Palatal Incompetence Research Articles

Palatal Lift Appliance in a Case of Palatal Incompetence Secondary to Motor Neurone Disease

Velopharyngeal deficiencies are challenging conditions to manage, often requiring input from a number of different specialties including restorative dentistry. Palatal incompetence, that is, the inability of a structurally intact palate to elevate and close the nasopharynx from the oropharynx can result in hypernasality and air escape, compromising speech sounds as well as causing swallowing difficulty. The palatal lift appliance is a prosthesis designed to elevate the palate to aid velopharyngeal closure, and has been used to manage patients with neurological disorders affecting the palate. This report presents such management in a patient with motor neurone disease. CPD/Clinical Relevance: Dentists should be integral in the management of patients with motor neurone disease to help maintain oral health and prevention of dental disease, but also to provide speech prostheses and liaise with speech and language therapists. Patients with motor neurone disease may present to a generalist for routine dental care, and GDPs should be aware of the challenges of managing the dental work for this group of people.

How we do it: Laser reduction of peri‐tubal adenoids in selected patients with otitis media with effusion

. The literature supports the benefit of adenoidectomy in patients with otitis media with effusion (OME). . It is difficult to clear adenoid tissue from around the Eustachian tubes using curettes and this conventional method of adenoidectomy is contra-indicated in patients with cleft palates. . Laser reduction of peri-Eustachian adenoid tissue without myringotomies or grommet insertion was performed in three patients with OME. Two patients had previous adenoidectomies performed with curettes and one patient had a cleft palate. . In all three patients, the OME resolved and all had closure of the air-bone gap that was maintained during long-term follow-up (14 months-4 years). . This technique resolved OME without the need for myringotomies or grommet insertion and should be considered particularly in patients who have peri-tubal recurrence of adenoidal tissue following conventional adenoidectomy or in patients with cleft palate where there is concern with regards to palatal incompetence.

Laser-assisted uvulopalatoplasty: postoperative complications.

Laser-assisted uvulopalatoplasty (LAUP) has become a widely used procedure for the treatment of snoring and mild sleep apnea in the United States. Between July 1993 and December 1994, the authors of this study prospectively evaluated 541 consecutive patients referred to their hospital for possible LAUP to treat loud disruptive snoring. Of the 541 patients, 275 patients had a total of 754 LAUP procedures. There were 26 complications (3.45%). These complications included postoperative hemorrhage in 16 patients (2.12%), local infection in 4 patients (0.53%), temporary palatal incompetence in 4 patients (0.53% , and temporary loss of taste in 2 patients (0.27%). None of the 16 patients with postoperative hemorrhage required a blood transfusion. Only 10 patients (1.3%) had hemorrhage that required medical attention; in the other patients, the bleeding stopped spontaneously. There were no cases of hypernasal speech, permanent palatal incompetence, nasopharyngeal stenosis, airway compromise, or death.

Effects of surgical therapy of obstructive snoring on swallowing and voice quality

The efficacy of uvulopharyngopalatoplasty (UPPP) in treating obstructive snoring has been reported from many centers. The reduction of uvula and soft palate may result in palatal incompetence. We examined 23 patients undergoing UPPP pre- and postoperatively and found a slight preoperative hypernasality in three patients. None of our patients had problems with swallowing. During the first week postoperatively, most of the patient had hypernasality and noted a nasal escape of liquids. Three to four months after surgery, three patients still had problems swallowing. All 21 patients seen during the last follow-up examination had a nasal escape of air detected by auscultation in at least one of the tests. Two patients had an audible hypernasality. Two patients could not pronounce the letters any more. More than one year after surgery, palatal incompetence was no longer detectable.

Nasopharyngeal brachytherapy with access via a transpalatal flap

We used a posteriorly based transpalatal flap for interstitial nasopharyngeal brachytherapy in five patients with nasopharyngeal carcinoma. All of these implants were done with iodine 125 seeds. The disease in three of five patients has been controlled locally for 27, 30, and 40 months, respectively. Two patients experienced local failure and died. There have been no palatal healing problems despite high doses of previous radiation in all of our patients. No palatal incompetence has been seen. This technique appears safe and should be considered for discrete lesions of the high posterior or superior nasopharynx that cannot be approached by less invasive methods.

Uvulopalatopharyngoplasty complications and avoidance strategies

Reports of uvulopalatopharyngoplasty complications were elicited from 72 locations in the United States. We asked physicians to report all complications that had occurred in the 9 years since the operation was introduced. Sixteen fatalities were reported; respiratory distress was the most common cause. Forty-six cases of nasopharyngeal stenosis were reported and 42 cases of palatal incompetence were reported. Hemorrhages and wound dehiscences were also reported. A retrospective analysis of the complications was made and diagnostic-therapeutic strategies are discussed with respect to prevention of complications.

Definitive radiation treatment for early stage carcinoma of the soft palate and uvula: The indications for iridium 192 implantation

From 1971 to 1984 59 T1 and T2 carcinomas of the soft palate and uvula were treated definitively by irradiation at the Henri Mondor hospital. Included are ten patients previously irradiated to the oropharyngeal area for either a carcinoma of the soft palate or another malignancy. Sixteen patients were treated by external irradiation alone, 14 by Iridium 192 implantation, and 29 by a combination of the two. Two techniques of implantation were used: the guide gutter technique (33 patients) and the plastic tube technique (10 patients). Clinically negative neck nodes ( 51 59 ) either received prophylactic telecobalt therapy ( 39 51 ) or were surveilled ( 12 51 ). Clinically involved nodes ( 8 59 ) were managed either by external irradiation alone ( 4 8 ) or combined with neck dissection ( 4 8 ). Local failure was 25% ( 4 16 ) after exclusive telecobalt therapy, 18% ( 5 19 ) after combined telecobalt therapy and implantation, and 0% ( 0 14 ) after Iridium 192 implantation alone. No local failures were seen with the plastic tube technique ( 0 10 ) as compared to 15% ( 5 33 ) for guide gutters. Only two nodal failures were observed ( 2 59 ): 3%). Crude 5-year disease-free survival was 33%. Severe complications were limited to one osteonecrosis, one soft tissue necrosis, and one partial palatal incompetence. Salivary impairment was reduced when implantation was used for part or all of the treatment. We recommend 45 Gy external radiation followed by 30 Gy from Iridium 192 implantation using the plastic tube method unless there has been prior oropharyngeal irradiation, in which case we give 60 Gy from implantation alone. For clinically negative neck nodes, we recommend 45 Gy prophylactic external neck irradiation. For clinically positive lymph nodes, this should be followed by either a 25 to 30 Gy boost to the involved nodes or a neck dissection.

Indications of congenital palatal incompetence before diagnosis.

By questionnaire, parents of 28 children with CPI were asked about pregnancy and delivery; speech, developmental, and health history; and the circumstances of the CPI diagnosis. A normal control group was used for comparison. CPI children had lower birth weights and, during early childhood, were more poorly understood by parents and more frequently had nasalized speech. In 50%, CPI diagnosis was made following adenoidectomy. Data and clinical findings indicate that possible predictors of CPI are unusually defective speech production, particularly characterized by nasalization, as a young child; a short or poorly mobile palate; anterior dimpling of the soft palate during elevation; radiographic abnormalities of the cervical vertebrae; neurologic abnormalities (developmental milestones or clinical examination); and nasal leakage of liquids as a very young infant. Temporary velopharyngeal incompetence and nasalized speech may occur in the normal patient following adenoidectomy but the disorder resolves in a day or two. Persistent nasalized speech following adenoidectomy indicates the likelihood of CPI; such a patient requires evaluation by a speech pathologist and possible surgical correction.

Unexpected reduction and removal of an obturator in a patient with palate paralysis.

The speech prosthesis has proven to be a valuable and conservative treatment measure for children with palatal incompetence (Blakeley, i960; Harkens et ah, i960; Rosen & Bzoch, 1958). Surgical management as a general approach, at least in young children, may now prove to be somewhat heroic. After palate repair in cases of cleft palate, or prior to palato-pharyngoplasty in non-cleft palatal incompetence, the speech appliance may serve as a valuable “test” device in addition to its treatment function.

Cinefluorographic studies of deglutition and phonation: A preliminary report

In this preliminary report, a description of cinefluorographic instrumentation is presented. A basic diagnostic test to compare deglutition and phonation more efficaciously is outlined. Illustrations of the fundamental kinesiology necessary to produce American phonemes are included to complement the normal patients and patients with palatal incompetence.