranking = 2keywords = speech (Clic here for more details about this article) |
9/48. Palatal lift prosthesis for palatopharyngeal closure in Wilson's disease.This is a report of our work on a female patient with Wilson's disease who was treated for speech improvement. A palatal lift prosthesis was constructed to displace the soft palate superiorly and posteriorly and partially restore the functional deficiencies of palatopharyngeal insufficiency. Cephalometric radiographs confirm the association between the displacement of the soft palate and speech improvement.- - - - - - - - - - ranking = 2keywords = speech (Clic here for more details about this article) |
10/48. Speech benefits of posterior pharyngeal flap are preserved after surgical flap division for obstructive sleep apnea: experience with division of 12 flaps.Attachment of a posterior pharyngeal flap is commonly performed for the surgical management of velopharyngeal insufficiency. Obstructive sleep apnea has been found to occur in as many as 38% of patients undergoing posterior pharyngeal flap attachment. Often, this is temporary in the early postoperative period. When it occurs later after surgery, however, it can require active treatment. Many patients improve with the use of nighttime nasal C-PAP. Those patients who do not improve sufficiently with nasal C-PAP may require surgical flap division. We report surgical flap division in 12 such patients. All patients had preoperative and postoperative perceptual speech evaluations, and most had preoperative and postoperative pressure flow studies. In 11 of the 12 patients who underwent surgical flap division, velopharyngeal function did not deteriorate. We hypothesized that the persistence of the speech improvement in those patients is either secondary to the bulk of tissue from the flap, which remains in the posterior pharyngeal wall and provides a pad to assist with velopharyngeal closure, or is secondary to the speech mechanisms that the patients learned with the flap in place and were able to continue even after flap division.- - - - - - - - - - ranking = 3keywords = speech (Clic here for more details about this article) |
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