Palatal Lift Research Articles

Prosthodontic management of velopharyngeal incompetence with palatal lift prosthesis: A case series

Velopharyngeal dysfunction is a palatal defect that occurs when the soft palate or the velum fails to close an opening called the velopharyngeal port or lift adequately to posterior pharyngeal wall. It primarily affects the articulation and resonance of speech and often leads to nasal intonation due to escape of air through the nose. This article presents a series of such cases that have been treated by prosthodontic rehabilitation.

Speech-aid prosthesis in velopharyngeal incompetency patient with cleft palate: can speech aids be applicable for adult patient?

BackgroundVelopharyngeal incompetence (VPI) therapy for cleft palate (speech therapy alone, speech therapy using speech aids, or combined therapy such as speech therapy using a pharyngeal flap), is more effective in younger patients than in adult patients. Speech therapy is known as very difficult for patients who still have VPI as an adult. Because of the possibility of subsequent speech disorders, the timing of surgery for cleft palate is accelerating. Herein, we present a case of an adult with articulation disorder due to VPI who was treated by speech therapy and a speech-aid prosthesis.Case presentationA woman who underwent cleft palate surgery at 8 years of age still had difficulty with articulation due to VPI as a 24-year-old adult because of a lack of continuous speech therapy. We decided to use a speech-aid application using palatal lift, and a reduction program was conducted four times, along with simultaneous speech therapy, over a period of 1 year and 7 months. During the therapy period, she was able to speak normally within a relatively short period of time, and after implementation of the reduction program, the therapy was completed by completely removing the device. Long-term observations have shown normal speech function without recurrence, even after the device was removed.ConclusionAs seen in this case, speech therapy using speech aids can show a good result for adult patients with cleft palate who missed the usual timing for the treatment of articulation disorders, depending on the situation. Therefore, it is hereby reported as a therapy option worthy of consideration.

A Case of Applying a Palatal Lift Prosthesis to a Child with the Juvenile Form of Late-onset Pompe Disease with Dysarthria

A Case of Applying a Palatal Lift Prosthesis to a Child with the Juvenile Form of Late-onset Pompe Disease with Dysarthria

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.

Palatal Lift Prosthesis for Velopharyngeal Incompetence: A Case Report

Velopharyngeal incompetence often distorts the voice quality making it difficult for the listener to comprehend.A cost-effective treatment approach for this is palatal lift prosthesis. This prosthesis enables the incompetentsoft palate to approximate with the posterior pharyngeal wall. As a result articulation of speech is improved

弾力のある可動域をもった軟口蓋挙上装置（モバイル軟口蓋挙上装置Fujishima type）の考案と使用経験

弾力のある可動域をもった軟口蓋挙上装置（モバイル軟口蓋挙上装置Fujishima type）の考案と使用経験

Effect of Maxillary Osteotomy on Speech in Cleft Lip and Palate: Instrumental Outcomes of Velopharyngeal Function.

To investigate the effect of maxillary osteotomy on velopharyngeal function in cleft lip and palate (CLP) using instrumental measures. A prospective study. A consecutive series of 20 patients with CLP undergoing maxillary osteotomy by a single surgeon were seen at 0 to 3 months presurgery (T1), 3 months (T2), and 12 months (T3) post-surgery. Nasalance was measured on the Nasometer II 6400. For videofluoroscopy and nasendoscopy data, visual perceptual ratings, for example, palatal lift angle (PLAn), and quantitative ratiometric measurements, for example, closure ratio (CRa), were made using a validated methodology and computer software. Reliability studies were undertaken for all instrumental measures. Repeated measures analysis of variance (with time at 3 levels) for nasalance and each velar parameter. Planned comparisons across pairs of time points (T1-T2, T1-T3, and T2-T3) including effect sizes. A significant difference over time was found for nasalance (P = .001) and planned comparisons across pairs of time points were significant between T1 and T2 (P = .008), T1 and T3 (P = .002), but not between T2 and T3 (P = .459) providing evidence that maxillary osteotomy can impact on nasalance adversely and that the changes seen are permanent and stable. There were also significant differences over time for PLAn (P = .012) and CRa (P = -.059) and planned comparisons for both velar parameters reflected similar findings to those of nasalance. Maxillary osteotomy can adversely affect velopharyngeal function in patients with CLP. The study provides evidence for a much earlier post-surgery review even as early as 3 months after surgery.

Nasometric Scores in spinal and bulbar muscular atrophy - Effects of palatal lift prosthesis on dysarthria and dysphagia

Spinal and bulbar muscular atrophy (SBMA) is a hereditary neuromuscular disease affecting only males characterized by progressive muscular atrophy and weakness in bulbar and limb muscles. The present study aimed to evaluate the features of velopharyngeal dysfunction (VPD) in SBMA subjects by an acoustic analysis of speech. Twenty-three genetically confirmed patients with SBMA were enrolled and assessed their speech by measuring the nasalance score with a Nasometer II. The nasalance scores of the SBMA group was higher than that of healthy controls (p = .035) and significantly correlated with the total score of the revised amyotrophic lateral sclerosis functional rating scale (rs = −0.520, p = .011). On the basis of the results of the VPD study, the efficacy of a palatal lift prosthesis (PLP) was assessed in two patients with SBMA to treat their VPD. The PLP improved dysarthria in both cases, although the impact of the prosthesis on dysphagia was not consistent. The present study suggested that the nasalance score is a useful quantitative measurement to evaluate VPD in patients with SBMA. A PLP may improve dysarthria in SBMA patients by reducing VPD, but the clinical application of this procedure should be considered carefully in view of its possible negative effect on dysphagia.

Treatment of velopharyngeal insufficiency in a patient with a submucous cleft palate using a speech aid: the more treatment options, the better the treatment results

BackgroundThe submucous cleft palate (SMCP) is a type of cleft palate that may result in velopharyngeal insufficiency (VPI). Palate muscles completely separate oral and nasal cavities by closing off the velopharynx during functional processes such as speech or swallow. Also, hypernasality may arise from anatomical or neurological abnormalities in these functions. Treatments of this issue involve a combination of surgical intervention, speech aid, and speech therapy. This case report demonstrates successfully treated VPI resulted from SMCP without any surgical intervention but solely with speech aid appliance and speech therapy.Case presentationA 13-year-old female patient with a speech disorder from velopharyngeal insufficiency that was caused by a submucous cleft palate visited to our OMFS clinic. In the intraoral examination, the patient had a short soft palate and bifid uvula. And the muscles in the palate did not contract properly during oral speech. She had no surgical history such as primary palatoplasty or pharyngoplasty except for tonsillectomy. And there were no other medical histories. Objective speech assessment using nasometer was performed. We diagnosed that the patient had a SMCP. The patient has shown a decrease in speech intelligibility, which resulted from hypernasality. We decided to treat the patient with speech aid (palatal lift) along with speech therapy. During the 7-month treatment, hypernasality measured by a nasometer decreased and speech intelligibility became normal.ConclusionsSurgery remains the first treatment option for patients with velopharyngeal insufficiencies from submucous cleft palates. However, there were few reports about objective speech evaluation pre- or post-operation. Moreover, there has been no report of non-surgical treatment in the recent studies. From this perspective, this report of objective improvement of speech intelligibility of VPI patient with SMCP by non-surgical treatment has a significant meaning. Speech aid can be considered as one of treatment options for management of SMCP.

Prosthetic Rehabilitation with Palatal Lift/Augmentation in a Patient with Neurologic/Motor Deficit Due To Cancer Therapy for Chondrosarcoma.

This clinical report describes the prosthetic rehabilitation of a 25-year-old man with a history of grade II chondrosarcoma at the skull base who had undergone surgical resection and thereafter developed velopharyngeal incompetency (VPI), dysarthria, and dysphagia. Upon baseline fiberoptic endoscopic evaluation of swallowing (FEES), the patient had an atypical pattern of VPI with minimal to no velar lift during speech, blow, or suck tasks, but near complete velar lift and seal during swallowing. A palatal augmentation prosthesis combined with a resilient palatal lift extension was fabricated to enhance speech by displacing the soft palate and to decrease hypernasality, while avoiding interference with bolus transport. A resilient wrought wire extension was necessary to accommodate the velar movement upon swallowing while keeping the integrity of the velar lift during speech. In conclusion, this unique combination prosthesis was able to help the patient's atypical pattern of VPI by improving speech and preserving swallowing function, which was confirmed during a post-endoscopic evaluation.

Fabrication of palatal lift prosthesis for a patient with palatal defect

Fabrication of palatal lift prosthesis for a patient with palatal defect

Soft obturator prosthesis for postoperative soft palate carcinoma: A clinical report

An intraoral prosthesis with a soft flexible obturator was provided for a patient with a soft palate perforation after surgical and chemoradiotherapy treatments of a soft palate tumor. An obturator composed of movable and flexible silicone was attached to a structure similar to a palatal lift; it was therefore able to move according to the movement of the soft palate, which was confirmed by endoscopic examination. The application of this prosthesis resulted in complete disappearance of hypernasality and food reflux, and the patient was able to eat without particular limitation during daytime wearing. This type of prosthesis represents a potential prosthetic approach to a soft palate nasal-oral fistula.

Prosthodontic Rehabilitation of Arabic Speaking Individuals with Velopharyngeal Incompetence: A Preliminary Study.

Background:Hypernasality is a frequently encountered problem in the speech of individuals with velopharyngeal incompetence. The use of palatal lift appliance (PLA) is the main treatment option for correction of velopharyngeal incompetence. The literature on the outcomes of using prosthetics treatment for Arabic speaking patients is scarce.Objective:The aim of this study was to investigate the effect of using PLA on hypernasality of Arabic speaking patients with velopharyngeal incompetence.Methods:Six participants with age ranging from 9 to 61 years (4 males and 2 females) were recruited between October 2013 and August 2014. Written informed consents were taken from all the adult participants/the guardians of under-aged participants. All patients exhibited hypernasality with different etiologies for velopharyngeal incompetence (head injury, cerebrovascular accident, and neurological disorders). They were treated with PLAs which were constructed to elevate the dysfunctional soft palate. Nasalance scores and perceptual speech acceptability ratings were measured/evaluated in both situations; with and without appliances. Paired t-test was used to analyze the perceptual ratings and nasalance scores in order to detect any significant change in hypernasality pre and post insertion of PLA.Results:There was a statistically significant decrease (p>0.05) in nasalance scores (Pa, Pi, Ma, Mi, a, i) after PLA insertion. The subtest /u/ showed insignificant change (p= 0.056). Perceptual ratings showed significant reduction in hypernasality which was consistent with nasalance measurements.Conclusion:PLAs can reduce hypernasality in Arabic speaking patients who suffer from velopharyngeal impairment.

Palatal lift prosthesis for bolus transport in a patient with dysphagia: A clinical report

A palatal lift prosthesis (PLP) is an intraoral device that provides lift for the soft palate. The usual purpose of a PLP is to reduce nasopharyngeal reflux and the hypernasal speech caused by velopharyngeal incompetence. However, for this patient, the main purpose was to relieve a functional blockage at the oropharyngeal isthmus by suspending the soft palate. A PLP with soft and flexible lift was applied in a patient with a traumatic brain injury and dysphagia. The PLP improved oropharyngeal bolus transit time by relieving the blockage at the oropharyngeal isthmus. This type of PLP may help to improve bolus transport for patients with dysphagia.

Outcomes of Palatal Lift Prosthesis on Dysarthric Speech.

This study was designed to investigate the effect of palatal lift prosthesis (PLP) on the speech of individuals with different types of dysarthria. Thirty (19 males and 11 females) native speakers of Jordanian Arabic with dysarthria participated in the study. The age of the participants ranged from 8 to 67 years with an average of 34.1 years. Traumatic brain injury was the most common etiology of dysarthria among 12 participants, stroke among 11, multiple sclerosis among 3, and pseudobulbar palsy among 2; 1 participant had Parkinson disease, and another participant had amyotrophic lateral sclerosis. Five acoustic and aerodynamic measures were evaluated to determine the speech outcomes including nasalance scores, sequential motion rate, speech rate, vital capacity, and sound pressure level. The acoustic measures were obtained from the participants in PLP-out and PLP-in conditions. Results showed statistically significant decrease in the nasalance scores of the syllable repetition, vowel prolongation, and sentence repetition tasks in the PLP-in condition below the 28% cutoff score. Furthermore, results revealed statistically significant increase in sequential motion rate, speech rate, vital capacity, and sound pressure level (P = 0.000). The use of PLP is an effective treatment option of dysarthric speech. Besides nasalance scores, the sequential motion rate, speech rate, vital capacity, and sound pressure level are considered reliable speech measures that may be used to evaluate the effect of PLP on dysarthria.

Prosthodontic Management of Velopharyngeal Dysfunction in Speakers With Neurological Conditions

The purpose of this article is to describe the use of palatal lift and nasal obturator interventions for children and adults with velopharyngeal dysfunction due to neurological conditions. These intervention procedures are illustrated with brief summaries of an adult and a child with velopharyngeal dysfunction due to traumatic brain injury. The use of 3D printing to produce nasal obturators is introduced.

Fabrication of palatal lift prosthesis using thermoplastic resin for a patient with velopharyngeal insufficiency

Fabrication of palatal lift prosthesis using thermoplastic resin for a patient with velopharyngeal insufficiency

A Novel Patient-Controlled Bidirectional Palatal Lift Appliance

Palatal lift appliances have a role in management of velopharyngeal dysfunction for immobile palates of adequate length where surgery is contraindicated. Conventional appliances involve acrylic/wire work adjustment over successive appointments until they can be tolerated without gagging. A novel appliance has been developed where the lifting plate is incrementally distalized by the patient and vertically adjusted to optimize soft palate positioning. The design, construction, and utility of the appliance, which was developed in Dundee Dental Hospital, are described. The subject was a 12-year-old boy with a variant of Moebius syndrome and velopharyngeal dysfunction. Previous pharyngoplasty had been carried out and further surgery was contraindicated. The appliance is constructed and fitted and the flexible spring arm is vertically adjusted to lift the soft palate. The screw is turned incrementally at home, extending the lifting plate posteriorly. Videofluoroscopy allows visualization of the appliance and soft palate positioning. The procedure improved soft palate positioning, as demonstrated by videofluoroscopy, and objective speech outcomes. The appliance was well tolerated and led to improved speech outcomes for the patient. Adjustments were quick and easy for both clinician and patient. Further studies are needed to definitively determine the efficacy of the appliance.

Prosthetic rehabilitation of a child with velopharyngeal dysfunction – A case report

The speech of person is a unique mode of expression for an individual. Alterations or deviation from normal speech leading to nasal and unintelligible speech have enormous effects on the psychological well being of a person as it hampers social interactions. The anatomic or functional anomalies occurring as a result of congenital or traumatic defects leading to velopharyngeal dysfunctions influence the speech by making it completely atypical. The cleft palate patients may have residual velopharyngeal inadequacy even after surgical repair. A removable palatal lift appliance in conjuction with speech therapy is a viable treatment option for such patients as it is economical, easy to fabricate and easy to use.

Evaluation of a modular palatal lift prosthesis with a silicone velar lamina for hypernasal patients

Speech bulbs and palatal lift prostheses are used to improve oral-nasal balance in speakers with hypernasality resulting from velopharyngeal dysfunction. Fabricating such speech prostheses is often a protracted process, and the nasopharyngeal impression can be uncomfortable for the client. The purpose of this study was to develop and test a modular palatal lift prosthesis with a silicone velar lamina that can be fabricated without a nasopharyngeal impression. Six adult participants with different etiologies were treated with both a conventional palatal lift prosthesis and the new prosthesis. The outcome measures were nasalance scores, speech acceptability ratings, and participant responses on a questionnaire. Inferential statistical analyses were conducted with nonparametric Friedman tests and 2-tailed paired Wilcoxon signed ranks tests. The probability was set at P<.1. Among the 3 speaking conditions (no prosthesis, acrylic resin prosthesis, modular silicone palatal lift prosthesis), no differences were found in nasalance scores for the oral stimuli. For the nasal sentences, a numerically greater reduction was observed for the silicone than for the acrylic resin prosthesis. Speech acceptability was better with the modular silicone palatal lift prosthesis (z=2.032, P<.05) and the acrylic resin prosthesis (z=1.753, P<.1) than with no prosthesis. The questionnaire showed better subjective speech acceptability with the acrylic resin prosthesis (z=1.706, P<.05) and the modular silicone palatal lift prosthesis (z=1.706, P<.05) than with no prosthesis. Swallowing comfort was also numerically better for the acrylic resin prosthesis than for the modular silicone palatal lift prosthesis. This study demonstrates the feasibility of a new design for a flexible and modular palatal lift prosthesis. The functional outcomes were comparable to those of the traditional design. Although the overall results in this study favored the traditional prosthesis, the new design may be viable for patients who require alternative treatment solutions.