Palate Insufficiency Research Articles

Measurement Matters: MRI Analysis of Differing Anatomic Measurement Techniques for Velar Length and the Velopharyngeal Needs Ratio.

Advances in imaging tools provide opportunities to enhance how velopharyngeal (VP) variables are quantified to facilitate surgical decisions. The purpose of this study was to use magnetic resonance imaging (MRI) to determine if quantitative differences were present between measures of linear and curvilinear velar length, and subsequently, the VP needs ratio. Data were prospectively collected from patients presenting with repaired cleft palate and/or congenital palatal insufficiency with or without VPI at a single center tertiary children's hospital. Quantitative measures of the velopharynx using a novel nonsedated MRI protocol were obtained. Paired samples t tests were conducted to assess if differences were present between the VP needs ratio and measurements of linear and curvilinear velar length at rest and during sustained phonation. Intraclass correlation coefficients were calculated to assess intra/inter-rater reliability. Significant differences were present between measurements of linear and curvilinear velar length at rest (P ≤ 0.001) and during sustained phonation (P ≤ 0.001). Significant differences were also present in the VP needs ratio (P ≤ 0.001). Curvilinear velar length at rest and during sustained phonation was longer than that of linear velar length at rest and during sustained phonation. No significant differences were observed between measures of effective velar length (P = 0.393). Measurement differences influence the VP needs ratio. This may have implications for comparisons to previously reported normative reference values and for those who are anatomically at risk for VPI. MRI provides an enhanced imaging modality to assess normative benchmarks and the anatomic variables used to define VP anatomy for clinical decision-making.

Efficacy of a new membrane obturator prosthesis in terms of speech, swallowing, and the quality of life of patients with acquired soft palate defects: study protocol of the VELOMEMBRANE randomized crossover trial

BackgroundSoft palate defects created during oral cancer surgery may prevent complete palatal closure and trigger palatopharyngeal insufficiency. One current treatment employs a rigid obturator prosthesis; an extension of acrylic resin at the level of the hard palate ensures surface contact with the remaining musculature. Unfortunately, airflow escape often causes hypernasality, compromises speech intelligibility, and creates swallowing problems (including leakage of food and fluid into the nasal airway). We plan to test a new removable denture featuring a thick dental dam that serves as a membrane obturator. The principal objective of the clinical trial is a comparison of speech handicap levels after 1 month in patients with acquired velar insufficiencies who wear either the new device or a conventional, rigid obturator. The secondary objectives are between-device comparisons of the swallowing handicaps and the health-related qualities of life.MethodsThe VELOMEMBRANE trial is a superiority, open-labeled, two-way, random crossover clinical trial. Adult patients exhibiting velar or palatovelar substance loss after tumor excision and who are indicated for rigid obturator-mediated prosthetic rehabilitation will be recruited in two teaching hospitals in France. Fourteen participants will be randomly allocated to wear both prostheses for 1-month periods in either order. The new membrane obturator is a removable resin prosthesis incorporating a rigid extension that holds a dental dam to restore the soft palate. The primary outcome will be the extent of phonation-related disability (the overall score on the Voice Handicap Index [VHI]). The secondary outcomes will be the Deglutition Handicap Index and health-related quality of life scores of the European Organization for Research and Treatment of Cancer (EORTC).DiscussionHigh-quality evidence will be provided to document the utility of a new medical device that may greatly improve the management and quality of life of patients with acquired velar insufficiency.Trial registrationClinicalTrials.govNCT04009811. Registered on 4 July 2019

Rehabilitation of a patient with palatal defect- A case report

Defects in the jaw and face area are caused by congenital anomalies and some infections. In this study, we present a case of palatal insufficiency after maxillectomy, treated with shutter which was applied to ensure the aesthetics, phonation and functional deficiency of the patient.

Identification of 22q11.2 Deletion Syndrome via Newborn Screening for Severe Combined Immunodeficiency.

Chromosome 22q11.2 deletion syndrome (22q11.2DS), the most common cause of DiGeorge syndrome, is quite variable. Neonatal diagnosis traditionally relies on recognition of classic features and cytogenetic testing, but many patients come to attention only following identification of later onset conditions, such as hypernasal speech due to palatal insufficiency and developmental and behavioral differences including speech delay, autism, and learning disabilities that would benefit from early interventions. Newborn screening (NBS) for severe combined immunodeficiency (SCID) is now identifying infants with 22q11.2DS due to T cell lymphopenia. Here, we report findings in such neonates, underscoring the efficacy of early diagnosis. A retrospective chart review of 1350 patients with 22q11.2DS evaluated at the Children's Hospital of Philadelphia identified 11 newborns with a positive NBS for SCID. Five out of 11 would have been diagnosed with 22q11.2DS without NBS, whereas early identification of 22q11.2DS in 6/11 led to the diagnosis of significant associated features including hypocalcemia, congenital heart disease (CHD), and gastroesophageal reflux disease that may have gone unrecognized and therefore untreated. Our findings support rapidly screening infants with a positive NBS for SCID, but without SCID, for 22q11.2DS even when typically associated features such as CHD are absent, particularly when B cells and NK cells are normal. Moreover, direct NBS for 22q11.2DS using multiplex qPCR would be equally, if not more, beneficial, as early identification of 22q11.2DS will obviate a protracted diagnostic odyssey while providing an opportunity for timely assessment and interventions as needed, even in the absence of T cell lymphopenia.

A complete denture with pharyngeal bulb in an edentulous patient with cleft palate

A cleft palate whether congenital or acquired is present when an oro-nasal communication exists between palate and nose. Selected cleft patients with gross deficiencies of palatal tissues are best treated prosthodontically, without surgical intervention. This article presents a case report of an edentulous patient with palatal insufficiency successfully rehabilitated with a complete denture along with pharyngeal bulb.

Technical details of rotation palatoplasty in patients with Veau 1 cleft palate.

In cleft palate repair, elongation of the cleft toward the posterior is critically important to prevent velopharyngeal insufficiency. The purpose of many cleft palate repair techniques has been to ensure this elongation. Rotational palatoplasty is a recent cleft palate repair technique. In this technique, the soft palate is transformed into a rotational flap to allow the palate to elongate in patients with a cleft palate. This technique, which is used in all types of cleft palate and velopharyngeal insufficiency, is easy to use, practical, and efficient, especially in patients with a Veau 1 cleft palate. The aim of this study was to explain the technical details of the rotation palatoplasty technique in Veau 1 cleft palate with the aid of figures.

Prosthetic Rehabilitation of an Edentulous Veau's Class II - A Case Report

Patients with acquired defects or congenital malformations of the palate exhibit disturbances in speech including hypernasality, nasal emission and decreased intelligibility of speech. Maxillofacial prosthesis is an art and science which not only replaces the lost structure but also sometimes restores the function.obturator is a prosthesis which closes the palate and pharyngeal defects and improving the speech and other function. This article presents a case report of a completely edentulous patient with palatal insufficiency rehabilitated prosthodontically with a hollow bulb obturator and a procedure for fabrication of closed hollow bulb obturator prosthesis. DOI: http://dx.doi.org/10.3329/bjms.v12i4.16665 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 435-438

Fabricating a Partial Denture Obturator for the rehabilitation of Maxillectomy Patient - A Case Report

Obturator prostheses are considered to be the preferred choice for the restoration of maxillary defects. Patients with palatal insufficiency, speech and deglutition becomes impaired, thereby requiring prosthodontic rehabilitation. The prosthodontic rehabilitation of patients with acquired defects of the maxilla after surgical resection is the complete responsibility of a maxillofacial prosthodontist. He has to recreate an artificial barrier between the cavities and thus restore the functional capabilities of speech, mastication and swallowing. Palatal obturator is the only substitute which covers the defect and contributes to normal speech production. It eliminates hypernasality and improves the communication.DOI: http://dx.doi.org/10.3329/updcj.v1i2.13983 Update Dent. Coll. j. 2011: 1(2): 25-28

Submucous Cleft Palate and Velopharyngeal Insufficiency: Comparison of Speech Outcomes Using Three Operative Techniques by One Surgeon

Submucous Cleft Palate and Velopharyngeal Insufficiency: Comparison of Speech Outcomes Using Three Operative Techniques by One Surgeon

Effects of Cleft Width and Veau Type on Rates of Palatal Fistula and Velopharyngeal Insufficiency after Cleft Palate Repair

Effects of Cleft Width and Veau Type on Rates of Palatal Fistula and Velopharyngeal Insufficiency after Cleft Palate Repair

NAZOPHARYNGOENDOSCOPIC STUDY OF THE VELOPHARYNGEAL RING FUNCTION

This paper presents the application of nazopharyngoendoscopic study to assess the function of the velopharyngeal ring in children having congenital cleft lip and palate, as well as the velopharyngeal insufficiency. The effectiveness of surgical treatment of the defect of hard and soft palate and velopharyngeal insufficiency depends on the maximum restoration degree of the velopharyngeal ring muscle structures correct orientation.

Use of Rotation Flap in Repair of Cleft Palate and Velopharyngeal Insufficiency

Although cleft palate anomaly is frequent, the criterion standards in surgical treatment have not been determined yet. There are a few techniques described for cleft palate repair owing to the limited tissue in the palatal mucosa, the rigid structure of the palatal mucosa, and the limited vascularity of the hard palate. In this study, a novel cleft palate repair technique based on separating the soft palate from the hard palate as a musculomucosal flap and using it as a rotation flap has been described. The operation is evaluated individually for each anomaly because variations occur in the surgical technique according to the extension of the cleft toward the teeth in the palate. This operation was performed on a total of 28 patients (17 girls and 11 boys) aged between 1.5 and 16 years and presented to our clinic. Patients were assessed for speech analysis outcomes, tympanogram values, hearing functions, magnitude of palatal lengthening during the operation, and rate of fistulae. Statistically significant differences in values of the speech analysis and the audiometric assessment were determined between before and 6 months after surgery. Complete recovery of otitis was observed 1 month after surgery without another treatment in 9 (42.8%) of 21 patients who were detected to have serous otitis media preoperatively. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all types of cleft palate, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this technique.

Speech Outcomes following Pharyngeal Flap in Patients with Velocardiofacial Syndrome

Velocardiofacial syndrome is the most common defined disorder associated with palatal insufficiency. The authors' purpose is to evaluate one surgeon's experience with correction of velopharyngeal insufficiency in velocardiofacial syndrome using a tailored pharyngeal flap. The authors reviewed the records of all children with velocardiofacial syndrome and velopharyngeal insufficiency who were managed with a pharyngeal flap between 1983 and 2009. Data collected included age at operation, preoperative videofluoroscopic findings, speech outcomes, complications, and need for a secondary operation. The authors identified 33 patients with velocardiofacial syndrome and velopharyngeal insufficiency who had postoperative speech evaluations. Velopharyngeal insufficiency was diagnosed at a median age of 5 years. Palatal findings were: Veau type I (n = 4), overt submucous (n = 6), or occult submucous (n = 23). Median preoperative lateral pharyngeal wall movement was 22 percent (range, 0 to 90 percent). Successful correction of velopharyngeal insufficiency was achieved in 29 of 33 patients (88 percent). One patient had a medially displaced right internal carotid artery, and evidenced intraoperative bleeding and required a blood transfusion. One patient developed obstructive sleep apnea. A tailored pharyngeal flap is highly effective for correction of velopharyngeal insufficiency in velocardiofacial syndrome with few complications.

Palatal Insufficiency as Isolated Sign of GQ1b Antibody Syndrome

Antiganglioside GQ1b antibodies mediate a continuum of disorders with overlapping features, fostering the concept of anti-GQ1b antibody syndrome. We present a patient whose palatal insufficiency was the only clinical sign of postinfectious GQ1b antibody syndrome. Cerebral magnetic resonance imaging confirmed involvement of the glossopharyngeal nerve and vagus nerve bilaterally, revealing gadolinium enhancement of both nerves bilaterally and thickening of the left nervus vagus. Magnetic resonance imaging may help in diagnosing postinfectious GQ1b antibody syndrome, especially at early stages and in monosymptomatic patients. Early diagnosis may lead to early therapy, resulting in a milder disease course by preventing further deterioration leading to the ataxia and ophthalmoplegia usually observed in patients with postinfectious GQ1b antibody syndrome.

P257 MRI findings in a patient with palatal insufficiency as isolated symptom of post-infectious GQ1b antibody syndrome

P257 MRI findings in a patient with palatal insufficiency as isolated symptom of post-infectious GQ1b antibody syndrome

Evaluation of Hypernasality in Vowels Using Voice Low Tone to High Tone Ratio

The voice low tone to high tone ratio (VLHR) is defined as the power ratio of low frequency to high frequency energy obtained by dividing the voice spectrum with a specific cutoff frequency. In a previous study, VLHR correlated significantly with nasalance and perceptual rating of hypernasality for a single vowel. The methodology was optimized in this study by investigating the correlations among other vowels. Voice signals of six sustained vowels vocalized by subjects with hypernasality were collected. Vowel nasalance was obtained with a nasometer, and hypernasality rating scores were provided by two speech-language pathologists. The VLHRs calculated using different cutoff frequencies were correlated with nasalance and hypernasality rating scores. Eight subjects with hypernasality caused by palatal fistula or velopharyngeal insufficiency. VLHR, nasalance, and hypernasality rating score. The correlation of VLHR with nasalance and hypernasality rating was most significant using a cutoff frequency of 600 Hz. The correlation of VLHR with nasalance was significant (r = .62, p < .01, Pearson's correlation), as was the correlation of VLHR with hypernasality score (Spearman's rank correlation coefficient = .62, p < .01). VLHR correlated significantly with nasalance and hypernasality in the six sustained vowels and may provide another quantitative index for the evaluation of hypernasality in sustained vowels.

Speech outcomes after soft palate reconstruction with the soft palate insufficiency repair procedure

Measurement of functional outcomes related to different methods of soft palate reconstruction is necessary to determine efficacy of surgical intervention after resection for oropharyngeal cancer. Speech data were collected across 4 evaluation times for 4 groups of patients (2 groups consisted of patients with <or= half the soft palate resected followed by conventional reconstruction; 2 groups consisted of patients with half or more of the soft palate resected followed by reconstruction with an adhesion or the soft palate insufficiency repair (SPIR). Sixty-two patients were included. Speech was preserved when conventional reconstructive procedures were used to close smaller defects. For larger defects, reconstruction with an adhesion resulted in poorer speech outcomes than the SPIR. The SPIR group achieved normal speech results at all points of evaluation. The results demonstrate that the SPIR is emerging as an efficacious surgical technique for reconstruction of larger soft palate defects.

Prosthetic rehabilitation of a completely edentulous patient with palatal insufficiency

This article presents a case report of a completely edentulous patient with palatal insufficiency successfully rehabilitated with closed hollow bulb obturator prosthesis and also describes a simple technique for fabricating a two-piece hollow bulb obturator that allows for control of the bulb's wall thickness and weight of the prosthesis.

Surgical Repair of Unidirectional Palatopharyngeal Epignathus: Case Report and Review of Literature

Epignathus is an extremely rare, benign, congenital teratoma that arises from within the oral cavity and may be attached to the mandible, palate, or base of the skull. Because of its location, it can cause airway and feeding problems, as well as secondary defects due to the presence of an intraoral tumor. This tumor usually causes death in neonates, due to airway obstruction. Surgical removal is usually impossible, especially in large tumors (Stone, 1951; Bennett, 1970). A patient with a neonatally diagnosed nonobstructive palatopharyngeal epignathus is described. It was associated with a shortened palate, cleft uvula, and velopharyngeal insufficiency, and was successfully excised surgically.

Uvulopalatopharyngoplasty without complications: a Fujita complication

In 17 illustrations, a modification of Fujita's technique of UPPP is presented. This operation consists of excising redundant velar tissues from the free margin of the soft palate, tonsillar pillars, and uvula without reducing the muscles of the velum. In addition, the uvula muscle is almost completely preserved. Seventy patients, with habitual snoring or with obstructive sleep apnea syndrome, who underwent this surgery were followed-up from six to 24 months and did not show any palatal insufficiency with air and liquid escape through the nose. Additional remarks are made concerning the difficulties encountered during intubation of 60 percent of patients with chronic rhonchopathy.