Functional anatomy of the soft palate applied to wind playing

2010 ◽  
Vol 25 (4) ◽  
pp. 183-189 ◽  
Author(s):  
Alison Evans ◽  
Bronwen Ackermann ◽  
Tim Driscoll
Keyword(s):  
Soft Palate ◽  
High Pressures ◽  
Prolonged Exposure ◽  
Functional Anatomy ◽  
Velopharyngeal Insufficiency ◽  
Related Disorder ◽  
Velopharyngeal Closure ◽  
Teachers And Students ◽  
Wind Players ◽  
Air Passage

Wind players must be able to sustain high intraoral pressures in order to play their instruments. Prolonged exposure to these high pressures may lead to the performance-related disorder velopharyngeal insufficiency (VPI). This disorder occurs when the soft palate fails to completely close the air passage between the oral and nasal cavities in the upper respiratory cavity during blowing tasks, this closure being necessary for optimum performance on a wind instrument. VPI is potentially career threatening. Improving music teachers' and students' knowledge of the mechanism of velopharyngeal closure may assist in avoiding potentially catastrophic performance-related disorders arising from dysfunction of the soft palate. In the functional anatomy of the soft palate as applied to wind playing, seven muscles of the soft palate involved in the velopharyngeal closure mechanism are reviewed. These are the tensor veli palatini, levator veli palatini, palatopharyngeus, palatoglossus, musculus uvulae, superior pharyngeal constrictor, and salpingopharyngeus. These muscles contribute to either a palatal or a pharyngeal component of velopharyngeal closure. This information should guide further research into targeted methods of assessment, management, and treatment of VPI in wind musicians.

scholarly journals Prosthetic Rehabilitation of Velopharyngeal Insufficiency: Pharyngeal Obturator Prostheses with Different Retention Mechanisms

2010 ◽  
Vol 04 (01) ◽  
pp. 081-087 ◽  
Author(s):  
Suleyman Hakan Tuna ◽  
Gurel Pekkan ◽  
Hasan Onder Gumus ◽  
Alper Aktas
Keyword(s):  
Soft Palate ◽  
Velopharyngeal Insufficiency ◽  
Prosthetic Rehabilitation ◽  
Retention Mechanisms ◽  
Velopharyngeal Closure ◽  
Intelligible Speech

ABSTRACTPharyngeal obturator prostheses restore the congenital or acquired defects of the soft palate and allow adequate closure of palatopharyngeal sphincter. Two patients with soft palate defect and subsequent velopharyngeal insufficiency were rehabilitated using pharyngeal obturator prostheses which had different retention mechanisms. Since it is necessary for swallowing and intelligible speech, the patients were examined in terms of adequate velopharyngeal closure after prosthetic treatment. The results were satisfying for both the patients and physicians. (Eur J Dent 2010;4:81-87)

Double-opposing Z-Plasty Extended with a Pedicled Buccal Fat Pad Flap for Correcting Velopharyngeal Insufficiency after Primary Palatoplasty

2021 ◽  
pp. 105566562110471
Author(s):  
Hojin Park ◽  
Jin Mi Choi ◽  
Tae Suk Oh
Keyword(s):  
Soft Palate ◽  
Surgical Outcomes ◽  
Velopharyngeal Insufficiency ◽  
Moderate Degree ◽  
Fat Pad ◽  
Buccal Fat Pad ◽  
Pharyngeal Wall ◽  
Mucosal Flap ◽  
Velopharyngeal Closure ◽  
Submucous Cleft Palate

Introduction Furlow double-opposing Z-plasty (DOZ) lengthens the soft palate; however, this lengthening is achieved at the expense of increased mucosal flap tension. Thus, its use is limited in patients with severe tension applied on mucosal flap after DOZ. In this study, DOZ was combined with a buccal fat pad (BFP) flap to maximize palatal lengthening and muscle repositioning. Methods This study included patients who underwent surgical correction for velopharyngeal insufficiency between December 2016 and February 2019. Patients with more than moderate degree hypernasality following primary palatoplasty were included in the study. Patients younger than 4 years of age, those with a submucous cleft palate, or syndromic patients were excluded. Speech outcomes were investigated for those who underwent DOZ only (DOZ group, n = 17) and those in whom a BFP was used (BFP group, n = 15) pre- and postoperatively. The velopharyngeal gaps between the uvula and pharyngeal wall were measured before and immediately after surgery to estimate the palatal length. Results Most patients who received a BFP showed improvement in hypernasality. However, the hypernasality of the DOZ group was more severe than that of the BFP group (p = 0.023). The extent of palatal lengthening was 4.4 ± 1.7 mm and 7.5 ± 2.1 mm in the DOZ and BFP groups, respectively (p = 0.001). Conclusions BFPs reduced the tension of the DOZ mucosal flap and maximized palatal lengthening and muscle repositioning. They promoted velopharyngeal closure in patients with moderate and moderate-to-severe velopharyngeal insufficiency. Hence, our method improves the surgical outcomes of patients with velopharyngeal insufficiency after primary palatoplasty.

Nasendoscopic Evaluation of Stress Velopharyngeal Insufficiency in Wind Musicians: A Pilot Study

2015 ◽  
Vol 30 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Alison Evans ◽  
Tim Driscoll ◽  
Jonathan Livesey ◽  
David Fitzsimons ◽  
Bronwen Ackermann
Keyword(s):  
Soft Palate ◽  
Objective Assessment ◽  
Velopharyngeal Insufficiency ◽  
Air Leak ◽  
Speech Language Pathologist ◽  
Wind Instrument ◽  
Velopharyngeal Closure ◽  
Before And After ◽  
And Function

OBJECTIVE: To investigate the anatomy and function of the velopharyngeal mechanism in musicians who experience symptoms of stress velopharyngeal insufficiency (VPI) compared to musicians who do not. METHODS: The velopharyngeal mechanism of 13 musicians, 8 with reported symptoms of stress VPI and 5 without, were evaluated using video nasendoscopy before and after 30 minutes of playing. All nasendoscopic recordings were rated by an external speech-language pathologist and ear, nose and throat surgeon for maintenance of velopharyngeal closure, type of velopharyngeal closure pattern, and velopharyngeal gap. RESULTS: Six out of 8 cases with stress VPI had nasal air leak during the assessment, 2 of whom had fatigue-related increased symptoms. Three controls had mild nasal air leak without affecting the consistency of soft palate seal nor quality of playing, suggesting that evidence of nasal air leak is not always symptomatic of stress VPI. All cases had unusual anatomical characteristics, such as the soft palate closing against an irregular surface on the posterior nasopharyngeal wall, which may cause insufficient velopharyngeal closure. Typically the soft palate contacted the nasopharyngeal wall higher when playing a wind instrument compared to during speech. CONCLUSION: Specific anatomical features and factors such as fatigue and stress may affect maintenance of velopharyngeal closure in persons with stress VPI. It is important that musicians with stress VPI are evaluated while playing their instrument. Future studies into stress VPI would benefit by including objective assessment components and some degree of quantifiable measurements.

Evaluation of Velopharyngeal Closure Function With 4-Dimensional Computed Tomography and Assessment of Radiation Exposure in Pediatric Patients: A Cross-Sectional Study

2021 ◽  
pp. 105566562110017
Author(s):  
Yoshikazu Kobayashi ◽  
Masanao Kobayashi ◽  
Daisuke Kanamori ◽  
Naoko Fujii ◽  
Yumi Kataoka ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Exposure Dose ◽  
Velopharyngeal Insufficiency ◽  
Radiation Doses ◽  
Secondary Surgery ◽  
Cross Sectional ◽  
Computed Tomography Images ◽  
Velopharyngeal Closure ◽  
Closure Function

Objective: Some patients with cleft palate (CP) need secondary surgery to improve functionality. Although 4-dimensional assessment of velopharyngeal closure function (VPF) in patients with CP using computed tomography (CT) has been existed, the knowledge about quantitative evaluation and radiation exposure dose is limited. We performed a qualitative and quantitative assessment of VPF using CT and estimated the exposure doses. Design: Cross-sectional. Setting: Computed tomography images from 5 preoperative patients with submucous CP (SMCP) and 10 postoperative patients with a history of CP (8 boys and 7 girls, aged 4-7 years) were evaluated. Patients: Five patients had undergone primary surgery for SMCP; 10 received secondary surgery for hypernasality. Main Outcome Measures: The presence of velopharyngeal insufficiency (VPI), patterns of velopharyngeal closure (VPC), and cross-sectional area (CSA) of VPI was evaluated via CT findings. Organ-absorbed radiation doses were estimated in 5 of 15 patients. The differences between cleft type and VPI, VPC patterns, and CSA of VPI were evaluated. Results: All patients had VPI. The VPC patterns (SMCP/CP) were evaluated as coronal (1/4), sagittal (0/1), circular (1/2), and circular with Passavant’s ridge (2/2); 2 patients (1/1) were unevaluable because of poor VPF. The CSA of VPI was statistically larger in the SMCP group ( P = .0027). The organ-absorbed radiation doses were relatively lower than those previously reported. Conclusions: Four-dimensional CT can provide the detailed findings of VPF that are not possible with conventional CT, and the exposure dose was considered medically acceptable.

Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate

2019 ◽  
Vol 57 (4) ◽  
pp. 420-429
Author(s):  
Susanna Botticelli ◽  
Annelise Küseler ◽  
Kirsten Mølsted ◽  
Helene Soegaard Andersen ◽  
Maria Boers ◽  
...  
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Trial ◽  
Velopharyngeal Insufficiency ◽  
Primary Surgery ◽  
Multicenter Randomized Controlled Trial ◽  
Palate Repair ◽  
Velopharyngeal Function

Aim: To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. Design: Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). Setting: Tertiary health care. One surgical center. Patients and Methods: One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). Main outcome measurements: Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. Results: No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate “cleft size at tuberosity level” was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = −.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). Conclusions: Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.

Surgical Management of Velopharyngeal Insufficiency Due to Unilateral Oropharyngeal Agenesis in a Patient With Stickler Syndrome

2020 ◽  
pp. 105566562097741
Author(s):  
Bronson Wessinger ◽  
Kyle Kimura ◽  
James Phillips ◽  
Ryan H. Belcher
Keyword(s):  
Surgical Management ◽  
Soft Palate ◽  
Surgical Correction ◽  
Velopharyngeal Insufficiency ◽  
Patient Specific ◽  
Stickler Syndrome ◽  
Pharyngeal Flap ◽  
Nasal Regurgitation

Velopharyngeal insufficiency (VPI) results from defects interfering with closure of the velopharyngeal port. It can lead to many issues ranging from nasal regurgitation to severe speech abnormalities. Treatment is tailored to patient-specific etiology and severity, often involving surgical correction. A rare, and therefore seldom, described cause of VPI is isolated unilateral agenesis of the soft palate. We describe the case of a 2-year-old patient with Stickler syndrome possessing a unique anatomic presentation of this pathology, managed successfully with a unilateral pharyngeal flap.

Assessment of the New L Pharyngeal Flap for Velopharyngeal Insufficiency

2020 ◽  
pp. 105566562095015
Author(s):  
Mohammad Waheed El-Anwar ◽  
Ezzeddin Elsheikh ◽  
Mohamed Abdelmohsen Alnemr ◽  
Amal Saed Quriba ◽  
Elham Hassan ◽  
...  
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Speech Therapy ◽  
Velopharyngeal Insufficiency ◽  
Valve Closure ◽  
Speech Evaluation ◽  
Obstructive Sleep ◽  
Horizontal Part ◽  
Pharyngeal Flap ◽  
Speech Assessment

Objective: To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI). Methods: This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation. Results: Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported. Conclusion: The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication.

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.

Morphologic Significance of Bifid Uvula

PEDIATRICS ◽  
1985 ◽  
Vol 75 (3) ◽  
pp. 553-561
Author(s):  
Robert J. Shprintzen ◽  
Richard H. Schwartz ◽  
Avron Daniller ◽  
Lynn Hoch
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Velopharyngeal Insufficiency ◽  
Pediatric Practice ◽  
Submucous Cleft Palate ◽  
Hypernasal Speech ◽  
Definition Of

Bifid uvula is often regarded as a marker for submucous cleft palate although this relationship has not been fully confirmed. The reason for the tacitly assumed connection between these two anomalies has, in part, been perpetuated by the generally accepted definition of submucous cleft palate as the triad of bifid uvula, notching of the hard palate, and muscular diastasis of the soft palate. Recently, investigations have provided evidence of more subtle manifestations of submucous cleft palate by the use of nasopharyngoscopic examination of the palate and pharynx. It has been determined that submucous cleft palate can occur even when a peroral examination shows an intact uvula. This finding places the "marker" relationship in question. In order to determine the frequency of association between bifid uvula and submucous clefting, a total ascertainment of children with bifid uvula from a suburban pediatric practice was examined nasopharyngoscopically. It was determined that in all but two cases, children with bifid uvula had some or all of the landmarks of submucous cleft palate. Several of the children were found to have velopharyngeal insufficiency and mildly hypernasal speech. This finding prompts caution in the recommendation of adenoidectomy in the presence of bifid uvula.

Long-term Morphological Changes of the Velum and the Nasopharynx in Patients With Cleft Palate

2021 ◽  
pp. 105566562110452
Author(s):  
Takeshi Harada ◽  
Tadashi Yamanishi ◽  
Takayuki Kurimoto ◽  
Setsuko Uematsu ◽  
Yuri Yamamoto ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Cleft Lip ◽  
Morphological Changes ◽  
Morphological Development ◽  
Depth Ratio ◽  
Lateral Cephalograms ◽  
Velopharyngeal Closure ◽  
Pharyngeal Depth

Objective To investigate long-term morphological changes in the soft palate length and nasopharynx in patients with cleft palate. We hypothesized that there would be differences in the morphological development of the soft palate and nasopharynx between patients with and without cleft palate and that these developmental changes would negatively affect the soft palate length to pharyngeal depth ratio involved in velopharyngeal closure for patients with cleft palate. Design Retrospective, case-control study. Setting Institutional practice. Patients Ninety-two patients (Group F) with unilateral cleft lip, alveolus, and palate and 67 patients (Group CLA) with unilateral cleft lip and alveolus not requiring palatoplasty were included. Main Outcome Measures The soft palate length, nasopharyngeal size, and soft palate length to pharyngeal depth ratio were measured via lateral cephalograms obtained at three different periods. Results Group F showed a shorter soft palate length and smaller nasopharyngeal size than Group CLA at all periods. Both these parameters increased with age, but the increase in amount was significantly less in Group F compared with that in Group CLA. The soft palate length to pharyngeal depth ratio in Group F decreased with age. Conclusions In patients with cleft palate, the soft palate length to pharyngeal depth ratio, which is involved in velopharyngeal closure, can change with age. Less soft palate length growth and unfavorable relationship between the soft palate and nasopharynx may be masked in early childhood but can manifest later on with age.

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