scholarly journals Current Controversies in Diagnosis and Management of Cleft Palate and Velopharyngeal Insufficiency

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Pablo Antonio Ysunza ◽  
Gabriela M. Repetto ◽  
Maria Carmen Pamplona ◽  
Juan F. Calderon ◽  
Kenneth Shaheen ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Speech Pathology ◽  
Imaging Diagnosis ◽  
Diagnosis And Management ◽  
Velopharyngeal Closure ◽  
Articulation Disorders ◽  
Recent Method ◽  
Genetics And Genomics ◽  
Velopharyngeal Function

Background. One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI).Objective. This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate.Materials and Methods. An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy.Results. Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented.Conclusion. This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management.

An Innovative Collaborative Treatment Model: The Community-Based Speech-Language Pathologist and Cleft Palate Team

2017 ◽  
Vol 54 (2) ◽  
pp. 242-244 ◽  
Author(s):  
Lynn Marty Grames ◽  
Mary Blount Stahl
Keyword(s):  
Cleft Palate ◽  
Continuing Education ◽  
Collaborative Care ◽  
Speech Therapy ◽  
Care Program ◽  
Speech Pathology ◽  
Treatment Model ◽  
Community Based ◽  
Speech Language Pathologist ◽  
Articulation Disorders

Problem Children with cleft-related articulation disorders receive ineffectual or inappropriate speech therapy locally due to lack of training and a disconnect between the team and local speech-language pathologists. Solution A collaborative care program that is billable for the team allows the local speech-language pathologist to earn continuing education units and facilitates effective local speech therapy. This program is the first of its kind, according to the American Speech-Language-Hearing Association Continuing Education Board for Speech Pathology.

Velopharyngeal Function in Nonsyndromic Cleft Palate: Relevance of Surgical Technique, Age at Repair, and Cleft Type

1998 ◽  
Vol 35 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Eileen M. Marrinan ◽  
Richard A. Labrie ◽  
John B. Mulliken
Keyword(s):  
Surgical Technique ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Velopharyngeal Insufficiency ◽  
Significant Variable ◽  
Muscle Complex ◽  
Cleft Lip Palate ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function ◽  
Repair Group

Objective The goal of this study was to determine the relative importance of surgical technique, age at repair, and cleft type for velopharyngeal function. Design This was a retrospective study of patients operated on by two surgeons using different techniques (von Langenbeck and Veau-Wardill-Kilner [VY]) at Children's Hospital, Boston, MA. Patients We included 228 patients who were at least 4 years of age at the time of review. Patients with identifiable syndromes, nonsyndromic Robin sequence, central nervous system disorders, communicatively significant hearing loss, and inadequate speech data were excluded. Main Outcome Measure Need for a pharyngeal flap was the measure of outcome. Results Pharyngeal flap was necessary in 14% of von Langenbeck and 15% of VY repaired patients. There was a significant linear association (p = .025) between age at repair and velopharyngeal insufficiency (VPI). Patients with an attached vomer, soft cleft palate (SCP), and unilateral cleft lip/palate (UCLP) had a 10% flap rate, whereas those with an unattached vomer, hard/soft cleft palate (HSCP), and bilateral cleft lip/palate (BCLP) had a 23% flap rate (p = .03). Age at repair was critical for the unattached-vomer group (p = .03) but was not statistically significant for the attached-vomer group (p = .52). Conclusions Surgical technique was not a significant variable either in aggregate or for the Veau types. Patients in the earliest repair group (8-10 months) were the least likely to require a pharyngeal flap. Early repair was more critical for HSCP and BCLP patients. There was no correlation between velopharyngeal insufficiency and Veau hierarchy. The attached vomer/levator muscle complex may be a more important predictor of surgical success than the anatomic extent of cleft.

Comparing the Unaided Visual Exam to Lateral Cinefluorography in Estimating Several Parameters of Velopharyngeal Function

1984 ◽  
Vol 49 (2) ◽  
pp. 136-139 ◽  
Author(s):  
C. R. Eisenbach ◽  
W. N. Williams
Keyword(s):  
Medical Records ◽  
Velopharyngeal Insufficiency ◽  
Poor Agreement ◽  
Connected Speech ◽  
Visual Examination ◽  
Management Decisions ◽  
Form And Function ◽  
Velopharyngeal Closure ◽  
Velopharyngeal Function ◽  
And Function

Retrospectively, the medical records of patients with known velopharyngeal insufficiency (VPI) were reviewed for comments based on an unaided visual examination regarding their velopharyngeal function. These comments were compared to objective findings obtained from the cinefluorographic evaluations performed on each of the patients. A total of 68 recorded comments (47 patients) were identified and fell into four broad categories: (1) velar length, (2) depth of the nasopharynx, (3) velopharyngeal closure, and (4) velar mobility. The results revealed an agreement level of 60% between judgments made from visual examinations and cinefluorographic evaluations. This relatively poor agreement suggests that management decisions concerning VPI must include some method of objectively assessing velopharyngeal form and function during connected speech.

scholarly journals Asymmetry and Positioning of the Levator Veli Palatini Muscle in Children With Repaired Cleft Palate

2020 ◽  
Vol 63 (5) ◽  
pp. 1317-1325 ◽  
Author(s):  
Katelyn J. Kotlarek ◽  
Catherine M. Pelland ◽  
Silvia S. Blemker ◽  
Michael S. Jaskolka ◽  
Xiangming Fang ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Levator Muscle ◽  
Future Research ◽  
Imaging Protocol ◽  
Levator Veli Palatini ◽  
Velopharyngeal Closure ◽  
History Of ◽  
Magnetic Resonance Imaging Protocol ◽  
The Impact

Purpose The purpose of this study is to examine the differences in velopharyngeal dimensions as well as levator veli palatini (levator) muscle morphology, positioning, and symmetry of children with repaired cleft palate with velopharyngeal insufficiency (VPI), children with repaired cleft palate with complete velopharyngeal closure, and children with noncleft anatomy. Method Fifteen children ranging in age from 4 to 8 years were recruited for this study. Ten of the participants had a history of repaired cleft palate, half with documented VPI and the other half with velopharyngeal closure. Five participants with noncleft anatomy were matched for age from a normative database. The magnetic resonance imaging protocol, processing methods, and analysis are consistent with that used in previous literature. Results Regarding velopharyngeal dimensions, median values were statistically significantly different between groups for sagittal angle ( p = .031) and effective velopharyngeal ratio ( p = .013). With respect to the levator muscle, median values were statistically significant for average extravelar length ( p = .018), thickness at midline ( p = .021), and thickness between the left and right muscle bundles at the point of insertion into the velum ( p = .037). Remaining measures were not statistically significant. Conclusions The levator muscle is significantly different among these three groups with respect to thickness at midline, extravelar length, and symmetry at the point of insertion into the velum. Sagittal angle and effective velopharyngeal ratio are also significantly different. Participants with repaired cleft palate and VPI displayed the greatest degree of asymmetry. Future research should control for surgical procedure type to determine the impact of surgery on the levator muscle and surrounding velopharyngeal anatomy.

Predictors of Success After Furlow Palatoplasty for Repair of Cleft Palate: Does Syndrome Matter?

2021 ◽  
pp. 019459982110389
Author(s):  
Sean S. Evans ◽  
Randall A. Bly ◽  
Kaylee Paulsgrove ◽  
Jonathan A. Perkins ◽  
Kathleen Sie
Keyword(s):  
Cleft Palate ◽  
Speech Therapy ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Speech Errors ◽  
Velopharyngeal Insufficiency ◽  
Predictors Of Success ◽  
Oronasal Fistula ◽  
Cleft Palate Repair ◽  
Velopharyngeal Function

Objective To determine predictors of success following Veau 1 and 2 cleft palate repair in patients with and without syndromes. Study Design Retrospective review of prospectively collected data. Setting Tertiary care children’s hospital. Methods All children <18 months of age undergoing Furlow palatoplasty for Veau 1 and 2 cleft repair between 2000 and 2014 with postoperative perceptual speech assessment (PSA). Results In total, 368 consecutive patients were identified; 95 were excluded, resulting in 273 patients. Median age at surgery was 13.0 months (interquartile range [IQR], 11-15 months) with postoperative PSA at a median of 32.3 months (IQR, 26.3-44.5 months). Fifty patients (18.3%) had syndrome diagnosis; 59 patients (21.6%) had nonsyndromic Robin sequence. Velopharyngeal insufficiency (VPI) occurred in 27 patients (10.5%); 13 underwent secondary speech surgery. Cleft-related speech errors occurred in 46 patients (17.6%). Non-cleft-related speech errors occurred in 155 patients (59.6%) and reduced intelligibility in 127 patients (47.9%). Oronasal fistula occurred in 23 patients (8.8%) and was exclusive to Veau 2 clefts. In multivariate analysis, age >13 months at palatoplasty demonstrated a 6-fold higher rate of VPI (hazard ratio [HR], 6.64; P < .01), worse speech outcomes (HR, 6.04; P < .01; HR, 1.60; P < .01; HR, 1.57; P = .02), and greater speech therapy utilization (HR, 2.18; P < .01). Conclusion VPI occurred in 10% of patients undergoing Furlow palatoplasty repair of Veau 1 or 2 clefts. Age <13 months at palatoplasty was associated with improved speech outcomes and lower VPI incidence (2.8% vs 16.2%). Syndromic diagnosis was associated with noncleft speech errors and reduced intelligibility on univariate analysis but not velopharyngeal function after palatoplasty.

Laryngeal Airway Resistance in Children with Cleft Palate and Adequate Velopharyngeal Function

1995 ◽  
Vol 32 (2) ◽  
pp. 138-144 ◽  
Author(s):  
David J. Zajac
Keyword(s):  
Cleft Palate ◽  
Airway Resistance ◽  
Vowel Production ◽  
Effort Level ◽  
Syllable Repetition ◽  
Velopharyngeal Closure ◽  
Velopharyngeal Function ◽  
Laryngeal Resistance ◽  
Repetition Task ◽  
Laryngeal Airway

Laryngeal airway resistance during vowel production was determined for 10 children without cleft palate and 14 children with cleft palate and adequate velopharyngeal function. The children with cleft palate were further grouped according to either complete or incomplete velopharyngeal closure. All children performed a syllable repetition task with nostrils occluded at self-determined effort and a targeted effort typical of adult speech. Results indicated that all children exhibited significantly greater laryngeal resistance at self-determined effort. No significant differences occurred among the groups of children at either effort level. Some children with incomplete velopharyngeal closure, however, tended to exhibit relatively increased laryngeal resistance at the targeted effort level when their nostrils were unoccluded. Implications for a regulation-control model of speech production and clinical assessment are discussed.

Velar Closing Ratio As a Predictor for the Verlopharyngeal Function After Double Opposing Z-Plasty for Postpalatoplasty Velopharyngeal Insufficiency in Patients With Cleft Palate

2020 ◽  
pp. 105566562095408
Author(s):  
Cheng-Chun Wu ◽  
Faye Huang ◽  
Ching-Hua Hsieh ◽  
Chih-Pin Fu ◽  
Yi-Lin Tsai ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Surgical Outcome ◽  
Medical Records ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Velopharyngeal Insufficiency ◽  
Stepwise Logistic Regression ◽  
Receiver Operating Characteristic Curves ◽  
Surgical Methods ◽  
Velopharyngeal Function

Background: This study was designed to identify the potential predictors of postoperative velopharyngeal function after double opposing Z-plasty (DOZP) for the treatment of velopharyngeal insufficiency (VPI) in patients who had prior palatoplasty for cleft palate. Methods: This retrospective study reviewed the medical records of consecutive patients who received DOZP for VPI after receiving a prior palatoplasty treating cleft palate between 2004 and 2017. The speech outcome of patient was measured using the Pittsburgh Weighted Speech Scale (PWSS) at 6 months following surgery and determined the outcome suggests velopharyngeal competence (PWSS ≤2) or incompetence (PWSS >2). Stepwise logistic regression was used to identify the variables for the prediction of competent surgical outcome. The specific receiver operating characteristic curves with an area under the curve (AUC) was used to evaluate the predictor related to the surgical outcome as competence. Results: The study included 93 patients. Age, relative velar length, velar lengthening, and closure pattern were not significantly associated with postoperative competence status of the patient. The only variable that predicted a successful surgical outcome was preoperative velar closing ratio. However, the accuracy of velar closing ratio in predicting a competent surgical outcome is only moderate (AUC = 70.37). Conclusion: The results of this study showed that preoperative velar closing ratio may predict, with moderate accuracy, a successful surgical outcome in patients with postpalatoplasty VPI who undergo DOZP. Therefore, in patients with a low preoperative velar closing ratio, some alternative surgical methods other than DOZP may be considered to avoid unsatisfactory surgical outcome.

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